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Biomedical subjects

M Malerba

Publications and source records attributed to M Malerba.

At least 37 records · Page 2Linked to original sources
PubMed1999

A randomized trial of cefepime and ceftazidime for the treatment of community-acquired pneumonia.

We compared the effectiveness and safety of ceftazidime and cefepime in hospitalized patients with community-acquired pneumonia. The 148 enrolled patients received 2 g ceftazidime three times daily or 2 g cefepime twice daily. The clinical success rate was the same for both drugs. Even the microbiological effectiveness was similar. Both drug regimens were well tolerated. We conclude that 2 g ceftazidime three times daily were as effective as 2 g cefepime twice daily for the treatment of community-acquired pneumonia in hospitalized patients. The cost of ceftazidime treatment was, however, higher than the cost of cefepime treatment.

Aged↗
PubMed1999

Palliative surgery for far-advanced gastric cancer: a retrospective study on 305 consecutive patients.

Few reports of the Western countries have investigated the value of palliative surgery for stomach cancer. The aim of this study was to evaluate the results of palliative surgery in a large series of patients affected by gastric carcinoma, consecutively treated by the same surgical team. The hospital records of 305 patients affected by gastric cancer who did not undergo surgical treatment or who underwent a palliative surgical procedure at our unit between 1981 and 1995 were reviewed. Univariate and multivariate analyses were used to calculate the 5-year survival probabilities with respect to the following variables: demographic data, tumor location and gross appearance, spread of the disease, histological type according to P. Lauren, and type of treatment. Multivariate logistic regression analysis showed that resectional surgery and tumor spread limited to local sites were independently associated with better survival. The study indicates that even though there are host-related factors that govern survival in far-advanced stomach cancer, the type of surgery can have a significant effect on prognosis; resectional surgery should be undertaken whenever possible in such patients.

Aged↗
PubMed1999

[Tracheal stenosis due to metastatic adenopathic compression from breast carcinoma].

Paratracheal lymph-nodal metastases secondary of breast cancer aren't frequent in this kind of cancer. Here is described the case of a 76-years-old woman come to our note for ingravescent dyspnoea caused by metastatic adenopathy compression of the tracheal lumen. After excluding other treatments, a tracheal stent is put on. The obstruction gets better right away, the initial severe respiratory symptoms are improved and the ventilation is almost normal.

Aged↗
PubMed1998

Transfusion timing and postoperative septic complications after gastric cancer surgery: a retrospective study of 179 consecutive patients.

BACKGROUND: Immunosuppression associated with homologous blood transfusion was first observed in renal allograft transplantation. Clinical effects of transfusion-induced immunosuppression in surgical patients have been debated in the literature for more than a decade with contradictory results. OBJECTIVE: To investigate whether homologous blood transfusions significantly affect postoperative septic morbidity and mortality in patients undergoing elective surgery for gastric cancer. DESIGN: Case series. SETTING: Hospitalized care. PATIENTS: The hospital records of 209 patients who underwent elective surgery for gastric cancer at the Department of Surgery of the Hospital del Mar, Autonomous University of Barcelona in Spain, and at the Department of Surgery of the Catholic University of Rome in Italy from April 1984 to December 1990 were reviewed, and 179 patients were included in the study. MAIN OUTCOME MEASURES: The following variables were entered into univariate and multivariate analyses to identify factors potentially affecting postoperative septic morbidity: demographic data, weight loss, preoperative serum albumin level and lymphocyte count, type and duration of operative procedure, amount and timing of blood transfusion, and stage of disease. RESULTS: Univariate analysis showed that a large quantity of blood transfused (> 1500 mL) and transfusion in the postoperative period (group C) were associated with a worse clinical outcome. Postoperative transfusion was an independent predictor of septic morbidity in multivariate analysis. CONCLUSIONS: Despite transfusion-induced immunomodulation, homologous blood transfusion should not be considered a risk factor for postoperative septic morbidity in patients undergoing elective major abdominal surgery. The timing-response relationship between transfusions and septic morbidity in multivariate analysis may be the effect of uncontrolled confounders such as variation of volemia induced by stress response in patients who were developing or had just developed infectious complications.

Adult↗
PubMed1998

[Total gastrectomy and quality of life].

