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Biomedical subjects

P Pietri

Publications and source records attributed to P Pietri.

At least 19 recordsLinked to original sources
PubMed1999

Pulmonary arteriovenous malformations: lung transplantation as a therapeutic option.

Multiple pulmonary arteriovenous malformations (PAVM) constitute an uncommon cause of respiratory disability. They may lead to severe hypoxaemia via right-to-left shunts and are sources of substantial mortality and morbidity. Conservative surgical resection has been proposed as the treatment of choice. More recently, percutaneous balloon or coil embolization of the feeding vessels offered an efficacious and safe alternative therapy for patients whose fistulas are too numerous to excise. This study reports an unusual case of respiratory disability in a patient with multiple and microscopic pulmonary arteriovenous malformations who failed to respond to embolotherapy and who received a double lung transplantation with good initial outcome.

Adult↗
PubMed1999

[The role of echo-endoscopy in the staging of squamous-cell carcinoma of the esophagus. The correlation between the surgical and anatomicopathological findings].

BACKGROUND: Endoscopic ultrasonography (EUS) is a relatively new diagnostic method to assess the extent and the depth of infiltration of esophageal carcinoma. METHODS: From October 1990, 100 patients affected by esophageal squamous cell carcinoma underwent preoperative evaluation with endoscopic ultrasonography, 85 of whom were operated on. The first 23 patients underwent endosonography with an Olympus GF-EUM2 with a 7.5 MHz echo-probe; the remaining 77 patients underwent EUS with an Olympus GF-EUM3 with a 7.5-12 MHz echo-probe. RESULTS: In 33 cases (33%), the procedure was not completed because of the impossibility of passing through the neoplastic stenosis. The depth of infiltration was correctly defined by EUS in 73 of 85 patients (86%) compared with 47% of Computed Tomography (CT) (p < 0.05). Overestimation occurred in 6 patients (7%), whereas underestimation occurred in 6 cases (7%). Lymph-node involvement was correctly classified by EUS in 50 of 57 patients (88%) compared with 39% of CT. CONCLUSIONS: EUS provides a high degree of accuracy in assessing both T and N parameters in staging esophageal cancer. The major problem of the method is still the frequent impossibility of passing through a neoplastic stenosis.

Adult↗
PubMed1996

Saphenous vein bypass: an alternative to internal carotid reconstruction.

OBJECTIVE: Venous grafting is rarely employed for carotid reconstruction; the aim of this retrospective study was to assess its value as an alternative to endarterectomy. MATERIAL: Between January 1980 and June 1990, we performed 212 carotid artery venous bypasses (CVB) on 208 patients. Twenty-nine patients were asymptomatic, 60 had non-hemispheric symptoms and 119 focal symptoms. The indication for surgery was stenosis in 185 cases, kinking in 18 and aneurysms in nine. The main criteria to use CVB were length of the lesion in 86 cases, extent of atherosclerosis in 75, dysplasia in 12, intraoperative failure of endarterectomy in 21, aneurysms in seven and long-term restenosis or occlusion in 12. RESULTS: There were 11 deaths, three strokes and nine transient ischaemic attacks. Angiographic control showed one occlusion giving an immediate patency rate of 99.5%. Mean follow-up was 104.3 +/- 46.1 months with 15 patients lost to follow-up. Eighty patients died; life expectancy was 52.4 +/- 7.5 at 10 years. Including occlusions and restenosis as failures, the secondary patency rate was 96.4 +/- 3.7 at 10 years. The annual stroke rate was 1.3% and the neurologic event-free-population 87 +/- 2.4% at 10 years. CONCLUSION: CVB is a valuable alternative to endarterectomy for reconstruction of the carotid artery. The indications are extensive atherosclerosis involving the common carotid artery, intraoperative anatomic failure of endarterectomy, and long-term restenosis.

Adult↗
PubMed1996

[Recurrent inguinal hernia. Propositions of classification and surgical strategy].

We reviewed 1005 cases of groin hernia in 932 patients including 113 recurrent hernias. Eighty-seven percent of the patients were seen again one year after surgery for an evaluation of technique, results and complications. The data obtained was used to propose a simple anatomoclinical classification into three types which could be used to orient surgical strategy. Type R1 includes first relapse oblique external reducable hernia of less than 2 cm in non-obese patients: the Lichtenstine-gilbert technique is indicated. Type R2 includes inferior, direct reducable first relapse hernia of less than 2 cm in non-obese patients: the Wantz-Trabucco technique is indicated. Type R3 includes all the other forms: the Stoppa technique, or alternatively laparoscopy, is proposed.

Age Factors↗
PubMed1996

[Antiplatelet therapy during coronary endoprosthesis placement].

