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Biomedical subjects

M Gennaro

Publications and source records attributed to M Gennaro.

At least 19 recordsLinked to original sources
PubMed2004

A third generation regimen VACOP-B with or without adjuvant radiotherapy for aggressive localized non-Hodgkin's lymphoma: report from the Italian Non-Hodgkin's Lymphoma Co-operative Study Group.

The objective of this multicenter prospective study was to determine the clinical efficacy and toxicity of a polychemotherapeutic third generation regimen, VACOP-B, with or without radiotherapy as front-line therapy in aggressive localized non-Hodgkin's lymphoma. Ninety-three adult patients (47 males and 46 females, median age 45 years) with aggressive localized non-Hodgkin's lymphoma, 43 in stage I and 50 in stage II (non-bulky), were included in the study. Stage I patients received VACOP-B for 6 weeks plus involved field radiotherapy and stage II patients received 12 weeks VACOP-B plus involved field radiotherapy on residual masses. Eighty-six (92.5%) achieved complete remission and 4 (4.3%) partial remission. Three patients (3.2%) were primarily resistant. Ten-year probability of survival, progression-free survival and disease-free survival were 87.3, 79.9 and 83.9%, respectively. Eighty-four patients are surviving at a median observation time of 57 months (range: 6-126). Statistical analysis showed no difference between stages I and II in terms of response, ten-year probability of survival, progression-free survival or disease-free survival. Side effects and toxicity were negligible and were similar in the two patient groups. The results of this prospective study suggest that 6 weeks of VACOP-B treatment plus radiotherapy may be the therapy of choice in stage I aggressive non-Hodgkin's lymphoma. Twelve weeks of VACOP-B treatment with or without radiotherapy was shown to be effective and feasible for stage II. These observations need to be confirmed by a phase III study comparing first and third generation protocols in stage I-II aggressive non-Hodgkin's lymphoma.

Adolescent↗
PubMed2004

Weight cycling in treatment-seeking obese persons: data from the QUOVADIS study.

OBJECTIVE: To determine parameters of weight history useful for the assessment of weight cycling and their association with psychological distress and binge eating. DESIGN: Cross-sectional. SUBJECTS: A total of 1889 treatment-seeking obese subjects, enrolled by 25 Italian centers (78% female subject), aged 20-65 y (median 45); 1691 reported previous efforts to lose weight (median age of first dieting, 30 y). MEASUREMENTS: The number of yearly attempts to lose weight, weight gain since age 20 y, cumulative weight loss and gain were checked by a predefined structured interview. Psychological distress was tested by means of Symptom Check-List 90 (SCL-90), Binge Eating Scale (BES) and Three Factor Eating Questionnaire (TFEQ). RESULTS: Differences in anthropometric, clinical and psychological parameters were observed in relation to previous attempts to lose weight. Patients in the upper quartile of parameters of weight history were considered weight cyclers. In multivariate logistic regression analysis, after correction for age, sex and BMI, a high BES score was the only factor systematically associated with a high frequency of dieting (OR, 1.70; 95% confidence interval, 1.22-2.36; P=0.022), with higher cumulative weight loss (1.42; 1.12-1.80; P=0.003) and cumulative weight gain (1.38; 1.06-1.79; P=0.017). However, the sensitivity, specificity and positive predictive value of a high BES score were very low to detect cyclers. Weight cycling did not carry a higher risk of complicating diseases. CONCLUSIONS: Weight cycling is associated with psychological distress, and binge eating independently increases the risk, but cannot be used to predict cycling. Also, obese patients who do not experience overeating as a loss of control discontinue treatment or regain weight following therapy.

Adult↗
PubMed2003

Altered maturation of peripheral blood dendritic cells in patients with breast cancer.