We have evaluated quality of life after surgery in 24 patients (9 males and 15 females mean age 64.23 years, range 47-83 years) who underwent total gastrectomy for cancer (23 carcinomas and 1 lymphoma) in the last three years at the Department of Clinical Surgery, University of Siena. Intestinal continuity was re-established with Y jejunal loup according to Roux. All patients were studied prospectively: after the operation every six months they were interviewed using Korenaga's questionnaire. Group performance status scale was used to determine the level of activity of each patients. Comparing symptoms of patients after six months and 18 months there was a significant difference (p = 0.005) in terms of number of meals throughout the day, food tolerance and abdominal pain. Postoperative performance status revealed a complete recovery in 11 of 24 patients (45.8%) after 18 months. According to our experience patients who have undergone total gastrectomy enjoy a good quality of life and most of them return to the preoperative lifestyle in 18 months.

Activities of Daily Living↗
PubMed1998

[Short bowel syndrome].

In the last year at the Department of Surgery of the University of Siena two patients presenting a clinical feature of intestinal infarct have been operated. In these patients a wide intestinal resection has been performed. After this surgical operation, a patient had a residual tract of 40 cm of bowel and the other 50 cm. It was not possible during operation to preserve the Bauin valve in a case; in the other, this valve has been sacrificed during a previous operation for cecal neoplasm. In the postoperative period, patients were transferred temporarily in the intensive care unit, and after some days they returned to the department where total parenteral nutrition with progressive decreasing mixture in calories over time was administered. Enteral nutrition was also started and the quantity of water, calories and azote was slavly increased. In a second time an oral diet was started up to completely weaning from parenteral and then enteral nutrition. At present, these patients are enlisted in quarterly follow-up and are completely stabilized. They are independent from artificial nutrition and they have a good quality of life.

Aged↗
PubMed1998

[Total gastrectomy and malnutrition].

BACKGROUND: The operation more frequently performed for gastric malignancy is total gastrectomy. METHODS: Our reconstructive technique is Roux en Y esophago-jejunostomy, jejunal interposition after gastrectomy. In the next weeks after operation there is always an important, sometimes pathologic, slimming in gastrectomized patients. But is this slimming due to malnutrition or malabsorption? This is the real question. In our Institute a quarterly perspective clinical and instrumental follow-up for these patients has been prepared. RESULTS: We started with 41 patients, but we conducted the complete study only on 23. Of these patients, 56% have lost 10 kg weight, 25% 5 kg and 18% have not lost weight after 2 weeks from discharge dimission. But after 5 weeks, all patients had stabilized their own weight, and 18 months later the first two groups regained weight again, 1-2 kg. With our follow-up, we had educated patients to a correct personal natural diet necessary to normal social and working life. With our program in 3-4 weeks the weight of each patient was stable and we were able to control the malabsorption. CONCLUSIONS: Moreover, according to personal experience, it is important to plan a follow-up to rehabilitate patients to usual social life. This program allows to evaluate malnutrition and the possible iron or vit. B12 deficiency.

Aged↗
PubMed1997

[Further comment on central venous catheter infections].

Many reports from the surgical literature document the incidence of catheter related sepsis varies between 1 and 10 per cent. In many instances sepsis is secondary to contamination from normal saprophyte cutaneous bacteria. In our Institute we set down a standardized methodology to reduce the contamination of venous central access from cutaneous bacteria. Of 31 patients studied, none had bacteria in the last 5 cm of central venous catheter, 2 had streptococcus alpha haemolytic colonies and coagulase negative staphylococcus colonies at the same time on skin over the region of venepuncture. With our paper we had attained one's awareness that it is very difficult to obtain zero per cent in contamination of central venous catheter, mainly in immunodepressed or critical patients, but with careful dressing and with new technology it is possible to reduce the contamination and following sepsis.

Aged↗
PubMed1996

Protein-sparing therapy after major abdominal surgery: lack of clinical effects. Protein-Sparing Therapy Study Group.

