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Biomedical subjects

P Fiorani

Publications and source records attributed to P Fiorani.

At least 73 records · Page 4Linked to original sources
PubMed1990

An external carotid artery shunt to prevent cerebral ischaemia during carotid surgery.

The contribution of the external carotid artery to cerebral blood flow in the presence of an internal carotid occlusion or severe stenosis is well documented. This study was undertaken in order to try and exploit the external carotid artery as a collateral pathway to avoid cerebral ischaemia during carotid surgery. The main problem is to ascertain when the external carotid artery is relevant to cerebral perfusion, and to assess if the insertion of a shunt from the common to the external carotid artery is a useful way of ensuring adequate cerebral perfusion in patients with cerebral ischaemia during carotid clamping. In order to do this, it was necessary to assay the haemodynamic role of the external carotid artery by means of a technique which monitors cerebral function in a reliable way. We tried to evaluate this possibility by an intra-operative haemodynamic study during carotid surgery in 35 patients operated on under local anaesthesia. The insertion of a shunt between the common and external carotid artery was able to reverse brain ischaemia during clamping in four of eight patients with a neurological deficit during temporary carotid occlusion. In selected cases therefore cerebral protection with an external carotid shunt might be a valuable adjunct in the performance of carotid surgery.

Aged↗
PubMed1989

Clinical significance of intraoperative cultures of aneurysm walls and contents in elective abdominal aortic aneurysmectomy.

To investigate the clinical significance of intraoperative cultures in elective abdominal aortic aneurysmectomy, we cultured the aneurysmal wall and contents in 90 patients undergoing vascular graft surgery. Prosthetic graft infection was documented in 1 out of 62 patients with negative cultures and in none of 28 patients with positive cultures (chi 2 = 0.4, p greater than 0.1). Bacterial growth was seen in neither of 2 inflammatory aneurysms, 3 of 14 atherosclerotic aneurysms and 2 of 5 aneurysms without specific features. A retrospective analysis of patients' charts aimed at finding possible risk factors failed to identify any correlation between results of cultures and length of hospitalization before surgery, time interval between angiography and surgery, route of angiography procedure or minutes of surgery before sample collection. We conclude that positive cultures may not imply clinical infection at the time of surgery and that prolonged post-operative organism-specific antibiotic therapy does not appear necessary to prevent graft contamination in patients undergoing elective abdominal aortic aneurysmectomy.

Adult↗
PubMed1989

Very low calorie diet induces opposite effects on sympathetic nervous system and adrenomedullary responses.

The effect of very low calorie diet (VLCD) on catecholamine excretion during 24 h was examined in nine obese men, with normal blood pressure, maintained on low sodium balance, after 3 days and 14 days of the diet period. A significant decrease in the total daily noradrenaline (NA) excretion was observed at the end of the diet (P less than 0.05). The daily excretion of adrenaline (A) increased (P less than 0.05) with a fall in the NA/A ratio (5.1 +/- 2.6 vs 12.5 +/- 3.7; P less than 0.03). The results demonstrate that the sympathetic nervous system is influenced to a greater extent by caloric intake than sodium homeostasis and that the VLCD exerts different effects on SNS and adrenomedullary secretion.

Adrenal Medulla↗
PubMed1989

[Clinical study of picotamide in patients with vascular diseases].

The authors report on a group of 44 patients operated on for vascular disease, treated with antiplatelet therapy (picotamide). These patients were followed up for a period of 12 months with clinical and instrumental controls (Doppler ultrasound) in order to evaluate the evolution of atherosclerotic disease.

Adult↗
PubMed1989

Approach to the abdominal aorta: impairment of respiratory function after supraumbilical transverse and midline laparotomy.

