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R Dionigi

Publications and source records attributed to R Dionigi.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Immediate post-operative enteral nutrition].

Patients with cancer of the upper digestive tract may present with malnutrition, which may cause immunodepression and an increased rate of postoperative complications. In this study we describe the rationale and the feasibility of immediate postoperative enteral nutrition (NEPI) and evaluate its effectiveness for the nutritional support of patients undergoing surgery of the upper digestive tract. We studied 46 patients undergoing the following procedures: total gastrectomy (n = 22); oesophageal resection (n = 12); duodenocephalopancreasectomy (n = 12). NEPI was started on postoperative day 0 with a polymeric diet (calories: 53% as CHO, 22% as proteins, 25% as lipids) aiming at a calorie intake of 25 Kcal/Kg/day by postoperative day 4. It was possible to administer 24 Kcal/kg/day with the enteral diet from the 4th to the 10th postoperative day. Oral intake was resumed on average on postoperative day 13, and the mean hospital stay was 27 +/- 17 days. Tolerance of NEPI was good in most patients: only 5 patients (11%) interrupted the enteral nutrition. The mean postoperative weight loss was 3.7%. The rate of septic complications was 27%; mortality was nil. The surgical procedures caused a transient and reversible acute-phase decrease of nutritional and immunological parameters in the early postoperative period. However the NEPI preserved the nutritional status postoperatively as shown by the lack of significant changes in the nutritional indices at 10-14 days after surgery, as compared with baseline. In summary, we documented that NEPI can be started from postoperative day 0 with good intestinal tolerance, allowing adequate nutritional support, after extensive surgical procedures on the upper digestive tract.

Adolescent↗
PubMed1993

Performance evaluation of a hand-held gamma detector probe used for radioimmunoguided surgery.

The success of radioimmunoguided surgery (RIGS) is dependent on the performance parameters of the apparatus, its correct handling, and the employment of a suitable radioactive compound. In the present study the authors examined the performance of the Neoprobe 1000 device with respect to the radioisotope 99mTc. Detecting efficiency was evaluated experimentally using a phantom containing a radioactive point source which could be moved both vertically and horizontally with respect to the central axis of the probe. In this way curves representing the variations in efficiency as a function of the vertical and horizontal distances of the source from the probe were constructed. Furthermore, values of minimum detectable activity as a function of source depth, counting time and background radioactivity were calculated. These results were compared to those previously obtained using 125I, the radioisotope most frequently employed in RIGS. The graphs and tables included could serve as a practical aid to help the operator obtain the best possible measuring conditions, thereby maximizing his/her results.

Humans↗
PubMed1992

[Evaluation of the efficacy and tolerability of nimesulide in the treatment of mastodynia].

In a double blind clinical trial 40 female patients, aged between 14 and 65 years, affected by mastodynia associated with benign non neoplastic disease of the breast, underwent oral treatment with nimesulide (200 mg/day) or placebo for a period of 15 consecutive days, during which no other drug therapy was assumed. The administration of nimesulide produced a clinically significant attenuation of mammary tenseness and mastodynia, in most cases up to complete remission of the symptoms. No adverse reaction was observed.

Adolescent↗
PubMed1992

[The evaluation of the efficacy of drapes and gowns of nonwoven fabric versus drapes and gowns of cotton in reducing the incidence of postoperative wound infections].

The importance of the preparation of an operative field which will guarantee satisfactory conditions of asepsis during the entire operation is an indispensible premise for controlling the development of postoperative wound infections. This paper compared the efficacy of disposable clothes and gowns in TNT FABRIC 450* in relation to cotton gowns in reducing the incidence of postoperative wound infections. Cotton items were used for 25 subjects out of a group of 50 operated patients and nonwoven fabric (TNT FABRIC 450*) items were used for the other 25. Thorough bacteriological tests were performed in each patient before, during and after the operation. On the basis of the duration of the operation, it was observed that TNF FABRIC 450* was as efficacious as cotton in controlling postoperative infections in those operations with a short or medium duration; it offered greater protection in lengthy operations, with a higher risk of endogenous and exogenous contamination. It was also observed that disposable items were indispensable in patients treated with radioactive materials and offered greater safety in seropositive patients.

Asepsis↗
PubMed1991

Effects of high-dose IgG on survival of surgical patients with sepsis scores of 20 or greater.

Sixty-two consecutive septic surgical patients receiving standard multimodal intensive care unit treatment who developed a sepsis score of 20 or greater (day 0) were randomized to receive 0.4 g/kg of either intravenous IgG (29 patients) or human albumin (controls; 33 patients), repeated on days +1 and +5, in a prospective, double-blind, multicenter study. The two groups were similar in age, initial sepsis scores, and acute physiology and chronic health evaluation II score. A significantly lower mortality was recorded in the IgG-treated group (38%) than in controls (67%). Septic shock was the cause of death in 7% of IgG-treated patients and in 33% of controls. The results of this study indicate that high-dose IgG improves survival and decreases death from septic shock in surgical patients with a sepsis score of 20 or greater.

