Biomedical subjects
Publications and source records attributed to M Braga.
The Authors compare pH measurements taken over a 24-h period to monitor, using an original method, a sample group of 11 healthy subject and a series of patients suffering from gastroenteropancreatic diseases. The data obtained confirm the utility of the functional study of gastrointestinal secretion.
Healy's non-parametric method, originally applied to growth data, provides an efficient and flexible tool for computing smoothed centile curves. We used this procedure to calculate reference curves for blood lead levels. A sample of 402 blood donors living in Brescia and its surrounding area was used as a reference population. No exclusion criteria but occupational exposure to lead were adopted. The comparison between the reference values obtained with Healy's procedure and the tolerance limits, based on the normal approximation, computed within age strata is discussed.
In the present study, a definition of the reference values of blood cadmium (Cd-B) and urinary cadmium (Cd-U) was attempted, adopting the same methodology as that used for Hg-B by ICOH and IUPAC. Papers published from 1976 onwards were reviewed. The majority of the studies were concerned with the formation of control groups for toxicological and epidemiological investigations rather than with the definition of reference values. Since the number of subjects for whom data on cadmium were available was small, only the data on Cd-B were considered. After evaluation, only four studies were found to be suitable for the establishment of tentative reference values for Cd-B. It is essential in all such studies to check the statistical and analytical methods for correctness, and the case-list must be selected taking smoking into account as the main interfering factor. It was found that Cd-B values show less dispersion when geometric means and standard geometric deviations are used instead of arithmetic means and standard deviations.
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We evaluated the efficacy of an oral artificial supplementation in 22 patients who underwent surgery for gastric or pancreatic cancer. From 8th to 14th postoperative day, 11 patients (cases) received a diet consistent in their REE, and an oral integrator (40% of REE); controls received only the diet. On 7th and 15th day, nutritional and anthropometric parameters were evaluated, and bioelectrical impedance analysis (BIA) was performed to assess body composition. The dietary caloric input was similar in cases (1154 kcal, 86.0% of REE) and controls (1393 kcal, 92.3% of REE). Due to the integrator, cases reached 121.4% of REE (p less than 0.001). The nutritional and anthropometric parameters studied did not show significant variations in the two groups, but BIA showed a decrease of fat mass in controls with respect to cases (p less than 0.02). Our results demonstrate that the oral artificial supplementation was well tolerated, and did not reduce food intake, but induced a significant increase of total caloric input.
OBJECTIVE: To assess the effect of blood transfusion on the development of infection after elective operations for gastrointestinal and pancreatic cancer. DESIGN: Prospective open study. SUBJECTS: 285 consecutive patients admitted with gastric, colorectal, and pancreatic cancer, 215 of whom were suitable for the study. MAIN OUTCOME MEASURES: Sex, age, total iron binding capacity, measurement of haemoglobin and serum albumin concentration, assessment of immune response by delayed hypersensitivity skin test, and weight loss were recorded, as were duration of operation, operative blood loss, and pathological TNM stage of the disease. RESULTS: Sixty patients (28%) developed infections postoperatively. Univariate analysis showed that the development of infection was significantly associated with the amount of blood transfused (p < 0.001), operative blood loss (p < 0.05), and length of operation (p < 0.01), but not weight loss (p = 0.07) or delayed hypersensitivity response (p = 0.08). Multiple logistic analysis showed that blood transfusion was a significant independent variable only when more than 1,000 ml were transfused (odds ratio 6.5, p < 0.05). CONCLUSION: Transfusion of more than 1,000 ml of blood is an independent risk factor in the development of infection postoperatively in patients undergoing operations for gastrointestinal cancer.
