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Biomedical subjects

A Fracasso

Publications and source records attributed to A Fracasso.

At least 37 records · Page 2Linked to original sources
PubMed1990

Mitral valve disruption following percutaneous balloon valvuloplasty.

Two cases of massive mitral regurgitation due to mitral valve disruption following percutaneous balloon valvuloplasty are reported. This severe complication occurred in two elderly women with recurrent mitral stenosis after previous surgical commissurotomy. Due to their unstable hemodynamic and clinical condition, both patients underwent emergency valve replacement. At surgery, the commissures appeared fused and heavily calcified; the chordae tendineae thickened, shortened, and fused; and the leaflets presented a large tear with sheared edges. Because the technical aspects of both procedures were unremarkable, the anatomic features of the mitral valve seemed to affect the occurrence of severe mitral regurgitation. Percutaneous balloon valvuloplasty should be therefore applied carefully to patients with prior surgical valvotomy, in whom the structural alterations of the mitral apparatus may predispose to severe valvular damage.

Acute Disease↗
PubMed1990

Early and late survival of repaired type A aortic dissection.

From 1 January 1977 to 31 December 1988, 119 patients were operated upon for type A aortic dissection. The maximum follow-up was 11.7 years (median 5.6 years); follow-up was 100% complete. Actuarial survival was 47.3% +/- 5%. The death risk decreased rapidly to a constant rate of 0.0027 events/month after 3 months. There were 41 early deaths, mostly due to haemorrhage, brain damage and low output syndrome. A significantly higher probability of early death was observed in patients with preoperative myocardial ischaemia or infarction (P less than 0.0001) or preoperative cerebral symptoms (P = 0.0002). Extended dissection increased the risk proportionally to the length of the aorta involved (P = 0.0002). Typical dissection originating from an intimal tear in the ascending aorta had a significantly lower operative risk than atypical dissection with an intimal tear not localized in the aortic root (P = 0.0006). Of the 14 late deaths, 2 were unrelated to dissection, 2 were of unknown origin and 4 were sudden. Stroke was the cause of 2 and congestive heart failure the cause of 4 deaths. The probability of late death was higher in patients with perioperative brain damage (P = 0.003) and in patients with preoperative shock (P = 0.0025). It was significantly lower in patients with dissection of hypertensive aetiology (P = 0.002). There were 13 reoperations on 12 patients. Early reoperations were due to rupture of the distal aortic anastomosis. Late reoperations were mostly due to dehiscence of aortic valvular prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

Early and late results after repair of tetralogy of Fallot.

Between January 1, 1975, and December 31, 1988, 233 patients were operated on for correction of tetralogy of Fallot (TOF). Mean follow-up was 13.9 years (median 7.65 years) and was 99.6% complete. Actuarial survival was 84 +/- 3%. The risk of death decreased gradually to a constant rate of 0.00034 deaths/month by the 6th postoperative month. There were 22 early deaths, due mostly to Low Output Syndrome. The principal incremental risk factor was the postrepair ventricular pressure ratio (PRV/LV) (P less than 0.0001). Other factors were: patent ductus arteriosus (PDA; P = 0.02), other associated anomalies (P = 0.005), higher preoperative hemoglobin levels (P = 0.06) and use of transannular patches (P = 0.02). The operative risk was significantly reduced by a recent operative date (P = 0.01) and by an older age at operation (P = 0.12). Among 8 late deaths, 2 were unrelated to the cardiac condition, 2 occurred suddenly, 3 were due to congestive heart failure and the last was due to reoperation for patch endocarditis. The risk of late death was significantly higher in patients operated on at an older age (P = 0.04). There were 10 open heart reoperations: 5 for patch dehiscence, 4 for residual pulmonary stenosis and 1 for residual atrial septal defect. The reoperation-free actuarial survival was 82 +/- 3%. With the present operative standards, the parametric operative risk of an average patient with simple TOF (hemoglobin = 12 g, PRV/LV = 0.5) is 0.7%. Where the TOF is severely cyanotic (hemoglobin = 25 g) and the pulmonary arteries are severely restricted, the average mortality is 30%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

On-line bioelectric impedance during haemodialysis: monitoring of body fluids and cell membrane status.

We have measured by a computed integrated system (BIA 109, RJL AKERN) the changes of bio-impedance (BI) deriving from a tetrapolar system working on 800 microA, 50 kHz current, in 23 haemodialysed patients. Resistance (R) and reactance (Xc) have been continuously monitored during haemodialysis in each patient. Resistance was strictly inversely correlated to the decrease of body weight (r = 0.82). Also, Xc increased almost constantly. In most of the patients the increase of Xc was proportionally greater than R, resulting in an increase of phase angle (PA). However, Xc showed a transient decrease in response to seven severe symptomatic hypotensive episodes, whereas R maintained the increasing trend, causing a sharp reduction of phase angle. As Xc is an expression of storage of electrical charge by the cells acting as condensers, and phase angle quantifies the active capacitive component in relation to passive electrical resistance, these parameters may be important to evaluate cell membrane function. In fact, the univocal increase of R, Xc and phase angle observed during normal unevenful haemodialysis probably indicates improvement of cellular activities due to the depurative treatment. On the contrary, the transient reduction of Xc and phase angle observed during hypotensive crises may be an expression of cellular distress because of a too rapid ultrafiltration.