Adolescent↗
PubMed1991

Stapling techniques to facilitate resection of the head of the pancreas.

Thirteen patients underwent duodenocephalopancreatectomy (DCP) with the mechanical staplers to divide the pancreatic neck and to secure haemostasis of the retroportal pancreatic lamina. The stapling techniques used on the pancreas are described. In nine patients with DCP the stapled distal pancreas was anastomosed to the jejunum with Roux-en-Y drainage; one pancreatic complication and no deaths were observed. In four other patients undergoing DCP who were at high risk for severely compromised general conditions, reconstruction of the digestive tract was simplified by leaving the stapled distal pancreas definitively closed: pancreatic complications were recorded in two cases, with no deaths. Mechanical staplers considerably facilitated resection of the neck of the pancreas and of the retroportal pancreatic lamina. All 13 patients who underwent DCP with the use of stapler techniques on the pancreas, including four high-risk patients, were discharged to convalesce on an oral diet after a median postoperative hospital stay of 23 days (range 16-90 days).

Adult↗
PubMed1990

[The prevention of deep venous thromboses after radical or modified mastectomy interventions].

With the aim of preventing deep vein thrombosis after radical or modified mastectomy, 100 patients were randomly assigned to one of two different groups: the first group was treated with defibrotide (400 mg b.i.d. e.v.) starting from the day before the operation and continuing for the following seven days. The second group was given calcium heparin (5,000 IU b.i.d. by s.c. route) from day 0 to the 7th post-operative day. Neither side effects nor DVT or PE were observed. The quantity of fluids from the drainages rapidly decreased in both groups from the first day to the third one, while the quantity of blood cells was negligible starting from the second post-operative day. On this basis defibrotide may be considered an effective and well tolerated drug for the prevention of DVT.

Female↗
PubMed1989

Multicenter study of aztreonam in the prophylaxis of colorectal, gynecologic and urologic surgery.

The preliminary results of four multicenter, comparative protocols on the efficacy and safety of aztreonam are discussed. This monobactam antibiotic was used as short-term prophylaxis in patients undergoing colorectal, gynecologic or urologic surgery. When compared with gentamicin in a group of 295 patients undergoing colorectal surgery, aztreonam significantly reduced the incidence of abdominal wound infection (p less than 0.025); it also reduced the incidence of perineal wound and intra-abdominal infections, although these differences were not statistically significant. In patients undergoing abdominal and vaginal hysterectomy, aztreonam was compared with cefotaxime (both combined with clindamycin) in 170 and 142 patients, respectively. No difference in the incidence of infection was found between the two treatment regimens. In the 175 patients undergoing transurethral resection of the prostate, aztreonam was compared with placebo. The prophylactic regimen significantly reduced the number of urinary tract infections (p less than or equal to 0.0001). Its efficacy was particularly evident during the first 10 postoperative days. Side effects experienced by patients taking aztreonam were minor and similar in all three treatment groups studied. Aztreonam (alone or combined with clindamycin) offers a new and efficacious alternative to the standard antibiotic regimens currently used prophylactically in the high-risk postoperative patient.

Abdomen↗
PubMed1989

Comparative multicenter study on efficacy and safety of aztreonam and gentamicin in prophylaxis of high-risk colorectal surgery.

The usefulness of antibiotic prophylaxis in reducing the incidence of postoperative infections following colorectal surgery has been defined in many clinical studies. Since a single antibiotic agent covering all the potential pathogens (i.e. Gram-negative aerobes and anaerobes) is not currently available, a combination therapy is usually administered. The present study reports the preliminary results on comparative efficacy and safety of aztreonam and gentamicin (both combined with clindamycin) as short-term prophylaxis in colorectal surgery. Four hundred and fifty-four patients, out of 495 enrolled, were considered evaluable. Incidence of abdominal wound infections was significantly lower in the aztreonam-treated group (5.8% vs 12.5% - p less than or equal to .025). The incidence of perineal wound and abdominal infections, of fever, of need for postoperative antibiotics and the length of postoperative stay were lower in the monobactam group, even if none of these differences were statistically significant. Gram-negative aerobic microorganisms were more often isolated in infected patients from the gentamicin group. Side effects were minor and similar in the two groups. From these preliminary data, the aztreonam-clindamycin combination can be considered a major candidate to replace many of the presently available oral and parenteral regimens.

Adult↗
PubMed1987

[Evaluation of the delayed hypersensitivity response by the Multitest-IMC. Multicenter study for the definition of reference values in a sample population].

