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M Righini

Publications and source records attributed to M Righini.

12 recordsLinked to original sources
PubMed2001

[Thrombopenias induced by heparin: diagnostic and therapeutic innovations].

Heparin-induced thrombocytopenia (HIT) is a difficult immune-mediated phenomenon that physicians have to cope with. It is caused by platelet-activating, heparin-dependent IgG antibody and may be associated with venous and arterial thrombosis, potentially fatal. Simple tests are now available which can detect most antibodies implicated in HIT. The old term "white clot syndrome" suggested that HIT was mostly associated with arterial thromboembolic events, but more recent publications indicate that HIT is also an important risk factor for venous thromboembolism. In case of suspicion of HIT, treatment by heparin should imperatively be stopped and an alternative anticoagulant treatment should be started before any laboratory confirmation.

Anticoagulants↗
PubMed2000

Effects of age on the performance of common diagnostic tests for pulmonary embolism.

PURPOSE: The diagnosis of pulmonary embolism in the elderly is often difficult because of comorbid medical conditions, and perhaps also because diagnostic tests have a lower yield. We analyzed the diagnostic performance of common diagnostic tests for pulmonary embolism in different age groups. METHODS: We analyzed data from two large studies that enrolled 1,029 consecutive patients presenting to the emergency department with clinically suspected pulmonary embolism. The clinical probability of pulmonary embolism (high [>/=80%], intermediate, or low [</=20%]) was estimated by the treating physician. All patients underwent a sequential diagnostic protocol, including ventilation-perfusion lung scan, measurement of plasma D-dimer level, lower limb venous compression ultrasonography, and pulmonary angiography if the noninvasive work-up was inconclusive. RESULTS: The prevalence of pulmonary embolism increased progressively, from 12% in patients <40 years of age to 44% in those >/=80 years of age. The positive predictive value of a high clinical probability of pulmonary embolism was greater in the elderly (71% to 78% in those >/=60 years old versus 40% to 64% in those </=59 years old). The sensitivity of D-dimer testing was 100% in all age groups, but its specificity decreased markedly with age, from 67% in those </=40 years old to 10% in those >/=80 years old. The diagnostic yield of lower limb compression ultrasonography was greater in the elderly. The proportion of lung scans that were diagnostic (normal, near-normal, or high probability) decreased from 68% to 42% with increasing age. CONCLUSIONS: Age affects the performance of common diagnostic tests for pulmonary embolism and should be kept in mind when evaluating patients suspected of having this condition.

Adult↗
PubMed1999

[Menorrhagia, hypermenorrhea and disorders of hemostasis].

Menorrhagia is a common clinical problem. About 10% of women aged between 30 and 49 take medical advice for abnormal uterine bleeding. Underlying bleeding disorders are found in about 20% of women, once pelvic abnormalities are excluded. It is important to characterize a bleeding disorder since specific treatments can be provided. Moreover, these women are susceptible to present other haemorrhagic complications, particularly in case of invasive procedures. This review aims at drawing the attention a) on the importance of a careful medical history to assess menorrhagia and a possible bleeding disorder, b) on von Willebrand disease, the main coagulation disorder involved in case of menorrhagia and c) on several therapeutic possibilities.

Blood Coagulation Disorders↗
PubMed1993

Ocular growth in the fetus. 1. Comparative study of axial length and biometric parameters in the fetus.

The knowledge of ocular growth during fetal life, when compared with other fetal biometric parameters, could not only provide a better definition of malformation syndromes but could also give a better understanding of certain pathological processes in premature babies and in newborns. As the literature concerning prenatal ocular dimensions contains few data, the aim of this study was to measure the axial length of the globe (AL) in fetuses and compare this measurement with their gestational age, weight, height, head circumference (HC) and thoracic circumference (TC) in order to compile a reference table. In the present study, 76 globes from 38 fetuses (18-41 weeks gestational age) from the Department of Pathology (Timone University Hospital, Marseille) were examined. Ultrasonography A and B were used to measure the AL, and a pathological examination determined fetal weight, HC, TC and height. We were interested to find out which of the parameters studied would give the best correlation with ocular growth. Statistical analysis showed that HC remained the most discriminant factor and correlated best with ocular growth. We thus obtained an equation for ocular size according to HC that could serve as a basis for detecting pre- or postnatal ocular defects.

Anthropometry↗
PubMed1990

Stab wounds to the chest: a retrospective review of 100 consecutive cases.