The efficacy of thymopentin in reducing postoperative infections (PI) was prospectively evaluated in 138 patients with abdominal cancer, who underwent major surgery. Comparable subsets of patients were obtained according to age (cutpoint 65 years) and nutritional status (patients with serum albumin less than 30 g/l or weight loss greater than or equal to 10% with respect to their usual body weight were considered as malnourished). Patients were then at random attributed to a control group and to a thymopentin receiving (Thy) group, in the latter thymopentin (50 mg) was given three times before surgery and three times after operation. All patients received perioperative short term antibiotic prophylaxis and postoperative parenteral nutrition. The severity of Pl was expressed by the sepsis score which was calculated on all those patients developing Pl. Overall complication rate was 26.3% in the control group and 20.3% in the Thy group (p ns). Surgical-related infections occurred in 14 (20.3%) control group patients and in 10 (14.5%) Thy group patients (p ns). The average sepsis score was 10.11 +/- 6.69 in control group (2 patients died) and 6.85 +/- 3.80 in the Thy group (all patients survived) (p less than 0.05). By considering the elderly patients, a reduction in both Pl rate and the average sepsis score was observed in Thy group. Otherwise, no difference was observed in the young patients. Our data suggest that Thymopentin is useful in reducing both the incidence and the severity of Pl in elderly patients.
Twenty-six patients with advanced colorectal cancer were treated with a combination based on multimodal biochemical modulation of 5-fluorouracil by means of high dose folinic acid, low-dose alpha-2b interferon and dipyridamole. The overall response rate was 42% (95% confidence intervals = 23%. 61%) with four complete remissions (15%). The median duration of response was 9 months and the median survival for responders was 15 months (all patients = 12 months). Toxic side effects included oral mucositis (grade III-IV = 38%) and a generally mild flu-like syndrome. This regimen seems active and safe enough to be compared with the combination of fluorouracil and high-dose folinic acid.
The cytological appearances of an oxyphilic pancreatic carcinoma are reported and the histological and clinical features are described. Despite the presence of pulmonary and subcutaneous metastases this tumour did not behave in an aggressive fashion.
We studied 251 outpatients affected by chronic and acute urticaria-angioedema syndrome, triggered or exacerbated by drugs, to evaluate the prevalence of adverse reactions to each pharmacological group. Among these patients, 134 (53.4%) presented one or more adverse reactions to a single drug: 100 (74.7%) reacted to NSAIDs, 33 (24.7%) to antibiotics and 1 to B vitamin complex. The remaining 117 patients (46.6%) presented adverse reactions to more than one drug. Considering the patients all together, 123 (49%) had adverse reactions to ASA, 116 (46.2%) to pyrazones, 65 (25.9%) to antibiotics, 26 (10.3%) to NSAIDs different from ASA and pyrazones. In our experience, according to other reports, there is a greater frequency of drug reactions to NSAIDs vs other drugs. ASA is the more frequently involved drug.
Villous adenomas of the duodenum are rare, and malignancy is discovered in about 30% of the lesions. The authors describe two cases of villous adenoma of the second portion of the duodenum (13 and 8 cm in diameter). The diagnosis was obtained through endoscopy, which did not demonstrate any malignant change. In both patients, malignant change was shown by intraoperative frozen sections, and a pancreatico-duodenectomy was performed. Review of the literature and the authors' experience indicate endoscopic biopsies do not rule out the presence of malignancy in adenomatous pathology of the duodenum. Therefore, laparotomy should be performed whenever endoscopic excision of the neoplasm is not feasible. The authors emphasize the importance of an intraoperative diagnosis based on accurate frozen sections and propose a correct procedure to obtain the best results.
We studied food intake and nutritional status of 28 patients who had undergone total gastrectomy for gastric cancer. At discharge, patients were instructed to keep a high protein, high calorie diet and to record food intake on a specific form, twice weekly. Nutritional follow-up, consisting in a computerized determination of dietary intake and nutritional assessment was performed monthly during the first postoperative year. The average calorie intake was 1,431.8 Kcal/day one month after operation and 2,225.4 Kcal/day one year after surgery (p less than 0.001). In particular, only one patient exceeded 2,000 Kcal/day one month after total gastrectomy, while 21 patients exceed 2,00 Kcal/day one year after operation. The evaluation of nutritional parameters in the postoperative course showed that a significant increase in body weight, serum albumin and total iron binding capacity was observed only in patients who exceed 2,000 Kcal/day one year after operation. These results indicate that malnutrition is not an inevitable consequence of total gastrectomy; in fact, a close relationship between calorie intake and the variations of nutritional parameters was observed.