Tumours have at least two mechanisms that can alter dendritic cell (DC) maturation and function. The first affects the ability of haematopoietic progenitors to differentiate into functional DCs; the second affects their differentiation from CD14+ monocytes, promoting an early but dysfunctional maturation. The aim of this study was to evaluate the in vivo relevance of these pathways in breast cancer patients. For this purpose, 53 patients with invasive breast cancer were compared to 68 healthy controls. To avoid isolation or culture procedures for enrichment of DCs, analyses were directly performed by flow cytometry on whole-blood samples. The expression of surface antigens and intracellular accumulation of regulatory cytokines upon LPS stimulation were evaluated. The number of DCs, and in particular of the myeloid subpopulation, was markedly reduced in cancer patients (P<0.001). Patient DCs were characterized by a more mature phenotype compared with controls (P=0.016), and had impaired production of IL-12 (P<0.001). These alterations were reverted by surgical resection of the tumour. To investigate the possible role of some tumour-related immunoactive soluble factors, we measured the plasmatic levels of vascular endothelial growth factor, IL-10 and spermine. A significant inverse correlation between spermine concentration and the percentage of DCs expressing IL-12 was found. Evidence was also obtained that in vitro exposure of monocyte-derived DCs to spermine promoted their activation and maturation, and impaired their function. Taken together, our results suggest that both the above-described mechanisms could concomitantly act in breast cancer to affect DC differentiation, and that spermine could be a mediator of dysfunctional maturation of DCs.

Adult↗
PubMed2003

[Jeiuno-ileal diverticula complicated by perforation. Clinical case].

The diverticular disease is rarely located in the small intestine (0.1-1.4%). The most important feature is due to the lack of a typical symptomatology which may appear only on the occasion of the complications it may incur (perforation, haemorrhage and so on). It isn't also infrequent that the surgeon may observe intestinal diverticula accidentally, on the occasion of laparotomies carried out in emergency or for other pathologies. The literature on intestinal diverticula is reviewed and personal experience in a clinical case presenting as acute abdomen is described.

Abdomen, Acute↗
PubMed2003

[Day Surgery. Five years of experience and activity].

BACKGROUND: The aim of this paper is to evaluate the management of an integrated unit of Day Surgery in a General Surgery Department. METHODS: An outline of the first 5 years of activity is presented. Setting of investigation: little provincial hospital. Patients have been selected on a basis of Day Surgery specific features: a total of 1,294 patients. Pathologies treated: inguinal hernias, phlebectasias, phimosis, borsitis, arthritic cysts, tendon cysts, carpal tunnel, Dupuytren's disease ("crispatura tendinum"), lymphadenitis, mammary nodules, hemorrhoids, hydroceles, varicoceles, adipomas. Patients' selection parameters, surgical operation type and modalities, postoperative course, protected discharges from hospital, follow-up and complications have all been carefully recorded. RESULTS: The most numerous operations were related to hernial pathology (54.32%) and to adipomas (10.81%). The form of anesthesia was mainly loco-regional. Only 4 cases (0.3%) had to be hospitalized for the night after operation. COMPLICATIONS: 1 serious wound infection, needing removal of the hernial prosthesis; 1 painful "tumefaction" on the inguinal wound for hernioplastic operation; 3 "seromas" in inguinal hernioplastics. CONCLUSIONS: Advantages of Day-Surgery: cut in health costs due to the reduction of admissions to hospital; reduction in hospital infections and in surgical wounds; reduction in drug use; thinning of waiting lists; increase of available beds for other pathologies; reduction of disability days; high appreciation index.

Adolescent↗
PubMed2001

Axillary lymph node staging in breast cancer by 2-fluoro-2-deoxy-D-glucose-positron emission tomography: clinical evaluation and alternative management.

BACKGROUND: Surgical removal of axillary lymph node and histologic examination for metastases are used to determine whether adjuvant treatment is necessary for patients with breast cancer. Axillary lymph node dissection (ALND) is a costly procedure associated with various side effects, and 80% or more of patients with tumors of 20 mm or less are lymph node negative and might avoid ALND. In this study, we evaluated whether an alternative, noninvasive method--i.e., positron emission tomography (PET) with 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG)-- could be used to determine axillary lymph node status in patients with breast cancer. METHODS: One hundred sixty-seven consecutive patients with breast cancers of 50 mm or less (range = 5-50 mm; mean = 21 mm) scheduled for complete ALND were studied preoperatively with FDG-PET, and then PET and pathology results from ALND were compared. All statistical tests were two-sided. RESULTS: The overall sensitivity, specificity, and accuracy of lymph node staging with PET were 94.4% (PET detected 68 of 72 patients with axillary involvement; 95% confidence interval [CI] = 86.0% to 98.2%), 86.3% (82 of 95 patients without axillary involvement; 95% CI = 77.8% to 91.9%), and 89.8% (150 of 167 patients with breast cancer; 95% CI = 84.2% to 93.6%), respectively. Positive- and negative-predictive values were 84.0% (68 patients with histologically positive lymph nodes of 81 patients with positive FDG-PET scan; 95% CI = 74.2% to 90.5%) and 95.3% (82 patients with histologically negative lymph nodes of 86 patients with negative FDG-PET scan; 95% CI = 88.2% to 98.5%), respectively. When PET results for axillary metastasis were analyzed by tumor size, the diagnostic accuracy was similar for all groups (86.0%-94.2%), with higher sensitivity for tumors of 21-50 mm (98.0%) and higher specificity for tumors of 10 mm or less (87.8%), and the range was 93.5%-97.3% for negative-predictive values and 54.5%-94.1% for positive-predictive values. Among the 72 patients with axillary involvement, PET detected three or fewer metastatic lymph nodes in 27 (37.5%) patients, about 80% of whom had no clinically palpable axillary lymph nodes. CONCLUSIONS: Noninvasive FDG-PET appears to be an accurate technique to predict axillary status in patients with breast cancer and thus to identify patients who might avoid ALND. These results should be confirmed in large multicenter studies.

