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Biomedical subjects

G Chiesa

Publications and source records attributed to G Chiesa.

67 records · Page 4Linked to original sources
PubMed1977

New procedure for evaluation of normal and abnormal gait.

In this paper a new procedure is presented that permits a quantitative clinical evaluation of an important aspect of human locomotion. It involves a spatio-temporal representation of the evolution of the group reaction vector (sagittal plane) for a single hind limb during the stance phase of a step. This representation is provided directly on line by use of a computer. Some preliminary results are presented for normal subjects and for patients with a variety of motor disorders.

Biomechanical Phenomena↗
PubMedDate not supplied

Mechanisms of HDL reduction after probucol. Changes in HDL subfractions and increased reverse cholesteryl ester transfer.

Treatment with probucol, a widely used lipid-lowering agent, is associated with a significant reduction of high density lipoprotein (HDL) cholesterol levels, but with an apparently improved removal of cholesteryl esters from tissues (e.g., from tendon xanthomas). The effects of probucol (500 mg twice daily) on HDL subfraction distribution and cholesteryl ester transfer activity were tested in 12 patients with stable type II hyperlipidemia [low density lipoprotein (LDL) cholesterol greater than 180 mg/dl] after a placebo-controlled cross-over trial. Probucol significantly lowered total cholesterol (-13.8%), LDL cholesterol (-9.1%), and HDL cholesterol (-30%). By rate zonal ultracentrifugation, a marked reduction of HDL2 cholesterol (-68%) was shown, whereas changes in HDL3 were less significant (-21%). These findings were confirmed by polyacrylamide gradient gel electrophoresis, typically showing a reduction or disappearance of HDL2b particles and the prevalence of particles in the HDL3a range. Cholesteryl ester transfer from HDL to lower density lipoproteins was significantly increased (30%) in all patients. These findings suggest that, in addition to the well-documented in vitro changes (prevention of LDL peroxidation and macrophage uptake), probucol characteristically modifies HDL particle distribution in vivo, and is associated with a significant increase of cholesteryl ester transfer activity.

Apolipoproteins↗
PubMedDate not supplied

[Percutaneous or surgical trachetomy. Prospective, randomized comparison of the incidence of early and late complications].

BACKGROUND: To compare early and late complications after either conventional surgical or percutaneous dilatational tracheostomy. DESIGN: Prospective, randomized study. SETTING: General intensive care unit and neuro-surgical intensive care unit in a university hospital. PATIENTS: 50 consecutive patients, requiring tracheostomy for prolonged mechanical ventilation. INTERVENTIONS AND MEASUREMENTS: Patients were randomly allocated to receive either surgical (surgical group, n = 25) or percutaneous dilatational tracheostomy (percutaneous group, n = 25). Occurrence of perioperative complication were carefully evaluated during ICU stay. Late complications were evaluated with both physical and endoscopic examination at 1, 3 to 6 months after tracheostomy. RESULTS: All surgical and percutaneous tracheostomies were successfully completed and no deaths directly related to the tracheostomy procedures were reported. Completion of the procedure required 41 +/- 14 min in the surgical group and 14 +/- 6 min in the percutaneous one (p < 0.0001). The incidence of early perioperative complications was higher in the surgical group (36%) than in percutaneous one (12%), (p < 0.05). The endoscopic follow-up demonstrated one segmental malacia and one stenosis of the trachea in the percutaneous group only (p = n.s.). Skin repair was better after percutaneous tracheostomy than in the surgical group (p < 0.01). CONCLUSIONS: In experienced hands, percutaneous dilatational tracheostomy is as safe and effective as the conventional surgical tracheostomy. The percutaneous technique is less time-consuming and has a lower rate of early infectious complications with better cosmetic results than the surgical technique.

Female↗
PubMedDate not supplied

Efficacy of ketorolac tromethamine and extrapleural intercostal nerve block on post-thoracotomy pain. A prospective, randomized study.

