[Surgical treatment of breast carcinoma].
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Breast Neoplasms↗
Biomedical subjects
P Paoletti
Publications and source records attributed to P Paoletti.
[Cerebral vasospasm caused by subarachnoid hemorrhage].
Vasospasm is one of the most frequent complications of subarachnoid hemorrhage (SAH) and causes high mortality rates and serious neurologic deficits, resulting in invalidity. Diagnosis is based on precise clinical criteria (onset between the 3rd and the 8th day after the SAH) and is confirmed by angiographic examination. The etiology certainly involves many factors, though the identification of the primary cause (conductive to morpho-structural alterations of the artery walls) seems to be troublesome. Experimental evidence indicates that the basis of the reactions which cause the onset of the vasospasm lies in the blood which pools in the subarachnoid zone. The authors summarize the main pathogenetic theories, especially as far as the initial biochemical sequence is concerned. Among the numerous classes of substances involved in the genesis of vasospasms, a relevant role is played by oxyhaemoglobin, free radicals, lipidic peroxides and by the metabolites of arachidonic acid. The main purpose of vasospasm treatment is the possibility to eliminate and prevent ischemic complications. Early surgical exclusion of the aneurysm causing the bleeding allows for the removal of peri-aneurysmatic blood clots. Pharmacological treatment employs numerous classes of substances: among these calcium antagonists presently appear to give satisfactory results.
Arachidonic Acid↗
[Deferred surgery of cerebral aneurysms. Long-term follow-up in 103 cases].
Between January 1981 and December 1985, 120 consecutive SAH patients were admitted. 73% were in satisfactory conditions and 27% in poor ones. All the patients underwent treatment with antifibrinolytics. Angiographic examination was performed 10 days after the last hemorrhagic event, while the patient's general and neurologic conditions were stable. The reparative operation was carried out immediately after. During the waiting phase there were 16 relapses, (15.5%), resulting in death in 11 (10.7%), and 13 cases of symptomatic vasospasm (12.6%), resulting in death in 5 (4.9%). Overall mortality was 20.4%, with a 17.5% preoperative mortality. On 89 operations carried out on 85 patients, the intraoperative mortality was 3.5%, and neurologic morbidity (transitory in all cases) was 3.5%. All patients underwent intra- or post-operatory angiography to prove the complete exclusion of the aneurysms. After an average follow-up of 36 months, on a total of 103 aneurysm SAH cases, there were 18 preoperative deaths and 3 surgical deaths (within 30 days from the operation); one patient died of unrelated causes during the follow-up period. Seventy-three patients (72.9%) were fully recovered (51.5% returned to their previous job and 21.4% obtained lesser employment). 5.8% of the patients had a varying degree of invalidity. The results of this series were satisfactory both for the low surgical mortality and morbidity rates and for the high percentage of total recoveries. Nevertheless the prevalence of fatal relapses still leaves room for alternate medical and/or surgical treatments.
Aged↗
Extradural haematoma of the posterior fossa: a report of eight cases and a review of the literature.
The authors review the literature and present 8 cases of extradural haematoma of the posterior fossa operated from 1979 to 1985 at the Neurosurgical Clinic of the University of Pavia. Emphasis is placed on the importance of an early diagnosis of the symptoms which are often ignored due to the absence of specific clinical signs. The authors recognize a substantial improvement in results because of the recent introduction of CT scanning facilities which permit an early and precise diagnosis of this traumatic pathology.
Adolescent↗
The assessment of gas exchange by automated analysis of O2 and CO2 alveolar to arterial differences.
A computer program to measure breath by breath alveolar pressure (PA) and alveolar to arterial difference (AaD) for O2 and CO2, by a mass-spectrometer has been implemented. The program allows the determination of alveolar gas by different methods: 1. Bohr's equation (BE); 2. ideal alveolar air equation for O2 (IDO2); 3. end-tidal (ET); 4. by the Rahn's definition of 'mean alveolar gas', i.e., alveolar pressures are defined when instantaneous respiratory exchange ratio (IRQ) equals mean respiratory exchange ratio (MRQ). This automated technique has been used in 16 patients with chronic obstructive lung disease (COLD) and 15 patients with pulmonary embolism (APE). In both groups of patients it was always possible to find in each breath the point where IRQ = MRQ and therefore to measure AaD by RD. IDO2 was significantly lower than PAO2 by the other methods. Also ET values of O2 and CO2 were significantly different from RD and BE in both groups of patients, however the difference was consistently higher in COLD patients. The different shape of the expirograms (steeper expirograms in COLD) is responsible for this different result. RD and BE AaD characterize gas exchange more precisely than ET, because the contribution of high VA/Q units is also evaluated. This is particularly important in COLD patients. Consideration on dead space measurements are also reported both for COLD and APE patients. In conclusion this automated technique provides the assessment of gas exchange for the use in clinical respiratory physiology and for the monitoring of gas-exchange in critically ill patients.
