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Biomedical subjects

A Del Gaudio

Publications and source records attributed to A Del Gaudio.

At least 19 recordsLinked to original sources
PubMed2006

Remifentanil vs fentanyl with a target controlled propofol infusion in patients undergoing craniotomy for supratentorial lesions.

AIM: Remifentanil hydrochloride is an ultra-short acting m-opioid receptor agonist. This study compared the use of remifentanil with that of fentanyl during elective supratentorial craniotomy in a target controlled infusion (TCI)-propofol anesthesia regimen and evaluated the quality of recovery from anesthesia. METHODS: After written informed consent for this prospective study, 40 adult patients were randomly divided into 2 groups: in group F analgesia was provided with fentanyl 2-3 mg kg(-1) h(-1) and in group R with remifentanil 0.25 mg kg(-1) h(-1). Anesthesia was induced with thiopental and pancuronium bromide, and maintained with propofol-TCI, pancuronium, air and oxygen and fentanyl (group F) or remifentanil (group R), respectively. After tracheal intubation, infusion rate of remifentanil was reduced and then adjusted to maintain stable hemodynamics. Hemodynamics and recovery time were monitored for 60 min after surgery. Analgesic requirements, propofol intraoperative consumption, nausea and vomiting in postoperative period were monitored. Recovery was evaluated according to a modified Aldrete score. RESULTS: Baseline hemodynamics were similar in both groups. Mean arterial pressure differed between the 2 groups (P<0.05) with the greatest decrease in group R during dura opening (P<0.001). Postoperative mean arterial pressure was higher in group R. Patients in group R exhibited a faster recovery. The incidence of nausea and vomiting was similar in the 2 groups. Noteworthy, there was a reduction in the amount of propofol used in group R. CONCLUSIONS: Remifentanil appears to be a reasonable alternative to fentanyl during elective surgery of supratentorial lesions.

Adult↗
PubMed2001

Propofol EEG burst suppression in carotid endarterectomy.

BACKGROUND: The results of randomized trials indicate that carotid endarterectomy, performed with a low morbidity-mortality perioperative risk, is the best therapeutic option both for patients with high-grade symptomatic and asymptomatic stenosis. Since the main operative risk is represented by embolic or hemodynamic cerebral ischemia, it appears necessary to maintain an adequate intraoperative cerebral blood flow and to carry out a meticulous endarterectomy. METHODS: On the basis of these considerations we prospectively studied a series of 100 consecutive patients operated on for high-grade carotid stenosis, by using a protocol based on: 1) an accurate selection of patients for surgery; 2) meticulous surgical technique without any shunt; 3) perioperative cerebral protection by barbiturate or propofol; 4) pre- and postoperative medical treatment of risk factors. All patients of our series performed preoperatively brain CT scan, transcranial Doppler, carotid duplex scanning, four vessel angiography, brain 99mTc-HMPAO SPECT. Eighty-two patients had symptomatic carotid stenosis ranged between 70 and 90%, 18 had carotid stenosis higher than 90%. RESULTS: In this series there have been one postoperative death due to myocardial infarction and one major stroke. CONCLUSIONS: We think that this protocol can significantly minimize risks of endarterectomy and probably maximize the benefits of surgery, also in patients with asymptomatic high-grade carotid stenosis.

Aged↗
PubMed2001

Hypertonic saline solution: a safe alternative to mannitol 18% in neurosurgery.