Midline and transverse incision are commonly used in upper abdominal surgery. A comparison of the two procedures with respect to the respiratory function, assessed by spirometry, blood gas analysis, inspiratory and expiratory pressures, and thoraco-abdominal respiratory synchronism, was made in two groups of patients after surgery on the abdominal aorta. 32 patients affected by abdominal aortic obstructive or aneurysmatic disease, candidates for aortoiliac revascularization, were randomized into two groups of 17 (group A) and 15 (group B) patients respectively. Group A underwent midline laparotomy and group B supraumbilical transverse laparotomy. Ventilatory function and blood gas analysis were determined on the day before operation and on the second and eight postoperative day. All patients showed a depressed ventilatory function postoperatively, but the impairment was significantly minor after transverse laparotomy.

Adult↗
PubMed1988

One year follow-up of patients clinically preselected for excessive risk of stroke.

From a consecutive series of 812 patients at risk of stroke we selected 100 who seemed to be at high risk (excessive stroke risk--ESR) on the following clinical criteria: either multiple reversible ischemic attacks in one carotid territory or multiple (or bilateral) severe stenotic carotid lesions. The patients of the first subgroup received medical therapy and those of the second were referred for surgery. The 100 patients were followed up for 12 months, during which 29 patients had cerebral ischemic events: 17 having stroke and 12 TIA. This study suggests that it is possible to identify beforehand subgroups of ESR patients, thereby facilitating the selection of patients for brain protection and avoiding huge trials of unselected cerebrovascular patients.

Aged↗
PubMed1988

Low molecular weight heparin prevention of post-operative deep vein thrombosis in vascular surgery.

Ninety-two patients undergoing vascular surgery took part in a controlled clinical trial to study the effectiveness of a new low molecular weight (LMW) heparin for prevention of post-operative deep vein thrombosis. Forty-six patients were treated daily, for 7 days after operation, with a single subcutaneous injection of 15,000 Anti X-activated Factor Units of the new LMW heparin; the remaining 46 patients were treated, for the same period, with 2 daily subcutaneous injections of 5,000 International Units of calcium heparin. Deep vein thrombosis detection was by the radioactive fibrinogen uptake test, performed each day during therapy in all patients. A very low incidence of sub-clinical deep vein thrombosis was observed; in 3 (6.5%) patients in the LMW heparin group and in 4 (8.6%) patients of the calcium heparin group. The results of laboratory investigation showed that the antithrombotic activity (inhibition of Factor Xa) of the LMW preparation was significantly greater than that of calcium heparin, while activated partial thromboplastin time was greater in the calcium heparin group. The new preparation also showed better local tolerance, with less pain on subcutaneous injections.

Aged↗
PubMed1988

Consumption coagulopathy and low-dose heparin in the surgical repair of abdominal aortic aneurysm: a study of fifteen cases.

Surgical repair of abdominal aortic aneurysm (AAA) is frequently associated with DIC. 15 patients affected by AAA were studied to evaluate the risk of consumption coagulopathy and the efficacy of daily low-dose calcium heparin prophylaxis. The coagulation parameters investigated showed a postoperative decrease of AT III activity levels and platelet count the other laboratory tests did not show any significant modifications. Low dose heparin was effective in preventing coagulation activity or thrombotic episodes. No thromboembolic complications were observed, except nonfatal myocardial infarction.

Aged↗
PubMed1981

Autoradiographic studies of the smooth muscle cells in human arteries.

We have studied the kinetics of smooth muscle cell growth in the tunica media of human arteries obtained from 12 patients affected by obstructive vascular disease, and one case operated because of a trauma. The studies were carried out on arterial samples by autoradiography after in vitro labelling with 3H-thymidine. Different patterns of radioactive nucleotide uptake were detected. On nine elastic and muscular arteries without pathological changes it was demonstrated that the turnover of smooth muscle cells in human medias was very low, and similar to that found in experimental animals. The medias under atherosclerotic plaques showed variable levels of tritium uptake. Although the number of cases surveyed was limited, a possible explanation is that the different levels of uptake could depend on the different evolutive stages of the atherosclerotic process. It cannot, however, be excluded that the proliferative activity of the smooth muscle cells may be related to focal damages of the tunica media.

Adult↗