In a retrospective review of 100 consecutive cases of stab wounds to the chest, 44 patients were successfully treated with tube thoracostomy, 14 patients required thoracotomy, 17 patients with small pneumothoraces were observed, and 25 patients were asymptomatic. The overall mortality was 4%, operative mortality was 7.1%, and the mortality rate for cardiac injuries was 50%. Of the eight patients with cardiac injuries, three were dead on arrival to the hospital and one patient died in the operating room. Patients treated with tube thoracostomy had a shorter hospital stay than patients managed by observation alone. Our findings support the opinion that asymptomatic patients (normal chest x-rays) may be discharged after 24 hours of observation and asymptomatic patients with nonprogressive small pneumothoraces (less than 20%) not requiring a chest tube may be discharged after 48 hours of observation. All patients should have close outpatient follow-up.

Adult↗
PubMed1982

Mediastinal hyperfunctioning parathyroid adenoma.

A patient presented with peptic ulcer disease and nephrolithiasis. Laboratory investigation disclosed hyperparathyroidism and following neck exploration, hypercalcemia persisted. After two years' follow-up, a retroesophageal mass that proved to be a parathyroid adenoma was discovered. This case is presented to illustrate the unusual occurrence of a posterior mediastinal tumor and the difficulty in managing ectopic parathyroid adenomas.

Adenoma↗
PubMedDate not supplied

[Value of D-dimers in diagnosis of acute pulmonary embolism].

FIBRIN BREAKDOWN PRODUCTS: D-dimers are protein substances resulting from the action of 3 enzymes, thrombin, factor XIII and plasmin, on the fibrinogen molecules. In the case of thrombosis, all these enzymatic reactions are activated, explaining the increase in D-dimer levels induced. The notion of a threshold is only significant for a given test; the 500 micrograms/L threshold is widely used for tests relying on ELISA methods (enzyme-linked immunosorbent assay). FROM A TECHNICAL POINT OF VIEW: The use of D-dimer ELISA in excluding pulmonary embolism is now well established. New quantitative tests with latex, based on a turbidimetric method, also appear interesting in this context. The latter is reliable, rapid, inexpensive, remarkably sensitive (97 to 100%) and widely available. INTEREST: Performed in the initial stages of diagnosis in an out-patient population with a 20-25% prevalence of the disease, it excludes the diagnosis in around 30% of patients. Decisional analysis models have shown that this method is economically profitable. However, in elderly hospitalised patients, its clinical utility is lesser because of its low specificity in this population. The association of high clinical probability of pulmonary embolism and normal D-dimer leves is rare and has a weaker negative predictive value, even when the ELISA technique is used.

Acute Disease↗
PubMedDate not supplied

[Immunohistologic study of the epiretinal membranes in proliferative diabetic retinopathy and retinal detachment with vitreo-retinal proliferation].

An immunohistological study was performed in specimens of epiretinal membranes obtained during surgery in patients with proliferative diabetic retinopathy or retinal detachment with proliferative vitreoretinopathy. Using immunostaining procedures, these membranes were found to contain great amounts of immunoglobulins and complement, as well as a strong expression of class II antigens. These results confirm the involvement of auto-immune phenomena in intra-ocular proliferative diseases and the close relationship between the immune system and peptide growth factors.

Cell Division↗
PubMedDate not supplied

[Immunopathologic study of retinal detachment with vitreo-retinal proliferation].

Immunopathological studies were performed on biopsies or autopsies of pars plana samples from patients with retinal detachment, with or without vitreo-retinal proliferation. Immunoglobulins and complement deposits have been found in vitreo retinal proliferation, together with a deviant expression of HLA-DR and DQ antigens by pigmented epithelial cells of the ciliary body. Gamma interferon is able to induce this expression in vitro, and the inducing effect of this lymphokine and other mediators has been tested on pigment epithelium cultures. Cultured pigment epithelial cells expressed HLA-DR and DQ antigens after being stimulated by very low doses of gamma interferon. The precise target of this immune reaction is still impossible to determine, but its consequences could be the release of growth factors as FGF, which has been found at very high levels in pigmented and non pigmented cells of pars plana and ciliary processes. Our work asserts the existence of auto-immune phenomena in retinal detachment with vitreo-retinal proliferation as well as in proliferative diabetic retinopathy, their exact involvement remaining to determine.

HLA-DQ Antigens↗