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Biomedical subjects

V Lepore

Publications and source records attributed to V Lepore.

At least 37 records · Page 2Linked to original sources
PubMed1996

Replacement of the ascending aorta with composite valve grafts: long term results.

BACKGROUND AND AIMS OF THE STUDY: Long term survival after replacement of the aortic root is improving. The most common cause of late death is progression of disease in the remaining aorta (dissection or atherosclerosis). The purpose of this study was to review our clinical experience with composite graft replacement of the aortic root with special reference to long term results. MATERIALS AND METHODS: One hundred twenty-six patients (mean age: 53 years) with different pathologies of the ascending aorta underwent aortic root replacement with a composite-graft prosthesis over a 12-year period. Twenty-three patients had previously undergone cardiovascular surgery. The surgical technique included resection of the ascending aorta with the aortic valve and end-to-side anastomosis between full-thickness buttons of the aortic wall with the coronary ostia and the graft. One or more associated cardiovascular procedures were performed in 24 cases. Long term follow up to July 1995 is complete. Uni- and multivariate analysis were performed to identify risk-factors for early and late mortality and reoperation. RESULTS: Twenty-three patients died during the first 30 days (18%). Sixteen of them had aortic dissection. The most common cause of early death was heart failure. Twenty-three patients died during the follow up time with heart failure, again, being the most common cause of death. Thirteen late reoperations on the composite-graft or the remaining aorta were performed in 12 patients, six of whom had Marfan's syndrome. The 30-day mortality at reoperation was 30%. CONCLUSIONS: This surgical option offers good long term results with a five-year actuarial survival of 67% or 75% when the 30-day mortality is excluded. Careful follow up of patients with Marfan's syndrome and/or aortic dissection is mandatory to increase the long term survival.

Adolescent↗
PubMed1995

The "90 degrees bent" two-stage venous cannula.

A 90 degree bent two-stage venous cannula for cardiopulmonary bypass is presented and discussed. Its main advantages, compared to similar straight ones, are that it is out of the way of the surgeon, by being placed under the right sternum and also that the venous return seems uninfluenced by displacement of the heart when operating on the posterior side of the heart. No major drawbacks for the cannula have been noticed so far.

Cardiac Catheterization↗
PubMed1994

Factors affecting course and survival in Alzheimer's disease. A 9-year longitudinal study.

OBJECTIVE: To evaluate mean survival and to identify prognostic factors in a cohort of patients with Alzheimer's disease (AD). DESIGN: Multicentric 9-year cohort analytic study. SETTING: Seven neurology departments throughout Italy between April 1982 and January 1984. PATIENTS: We recruited a consecutive sample of 145 patients affected by probable AD (Multicenter Italian Study on Dementia protocol, National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria). Five were misdiagnosed, and 21 could not participate in the longitudinal study. The clinicodemographic characteristics of the 119 enrolled patients (49 men, 70 women; mean age, 64.7 years; SD, 4.1 years; mean duration of disease, 3.1 years; SD, 1.8 years) did not differ from those of the 26 excluded patients. All underwent extensive cliniconeuropsychological testing every 6 months for at least 2 years until the patient died or our survey ended (April 30, 1991). Mean follow-up was 5.1 years (SD, 2.5 years). MAIN OUTCOME MEASURES: Death, severe functional impairment (a score > or = 17 on the Blessed Dementia Scale), and severe cognitive impairment (a score of < or = 7 on the Information-Memory-Concentration Test). RESULTS: Survival curves obtained by the Kaplan-Meier method indicated that (1) patients with early- and late-onset disease (ie, before or after age 65 years) showed no difference either in relative survival or in time to reach predetermined functional and cognitive end points; (2) severely aphasic patients became profoundly demented significantly sooner than those with mild to moderate aphasia (P < .0001). Among clinicodemographic variables analyzed by a Cox model, severe language disability and functional loss proved to be the best predictors of death independent of age at onset or degree of dementia. CONCLUSIONS: Age at onset did not influence course and survival in AD. Severe aphasia appears to be the best predictor of death and unfavorable course.

