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Biomedical subjects

D Miotto

Publications and source records attributed to D Miotto.

83 records · Page 5Linked to original sources
PubMedDate not supplied

[Endoscopic approach to biliary stones: experience acquired in a general surgery unit. Comparison of 2 periods].

The outcome of the laparoscopic technique, that in the first years needed to be applied in non complicated situations, imposed a more frequent use of ERCP preoperatively; this procedure was originally confined to a handful of European and American centers, but later spread to almost all large hospitals. Improvements in the techniques and materials have gone side by side with more specific indications and the assessment of complications. The purpose of the present study was to analyze the experience of a General Surgery Unit in terms of acquiring and developing skills in treating biliary stones by ERCP.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

[Substance P in the sputum of patients with chronic obstructive pulmonary disease and occupational exposure to respiratory irritants].

The role of tachykininis in airway inflammation has been extensively demonstrated in experimental animal models, but evidence in humans is very sparse. The aim of this study was first to quantify the content of substance P (SP) in sputum of a group of patients, with chronic obstructive pulmonary disease and with exposure to occupational irritants. Secondly, to compare them with sputum SP content of a group of control subjects.

Humans↗
PubMedDate not supplied

Subarachnoid anesthesia for loco-regional antiblastic perfusion with circulatory block (stop-flow perfusion).

AIM: Loco-regional antiblastic perfusion with circulatory block (stop-flow perfusion, SFP) is a procedure designed to treat solid tumors of the limb and pelvis in an advanced stage, like melanoma, sarcoma of the soft tissues and colon-rectal cancer. The aim of this study was to evaluate if subarachnoid anesthesia could represent a safe and suitable anesthetic technique for this procedure. METHODS: Thirty SFP procedures were performed in the angiographic room, 15 for the treatment of lower-limb neoplasias and 15 for pelvic neoplasias. The patients (ASA I-III) had a mean age of 59.1 years (range: 19-81 years). The patients were given different dosages of bupivacaine (range: 10-20 mg) in hyperbaric solution at the concentration of 0.5% and 1% by lumbar subarachnoid injection at different levels (from T12-L1 to L3-L4). Standard monitoring was set up (ECG, pulse-oximetry, and non-invasive artery pressure). The use of any anesthetic and analgesic drug, eventually used in the intra- or postoperative period, was recorded. RESULTS: The lumbar puncture was approached at L1-L2 and L2-L3 levels in 80% of the cases. Doses of bupivacaine between 12 mg and 14 mg were administered in 2/3 of the cases. Bupivacaine was formulated in hyperbaric solution and administered at a concentration of 0.5% (8 patients) or 1% (22 patients). Complica-tions related to the anesthetic technique were absent. Intraoperative pain control was almost complete with one exception, when the procedure lasted unusually long. Pain control was satisfying immediately after the procedure as well: only in 3 cases were non-opiod analgesics administered within the first 6 h. CONCLUSIONS: Spinal subarachnoid anesthesia has proven to be an effective, safe, and easy-to-manage technique for carrying out SFP procedure in a non-conventional environment such as an angiographic room. It was free of serious side effects and well tolerated even in patients in poor general conditions.

Adult↗
PubMedDate not supplied

Vascular parenchymal sources of upper gastrointestinal bleeding.

Fourteen cases of upper gastrointestinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.

Adult↗
PubMedDate not supplied

[Radiologic management of abdominal surgical drainage].

The authors consider their early results in radiological drainage management of abscesses and fistulas complicating abdominal surgery by integrated use of angiographic materials and interventional methods. Twenty-five patients, affected by isolated (32%) or communicating (68%) abscesses, were treated. Cavity obliteration and clinical recovery were obtained in 18 patients (72%), partial success in 1 (4%); a patient was treated unsuccessfully. Five patients were not evaluated because they died or underwent surgery again. Average drainage interval was 54 days. Drainage management was carried out by replacement of surgical catheters and fibrin occlusion. Fibrin occlusion was performed in 7 patients with the following results: 3 successes, one partial success and one failure. Two cases were not evaluated. Although a comparison with a control group was not performed, the authors consider the procedure a safe, economic and simple method for abdominal abscess management.

Abdomen↗
PubMedDate not supplied

[The percutaneous transluminal angioplasty of Brescia-Cimino arteriovenous fistulae. An evaluation of the results].

The average patency time after creating an endogenous arteriovenous Brescia-Cimino fistula for hemodialysis is limited. May 1990 through October 1992, 29 PTAs were performed in 23 patients with malfunctioning hemodialysis Brescia-Cimino fistulas of the forearm, by cannulation of the venous anastomotic branch and by balloon catheter dilatation. Thirty-six venous stenoses, 7 arterial anastomotic stenoses and 1 venous occlusion were treated. In 5 patients a second dilatation became necessary due to recurrent fistula malfunction after a mean period of 5 months. Twenty-eight of 29 PTAs (96%) were immediately successful. The primary patency rates were 79% at 6 months, 61% at 1 year and 61% again at 2 years. The secondary patency rates were 90%, 83% and 83%, respectively. Three post-PTA fistula thromboses (10%) were observed: two of them were successfully treated by local fibrinolysis while in the extant case a new A-V shunt was created. In our opinion, PTA is the treatment of choice for malfunctioning Brescia-Cimino fistulas; the incidence of complications was low in our series.

Adult↗
PubMedDate not supplied

[Long-term results of chemoembolization for hepatocarcinoma].

We reviewed the long-term results of transcatheter arterial chemoembolization in the treatment of inoperable hepatocellular carcinoma (HCC) complicating cirrhosis; the survival analysis was used to assess the clinical efficacy of the procedure. Several chemoembolization protocols are discussed because no standard treatment exists. Literature data show cumulative survival rates after chemoembolization for an HCC to range 60% to 80% at one year and 40% to 50% at two years; comparative studies, although contradictory, show a trend of chemoembolization to prolong survival in patients with inoperable carcinoma. The main prognostic factors are tumor size and extent, liver function impairment, the grade of Lipiodol tumor uptake, and the tumor response to therapy. The complication rates of chemoembolization vary largely in the literature, mainly because of the different standards used to define adverse events. Chemoembolization morbility rate is usually high, ranging 20% to 55%, but most complications are generally well treated with conservative management. The mortality rate is usually very low and well acceptable for a palliative anticancer therapy. In conclusion, chemoembolization is clinically effective in prolonging survival in cirrhotic patients with HCC; the lack of any reliable alternative therapy makes chemoembolization play a major role in the treatment of HCC when surgery or percutaneous ethanol injection are unfeasible.

Carcinoma, Hepatocellular↗