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Biomedical subjects

L Belli

Publications and source records attributed to L Belli.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Doppler echo in evaluating arteriovenous fistulae for dialysis].

US-Doppler has recently gained attention as a noninvasive method for the functional evaluation of arteriovenous fistulas (FAV). Twenty patients with well-functioning FAV were studied, and the results compared with those from a control group of 10 healthy subjects. Time average velocity (TAV) was calculated as hemodialysis parameter, together with telesystolic (Vts) and telediastolic (Vtd) velocities, absolute (F) and normalized (FN) fluxes to the area unit (cm2 1) and resistance index (IR). All of them proved to be statistically significant indexes of FAV functionality. Doppler has thus proved to be a valuable means both to calculate FAV capacity in a patient and to establish FAV functionality. Four parameters are recommended: FN greater than 2000 ml/min/cm2; IR less than 0.05; TAV greater than 50 cm/s: and Vtd greater than 35 cm/s.

Adult↗
PubMed1989

[Metastatic breast cancer. Chemotherapy with adriamycin, vindesine, cyclophosphamide and 5 FU. Value of continuous 5 FU perfusion. Results of controlled trials].

Ninety-four patients with metastatic breast cancer were entered in a prospective randomised trial comparing 2 schedules of the same combination chemotherapy. Group I consisted of 46 patients, treated in a monthly three day course with adriamycin (ADM), cyclophosphamide (CPM), vindesine (VDS) and 5 fluoro-uracil (5 FU). Group II included 48 patients who received the same total monthly doses in 4 injections of ADM, CPM, VDS on days 2, 5, 16, 19 of each month together with a continuous infusion of 5 FU over a total of 10 days (days 1-5 and 15 and 19). Patient characteristics in the 2 groups as regards essential prognostic parameters were identical. We observed no difference in myelosuppression between the 2 groups. There were fewer gastrointestinal side effects in group II. Whereas complete alopecia occurred in 100% of patients in group I, only 33% of patients with the fractionated schedule totally lost their hair. The objective response rates at 8 months were 75 and 74% respectively, but the complete response rates (17.5 versus 28%) showed an advantage for group II. This advantage was not statistically significant. Durations of response were 15 months (group I) and 18 months (group II) and the median survival was 27 months in both. We conclude that prolonged low dose and fractionated administration of chemotherapy over 2 five day courses per month improves the therapeutic index and diminishes side effects.

Adult↗
PubMed1989

Thrombosis of portal vein in absence of hepatic disease.

Of 602 patients referred for portal hypertension during a 20 year period, 18 children (mean age of 5.0 years) and 29 adults (mean age of 26.5 years) had thrombosis in the portal bed with a healthy liver (7.8 per cent incidence). In 29 of the 47 patients we studied, the causative factor remained obscure. Variceal hemorrhage occurred in all and was the indication for our observation and treatment. In 11 adult patients (mean age of 22.1 years), surgical treatment was not performed because of reluctance of the patient or because of technical reasons: nine of the patients rebled and one patient died because of massive bleeding. Direct procedures on esophageal varices had a high rate of rebleeding (seven of 11 patients) independent of the age of the patient when the operation was performed. In 13 patients, shunting offered a good chance of long term protection: three of the 13 rebled at a mean follow-up study of 5.7 years. No recurrence of bleeding was observed in 15 patients when variceal eradication had been obtained after chronic endoscopic sclerotherapy at one to eight years of follow-up study (mean of 3.9 years). The data from this study indicate that sclerotherapy should be the first choice of treatment to control recurrent bleeding in extrahepatic portal hypertension caused by thrombotic obstruction, particularly in the young patient.

Adolescent↗
PubMed1989

[Arthrographic semeiotics of traumatic capsular and ligamentous pathology of the tibiotarsal articulation].

One-hundred and fifty-five patients with recent trauma were submitted to arthrography of the ankle joint in order to evaluate the actual diagnostic value of the methodology. Arthrography clearly demonstrated the single ligaments (anterior talo-fibular, calcaneal-fibular, posterior talo-fibular, and deltoid) and the capsular damage or rupture. The technical factors affecting the quality of the examinations are discussed. Arthrographic accuracy was 94.2%, with 92.7% sensitivity and 100% specificity. Arthrography of the ankle joint proved to be a quick and low-cost method providing good diagnostic results and no complications, thus allowing better preoperative planning in capsular and ligament injuries.

Adolescent↗
PubMed1988

Outcome of patients with rectal cancer treated by stapled anterior resection.

The mortality, morbidity and long-term survival in stapled anterior resection for rectal carcinoma has been analysed in 74 patients. Twelve patients were Dukes' A, 26 B, 29 C, and 7 'D' (submitted to hepatic resection). Operative mortality rate was 3 per cent. Three patients (4 per cent) had clinical anastomotic leakage. Two patients (3 per cent) developed anastomotic stenosis. Local recurrence was present in three patients (4 per cent). The mean (+/- s.e.m.) overall survival rate at 5 years was 67 +/- 6 per cent. There was no significant difference in survival between Dukes' B and C (70 +/- 10 per cent versus 59 +/- 10 per cent, P = 0.209). Patients with absent local spread had a significantly better 5-year survival rate than those with positive local lymph nodes (80 +/- 7 per cent versus 54 +/- 9 per cent, P less than 0.01). The present results confirm the satisfactory use of the EEA stapler device for colorectal anastomoses in rectal cancer and in patients with resectable liver metastasis.

