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Biomedical subjects

F Brunelli

Publications and source records attributed to F Brunelli.

At least 37 records · Page 2Linked to original sources
PubMed1995

Comparison between the effects of neostigmine and ranitidine on interdigestive gastroduodenal motility of patients with gastroparesis.

The antroduodenal motor effects of ranitidine, and H2-receptor antagonist with cholinergic activity, and neostigmine, a cholinomimetic drug, were compared in 16 patients with idiopathic gastroparesis characterized by dysmotility-like dyspepsia, delayed gastric emptying at scintigraphy and absence of gastroduodenal phase 3 of the migrating motor complex during a manometric recording of at least 300 min. After overnight fasting in 8 of these patients, neostigmine was administered intravenously at a dose of 0.5 mg, and in the remaining 8 patients ranitidine was given intravenously at a dose of 100 mg. Ranitidine induced a gastroduodenal phase 3 activity in a significantly (p < 0.02) higher percentage of patients (87.5%) in comparison with neostigmine (25%). In the majority of patients, neostigmine induced only an irregular increase in gastroduodenal motor activity sometimes characterized by propagated and nonpropagated clustered contractions. This property of ranitidine of inducing a phase 3 activity in these patients cannot be ascribed to its weak cholinergic activity, as neostigmine, which has a more intense cholinergic activity than ranitidine, is unable to produce the effect demonstrated by ranitidine. Another unknown mechanism able to trigger the neurohormonal program of migrating motor complex phase 3 or to abolish inhibitory influences should be taken into account to explain this effect of ranitidine.

Adult↗
PubMed1995

Abnormal esophagocardiac inhibitory reflex in patients with diffuse esophageal spasm.

The aim of this study was to establish if patients with an esophageal dysmotility similar to that found in the majority of patients with 'swallow syncope' may also have a pathologic esophagocardiac reflex similar to that observed in these patients. The effects on heart rate induced by dry and solid swallows and by intraesophageal balloon distension were studied in 8 normal subjects and in 10 patients with diffuse esophageal spasm by simultaneous recording of ECG and intraesophageal pressures. Dry swallows induced a brief increase in heart rate, while deglutition of a solid bolus initially induced an increase followed by a decrease in heart rate, significantly more marked in patients with diffuse spasm. The intraesophageal balloon inflation induced a decrease in heart rate which was significantly more intense in patients with diffuse spasm. In conclusion, the esophageal wall distension either due to solid bolus ingestion or to balloon inflation elicits an inhibitory esophagocardiac reflex which is more intense in patients with diffuse spasm and might induce cardiac arrhythmias in predisposed subjects.

Adult↗
PubMed1995

Patterns of gastric emptying in dysmotility-like dyspepsia.

BACKGROUND: As the gastric emptying time delay of patients with functional dyspepsia is not correlated with the severity of dyspepsia complaints, we investigated the pattern of intragastric distribution of a meal with an ultrasonographic method in different groups of dyspeptic patients. METHODS: The final gastric emptying time and the postprandial variations of the cross-sectional area of the gastric antrum were measured ultrasonographically, and dyspeptic symptoms were scored in 41 patients with dysmotility-like dyspepsia, of whom 31 did not have digestive or systemic diseases known to affect gut motility (group A) and 10 had scleroderma involving the upper gut (group B). Twelve normal subjects were examined as a control group. RESULTS: The final emptying times of groups A and B did not differ significantly but were both significantly longer than that of controls, whereas the antral area at 60 min showed a significantly greater increase in patients of group A than in group B. The symptom score showed significantly more severe dyspepsia in group A than in group B. CONCLUSIONS: The fact that the postprandial antral distention was more marked in the dyspeptic patients with more severe symptoms suggests that this motor pattern could play a more important role in the genesis of dyspeptic symptoms than the delay in gastric emptying time, which was similar in the two groups.

Adult↗
PubMed1995

Microsurgical reconstruction of sensory skin.

