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Biomedical subjects

J Marotta

Publications and source records attributed to J Marotta.

16 recordsLinked to original sources
PubMed2001

Trends in case-mix-adjusted use of radiology resources at an urban level 1 trauma center.

OBJECTIVE: The objective of our study was to determine the utilization rates of diagnostic radiology services at an urban level 1 trauma center. MATERIALS AND METHODS: This was an observational study of imaging use patterns from 1993 to 1998. Data were segregated by patient type and imaging procedure. Annual hospital admissions were adjusted for severity of illness using the Health Care Financing Administration's case-mix index. Per-patient imaging trends for the emergency department and outpatients were assessed using a ratio of the total number of procedures to the number of patient visits. Linear regression models were used to assess the strength of associations between resource use, measured as relative value units (RVUs), and independent variables (calendar year, patient type, and examination type). RESULTS: The RVUs for all imaging increased 53% for inpatients, 69% for outpatients, and 85% in the emergency department. No significant trend for use was found for the aggregate of inpatient imaging. There was a significant increase in the inpatient MR imaging RVUs (p = 0.04). No significant trend was found for the aggregated outpatient imaging RVUs. The trends were significant for angiography (p = 0.006), MR imaging (p = 0.002), and sonography (p = 0.04). The aggregated emergency room imaging RVUs showed a significant increase over time (p < 0.03). CONCLUSION: The number of imaging procedures increased during the study period. There was no overall trend toward increasing use of imaging in inpatients once an adjustment for severity of illness was made. Increases in patient visit-adjusted emergency department use of CT, sonography, and nuclear medicine procedures resulted from changes in practice patterns. For emergency department and outpatient settings, adjusting for the number of patient visits explains a significant portion of the increase in utilization.

Academic Medical Centers↗
PubMed1998

[Rare testicular tumors].

We report one case of "sex-cord stromal tumor" composed by Leydig and Sertoli cells. An epidermoid cyst of the testicle will be described. Finally, a case of scrotal leiomyoma is reported.

Adult↗
PubMed1997

Materials used in urological devices.

The most commonly used materials in the manufacture of urological devices are discussed with respect to their application to urinary catheters, penile implants, testicular implants, artificial urinary sphincters, and urological stents. The manufacturing, physical properties, and general chemical and biological behavior of there materials are reviewed. Attention is paid to future research trends and the general condition of the field of urological device materials.

Biocompatible Materials↗
PubMed1997

[The value of retrograde ureterorenoscopy in the treatment of bulky kidney calculi].

OBJECTIVE: To assess the value of retrograde endoscopic lithotripsy for very large pyelocaliceal stones. MATERIAL AND METHODS: Eighteen patients between the ages of 28 and 80 years (mean : 52) and presenting a staghorn renal calculus (n = 7) or with a maximal diameter greater than or equal to 20 mm (n = 11) were initially managed by rigid or flexible retrograde ureterorenoscopy, with ballistic (Lithoclast) or electrohydraulic (Riwolith) stone fragmentation. In 16 cases (89%), an additional extracorporeal shock-wave lithotripsy (ESWL) session was performed immediately after the endoscopic procedure. Early complications consisted of 3 cases of bacteraemic discharge rapîdly responding to medical treatment and 1 death from septic shock on the 8th postoperative day. Twelve patients (67%) were subsequently treated by ureteroscopy (n = 4) or ESWL (n = 11). RESULTS: 17 patients were evaluated after this therapeutic procedure, with a follow-up of 3 to 6 months (mean : 4). Stone elimination was complete for 8 patients (47%), 3 of whom initially presented a staghorn calculus. A residual stone was observed in 9 cases (53%), with a maximal diameter < 5 mm in 7 cases (41%). One patient (5%) underwent secondary percutaneous nephrolithotomy. CONCLUSION: Technological progress has clearly facilitated the ureteroscopic approach to very large pyelocaliceal stones, but fragmentation and stone elimination remain problematical. This unconventional approach constitutes a potential field of technical progress, but does not represent a really efficient alternative to PCNL at the present time.

Adult↗
PubMed1997

Piezoelectric extracorporeal shock-wave lithotripsy of lower pole nephrolithiasis.