Aged↗
PubMed1988

The Milan clinical trial with cyclosporine in cadaveric renal transplantation. A three-year follow-up.

Between February and November 1983, 108 recipients of cadaveric renal transplants entered a randomized multicenter trial and were treated either with cyclosporine (CsA) and prednisone (n = 55) or with conventional treatment based on azathioprine (Aza) and glucocorticoids (n = 53). The graft survival probability at 3 years was 76% for CsA patients and 48% for Aza patients (P less than 0.001). The cumulative number of acute rejections was significantly lower in the CsA group (32 vs. 104, P less than 0.001). Incidence of early posttransplant anuria was similar in both groups and did not affect renal function after three years. Nephrotoxicity in CsA patients, when present, was handled by reducing the dose of CsA, but in 12/55 patients a change to conventional therapy was thought to be necessary. However, in this group of 12, one patient lost the allograft because of irreversible rejection and one patient died 14 months later because of an infection. Mean creatinine clearance after three years was significantly lower in the CsA patients (54.7 +/- 2.6 ml/min) than in Aza patients, (67.2 +/- 4.9 ml/min, P less than 0.05). Considering only patients with grafts functioning after three years and still on the original randomized therapy, the mean creatinine clearance was similarly and significantly decreased from 1 to 3 years in both groups. There were no significant differences in occurrence of severe infections. Side effects such as hypertension, hypertrichosis, tremor and gum hyperplasia were more frequent in CsA patients.

Acute Kidney Injury↗
PubMed1988

Effect of superoxide dismutase on liver ischemia-reperfusion injury in the rat: a biochemical monitoring.

Oxygen free radicals have been implicated in the pathogenesis of postischemic liver injury. High-dose superoxide dismutase (SOD), a radical scavenging enzyme, has been investigated in a rat model of liver ischemia reperfusion by biochemical monitoring. Blood vessels to the median and left lobe were clamped for 1 h and then reperfusion was allowed. The indices used were serial venous blood levels of AST, ALT, calcium, and ATP determination in liver tissue. In SOD-treated animals (7,5000 U i.v.) a significant attenuation of the rise in enzyme levels was observed as well as the absence of the decrease in calcium level in the early phase after reperfusion as compared with control rats, and furthermore ATP restoration was significantly increased.

Adenosine Triphosphate↗
PubMed1988

Cell metabolism response to cardiopulmonary bypass in patients undergoing aorto-coronary grafting.

The main parameters of muscle acid-base, water and energy metabolism were studied in ten patients undergoing low-flux (1.5 l/min/m2), low-pressure (40 to 60 mmHg) hypothermic (26 degrees C) cardiopulmonary bypass (CPB) for aortocoronary grafting; absolute gas exchange and haemodynamic data were also measured throughout the entire CPB period. At the end of CPB a substantial preservation of water and energy metabolic indexes was found; a condition of extracellular metabolic acidosis was apparently sustained by muscle cell anaerobic glycolysis enhancement with a consequent increase of both muscle and plasma lactate content. Subnormal cell phosphocreatine levels as well as reduced bicarbonate buffer stores and decreased intracellular pH, were detected. Direct limiting effects of hypothermia on tissue O2 delivery and muscle oxidative metabolism as well as vasoconstriction and arteriovenous shunting associated with CPB procedures are likely to be involved in the above mentioned alterations of cell metabolism.

Acid-Base Equilibrium↗
PubMed1988

[Percutaneous transluminal angioplasty of supra-aortic vessels. Presentation of 16 cases].

Sixteen cases are reported of dilatation of supra-aortic vessels; in 14/16 patients the vessel involved was either the subclavian artery or the brachiocephalich trunk. Special attention is paid to the choice of patients--the ideal one presenting with a single uncalcified lesion, with stenosis more than 50% of diameter; the symptoms have recently appeared, with a significant difference (more than 20 mmHg) in the pressure of the two arms. The technical aspects of the angioplastic procedure are discussed, especially in order to preserve the intracranial circulation and to limit possible complications. The presence of reversed blood flow in the vertebral artery is extremely important to preserve intracranial circulation from possible embolism; normal flow obtained at the end of the procedure is therefore an useful proof of successful dilatation. The advantages are stressed of dilatation over the surgical techniques used in the past. Finally, the importance is emphasized of a correct follow-up and doppler control of supra-aortic circulation.

Angioplasty, Balloon↗
PubMed1987

Liver arterialization prevents thrombocytopenia after portacaval shunt in rats.