Loss of sensory function is a severe impairment for the hand which loses a lot of its dexterity, becomes "blind" if not guided by sight and is susceptible to burns, wounds and infections. Nerve repair by sutures or grafts is the preeminent operation if the condition of the skin is good. When skin is damaged, various sensory flaps (both free microvascular and local pedicle) may be used. Island flaps from the pulp of another digit give inconsistent results. Sensory flaps from the back of the index finger to the thumb give a fair two-point discrimination. Free microvascular flaps from the pulp or the web of the hallux or from two or even three toes are safe and good operations which restore both perfect skin coverage and excellent sensory function with good two-point discrimination. The damage at the donor site is well tolerated. When previous operations have covered the digit or the hand by means of non-sensory skin, direct neurotization of this skin is possible. Research has been done in animals showing the formation of free endings inside the neurotized skin. Rehabilitation of the previously existing sensory corpuscles is even possible. Our series includes 12 island flaps from the pulp, 19 pedicle flaps from the dorsum, 17 homodigital reverse flow flaps, 38 different types of free neurovascular flaps from the foot and 3 direct sensory neurotization.

Amputation, Traumatic↗
PubMed1994

Upper tibial corticocancellous flap anatomy study (19.2.93).

A cortico-cancellous flap from the anterolateral aspect of the upper third of the tibia was presented. Sixty lower limbs of "fresh" cadavers were dissected. The vascular bundle includes the anterior tibial artery and its recurrent collateral branches and recurrent and musculoperiosteal arteries. The flap is harvested with the interosseous membrane and can be used either free or predicled. We used this flap for two patients suffering from pseudarthrosis. Long range clinical and radiological results are good.

Adult↗
PubMed1994

[A free transfer of the pulp of the toe with an exteriorized flap. A compromise between microsurgery and traditional surgery].

Free toe pulp transfer represents the most sophisticated technique which corresponds functionally as close as possible to total restoration of the digital pulp. However, this operation presents technical disadvantages related to the very small calibre of the vessels when the vascular anastomosis is performed in the digit. When the artery and vein are anastomosed in the metacarpal region to achieve vessels with a larger calibre, the passage of the pedicle in the finger is difficult and requires complete opening of the digital canal, resulting in a finger which is often enlarged with limited mobility. The authors propose a technique which overcomes these two disadvantages.

Anastomosis, Surgical↗
PubMed1993

[Local anesthesia of the finger through the flexor tendon sheath].

A series of 350 cases of local anaesthesia of the finger using the flexor tendon sheath is reported. The patients were ranked ASA 1 or 2 and the youngest was 12 months old. This technique was used for day case surgery, such as nail trauma and tumours, wound exploration, tumour and cyst removal, tenolysis and neurolysis. The needle was inserted on the palmar aspect of the metacarpophalangeal joint, into the digital flexor tendon of the corresponding finger. Thereafter the needle was withdrawn very slightly in order to inject the local anaesthesia solution within the sheath, and not the tendon. The volumes were respectively 1 ml in children and 3 to 4 ml in adults of either 2% lignocaine or 0.5% bupivacaine without adrenaline. As palmar injections are painful a freezing spray solution was used prior to insertion of the needle. There was no anaesthesia of the dorsal digital nerves, as opposed to the findings of the author of the first series. This technique, which can be qualified as being easy and reliable, could be a valuable alternative for the ring or interdigital blocks, which carry a significant risk of vascular and neurological complications.

Adolescent↗
PubMed1993

[Dorso-ulnar thumb flap].

The arterial supply of the dorsal surface of 25 thumbs was studied with the help of a light microscope. An arterial vessel, localized on the dorso-ulnar side and connecting the head of the first metacarpal bone with the dorsal arcade of the nail matrix was constantly found in all dissections. The author reports the results of the anatomical study and the clinical applications of a skin flap which can be raised on the dorso-ulnar surface of the MP joint with a distal pedicled. Clinical experience is based on 9 flaps for coverage of distal skin defects (dorsal or volor) of the thumb.

Amputation, Traumatic↗
PubMed1992

[Description of a vascularized bone graft taken from the head of the 2nd metacarpal bone].