Adult↗
PubMed1990

[Morphine in the inferior cerebellar cisterna for oncologic pain in the ORL area].

The study aimed to assess whether the infusion of microdoses of morphine in the cisterna magna, close to the sensitive nuclei of the cranial nerves (V-VII-IX-X) involved in painful syndromes of the head and neck, is able to control severe oncological pain in this region which does not respond to traditional pain killing treatment or neurolesive practices. Cisternal catheters were inserted in eight patients with cancer of the head and neck. The intensity of pain was assessed using VAS and the quality of analgesia obtained using cisternal morphine was judged to be: excellent, good, inadequate or null. Treatment lasted a mean of 121 days. Good or excellent analgesia was achieved in 7 patients using a mean daily dose of 1.5 mg morphine during the initial stage and 4.8 mg during the final stage; in one patient with a large component of "deafferent pain", good pain relief was obtained by associating cisternal morphine with chlorimipramin per os. The side-effects observed were almost always short-term and easily resolved. Morphine treatment was begun in the hospital and in all cases continued at home. This efficacious pain killing method should be given adequate attention in the global strategies used to treat oncological pain in the head and neck region.

Aged↗
PubMed1989

Source and route of microbial colonisation of parenteral nutrition catheters.

To assess the effectiveness of tunnelling the polyurethane venous catheter for parenteral nutrition in reducing the frequency of catheter microbial colonisation, and to investigate the routes taken by microorganisms colonising the central venous catheter, 109 patients were randomised to traditional subclavian catheterisation (58, group A) or to subcutaneous catheter tunnelling (51, group B). Samples were taken from patients and their nurse attendants to identify their indigenous flora. Cultures were also done of swabs from the catheter insertion site, blood, nutrient solution, segment of the catheter, and washings of the catheter hub. Intravascular segment colonisation was commoner in group A (18/58) than in group B patients (4/51), and bacterial migration from insertion site to intravascular segment was also commoner among group A (9/58) than among group B patients (1/51). Catheter hub contamination was responsible in 10 out of 22 cases of microbial colonisation; in 6 of these 10 the bacterium isolated was present on the skin of nurses who changed the bag. Contamination of the insertion site skin and of the CVC hub were equally responsible for the microbial colonisation of the intravenous segment of the catheter.

Adult↗
PubMed1989

[Results of emergency aortocoronary bypass in complicated coronary angioplasty].

Sixteen out of 293 (5.4%) procedures for percutaneous transluminal coronary angioplasty, performed between 1985 and 1988, were complicated by acute closure and required emergency revascularization surgery. The injured vessel was the left anterior descending artery in 14 cases and the right coronary artery in 2 cases. All patients had persistent chest pain associated with ST-segment elevation in 14 cases and ST-segment depression in 2 cases. Two patients developed cardiogenic shock and were in cardiac arrest at the beginning of operation; one of these died immediately after the operation. Thus the overall mortality rate was 6.2%. Enzyme evidence of myocardial infarction (CPK-MB greater than 40 UI/I) occurred postoperatively in 8 patients (50%), but only the 6 patients (37.5%) with electrocardiographic evidence of myocardial necrosis (new Q-waves or loss of R-wave voltage) showed akinesis of the myocardium perfused by the occluded vessel at the echocardiographic examination performed two weeks after the operation. The occurrence of myocardial infarction was correlated with the degree of preoperative ischemia and hemodynamic deterioration. A collateral flow was present in 3 cases and none of these showed evidence of myocardial necrosis after the operation. Our results show that emergency bypass surgery for failed coronary angioplasty is less satisfactory than elective surgery, and has a higher mortality and myocardial infarction rate. Thus, the risk of emergency operation for complicated dilation must be considered when selecting of candidates for coronary angioplasty.

Adult↗
PubMed1989

Effect of phthalate acid esters on transport in toad bladder membrane.