A low platelet count is a common finding in liver cirrhosis. Clinical practice has shown that a variable number of cirrhotic patients in whom portasystemic shunting procedures have been performed does not recover from thrombocytopenia: this observation questions the role that portal hypertension may have in maintaining the low platelet count. We have previously described the appearance of thrombocytopenia in rats submitted to portacaval shunt 1 month after the operation. In the present study we have investigated a supposed protective influence of a good liver function in maintaining a normal thrombocytopenia: 56 male Wistar rats were divided into 4 groups: group A (15 rats) sham-operated; group B (16 rats) submitted to portacaval shunt (PCS); group C (17 rats) submitted to PCS plus arterialization of the portal stump by the right renal artery, and group D (8 rats) submitted to PCS plus right nephrectomy. Group B (PCS) and D (PCS plus right nephrectomy) showed a marked thrombocytopenia, whereas group A (sham-operated) and C (PCS plus liver arterialization) evidenced a normal platelet count. These results strongly support the hypothesis that a low platelet count can ensue during a chronic liver disease in the absence of portal hypertension and that restoration of the hepatic blood flow can prevent thrombocytopenia.

Animals↗
PubMed1987

[Intravenous leiomyomatosis with uterine onset and extending to the heart. Value of the radiological study].

Two cases are reported of intravenous leiomyomatosis with extension of neoplastic thrombus to the right atrium; an histological documentation of each patient has been successfully obtained during surgical procedure. International literature is reviewed and a useful diagnostic protocol for the correct evaluation of these patients is suggested, in order to choose the best surgical approach. The important role of CT with intravenous injection of contrast medium is pointed out. The advantages resulting from the use of echotomography and from angiographic study of the inferior vena cava are stressed.

Adult↗
PubMed1986

Proliferating and quiescent cells exhibit different subcellular distribution of protein kinase C activity.

The activity of calcium, phospholipid-dependent protein kinase (PKc), which is thought to play an important role in cell proliferation, has been measured in the particulate and soluble fractions of cultured cells, under different proliferative conditions. Our results indicate that proliferating cells display higher PKc activity than quiescent cells. Furthermore, in both normal and transformed cells, PKc is preferentially associated with the particulate fraction when the cells are proliferating, while in mitotically quiescent cells the majority of the enzyme activity is found in the soluble fraction. These data suggest tha PKc activity and subcellular distribution undergo spontaneous changes according to the proliferative state of the cells.

Animals↗
PubMed1986

Portal thrombosis in cirrhotics. A retrospective analysis.

The development of thrombotic obstruction in the portal bed of cirrhotic patients presents special problems in diagnosis and treatment. In the cirrhotic population treated for portal hypertension at our Surgical Department during the period 1967-1983 (512 patients), the incidence of thrombosis in the portal bed was 16.6% (85 patients). Bleeding was the main presenting symptom (70/85), with a mean of four episodes prior to treatment. Careful angiographic studies and intraoperative evaluation are fundamental steps to determine the exact anatomical involvement, the presence of recanalized veins or fresh occluding clots, and the applicability of shunt procedures. A massive portosplenomesenteric involvement often associated with poor surgical possibilities was found in 19 patients (22.3%). The presence of partially recanalized veins and fresh occluding clot suitable for disobliterative techniques prior to shunt was found in 16 patients, and out of 73 operated patients a total of 55 shunt procedures could be performed. Fifty-three patients who bled from varices could be followed up to 5 years: 39 underwent a shunt procedure with a 51.2% 5-year survival rate, while only one of 14 nonshunted or nonoperated survived up to 3 years, and a lethal bleeding was the cause of death in all but one. Disobliterative techniques (Fogarty thrombectomy and endovenectomy of intimal fibrotic thickenings) prior to shunting provided a good long-term patency rate with a 50% protection from lethal bleeding recurrences. Nonshunt procedures and the extensive involvement of the portal bed are associated with bad prognosis. Also, endoscopic sclerotherapy, attempted in patients with massive thrombosis, could not prevent recurrences and death from bleeding. Despite a 30% failure rate in our study, shunting surgery should be considered the only therapeutical possibility of preventing further thrombotic recurrences and consequent life threatening bleeding episodes.

Adult↗
PubMed1986

Does large spontaneous portal systemic shunt in cirrhosis protect from the risk of gastroesophageal bleeding?

The risk of gastroesophageal bleeding in cirrhotic patients with massive spontaneous portosystemic shunt (SPSS) has been evaluated variously in the literature. We undertook a retrospective study in a large group of cirrhotic patients admitted to our surgical department to evaluate the incidence of large SPSS and the correlation with current or previous episodes of gastroesophageal hemorrhage. Of 456 patients submitted to splenoportography or celiac-mesenteric angiography, 20 showed evidence on the roentgenograms of large self-established SPSS. They were classified into three groups: (a) splenorenal shunts (three patients); (b) mesenteric-caval shunts (two patients), and (c) large patent umbilical vein (15 patients). Twelve of these 20 patients had one or more episodes of gastrointestinal bleeding, and seven of them were submitted to surgical treatment to prevent recurrent bleeding. No correlation was found between the risk of esophageal hemorrhage and the type of SPSS. We concluded that, despite the presence of massive SPSS, cirrhotic patients have an unpredictable risk of bleeding and they often require surgical treatment to prevent recurrent episodes.

Collateral Circulation↗