Aged↗
PubMed1994

Reliability among neurologists in the severity assessment of blepharospasm and oromandibular dystonia: a multicenter study.

The reliability of a scale of 0 to 4 (where 0 is normal) in rating the severity of blepharospasm (BS) and oromandibular dystonia (OMD) was evaluated by the concordance among six neurologists from different neurological institutions. As expressed by k index, interobserver agreement was moderate either for BS or for OMD according to the Landis classification. Neurologists showed different rating attitude toward BS and OMD. In fact, the category analysis showed that raters were inclined to overestimate BS and to underestimate OMD. The familiarity with dystonia influenced reliability more than the length of professional experience in neurology. In fact, when examiners were subdivided into subgroups (each of three raters) according to the former criteria, the level of interobserver agreement increased significantly. Almost perfect agreement was obtained in intrarater comparisons. These results may be of value with regard to the conduct of multicenter epidemiologic and clinical studies on focal dystonias.

Adult↗
PubMed1993

Surgical treatment of a large eventration of the left diaphragm.

Total eventration of the left diaphragm is a rare condition in adults. It is now generally accepted that surgery is indicated only in cases of distinct complaints involving abdominal or thoracic organs which can be related to this pathological condition. The accepted routine surgical procedure for treatment of the eventration is plication of the diaphragm without incision or excision of the pathologically changed part of the diaphragm. In rare cases, reinforcement of the very thin membrane with some foreign material may be necessary. We describe an adult patient with extensive eventration and severe symptoms in whom we used a special technique for restoration of the diaphragm with very good results.

Aged↗
PubMed1993

Genetic contribution to idiopathic adult-onset blepharospasm and cranial-cervical dystonia.

A family study in 29 patients with idiopathic adult-onset blepharospasm (n = 16) and cranial-cervical dystonia (n = 13) was undertaken by examining 189 first-degree relatives. Six relatives with dystonia were identified in 6 families. A further 3 affected relatives, now deceased, were from 2 other families. All the secondary cases were parents or siblings. There was a tendency for affected relatives to have the same type of dystonia of index patients. To assess the significance of secondary cases we compare the incidence of affected siblings between probands and their spouses. Dystonia was found in 5 out of 120 proband siblings whereas none of the 142 spouse siblings was affected (p < 0.05). Segregation analysis suggested an autosomal-dominant transmission and reduced penetrance or, alternatively, polygenic inheritance.

Adult↗
PubMed1992

Technical options in reconstruction of large mediastinal veins.

Twelve patients who underwent graft replacement of the large mediastinal veins were reviewed. A preoperative superior vena caval (SVC) syndrome was present in seven patients. The most frequent diagnosis was a primary thoracic malignant neoplasm (10 patients). Reconstruction was performed with a pericardial tube in four patients, venae saphena magna in three patients, umbilical vein in three patients, and Dacron grafts in two patients. A temporary bypass was used in three patients. All the patients survived the operation. Eight patients died within 15 months of the surgery. Four patients are long-term survivors without signs of an SVC syndrome. Based on our experience and a review of the literature, we recommend the use of two autogenous vein grafts or a ringed polytetrafluoroethylene graft with a diameter of about one half that of the normal SVC to replace the large mediastinal veins.

Adult↗
PubMed1991

Esophagocutaneous drainage to treat late and complicated esophageal perforation.

Five patients with complicated esophageal perforation--three with spontaneous rupture, one with dehiscence after resection of a diverticulum, and one with an iatrogenic lesion--were successfully treated by esophagocutaneous drainage of the esophageal perforation. At thoracotomy, after careful debridement and cleaning of the mediastinum and pleura, a T-tube drain was placed in the esophagus through the perforation in addition to pleural drains. A feeding jejunostomy and a gastrostomy was carried out via a separate laparatomy in 4 cases. Postoperatively the patients were managed according to a protocol with subsequent removal of pleural drains, esophageal T-tube and, after esophageal healing, gastrostomy and feeding jejunostomy. Broad-spectrum antibiotics were given initially. Healing was slow but progressive and without major problems. The healing process was followed by repeated contrast swallows. In all cases the esophagus healed without residual stenosis within 8-12 weeks. This method seems to be a way to save the life and the esophagus of patients with esophageal perforations complicated by late discovery or failure of primary repair.