Coronary stent implantation is today a catheterisation laboratory routine procedure for de novo lesions and less frequently for bail-out situations. Antithrombotic pharmacological regimens based upon coumadin have filed to prevent sub-acute stent thrombosis. The use of new antiplatelet therapy (ticlopidine alone or in association with aspirin) have reduced the sub-acute thrombosis rate to 1%. Routine combining heparin is not useful. The benefit of ultrasound guided stenting or high pressure balloon expansion is not demonstrated in the thrombosis prevention. New pharmacological approaches inducing fibrinogen platelet receptor antagonists (antii GP IIb-IIIa) may extend stent implementations more especially in acute coronary syndromes.

Angioplasty, Balloon, Coronary↗
PubMed1995

Modeling drug information for a prescription-oriented knowledge base on drugs.

There exists little theoretical analysis how to represent knowledge on drugs required for computerized drug-prescription applications. A work package drug information modeling is described which was part of the European OPADE project. We describe the content and structure of a Drug Knowledge Base (DKB) designed to meet the requirements of decision-support systems in the domain of drug therapy, and to facilitate data transfer from various information sources. The definition of the DKB content is derived from the analysis of information requirements at the various stages of the process of the clinical usage of drugs (prescribing, administration, and follow-up). The DKB structure results from the classification of the various data items along two dimensions: (1) entities in the pharmaco-therapeutic domain for which information must be defined (the PharmacoTherapeutic Group, the Component, the ManufacturedPreparation, and the Presentation), and (2) the validity score of the pharmaco-therapeutic information (international, national, or local).

Drug Administration Schedule↗
PubMed1995

[Use of polypropylene (Marlex) prosthesis in the surgical treatment of inguinal and crural hernia].

High biocompatibility, low cost and easiness in use are most important reasons for the spread of biological prosthesis in inguinal and femoral hernia repairs; this fact has changed the surgical approach to this kind of pathologies. This new approach consists in re-creating a normal anatomic function of the abdominal wall, without new tension between muscles and aponeurotic structures. The authors present their experience after 379 inguinal and femoral hernia repairs between January 1992 and December 1993.

Adult↗
PubMed1995

Clinical aspects and treatment of inflammatory abdominal aortic aneurysms.

An increasing number of inflammatory abdominal aortic aneurysms are reported today, although it is not clear whether these are nosologically independent lesions or a particular evolution of atherosclerotic aneurysms with enhanced phlogistic processes and fibrous reaction. Several pathogenetic theories have been proposed (microfissuration, autoimmunity, lymphatic stasis); clinical symptoms are characterised by the frequent involvement of contiguous retroperineal structures (in particular the urinary excretory tract and duodenum) which may be dislocated or compressed by the neoformation. CT or NMR appear to be the instrumental tests which give the most reliable diagnosis regarding the suspected inflammatory nature of the aneurysm. A correct pre-operative diagnosis is particularly important given that the morphological peculiarities (fibrosis and tenacious synechiae) add considerable pitfalls and difficulties to the operation. In this respect, the use of special technical devices, such as minimum dissection, permit a marked reduction of perioperative complications.

Aged↗
PubMed1994

[Pilot study of the efficacy of ticlopidine in early patency of coronary endoprostheses].

Subacute thrombosis of coronary stents is the main complication of this technique. The authors studied the outcome of 387 patients and 400 coronary arteries who underwent implantation of 427 stents between December 1989 and February 1994 and followed up one month after the procedure: all patients receive 500 mg of ticlopidine daily from three days before angioplasty throughout the hospital period and continued for at least one month. Anticoagulation with heparin was undertaken by the intravenous route after implantation and relayed with subcutaneous heparin for one week until control coronary angiography performed in the first 300 patients. At one month, 96.9% of patients were free of clinical coronary events. The following major complications were observed: 5 deaths (1.3%), 5 Q wave myocardial infarctions (1.3%); no emergency bypass surgery. The peripheral vascular complication rate was 3.6%. Univariate analysis three risk factors of subacute thrombosis: age (p = 0.0058), arterial diameter of less than 3 mm (p < 0.01) and implantation for occlusive dissection (p = 0.03). Multivariate analysis showed two independent risk factors: age (p = 0.001) and arterial diameter of less than 3 mm (p = 0.01). This pilot study shows a particularly low subacute thrombosis rate in unselected indications with an acceptable level of vascular complications.

Adult↗
PubMed1991

Isolation of Enterobacter amnigenus from a heart transplant recipient.

The isolation of Enterobacter amnigenus from a human source is reported. This microorganism was grown from an intravenous catheter and, along with Pseudomonas aeruginosa, from the blood of a heart transplant patient. The biochemical characteristics and antimicrobial susceptibilities of the isolate are described.

Bacteremia↗
PubMed1990

Observer variation in mammary thermography: results of a teaching file test carried out in four different centers.

To evaluate observer variation in mammary thermography, a teaching file test of 159 thermographies was worked out by 4 senology centers. The evaluation of accuracy and the K index of variability demonstrated a significant variability among centers. The reliability of thermography in senology seems to be too poor for it to be able to direct any therapeutic decision, either diagnostic or prognostic.

Breast Neoplasms↗