Biomedical subjects

E Pastore

Publications and source records attributed to E Pastore.

At least 19 recordsLinked to original sources

PubMed2003

[Laparoscopic conservative treatment of ovarian dermoid cysts].

Two methods for the laparoscopic dissection of dermoid ovarian cysts, less than 10 cm, in 55 fertile women, are compared. Water dissection was performed in 23 patients and bipolar scissors were used in 32 patients, creating a rhomb on the surface of the ovary, just to obtain a good traction for atraumatic dissection. The mean surgical time, complications and hospital stay have been compared. Operative laparoscopy is the technique of choice to remove most, if not all, ovarian dermoid cysts. It is suggested to use particular strategies in order to safely and easily dissect in toto the cysts.

Adolescent↗

PubMed2002

Does chronic pacing affect exercise capacity after Mustard operation for transposition of the great arteries?

Late survival after Mustard repair of transposition of the great arteries is generally good but is often characterized by progressive deterioration of ventricular function and by late postsurgical arrhythmias, thus imposing the need for permanent pacing. To evaluate how chronic pacing affects long-term exercise capacity, we compared two groups of these patients: group 1, comprising 12 patients, aged 9.0 +/- 2.6 years, without pacemaker; and group 2, comprising 18 patients, aged 9.3 +/- 2.0 years, with pacemaker. Patient evaluation included history, physical examination electrocardiograph, Holter monitoring, and echocardiography. Pacing modes were as follows: AAI (6 patients), AAIR (9 patients), VVI (2 patients), and VVIR (1 patient). At exercise test we evaluated exercise tolerance, maximum heart rate, blood pressure, oxygen consumption, and cardiac output at rest and at peak exercise. The two groups were comparable for all variables examinated. All pacemakers showed normal function. During the exercise, 11 of 12 patients in group 1 showed sinus rhythm, and in group 2, 11 patients showed sinus rhythm, 5 junctional rhythm, and 2 continuous pacing. There were no significant differences between groups. Chronically paced Mustard patients but with restoration of spontaneous rhythm during the exercise test do not show reduced exercise tolerance in comparison with nonpaced Mustard patients.

Arrhythmias, Cardiac↗

PubMed2002

[Value and significance of cystoscopy during laparoscopic hysterectomy].

The purpose of our study is to identify the ureteral and vesical lesions that may occur in the course of total laparoscopic hysterectomy using intraoperative cystoscopy. After the patient has been placed in dorsolithotomic position, we used a Hourcabie manipulator, a 10 mm umbilical trochar and two 5-mm suprapubics. Total hysterectomy is carried out and after closing the vagina 5 ml of stain in a physiological solution are injected into the vein to carry out cystoscopy. Analysis refers to the first 120 patients from 1998 to 1999 treated with laparoscopic hysterectomy. No material or vesical intraoperative lesions were found in any of the patients with the exception of a vesical lesion which was sutured during laparoscopy. Even with the cystoscopic finding normal, 2 fistulas were observed 20 and 25 days after the operation, so the negativity of the cystoscopy excludes certainly immediate complications but not late ones. Furthermore, not all surgeons carry out intraoperative cystoscopy, so the data available are scanty.

Cystoscopy↗

PubMed2002

[The use of Foley's catheter and suturing to control abdominal wall haemorrhage provoked by the trochar. Comparative study].

Lesions of the abdominal vessels are becoming more frequent owing to the increase in the number of laparoscopies carried out with trochars: they occur in fact in 2% of cases. A study has been carried out to compare the effectiveness of 2 methods for stopping haemorrhage: the use of a Foley catheter and suturing with a Reverdin needle. Abdominal haemorrhages take place as a result of lesions during introduction of accessory trochars in the superficial, circumflex and deep epigastric vessels. Six patients were treated with Foley's catheter while 13 were treated with Reverdin's needle under visual control, maintaining the same operative route, something that is not possible with the Foley catheter. Patients treated with suturing were discharged within 24 hours without irritation or pain.

Abdominal Wall↗

PubMed2001

Cardiorespiratory functional assessment after pediatric heart transplantation.