Adult↗
PubMed2001

Conservative surgery in breast cancer. Significance of resection margins.

We approached the issue of surgical margins in the conservative treatment of breast cancer by examining the literature germane to four precise questions: At what distance from the macroscopic margin of the tumour should the resection margin be? To what extent do histologically clear resection margins indicate complete local control of the disease? To what extent do histologically involved margins indicate persistence of disease? and Does the local recurrence rate correlate with the status of the resection margin? We propose categorizing margin involvement into five groups (absent, focal, minimal, moderate and extensive involvement) according to strict histological criteria, and assigning increasingly aggressive subsequent treatments according to the extent of any margin involvement.

Journal Article↗
PubMed2000

Impact of nodal status on indication for adjuvant treatment in clinically node negative breast cancer. Istituto Nazionale per lo Studio e las Cura dei Tumori.

We addressed the problem of the need for axillary dissection in clinically node-negative breast cancer by determining how the information provided by the dissection suggests a different treatment to that indicated by primary tumour characteristics and age alone. We examined retrospectively 260 cases of clinically node negative early breast cancer all of whom underwent breast surgery, radiotherapy and axillary dissection. We assigned adjuvant therapy according to accepted guidelines with and without consideration of pathological node status and compared the difference. Fifty-six patients had involved axillary nodes. There was no change in adjuvant chemotherapy indication for the 44 cases over 65 years. The change in indication for the remaining 216 cases was 18.5% to 6%, depending on whether none or all of the intermediate risk patients were originally assigned chemotherapy (all were originally assigned tamoxifen). Since the trend is for most intermediate risk patients is to be assigned adjuvant chemotherapy, and since tamoxifen is anyway considered effective therapy for low and intermediate risk patients, we conclude that the information provided by axillary dissection is probably not necessary if guidelines recommending wide application of systemic adjuvant chemotherapy are applied. Satisfactory prognostic information can be obtained by consideration of primary tumour characteristics, while new prognostic markers are likely to further refine prognostic precision in the near future.

Adult↗
PubMed1996

Perfluorocarbon emulsion prevents eicoasanoid release in skeletal muscle ischemia and reperfusion.

