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Biomedical subjects

A Franchello

Publications and source records attributed to A Franchello.

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

[Endoscopy or surgery in the treatment of obstructive jaundice].

The role of operative endoscopy as opposed to surgery in the treatment of obstructive jaundice is in continuous positive evolution due to the rapid technical progress made in the use of this method. Of a total of 93 patients treated over the course of 3 years, some received surgical treatment alone, others endoscopic treatment alone, and a third group received endoscopic therapy followed by surgery. Various parameters were taken into consideration for the three groups studied: the pathological cause of jaundice, age, sex, success of the method used, early and late complications, hospital deaths. Results were then compared.

Age Factors↗
PubMed1990

Beneficial effect of enhanced macrophage function in the trauma patient.

Host immunosuppression after trauma contributes to septic morbidity. The macrophage is a key element in the host immune response. This study evaluated glucan, a macrophage stimulant, in a prospective, randomized, double-blind study of 38 trauma patients undergoing surgery. Glucan (21 patients), 50 mg/m2, or placebo (17 patients) was given intravenously daily for 7 days. Delayed hypersensitivity skin testing was performed on days 1 and 7 after trauma. Serum interleukin-1 (IL-1) and tumor necrosis factor (TNF) were assayed after trauma. While the total mortality rate was significantly less in the glucan group (0% versus 29%) (p less than 0.05), the mortality rate from sepsis was not statistically different (0% versus 17.6%). Glucan therapy significantly decreased septic morbidity (9.5% versus 49%; p less than 0.05). Serum IL-1 had a greater increase in glucan patients on day 3 after trauma (143.4 +/- 19.3% versus 78.6 +/- 11.7%; p less than 0.05), but there was no difference thereafter. Serum TNF did not vary between groups. Early increase in IL-1 correlated with subsequent skin test conversion to positive. Neither serum IL-1 nor TNF was a reliable indicator of future sepsis. Further clinical trials are indicated to evaluate biologic response modifiers that activate macrophages in the trauma patient.

Adult↗
PubMed1990

[Segmental portal hypertension caused by splenic vein thrombosis].

Seventeen cases of segmental portal hypertension due to splenic vein thrombosis are reported. This syndrome may be asymptomatic for a long time and then present suddenly in the form of a serious picture of high digestive haemorrhage due to rupture of gastric fundus varices as a result of hypertrophied submucous collateral drainage circulation. Useful for diagnosis are oesophagogastroduodenoscopy, which points to stomach varices, and splenoportography or splenic artery angiography with venous phase, which highlight pathognomonic dilatation and tortuosity of the gastroepiploic veins. Surgical exploration typically shows: presence of large epiploic vessels, splenomegaly, absence of changes in the liver and in the portal and mesenteric circulation. Curative treatment of choice is splenectomy.

Adult↗
PubMed1990

[Intramural hematoma of the duodenum. Diagnosis and therapy].

Two cases of intramural haematoma of the duodenum caused by injury are examined. The clinical signs were non-specific: vomiting and epigastric pain. The salient features of laboratory tests were leucocytosis and hyperamylasaemia. Radiography of the digestive tract revealed classic bunching of the mucous plicae in the second section of the duodenum in one case and a mark on the gastric antrum together with a clear stretch in the third duodenal section in the other. Surgical examination and drainage of the haematoma was performed in one case while the other was given conservative treatment. Both patients were clinically cured on release from hospital.

Adolescent↗
PubMed1989

[Distal pancreatectomy with conservation of the spleen. Apropos of 3 consecutive cases].

Three distal pancreatectomies with preservation of the spleen are described. The indications were infiltration of the pancreatic tail by a gastric adenocarcinoma in the first patient; acute and chronic inflammation of the pancreas in the second and third. This type of operation takes very little longer than classic distal pancreatectomy with splenectomy, does not increase the incidence of postoperative complications and above all prevents the onset of sometimes lethal sepsis especially in young patients.

Acute Disease↗
PubMed1989

[Retrospective analysis of 1354 autopsies in cases of death caused by trauma].

1,354 deaths due to traumatic causes arising in 1976-1985 among patients admitted to the Molinette Hospital, Turin were analysed. The causes were divided into 5 major groups with to monitoring the course of the pathologies concerned over time. The results confirm an increase in deaths from septic shock that reflects increased recourse to surgery and the application of resuscitation manoeuvres and equipment, but a decrease in death due to haemorrhagic shock. These two pathologies represent the major lines for future research aimed at improving the prognosis in traumatic lesions.

Adult↗
PubMed1988

[Frequency of in vitro sensitivity to netilmicin and ceftizoxime on selected highly resistant flora in surgical intensive therapy].

The in vitro sensitivity of 132 gram positive and gram negative bacterial strains to Netilmycin and Ceftizoxime was assessed in order to update the statistics on the a priori efficacy of the antibacterial drugs. The flora studied were carefully selected as an extreme case of resistance to the standard antibiotics. Netilmycin was found to be effective against Staphylococci, Pseudomonas and Enterobacter, Ceftizoxime against Serratia, Acinetobacter, Proteus and Klebsiella. Both drugs were equally effective against E. coli and Citrobacter.