Aged↗
PubMed1990

Botulinum A toxin treatment for eyelid spasm, spasmodic torticollis and apraxia of eyelid opening.

Botulinum-A toxin (botAtox) was used in the treatment of blepharospasm (BS), idiopathic hemifacial spasm (HFS), idiopathic spasmodic torticollis (ST) and apraxia of eyelid opening (AEO). The injection of 7.5-30 U botAtox per eye spread over 3 or 4 sites in the palpebral part of orbicularis palpebrae (OP) reduced palpebral spasm in 12/13 cases of BS and in 7/8 cases of HFS. The effect lasted for 14.5 weeks on average (range 4-30 weeks). Palpebral ptosis (lasting 1-3 weeks) was the most frequent side effect (16/107 eyes treated) but was not related to dose of botAtox or number of inoculation sites. Injection of 60-160 U botAtox into the sternocleidomastoid, trapezius and splenius capitis muscles reduced ST objectively in 1/4 patients for about 4 weeks. In the other patients the reduction or abolition of the hypertrophy of the previous hyperactive muscles was accompanied by persistence or rearrangement of the dystonia pattern, suggesting a change in the pattern of activity of the neck muscles after botAtox. 5 U botAtox per eye spread over 4 sites in the OP significantly reduced the frequency of the episodes of involuntary eyelid closure in 2 patients with AEO but not BS. The therapeutic effect lasted for 7 months after the first treatment and for 8 months after the second in a 46 year old woman with a 6 month history while the second patient (72 year old parkinsonian) has now completed her 3rd month of treatment.

Adult↗
PubMed1990

Pneumothorax in pregnancy.

Since 1957, only 15 cases of isolated spontaneous pneumothorax in pregnancy have to our knowledge been reported in the English literature. The treatment of pneumothorax in pregnancy is more difficult than in non-pregnant patients. A case is reported and therapy discussed.

Adult↗
PubMed1989

Facial dystonia: clinical features, prognosis and pharmacology in 31 patients.

The natural history and response to different treatments were assessed in 31 consecutive patients with blepharospasm (BS) and/or oromandibular dystonia (OMD). The mean age at onset was 52.4 years and there was a female preponderance of 2.5 to 1. Ocular symptoms preceded the onset of blepharospasm in more than 50% of the affected patients, whereas psychiatric and dental problems prior to the onset of focal dystonia were found in 10% and 13% of the cases respectively. Dystonia elsewhere, mainly in the craniocervical area, was found in 23% of patients and appeared to follow a somatotopic progression. The first 2-3 years of history were crucial for the spread of dystonia to other face and body parts. When OMD was the first symptom, a lower tendency of dystonia to progress elsewhere was observed. A putative cause was found in 14% of patients who showed clinical and radiographic evidence of basal ganglia or rostral brainstem-diencephalon lesions. The response to different drugs was inconsistent although transient improvement was induced by haloperidol in 6 patients, by L-Dopa plus deprenyl in 3 patients, by trihexyphenidyl in 2 patients and by clonazepam in 2 patients. One, apparently spontaneous, remission was observed. Botulinum A toxin was injected in the orbicularis oculi of 8 patients affected by BS: moderate to marked improvement lasting 5 to 30 weeks (mean 14.5 weeks) was achieved in all cases; transient ptosis, lasting 1 to 3 weeks, occurred in 3 cases.

Adult↗
PubMed1989

Long-term follow-up of operative treatment for pulmonary metastases.