Eicosanoids play an important role in mediating deleterious effects following skeletal muscle ischemia-reperfusion injury. It has previously been shown that oxygenated perfluorocarbon emulsion (O2 Fluosol-DA 20%) decreases the amount of muscle necrosis and neutrophil sequestration when given during the reperfusion phase following skeletal muscle ischemia. As thromboxane is known to alter the endothelial cytoskeleton, thereby favoring diapedesis of neutrophils, the effects of O2 Fluosol-DA 20% on thromboxane release in a canine gracilis muscle model were investigated. The gracilis muscle on one randomly selected side of 14 adult mongrel dogs (body-weight 22-26 kg) was subjected to 6 h of normothermic ischemia followed by 48 h of normothermic reperfusion. The control group (n = 7) underwent ischemia-reperfusion, but without any pharmacological intervention. The Fluosol group (n = 7) were infused with O2 Fluosol-DA 20% (4.3(0.2) ml O2/100 ml) at 12 ml/min for 40 min via the gracilis artery following the ischemic period. Thromboxane B2 levels were measured from blood samples obtained at pre-ischemia, and at 1 h and 48 h of reperfusion. The gracilis muscles were harvested at the end of the experiment and extent of muscle necrosis quantitated by serial transections, nitroblue tetrazolium staining and computed planimetry. The mean(s.e.m.) muscle necrosis in the control group (59(6)%) was significantly higher than in the Fluosol group (22(5)%, P < 0.05, t-test). Thromboxane levels (pg/ml) in the control group at 1 h of reperfusion were significantly higher than the pre-ischemic and 48-h reperfusion levels (7286(1383) versus 1336(592) and 2314(1297), P < 0.05 by ANOVA and Student-Newman-Keuls test). The thromboxane level in the Fluosol group at 1 h reperfusion was significantly lower than the control group (2700(556) and 7286(1383) pg/ml, respectively; P < 0.05, t-test). In contrast, there was no statistically significant difference between thromboxane levels in the Fluosol group at 1 h reperfusion compared with levels at pre-ischemia and 48 h reperfusion (2700(556) versus 1336(592) and 1400(474). Thus, perfluorocarbons are effective in decreasing skeletal muscle necrosis, probably by maintaining the endothelial integrity and preventing vasospasm, secondary to their inhibitory effect on thromboxane release. Perfluorocarbons may also minimize some of the deleterious pulmonary effects known to be caused by increased levels of eicosanoids during reperfusion.

Animals↗
PubMed1996

Complementary distal arteriovenous fistula and deep vein interposition: a five-year experience with a new technique to improve infrapopliteal prosthetic bypass patency.

PURPOSE: In an attempt to improve graft patency results of prosthetic bypasses to infrapopliteal arteries, we used a new type of adjunctive technique that combines an arteriovenous fistula and vein interposition (AVF/VI). METHODS: Over the past 5 years, 68 such reconstructions were performed in 62 patients with critical ischemia in whom a totally autogenous vein bypass was not feasible. Forty-seven patients (76%) had one or more failed ipsilateral infrainguinal bypasses. The AVF/VI was performed by transposing the central portion of the adjacent deep vein onto the side of the recipient artery. The distal end of a 6-mm polytetrafluoroethylene (PTFE) ringed graft then was anastomosed to the hood of the AVF. The segment of vein interposed between the PTFE graft and the recipient artery widened the anastomosis and improved the compliance mismatch. Simultaneous pressure measurements of the radial artery and the distal portion of the graft were obtained in all cases. RESULTS: Significant pressure gradients ranging from 35 to 70 mm Hg were detected in 26 bypasses (38%), which led to banding of the venous outflow that decreased the gradient to within 20 mm Hg. A gradient < or = 30 mm Hg was found in 28 bypasses (41%), and no banding was required if the absolute intragraft systolic pressure was > or = 100 mm Hg. Only 14 bypasses (21%) had no detectable pressure gradients. Twenty-six bypasses originated from femoral arteries, 34 from iliac arteries, and 8 from patent proximal grafts. The recipient arteries were the anterior tibial artery in 33 cases, posterior tibial in 17, peroneal in 15, dorsalis pedis in 2, and lateral plantar in 1. All patients began a regimen of heparin 6 to 8 hours after surgery and continued to receive chronic anticoagulation. Cumulative, 3-year assisted primary graft patency rates were 78%, 70%, and 62%, respectively. Cumulative 3-year AVF patency rates were 65%, 57%, and 46%, respectively. The 3-year limb salvage rate was approximately 78%. CONCLUSION: Adjunctive AVF/VI significantly improves infrapopliteal PTFE graft patency and limb salvage rates. The combination of a decreased compliance mismatch at the distal anastomosis and the abolishment of a large pressure gradient at the distal anastomosis while maintaining higher graft flow rates may have contributed to the improved results.

Aged↗
PubMed1996

Superior vena caval Greenfield filters: indications, techniques, and results.

PURPOSE: This study assessed the clinical feasibility of placement of the titanium Greenfield filter within the superior vena cava (SVC) in patients with upper extremity deep venous thrombosis and evaluated the short-term results. METHODS: During the past 14 months, we have encountered 6 patients who had upper extremity central venous thrombosis in whom anticoagulation was deemed either contraindicated or ineffective in preventing recurrent pulmonary embolism. All patients underwent percutaneous insertion of a Greenfield filter into the SVC for prophylaxis for pulmonary embolism. Two of these patients had already undergone insertion of an inferior vena cava filter and two other patients had simultaneous insertion of SVC and inferior vena caval filters. RESULTS: No complications such as filter migration, misplacement, excessive hemorrhage, or pneumothorax occurred. Two patients subsequently underwent uncomplicated insertion of a Swan-Ganz catheter despite the presence of the filter. Two patients died of unrelated causes without clinical evidence of complications related to the filter. During the follow-up period from 4 to 14 months, there was no clinical evidence of pulmonary embolism in the remaining four patients. CONCLUSIONS: This procedure can be performed safely and is effective for the prevention of pulmonary embolism in patients with upper extremity venous thrombosis.

