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Biomedical subjects

P Costa

Publications and source records attributed to P Costa.

At least 199 records · Page 11Linked to original sources
PubMed1987

A girl with G syndrome and agenesis of the corpus callosum.

We report on a female patient with G syndrome. The clinical expression is relatively severe and includes 2 manifestations not previously reported, ie, agenesis of the corpus callosum and umbilical hernia. These new findings support the notion that there is a developmental defect of the midline as the basis of the G syndrome.

Abnormalities, Multiple↗
PubMed1987

Potassium disturbances as a cause of metabolic neuromyopathy.

We report two cases of ascending muscular weakness progressing to areflexic quadriplegia caused by severe derangement of potassium homeostasis. The first patient presented with a 17-alpha-hydroxylase deficiency and severe hypokalemia. The second case had primary adrenocortical deficiency (Addison's disease) and extreme hyperkalemia. Complete recovery ensued after correction of the metabolic disorder in both cases. The role of potassium in the pathophysiology of neuromuscular excitation is discussed. We conclude that when neuromyopathy is present, metabolic causes should be considered and the serum potassium determined.

Addison Disease↗
PubMed1987

Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures.

From January, 1979, to December, 1984, at the Cardiac Surgery Department of the University of Torino Medical School, major sternal wound infections developed in 48 (1.86%) of 2,579 consecutive patients. These patients underwent open-heart procedures through a midline sternotomy and survived long enough for infection to appear. Possible risk factors were evaluated by means of a multivariate analysis. For the group of patients, we considered age, sex, hospital environment (different locations of our surgical facilities over the years), interval between hospital admission and operation, antibiotic prophylaxis, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, postoperative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of treatment in the intensive care unit. Univariate analysis indicated that age, sex, type and mode of surgical procedure, antibiotic prophylaxis, and duration of mechanical ventilation were not significantly associated with wound infection. For all other predisposing factors, a p value of less than .05 was demonstrated. These variables were entered in a multiple stepwise logistic regression. Six emerged as significant: hospital environment (p = .0001), interval between admission and surgery (p = .041), reoperation (p less than .0001), blood transfusions (p = .031), early chest reexploration (p less than .0001), and sternal rewiring (p less than .0001). Contamination of patients may occur before, during, and after operation, and any kind of reintervention may predispose to wound infection.

Cardiac Surgical Procedures↗
PubMed1986

Myocardial protection by perioperative diltiazem drip: a clinical evaluation.

This study was undertaken to evaluate the potential role of a perioperative calcium-channel blocker (Diltiazem) infusion in improving myocardial preservation. Forty consecutive CAD patients were randomly assigned to a control (C; n = 20) and a treated (D; n = 20) group. In patients in the latter group diltiazem was continuously infused at 0.5 to 2.0 mcg/kg/min i.v. from anesthesia induction until the aortic cross-clamping, and from myocardial reperfusion till the 48th postoperative hour. During the preCPB phase hypertension occurred less frequently in group D (3 vs 12 cases, p = 0.0033). In the immediate postischemic period, depression of contractility and the need for inotropic support were observed in 3 cases in group D and in 9 in group C (p = 0.0384). Postoperatively, group D patients had a lower incidence rate of hyperkinetic arrhythmias or conduction disturbances (p = 0.0218), as well as of ECG signs of ischemia (p = 0.0016). Significant CK enzyme level increase was noted in 13 patients in group C versus 4 in group D (p = 0.0040). Two perioperative myocardial infarctions were diagnosed, both in group C. These clinical data show that continuous perioperative infusion of diltiazem can effectively increase myocardial preservation during ischemic arrest, without unfavorable effects on the hemodynamics, electrical activity or mechanical performance of the heart.

Benzazepines↗
PubMed1986

Diltiazem cold cardioplegia in coronary artery surgery: effects on myocardial function and ischemia.

This study was undertaken to evaluate the myocardial preservation obtained by adding a calcium channel blocker, diltiazem (200 mcg/kg of body weight) to cold potassium cardioplegia in 24 patients with coronary artery disease who underwent myocardial revascularization, and were randomly divided into a treated Group D and a Control Group C. No significant differences were noted between the groups in cardiac electrical arrest and recovery time, recovery rhythm, mechanical function recovery, inotropic support, stroke index, or cardiac index. After cardiopulmonary bypass, the stroke index decreased by 13.1% in Group D and by 20.7% in Group C; cardiac index increased in both--18.6% and 14.0%, respectively--but the results were possibly from compensatory heart rate increases. Peripheral deltaP/deltat and endocardial viability ratios decreased in both groups. Coronary sinus enzymes and serum CK were slightly lower in the treated group. Serum CK-MB, however, was significantly higher in the Control Group. Electrocardiographic ischemic changes occurred in four patients, all in Group C (p =.046). Hyperkinetic arrhythmias occurred in five of the controls, but in none of the treated patients (p =.018). One perioperative myocardial infarction was diagnosed in the Control Group. These data suggest that diltiazem has no negative side effects on hemodynamics or cardiac rhythm and does not reduce impairment of myocardial function due to ischemia, but it does decrease the incidence of ischemic lesions in patients undergoing coronary artery bypass procedures.

Journal Article↗
PubMed1986

On newborn cuddliness.

