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Biomedical subjects

M Monaco

Publications and source records attributed to M Monaco.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Endoscopic obstruction treatment].

The Authors reported the last year personal experience of disobstruction endoscopic therapy; they described therefore an examination of the several techniques proposed from the international literature and in particular dwell upon laser-therapy and airway stents implantation. They emphasized the treatment importance, mostly palliative, but the effective symptomatology improvement due to airway obstruction, bleeding, pain and secretions retenction. They emphasize finally the necessity of a careful and scrupulous patients selection for disobstruction endoscopic therapy.

Aged↗
PubMed2000

Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies.

Predisposing factors, clinical characteristics, and antimicrobial treatment of 37 hematology patients with Stenotrophomonas maltophilia bacteremia who were seen at the department of hematology of the University La Sapienza (Rome) from 1987 to 1996 were evaluated. The results were compared with a control group of patients with Pseudomonas aeruginosa bacteremia. Profound neutropenia was more prolonged in the S. maltophilia group (P=.025), severe cellulitis occurred only in S. maltophilia-infected patients (11 [30%]; P=.0002), and the bacteremia presented as breakthrough infection in 56% of the cases due to S. maltophilia (vs. only 24% of those due to P. aeruginosa; P=.002). Acute mortality rates associated with S. maltophilia and P. aeruginosa bacteremia were 24% and 21%, respectively. In both groups, profound neutropenia and hypotension at the onset of bacteremia, duration of profound neutropenia during bacteremia, severity-of-illness score > or =4, and inappropriate antibacterial treatment were factors significantly associated with death. Most S. maltophilia isolates were resistant to aminoglycosides, beta-lactams, and ciprofloxacin. Cotrimoxazole and ticarcillin-clavulanic acid showed borderline activity. Prompt administration of in vitro-active antibiotics may improve the prognosis of S. maltophilia bacteremia, especially for immunocompromised patients, and novel drug combinations are needed for the treatment of severe infections.

Adolescent↗
PubMed2000

Feasibility of peripheral blood stem cell rescue as intensification in elderly patients with acute myelocytic leukaemia: a pilot study from the Gimema Group. Gruppo Italiano Malattie Ematologiche Maligne Dell'Adulto.

Elderly patients with untreated acute myeloid leukaemia (AML, n = 47) tested the feasibility of out-patient consolidation therapy and post-consolidation treatment (for patients aged < 71 years) with autologous peripheral blood stem cell transplantation (APBSCT). Overall, 13 patients out of 24 (51%) who achieved complete remission (CR) were eligible for further treatment after consolidation. Five patients were primed with granulocyte colony stimulating factor (G-CSF); a suitable number of CD34+ cells were harvested in three patients and were actually autotransplanted. The toxicity of APBSCT was negligible. Psychosocial problems impaired treatment of some patients on an out-patient basis. Resistant disease, toxicity and logistic problems reduced the number of patients to whom this procedure could actually be applied.

Acute Disease↗
PubMed2000

In vitro activity of fluconazole and voriconazole against isolates of Candida albicans from patients with haematological malignancies.

We evaluated the activity of fluconazole and voriconazole against 83 Candida albicans isolates from patients with haematological malignancies, comparing the NCCLS microdilution method (M27-A) with a modified method with RPMI-2% glucose and MIC endpoint at 50% inhibition. Both drugs were highly active regardless of the year, the site of isolation of the strain and the test method employed. In several strains isolated during the last few years, trailing growth leading to difficulty in interpretation of the endpoint of the test has been observed for both drugs by the NCCLS method, but not by the modified method. In our experience, azole resistance of C. albicans is still not a clinical problem, however, the emerging phenomenon of the 'trailing effect' by the NCCLS method, even though resolvable by technical modifications, seems at least to indicate a reduction in the inhibitory activity of the azoles.

Antifungal Agents↗
PubMed2000

Deficit-undamaged visual field area monitoring in glaucomatous patients with advanced perimetric damage: its usefulness.