From 1954 onwards, 132 patients underwent 165 resections for pulmonary metastases. No other forms of therapy were adopted. The operative mortality was 7.6% (10 patients). After a minimum follow-up of 5 years, the overall survival rate was 20%. The 10- and 15-year survival rates were 6% and 3%, respectively. The major cause of late death was recurrence or spread of the primary disease in 102 patients (83.6%) while 5 patients died of reasons not related to cancer. Fifteen patients (12.3%) are still alive, 13 of whom have no clinical cancer. The presence of symptoms, the disease-free interval of less than 1 year and the number of metastases showed a statistically significant detrimental influence on survival (P less than 0.001, P less than 0.05 and P less than 0.046, respectively). The best 5-year survivals of 42%, 24%, 23% and 23% were noted for metastases from malignancies in the body of the uterus, kidney, bone and colon, respectively. Longterm survival or clinical cure can be achieved with surgery alone by an aggressive approach in selected malignancies.

Adolescent↗
PubMed1989

Autotransfusion of mediastinal blood in cardiac surgery.

A series of 135 adults undergoing cardiac surgery was randomized to an autotransfusion group (n = 67) or a control group (n = 68). In the autotransfusion group mediastinal blood was collected and reinfused during the first 6 postoperative hours. Blood from the reservoir was taken for bacteriologic culture at the end of that time. The postoperative blood was comparable in the two groups. The average requirement of bank blood was 2.7 units in the autotransfusion group and 3.3 units in the controls (p less than 0.05). The average volume of autotransfusion blood was 336 ml. There were no clinical infections in the autotransfusion group, although 19% of the cultures were positive, and no apparent alteration of the coagulation mechanisms arose from infusion of autologous blood. No clinically significant intergroup differences were found in hematologic, renal or hepatic parameters, neurologic function or use of antibiotics.

Aged↗
PubMed1989

Primary tracheal rhabdomyosarcoma. Case report.

A case of primary tracheal rhabdomyosarcoma is presented--the second in the English-language literature. The treatment policy is discussed on the basis of this case and the literature is reviewed.

Adolescent↗
PubMed1989

Atrial myxomas: results of 25 years' experience and review of the literature.

Twenty patients with atrial myxoma from a 25-year period were reviewed. Sixteen patients had a tumor in the left atrium, three in the right, and one had a biatrial myxoma. The main clinical presentations were dyspnea and tachyarrhythmias seen in 11 patients. Nineteen patients had a correct preoperative diagnosis. Echocardiography confirmed the diagnosis in eight patients, angiocardiography in four, and both these techniques in seven. The diagnosis was established at the operative table in one case in which the preoperative diagnosis was mitral stenosis. All tumors were successfully removed with cardiopulmonary bypass. There were no operative deaths. Excision of the tumor resulted in marked symptomatic improvement. No recurrences have been observed. A differential approach to preoperative investigation, surgical treatment, and follow-up is suggested according to the clinical behavior of the tumor. Excision of the tumor appears to be curative, with no recurrences at long-term follow-up in cases of "sporadic" myxoma. The risk of recurrences is much higher when a "complex" or a "familial" myxoma is faced. For these types, our recommendations are presented.

Adult↗
PubMed1988

Torsion of a lung lobe: diagnosis and treatment.

Intraoperative lobar torsion occurred in 4 of about 2000 patients subjected to thoracotomy. Two of the patients died. Early diagnosis and proper management are of great importance to the outcome. Temporary deflation of the diseased lung by using double lumen endobronchial tube is a potential risk. Early progressive lobar opacity without signs of atelectasis on conventional chest radiograph is indicative of this serious complication. Computerized tomography and bronchoscopy are of diagnostic value. Exploratory thoracotomy must be performed without delay. The injured parenchyma should be sacrificed unless the diagnosis is obtained very early. When the injured lobe or lung is rotated back into normal position the airways may be flooded with serosanguinous fluid which promptly has to be removed. If an attempt is made to save the lobe or the lung, tracheostomy for frequent suction of the airways is indicated in order to prevent "spill-over" and dangerous postoperative hypoxia.

Adult↗