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Biomedical subjects

R Rosati

Publications and source records attributed to R Rosati.

At least 91 records · Page 5Linked to original sources
PubMed1985

Boerhaave syndrome: a report of two cases.

Two cases of Boerhaave's syndrome are reported. They were treated by surgery within 12 hours from the onset of symptoms. In both cases the perforation was located on the anterior wall of the distal third of the thoracic esophagus. In view of the rapid onset of severe complications, particularly mediastinitis, the role of early diagnosis in relation to prognosis, is stressed.

Adult↗
PubMed1984

The selective impact of a cardiology data bank on physicians' therapeutic recommendations.

We asked the physicians and medical students caring for 60 patients with symptomatic coronary artery disease, immediately after reviewing cardiac catheterization data, to choose medical or surgical therapy and to estimate prognosis one and three years after either therapy. The next day, each participant was given prognostic estimates generated from a large coronary artery disease data bank and again asked to estimate prognosis and choose therapy. Participants unanimously chose medicine for 20 patients (Group I) and surgery for 21 patients (Group III). For 19 patients (Group II), participants were divided on their choice of therapy. After seeing data bank estimates, participants rarely changed recommendations for Group I or Group III, but changed ten percent (9/90, p less than 0.01) of their Group II recommendations. Changes of recommendations by far (9/12, p = 0.02) favored medicine, causing the majority recommendation to change to medicine for two Group II patients. Therapeutic recommendations were guided mostly by pathoanatomy and the chance of improving medical regimens. Computer-generated prognostic data selectively influenced choices among the Group II cases where recommendations had been divided, resulting in changes toward less costly therapy.

Cardiac Catheterization↗
PubMed1984

Acid load after intravenous aminoacid infusion: comparison of clorurated vs. acetated solutions.

Ten patients who underwent elective abdominal surgery were given a daily load of one liter of a 10% aminoacid solution randomly containing cationic aminoacid as clorure or acetate salt during the first four post-operative days. None of the patients developed acidosis but the mean daily urinary excretion of titratable acidity and ammonium ions was significantly higher in clorure treated patients. An aminoacid solution containing aminoacid as acetate acts as a sparing solution for tubular buffer activity, and therefore should be preferred for patients with tubular impairment.

Abdomen↗
PubMed1983

[Separation of monocytes and their use in a cytotoxicity test].

Observations of acute rejections in uremic patients transplanted with Kidney grafts from Human Leucocyte Antigens (HLA) identical or compatible donors have suggested the importance of the role play by antigens not codified by the Major Histocompatibility Complex (MHC). Some works detected anti-monocytes antibodies that could not be absorbed with platelets (HLA-ABC) or with B lymphocytes (HLA-DR) or granulocytes but only with endothelial cells. Since endothelial cells and monocytes share not HLA surface determinants. Methods to isolate monocytes and endothelial cells have been attempted. We isolated monocytes by Percoll gradients. We checked the purity of our cell population by using monoclonal monocytes. From 30 ml of whole blood we obtained a mean of 50 X 10(6) (min. 12, 6 X 10(6) max 14 X 10(-6] mononuclear cells. After centrifugation of Percoll gradients we recovered a mean 7, 8 X 10(6) cells (Low 1, 3 X 10(6); max. 15 X 10(6] in the monocytes interface. By testing with monoclonal antibodies we found that a mean of 68, 95% (min. 58%; max. 82%) of these cells were living monocytes. We used the cell suspension to detect anti-monocyte antibodies in sera from 171 politransfused uremic patients with long incubation NIH cytotoxicity test.

Antigens, Surface↗
PubMed1983

[Specific antibodies against lymphocytes and monocytes in multiple-transfused uremic patients].

Kidney patients waiting for transplant usually undergo deliberate transfusion without clinical need in order to improve the outcome of the transplantation. Besides the beneficial transfusion effect on graft survival antibodies against the Major Histocompatibility Complex (MHC) can be detected after blood transfusions. Preliminary studies have shown antibodies against surface determinants of endothelial cells and monocytes too. Following that it is necessary to investigate how these different antibodies can affect the kidney allograft survival in politransfused uremic patients. We tested 171 sera from uremic patients to detect antibodies directed against T and B lymphocytes and monocytes by using long incubation standard NIH cytotoxicity technique. Antibodies against B cells have been tested at 20 degrees C and 4 degrees C. 54 patients (31,6%) showed anti-HLS antibodies: sera from 23 patients (13,5%) were positive against I and B cells (T+B+) and monocytes (M+) and that's probably due to anti-HLA-A,B,C and DR antibodies. 17 patients (9,9%) were T+B+ for the presence of anti HLA- A,B,C antibodies. 10 patients (5,8%) were T+. It is not yet clear why 18 patients (10,5%) showed anti B Lymphocytes antibodies tested at 20 degrees C. Probably the presence of anti HLA-DR antibodies caused the positivity of 4 B+M+ patients (2,33%). Sera from 5 patients (2,92%) showed anti B Lymphocytes antibodies tested at 4 degrees C. 21 patients (12,3%) were M+ only.

Antibodies↗
PubMed1983

Prophylactic portosystemic shunt: a special indication.

Generally, when a splenectomy is performed to treat either a severe hypersplenism or another splenic affection in a cirrhotic patient with uncomplicated esophageal varices, the question arises whether to associate or not a prophylactic shunt. In fact, splenectomy alone does not lower the portal pressure and does not affect positively the esophageal varices. Because of this, 36% of these patients will eventually undergo a bleeding episode from varices. Furthermore, in the patients surviving the first bleeding, the occurrence of splenoportal thrombosis following splenectomy does prevent a therapeutic shunt to be performed. For this reason splenectomy with a complementary prophylactic shunt was performed in 24 patients. This operation, which showed 16% mortality rate, significantly prevented bleeding (0%). Furthermore in the treated patients, splenectomy has lowered the portal pressure. Encephalopathy occurred in 30% of cases, however the accuracy in the selection of patients together with a proper diet and medical treatment have avoided severe complications. The 5 year survival rate was 60%. Nevertheless, the indication to a prophylactic shunt must be limited to these particular cases.

Adolescent↗
PubMed1982

Incremental value of the exercise test for diagnosing the presence or absence of coronary artery disease.

To determine the incremental value of the exercise test (ETT) for diagnosing coronary artery disease (CAD), we derived a multivariate logistic regression model for the pre-ETT prediction of CAD using data from 3840 patients at Duke University. We then applied the model to 324 patients at the Brigham and Women's Hospital. Using seven clinical factors, the multivariate model had an 84% overall predictive accuracy on both the training (Duke) and the validation (Brigham) sets of patients. Three ETT factors (ST-segment change in patients not taking digitalis, absence of ST-segment change in patients taking digitalis, ETT stopped because of ECG or blood pressure changes) had incremental, significant predictive power, but overall predictive accuracy based on both clinical and ETT factors improved only to 87%. When the ETT result was important enough to move the probability of CAD across a potential therapeutic threshold, the direction of the change in probability was correct only two-thirds of the time. Thus, the ETT was of limited value in predicting the presence or absence of CAD after other easily obtainable clinical data were taken into account.

Adult↗