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Biomedical subjects

M Montanari

Publications and source records attributed to M Montanari.

At least 73 records · Page 4Linked to original sources
PubMed1986

Early detection of necrotizing pancreatitis by computer.

In 59 patients admitted with a clinical picture compatible with acute pancreatitis, 88 features, recorded within the first day, were retrospectively collected and stored in a database programmed on a NCR DM V personal computer. On the basis of the final diagnosis, the patients were divided into two groups, according to Becker's grading of acute pancreatitis. A third group comprised the false-positives. Using 14 significant differences (p less than 0.025) between the three groups, a Bayesian analysis was programmed for early prediction, in terms of percentage probability, of each of the three final diagnoses. A retrospective assessment of computer performance was carried out in the patients entered the initial database, and further 38 underwent a prospective test. In the detection of necrotizing pancreatitis the procedure gave 95.8% accuracy, 91.9% sensitivity and 98.3% specificity. Previous diagnosis of pancreatitis, estimate of the degree of necrosis, data to be used for the processing, are discussed. Performances, similar in retrospective and prospective series, proved higher as compared to diagnostic peritoneal lavage. Comparison with Ranson's multiple criteria or computed tomography is inappropriate. The system seems to be reliable feasible and adaptable. The choice of treatment is difficult in acute pancreatitis. A computer-aided analysis may provide a better approach, than an unaided clinical estimate, to several decisional problems in acute pancreatitis.

Acute Disease↗
PubMed1986

Effect of age on the pharmacokinetics of indobufen.

Eighteen patients of both sexes, aging between 54 and 81 years entered a study on the effects of age on the disposition kinetics of indobufen, a potent inhibitor of platelet aggregation. Plasma levels and urinary excretion of the drug were assayed by HPLC after a single oral dose (200 mg) and after the last dose of a repeated oral schedule (200 mg b.i.d. for 5 days). At steady-state, indobufen plasma levels were about double those after the single dose; plasma level profiles were similar. No significant differences were detected between single dose and steady-state as regards pharmacokinetic parameters of the drug which, at steady-state, were (mean +/- SD, n = 16): Cmax = 32.6 +/- 9.3 micrograms/ml, t 1/2 beta = 12.8 +/- 4.4 h, Pl.Cl. = 14.9 +/- 6.1 ml/min, Vd beta = 223 +/- 63 ml/kg. Evidence of reduced efficiency and rate of indobufen elimination was found in elderly patients compared to young healthy subjects. This is probably because of the age-related decrease in renal function. In the patients of the present study, average Cr.Cl. was about 60 ml/min, corresponding to 50-60% of the normal values in young subjects. A statistically significant correlation was found in patients between drug plasma clearance and Cr.Cl. in agreement with the findings of a previous study on the effects of renal insufficiency on indobufen kinetics. The same dose reduction of indobufen as previously suggested for patients with mild to moderate renal insufficiency should, therefore, be adopted in elderly patients.

Administration, Oral↗
PubMed1985

[Therapy of brucellosis: clinical experience with a rifampicin- doxycycline combination].

After an examination of the data on brucellosis treatment in the literature, it is concluded that short-term courses of cotrimoxazole and tetracyclines give largely unsatisfactory results. In view of the synergism noted between rifampicin and doxycycline against in vitro and animal brucella, the association was given to 19 clinical cases and was found to be effective and easily handled. It is therefore concluded that this treatment is currently the best alternative to the classic streptomycin-doxycycline association.

Adolescent↗
PubMed1985

[Colon-rectal anastomosis with mechanical sutures (personal experience in 96 cases)].

From 1 October 1981 to 30 September 1985 ninety-six patients underwent colorectal resection with EEA Auto-suture stapled anastomosis for cancer or diverticula. As compared with manual suture, the mechanical procedure involved some technical problems and peroperative drawbacks (partial leakage, hemorrhage), which decreased after the initial phase of our experience. The EEA Stapler proved a reliable and useful procedure, especially in low colo-rectal anastomoses, which present a higher risk of leakage, owing to difficulties with manual technique. Clinical or x-ray fistulas occurred in four patients after colon-to-colon (5.8%) and were six following colorectal anastomoses (22.2%). Only in three cases a colostomy was necessary. In spite of suitability of the mechanical procedure, a colostomy was carried out to protect low colo-rectal anastomoses, when general risk factors were present or when the suture was improperly performed or transection circles were incomplete. The introduction of the EEA Stapler allowed for a higher number of anterior resection of the rectum, with a corresponding decrease of abdominoperineal procedures, and promoted a more extensive indication to palliative anterior resection. It is still a matter of concern whether the high number of anterior resections would be followed by an increased local recurrence rate, in consideration that radicality depends on a wide exeresis with a complete lymphoadenectomy.