OBJECTIVE: A prospective multicenter randomized trial was designed to evaluate the clinical efficacy of postoperative protein-sparing therapy. SUMMARY BACKGROUND DATA: The metabolic effect of postoperative protein-sparing therapy has been shown by several studies, but the clinical utility of this treatment has not been investigated by large prospective trials. METHODS: Six hundred seventy-eight patients undergoing major elective abdominal surgery were randomly assigned to receive either protein-sparing therapy after surgery (protein-sparing therapy group) or conventional therapy (control group). The patients were monitored for postoperative complications and mortality. RESULTS: The rate of major postoperative complications was similar in both groups (protein-sparing therapy group, 19.5%; control group, 20.9%; p=0.66) as were the overall postoperative mortality rates (4.7% and 3.5%, respectively; p=0.43). CONCLUSIONS: The present study indicates that routine protein-sparing therapy for patients normonourished or mildly malnourished undergoing major abdominal surgery is not clinically justified.

Abdomen↗
PubMed1996

Ineffectiveness of intravenous beta 2-agonists on improving exercise tolerance in patients with reversible chronic airway obstruction.

The effects on exercise tolerance after acute administration of beta 2-agonists were investigated in 11 patients with partly reversible chronic airway obstruction after 400 micrograms of salbutamol (S) given intravenously (i.v.) and after 400 micrograms i.v. of a new selective beta 2-agonist, broxaterol (B), by a cardiopulmonary incremental exercise test. At rest, while VE increased in respect to basal conditions (C) after S (from 13.3 +/- 2.2 to 14.4 +/- 2.8 l/min; p < 0.05) and after B (from 13.6 +/- 3.1 to 15.5 +/- 3.6 l/min; p < 0.05), VO2, VCO2 and VO2/HR showed no substantial variations. A small, not significant reduction of PaO2 was observed both after S (from 82.7 +/- 11.7 to 79.1 +/- 16.7 mm Hg) and B (from 81.6 +/- 10.5 to 78.0 +/- 11.0 mm Hg). The maximum workload increased neither after S (from 67.5 +/- 39.1 to 66.6 +/- 37.0 W) nor after B (from 65.7 +/- 39.3 to 60.0 +/- 35.8 W). At peak of exercise, VO2, VCO2 and VO2/HR did not change after S and B as compared with C, whereas VE remained higher after both beta 2-agonists throughout the effort. VO2 at ventilatory anaerobic threshold (AT) was significantly greater either after S (from 744 +/- 378 to 815 +/- 302 ml/min; p < 0.05) and after B (from 756 +/- 290 to 842 +/- 292 ml/min; p < 0.05). The PaO2 increase shown by these patients during effort was greater after beta 2-agonists administration, delta PaO2 from rest to peak of exercise amounting to 14.9 +/- 14.3 vs. 7.8 +/- 8.2 mm Hg after S and to 17.8 +/- 15.1 vs. 8.8 +/- 10.9 mm Hg after B, in respect to relative baseline (p < 0.05). We conclude that beta 2-agonists, when given acutely, do not improve exercise tolerance in patients with reversible chronic airflow obstruction, although these drugs can induce a small increment of ventilatory AT. In addition, arterial blood gases do not deteriorate at rest and are better preserved during exercise after beta 2-agonists.

Adrenergic beta-Agonists↗
PubMed1995

Effect of two beta 2-agonist drugs, salbutamol and broxaterol, on the growth hormone response to exercise in adult patients with asthmatic bronchitis.

The aim of our study was to evaluate the effect of the iv administration of two different beta 2- receptors agonists, salbutamol and broxaterol, on the growth hormone (GH) response to maximal exercise in 11 patients (8 males and 3 females; age range 18-65 yr; mean +/- SE age 56 +/- 13 yr; BMI 26.2 +/- 1.4 kg/m2) with chronic asthmatic bronchitis. All the subjects underwent four cycloergometric exercise tests (incremental workload until maximal predicted heart rate). At baseline, at maximal exercise, at the end of the recovery period and 60 min after the end of each exercise, blood samples were drawn for the assay of GH, glucose, insulin, lactates, norepinephrine and epinephrine. Two exercises were performed without treatment while the remaining two were performed 60 min after the administration of 400 micrograms of either salbutamol or broxaterol (both diluted in 10 ml of saline) according to a randomized double blind cross-over design. Both exercise tests performed without treatment caused a significant (p < 0.05) and similar GH peak with respect to baseline values (from 0.3 +/- 0.1 micrograms/L to 2.8 +/- 1.3 micrograms/L, mean of the two exercise tests). Salbutamol pretreatment blunted the GH response to exercise which caused a no more significant serum GH peak over the baseline levels (from 0.6 +/- 0.2 micrograms/L to 1.4 +/- 0.6 micrograms/L,). Moreover, broxaterol completely abolished the GH response to exercise (baseline level 0.6 +/- 0.2 micrograms/L; peak levels 0.4 +/- 0.1 micrograms/L). The serum GH peak after exercise + broxaterol was significantly (p < 0.05) lower as compared to exercise + salbutamol. In conclusion, we have demonstrated for the first time that beta 2 stimulation blunts the physiological GH response to maximal exercise in adult human subjects. It can be suggested that changes in brain neurotransmitters, possibly an increase in the alpha-adrenergic tone, are likely to be involved in this endocrine effects of exercise.