Aged↗
PubMed1996

The natural history of the external carotid artery after carotid endarterectomy: implications for management.

PURPOSE: Most surgeons perform some type of endarterectomy of the external carotid artery (ECA) routinely during standard carotid endarterectomy (CEA). This approach has been shown to result in a small percentage of ECA occlusions, the clinical significance of which remains poorly understood. We have modified our approach to the management of the ECA during standard CEA by averting any attempt at external CEA. To evaluate the natural history of the untreated ECA after CEA, we reviewed the preoperative, postoperative, and follow-up duplex scans obtained from 232 CEAs over the past 4 years. METHODS: Preoperative and postoperative carotid artery duplex examinations with specific evaluation of the extent of ECA stenosis were available for review on 114 CEAs performed between January 1991 and July 1994. All CEAs were performed for internal carotid artery stenosis greater than 75% as determined by duplex scanning, which was confirmed by either contrast arteriography or magnetic resonance angiography. RESULTS: Seventy-three (64.0%) procedures were performed for symptomatic lesions, whereas 41 (36.0%) were performed for asymptomatic stenosis. There were no perioperative strokes or transient ischemic attacks in this group, and there was one postoperative death (0.9%). Short- and intermediate-term follow-up demonstrated insignificant changes in ECA diameter after operation, with no cases of ECA occlusion and only five cases progressing to greater than 75% on the 1-year follow up duplex examination. CONCLUSION: We conclude from these data that averting external CEA during standard CEA does not result in significant progression of ECA stenosis or occlusion.

Aged↗
PubMed1995

Noninvasive predictors of patency for infrapopliteal PTFE bypasses with combined arteriovenous fistula and vein interposition technique.

BACKGROUND: Despite recent increased indications for infrapopliteal prosthetic bypass grafts with complementary arteriovenous fistulas, objective documentation of improved perfusion to the foot is lacking. In addition, the value of post operative noninvasive testing in the prediction of bypass success remains unclear. PATIENTS AND METHODS: Over a 3-year period, 41 patients with limb-threatening ischemia were treated with 41 infrapopliteal 6-mm polytetrafluoroethylene (PTFE) bypasses with a complementary arteriovenous fistula at our institution. Twenty-four patients were men and 17 were women, with an average age 71.3 +/- 8.6 years. Thirty-one patients (76%) had undergone at least 1 previous failed ipsilateral arterial bypass. Preoperative and early postoperative (less than 1 month) pulse-volume recordings of transmetatarsal amplitude (TMA) were available for analysis in 28 patients. Postoperative duplex evaluations of graft velocity, fistula patency, and prograde distal arterial flow were performed in 26 of the original 41 patients. These data were correlated to early graft failure in an attempt to identify specific noninvasive predictors. RESULTS: Cumulative primary patency rates of the original 41 patients were 79.0%, 69.2%, and 63.8% at 1, 2, and 3 years, respectively. The early postoperative TMA values ranged from 3 to 50 mm with a mean of 21.6 +/- 14.8 mm (P < 0.001). Twenty-one patients (75%) had patent grafts on follow-up of 2 to 37 months (mean 18.6). The early postoperative TMA in this group of patients was 26.5 +/- 12.4 mm compared with 3.3 +/- 2.8 mm in the 6 patients whose grafts failed within 6 months (P < 0.001). A TMA of < 5 mm was 83% sensitive and 95% specific for the prediction of early graft failure. Of the graft examined by duplex ultrasonography, 21 (81%) remained patent during the follow-up period. The midgraft peak systolic velocity (PSV) of these grafts was 109 +/- 8.0 cm/s compared with 74.2 +/- 15.3 cm/s for the 5 initially patent bypasses that subsequently failed at any time during the follow-up period (P < 0.05). PSV of < 70 cm/s was 60% sensitive and 86% specific in predicting early graft failure. The combination of early postoperative TMA < 5 mm and early midgraft PSV < 70 cm/s was 100% sensitive and 100% specific for the prediction of early graft failure. CONCLUSIONS: These data show that infrapopliteal PTFE arterial bypasses with complementary arteriovenous fistulas significantly improve arterial perfusion at the level of the foot in the majority of patients. Also, both the postoperative TMA and midgraft PSV appear to be reliable predictors of graft outcome. Further experience with the noninvasive surveillance of these bypasses may become as rewarding as it is in standard vein bypasses.