Sclerosing peritonitis is a serious complication in patients on long-term peritoneal dialysis; it markedly decreases transport of water and solute across the peritoneal membrane. Although the precise mechanism is unknown, organic compounds (i.e., plasticizers) from plastic tubing and dialysis bags have been suggested to be a cause of the syndrome. The effects of three such compounds on water and sodium transport in vitro were studied in the toad bladder. The compounds studied were didodecylphthalate, dioctylphthalate, and benzylbutylphthalate. After 4 hr incubation in vitro, dioctylphthalate and benzylbutylphthalate significantly inhibited vasopressin-stimulated water flow in toad bladder. Basal water flow was not affected by any of the three compounds. Sodium transport, as measured using short-circuit current, was decreased to an equivalent degree by all compounds; inhibition of short-circuit current was dose dependent and was approximately 30% at 10(-3) M. The onset of action was between 3.5 and 4 hr, and the effect on short-circuit current was not reversible. These results demonstrate that the plasticizers (to which patients of all sorts are commonly exposed) inhibit transport across living membranes. In the toad bladder these compounds decrease sodium transport and maximal water flow. Although other evidence suggests that the cumulative toxic effects of these compounds may play a causal role in sclerosing peritonitis in patients on peritoneal dialysis, our study suggests that chronic exposure to the phthalate acid esters in patients with normal renal function may result in sodium wastage, polyuria, and a concentrating defect resistant to AVP.

Animals↗
PubMed1988

Determinants of late survival of 105 patients operated for dissection of the aorta.

In the surgery of aortic dissection, only a small section of aorta compared to the extent of the aortic damage, is usually replaced. The disease is not cured by surgery and needs continuous postoperative surveillance and medical therapy. We report the follow-up of 105 patients who were operated upon between January 1970 and April 1986 and discharged from hospital. Overall actuarial survival was 90% at 5 years, 52% at 10 years and 39% at 15 years. There were 20 deaths, mostly (85%) related to cardiovascular causes. Survival times were correlated, using multivariate methods, with several pre-, peri- and postoperative variables to identify significant risk factors and to calculate actuarial survivals. We found that postoperative low output syndrome (p = 0.007) and stroke (p = 0.04) adversely affected survival and that previous aortic disease or operation (p = 0.004) was associated with an increased rate of dissection-related complications. On the contrary, preoperative hypertension was related to a significantly better survival (p = 0.01) and survival free of dissection-related complications (p = 0.001). When dissection was related to hypertension, adequate postoperative medical treatment neutralized the progression of the aortic damage and its consequences. When dissection was not due to hypertension, the observed survival was unsatisfactory, probably because of a more fragile aorta and inadequate medical follow-up therapy.

Actuarial Analysis↗
PubMed1988

Tricuspid atresia versus other complex lesions. Comparison of results with a modified Fontan procedure.

Several modifications of the Fontan principle are currently applied to the treatment of tricuspid atresia with low mortality. The use of these modifications in other malformations has most frequently been associated with less satisfactory results. At our institution, from June 1977 to October 1986, 35 consecutive patients, whose ages ranged from 8 months to 20 years (median age 3.4 years), underwent a modified Fontan procedure. Twenty patients with a median age of 3.2 years (group I) having tricuspid atresia (16 patients) or hypoplastic right heart syndrome (four patients) were treated by means of a right atrium-pulmonary artery anastomosis (12 patients) or right atrium-subpulmonary chamber connection (eight patients). Fifteen patients (group II) with a median age of 3.6 years, having a single left ventricle (10 patients), left atrioventricular valve hypoplasia or atresia (three patients), or double-outlet right ventricle (two patients), underwent right atrium-pulmonary artery anastomosis, together with a repositioning of the atrial septum to the right of the right atrioventricular valve, which thus left intact the inlet to the ventricle(s). The operative mortality rate was 25% in group I and 0% in group II. One patient in group I and one in group II died late postoperatively. All the 28 survivors are free of symptoms 3 months to 9 years after correction. According to our results, low risk can be associated with modified Fontan procedures in the treatment of complex heart malformations other than tricuspid or pulmonary atresia. Preserving the integrity of the entire inlet to the ventricle(s) by repositioning the interatrial septum, as done in group II malformations, might be helpful in improving the quality of the repair.

Adolescent↗
PubMed1986

Removal of phosphate (Pi) by either bicarbonate dialysis or biofiltration in uremics.

The kinetics of extra and intracellular red blood cell (RBC) Pi and its removal by different therapeutic modalities were evaluated in 30 uremic patients over a 6 mo. period. Acetate hemodialysis alone, combined with hemoperfusion, or associated once a week with plasma-perfusion sessions using an activated bauxite cartridge, bicarbonate dialysis either in single pass or in recirculating system (40 L) and biofiltration, were the depurative treatments employed. The treatments with acetate buffer showed a temporary intracellular shift of Pi at the end of the sessions with post-dialytic plasma Pi rebound. This was not evident with bicarbonate buffer and biofiltration where acidosis was corrected better, and similarly during plasma perfusion treatment because blood pH remained unchanged. These findings may explain the better plasma Pi level at the end of our study with these later therapeutic models compared to acetate dialysis alone or combined with hemoperfusion. In these conditions Pi removal is limited by the correction of acidosis which implies acetate metabolism with ATP activation leading to a transient Pi intracellular influx and a subsequent efflux into the extracellular compartment.

Acetates↗