OBJECTIVE: To evaluate the efficacy of the EDAP LT 02 lithotriptor for the treatment of lower pole nephrolithiasis. METHODS: From January 1994 to September 1995, 91 patients presenting with solitary radiopaque calculi of the lower pole calix were treated by piezoelectric extracorporeal shock-wave lithotripsy (ESWL) with the EDAP LT 02. Among them, 82 were available for follow-up. The stones' largest diameter of these patients varied from 5 to 15 mm (mean = 8.1). Indications for ESWL were pain in 63 (77%), hematuria in 5 (6%), associated infection in 6 (7.5%) and stone size in 8 (10%) asymptomatic patients. Stone localization was assessed as very easy in 74 cases (90%) and difficult in 8 cases (10%) but no intraoperative IVP was needed. ESWL sessions were performed with intravenous sedo-analgesia in 69 cases (80%) and general anesthesia in 17 cases (20%). After ESWL we advised patients to combine a diuresis with postural drainage. RESULTS: Most patients were treated with one session of ESWL: none required more that two (mean = 1.05). The mean hospital stay for one session was 1.2 +/- 0.7 days. Obstructive complication rate was 11% and auxiliary treatments were necessary in 6%. The stone-free rate of in situ piezoelectric ESWL monotherapy was overall 84%, and 95% of patients with pain were cured. CONCLUSION: In the absence of abnormality of the upper urinary tract, the vast majority of small lower pole caliceal stones can be completely removed by piezoelectric ESWL without recourse to more invasive methods.

Adult↗
PubMed1996

In vitro measurement of silicone bleed from breast implants.

A method to measure gel bleed from intact silicone gel-filled breast implants was developed. This nondestructive technique permits accurate and reproducible serial measurements of silicone bleed from smooth wall breast implants (n=10) under simulated physiologic conditions in vitro. Gel bleed rates from new low bleed gel-filled implants and intact explants (unbarriered, low bleed, double lumen) were determined. These results demonstrate the reliability of this method to quantify silicone gel bleed and may permit a meaningful comparison of bleed rates from implants in the future.

Breast Implants↗
PubMed1996

[Liposarcoma of the spermatic cord].

The liposarcoma is mainly located in the retroperitoneum and rarely involves the spermatic cord. Dissemination occurs more often via haematogenous way than by lymphatic way. The incidence of local recurrence is higher than distant metastases. The treatment of choice is the wide excision. Adjuvant radiotherapy is recommended in the well differentiated and myxoid type of tumors if the local control during excision is not complete or wide enough. Benefit of chemotherapy is still controversial and limited. Case report of a stage 1 liposarcoma of the spermatic cord, four years after excision of a large lipoma during a hernia repair. The treatment consisted in radical excision of this liposarcoma without any adjuvant therapy. Follow-up of 30 months without recurrence.

Adult↗
PubMed1995

[Value of urodynamic studies in the framework of total radical prostatectomy].

In the service, sixty patients underwent a radical prostatectomy between 1987 and 1994. The last 35 candidates to radical prostatectomy were prospectively analyzed in urodynamic parameters preoperatively and two months afterwards. Five patients present an incontinence: two total incontinence and three moderate incontinence. In two of the patients there was a detrusor instability, in two others an urethral instability and in the last patient, we discover a diminution of the bladder functional capacity on the postoperative urodynamics. So, the question is now to determine if incontinence is only caused by a sphincteric insufficiency or by a bladder or urethral dysfunction. The preoperative urodynamics are important to appreciate the quality of sphincters and the quality of the bladder; it's also an important meeting between the patient and the surgeon. The postoperative urodynamics seem to be reserved to the patients who have some problems, so to search an explanation for the incontinence. All our patients underwent rehabilitative physiotherapy, which seems to help them to recover their continence.

Adenocarcinoma↗
PubMed1991

Influence of high cholesterol feeding on the pattern and progression of experimental cerebral ischemia.

The aim of our research was to study if cholesterol feeding might affect the ischemic changes in the vessels surrounding infarction foci in Sephadex G-75-induced cerebral ischemia model (SG-75). One hundred-twenty-four rabbits were divided as follows: group I was given standard food for 5 weeks; group II: as group I and then injected with SG-75; group III: standard food plus 1% cholesterol for 5 weeks; and group IV: as group III and then injected with SG-75. Rabbits were sacrificed 3 h, 6 h and 2, 5 and 7 days after ischemia had occurred. Vessels surrounding infarction foci (SIF) were identified by using a 6% carbon perfusion. Samples were examined by light microscopy and transmission electron microscopy (TEM). The occurrence of hemorrhagic infarction (HI) showed a clear time/course increase in group II whereas a decrease after 2 days in group IV was observed. The rate of HI was 40% and 20% in group II and IV, respectively. SIF vessels showed red blood cells leakage in group II, whereas multiple platelet thrombi appeared in group IV. This phenomenon caused a more extensive ischemic damage, when compared to group II. By making use of a widely employed model of high cholesterol diet and of a more physiological model of cerebral ischemia devised by us, we have provided the evidence that the hypercholesterolemia-induced changes in the SIF vessels strongly affect the pattern and progression of cerebral ischemia.

