[Complete atrioventricular canal. Clinical and surgical considerations].
Explore the source record for details and available documents.
Child↗
Biomedical subjects
P Pugliese
Publications and source records attributed to P Pugliese.
[Value of intravenous nitroglycerin in hypertension after extracorporeal circulation].
The authors compare the haemodynamic effects of intravenous nitroglycerin (IV TNT) in 14 patients developing hypertension (mean blood pressure greater than 90 mmHg) and in seven normotensive patients (70 less than mean blood pressure less than 90 mmHg) after cardiac surgery with extracorporeal circulation (ECC). TNT was administered at doses of 0.5, 1, 2 microgram.kg-1.min-1 then 2 microgram.kg-1.min-1 with the association of vascular filling in order to restore right and left arterial pressures to their initial values. Various haemodynamic parameters were measured or calculated. The results obtained: in the hypertensive patients, at the low dose (0.5 microgram.kg-1.min-1) a prevalent venodilatory action was noted: RAP: 7.64 +/- 2.76 p less than 0.05; LAP: 9.07 +/- 3.19 p less than 0.05; at the middle dose (1 microgram.mg-1.min-1) venodilation continued resulting in a fall in BP 95.28 +/- 26.11 p less than 0.01 and above all in Cl: 2.28 +/- 0.36 p less than 0.01; at the maximum dose used, the action of TNT affected both the venous and arteriolar sector causing a major fall in BP: 89.64 +/- 23.88 p less than 0.001, in Cl: 2.29 +/- 0.33 p less than 0.01 and above all RVSI: 19.94 +/- 6.24 p less than 0.05. The association of vascular filling led to an increase in RAP and LAP (p = NS), Cl (p = NS) whilst BP remained low: 92.78 +/- 17.56 p less than 0.001 and also RVSI: 18.12 +/- 4.44 p less than 0.01. In the normotensive patients the administration of TNT, whatever the dose used, did not cause any significant changes (p = NS). In conclusion, the authors emphasise the value of the use of TNT in postoperative hypertensive states, in particular when associated with myocardial ischaemia.
Adult↗
[Electro-systolic stimulation with an isotopic pacemaker. Apropos of 64 treated cases].
Explore the source record for details and available documents.
Adams-Stokes Syndrome↗
Interventricular septal defect with aortic insufficiency--surgical considerations.
Fourteen consecutive cases of ventricular septal defect (VSD) associated with aortic insufficiency (AI) are considered from a pathological and surgical point of view. In one operated patient the AI was due to previous endocarditis with perforation of both coronary cusps. In the remaining 6 cases one or 2 aortic cusps were prolapsed. Closure of VSD was accomplished with teflon patches in 6 and with direct suture in one. The aortic valve was replaced with an aortic Bjork-Shiley prosthesis in one case, and simple valve reconstruction was carried out in the remaining 6 patients. There was no mortality. In 3 patients who presented with residual AI one month after operation, the cardiothoracic ratio and the electrocardiogram have nevertheless returned progressively to normal limits. The authors favor correction at preschool age on the principle that early closure of the VSD may prevent or control the AI. However, in small children in whom the severity of AI may suggest the necessity for valve replacement, the operation is postponed as long as possible to avoid functional prosthetic stenosis later in life.
Adolescent↗
[Effect of intravenous nytroglicerin in hypertensive patients during and after open heart surgery (author's transl)].
The present study was performed to compare hemodynamic effect of intravenous Nitroglycerin (TNT i.v.) in 14 patients developing acute hypertension (Group I) and in 7 non hypertensives after open heart surgery (Group II). In all patients, m.a. 56.6 yrs, (10 mitral and/or aortic prosthetic valve replacements, 9 aorto-coronary bypass, 1 open mitral commissurotomy, 1 closure of atrial septal defect) TNT was infused at doses of 0.5, 1, 2 microgram X kg X min. and subsequently at 2 microgram X kg X min. after volume administration (2 + V.A.) to maintain right and left atrial pressure the same as control (P = N.S.). Mean arterial, right and left atrial pressures (MAP, RAP, LAP), cardiac frequency and index (CF, CI and systemic vascular resistance index (SVRI) were monitorized. TNT i.v. resulted in hypertensive patients (Group I) in reduction vs. control of: a) RAP (--20.17%) and LAP (--20.58%) at 0.5 microgram X kg X min. b) RAP (--26.13%), LAP (--27.50%), MAP (--19.94%) and CI (--12.98%) at 1 microgram X kg X X min. c) RAP (--22.47%), LAP (--26.89%), MAP (--24.68%), CI (--12.6%) and SVRI (--17.34%) at 2 microgram X kg X min. When RAP and LAP was maintained by volume administration TNT i.v. (2 microgram X kg X min.) resulted in an even greater increase in CI and a greater decrease in MAP and SVRI ((--22.04% and --24.88% respectively). No significant hemodynamic modification (P less than or equal to 0.05) were observed in non hypertensive patients (Group II) at all doses of TNT i.v. The results confirm a predominant venodilator effect of TNT at low doses and a good effect on arterial resistances at high doses in hypertensive patients. In view of previous reports of differing effects on ischemia TNT i.v. may be preferable to other vasodilator drugs for control of acute post-ECG hypertension, only on condition to maintain an adequate left ventricular filling pressure to prevent a fall of cardiac index. Moreover the absence of significant (P less than or equal to 0.05) hemodynamic modifications in non hypertensive patients may be a further advantage in the treatment of myocardial ischemia with i.v. TNT.