Cefotaxime↗
PubMedDate not supplied

Use of hepatitis C virus-positive grafts in liver transplantation: a single-centre experience.

AIM: Our goal was to evaluate the outcome of HCV(+) recipients after liver transplantation (LT) using HCV(+) donors and the interaction between donor and recipient viral strain. METHODS: We performed a retrospective analysis of 21 LT performed between 1998 and 2004 using livers from HCV(+) donors in HCV(+) recipients. Two hundred thirty-seven patients with HCV cirrhosis who underwent LT with livers from HCV(-) donors were the control group. Ishak score (IS) was evaluated for all HCV(+) grafts. The considered variables included donor age, hepatic enzymes, intensive care unit stay, HCV genotype, ischemia time, recipient age, UNOS status, Child score, HCV genotype (before and 6 months after LT) and IS (after LT). We analyzed patient, graft, and disease-free survival. RESULTS: HCV(+) donors were significantly older than HCV(-) donors. The cumulative 5-year patient and graft survivals and disease free intervals were not different between groups. IS grading was more than 2/18 in two cases; the only graft with a staging score over 2/6 was retransplanted for early nonfunction. In two cases, different HCV genotypes were matched and donor strain took over the recipient strain. In one patient, donor genotyping 2a-2c took over recipient genotyping 1b and 9 months after LT recurrent hepatitis was documented, but antiviral therapy cleared HCV. CONCLUSIONS: Livers from HCV(+) donors can safely be used in HCV(+) recipients. Hepatic biopsy must always be performed; livers with bridging fibrosis should not be used. The takeover of one strain by another may change the prognosis of the patient if the predominant strain is more sensitive to antiviral therapy.

Disease-Free Survival↗
PubMedDate not supplied

Mycophenolate mofetil monotherapy in liver transplantation.

AIM: Calcineurin inhibitors (CI) are associated with significant morbidity in transplant recipients. The aim of this study was to evaluate the effectiveness and safety of mycophenolate mofetil (MMF) monotherapy in liver transplantation (LT). METHODS: We analysed 32 patients (24 males, 8 female, of mean age 55.7 years) who underwent LT between 1994 and 2003. In 29 patients immunosuppressive therapy was cyclosporine; in three patients it was tacrolimus. Eleven patients were submitted for LT due to hepatitis B cirrhosis; eight for hepatitis C cirrhosis, six for alcoholic cirrhosis, and seven for other diseases. In these patients, MMF was added gradually, simultaneously reducing the dosage of CI up to complete withdrawal. We considered the efficacy (decrease in serum creatinine) and the incidence of complications (acute and chronic rejection, leukopenia, diarrhea). RESULTS: Patients were converted to MMF after a median of 50 months after LT. MMF monotherapy was started after a median of 9 months in association with CI. Indications for switch to MMF monotherapy were adverse effects of CI (renal disfunction in 30 patients) and de novo tumoral evidence after LT in two patients. Median dosage of MMF was 750 mg twice daily (500-1500 mg). There was a statistically significant decrease in serum creatinine levels (2.02-1.7 mg/dL; P = .0001). Side effects were: leukopenia in five of 32 patients (15.6%), diarrhea in four of 32 patients (12.5%), and one acute rejection. CONCLUSION: MMF monotherapy improved renal function and was not associated with a significant risk of allograft rejection. Side effects were mild with dose regimens up to 750 mg twice daily.

Adult↗
PubMedDate not supplied

New-onset diabetes after liver transplantation.

AIM: The impact of new-onset diabetes (NOD) posttransplantation has been underestimated in the past. The aim of this study was to evaluate the incidence of diabetes after liver transplantation. METHODS: We retrospectively analyzed the incidence of NOD in 899 patients transplanted in our center. According to International Consensus 2003 Guidelines, criteria for diagnosis of diabetes were: fasting plasma glucose > or =126 mg/dL, symptoms of diabetes plus casual plasma glucose concentrations > or =200 mg/dL, and 2-hour plasma glucose levels > or =200 mg/dL during an oral glucose tolerance test. We considered only patients with follow-up over 10 months. We evaluated the risk factors correlated with NOD (age, hepatitis C virus [HCV] positivity, tacrolimus vs cyclosporine, steatosic graft), and the outcomes of diabetic patient and their grafts. RESULTS: The incidence of NOD was 10.8% (90/830 patients). Sixty nine patients were diabetic before transplantation. Recipient age >45 years (14.7% vs 6.8%, P = .002, OR = 2.4) and HCV positivity (15.5% vs 7.8%, P = .001, OR = 2.2) significantly correlated with NOD. Multivariate analysis confirmed these variables to be independently associated with diabetic risk. Tacrolimus was associated with an increased risk of NOD (16.2% in HCV-negative patients, 25% in HCV-positive patients), but this difference was not statistically significant. Steatotic grafts (>10%) were associated with an increased risk of NOD (28.6% vs 10%, P = .001, OR = 3.6). The outcome of patients and grafts in the group of diabetic patients was not significantly different from all other patients. CONCLUSIONS: The incidence of NOD was more relevant in patients older than 45 years and/or HCV-positive. A steatotic graft was an important risk factor, and the match with high-risk patients should be avoided.

Age Factors↗