Adolescent↗
PubMed1994

Uremic lung.

Explore the source record for details and available documents.

Humans↗
PubMed1994

Cardiorespiratory intermediate intensive unit: heart-lung interactions.

The heart and lung (the body's gas transport system) are neurally, mechanically, humorally and functionally linked. Several clinical-therapeutic consequences involve heart-lung interactions. Three of these conditions are described here: 1) pulsus paradoxus in asthma; 2) survival in chronic cor pulmonale; and 3) Cheyne-Stokes breathing in congestive heart failure. They provide examples of the pathophysiological and clinical complexity that such correlations involve. The most remarkable "effects" of the heart-lung relationship as a metabolic unit are represented by development of cardiorespiratory intensive care units, and efforts to bring about methods of monitoring cardiorespiratory function.

Asthma↗
PubMed1994

Effects of beta 2-agonists during cardiopulmonary exercise test in COPD patients.

The aim of this study was to evaluate endocrine-metabolic, respiratory and cardiovascular effects of two beta 2-sympathomimetic selective agents, such as broxaterol and salbutamol, before and during cardiopulmonary exercise test (CPX). Twelve in-patients with chronic obstructive pulmonary disease (COPD) (with partially reversible airways obstruction) were included. Broxaterol (400 micrograms) and salbutamol (400 micrograms) were administered i.v., according to a double-blind, cross-over study. Before treatment and within 60 min after the administration of each agent, the patients underwent incremental CPX by bicycle ergometer to the maximum tolerable threshold. At these times the following variables were assessed: minute ventilation (VE), oxygen consumption (VO2), carbon dioxide production (VCO2), VE/VO2 ratio and O2 pulse, glycaemia, insulinaemia, plasma norepinephrine (NE) and epinephrine (E), arterial oxygen and carbon dioxide tension (PaO2 and PaCO2), plasma lactates, heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure. Spirometry was performed before and after the administration of each beta 2-adrenoceptor agonist. CPX brought about a significant increase in VE, VO2, VCO2, and O2 pulse. Broxaterol or salbutamol administration did not significantly modify the increases caused by CPX. At rest, 60 min after treatment, both bronchodilators caused a significant rise in glycaemia. A significant reduction of PaO2 (after broxaterol) and PaCO2 (after salbutamol) was observed at rest. In contrast, both agents caused no modification to potassium and insulin levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Changes in the heart rhythm and slow-release beta-2 agonist therapy (peroral) in asthmatic patients. A Holter study].

Slow-release formulations of salbutamol, used in asthmatic patients, may have few effects on cardiac rhythm. This study was designed to compare incidence and type of cardiac arrhythmias in a group of ten patients with stable bronchial asthma before and after 6 weeks treatment with a slow-release formulation of salbutamol. After a baseline spirometric and electrocardiographic evaluation, patients received placebo for a two-weeks period. At the end of this period patients repeated spirometry and carried out a 24-hour-ambulatory-E-Holter-monitoring. Subsequently, patients received for 6 weeks a treatment with a slow-release formulation of oral salbutamol. At the end of this period patients repeated spirometry, a 24-hour-ambulatory-EG-Holter-monitoring and potassium serum levels were controlled. We concluded from our study that, in patients with moderate bronchial asthma the treatment with an oral formulation of slow-release salbutamol may carry out a significant and durable bronchodilator effect, without causing important cardiac arrhythmias.

Administration, Oral↗