Adult↗
[Treatment of coarctation of the aorta in paediatric age. Result of 7 years of experience (author's transl)].
Results of 83 consecutive operations for coarctation of the aorta in the paediatric age group (0-20 years), performed in our Institution between September 1971 and May 1978 are presented. Mean age at operation was 7.04 years. All patients have been divided into two groups according to age under or over one year. Group one comprises 13 cases under one year of age. There were two death (15.23%). In group two there were 70 cases with two deaths (2.85%). The main post-operative complications are analyzed. Particular attention is paid to the incidence of postoperative hypertension in relation to age bracket and with this point in mind discussion is carried out on the opportunity of early operation before stable hypertension has set in.
Adolescent↗
[Postoperative levels of blood insulin, urinary insulin, blood sugar and blood potassium in open heart surgery].
Explore the source record for details and available documents.
Adolescent↗
Gallbladder volume in adults and its relationship to age, sex, body mass index, body surface area and gallstones. An epidemiologic study in a nonselected population in France.
BACKGROUND/AIMS: The role of a large gallbladder volume with regard to a predisposition for gallstones is unknown. It is possible that an increase in gallbladder volume could result in impaired gallbladder motility and bile stasis. We looked for factors affecting gallbladder volume in a random population in the southeast of France. METHODS: To assess the relationship between gallbladder volume and gallstones, 528 subjects over the age of 30 were studied (72 with lithiasis). Age, sex, body mass index, body surface area and gallbladder volume were collected for each subject. A linear regression analysis was performed to look for significant variables. RESULTS: The overall adjusted prevalence of cholelithiasis was 13.9% in our population. On linear regression analysis, two variables (age and surface area) were found to be independently correlated with gallbladder volume. Gallbladder volume was significantly increased in subjects over 50 years (p < 0.001). There was a positive correlation between gallbladder volume and body surface area (r = 0. 33, p < 0.001). In this study, the presence or absence of gallstones did not significantly affect the gallbladder volume. CONCLUSIONS: We report that there is dilatation of the gallbladder with age and with an increase in body surface area. Whether this could represent risk factors for the occurrence of gallstone remains uncertain.
Adult↗
Outcome of patients treated with home enteral nutrition.
BACKGROUND: The aims of this study were to prospectively analyze the 1-month mortality and long-term outcome of home enteral nutrition (HEN) patients in order to determine the benefits of this treatment. METHODS: Between 1990 and 1996, 417 patients, aged 64 +/- 25 years, were discharged on HEN and followed up until December 31, 1998, when outcome was assessed, which allowed us to determine survival probabilities and conditions associated with survival. RESULTS: The mean duration of HEN was 242 +/- 494 days, with a 24- to 103-month follow-up. Probabilities of being alive at 1 month, 1 year, and 5 years were 80%, 41.7%, and 25%, respectively. Factors associated with death were dementia, neurologic disease, head and neck cancer, AIDS, and age over 70 years. A total of 5.5% of patients remained dependent on HEN, 32.6% resumed full oral nutrition, 20.2% of patients died during the first month on HEN, and 35% died after more than 1 month on HEN (219 +/- 257 days). A total of 6.7% of patients stopped HEN for other reasons. CONCLUSIONS: HEN provides well-tolerated long-term nutritional support in many patients. However, because of their likelihood of being old and the nature of the underlying disease, these patients as a group tend to have a modest prognosis. This calls for the determination of more accurate selection criteria, and the measurement of the impact of HEN on quality of life.
Adolescent↗
Colon cancer in pregnancy: report of a case and review of the literature.
Most colon cancer cases occur in patients over 50 years of age, although about 3% of colorectal cancer patients are younger than 40. During pregnancy the incidence of this neoplasm is estimated to be 0.002%. To date only 32 cases of colonic cancer arising above the peritoneal reflection during pregnancy have been described in the literature. We report another such case, stressing the need for constant alertness on the part of physicians in the presence of abdominal pain and/or distension, a palpable abdominal mass, rectal bleeding and/or weight loss during pregnancy. In fact, the reportedly poorer prognosis of this cancer in pregnant patients is mainly due to the fact that the initial symptoms of the malignancy are usually attributed by the patient, but also by physicians, to normal pregnancy.