Limited data are available on the exercise capacity of young heart transplant recipients. The aim of this study was therefore to assess cardiorespiratory responses to exercise in this group of patients. Fourteen consecutive heart transplant recipients (six girls and eight boys, age-range 5-15 yr) and 14 healthy matched controls underwent a Bruce treadmill test to determine: duration of test; resting and maximum heart rates; maximum systolic blood pressure; peak oxygen consumption (VO2 peak); and cardiac output. Duration of test and heart rate increase were then compared with: time since transplantation, rejections per year, and immunosuppressive drugs received. The recipients also underwent the following lung function tests: forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). When compared with healthy controls, transplant recipients had tachycardia at rest (126 +/- 3.7 beats/min; p < 0.001); significantly reduced tolerance (9.3 +/- 0.4 min; p < 0.001), a maximum heart rate of 169 +/- 5.4 beats/min (p < 0.05); a cardiac output of 5.65 +/- 0.6 L/min (p < 0.05); and a lower heart-rate increase from rest to peak exercise (p < 0.001) but a similar VO2 peak. The heart-rate increase correlated significantly with time post-transplant (r = 0.55; p < 0.05), number of rejection episodes per year (r = - 0.63; p < 0.05), and number of immunosuppressive drugs (r = - 0.60; p < 0.05). The recipients had normal FVC and FEV1 values. After surgery, few heart transplant recipients undertake physical activity, possibly owing to over-protective parents and teachers and to a lack of suitable supervised facilities. The authors stress the importance of a cardiorespiratory functional evaluation for assessment of health status and to encourage recipients, if possible, to undertake regular physical activity.

Adolescent↗

PubMed2000

Clinical and cardiorespiratory assessment in children with Down syndrome without congenital heart disease.

OBJECTIVE: To assess the clinical and functional status of a young Down syndrome (DS) population without congenital heart disease. DESIGN: Prospective study of children with DS and control subjects. SETTING: Bambino Gesù Children's Hospital, Rome, Italy. PARTICIPANTS AND METHODS: Forty-two children with DS (mean +/- SD age, 9.8 +/- 3.6 years) underwent genetic, clinical, neuropsychological (IQ), and cardiorespiratory evaluation. Cardiorespiratory fitness was assessed with a treadmill test and a lung function test to determine forced vital capacity, first-second forced expiratory volume, and peak expiratory flow. Data were expressed as a percentage of the predicted values for control children. To assess cooperation during exercise testing, we devised a compliance scale assigning a score according to the subjects' ability to understand instructions, ability to walk and run as required, and need for vocal encouragement. RESULTS: Eighteen (43%) of 42 children with DS were obese, 10 (24%) were short, and 17 (40%) had microcephaly. On the Leiter International Performance Scale, 2 of 35 subjects had a normal IQ score (80-120); all others had low IQ scores (79 to <40). Five subjects did not undergo cardiorespiratory assessment. Eighteen of 37 subjects completed lung function tests: the results for 10 were unremarkable, and results from 8 revealed reduced forced vital capacity because of poor compliance. The subjects tested had low exercise tolerance (mean +/- SD tolerance percentage, 61% +/- 12%), mild tachycardia (maximal heart rate, 91% +/- 4%), and a mild hypertensive response (maximal blood pressure, 89% +/- 8%). Compliance scores correlated significantly with exercise time and age but not with IQ. CONCLUSIONS: Clinical and cardiorespiratory assessment is feasible in subjects with DS without congenital heart disease and should be useful in gauging their fitness level for safe physical activity.

Adolescent↗

PubMed1998

The natural history and the effects of gabapentin in amyotrophic lateral sclerosis.

Glutamate excitotoxicity seems to play an important role in the aetiopathogenesis and progression of Amyotrophic Lateral Sclerosis (ALS). Gabapentin is a modulator of the glutamatergic system and has been shown to prolong survival in the transgenic model of familial ALS. It has also been demonstrated to slow the decline of arm strength in human sporadic cases. The aim of our study was to assess the effects of different dosages and duration of treatment of gabapentin on the natural history and survival of ALS patients. A total of 110 patients affected by definite ALS entered the study. After a 6-12 month period of observation, patients were randomly assigned to receive oral gabapentin 500 mg/day (Group A) or 1000 mg/day (Group B) for 6 months. In addition a group of patients received gabapentin 500 mg/day for 6 months and 1000 mg/day for a further 6 months (Group C). A group of 121 patients referred to our Institute, who received only symptomatic treatment, was considered as the control group (Group D). Each patient was seen at entry and every 3 months. All average slopes were negative but the comparison of all slopes showed a trend toward a slower rate of decline of muscle strength loss in all treated groups of patients compared with the control group. The differences were statistically significant. Analysis between the pretreatment and treatment period showed a statistically significant decrease of the decline of muscle strength and Norris score during the treatment period. Survival analysis showed a significantly longer survival in treated patients of Groups B and C. Our study suggests that gabapentin may be an effective drug for ALS; hence a controlled trial involving a sufficient large number of patients is warranted.