The authors describe a new vascularised bone graft from the distal part of the second metacarpal. They report an anatomic study on 20 cadavers which demonstrates the existence of two dorsal first web arteries (superficial and deep). The existence of free anastomosis between the two arteries is demonstrated. The vascularisation of the bone graft relies upon the deep first web artery which lies against the lateral aspect of the bone. The operative procedure is described and the authors stress the necessity to transfer the vascularized bone graft with a large soft tissue pedicle.

Arteries↗
PubMed1992

[Sensory retraining of the hand using gnosis rings].

Sensory reeducation is very important. Many methods are used but it is difficult to assess their efficiency. Besides the routine methods we are using the gnostic rings which have on their periphery 5 symbols: a letter = A, a number = 3, a geometrical figure = a circle, a rough surface and a smooth convex surface. The symbols of the rings are in 3 different sizes (1.5 - 1 and 0.5 cm). The gnostic rings have 3 advantages: 1) they allow a precise evaluation in percentage. 2) they require an important brain effort, 3) they may be kept in the pocket and used several times during the day.

Equipment Design↗
PubMed1992

Combined second toe and partial nail transfer from the big toe by means of an exteriorized pedicle.

The hand of a three-year old girl was reconstructed by means of a bilateral second toe transplantation following traumatic amputation of all five digits. In a second operation, aimed at reconstructing the index finger, the nail apparatus of the big toe was transferred to the thumb as an "island flap" based on a pedicle from the second toe. The thumb was subsequently lengthened enabling a three-fingered hand to be obtained with only minimal functional impairment of the feet. The authors suggest an original technique allowing transfer of the second toe and of the big toe nail in only one operative stage. The technique of leaving the pedicle exteriorized during transplantation (autonomization) facilitates positioning of the nail onto the recipient site and eliminates subsequent problems of commissural retraction.

Amputation, Traumatic↗
PubMed1992

A new flap based on the distal branches of the radial artery.

A flap based on the distal branches of the radial artery is raised on the dorso-lateral aspect of the distal third of the forearm. Thirty fresh cadaver dissections have established the anatomical rationale of the flap. The potential territory is supplied by a subaponeurotic plexus of vessels fed by lateral branches of the radial artery in the distal third of the forearm. This new knowledge of the anatomy has been applied to the performance of this flap in seven clinical cases. Various methods of application to hand and wrist reconstruction are described along with a discussion of the various advantages and disadvantages.

Adult↗
PubMed1992

"Oesophageal angina" in patients with angina pectoris: a possible side effect of chronic therapy with nitroderivates and Ca-antagonists.

The study was carried out on 18 patients with angina pectoris in whom the usual treatment with nitroderivatives and/or Ca-antagonists did not improve or prevent the angina-like chest pain in the absence of unstable angina. The patients underwent the following oesophageal examinations: X-ray, endoscopy-biopsy, manometry, acid perfusion test and 24-hour oesophageal pH ambulatory monitoring, the latter two being made in association with dynamic ECG. The presence of coronary insufficiency had been previously determined by means of ECG and scintigraphic stress tests and, when necessary, coronary arteriography was performed. In 10/18 patients severe oesophageal motor disorders were observed, the most frequent being diffuse oesophageal spasm. In the entire group the lower oesophageal sphincter basal tone was significantly lower than normal. In 14/18 patients a pathologic gastroesophageal reflux was detected: in 2 of these patients a temporal correlation between pain attacks and episodes of gastroesophageal reflux were observed in the absence of ECG modifications. Acid perfusion test induced the angina-like chest pain in another 2 patients without ECG modifications. In conclusion, the angina-like chest pain of these patients is not due to a failure of the antianginal therapy in relieving the coronary insufficiency, but is most probably related to gastroesophageal reflux. This oesophageal disorder may be considered a side effect caused by prolonged therapy with nitroderivatives and Ca-antagonists. In fact, these drugs decrease the lower oesophageal sphincter tone which is the main barrier against the reflux of gastric contents into the oesophagus so favoring gastroesophageal reflux and related disorders, including oesophageal pain.