BACKGROUND: To evaluate the usefulness of hypertonic saline solutions (HTS) as an alternative to mannitol in neurosurgery. METHODS: Thirty patients subjected to craniotomy for supratentorial cerebral tumors were randomly divided in to three Groups: M: had mannitol 0.5 g.kg-1 as bolus at the start of skin incision, and postoperatively 0.5 g.kg-1 daily three times a day for 3 days (72 hrs); HM: had mannitol 0.25 g.kg-1 as bolus at the start of skin incision plus 3% HTS, 20 ml.h-1 intraoperatively and mannitol 0.25 g.kg-1 daily three times a day for 3 days plus HTS in the concentration of 3% in the first day and 2% and 1% the second and the third day after surgery; H: had 3% HTS 3.5 ml kg-1 as bolus at the start of skin incision plus 3% HTS, 20 ml hr-1 intraoperatively and 3% HTS, 20 ml h-1 on the first day and 2% and 1% the second and the third day after surgery. FR, MAP, ICP, CVP and diuresis were continuously monitored intraoperatively and postoperatively for 72 hrs. ICP was monitored intraoperatively until dural opening and in the postoperative period for 72 hrs at least. RESULTS: Diuresis was increased in the first and second Group (M and HM) more than in the H Group especially in the postoperative period, but this change was not a significative one (35.31 ml.kg-1.h-1+/-4.57 and 36.56+/-3.92 vs 3.23 ml.kg-1.h-1). Mean serum Na+ values declined in the postoperative period, in Groups M and MH and remained stable in the postoperative period in the Group H (137.6+/-7 mEq.l-1 and 136.5+/-6.5 mEq.l-1 vs 139.2+/-5 mEq.l-1). Serum osmolality increased significantly in the postoperative period in group H and remained unchanged in the same period in Group M and MH. Potassium values declined significantly during the whole period in all groups but remained in a normal clinical range. CVP values decreased in Groups M and MH in the postoperative period, and increased although not significantly in the postoperative period in the Group H patients. Ht values declined significantly in all groups without differences among the groups although the reduction was greater in group H. CONCLUSIONS: HTS can safely be used in humans they obtain a reduction of ICP without reducing CVP, serum osmolality and Na+ serum values. Our data underline the possibility of their use as an alternative to mannitol in the treatment of patients scheduled for intracranial surgery, especially when multiple doses are needed.

Adolescent↗
PubMed1999

[Subarachnoid hemorrhage and systemic arterial pressure. Physiopathology and perioperative management].

A correct assessment of arterial pressure state during subarachnoid haemorrhage (SAH) is one of most critical issue in neurologic intensive care and in neuroanesthesia. It is important to evaluate two different clinical conditions during SAH: before and after aneurysmal clipping or embolization. Before clipping it is mandatory to evaluate a possibility of rebleeding and so it is important to maintain systolic pressure at lower level. Otherwise after clipping it can be useful to maintain systolic pressure at higher level to prevent vasospasm and related ischemia. In this review the Authors examine the pathophysiology of SAH and SAH complications as rebleeding, vasospasm and ischemia. According to international data, they propose pressure parameters appropriated for SAH according to timing of treatment so as to prevent and treat SAH complications.

Blood Pressure↗
PubMed1999

[The measurement of osmolality in neurologic intensive care].

Serum osmolality is one of the end-points in the management of neurologic intensive care patient. Its leading role in the concept of cerebrovascular homeostasis is underlined. Normal plasma osmolality is generally 285 mOsm kg-1, a value determined almost entirely by small molecules and ions (Na+, K+, urea and lactate). The plasma osmolality value is determined by measuring the changes in freezing point related to the zero value of a sample of distilled water. The measurement of plasma osmolality is very easy and inexpensive; its widely use could be very useful in the neurologic intensive care units to improve the treatment of neurological critical patient. According to the authors the monitoring of plasma osmolality should be mandatory to evaluate the effectiveness of treatment of brain edema.

Critical Care↗
PubMed1998

[Appropriate arterial pressure management for subarachnoid hemorrhage ].

A correct assessment of arterial pressure state during SAH is one of most critical issue in neurologic intensive care. It is important to evaluate two different clinical conditions: a) during SAH when the aneurysm is open, b) after aneurysmal clipping or embolization. The authors propose pressure parameters appropriated for SAH according to the timing of treatment so as to prevent and treat SAH complications.

Blood Pressure↗
PubMed1997

Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma.

BACKGROUND: Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series. METHODS: One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months. RESULTS: Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively). CONCLUSIONS: Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.

Adolescent↗
PubMed1997

[Total intravenous anesthesia in neurosurgery. Our clinical experience].

BACKGROUND: The quality of a "neuroanesthetic" technique is the result of its pharmacokinetics, of its effect on intracerebral homeostasis and metabolism, of its antinociceptive and neuroprotective features. Aim of this study is to test the effectiveness of TIVA as the technique of choice in neurosurgical patients throughout a retrospective analysis of 1982 patients scheduled for brain tumors, neurovascular surgery and spine lesions. METHODS: 1982 patients (1023 F, 959 M), ASA I-IV, aging 15-80 yrs scheduled for neurosurgery were studied. Hemodynamic and electrophysiological parameters were monitored carefully. Time of recovery was evaluated although this parameter is influenced by perioperative clinical status and by area and kind of brain damage. RESULTS: A good hemodynamic stability was observed. Recovery time was quick, related with brain damage and time of surgery. Incidence of postoperative nausea, vomiting and seizures was very low. Two cases of awareness were noted. CONCLUSIONS: 1982 neurosurgical operations were carried out in TIVA without major complications and side effects: the authors are therefore sure that TIVA can be considered the anesthetic technique "of choice" in neurosurgical patients.