Acetates↗

PubMed1998

Hypertension in young patients after renal transplantation: ambulatory blood pressure monitoring versus casual blood pressure.

The results of ambulatory blood pressure monitoring (ABPM) in children after kidney transplant were analyzed to ascertain any alteration in circadian BP profile, degree of hypertension, and efficacy of therapy. The data were also compared with casual BP data and left ventricular mass index (LVMI). We have examined 30 patients (17 male, 13 female), mean age 16.1+/-3.6 years after kidney transplant. All patients were receiving triple immune-suppressive therapy and 20 of them were also taking antihypertensive therapy. They underwent clinical examination with measurement of BP at rest, echocardiogram mono-2D, and ABPM. The following ABPM parameters were recorded: systolic (S) and diastolic (D) BP at rest; mean 24-h SBP and DBP; mean daytime SBP and DBP; mean nighttime SBP and DBP; nocturnal fall in SBP and DBP; and mean daytime and nighttime heart rate (HR). The patients were divided in two groups. Group A consisted of 20 patients taking antihypertensive treatment; group B consisted of 10 patients not taking antihypertensive treatment. Casual and ABPM data for the two groups were compared using the Student t test for unpaired data. Blood pressure at rest and LVMI were not statistically different between the two patient groups. The ABPM data showed statistical differences between the two groups for mean 24-h SBP and DBP, daytime and nighttime SBP, nighttime DBP, fall in nocturnal DBP, and nighttime HR. Mean 24-h SBP and DBP, mean daytime SBP and DBP, and mean nighttime SBP and DBP were significantly correlated to LVMI (respectively, P = .009, P = .005, P = .008, P = .007, P = .05, and P = .01). Twenty-four-hour ABPM was more useful in the diagnosis and management of hypertension than was casual BP at rest.

Adolescent↗

PubMed1997

Exercise tolerance and behavior of blood pressure in children and adolescents after renal transplant.

OBJECTIVE: The purpose of the study was to evaluate the exercise tolerance and the behaviour of blood pressure during a maximal exercise testing on treadmill for a group of patients with renal transplant carried out at least 6 months earlier. EXPERIMENTAL DESIGN, SETTING AND PATIENTS: In a retrospective study, nineteen patients were examined in our laboratory: 13 boys and 6 girls, mean age 15.8 years (range 10.5-22). INTERVENTIONS: All patients were given a clinical examination, an ECG at rest, a maximal exercise testing on treadmill (Bruce protocol), a mono-2D echo, a lung function test and 24-hour Holter monitoring. The results of the exercise test were compared with those of two control groups of same age and body surface area. RESULTS: The clinical examination of their cardiovascular apparatus gave normal results. The echo revealed anatomical and heart function anomalies related to the original disease. Exercise testing on treadmill showed a reduction in exercise tolerance (p < 0.001) and the maximal heart rate showed a statistically significant difference (p < 0.001) in comparison to control groups. Maximal systolic blood pressure was higher than in patients with same body surface area (p < 0.001) and higher than in peers (p = 0.133). CONCLUSIONS: In view of this hypertensive response, strenuous physical activity should be undertaken with caution and indeed submaximal aerobic activity is more suitable for this population of patients.

Adolescent↗

PubMed1997

[Cardiac rehabilitation in children. Interdisciplinary approach].

The concept of rehabilitation has been defined by the authors as a supervised process of progressive exercise training to improve aerobic fitness. Cardiac rehabilitation in children should be dedicated to patients with repaired complex congenital heart diseases who have residual functional and psychological problems. The basic objectives for rehabilitation are defined: to improve exercise efficiency, aerobic capacity and quality of life, to reduce the incidence of sudden death, to enable young patients to take part safely and effectively in athletics. The guidelines for organising a cardiac rehabilitation programme are specified. First of all the need of protected environments, functional evaluation before starting the programme, the description of the rehabilitation session and staff needed. Equally important is the psychosocial aspect. It is difficult to quantify, in a scientific manner, the effectiveness of psychosocial intervention, but it helps the children to integrate into social life thus enhancing their quality of life. The results of a census of 110 world-wide centres offering regular cardiac rehabilitation programmes are presented. Italy currently has only two centres suitable for pediatric cardiac rehabilitation: they treat a small number of patients. Personal experience, with 20 patients, agrees with that of Galioto, about an increase in exercise capacity of these patients after rehabilitation programme, with an increased cardiac output at rest and at peak of exercise, an increased O2 uptake and an increased duration of exercise testing. The usefulness of cardiac rehabilitation programmes, the need of interdisciplinary approach and increasing the case series are stressed.