This report contains the observations of the authors on the behaviour with time of the visual field areas (VF) which appear undamaged by deficit within the perimetric findings where at the same time there is advanced glaucomatous damage. A retrospective study has been made on the records of a Humphrey perimeter 640 VFA relating to glaucomatous patients with these perimetric characteristics in whom at least 12 examinations (programme "Central 30-2 threshold test") had been made and who, for a good part of the period of observation at least, had recorded a topographic stability of the deficits. There were found 12 series of examinations responding to the required necessities. The analysis of the findings used a method that separated from the global mean deviation (MD) that part concerning the pathological area and that referring to the "healthy" area of the visual field (VF). In 7 of the 8 cases where, at a certain point in the follow-up, there became evident a trend towards worsening, there was also a significant increase in the MD of the undamaged, which occurred before the deterioration of the "healthy" area became evident by the appearance of "probability symbols" in the "total deviation" map. In the 4 cases where there was stability with time, the MD values relating to the undamaged area of the VF were quite constant with time.

Chronic Disease↗
PubMed2000

[Reconstruction of the thoracic wall].

The resection of the thoracic wall for cancer, traumas or results of radiotherapy could require a reconstruction of the same wall with prosthetic material of different nature to the purpose of protect the important intrathoracic structures, avoid the flail chest and maintain a ventilation adjusted with aesthetically acceptable results. Numerous and varied they have been and they are the materials used to such aim, but the more numerous experiences concern the reconstructions of the wall with the employment of nets of Marlex or the patch of Gore-Tex. In the complete two years eight patients have arrived at our observation in which a prosthetic reconstruction has been performed with heterologous material. In three of them has been used the net of Marlex, in five the patch of Gore-Tex of two millimeters of thickness. The prostheses have stayed well you bear and in all the patients the authors have gotten a good stabilization of the thoracic wall.

Adult↗
PubMed2000

[Elective and emergency minimally invasive surgery in pleural diseases].

In the last years the video-assisted thoracic surgery (V.A.T.S.) assumed an important order for the diagnosis and treatment of the pleural disease. In this particular field, the procedure allows obtaining almost the same outcomes of traditional surgery and is very safety. V.A.T.S. reduces hospital time and trauma with a fast return to the working life. The Authors describe their experience and outline the diagnostic and therapeutic indications for the treatment of choice and emergency.

Elective Surgical Procedures↗
PubMed1999

[Open-window surgery of pleural empyema].

Thoracoscopic is performed for treatment of pleuric empiema with 65% of recovery. In the old patients the Authors achieved high grade of recovery with open window (OW) procedure. In the last two years, 7 patients with pleuric empiema underwent this treatment. In two patients the origin was tuberculosis, in 4 empiema was post-pneumonitic; in one case the cause was broncho-pleuric fistula after pneumonectomy. All the operations were performed under general anesthesia. The Authors began with thoracoscopy, drainage of cavity and then they performed the resection of one or more ribs and a pleuro-cutaneous flap: 5 patients recovered without complications. OW seems to be very useful in the case in which more radical approach is impossible. Continuous irrigations of the cavity, with rapid pulmonary expansion, permits recovery without the use of myocutaneous flaps.

Aged↗
PubMed1998

Risk factors of stroke after percutaneous transluminal coronary angioplasty.

Objective: to determine possible risk factors of a stroke after percutaneous transluminal coronary angioplasty (PTCA). Design: this is a retrospective evaluation of a consecutive group of 4088 patients undergoing PTCA between 1988 and 1995. We have studied the incidence, clinical characteristics, risk factors, and outcome. Results: seven patients, six males and one female (0.17%) developed a stroke after this procedure. In comparison with the control group, the stroke group did not differ regarding age or gender. The existence of a stroke (six located in the brain, and one in the spinal cord), represented 1.24% of all complications (P < 0.001), and 5% of all deaths (P < 0.01) of PTCA. Three patients developed TIA, two patients developed hemorrhagic strokes (in which they received previous thrombolytic therapy), and the other two patients suffered from an ischemic stroke. The statistically significant risk factors of a stroke after PTCA included: intracoronary thrombolytic therapy (P < 0.01), hypercholesterolemia (P < 0.001) and a prior PTCA (P < 0.05). Conclusions: although these procedural complications are infrequent, they are usually serious and important risk factors which could be identified prior to the procedure. These risk factors would allow identification of patients who are prone to a stroke after PTCA. Intracranial hemorrhage occurred only after thrombolytic therapy, and the factors related to hemorrhagic strokes were probably different from those predisposed to ischemic strokes and TIA. Copyright 1998 Lippincott Williams & Wilkins

Journal Article↗
PubMed1998

Use of voriconazole in treatment of Scedosporium apiospermum infection: case report.