Aged↗
PubMed1995

Preliminary results of a nonoperative approach to saphenofemoral junction thrombophlebitis.

PURPOSE: A prospective, nonrandomized study was conducted to evaluate the efficacy of a nonoperative approach of anticoagulation therapy to manage saphenofemoral junction thrombophlebitis (SFJT). METHODS: Over a 2-year period between January 1993 and January 1995, 20 consecutive patients with SFJT were entered into the study. They were hospitalized and given a full course of heparin. Duplex ultrasonography was performed before admission, both to establish the diagnosis and to evaluate the deep venous system. Two to 4 days after admission a follow-up scan was obtained to assess resolution of SFJT and to reexamine the deep venous system. Patients with SFJT alone and resolution of SFJT by duplex scanning were maintained on warfarin (Coumadin) for 6 weeks. Those with SFJT and deep venous thrombosis (DVT) were maintained on Coumadin for 6 months. Incidence of concurrent DVT and its location were noted. The efficacy of anticoagulation therapy was evaluated by measuring SFJT resolution, recurrent episodes of SFJT, and occurrence of pulmonary embolism (PE). RESULTS: There was a 40% incidence (eight of 20 patients) of concurrent DVT with SFJT. Of the eight patients, four had unilateral DVT, two had bilateral DVT, and two had development of DVT with anticoagulation. DVT was contiguous with SFJT in five patients and noncontiguous in three patients. Of 13 duplex scans obtained at 2 to 8 months follow-up, seven demonstrated partial resolution of SFJT, five had complete resolution, and one did not demonstrate resolution. There were no episodes of PE, no recurrences, and no complications of anticoagulation at maximum follow-up of 14 months. CONCLUSIONS: Anticoagulation therapy to manage SFJT was effective in achieving resolution, preventing recurrence and preventing PE within our follow-up period. There is a high incidence of DVT associated with SFJT that merits careful evaluation of the deep venous system during the course of management.

Adult↗
PubMed1995

The value and limitations of L-arginine infusion on glomerular and tubular function in the ischemic/reperfused kidney.

PURPOSE: The nitric oxide precursor, L-arginine, has been shown to have a salutary effect on ischemia and reperfusion injury in skeletal muscle, skin, and intestines. Because L-arginine also increases renal blood flow, glomerular filtration, and urine flow in experimental animals with normal renal function, we postulated that L-arginine may also improve renal function after renal ischemic injury. METHODS: Eighteen adult New Zealand white rabbits weighing 3 to 3.5 kg were subjected to bilateral normothermic renal ischemia by clamping both renal pedicles for 1 hour followed by 2 hours of reperfusion. The animals were randomized into three groups: group I (control, n = 6) received no additional treatment; group II (pretreatment, n = 6) received systemic intravenous L-arginine at 150 mg/kg over 20 minutes before induction of ischemia; group III (posttreatment, n = 6) received systemic intravenous L-arginine at 150 mg/kg over 20 minutes from the onset of reperfusion. Urine flow, creatinine clearance (CCR), fractional excretion of sodium (FENa), and renal failure index (RFI) were calculated before ischemia and 2 hours after reperfusion, by use of standard formulas. The changes of the various renal parameters were compared among the three groups. RESULTS: Bilateral normothermic renal ischemia for 1 hour produced a significant deterioration of glomerular filtration as evidenced by a CCR decrease from 11.1 +/- 1.8 to 2.49 +/- 0.9 ml/min (p < 0.01), FENa increase from 2.9% +/- 1.0% to 20.8% +/- 1.5% (p < 0.01) and RFI increase from 4.0 +/- 1.3 to 28.8 +/- 2.6 (p < 0.01). Pretreatment with L-arginine (group II) minimized the deleterious effects caused by ischemia on glomerular filtration (CCR of 2.49 +/- 0.9 ml/min in group I vs 4.95 +/- 2.5 ml/min in group II, p < 0.05) and tubular function (FENa of 20.8% +/- 1.5% in group I vs 13.0% +/- 5.6% in group II and RFI of 28.8 +/- 2.6 in group I vs 18.6 +/- 8.0 in group II, p < 0.05). Infusion of L-arginine at the onset of reperfusion (group III) produced a significant diuretic effect (urine flow from 32.6 +/- 13.4 ml/hr in group I to 63.3 +/- 18.8 ml/hr in group III, p < 0.05) and also minimized glomerular damage (CCR from 2.49 +/- 0.9 ml/min in group I to 4.80 +/- 1.2 ml/min in group III, p < 0.05); however, no beneficial effect was observed on tubular function. CONCLUSION: Induction of nitric oxide production by systemic L-arginine infusion can best preserve glomerular and tubular function in the ischemic/reperfused kidney when given before the ischemic insult.