Adolescent↗
PubMed1996

Early percutaneous endoscopic gastrostomy (PEG). A safe and effective enteral feeding technique in neurologic intensive care unit.

Enteral feeding by percutaneous gastrostomy is recommended as the "best choice" in NICU patients. It allows us to obtain early gut activation and to prevent physiopathologic events leading to multiorgan failure syndrome. In this retrospective study the Authors describe their experience related to 76 patients admitted in NICU between January 1992 and April 1994. In these patients percutaneous gastrostomy was easily and safety performed at the bedside with early enteral nutrition and drug administration and a related low incidence of infections complicating central and peripheral vein catheterization. Moreover the authors underline the avoidance of nasogstric tube and its side effects and a good compliance of patients and nurses that seems to be a real advantage of this technique. The authors suggest their 13 guidelines to improve management of enteral nutrition by gastrostomy and to avoid its short-comings.

Adolescent↗
PubMed1995

[Surgical treatment of rectal cancer: comparison of anterior resection and abdominoperineal excision].

From 1987 to 1992, 91 rectal neoplasms were operated in the Istituto di Patologia Speciale Chirurgica of the University of Bologna: 50 anterior resections and 41 abdomino-perineal amputations. The local recurrence rate shows no significant difference between the two groups. The mortality rate is 7.6% in anterior resections and 14.2% in abdomino-perineal amputations. Our results and literature review show that local recurrence and mortality rates depend more from the tumor stage than from the surgical procedure.

Adult↗
PubMed1989

Adrenal hemangiomas: two case reports with a review of the literature.

Hemangiomas, although frequently found elsewhere, are rarely encountered in the adrenal gland. Only 17 surgical cases of adrenal hemangiomas have been reported, with an additional case not surgically treated. The pertinent literature has been reviewed. Two additional cases, one identified preoperatively and both removed surgically, are presented herein. Ultrasonograms and computed tomographs showed large, necrotic masses without calcifications. Preoperative angiograms taken for case 1 demonstrated pooling of contrast media within this mass, strongly suggesting a diagnosis of hemangioma; case 2 lacked similar angiographic findings. The radiologic finding of calcifications, when present, along with the characteristic angiographic appearance of a hemangioma, allows the radiologist to correctly diagnose this benign tumor preoperatively. Although rare, these tumors should be part of the differential diagnosis of adrenal neoplasms.

Adrenal Gland Neoplasms↗
PubMed1986

Myelolipoma of the adrenal gland: report of two cases with a review of the literature.

Myelolipomas are rare, nonfunctioning, benign lesions composed of varying proportions of fat and bone marrow elements. The clinical and pathologic features are described with a brief discussion of the possible etiology and pathogenesis. Forty-seven cases in the world literature are reviewed including two of our patients. Twenty-four patients were seen initially with pain, 19 had hypertension, 15 were obese, and seven had hematuria. These tumors can be diagnosed by their characteristic appearance on ultrasonography, computerized tomography, and angiography and by their lack of hormonal alterations.

Adrenal Gland Neoplasms↗
PubMed1984

Extra-adrenal pheochromocytoma with reversible renal artery stenosis.

A rare case of extra-adrenal pheochromocytoma occurring in the aorto-caval space and responsible for right artery stenosis, is described. The pheochromocytoma was excised and the blood flow in the renal artery restored. The heightened blood pressure, of dual origin, returned to normal after the operation. Three years after surgery the patient was normotensive and urinary catecholamines and Plasmatic Renin Activity (P.R.A.) were normal.

Adrenal Gland Neoplasms↗
PubMed1983

[Billroth II gastric resection (100 homogeneous cases)].

The study of a homogeneous casuistry concerning 100 patients undergoing gastric resection according to Billroth II in the period 1974-1981 for peptic and duodenal ulcer gives the Authors the opportunity to confirm the criteria whereby this technique of reconstruction of the digestive duct is preferred to others.

Adult↗