PubMed Health⌕ Search

Biomedical subjects

A Gregori

Publications and source records attributed to A Gregori.

At least 19 recordsLinked to original sources
PubMed2007

Sick notes, general practitioners, emergency departments and fracture clinics.

BACKGROUND: General practitioner waiting times are increasing. The two national surveys regarding general practice showed that the number of patients waiting for >or=2 days for an appointment rose from 63% to 72% between 1998 and 2002, with 25% waiting for >or=4 days. The Department of Health recognised that many patients discharged from hospitals and outpatient clinics required to visit their general practitioner for the sole purpose of obtaining a sick note. The report entitled Making a difference: reducing general practitioner paperwork estimated that 518 000 appointments (and 42 000 GP h) could be saved by ensuring that these patients were issued with a sick note directly from hospital rather than being referred to their general practitioner. This practice was to be adopted from July 2001 and included patients discharged from wards as well as those seen in outpatient departments. METHOD: 50 emergency departments and fracture clinics in Scotland and England were contacted to assess whether these guidelines had been adopted. Only hospitals with both accident and emergency and fracture clinics were included; nurse-led and paediatric departments were excluded. RESULTS: Of the 25 Scottish emergency hospitals contacted, 4 (16%) accident and emergency departments and 8 (32%) fracture clinics issued sick notes. This was compared with 5 of 25 (20%) accident and emergency departments and 12 of 25 (48%) fracture clinics in England. Four Scottish and five English accident and emergency departments stated that it was policy to give sick notes, three Scottish and four English departments said that it was policy not to give them and the rest (72% in Scotland and 64% in England) stated that they had no clear policy but "just don't give them". CONCLUSION: The 2001 guidance from the joint Cabinet Office/Department of Health has not been fully incorporated into standard practice in Scotland and England. If all emergency departments and fracture clinics were to issue sick notes to patients requiring >7 days absence from work, this could reduce general practitioner consultations and improve waiting times.

Emergency Service, Hospital↗
PubMed2002

Minimally invasive laparoscopic neobladder.

PURPOSE: To our knowledge orthotopic reconstruction after laparoscopic radical cystectomy has not been described in the human. After anatomical and surgical studies on cadavers we developed an original technique and performed the first laparoscopic radical cystectomy with pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction in a patient. MATERIALS AND METHODS: Our technique has 3 steps, namely laparoscopic pelvic clearance, external reconstruction and laparoscopic reconstruction. After cystoprostatectomy and lymphadenectomy were completed via laparoscopy we removed the surgical specimens through a 5 cm. supraumbilical incision. Through the same incision an ileal loop was extracted from the abdominal cavity, isolated, detubularized and partially reconfigured. Intestinal continuity was restored extracorporeally. All intestinal loops were inserted back into the abdomen and pneumoperitoneum was started again. The ureteroileal (nipple valve) and urethroileal anastomoses were formed via laparoscopy and the neobladder was then completed with an intracorporeal running suture. RESULTS: Operative time was 450 minutes and blood loss was 350 ml. Postoperatively pain was minimal. The patient was ambulatory, regained bowel activity on postoperative day 2 and began food intake 2 days later. He was discharged home on postoperative day 7 with an indwelling catheter, which was removed after 7 days. Histopathological examination showed organ confined bladder cancer without margin invasion. CONCLUSIONS: To our knowledge we report the first case of laparoscopic radical cystectomy with ileal orthotopic reconstruction. This original technique combines the advantages of minimally invasive laparoscopy with the speed and safety of open surgery.

Aged↗
PubMed2001

Comparison of ultrasound-guided biopsies and prostatectomy specimens: predictive accuracy of Gleason score and tumor site.

OBJECTIVE: To critically evaluate the accuracy of sextant biopsies in predicting Gleason score and the site of tumor location in patients with clinically localized prostate cancer treated by radical perineal prostatectomy. METHODS: The case records of 289 patients with clinically localized prostate cancer who underwent radical perineal prostatectomy were reviewed, comparing the Gleason score and tumor site location as determined by sextant ultrasound-guided core biopsies with the Gleason score and tumor distribution within the surgical specimens. The prostatectomy specimens were further characterized by extent of disease as organ-confined, specimen-confined or margin-positive. RESULTS: The Gleason score was identical in 126 (43.5%) patients. An upgrading in the surgical specimen occurred in 118 (40.8%) cases, a downgrading in 43 (14.8%). Overall, 193 (66.7%) patients had a unilateral positive biopsy, while 96 (33.2%) patients had bilateral positive biopsies. Sixty-four (33.1%) patients with a unilateral positive biopsy had cancer confined to one side of the gland, while 127 (65.8%) showed bilateral disease; 142 (73.5%) patients had organ-confined tumors versus 51 (26.4%) patients with capsular penetration. In the 96 patients with bilateral positive biopsies, 64 (66.6%) patients had intracapsular cancer versus 32 (33.3%) patients with either specimen-confined or margin-positive disease. The overall rate of positive margins was 14%. Fifty-one (61.4%) of the 83 patients with non-organ-confined disease had posterolateral capsular penetration in the region of the superior pedicle of the neurovascular bundle, while 28 (33.7%) patients had apical capsular penetration, in the region of the inferior neurovascular pedicle. CONCLUSIONS: The ability of sextant ultrasound-guided biopsies to estimate the pathological grading is satisfactory: when we consider a difference of +/- 1 in the final Gleason score, the overall correlation is 80%. In 66% of the cases, sextant biopsies predicted unilateral disease when bilateral disease existed. A unilateral positive biopsy does not predict unilateral disease.

