Tracheal intubation with the aid of a 'dental mirror'.
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Dental Instruments↗
Biomedical subjects
A Mattei
Publications and source records attributed to A Mattei.
Preoperative APACHE II and ASA scores in patients having major general surgical operations: prognostic value and potential clinical applications.
OBJECTIVE: To assess the prognostic value of the APACHE II score and the American Society of Anesthesiologists (ASA) classification system in preoperative evaluation of patients. DESIGN: Prospective study. SETTING: University hospital, Italy. SUBJECTS: 187 consecutive patients undergoing elective or emergency major general surgical operations. INTERVENTIONS: Patients were evaluated preoperatively using both indices. MAIN OUTCOME MEASURES: Morbidity and mortality within 30 days. RESULTS: Logistic regression and ROC curve analyses showed that the APACHE II score predicted morbidity and mortality well; it was superior to the ASA system in predicting outcome (area under the curve 0.894 for the APACHE II index, 0.777 for the ASA system; p < 0.001). The APACHE II score without its age points (area 0.888) had the same prognostic value as the complete score (area 0.894; p = 0.55). CONCLUSIONS: The APACHE II score may help clinicians to evaluate preoperatively the risk of postoperative morbidity and death after major general surgical operations. Age does not seem to have a specific weight.
APACHE↗
Evaluation of the POSSUM scoring system in lung surgery. Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity.
The current study was designed to test the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) in a population of lung resection candidates, and to propose its use as an instrument of evaluation of surgical outcome and quality in thoracic surgery. 250 consecutive patients submitted to lung resection from 1993 through 1996 at our institution were prospectively evaluated. Two significant predictive models were than yielded by logistic regression analysis (model I: POSSUM alone; model II: Combining POSSUM Physiological Score with predicted postoperative FEV1 ) and compared with each other by means of ROC curves analysis. The study of the areas under the ROC curves showed that these models were equally predictive of postoperative complications (area of model I=0.66; area of model II=0.67). Both models showed no significant differences between predicted and observed morbidity (chi-square test p > 0.05). In particular, in model II there was perfect agreement between observed and predicted morbidity in the group of patients with a predicted morbidity above 60%. These results suggest that POSSUM may be appropriately used as a tool of surgical audit even in lung surgery.
Adult↗
Mortality in psychiatric hospital patients: a cohort analysis of prognostic factors.
BACKGROUND: This work followed a group of patients living in a psychiatric hospital in Central Italy in 1978 at the time of enforcement of the Italian reform law (No. 180) for closing down mental hospitals. The study had the following aims: a) to compare in terms of mortality patients discharged into the community with patients who did not experience deinstitutionalization; b) to determine the survival of the cohort of patients and to analyse prognostic risk factors for death; c) to analyse differences in mortality rates between psychiatric patients and the general population. METHODS: The study was designed as an historical follow-up investigation. Univariate (product limit) and multivariate (proportional hazards model) methods were used to estimate prognostic variables and related death risks. Mortality was assessed using standardized mortality ratios (SMR) on the entire cohort as well as after stratification according to age, sex, cause of death and discharge status, assuming the Abruzzo Region's population as standard. RESULTS: Length of hospitalization and discharge from hospital are prognostic variables for death risk, with relative risks respectively of 4.22 (95% confidence interval [CI]: 2.41-7.40) for a length of hospitalization of 10-25 years, and 8.13 (95% CI: 4.73-13.88) for non-discharge. The global SMR of the cohort was 2.68 (95% CI: 2.42-3.07). Non-discharged patients showed higher SMR than discharged. Excess mortality was found both in males and females for circulatory, respiratory and undefined diseases. A significantly lower mortality for cancer was observed in male patients. A strong excess mortality was observed in younger patients (20-29 years: SMRmales = 43.57; SMRfemales = 97.52). CONCLUSIONS: Longer periods of hospitalization and non-discharge from hospital are the main risk factors for death in psychiatric patients, who globally experience higher death rates than the general population for a wide spectrum of causes of death, whatever their diagnosis or gender. These findings strongly suggest positive actions in order to overcome the effects of institutionalization.