Aged↗
Lung function abnormalities in different connective tissue diseases.
Lung volumes, forced expiratory flow-volume curves, diffusing capacity indexes, and arterial blood gases were measured in 72 non-smoking patients with various connective tissue diseases (13 with rheumatoid arthritis, 17 with systemic lupus erythematosus, 25 with progressive systemic sclerosis, 10 with primary Sjögren's syndrome, 4 with polymyositis, and 3 with mixed connective tissue disease). Small airways disease and a diffusion capacity impairment were the most frequent and marked functional abnormalities in the whole group, and were often present in asymptomatic patients. Different lung function defects seemed to be present in each disease group. In fact, large airway obstruction was prevalent in progressive systemic sclerosis, diffusion capacity impairment in systemic lupus erythematosus, and small airways disease in rheumatoid arthritis. In contrast, primary Sjögren's syndrome appeared to be the connective tissue disease in which lung function abnormalities were less frequent and less pronounced.
Adolescent↗
Selected ion monitoring technique for the evaluation of sterols in cerebrospinal fluid: a new approach to desmosterol test for central nervous system tumors.
The desmosterol test for the diagnosis of central nervous system (CNS) tumors is proposed in a simplified form. The procedure is based upon the analysis of sterol profile in cerebrospinal fluid (CSF) by selected ion monitoring (SIM) technique. Applied to 55 patients with tumoral and non tumoral CNS disease, the new test detects average levels of CSF desmosterol in tumor bearing patients that are tenfold higher than in the absence of CNS neoplasia. On an individual basis, a concentration of CSF desmosterol equal to or higher than the mean plus twice the standard deviation for the reference group of patients with no CNS tumor, is considered a positive result. Based on this criterion, a correct diagnosis was made in 73% of cases vs 77% of the former test, which required a 5-day treatment period with a desmosterol-reductase inhibitor in order to increase CSF desmosterol concentration. With this revised procedure CSF desmosterol can be detected in smaller volumes of CSF without any drug pretreatment, thus making the test more suitable for clinical application.
Brain Neoplasms↗
Prostaglandin D2 monitoring in human CSF after subarachnoid hemorrhage: the possible role of prostaglandin D2 in the genesis of cerebral vasospasm.
Experimental and clinical studies indicate that cerebral vasospasm following subarachnoid hemorrhage (SAH) may be caused by changed biochemical properties of the endothelium and vascular smooth muscle cell exposed to vasoactive substances synthetized by cerebral arteries and released in clotted blood. Many compounds have been identified in CSF from SAH patients: Thromboxanes A2 and B2, Prostaglandins F2 alpha, E2 and D2 are the major prostanoids incriminated in the causation of cerebral arterial spasm. We have monitored the CSF PGD2 concentrations with serial lumbar punctures at different intervals from the hemorrhage in 16 patients admitted for SAH: PGD2 was measured with radioimmunoassay as its 9-methoxy derivative. The lumbar CSF PGD2 concentration ranges from 0.11 to 1.53 ng/ml. In 7 cases vasospasm was angiographically demonstrated. 9 patients presented no clinical or radiological evidence of vasospasm. In 5 cases cisternal CSF samples were available at the operation by cisternal punctures. There was no correlation between CSF PGD2 concentration and clinical course. In the 7 cases with evidence of vasospasm a significant increase of CSF PGD2 corresponded to neurological deterioration. In all 9 cases without evidence of vasospasm CSF PGD2 concentration trend was in a steady-state. The cisternal CSF PGD2 concentration was higher than lumbar CSF concentration in cases with arterial spasm. This suggests the importance of the clotting phenomenon in vasospasm onset after SAH. PGD2 is one of the most important spasmogens in clotted blood. Although its role in the genesis of vasospasm onset remains to be defined, its vasospastic action, in addition to that of other analogous compounds, seems to be relevant.
Humans↗
Total gastrectomy in the treatment of adenocarcinoma of the cardia. Review of the results in 73 resected patients.
Between January 1, 1971, and December 31, 1978, 73 patients with adenocarcinoma of the cardia were treated by total gastrectomy with distal esophagectomy. The continuity of the alimentary tract was restored by esophagojejunostomy using a Roux-Y procedure in 32 patients and jejunal loop interposition in 41 patients. The early postoperative mortality rate was 18 percent. The overall 5 year survival rate was 26.7 percent, and the 5 year survival rate for stage I and II disease was 91.6 percent and 25 percent, respectively, whereas none of the stage III and IV patients survived more than 4 years. Fifty-eight percent of the patients without nodal involvement lived more than 5 years. The 5 year survival rate was only 9.3 percent in the presence of nodal metastases. Our 5 year survival rates suggest the value of elective total gastrectomy for stage I or II adenocarcinoma of the cardia. Jejunal loop interposition is a time-consuming but functionally superior procedure in comparison to other reconstructive procedures after total gastrectomy.