Adult↗
Information and awareness of diagnosis and progression of cancer in adult and elderly cancer patients.
AIMS AND BACKGROUND: The present study examines the effects of physicians' attitudes towards providing information about diagnosis and progression of disease to cancer patients. The aims of the study were to: a) establish how many patients (subdivided into an adult and an elderly group) were informed and how many were aware of the diagnosis and progression of disease; b) identify possible significant differences between the two groups as regards information and awareness of disease; c) determine possible significant differences between information about diagnosis and disease progression and between awareness of diagnosis and progression within each group, and d) identify the patients' real needs. METHODS AND STUDY DESIGN: A total of 311 adults and 92 elderly cancer patients were enrolled in the study. A semi-structured clinical interview was employed to assess the "information" and "awareness" variables and the patients' needs. Statistical analyses were made with the chi squared test. RESULTS: Significant differences were observed between the two groups as regards information and awareness of diagnosis. Within each group, we found significant differences between information about diagnosis and progression and between awareness of diagnosis and progression. The principle needs expressed in both groups were to have clear information and emotional containment. CONCLUSIONS: The results of the study showed that physicians informed a greater number of adult than elderly patients and more often during the early rather than in the more advanced stages of the disease.
Adult↗
Myeloprotective effect of early primary granulocyte-colony stimulating factor during six courses of intensified 5-fluorouracil, epirubicin and cyclophosphamide (120FEC) chemotherapy for advanced breast cancer. Cooperative Group of Study and Treatment of Breast Cancer.
AIMS AND BACKGROUND: The neutropenia induced by six courses of an intensified FEC regimen is expected to be checked by early primary administration of G-CSF which is stopped eight days before the next chemotherapy course. Less information is available about megakaryocytic and erythroid toxicity over six courses. METHODS AND STUDY DESIGN: Sixty-six consecutive patients with metastatic breast cancer completed six courses of a randomized treatment with two FEC regimens administered every 21 days, in which 600 mg/m2 of cyclophosphamide and 5-FUwas associated with 60 or 120 mg/m2 of epirubicin (60FEC, 35 patients, vs 120FEC, 31 patients). 120FEC was supported by early primary G-CSF (days 4 to 13). Blood counts were obtained seven times during each course. RESULTS: The non-hematologic toxicity over 364 courses was similar in 60FEC and 120FEC. No cumulative hematologic toxicity was observed for white blood cells (WBC) and platelets (PLT), while for hemoglobin (Hb) a somewhat higher cumulative toxicity was observed with 120FEC than with 60FEC. WBC, PLT and Hb grade III-IV toxicity occurred in 40.1% and 45.6% (P=ns), in 23.1% and 0.8% (P <.0001) and in 15.6% and 3.0% (P <.005) of the two regimens, respectively. There were no febrile or hemorrhagic episodes. The epirubicin relative dose intensity delivered was 1.95 in 120FEC with respect to 60FEC. CONCLUSIONS: Our G-CSF schedule permitted to deliver six courses of 120FEC without any clinically relevant side effects. Grade III-IV leukopenia was similar with 120FEC and 60FEC, while grade III-IV thrombocytopenia and anemia occurred more often with 120FEC than with 60FEC.
Adult↗
Paclitaxel in anthracycline-treated breast cancer patients.
Between May 1995 and July 1997, paclitaxel (TX) (175 mg/m2 by 3 h i. v. infusion every 21 days) was administered to 70 consecutive patients (median age: 57 years) previously treated with the FEC regimen (cyclophosphamide and 5-fluorouracil, 600 mg/m2, plus epirubicin, 60 or 120 mg/m2) as an adjuvant setting or as a first-line therapy for metastatic disease. Sixty-eight patients were evaluable for response, while two died early. Patients received a median of 4.7 (3-12 course) of TX for a total of 211 courses. The overall response and stable disease rate was 54% in 11 patients, who relapsed following adjuvant FEC, and 60% in 57 patients, who received FEC as first treatment for their metastatic disease. No complete respose was obtained. In patients pretreated for metastatic disease, response and stable disease rates were similar irrespective of previous response to FEC. Main hematologic toxicity of TX was of short duration, grade II/III leukopenia (86% of patients) and non-hematologic toxicity was grade II/III peripheral neuropathy, related to the cumulative dose of TX. At this schedule, TX offers a significant rate of partial responses or disease stabilization in patients with metastatic breast cancer previously treated with FEC.
Adult↗
Left ventricular function in colon cancer patients receiving adjuvant fluoro-folate chemotherapy: an echocardiographic study.