Animals↗
PubMed1989

Computerized smoking cessation program for the worksite: treatment outcome and feasibility.

This study demonstrated the effectiveness of a computer-delivered smoking cessation program for the worksite. 58 VA Medical Center employees were randomly assigned to a computer group (computerized nicotine fading and stop-smoking contest) or a contest-only group. In comparison with the contest-only group, the computer group had nonsignificantly higher abstinence rates across follow-up, had marginally lower CO levels at the 3- and 6-month follow-ups, and smoked cigarettes with lower nicotine levels at the 10-day and 6-month follow-ups.

Adult↗
PubMed1978

The L-dopa on-off effect in Parkinson disease: treatment by transient drug withdrawal and dopamine receptor resensitization.

It has been suggested that patients with Parkinson disease partially compensate for neuron loss by developing denervation supersensitivity, and, if so, that prolonged levodopa (L-dopa) therapy might lead to desensitization. As a preliminary test of this hypothesis, and in order to study whether it was possible to "resensitize" a patient who had already presumably been desensitized by previous L-dopa therapy, a patient who had become unpredictably responsive to L-dopa was investigated. The patient had been taking L-dopa for eight years and had exhibited severe dyskinesia-akinesia oscillation ("on-off" phenomenon) before the study. There was no consistent response to his hourly doses of Prolopa (L-dopa and benserazide in a 4:1 ratio). He was first lowered, over 33 days, to 20% of his original Prolopa dose. The dosage was then increased until a consistent response was observed. The three main results achieved were, first, overall reduction by 64% of the daily requirement for L-dopa; second, conversion from a previously unpredictable to a predictable response to each dose of L-dopa; and, third, change in his movement fluctuations to a pattern more typical of "end-of-dose" akinesia than the "on-off" phenomenon. The results support the idea of dopamine receptor resensitization upon reduction of the L-dopa dosage.

Humans↗
PubMed1976

Peripheral neuropathy in oxalosis. A case report with electron microscopic observations.

A 61 year old man had chronic renal failure because of oxaluria and renal calculi. Two years before death, while on hemodialysis, he developed severe progressive peripheral neuropathy. At autopsy calcium oxalate crystals were found in the peripheral nerves and other tissues. Nerve lesions included segmental demyelination, axonal degeneration and crystalline deposits within the myelin sheath. Ultrastructurally there were foci of osmiophilic granular material within myelin lamellae and endoneurium, and pleomorphic lamellar bodies in the perinuclear Schwann cell cytoplasm. It is probable that chronic hemodialysis favors the deposition of oxalate in the Schwann cells and the development of neuropathy in patients with primary hyperoxaluria and renal failure.

Demyelinating Diseases↗
PubMedDate not supplied

Regionally selective effects of gonadectomy on cortical catecholamine innervation in adult male rats are most disruptive to afferents in prefrontal cortex.

Changes in gonadal hormones induced early in life produce substantial, seemingly permanent decreases in tyrosine hydroxylase (TH)-immunoreactive axon density in sensory, motor and prefrontal regions in the rat cerebral cortex. Less is known, however, about the responsiveness of cortical catecholamines to hormone stimulation during adulthood. In this study we expanded upon an earlier analysis of the effects of acute (4 day) and chronic (28 day) gonadectomy in adult male rats on TH innervation in right hemifield of the cingulate cortex to include assessment of sensorimotor areas previously examined following perinatal gonadectomy, the left cingulate hemifield, and one additional prefrontal area - the dorsal anterior insular cortex. Qualitative and quantitative analyses of immunoreactivity revealed modest, transient declines in innervation in sensorimotor areas 4 days after gonadectomy, and a return to normal innervation densities by 28 days after surgery. In cingulate and insular cortices, however, strikingly depleted axon densities observed following acute gonadectomy rebounded to significantly higher than normal levels of innervation 3 weeks later. All effects were attenuated in gonadectomized animals supplemented with testosterone. Thus, for cortical catecholamine innervation, as for other endpoints of hormone stimulation, gonadal steroid sensitivity appears to change dramatically with lifestage. In adult male rats, this sensitivity is also marked by a seemingly selective vulnerability of catecholamine innervation in prefrontal areas to changes in the hormone environment induced by gonadectomy.

Afferent Pathways↗