Adult↗
PubMed2000

Thyrotropin-releasing hormone time-dependently influences thyrotropin microheterogeneity--an in vivo study in euthyroidism.

Thyrotropin (TSH) is secreted not as one distinct hormone, but rather as a group of isohormones which differ in their oligosaccharide composition. Although the mechanisms regulating TSH glycosylation are not fully understood, there is strong evidence that TRH plays an important role. The aim of our study was to determine the dynamic influence of TRH on TSH microheterogeneity. Sera were obtained from euthyroid volunteers (n=20) before and 30, 60, 120, 180 and 240 min after intravenous, nasal and oral administration of TRH in three independent runs (randomized order, at a time-interval of 3 weeks between each run). TSH was immuno-concentrated and analysed by isoelectric focusing (IEF) and lentil lectin affinity chromatography. TSH immunoreactivity was measured by an automated second-generation TSH immunoassay. Overall, serum TSH concentrations reached maximal values 30 min after intravenous, 60 min after nasal and 180 min after oral TRH stimulation. IEF analysis revealed 63.3+/-3.3% of pituitary standard TSH (IRP 80/558) in the neutral pH range (8>pH>6). In contrast, 30 min after TRH stimulation 80.8+/-3.7% (P<0.001) and 60 min after TRH stimulation 44.9+/-2.2% (P<0.001) of the TSH of euthyroid probands were found in this pH range, whereas 180 min after TRH stimulation 58.4+/-2.3% (P<0.001) were detected in the acidic pH range (pH<6). This shift of TSH composition in euthyroidism after TRH stimulation was confirmed by lentil lectin analysis of TSH: core-fucose content of euthyroid TSH was 73.4+/-3.8% 30 min and 22.9+/-3.2% 120 min after TRH stimulation in contrast to basal (53.3+/-1.8%; P<0.001) and pituitary standard (IRP 80/558) TSH (63.0+/-0.9%; P<0.001). In conclusion, in euthyroidism, TRH stimulation time-dependently changes the distribution pattern of the TSH isoforms from an alkaline and neutral to a more acidic one. This corresponds to the secretion of isohormones with altered bioactivity which could influence the fine-tuning of thyroid function.

Administration, Intranasal↗
PubMed1998

Pelvic fractures: the golden hour.

Major accident units should be able to apply standard treatment methods to control life threatening haemorrhage within the 'Golden Hour', as recommended by the ATLS guidelines. In this study all 31 major accident units in Scotland were examined to determine their ability to stabilize a pelvic fracture within this period. We found that only eight units could potentially stabilize a pelvis within 1 h. In eight other units no appropriate emergency treatment was available. We recommend that all units designated to receive multiple injuries should have a pelvic stabilization device as well as the training and expertise to use it.

Acute Disease↗
PubMed1996

[Non-steroid anti-inflammatory agents and gastrointestinal protection: adequate prescription in primary care?].

OBJECTIVES: To find the frequency of prescription of gastro-intestinal protectors (GIP) at the same time as non-steroidal anti-inflammatory drugs (NSAID). To find certain characteristics linked to their use in primary care. To evaluate how correctly they are prescribed. DESIGN: A crossover descriptive study. SETTING: A base urban health area. PATIENTS: Patients over 14, who attended in 1994, who had a medical history and were treated with NSAID. MEASUREMENTS AND INTERVENTIONS: 1,115 medical histories were obtained by simple randomised sampling, of whom 205 were under treatment with NSAID. A questionnaire was used to evaluate: age, sex, NSAID treatment, GIP, history of peptic ulcer, corticoid or acenocoumarol treatment, tobacco, alcohol and related pathology. After a complete bibliographic review, some criteria were fixed for when it is correct to give GIP-NSAID. RESULTS: The prevalence of NSAID prescription was 18.39%. 34 patients treated with NSAID received GIP at the same time. Aceclophenac was the most widely prescribed NSAID; and H2 antihistamines, the drugs most commonly used as GIP.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Surgical treatment of varicocele at adolescence.

The problem of the surgical treatment of varicocele at adolescence is discussed. We tried to establish a good method for surgical operation capable eliminating the renal-spermatic reflux, the stasis of blood into the pampiniformis plexus with the increase of temperature and the altered metabolic exchanges with the spermatogenetic tissue. The technique of high ligation and division of the spermatic veins with Bilateral Scrotal Exploration (BSE), spermatic venography, microsurgical excision of dilated veins of the plexus and eversion of vaginalis membrane in order to avoid the frequent appearance of postoperative hydrocele is presented in a group of 150 adolescent patients.

Adolescent↗
PubMed1993

[Life habits and impotence].

The authors propose their experience of 595 men complaining of erectile dysfunction. Relationships among erectile dysfunction, taking specific medicaments (hypotensive agents) and habits (smoking) are considered. A collaboration among specialists in the management of impotent patients has been proposed.

Adult↗
PubMed1992

Interstitial white matter brain oedema does not alter the electroencephalogram.

An experimental study was performed to determine the effects of interstitial white mater oedema on the electroencephalogram (EEG). Using both rodent and feline infusion models of focal brain oedema no difference was found between the EEG waveforms recorded epidurally from the infused and control hemispheres. It is concluded that where focal slow-wave EEG abnormalities overlie oedematous brain the EEG abnormalities are not primarily related to the brain oedema but arise from either local biomechanical or other pathophysiological mechanisms.

Animals↗