Cardiotoxicity has been reported with increasing frequency after 5-FU administration. Since 5-FU-based regimens are increasingly used as adjuvant treatment for resected colon cancer patients, this carries a potential increased risk of cardiotoxicity. In the present study, we evaluated if fluoro-folate chemotherapy has any effect on left ventricular (LV) diastolic function in resected colon cancer. Twenty-five resected colon cancer patients receiving adjuvant fluoro-folate chemotherapy, were prospectively studied. Both digitized M-mode and Doppler echocardiography were performed, in order to investigate different aspects of LV diastolic function. None of the studied parameters was influenced by chemotherapy administration. Indeed, values recorded at the end of the 6-month treatment and 6 months later were not statistically different from baseline values. This study suggests that the use of fluoro-folate chemotherapy in otherwise normal subjects carries a very low risk of severe cardiotoxicity.
Aged↗
Sequential docetaxel and vinorelbine for patients with advanced breast cancer previously treated with anthracyclines: a phase II study.
With respect to their association, sequential non-cross-resistant cytostatics could be better tolerated and allow a similar antitumor effect. From January, 1998 to July, 1999, 42 consecutive patients with metastatic breast cancer (MBC) previously treated with anthracyclines as adjuvant- or first-line therapy entered a phase II multicenter study where docetaxel (TXT, 100 mg/m2/3 weeks/4 times) was followed by vinorelbine (VNR, 25 mg/m2/10 days/8 times). Median follow-up is 21 months and 22/42 patients have died. Four patients did not complete therapy due to early death, grade 3-4 gastrointestinal mucosytis (2 patients) and grade 3 neurotoxicity during TXT therapy. Overall response rate was 57%, and 5% of patients had stable disease. There were 38% of therapy failures due to non-evaluability (10%) or progressive disease (28%). Median time to progression and survival are 10.1 and 17.1 months. Sequential TXT-VNB is a suitable strategy for MBC patients previously treated with anthracyclines. It avoids haematologic toxicity and allows a good antitumor effect. Careful monitoring of intestinal mucosytis is required.
Adult↗
[Hepatic intra-arterial chemotherapy in the treatment of non-resectable colorectal liver metastasis: personal experience].
Explore the source record for details and available documents.
Adult↗
Aortic insufficiency. A multivariate analysis of incremental risk factors for operative mortality and functional results.
The object of this study was to establish which of four chosen preoperative parameters, namely NYHA functional Class, cardio-thoracic ratio (CTR), left ventricular end-diastolic pressure (LVEDP) and ejection fraction (EF), might affect, singly or in combination, the operative risk in isolated, chronic aortic insufficiency (AI). To this purpose we reviewed the records of all adult patients consecutively operated upon in our Department for isolated chronic AI, from 1979 to 1985. Patients with associated cardiac disease, transvalvular aortic gradient, recent endocarditis of a malfunctioning bioprosthesis were excluded from the study, leaving 89 consecutive patients (mean age 47.2 years) for evaluation. St. Jude or Duromedics mechanical prostheses were exclusively used for aortic valve replacement (AVR). Post-operatively all patients received long term anticoagulation. Follow up period ranged from 24 to 109 months (mean 61.8 months). The method of analysis was designed as follows: a) each patient was allocated a positive (+) or a negative (-) variable for the value of each parameter, b) five patient groups were formed on the basis of the free association of parameter variables, c) single variables and their association with early and late mortality, functional results as NYHA Class were compared by statistical methods (chi 2, Student's Test, Wilcoxon Test). The results of the study show: a) only EF significantly influenced early mortality (P less than 0.05), b) late mortality was significantly influenced (P less than 0.001) by NYHA Class and CTR, c) single parameter variables (+ or -) and or their association significantly conditioned functional results.
Aortic Valve↗
Successful repair of post-infarction heart rupture. Case report and review of the literature.
Left ventricular rupture secondary to acute myocardial infarction (AMI) if untreated, is invariably fatal. Successful surgical correction reported in the reviewed literature amounts to twenty cases. This is the case presentation of a 53 year old Caucasian woman admitted urgently to our Institution 6 hours after acute chest pain with a presumptive diagnosis of intrapericardial aortic rupture secondary to acute ascending aortic dissection. A cross-sectional echocardiogram demonstrated a posterior left ventricular rupture secondary to myocardial infarction. Emergency repair was carried out with the aid of cardiopulmonary bypass (CPB) and the patient was discharged after an uneventful recovery. However, five months later she was reoperated on for resection of a large pseudoaneurysm presumably secondary to incomplete resection of nonviable myocardium at the first operation. The patient made an uneventful recovery and remains asymptomatic and well. On the basis of this experience and review of the literature the authors propose a more aggressive approach in an attempt to improve the salvage rate of this not so rare complication of AMI.
Adult↗