We report a case of disseminated Scedosporium apiospermum infection in a neutropenic patient with acute myeloid leukemia. Due to progression of the mycosis after 7 days of amphotericin B lipid complex therapy and to high susceptibility of the mold to voriconazole in vitro, the patient was treated with intravenous voriconazole. After a few days of therapy, fever disappeared and skin lesions improved. However, the patient died after 1 month due to intestinal bleeding. Despite a negative outcome, this case seems to indicate a promising role for voriconazole in the treatment of S. apiospermum infections.

Acute Disease↗
PubMed1997

Aortic valve replacement through a minimally invasive approach.

Minimally invasive cardiac surgery is rapidly gaining interest because of fast recovery, reduced morbidity, shorter hospital stay, lower costs, and better cosmetic results. Aortic valve surgery can be performed through a small (10- to 12-cm) transverse sternal incision, and femoro-femoral cannulation is used for cardiopulmonary bypass. Exposure of the ascending aorta is satisfactory. From 1 March through 30 September 1996, 7 patients underwent aortic valve replacement through this approach. The mean age of the 5 women and 2 men was 58.8 years. We used this technique mainly in patients with chronic obstructive pulmonary disease, diabetes, or obesity, in the absence of coronary artery disease. There was no mortality, nor was there reoperation for bleeding, stroke, or wound infection. All patients were extubated after 2 hours in intensive care and were discharged on the 4th postoperative day. Additional cases are needed to properly assess the correct indication and surgical technique.

Aortic Valve↗
PubMed1996

High incidence of infectious gastrointestinal complications observed in patients with acute myeloid leukemia receiving intensive chemotherapy for first induction of remission.

An increased incidence of severe infections, in particular gastrointestinal complications, was observed in our institution among 35 consecutive patients with acute myelogenous leukemia submitted to their first intensive pilot protocol for induction of remission containing idarubicin, etoposide and cytosine arabinoside. Ten patients presented fever and severe diarrhea (4 or more loose stools/day for at least 4 consecutive days); 3 of these developed ileothyphlitis, which proved fatal in 2 cases, 7 needed amphotericin B addition to antibacterial treatment and, in 6 cases, a fungal infection was documented. We have compared these 10 patients with the other 25 submitted to the same chemotherapeutic protocol and the incidence of candidemias (5/10 compared to 0/25), the early use of systemic fluconazole from the onset of fever (0/10 compared to 9/25) and the pre-emptive use of total parenteral nutrition (0/10 compared to 8/25) differed in the two groups. We conclude that during this chemotherapeutic protocol the incidence of severe gastrointestinal infectious complications was particularly high (28.5%) and, even though only a small number of patients were studied, our results suggest an important role for Candida spp. in the pathogenesis of this disease.

Acute Disease↗
PubMed1996

Rising incidence of Candida parapsilosis fungemia in patients with hematologic malignancies: clinical aspects, predisposing factors, and differential pathogenicity of the causative strains.

Over the years 1983-1994, Candida parapsilosis causes 35 or 138 fungemic episodes (24 of 69 candidemias in the last quadriennium) in patients with hematologic malignancies who were being treated at a large university hospital in Italy. The central venous catheter was usually the source of bloodstream invasion; in most cases, the resolution of fungemia in patients receiving antifungal therapy required catheter removal. In seven cases, C. parapsilosis fungemia evolved to five proven (two cases with endocarditis) and two probable deep-seated infections; three of these seven patients died of deep-seated infections. Deep seated infection was associated with the detection of a circulating mannoprotein antigen of C. parapsilosis but not with in vitro resistance to antifungal agents. Almost all fungal isolates produced slime in vitro, but only 34% were pathogenic in a model of bloodstream infection in neutropenic mice. The four isolates associated with endocarditis or persistent fungemia with multiorgan failure were among the most virulent in the model of infection. Overall, our findings highlight the role of C. parapsilosis as an agent of fungemia in patients with malignant hemopathies.

Adolescent↗