Biomedical subjects
Publications and source records attributed to S Valente.
The Authors report their own results on the use of the microtransducer catheter in diagnosis of vesico-urethral disorders in 60 patients. The parameters concerning the static and dynamic UPP are discussed in order to define the meaning of such values in the etiopathogenetic arrangement of the semiology.
The AA report a case of newborn admitted to the hospital at the age of 12 days because of severe congestive heart failure, with electrocardiographical and radiological findings of right ventricular overload and increased pulmonary blood flow. Cardiac catheterization showed the origin of the right pulmonary artery from the ascending aorta in the presence of an intact ventricular septum. Surgical repair was performed on an emergency basis by deconnecting the anomalous right pulmonary artery from the aorta and reattaching it to the main pulmonary artery. Postoperative angiographic study, performed 12 months later, revealed excellent anatomical and functional result.
We selected five atopic children with asthma with previously documented late asthmatic response (LAR) associated with increased hyperresponsiveness to methacholine after the inhalation of Dermatophagoides pteronyssinus. The children had four allergen inhalation tests on 4 different days, at least 14 days apart. On days 1 and 4, saline placebo was inhaled 1 hour before the expected onset of LAR, and FEV1 was measured hourly until FEV1 returned within 10% of baseline value; then methacholine challenge was performed. On days 2 and 3, 20 and 40 mg of cromolyn was inhaled double blind 1 hour before the expected onset of LAR. FEV1 and methacholine responsiveness were measured as on days 1 and 4. The two doses of cromolyn significantly delayed the LAR onset without altering the overall LAR magnitude and prevented the allergen-induced increase in methacholine responsiveness. Both these effects were greater at the maximal dose used. We conclude that cromolyn can prevent the allergen-induced increase in methacholine responsiveness and that this effect is not due to alteration in the magnitude of LAR. Our findings reveal a possible explanation of the effectiveness of this drug in the treatment of allergic asthma.
We examined the involvement of inhibitory prostaglandins in refractoriness induced by repeated ultrasonically nebulized distilled water (UNDW) challenge. Six male subjects with asthma who developed both UNDW-induced bronchoconstriction and refractoriness after UNDW were studied on 3 separate days, 1 week apart. On each study day, subjects had an initial UNDW challenge. UNDW responsiveness was assessed with dose-response curves of UNDW volume output versus the percent fall in FEV1. The output provoking a 20% fall in FEV1 (PO20 UNDW) was calculated. FEV1 was measured again at 5-minute intervals until it returned to within 5% of baseline value. UNDW challenge was then repeated. On day 1, the two successive UNDW challenges were performed in absence of any treatment (control day). Before days 2 and 3, subjects received placebo capsules or indomethacin, 100 mg per day, in a double-blind, randomized fashion for 3 days. On both the control and placebo days, repeated UNDW inhalation provoked a significant increase in PO20 UNDW (p less than 0.01), indicating refractoriness. On the indomethacin day, the mean PO20 UNDW during the second UNDW challenge was not significantly different from that obtained during the initial test on that day (p greater than 0.05), indicating that refractoriness did not occur. We suggest that inhibitory prostaglandins are involved in the development of refractoriness after UNDW inhalation.
Seven asthmatic children with moderately to severely increased bronchial responsiveness to methacholine took part in a double-blind placebo-controlled study to assess the effect of a calcium channel blocker, diltiazem, on exercise-induced asthma (EIA), and its duration. On the control day, bronchial response to exercise was found to be highly reproducible when performed 2 h apart (intraclass correlation coefficient 0.92). Normal saline and diltiazem at concentrations of 1.75 and 3.50 mg/ml (estimated nebulized doses 5 and 10 mg, respectively) were given in random order before exercise on a bicycle ergometer. Exercise challenge was performed 20 min and 2 h after each treatment, and bronchial response was expressed as percent fall in the forced expiratory volume in 1 s. In the overall group, diltiazem did not significantly change resting bronchial tone and produced no significant (p = 0.18) attenuation of EIA. An almost complete protection was detected only in two subjects 20 min after diltiazem 10 mg. This limited effect waned 2 h after the administration.
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Twenty asthmatic subjects had two successive methacholine challenges, two successive challenges with ultrasonically nebulized distilled water (UNDW) and an UNDW followed by methacholine on three separate days. Only ten subjects showed a refractory period to repeated UNDW stimulation. Prior stimulation with UNDW provoked increased methacholine responsiveness in the non-refractory group and a more rapid recovery from methacholine-induced bronchoconstriction in the refractory subset.
In the present paper the authors, taking for a starting point the occasional recognition of an asymptomatic orthotopic ureterocele in pregnancy, refer to the present knowledge of its embryology, pathological anatomy and the form of therapeutic approach. In the light of such experience they confirm the role of clinical-instrumental diagnostic investigations of purely gynecological and obstetric pertinence in the recognition of pathologies of urological interest.
The postoperative urodynamic test results applied in the oncological field, compared case by case with preoperative results, allow us to gain interesting speculative hints at the etiopathogenesis of the micturitional disorders after radical gynaecological surgery, but it does not entitle us, up to date to recognize preliminarily those patients who are more easily predisposed to postoperative uro-gynaecological pathology.