We discuss the methodological implications of research into the newborn's response to cuddling, that is cuddliness, an item on the Brazelton NBAS scale. After analyzing its dimension as an interaction cycle, we describe an investigation into cuddliness in 52 newborns aged 0 to 3 hours before they had been fed or presented to their mothers. We report on the behavioral changes that proved to be most significant both for postural sequence and for involvement of the partner. These data are correlated with the variations in level of alertness observed during the maneuvers and characterizing the course of the interaction, which started in the quiet awake state (level 3-4) and ended with the transition either to sleepiness or to tension.

Arousal↗
PubMed1986

[Vesico-sphincter dyssynergia in the central paraplegic patient. Physiopathological reflections].

The vesico-sphincter dyssynergia is generally observed in paraplegic patients with supra sacral lesions (40% of our cases). The neurophysiologic basis of the vesico-sphincter dyssynergia are the field of controversies. The animal experimentations have shown that a section below the ponts, induce a neural reorganization, enough to produce a normal micturation, rising sacral short loop reflexes. The reality of such mechanism is discussed by different authors who consider a normal micturation as a brain stem reflex rather than a simple sacral reflex. These factors allow the authors to undergo a neurophysiologic, neuropharmacologic and urodynamic investigation, with the intention of shedding light on the pathophysiology of the vesico-sphincter dyssynergia in 20 cases of paraplegic patients. On the basis of our data the following conclusions were made: the importance of the polysynaptic reflexes evoked by cutaneous or vesical stimulation (below the neurologic lesions) on the different degrees of vesico-sphincter dyssynergia; the quality of voiding depends on the equilibrium between extension and flexor reflexes in paraplegic patients; the presence of a neural reorganization using short loop reflexes who are the expression of a complex system rather than a simple sacral reflex; the effect of chronic intrathecal morphinic drugs on the reflex equilibrium and the quality of voiding and the eventual relation between opiate receptors and vesical sphincter dyssynergia.

Electrophysiology↗
PubMed1986

Longitudinal assessment of children with congenital hypothyroidism detected by neonatal screening.

Clinical and laboratory data from 42 children (31 females and 11 males) with primary congenital hypothyroidism (CH) diagnosed by neonatal screening over a six-year period are reported. The mean age at onset of thyroid hormone therapy was 33 days. The adequacy of replacement therapy was assessed by repeated TT4, FT4, T3 and TSH serum determinations. The high serum TT4 concentrations frequently observed were not accompanied by clinical evidence of hyperthyroidism. rT3 levels determined in 28 CH children with TT4 greater than 15 micrograms/dl were clearly higher than in the controls. The mean weight, length and head circumference remained always between the 50th and 75th centile. The radiological assessment of the knee, mainly the distal femoral surface, has been considered as an important clinical value in the initial diagnosis and in the evaluation of both severity and duration of disease. The psychomotor development was assessed using Brunet-Lezine's test until age 36 months, Stanford-Binet at 4 and 5 and WISC at 6 years of age. The mean global developmental quotients (GDQ) were always between 85 and 97 at 6 to 72 months of age, only eight children were below 85. A significant correlation was found between GDQ at 6 months and the bone age. The neurological examination showed an impairment of posture, coordination and subtle deficits in motor and perceptual abilities in a small percentage of children.

Age Determination by Skeleton↗
PubMed1985

Visual evoked potentials and brainstem auditory evoked potentials in migraine and transient ischemic attacks.

A study of brainstem auditory evoked potentials (BAEPs) and pattern reversal visual evoked potentials (VEPs), recorded in intercritical phase, was carried out in 20 subjects (10 suffering from common migraine and 10 suffering from vertebrobasilar TIA) in order to obtain a comparative evaluation of cortical-subcortical functions. The data we obtained demonstrate the presence of BAEPs alterations in patients with previous vertebrobasilar TIA: no abnormalities were found in the migraine group. VEPs parameters are normal in both groups. Our data show that the study of the so-called "stimulus-related" potentials, such as BAEPs and pattern reversal VEPs, is useful in evaluating the damage produced by any noxa, while it cannot clearly emphasize individual factors predisposing to a specific pathology, as the absence of specific alterations in migraine patients demonstrates.

Adult↗
PubMed1985

[Adenocarcinoma of the kidney with invasion of the inferior vena cava. Apropos of 32 cases].

The authors present 32 cases of renal cell carcinoma with inferior vena cava involvement. Three sub-groups of patients can be distinguished on the basis of the level of this involvement: A (24 patients) with infra-hepatic involvement, B (6 patients) with retro-hepatic involvement and C (2 patients) with supra-hepatic involvement. The surgical tactics and results are analysed for each of these 3 sub-groups. The prognosis is relatively good in sub-group A, but is increasingly less favourable in groups B and C.

Aged↗
PubMed1984

Unilateral seizures following vincristine intravenous injection.

A case of acute central nervous system toxicity following the intravenous injection of vincristine was observed in a patient treated with a chemotherapy regimen including cyclophosphamide, doxorubicin and prednisone for non-Hodgkin lymphoma. The neurological symptoms consisted of right-sided epileptiform jacksonian seizures limited to the face, that lasted about 10 min, followed by spontaneous recovery. A cerebrospinal fluid study and computed tomographic scan of the brain failed to reveal any central nervous system lymphomatous involvement.

Antineoplastic Combined Chemotherapy Protocols↗