BACKGROUND: Post-thoracotomy pain causes severe impairment of the respiratory function. Epidural analgesia is effective in the treatment of post-thoracotomy pain but may give rise to significant side-effects. Other low-risk and cost-effective analgesic treatments are therefore required. METHODS: Thirty male patients who had undergone pulmonary lobectomy entered a prospective, randomized trial to evaluate the efficacy of ketorolac tromethamine (Group 2) and extrapleural intercostal nerve block (Group 3) with intermittent low-dose bupivacaine. Objective and subjective assessment was carried out at 8, 16, 24 and 48 hours postoperatively. RESULTS: There were no significant differences between Groups 1 (control group) and 2. Vital capacity was significantly lower in Group 3 (p<0.05) than in Group 1 after 16 hours. Forced Vital Capacity was significantly higher in Group 2 than in Group 3 after 16 and 24 hours (p<0.05). Peak expiratory flow was also significantly better in Group 2 than in Group 3 after 16 hours (p<0.05). On-demand opioid consumption was significantly lower in Group 2 (p<0.001) and Group 3 (p<0.05). No side-effects were observed. CONCLUSIONS: Ketorolac tromethamine was effective in the treatment of post-thoracotomy pain. Extrapleural intercostal nerve block allowed a significant reduction in the consumption of opioids. These analgesic techniques could be useful as low-risk, cost-effective and reproducible treatments when more effective techniques, such as epidural analgesia, are contraindicated.

Aged↗
PubMedDate not supplied

Temporary main bronchial occlusion under bronchoscopic control in the evaluation of candidates for pneumonectomy.

BACKGROUND: In this study we report our experience with temporary main bronchial occlusion in the preoperative evaluation of candidates for pneumonectomy. METHODS: Between January 1991 and January 1994, 57 candidates for pneumonectomy underwent a 15-minute temporary main bronchial occlusion with an inflatable balloon during fiberoptic bronchoscopy. The following parameters were monitored during bronchial occlusion: general status, ECG, arterial pressure, heart rate and respiratory rate. Arterial blood gases were measured after 7 and 14 minutes. Values at 7 and at 14 minutes were compared with those obtained before the procedure. Patients were considered suitable surgical candidates for pneumonectomy if PaCO2 < 42 mmHg and pH > 7.35. RESULTS: Fifty-three patients were considered functionally operable. Three patients were considered functionally inoperable (PaCO2 > 42 mmHg, pH < 7.35 and appearance of dyspnea). One patient was excluded from the analysis because of balloon mispositioning due to a coughing fit. Sixteen of the operable patients underwent pneumonectomy and all did well without clinical evidence of respiratory insufficiency. At present 11 patients are alive, all without chronic respiratory insufficiency (mean follow-up 14 months). No postoperative mortality related to cardiorespiratory problems was observed. CONCLUSIONS: Temporary main bronchial occlusion is a simple and inexpensive test that can correctly predict functional resectability in candidates for pneumonectomy.

Adult↗
PubMedDate not supplied

Surgical treatment of non-small cell lung cancer in patients 70 years of age or older.

BACKGROUND: Indications to surgical treatment of lung cancer in the elderly are still being discussed. The aim of this study was to evaluate postoperative complications and survival after surgery for non-small cell lung cancer (NSCLC) in patients 70 years of age or older. METHODS: During a 4 year and 6 month period, 76 patients (67 men and 9 women) entered the study. RESULTS: Postoperative complications occurred in 15 cases (19.7%) and the 30-day operative mortality was 1.3%. The overall 54 month actuarial survival was 53%. Mortality at 12 months wasn't related to stage of disease, histology or lobectomy versus wedge resection but was higher in those patients who had had postoperative cardiopulmonary complications. Results of preoperative spirometry, blood gas and cardiac status were predictive of mortality at twelve months (p < 0.05). CONCLUSIONS: Surgery for NSCLC in the elderly should not be denied on the basis of age alone. Postoperative outcome is mainly related to concomitant cardiopulmonary disease.

Aged↗