The author reports his own experience upon urodynamic evaluation of vesico-urethral function in patients suffering from urinary incontinence. The analysis of the results confirms the high significance of urodynamic investigation in cases of urinary incontinence either preoperatively, in order to define the conditions which lead to the pathology and to decide the most suitable therapeutic approach, or postoperatively, in order to confirm the realisation of therapeutic success.
Urinary pathology still arouses interest today most especially among those women who are entering old age and especially in relation to the fact that in this age static pelvic changes and trophism of the uro-genital organs occur with greatest frequency. An analysis is presented here of the urodynamic parameters followed in a group of patients affected by this pathology, compared with a control group.
The beta agonist fenoterol, the antimuscarinic ipratropium bromide and their combination were compared in 10 patients with stable reversible airway obstruction. A single-blind cross-over design was used in order to obtain cumulative dose-response curves. The dose inhaled by an IPPB apparatus on different days were: fenoterol, from 12.5 to 1.600 cumulate micrograms; ipratropium bromide, from 5 to 640 cumulate micrograms; combination (5:2), from 17.5 to 1.120 cumulate micrograms. The bronchodilator effect was measured as changes of FEV1 and of SGaw. Data were processed in order to identify the median effective dose (ED50) and the percentage change at ED50 (RED50). The mean ED50 in micrograms (+/- SD) resulted in: Fenoterol, ED50 (FEV1) = 132 (+/- 46); ED50 (SGaw) = 172 (+/- 62); Ipratropium bromide, ED50 (FEV1) = 14 (+/- 7); ED50 (SGaw) = 23 (+/- 11); Combination, ED50 (FEV1) = 109 (+/- 26); ED50 (SGaw) = 121 (+/- 53). The mean RED50% (+/- SD) resulted in: Fenoterol, RED50 (FEV1) = 30 (+/- 16); RED50 (SGaw) = 106 (+/- 78); Ipratropium bromide, RED50 (FEV1) = 21 (+/- 10); RED50 (SGaw) = 82 (+/- 66); Combination, RED50 (FEV1) = 35 (+/- 11) RED50 (SGaw) = 135 (+/- 81). The ED50 (FEV1) of the combination was significantly lower (p less than 0.05) than that of fenoterol. This increased potency of the combination supports evidence for an overadditive interaction between fenoterol and ipratropium bromide. Moreover, the efficacy of fenoterol (RED50) is enhanced by combining the two drugs.
We studied ten subjects who had an asthmatic response after the inhalation of ultrasonically nebulized distilled water and did not show any refractory period to repeated challenge with such water. The change in responsiveness to methacholine after inhalation of distilled water and the occurrence of any water-induced late asthmatic response were investigated on separate days. All of the tested subjects showed a significant increase in bronchial responsiveness to methacholine after prior stimulation with ultrasonically nebulized distilled water, which waned within two hours in eight of them. The other two subjects showed a progressive increase in responsiveness to methacholine, and they also had a further reduction in the caliber of the airways three to four hours after inhalation of distilled water. The late responses were less severe than the initial responses and lasted four to five hours. After the spontaneous recovery, no significant increase in responsiveness to methacholine was detected. Our results confirm previous observations on hyperresponsiveness induced by ultrasonically nebulized distilled water and demonstrate the occurrence of late reactions after inhalation of such water.
1068 patients were examined using a unified diagnostic protocol. 618 patients at high risk were screened out, and underwent further instrumental and surgical investigation. 17 cases of breast cancer were detected, while the remaining patients were addressed to an appropriate, highly reliable and repeatable follow-up for breast care.
Up to the end of 1982, reoperation for dehiscence of an aortic prosthesis was necessary in 5% of patients operated on for primary aortic valve replacement in the previous decade at the University of Padova Cardiac Surgery Center. This complication occurred early (median time to diagnosis 4 months) and was associated with an elevated 30-day operative mortality (27%, 70% CL 19-37%). This is probably (P = 0.09) related to preoperative heart failure. The follow-up of the traced surviving patients (92%) indicates a continuing poor prognosis with a 6-year survival rate of only 13.5% (70% CL 5.0-30%). All the events were cardiac related and directly or indirectly connected with the persistence or recurrence of dehiscence that was observed in 72% of the cases. In the face of these results, a retrospective study has been performed to identify, on the basis of the available data, the subsets of patients more prone to develop this complication. Our results suggest that a significant increased risk (P less than 0.001) can be identified in patients presenting with bacterial endocarditis (12.2% rate), in patients with concomitant aneurysm of the ascending aorta (10.9%) and in patients with degenerative regurgitation or severe calcifications of their native valve, with rates of 7.0 and 6.0 respectively. In these situations particular care is required to avoid undue stress on the annular tissue. We also suggest the use of buttressed interrupted sutures.
The Authors report the preliminary results of a study performed on patients submitted to radical hysterectomy according to Wertheim-Meigs for cervical-carcinoma, in order to evidence possible changes of the intestinal functionality, by means of a manometric investigation of the anal sphyncteres and measurement of the intestinal transit times. The manometric survey showed that no essential parameter was uniformly altered whereas the transit time measurement proved in some cases the slowing-down of the intestinal progression at the level of the ascending and transverse colon, and a normal transit in the descending colon as well as in the rectum in all examined cases.