Adult↗
Uncommon side-effects of interferon.
Beside the clinical manifestations usually observed during the treatment of chronic viral hepatitis with interferon, a small number of side-effects, less frequent and sometimes unexpected, have been described. These neurological, pulmonary, metabolic, cardio-vascular or psychiatric manifestations are uncommon but potentially severe. We here describe three cases of stroke that occurred during treatment with interferon in which the role played by the molecule could be questioned.
Adult↗
[Sudden deafness induced by interferon-alpha in viral hepatitis C].
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Antiviral Agents↗
[Encephalopathy associated with hyperammonemia in an alcoholic patient treated with sodium valproate].
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Ammonia↗
[Decisional analysis in the diagnosis of Chlamydia trachomatis].
The aim of this work is the use of decisional analysis for the clinical diagnosis of Chlamydia trachomatis, to verify the utility of making a routine direct immunofluorescence test with a strategy of no routine direct immunofluorescence test with a strategy of no routine test in women during gynecologic escannations. Patients eligible for this analysis were sexually active woman, who are not pregnant, woman in reproductive age who do not have evidence of a clinical syndrome associated with or known to be caused by Chlamydia trachomatis. Our results show that the decision as to the use of the test involves 0.87 utility, while the decision of no routine test involves a 0.80 utility. We can therefore deduce that the best strategy for a woman who subjects herself to routine gynecologic care is to use this test, because the Chlamydia trachomatis has been implicated as the etiologic agent of acute salpingitis, chronic and tubal infertility.
Adult↗
[Liver damage induced by the ingestion of a product of phytotherapy containing wild germander. Four cases].
We report 4 cases of patients who developed hepatic injury during administration of herbal medicines for loosing weight with Wild Germander. Three developed jaundice and one had fatigue. Aminotransaminase activities were increased in all patients. Outcome was favorable after drug withdrawal in all patients. Liver biopsy showed centrolobular necrosis and portal lymphoplasmocytic infiltration. Another drug than Wild Germander might have been implicated in hepatic injury in two patients. The similarity of these cases suggests, however, that Wild Germander, like other herbal medicines, may be responsible for hepatic injury.
Acute Disease↗
[Mixed venous oxygen saturation during infusion of PGI2 in the critically ill patient].
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Critical Illness↗
[The Ehlers-Danlos syndrome and its surgical implications].
The Ehlers-Danlos syndrome, type IV, i.e. the arterial and ecchymotic variety, has a severe prognosis and may represent a threat to life in that it predisposes to spontaneous rupture of the intestine and large vessels. The authors report a case in which spontaneous rupture of the colon and thoracic aorta occurred in short succession. Description of the syndrome and its many variants is preceded by a brief explanatory note on the formation and composition of collagen and its different types. The authors stress the important surgical implications of the syndrome the special risks deriving from elective surgery. Serious consequences may also derive from pregnancy trauma and from acts such as arteriography, endotracheal intubation, endoscopy and other invasive procedures. After examining the cases reported in literature (Sacks, Barabas, Beighton Sykes), they point out that, contrary to what is generally believed, the syndrome is not rare and cases, sporadic or familial, of recurrent episodes of spontaneous rupture of the intestine and large vessels or peripheral arteries are frequent. The authors come to the following conclusions: rupture of the aorta may occur spontaneously or after minimal trauma in subjects with EDS type IV and the cases complicated by spontaneous colon perforation would take advantage from definitive colostomy, considering the high incidence of recurrent perforations when intestinal continuity is restored.
Adolescent↗
[Impairment of diuresis in surgical intervention. Role of urinary prostaglandins].
In 8 patients who underwent abdominal surgery for non-neoplastic reasons, we have evaluated some parameters of renal function (PRP, NaU, GFR and diuresis) plasma levels of PRA and ADH and urinary prostaglandins PGE2 and 6-keto-PGF1 alpha. In 4 patients we found that surgery per se was associated with enhancements of PRA, ADH and 6-keto-PGF1 alpha. In other 4 patients, Indomethacin, a specific inhibitor of prostaglandin synthesis was given and this was followed by impairment of natriuresis and RPF. These data confirm the central role of prostaglandins in the control of diuresis and natriuresis and suggest that use of drugs affecting prostaglandin synthesis should be avoided in patients who are undergoing surgery.