Adenocarcinoma↗
Arachidonate metabolites and vasospasm after subarachnoid haemorrhage.
A wide literature exists about the pathogenesis of cerebral arterial spasm following subarachnoid haemorrhage: several compounds have been identified in human cerebrospinal fluid as possible vasoactive agents involved in the biochemical mechanism of vasospasm onset. Many experimental evidences exist for a major involvement of arachidonate metabolites. The present work represents a review of experimental data supporting the hypothesis of cerebral arterial spasm as a result of an imbalanced vascular regulatory mechanism involving arachidonate metabolites. The authors have also monitored, in 25 cases of aneurysmal subarachnoid haemorrhage, lumbar and cisternal CSF levels of prostacyclin and PGD2, as representative of vasodilating and, respectively, vasoconstrictor compounds. In all cases CSF arachidonate metabolite levels after SAH were significantly higher than in control cases. Ten patients presented with symptomatic vasospasm: lumbar CSF PGD2 levels show fluctuations with superimposed peaks related to the neurological deterioration due to vasospasm, while lumbar CSF prostacyclin concentration-trend suggest a decreasing synthesis. In 15 patients presenting without vasospasm, lumbar CSF concentration of arachidonate metabolites are in a 'steady-state'. These data confirm the existence of an imbalanced biochemical situation promoting vasospasm, markedly in cisterns near to the ruptured aneurysmal wall. The evaluation of cisternal CSF levels of arachidonate metabolites supports the hypothesis of the clotting phenomenon around the ruptured aneurysm as an important predictive pattern of vasospasm, as shown in CT findings.
6-Ketoprostaglandin F1 alpha↗
Prostacyclin and vasospasm in subarachnoid hemorrhage from ruptured intracranial aneurysm. A preliminary clinical study.
Experimental and clinical observations suggest the importance of arachidonate metabolites in the genesis of symptomatic cerebral vasospasm after subarachnoid hemorrhage. Prostacyclin (PG12) has a well demonstrated vasodilator action. The authors monitored CSF prostacyclin concentration in 12 consecutive cases of subarachnoid hemorrhage with the purpose of correlating the prostacyclin concentration trend with the clinical course and the risk for vasospasm. In three cases patients presented with clinical and radiological signs of vasospasm. CSF prostacyclin concentration showed a typical decreasing trend, which amounted to a minor form of protection from vasospastic agents. The nine cases which did not develop vasospasm demonstrated no significant changes in the prostacyclin CSF concentration trend. The authors also presented four cases in which cisternal CSF samples were available. In one case of developing vasospasm, the cisternal prostacyclin concentration was seven times lower than the highest lumbar CSF concentration. In three cases without evidence of vasospasm cisternal CSF demonstrated a balanced biochemical situation and a minor risk of vasospasm.
6-Ketoprostaglandin F1 alpha↗
Respiratory effects of occupational exposure to tobacco dust.
Few investigations of the respiratory effects of occupational exposure to tobacco dust have been carried out and the threshold limit value has not well been established. A cross sectional survey on a sample of 223 male and female workers at a cigar and cigarette factory in Lucca (Tuscany) showed a significantly higher prevalence of wheezing, attacks of shortness of breath with wheezing, dyspnoea, and rhinitis than in a reference population. A trend towards a decrease in forced end expiratory flows according to smoking habit and work duration was evident. Positive skin prick tests were observed in 26% of men and 23% of women and were positively associated with duration of work and negatively with cigarette smoking. Thin interstitial space involvement was observed on chest x ray examination in almost half the female workers with more than 35 years exposure. These findings suggest that prolonged exposure to tobacco dust may have negative health effects and that it is advisable to establish a threshold limit value for tobacco dust different from that of inert dust.
Adult↗
[Longmire's intervention in the treatment of adenocarcinoma of the cardias. Results in 41 patients].
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Adult↗
[Possibilities and limits of neurosurgery in the management of cerebral ischemia].
Surgical treatment of occlusive cerebrovascular diseases is based on the theory that improved cerebral blood flow in the occluded areas can potentially limit the degree of ischaemic damage. This, it is thought, will at least partially normalise neuron metabolism. The two commonly used surgical techniques are carotid endarterectomy and extracranial-intracranial anastomosis. The importance of the criteria used in selecting patients for surgery is discussed and it is emphasised that the most satisfactory results will only be obtained if the correct surgical indication is carefully established for each patient. The results obtained in 40 carotid endarterectomies and 94 E.I.A.B. are also presented. Mortality and morbidity rates for both procedures are minimal and the results were satisfactory in over 90% of the case, the neurological deficit being corrected or drastically reduced.