Cardiac Care Facilities↗

PubMed1996

[Functional evaluation by treadmill in children and adolescent following correction of Tetralogy of Fallot].

AIM OF THE STUDY: The Authors have examined 22 children (16m and 6f), mean age 9.64 +/- 2.63 years, range 5-15, after total correction for Tetralogy of Fallot, to evaluate the response of their cardiovascular apparatus during an exercise testing on treadmill (Bruce protocol). METHODS: Parameters examined: exercise duration, maximal heart rate (HR), maximal systolic blood pressure (max BP), non invasive cardiac output at rest and at the peak of exercise (CO), arterial oxygen saturation; lung function test at rest, echocardiogram and 24 hours Holter monitoring. CONTROL GROUP: 22 healthy peers, same gender, height and weight, not practising competitive sports. RESULTS: The exercise duration was significantly lower in the first group (77.8 +/- 11.8%; 86.5 +/- 8.2%; P = 0.006). Also max HR and max BP were significantly lower (max HR: 162 +/- 12 b/m'; 187 +/- 8 b/m'; P = 0.000), (max BP: 119 +/- 9 mm Hg; 126 +/- 12 mm Hg; P = 0.042). There were no differences for CO at rest (3.70 +/- 1.09 l/m'; 3.95 +/- 1.07 l/m'). In the first group, CO at peak of exercise was lower but not significantly (6.51 +/- 2.56 l/m'; 7.95 +/- 2.77 l/m'; NS). CONCLUSIONS: These results make more complete the not invasive functional evaluation for a better follow-up of these patients and a better choice for their physical activity.

Adolescent↗

PubMed1995

[Anesthesia in experimental single-lung transplantation: hemodynamic and respiratory changes during prostaglandin E1 and nitroglycerin infusion].

INTRODUCTION: The haemodynamic and oxyforetic modifications induced by continuous infusion (c.i.) of Prostaglandin E1 (PGE1) and Nitroglycerin (NG) during experimental lung transplantation have been studied. METHODS: Twenty lung transplants have been performed on pigs (Landrace). Haemodynamic monitoring consisted of ECG, femoral cannulation for arterial pressure and Swan Ganz catheter. Continuous infusion of drugs started during pneumonectomy. Data have been collected in phase 1: after the induction of anaesthesia; in phase 2: 30 min after the start of pulmonary vasodilation in one lung ventilation with left pulmonary artery clamped; in phase 3: 30 min after lung revascularization; in phase 4: at the end of the surgery. The animals have been divided in two groups. Group A consisted of 10 cases treated with 50 ng/kg/min in phase 2 and 25 ng/kg/min in phase 3 and 4 of PGE1; group B consisted of 10 cases treated with 1 ncg/kg/min in phase 2 and 0.5 ncg/kg/min in phase 3 and 4 of NG. RESULTS: In phase 2 and 4 PA, RVSWI, PRVI increased in group B more than in group A (p < 0.05); in phase 3 PA, PAWP increased in group B more than in group A (p < 0.05). DISCUSSION: In our experience PGE1 has shown to be a stronger pulmonary vasodilator than NG. PGE1 can be considered the drug of choice for pulmonary vasodilation in experimental single lung transplantation, even if more investigations are needed for reaching the real goal of this procedure.

Alprostadil↗

PubMed1990

[Hemodynamic and respiratory aspects in orthotopic liver transplantation].

Intraoperative hemodynamic and respiratory data from one-year experience of orthotopic liver transplantation with veno-venous bypass (10 cases) were collected. Seven different phases of OLT was submitted to one way analysis of variance. Variability is due to degree and duration of liver disease. Basal conditions include high cardiac output with low SVRI, elevated Qs/Qt. and low oxygen consumption. Anhepatic phase shows a lower cardiac index due to reduction in ventricular performance too. The functioning graft raises body oxygen consumption above baseline. Last phases show diminution of MAP and LVSWI and a normal Qs/Qt.

Adult↗

PubMed1989