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Biomedical subjects

A Gramegna

Publications and source records attributed to A Gramegna.

At least 19 recordsLinked to original sources
PubMed2001

[Economic burden and clinical course of HIV infection and AIDS today: how the variation of natural history, available treatments, and strictly related costs play a role in needs of health care].

In order to provide an updated balance of the evolution of the natural history of HIV infection, the major clinical end-points of disease morbidity and mortality were compared with the progressively increasing use of highly active antiretroviral therapy (HAART), in a cohort of patients followed by our tertiary care centre in an eight-year period including both the pre-HAART and the HAART era. Although direct expenditures for antiretroviral agents reached even 99.8% of overall costs related to drugs and blood derivatives at our entire unit in the year 2000, a clear shift towards outpatient assistance of HIV infection was realized during recent years, leading to an increased and greatly varied spectrum of infectious diseases hospitalized at our inpatient and Day-Hospital units. Due to the significant reduction of inpatient expenditures, even the elevated costs of management of HIV disease based on HAART and periodic virological and immunological monitoring are expected to remain cost-effective, at least during the next few years.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Preliminary results of a new technique for inguinal hernia repair].

BACKGROUND: An original technique for the treatment of inguinal hernia is described: this operative technique consists of a Marlex (mono-filament knitted polypropylene) mesh sutured in the preperitoneal space under the fascia trasversalis. METHODS: A total of 202 hernioplasties have been treated: 100 of these have been controlled after six months to detect complications and recurrencies. RESULTS: One recurrency (1%) was found. No previous selection of patients was done. The mesh-repair is simple, rapid, and causes less discomfort than conventional sutured herniorraphy. This technique is compared with the other tension-free mesh hernioplasties. CONCLUSIONS: This operative technique is a prophylaxis for the femoral hernia described as later complication of other techniques.

Adult↗
PubMed1997

[Preoperative colonic lavage and one-stage excision-anastomosis in obstruction of the left colon].

In a retrospective series of 95 patients requiring emergency surgery for distal colonic obstruction, primary bowel resection followed by immediate anastomosis after intraoperative colonic irrigation was performed. Carcinoma was the cause of obstruction in 81 cases (85%); 13 patients had diverticulitis, and 1 had sigmoid volvulus. The technique of on-table lavage was similar to that described by Dudley in 1980: a caecostomy tube was used in 86 patients (90%) and was removed on the tenth postoperative day. 4 patients died, none from complications of anastomotic leakage. There were three anastomotic leakages (3.1%) and 10 radiologic leaks were observed. 3 patients were reoperated. The mean hospital stay was 23 days. The results of this study suggest that intraoperative colonic irrigation is an effective method, enabling the surgeon to perform primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.

Aged↗
PubMed1997

[Extended lymphadenectomy in carcinoma of the right colon].

The Authors report on a retrospective study concerning 49 patients treated for a modified Dukes' stage B, C or D right colon cancer. A potentially curative right hemicolectomy with extended lymphadenectomy was performed. Locally advanced disease was treated by "en bloc" resection. Two (4.1%) patients died after surgery, in other 2 (4.1%) cases major postoperative complications were registered. Microscopic examination of the surgical specimens showed lymph node metastases in 44.9% of the cases: in this subgroup a metastatic involvement of the main (III level) nodal groups was detected in 22.7% of the patients. The Authors conclude that extended lymph node dissection does not increase postoperative complications and may play a role in the treatment of right colon cancer. A not negligible group of patients may be understaged or receive inadequate surgical treatment when submitted to traditional right colectomy.

Aged↗
PubMed1994

Pelvic perfusion in the adjuvant therapy of locally advanced rectal cancer. Feasibility trial and initial clinical experience.

PURPOSE: The increased risk of pelvic recurrence in patients with locally advanced rectal cancer seems to justify a more aggressive regional therapeutic approach. In this attempt a feasibility study has been recently activated on hyperthermochemotherapeutic pelvic wash in patients with resectable, locally advanced, cancer of the distal rectum. METHODS: Two alternative methods of hyperthermochemotherapeutic pelvic wash have been used in sequence. In the first method 3000 ml of warm (45 degrees C) saline solution containing 30 mg of mitomycin C were injected into the pelvis both intraoperatively and in the immediate postoperative period. In the second method a 60-minute perfusion of the pelvic space with 2000 ml of heated (45 degrees C) saline solution with 40 mg of mitomycin C was provided intraoperatively using an extracorporeal circuit. RESULTS: Four patients submitted to abdominoperineal amputation with pelvic lymph node dissection have been treated following one of the two methods. No complications related to the treatment occurred. Either the first or the second hyperthermochemotherapeutic pelvic wash method showed a high regional pharmacokinetic advantage with a perfusate/blood "AUCs" ratio of 576 and 374, respectively. CONCLUSIONS: The potential role of hyperthermochemotherapeutic pelvic wash as an additional regional treatment in locally advanced rectal cancer and the differences between the two methods, in our limited experience, are discussed.

Aged↗
PubMed1992

[Defecography and manometry in the postoperative follow-up of patients treated with colo-anal anastomosis by the Parks technique for neoplasm stenosis of the rectum].

The Authors report 15 cases of patients with adenocarcinoma of the rectum who were treated using Park's resection. Morphofunctional parameters are evaluated 3 months after surgery using defecography and manometry before the closure of the neostoma and the reactivation of the ano-rectal canal. Opaque defecography enables the morphology and dimensions of the anal canal to be examined together with modifications to the area between the rectum and the anal canal, and the impression of the pubo-rectal sling. In conclusion these data confirm the importance of surgery, whereas the correlation between defecographic and manometric results allows the functional recovery "ad integrum" of the area to be checked.

Adenocarcinoma↗
PubMed1989

On-table colonic irrigation in the treatment of left-sided large-bowel emergencies.

In a series of 27 patients who required surgery for distal colonic lesions, primary bowel resection with immediate anastomosis after intraoperative antegrade colonic irrigation was performed. The technique of on-table lavage was similar to that described by Dudley and Radcliffe in 1980; however, some new technical details are introduced to minimize fecal contamination. There were 17 men and 10 women (mean age, 68.5 years). Twenty patients were admitted for obstructing carcinoma of the left colon; 11 underwent immediate surgery, while the remaining 9 underwent delayed surgery after 12 hours of intravenous fluids and nasogastric suction. Of the remaining seven patients, five had perforated sigmoid diverticula and diffuse peritonitis and two had obstructing diverticular disease of the left colon with remarkable bowel distention. One hospital mortality occurred secondary to a ruptured aortic aneurysm. The radiologic anastomotic leakage rate was 14.8 percent. Clinical anastomotic dehiscence was not observed.

Aged↗
PubMed1987

Effect of timepidium bromide on the motor activity of the sphincter of Oddi: manometric evaluation of intracholedochal pressure.

The intracholedochal pressure changes induced by timepidium bromide were studied in 12 patients who had undergone surgery because of gall bladder stones and were receiving transient external bile drainage by the Kehr method. Cholangiomanometric examination, carried out under basal conditions and after an intravenous dose of 15 mg timepidium bromide, revealed a statistically significant decrease in mean intracholedochal pressure in all 12 patients. It is concluded that timepidium bromide is likely to exert a direct action on the sphincter of Oddi, decreasing its basal tone and thus causing a decrease in intracholedochal pressure.

Aged↗
PubMed1986

Malignant duodenocolic fistula. A case report.

Malignant duodenocolic fistula is a rare condition in which radical surgical treatment is seldom possible. A personal case treated by pancreaticoduodenectomy is presented with a review of the literature.

Adenocarcinoma, Mucinous↗