Brain Ischemia↗
Cisternal and lumbar CSF concentration of arachidonate metabolites in vasospasm following subarachnoid hemorrhage from ruptured aneurysm: biochemical and clinical considerations.
Two representative cases of subarachnoid hemorrhage in which prostaglandin D2 (PGD2) and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), stable metabolite of prostacyclin (PGI2), were monitored with serial lumbar punctures and detected in cisternal CSF during operations for aneurysm, are reported. In the case with demonstrated arterial vasospasm, prostaglandin D2 has a concentration trend with characteristic peak related to vasospasm; the synthesis of prostacyclin appears inhibited after the hemorrhage. In the patient without radiologic evidence of vasospasm, arachidonate metabolite concentration trend appears in a steady-state. Cisternal prostaglandin D2 concentration in the patient with demonstrated vasospasm is two times the highest lumbar CSF concentration, while 6-keto-prostaglandin F1 alpha concentration is very low. This suggests the role of the clotting phenomenon and likely confirms the importance of arachidonate metabolites in the genesis of cerebral arterial spasm following subarachnoid hemorrhage.
6-Ketoprostaglandin F1 alpha↗
Reference equations for the single-breath diffusing capacity. A cross-sectional analysis and effect of body size and age.
A longitudinal study was implemented in an unpolluted rural area of northern Italy (near Venice), before the start of the operation of a large oil-burning thermoelectric power plant, in order to investigate the effects of the future exposure to air pollution and to elucidate the natural history of obstructive airways diseases. During the first cross-sectional survey, a sample of the general population (n=3,300, 8 to 64 yr of age) performed several lung function tests, and information on risk factors and on the presence of respiratory symptoms were obtained by a standardized questionnaire. There were 712 subjects who were classified as normal on the basis of rigid criteria and who were able to perform satisfactorily a single-breath CO diffusing capacity (DLCOsb) test. The DLCOsb values showed an increase with height and age early in life and a later decrease with age. Two age groups were selected to determine an age at which DLCOsb stopped increasing and began to decline. Reference equations were computed (using age and height) in these 2 different age groups in each of the sexes. Similar equations were calculated for the total lung capacity derived from single-breath helium dilution measurements. The DLCOsb values in this study were higher than reported by other investigators. The method of selection of the study population, the strict criteria for normal, as well as technical, differences probably explain this finding. Reference equations for diffusing capacity corrected to lung volume (DL/VA) were computed only for adults (much greater than 20) in both sexes, because age and height coefficients in young subjects were insignificant.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Respiratory effects in relation to estimated tar exposure from current and cumulative cigarette consumption.
Relationships between estimated "tar" exposure from current and past cigarette consumption, were related to respiratory symptoms and function during the seventh survey (1981-1983) of the Tucson epidemiologic study of airways obstructive diseases. Smokers (n = 582; 280 males and 302 females) and exsmokers (n = 621; 345 males and 276 females), answered detailed questions on current and past smoking, and performed flow-volume maneuvers. Cough and phlegm were significantly associated with estimated "tar" exposure from current cigarette consumption. Cough, phlegm, and dyspnea were associated with reported deep inhalation in both sexes, while wheeze was so associated in females. In young smokers (less than 35 years), symptoms were more prevalent in those who had predominantly smoked cigarettes with estimated high "tar." Total exposure was more important in older smokers. Generally, exsmokers showed a lower prevalence of symptoms than smokers. Cross-sectional lung function measurements were significantly related to total estimated "tar" exposure and age. Multiple logistic regressions provided models which helped predict symptoms and lung function impairment in smokers and exsmokers on the basis of estimated "tar" exposure and pack-years of smoking.
Adolescent↗
[Protocol of combined surgical and polychemico-immunoradiologic therapy of stage T2N2MO lung cancer].
Preliminary data on the use of a combined surgical-polychemical-immunoradiotherapy protocol in the treatment of 13 T2N2M0 lung cancer patients are reported. The results are compared with those obtained in a 13 patient control group, homogenous by histotype, stage and surgical treatment who were given no other therapy. At 24 months the average survival rate in the first group was 61.5% compared to 15.3% in the second. It was significant that survival at 24 months after pneumonectomy rose from 16.6% to 50% and even more significantly survival after lobectomy rose from 14.2% to 71.4%.
Antineoplastic Combined Chemotherapy Protocols↗