Animals↗
PubMed1994

Outcome of patients with abnormal ocular pneumoplethysmographic measurements undergoing coronary artery bypass grafting.

A total of 1780 patients without symptoms of cerebral ischemia undergoing coronary artery bypass grafting (CABG) were screened before surgery for carotid stenosis by pneumophlethysmography. An abnormal test was defined as a difference in ophthalmic artery pressures of > or = 5 mmHg or ophthalmic-brachial pressure index < or = 0.69. Some 99 patients (5.6%) had an abnormal ocular pneumoplethysmographic measurement (89 unilateral, ten bilateral). Of these, 26 patients underwent prophylactic carotid endarterectomy before CABG (group 1), while the remaining 73 patients had reconstruction without previous carotid endarterectomy (group 2). A total of 100 patients (group 3) with normal ocular pneumoplethysmographic results were used as controls. The three groups were comparable with respect to age, diabetes, hypertension, smoking and severity of coronary artery disease. Early (30-day) postoperative stroke rates were 0 and 4% (n = 3) for groups 1 and 2 respectively, and 0% for group 3 (P > 0.07). Early mortality rates after CABG for groups 1 and 2 were 4% (n = 1) and 1% (n = 1), respectively and 2% (n = 2) for groups 3 (P > 0.4). Late follow-up (mean 48 months) demonstrated stroke rates of 0% for group 1, and 10% and 4% for groups 2 and 3 (P > 0.08). The early mortality and stroke rates in the ten patients with bilateral abnormal ocular pneumoplethysmographic values were 0 and 0%. However, late strokes occurred significantly more often (43%) in patients with bilateral abnormal results compared with those with unilateral abnormal findings when both groups did not undergo carotid endarterectomy (P < 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Silent myocardial ischemia is not predictive of myocardial infarction in peripheral vascular surgery patients.

Continuous ambulatory ECG (CAECG) monitoring has been advocated as an effective low-cost preoperative method for detecting silent myocardial ischemia in patients undergoing peripheral vascular surgery. In addition, silent ischemic events are associated with an increased incidence of postoperative myocardial infarctions. Ninety-six patients (mean age 73 years) admitted for elective aortic (24) or infrainguinal (72) operations over a 2-year period underwent 24-hour two- or three-lead CAECG monitoring. Results were reviewed by a single cardiologist blinded to the study. The criterion for ischemia was ST segment depressions of 1 mm or greater for 40 seconds or more 60 msec after the J point. Postoperative myocardial infarction was determined by ECG changes and/or elevated serum creatinine phosphokinase with positive MB isoenzymes. Risk factors included hypertension (71%), history of coronary artery disease (66%), smoking (61%), and diabetes mellitus (47%). Nine out of 96 patients (9.4%) had a positive CAECG test for silent myocardial ischemia. Only one patient (11.1%) developed postoperative myocardial infarction and there were no deaths in this group. The incidence of postoperative myocardial infarction in the nonischemic group was 16.1% (14/87). However, the mortality in this group was 6.9% (6/87). New and malignant arrhythmias requiring preoperative medical intervention were observed in seven patients (7.4%): two cases of ventricular tachycardia and five cases of atrial flutter/fibrillation. Contrary to previous reports, CAECG monitoring for silent ischemia was not a significant predictor of postoperative myocardial infarction or mortality in our patient population. However, we continue to recommend the preoperative use of CAECG monitoring as a diagnostic tool for unsuspected malignant arrhythmias.

Adult↗