Aged↗
PubMed1992

Interdigestive gastroduodenal motility in patients with ulcer-like dyspepsia: effect of ranitidine.

Interdigestive gastroduodenal motility was studied manometrically in 16 patients with ulcer-like dyspepsia due to hypersecretory gastroduodenitis (group A) and in a control group of 6 healthy subjects (group B). After a basal recording period sufficient to record at least two activity fronts (AF) of the migrating motor complex (MMC) of the gastroduodenal tract, we administered 100 mg of ranitidine intravenously to 8 patients of group A (group A1), and the same dose of ranitidine to the remaining 8 patients of group A (group A2) after pretreatment with cimetidine 200 mg i.v. to block the acid secretion. The interdigestive motility of patients with hypersecretory gastroduodenitis is characterized by a decrease in frequency and duration of the activity fronts of MMC, which may play a role in the pathogenesis of mucosal lesions. Ranitidine induced premature and prolonged activity fronts in all patients without antisecretory pretreatment, and in the majority of patients in whom the acid secretion was previously blocked.

Duodenitis↗
PubMed1991

["Esophageal" angina and angina pectoris].

In the last few years the non cardiac angina-like chest pain has encompassed more and more agitation not only in many patients but also in cardiologists, gastroenterologists and psychologists, as it involves socio-economic, pathophysiologic and therapeutic problems. The socio-economic aspect is well explained by the fact that in the USA at least 200,000 patients a year suffering from non cardiac angina-like chest pain, even when coronary arteriography has demonstrated normal coronary vessels, nevertheless continue to require cardiologic examinations and, if no one has clearly demonstrated the origin of their pain, they continue to live as invalids in constant fear of myocardial infarction. The discovery that the esophagus may be one of the causes of chest pain in these patients presenting with a previous diagnosis of "atypical" angina pectoris, unfortunately cannot resolve definitively the problem. An association of esophageal angina in patients with angina pectoris treated for long periods of time with Ca-antagonists and nitroderivatives has been described. In addition, the provocative or spontaneous tests to demonstrate the esophageal origin of chest pain give only a "likely" and not a "definite" diagnosis of esophageal angina. This also means to no "gold standard" text exist. Lastly, the "likely" diagnosis of esophageal angina is made in only about 50% of patients leaving the problem of the remaining 50% unanswered. These uncertainties induce some psychologists to assert that the cause of non cardiac angina-like chest pain is in the head ("panic disorder") and not in the esophagus, where the observed motor disorders should be an epiphenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1991

Long-term results after atrial correction of complete transposition of the great arteries.

This study presents the late results for the first 104 consecutive patients surviving and atrial repair for transposition of the great arteries (TGA) between January 1971 and December 1978 (group 1). Mean follow-up was 12 years (range, 0.1 to 17.7 years). The actuarial survival rate at 18 years was 84.2% (70% confidence limits, 79% to 88%) for simple TGA and 93.7% (70% confidence limits, 84% to 97%) for complex TGA. Nine of the 11 deaths were sudden. Two (2.6%) of the 78 late survivors operated on for simple TGA are in New York Heart Association functional class III or IV versus 4 (26.7%) of the 15 survivors with complex TGA; the other patients are doing very well. To better assess long-term results, we report the findings for randomly obtained electrocardiograms, Holter monitor recordings, radionuclide angiographic studies, and cardiac catheterizations performed in 1987 in a larger group of 159 long-term survivors of atrial repair operated on at Ospedale Riuniti di Bergamo from January 1971 to December 1984 (group 2), which includes all of group 1. The findings confirm that the arterial switch repair is the procedure of choice for complex TGA and that there is a major incidence (approximately 10%) of systemic right ventricular dysfunction and rhythm disturbances after the atrial repair. On the other hand, our late survival rate at 18 years of 84% for simple TGA with 97.5% of the patients in functional class I is a result that should be kept in mind, especially in institutions where the arterial switch is a relatively new approach and presumably is a higher risk to cause early death.

Cardiac Catheterization↗