Adult↗
Cabergoline: long-acting oral treatment of hyperprolactinemic disorders.
Cabergoline, a new orally active dopaminergic drug with an extremely long-lasting PRL-lowering effect, was given to 48 hyperprolactinemic women for 3-18 months (median, 8 months) at doses varying between 0.2-3 mg/week administered one to three times weekly. Serum PRL levels declined to normal in 41 women, 30 of whom received 0.2-1 mg cabergoline once weekly, 8 received 0.2-0.5 mg twice weekly, and 3 received 0.4-0.6 mg 3 times weekly. Five women had slightly supranormal serum PRL levels while receiving 0.3-0.6 mg once weekly, but the dose was not increased because the lower dose had produced the desired clinical benefit. Two women had 50% reductions in their serum PRL levels, but remained hyperprolactinemic while receiving 2-3 mg cabergoline weekly. Among 30 amenorrheic women, 28 had resumption of menses, the exceptions being 2 hypopituitary women, presumptive evidence of ovulation was available in 21. Marked tumor shrinkage occurred after 3-month treatment in 5 of the 6 women who had macroprolactinomas. Only 4 women had side-effects during the first weeks of treatment, and these vanished despite continued cabergoline administration at the same or reduced, but still effective, doses. In a short term, double blind study, cabergoline at 3 different schedules (0.4 mg twice weekly, 0.2 mg 4 times weekly, and 0.4 mg 3 times weekly for 3 weeks, followed by 0.4 mg twice weekly) or placebo was given to a total of 24 hyperprolactinemic women (6 in each subgroup) for 8 weeks, with weekly evaluation of serum PRL levels and side-effects. All 3 cabergoline schedules, but not placebo, induced significant reductions in serum PRL concentrations during the 8-week treatment period. Mild transient side-effects occurred in 7 drug-treated patients (nausea in 5; dizziness in 3). We conclude that cabergoline is effective treatment for hyperprolactinemia. Its efficacy, tolerability, and long duration of action may make it the drug of choice for patients with hyperprolactinemia.
Administration, Oral↗
[Arterial pressure and heart rate: postural variations in the elderly].
The behaviour of arterial blood pressure and heart rate after an active change from the supine to the upright posture was studied in the aged. A significant decrease in the average values for systolic and diastolic blood pressure and a significant increase in the average values for heart rate in the first minute of the upright posture were observed. The systolic and diastolic pressures are reduced in a higher percentage of the cases in the 80-94 year age class. In the same class the PAS is more frequently reduced in the male and the PAD in the female. The heart rate, in the upright posture, is higher in 80-94 year-old males without a significant difference between the sexes.
Aged↗
[The male factor in fertilization in vitro].
Every sperm parameter has an effect on the chances of fertilization. When fertilization has been obtained with a sperm, the cleavage rate is identical regardless of the count, the mobility or the results of the migration test. On the contrary, in case of teratospermia, the cleavage rate of fertilizing sperms is significantly decreased. The rate of pregnancy by transfer is identical with normal sperm and sperm deficiency.
Cleavage Stage, Ovum↗
Pharmacokinetics and biological effects of captopril and hydrochlorothiazide after acute and chronic administration either alone or in combination in hypertensive patients.
