Search PubMed⌕ Search

Biomedical subjects

P Carli

Publications and source records attributed to P Carli.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Management of chest pain by the Emergency Ambulance Service: the DOLORES register].

Pre-hospital management of chest pain is a difficult problem. The emergency doctor has to take triage decisions based on instantaneous data whereas the decisional rationale of the many pathologies concerned, including acute coronary syndromes, is often based on observation over several hours. There have been few studies of the efficacy of pre-hospital management of chest pain by an emergency ambulance service. Therefore, the DOLORES register was set up to assess this problem over a 6 month period by the emergency ambulance service of Necker Hospital in Paris. Between January and June 2004, the Necker emergency ambulance service was called out on 205 occasions for chest pain. Forty-three patients had acute coronary syndromes (ACS) with ST elevation. Of the remaining 162 patients, 32 stayed at home, 2 were admitted the following day by cardiologists for coronary angiography, 52 were admitted for observation to the emergency unit and 76 were admitted to the coronary care unit. In the latter two groups, the final diagnosis of ACS without ST elevation was retained in 11/52 and 57/76 patients respectively. Finally, 2 patients were admitted directly to the catheter laboratory. The clinical and paraclinical data noted by the emergency ambulance service and at hospital admission was concordant in all cases. Pre-hospital triage by the emergency ambulance service seems to be effective. These results require confirmation with a large scale study.

Angina, Unstable↗
PubMed2004

Laparoscopic surgery in a patient with ventriculoperitoneal shunt: monitoring of shunt function with transcranial Doppler.

We describe the use of transcranial Doppler (TCD) monitoring during laparoscopic resection of an ovarian cyst in a young woman who previously underwent ventriculoperitoneal shunting for hydrocephalus. Shunt function was not altered by pneumoperitoneum, except during transient episodes of high intra-abdominal pressure. The role of TCD monitoring during laparoscopic procedures in patients with cerebrospinal fluid shunt is discussed.

Adult↗
PubMed2004

[Pyloric stenosis management in France in 1999: a postal survey].

OBJECTIVE: The aim of this postal survey was to know how were treated infants with hypertrophic pyloric stenosis in France in 1999. METHODS: A questionnaire was sent to all French members of the Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (Adarpef). RESULTS: Half the cases of pyloric stenosis treated in France in 1999 were related by the survey. Preoperative management was short lasting (24 h) while the advised guidelines regarding biologic criteria for operation were poorly followed. Nevertheless, crush induction was only performed in 80%. CONCLUSION: The management of infants with pyloric stenosis must be improved, at least to obtain the generalization of crush induction.

Analgesics, Opioid↗
PubMed2004

Only superficial spreading melanoma is causing the melanoma epidemics?

Population-based data from the Tuscany Cancer Registry including 1836 malignant melanoma diagnosed during 1985-1999 were analysed according to the morphological type. Only superficial spreading melanoma (1017 cases) showed a striking increase in incidence during the period. This was true both for thin and thick tumours. A differential effect of sun exposure in melanoma development according to morphological type deserve to be investigated.

Humans↗
PubMed2004

Risk of second primary cancers, other than melanoma, in an Italian population-based cohort of cutaneous malignant melanoma patients.

A population-based study has been carried out in central Italy to investigate the risk of further non-melanoma primary cancers in a cohort of cutaneous malignant melanoma (CMM) patients. We considered 1835 invasive CMM cases (93.4% histologically verified) diagnosed between 1985 and 1999 by the Tuscany Cancer Registry, central Italy (1 200000 inhabitants) and actively followed up to the end of 1999 for vital status and for the occurrence of a second primary. Only cases diagnosed after 2 months (metachronous) from CMM diagnosis were considered. During 7758 person-years of observation, 94 cancers were observed (93.6% histologically verified) versus 73.8 expected, corresponding to a standardized incidence ratio (SIR) of 1.27 (95% confidence interval (CI) 1.03-1.56). The risk was similarly increased in both sexes, males SIR=1.31 and females SIR=1.23, and it was statistically significant among subjects younger than 60 years (SIR=1.76) but not among those of 60 years and older (SIR=1.14). Significant increased risks were observed for non-melanoma skin cancers (SIR=3.26) and non-Hodgkin's lymphoma (SIR=2.74). Physicians should be aware of the higher risk for non-Hodgkin's lymphoma and clinical follow-up should include lymph node palpation. However, the risk for extranodal lymphomas should also be kept in mind.

Cohort Studies↗
PubMed2004

Improvement of malignant/benign ratio in excised melanocytic lesions in the 'dermoscopy era': a retrospective study 1997-2001.