The latest investigations in the field of clinical immunology have proposed ways of assessing immunological efficiency that have also been used to identify patients most susceptible to infectious complications. The assessment of delayed hypersensitivity response (DHR) using anamnestic antigens is currently the most common method. The results of a polycentric study are presented. The study was conducted on a group of healthy subjects from various Italian regions divided into three age classes. Positive responses to the MT were noted in 96.4% of the population studied. The incidence of energy was statistically higher among females than males, while the mean response to the MT expressed in millimetres was statistically higher in males. Though 7 antigens were administered, the responsive population reacted on average to 3. The highest incidence of positive responses was to Candida, with Trichophyton responsible for the fewest.

Adolescent↗
PubMed1987

Sepsis score and acute-phase protein response as predictors of outcome in septic surgical patients.

In a series of 135 patients with severe surgical infections, we determined the sepsis score and the plasma level of the acute-phase proteins alpha-1-acid glycoprotein, alpha 1-antitrypsin, complement factor B, and C3. The initial sepsis score was a strong determinant of survival: in survivors it was significantly lower than in nonsurvivors. Only 8% of patients with a sepsis score above 20 survived. At the onset of severe sepsis, the plasma levels of all four acute-phase proteins were significantly lower in nonsurvivors. A significant elevation of C3a levels in the plasma of both surviving and nonsurviving patients indicated marked consumption of complement components in all patients with severe sepsis. A linear equation was developed to predict survival: sepsis index of survival (SIS) % = 121 + 0.26 (complement factor B) + 0.36 (alpha-1-acid glycoprotein)-6 (sepsis score). Based on our analysis, at the onset of severe sepsis, an SIS of 50% or more can correctly predict 88% of survivors and an SIS less than 50% can correctly predict 86% of nonsurvivors several days in advance of clinical outcome.

Adult↗
PubMed1986

Diagnosing malnutrition.

The measurement of selected anthropometric, biochemical and immunological variables, and clinical judgment can be used to assess nutritional state. Nutritional assessment has three main aims: to define the type and severity of malnutrition; to identify high risk patients; to monitor the efficacy of nutritional support. The problems associated with the various methods to assess the nutritional state and the applications of nutritional assessment in clinical practice are presented and discussed.

Humans↗
PubMed1986

Predictive indices for the identification of high-risk patients.

In this article, the predictive indices which have been developed during the last decade to assess the risk of complications during hospitalization are reviewed. These indices are based on the evaluation of nutritional and immunological parameters and are particularly suitable for the identification of the surgical patient at risk for postoperative septic complications. The authors also review the methods which have been proposed for the classification of the severity of disease in critically ill subjects and the sepsis score method for the prediction of clinical outcome in severely septic surgical patients.

Health Status Indicators↗
PubMed1985

Effect of Intralipid on some immunological parameters and leukocyte functions in patients with esophageal and gastric cancer.

This study has been undertaken to investigate if the intravenous (i.v.) infusion of fat emulsions may be associated with impairment of some immunological functions thus increasing the risk of septic complications. Fifteen malnourished patients with advanced gastric or esophageal cancer received for 2 weeks preoperatively and 1 week after surgery an isocaloric and isonitrogenous TPN treatment with Intralipid (group A: n=8) or glucose alone (group B: n=7) as energy substrate. Cluster analysis of 11 nutritional parameters and some tests of the humoral and cellular immunity (IgG, IgM, C3c, Factor B; polymorphonuclear (PMN) cells, total lymphocytes, T and B lymphocyte counts; 'in vitro' PMN chemotaxis, adherence to nylon fibers, phagocytosis of latex particles) were sequentially determined. The incidence and severity of post-operative infections were investigated and a 'sepsis score' was calculated for each patient. Pre- and postoperative TPN were not associated with an improvement of the nutritional status. The humoral and cellular immune parameters showed the same behaviour in patients receiving Intralipid and in controls. The chemotactic activity of PMN cells was constantly normal, granulocyte adherence fluctuated below the normality range in controls, whereas phagocytosis of latex was similar in both groups. Post-operative infectious episodes were less severe in patients receiving Intralipid. Our results do not confirm that Intralipid adversely affects some aspects of the humoral and cellular immune response.

Journal Article↗
PubMed1985

Sepsis score and complement factor B for monitoring severely septic surgical patients and for predicting their survival.

Sepsis score and complement factor B (FB) have been measured in 66 severely septic surgical patients in the intensive care unit, with the aim of monitoring their clinical course and predicting their outcome. Sepsis score correlated well with clinical course. 82% of patients with initial sepsis score less than 20 progressively improved and survived. Only 6% of patients with sepsis score greater than or equal to 20 survived. FB plasma level was significantly higher (p less than 0.01) in patients who subsequently survived. Two indices were identified which could predict patient outcome several days in advance with 100% accuracy: (1) the index of survival from sepsis defined as the combination of sepsis score less than 20 and FB greater than or equal to 45 mg/dl, and (2) the index of death from sepsis defined as sepsis score greater than or equal to 20 and FB less than 40 mg/dl.

Adolescent↗