The pharmacokinetics of free unchanged captopril, total captopril and hydrochlorothiazide (HCTZ) were investigated in three groups of patients with moderate essential hypertension and normal renal function on the first and on the 45th days of an oral treatment with either captopril (50 mg once daily, n = 7) or HCTZ (25 mg once daily, n = 10) or their combination captopril 50 mg + HCTZ 25 mg once daily, n = 8. Simultaneously, the effects of the three treatments on plasma converting enzyme activity (PCEA) and plasma renin activity (PRA) were measured. Elimination half-lives of total captopril after acute (7.8 +/- 2.3 h) or chronic (7.0 +/- 0.5 h) captopril dosing were similar to those of HCTZ after acute (6.5 +/- 1.0 h) or chronic (8.0 +/- 2.5 h) HCTZ dosing. Elimination half-life of free unchanged captopril was 0.81 +/- 0.09 h after acute and 0.96 +/- 0.03 h after chronic captopril dosing. Addition of HCTZ to captopril induced no major change in free and total captopril pharmacokinetic parameters, in PCEA inhibition and in PRA increase (as they were determined after captopril alone) on acute as well as on chronic treatment. Addition of captopril to HCTZ induced no major change in HCTZ pharmacokinetic parameters and in PRA increase compared with those determined after HCTZ alone. Chronic treatment with captopril + HCTZ resulted, like chronic captopril treatment, in no accumulation of captopril, in no significant modification of free and total captopril pharmacokinetic parameters and of PCEA inhibition (as determined after acute administration) but led to a significant enhancement of the acutely induced increase in PRA. Chronic treatment with captopril + HCTZ resulted, like chronic HCTZ treatment, in no accumulation of HCTZ, in no significant modification of HCTZ pharmacokinetic parameters (as determined after acute administration) but also led to a significant enhancement of the acutely induced increase in PRA. Thus, the longer duration of the antihypertensive action of captopril + HCTZ as compared to that of captopril cannot be ascribed to a pharmacokinetic or biological interaction between captopril and HCTZ.
Adult↗
Determination of the optimal dosage regimen of captopril + hydrochlorothiazide in the treatment of moderate arterial hypertension.
A multicentre controlled trial was carried out to determine the optimal dosage of a 2/1 combination of captopril plus hydrochlorothiazide (HCTZ) in mild hypertension at three doses against placebo in a 6 week double-blind trial. The number of patients was 111:27 received placebo; 26 were treated with captopril 25 mg plus HCTZ 12.5 mg (25/12.5); 25 with captopril 50 mg plus HCTZ 25 mg (50/25); and 33 with captopril 100 mg plus HCTZ 50 mg (100/50). A significant fall in blood pressure was seen in all four groups, but was greater with the active treatments. The percentage of patients who were normalized [diastolic blood pressure (DBP) less than or equal to 90 mm Hg] or good responders (10% fall in DBP) increased as a function of the dose. At Day 21, the antihypertensive effect of 50/25 was similar to that of 100/50, but greater than that of captopril 25-HCTZ 12.5. At Day 42, the antihypertensive effects of the three doses were similar. Tolerance data showed a higher incidence of side-effects with 100/50 than with the other dosages. Thus, 50/25 appeared to be the optimal dosage for the control of mild hypertension.
Captopril↗
Paradoxical stimulation of human sperm motility by 2-deoxyadenosine.
Exposure of cryostored human spermatozoa to 2-deoxyadenosine resulted in significant increases in percentage motility, the linear velocity of progression and the frequency of sperm head rotation, which were maximal at a dose of 2.5 mM. At the same dose both adenosine and caffeine significantly increased percentage motility, although neither compound influenced the quality of sperm movement as assessed by time-exposure photomicrography. 2-Deoxyadenosine was also significantly more effective than caffeine in sustaining the motility of cryostored spermatozoa as well as in enhancing the motility of fresh and washed preparations of human spermatozoa. The ability of caffeine and 2-deoxyadenosine to influence sperm motility was counteracted by the presence of calcium in the external medium although the latter was less susceptible to such inhibition and still enhanced motility in the presence of calcium levels (1.7 mM) typical of media used for in-vitro fertilization. The mechanism of action of 2-deoxyadenosine was associated with an increase of intracellular cAMP levels, which were sustained over a time course lasting from 5 to 180 min and exhibited significant dose dependency over the range 1-10 mM. The response to 2-deoxyadenosine did not involve any changes in the steady state levels of ATP and was augmented by the presence of the phosphodiesterase inhibitors, IBMX and caffeine. We conclude that 2-deoxyadenosine is a powerful stimulator of human sperm motility and that this effect involves an increase of intracellular cAMP levels via mechanisms which do not involve the classical 'R'-site receptor mediated pathway.
1-Methyl-3-isobutylxanthine↗