BACKGROUND: Because of the many limitations of studies based on the diagnostic setting of excised lesions, the impact of dermoscopy (epiluminescence microscopy, dermatoscopy) in melanoma screening during practice remains to be established. OBJECTIVES: We assumed that effects of the use of dermoscopy on some indicators of diagnostic performance in melanoma screening should be traceable retrospectively; therefore, we analysed the impact of routine dermoscopy use on the malignant/benign ratio in excised melanocytic lesions. METHODS: Preoperative and histological diagnosis of 3053 melanocytic lesions [319 melanomas (10.4%)] consecutively diagnosed and excised at the Department of Dermatology, University of Florence in the period 1997-2001 inclusive were retrieved. Six dermatologists who selected the lesions to excise and who performed preoperative diagnosis were divided into two groups according to their use of dermoscopy in routine activity (n = 2 dermoscopy users and n = 4 nonusers). The study period was divided into a predermoscopy period (1997), a shift phase (1998) and a dermoscopy period (1999-2001). RESULTS: During the study period, the malignant/benign ratio improved in dermoscopy users only (from 1 : 18 to 1 : 4.3, P = 0.037). No significant difference was found for nonusers (from 1 : 11.8 to 1 : 14.4). Dermoscopy users were more likely to have a melanoma diagnosed within a series of excised lesions than nonusers, even taking into account potential confounders such as sex, age and study period by means of multivariate analysis (odds ratio 1.55, 95% confidence interval 1.17-2.01). The percentage of 'problem' naevi (naevi with architectural disorder with or without cytological atypia and Spitz or Reed naevi) over the total number of excised lesions was higher in dermoscopy users than in nonusers (year 2001, 51.6% vs. 40.9%, P = 0.014). Similar findings were obtained after exclusion from the data set of lesions excised for cosmetic reasons. CONCLUSIONS: The adoption of dermoscopy in routine melanoma screening is followed by an improvement of the malignant/benign ratio in excised lesions, suggesting a more appropriate selection of pigmented lesions referred to surgery. Because of the possible limitations of a retrospective study design, future confirmation of this finding by means of a prospective, randomized study is advisable. The introduction of dermoscopy in routine practice may have major implications in large-scale melanoma screening with cost savings and a reduction of the dermosurgery workload.

Female↗
PubMed2004

Self-detected cutaneous melanomas in Italian patients.

Self-detection of suspicious pigmented skin lesion combined with rapid referral to dermatologic centres is the key strategy in the fight against melanoma. The investigation of factors associated with pattern of detection of melanoma (self- vs. nonself-detection) may be useful to refine educational strategies for the future. We investigated the frequency of melanoma self-detection in a Mediterranean population at intermediate melanoma risk. A multicentric survey identified 816 consecutive cases of cutaneous melanoma in the period January to December 2001 in 11 Italian clinical centres belonging to the Italian Multidisciplinary Group on Melanoma. All patients filled a standardized questionnaire and were clinically examined by expert dermatologists. Self-detected melanomas were 40.6%, while the remaining lesions were detected by a dermatologist (18.5%), the family physician (15.2%), other specialists (5%), the spouse (12.5%), a friend or someone else (8.2%). Variables associated with self-detected melanomas were female sex, young age, absence of atypical nevi, knowledge of the ABCD rule, habit of performing skin self-examination. Self-detected melanomas did not differ from nonself-detected tumours in term of lesion thickness; however, patients with self-detected melanomas waited a longer period before having a diagnostic confirmation (patient's delay) (> 3 months: odds ratio, 3.89; 95% confidence interval, 2.74-5.53). In order to reduce the patients' delays, educational messages should adequately stress the need for a prompt referral to a physician once a suspicious pigmented lesion is self-detected.

Adult↗
PubMed2003

[Single ventricle and obstetric anaesthesia: two cases report].

Single ventricle is a relatively rare abnormality found only in 0.5-1.5% of patients with congenital heart disease. Pregnancy results in an increased maternal morbidity and mortality in patients with right to left shunting, especially in cases associated with pulmonary hypertension and polycythemia and decreased arterial oxygen saturation. Most complications arise from decreases in systemic vascular resistance, causing an increase in right to left shunting and further hypoxemia and acidosis. For this reason, the major regional anaesthetic techniques are often avoided in these patients. The authors reported two successful management of regional anaesthesia for both caesarean and vaginal delivery.

Adult↗
PubMed2003

[Use of oral sildenafil (Viagra) in pulmonary hypertension after cardiac pediatric surgery].

Pulmonary hypertension remains a major cause of morbidity after cardiac surgery, although inhaled nitric oxide (iNO) was shown to have clinical benefit. Some patients are dependent on iNO, increasing the length of hospital stay. The authors report a case of a girl, nine years old (17 kg), with mitral insufficiency, atrial septal defect and pulmonary hypertension (80% of systemic pressure). Following cardiac surgery, pulmonary hypertension persisted and iNO could not be withdrawn. Sildenafil was administered orally (1,5mg x kg(-1), every 4 h) at the 15th postoperative day and iNO could be withdrawn within 24h with clinical improvement.

Administration, Inhalation↗