A prospective study on wound infections incidence was performed using a computer archive program. Data of 7000 patients submitted to surgical procedures from 1980 to 1988 were evaluated regarding a surveillance and a prevention program that was performed at 1984 (short term prophylaxis in contaminated and any clean-contaminated procedures; skin washing before the operation with a soapy solution of povidone iodine; regular report of all data about wound infection incidence to staff). Results were evaluated in four classes and regarding nutritional status. The reduction of wound infection incidence was statistically significant (1.8% vs 5.4%; chi square 63.70, p less than 0.001) and an important reduction was recorded in the malnourished patients (3.0% vs 15.4%; chi square 36.91, p less than 0.001).
The occurrence of maldigestion and malnutrition was studied in 14 patients who had undergone pancreaticoduodenectomy and occlusion of the Wirsung duct with Neoprene. Before discharge patients were put on a 70 g/day dietary fat intake. Mean faecal fat excretion was 32.9 g/day without enzyme replacement and fell to 14.2 g/day with pancrelipase supplementation. At discharge all patients were underweight (88 per cent of the usual mean body-weight) and nine patients showed alteration in laboratory nutritional parameters. At the time of discharge a low-fat diet (50 g/day) was prescribed. Six months after surgery, mean faecal fat excretion decreased further to 8.3 g/day (P less than 0.01) and all patients but one gained weight, reaching 93 per cent of the usual mean body-weight with normalized nutritional parameters. Our data show that the combination of enzyme replacement therapy and low-fat diet allows good correction of steatorrhoea and a significant improvement in nutritional status.
A double-blind random administration of 2 mg glypressin intravenously (i.v.) or placebo was given to 20 volunteer patients suffering from liver cirrhosis with portal hypertension and oesophageal varices. Experimental protocol required two basal intravascular oesophageal variceal pressure (IOVP) measurements, before and after bolus i.v. drug injection. The second measurement was taken as reference to determine whether the treatment was effective. Other measurements were taken 1, 3, 5 and 10 min after drug administration. The fall in IOVP at 3, 5 and 10 min in the patients who had been administered glypressin proved statistically significant (p less than 0.01) with mean percentage variations of -22.3%, -24.4% and -27.9%, respectively. In conclusion, the administration of glypressin in portal hypertensive patients brought about a marked reduction in transmural oesophageal variceal pressure in over 70% of the cases. This decrease may prove to be of clinical importance both as a first line therapy and as a possible aid to emergency sclerotherapy in the presence of active variceal bleeding.
Since the 1986, the National Institute for Occupational Accident Insurance (INAIL) provides each single Region with the occupational accident data on magnetic support. This strengthens the need to critically evaluate the most commonly used risk indicators. In this paper we discuss advantages and limits of the usual frequency and severity measures; the formulae for the standard errors are also given. A method proposed by I. Bross (1958), the RIDIT Analysis, is considered and exemplified. The appealing properties of this method ask for a more extensive application in this field.
In 40 eyes of 20 esotropic subjects in which a 'Fadenoperation' was performed on the medial recti we measured the resistance to ocular rotation in adduction before and after the operation. The difference between the two sets of force measurements demonstrates that the Fadenoperation on medial recti produces a mechanical restriction to adduction which can explain the effect of the surgical procedure on the strabismic deviation.
The effect of histamine control on the reaction produced by adjacent allergens or diluent control during skin test was evaluated in 742 patients sensitized to one or more inhalant allergens. In 4 cases (0.7%) both the diluent control and all the tested allergens were positive thus indicating an altered cutaneous reactivity. The allergens placed near the histamine control were positive in 183 cases (24.7%). Among these 144 (19.4%) were strong positive results according to the history. In 39 cases (5.2%) the positive result didn't correlate with the history. Of note in 35 cases (4.7%) the reaction was classified as weak positive (+) according to Berg and Johansson (1974). Although our findings confirm only partially those from Terho and Coworkers, we agree with the Authors on the opportunity of positioning the histamine control at a suitable distance from other allergens during skin test.