Aged↗
PubMed1985

Local and general treatment with ceftazidime as monotherapy in central nervous system infections and in septicemic infection.

Twenty-three patients (mean age: 47 years; range: 4 months to 79 years) admitted to Varese Regional Hospital over the period from October 1983 to March 1984 and suffering from severe infections of a septicemic nature were treated with ceftazidime. All patients had previously received other broad-spectrum antibacterial agents. Isolation of causative pathogens and evaluation of their susceptibility to ceftazidime justified use of the drug as monotherapy. Ceftazidime was administered intravenously at the mean dose of 60-120 mg/kg/day. In some cases, it was injected directly into the renal parenchyma (2 g/day) or into the cerebral ventricles (1 mg/kg/day). Local and systemic tolerance were optimal in all cases, no significant side effects being observed. Eradication of pathogens was excellent and clinical outcome satisfactory in all patients.

Adolescent↗
PubMed1985

Metabolic, water and electrolyte changes after moderate surgical trauma. Observations after different schedules of parenteral nutrition.

The effects of a moderate surgical trauma on body composition, in conditions comparable to fasting were assessed in a balance study. Two groups of patients under normal nutritional conditions were compared after cholecystectomy. The patients underwent for three days the following schedules of parenteral therapy: incomplete nutrition with balanced intake of water, sodium and potassium but carbohydrate deficient and lacking in amino acids (group 1, 10 cases); or complete nutrition with respect to calories, amino acids and other electrolytes (group 2, 9 cases). An evident loss in body weight was observed in patients undergoing incomplete nutrition, not justified by a moderately negative water balance. Statistical comparison of the two groups showed equal or positive balances for group 1 while group 2 gave negative results for all the parameters, particularly for nitrogen and potassium, suggestive of a loss in lean body mass greater than that usually occurring after simple fasting. Results confirmed the poor significance of serum values in expressing even significant degrees of electrolyte depletion. Substantial modifications in body composition may appear as clinical manifestations in cases with pre-existing malnutrition or when drugs that affect or are affected by the water and electrolyte balance are administered.

Adult↗
PubMed1984

Reversible cerebral ischemias: a comparative analysis of risk factors in TIAs and in RINDs.

A retrospective study in which 709 patients, 522 with RIND and 187 with TIA, were compared in respect of common risk factors (RFs) for acute cerebrovascular disease. The two forms of the disease differed significantly in respect of smoking, hematocrit, hypercholesteremia, hypertriglyceridemia and hyperuricacidemia. Although these RFs do not seem to be determinants of or discriminants between the two forms of acute cerebrovascular disease, it is nonetheless highly probable that, together with all the other RFs, they have a facilitatory role.

Atrial Fibrillation↗
PubMed1983

Effect of somatostatin on exocrine pancreas evaluated on a total external pancreatic fistula of neoplastic origin.

A patient with a pancreatic fistula, with a defunctionalized duodenum (subsequent to a previously performed Billroth II gastrectomy for cancer and choledochojejunostomy for metastatic infiltration in the bile duct) was submitted to prolonged synthetic somatostatin infusion (48 h). There was a mean reduction of 80% in pancreatic output, with no changes in the composition of sodium, potassium, and calcium, an increase in chloride and a decrease in bicarbonate. An increase in amylase was noted. The unique clinical features of this case have provided direct confirmation of the inhibiting action of somatostatin on the exocrine pancreas.

Aged↗
PubMed1983

Extracellular water, electrolyte and nitrogen balance after postoperative parenteral nutrition and intracellular involvement in muscle.

Brief periods of fasting or moderate trauma were previously shown to give rise to malnutrition characterized by negative nitrogen balance, reduction of lean body mass and relative increase of body water. The present study aimed to assess the possibility that brief low-calorie, low-protein parenteral fluid regimen after relatively moderate surgical trauma can modify the muscle metabolism and alter the water, electrolyte and protein composition. Well-nourished patients undergoing elective cholecystectomy were studied. During the first four postoperative days, seven patients (group I) received parenteral nutrition adequate as regards water, sodium and potassium but deficient in carbohydrates and without amino acids, while six patients (group II) had adequate parenteral supply of calories and nitrogen. The extracellular balance in regard to water, sodium, potassium, calcium, phosphorus, magnesium and urea was assessed in all 13 patients. Needle biopsy of muscle was performed during surgery and at the end of the observation period in six patients from group I and five from group II, in order to assess the total and the intracellular and extracellular water content and also sodium, chloride, potassium, magnesium, phosphorus and alkali-soluble protein nitrogen. In group I, but not in group II, there was weight loss and negative extracellular balance of all parameters, in particular potassium and nitrogen, and reduction of muscle potassium. The analyses of balance and of muscle cell composition showed considerable loss of lean body mass and indicated 'true' electrolyte disturbance, although clinical symptoms were absent and serum parameters remained normal.

Adult↗