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M Piedmonte

Publications and source records attributed to M Piedmonte.

At least 19 recordsLinked to original sources
PubMed2001

Preliminary results of an outcome tool used for evaluation of surgical treatment for fecal incontinence.

PURPOSE: The lack of an outcome tool to evaluate the outcome of surgical and medical treatment for fecal incontinence makes interpretation of success difficult. The purpose of this study was to evaluate a preliminary outcome tool for fecal incontinence. METHOD: Since 1994 an extensive database has prospectively been collected on all females undergoing an overlapping sphincter repair for fecal incontinence by a single surgeon. A simple incontinence form designed to examine outcome, developed by colon and rectal surgeons, was filled out preoperatively and postoperatively. RESULTS: Of 206 females evaluated for surgical treatment of their fecal incontinence, 65 underwent surgical treatment from January 1994 until July 1999. The mean age was 49 (range, 23-80) years, and the mean follow-up was 10 (range, 1-50) months. When comparing each variable (problems holding gas, staining of undergarments, accidental bowel movements, and need to wear pads) and lifestyle issue (physical, social, and sexual activities) preoperatively and postoperatively, there was significant improvement in all areas. Three parameters were chosen (change in accidental bowel movements, improvement in two of three lifestyle areas, and improvement in one of three lifestyle areas) to examine individual items from the database and to determine if they affected outcome. No single variable has a significant effect on the outcome. A scoring system was devised from the questionnaire. From preoperatively to postoperatively, there was a median 14-point improvement that was statistically significant. CONCLUSIONS: This preliminary tool to examine outcome for fecal incontinence measures parameters that are significantly improved by overlapping sphincteroplasty. More work is needed to refine and validate this tool because a standard outcome tool is needed for reporting the results of surgical treatment of fecal incontinence.

Adult↗
PubMed2000

Effects of single dose, postinduction dexamethasone on recovery after cardiac surgery.

BACKGROUND: Corticosteroids have been recommended to facilitate rapid recovery after cardiac surgery. We previously reported that dexamethasone given after induction of anesthesia decreases the incidence of postoperative shivering. We performed a post hoc analysis of the data obtained during that study, focusing on secondary outcomes. METHODS: A total of 235 adult patients undergoing elective coronary or valvular heart surgery were randomized to receive dexamethasone 0.6 mg/kg or placebo after induction of anesthesia. Patients who had pharmacologically treated diabetes mellitus, had hypersensitivity to dexamethasone, or were receiving treatment with corticosteroids were excluded. RESULTS: We found that, compared with placebo, patients receiving dexamethasone were more likely to remain tracheally intubated for 6 hours or less (26.4% vs 10.0%, p = 0.020) and had a lower incidence of early postoperative fever (20.2% vs 36.8%, p = 0.009) and new-onset atrial fibrillation during the first 3 days postoperatively (18.9% vs 32.3%, p = 0.027). However, we could not demonstrate a statistical difference in the intensive care unit or hospital length of stay, or in overall morbidity and mortality. The dexamethasone-treated patients were also more likely to have a higher blood glucose on admission to the intensive care unit (186 mg/dL vs 143 mg/dL, p = 0.012). CONCLUSIONS: Dexamethasone facilitates early tracheal extubation and is associated with a lower incidence of early postoperative fever and new-onset atrial fibrillation. Apart from a treatable decreased glucose tolerance, dexamethasone treatment was not shown to affect morbidity or mortality significantly.

Anesthesia↗
PubMed2000

Symptoms associated with infant teething: a prospective study.

CONTEXT: Studies of infant teething have been retrospective, small, or conducted on institutionalized infants. OBJECTIVES: To conduct a large, prospective study of healthy infants to determine which symptoms may be attributed to teething and to attempt to predict tooth emergence from an infant's symptoms. DESIGN: Prospective cohort. Setting. Clinic-based pediatric group practice. PATIENTS: One hundred twenty-five consecutive well children of consenting Cleveland Clinic employees. OUTCOME MEASURES: Parents daily recorded 2 tympanic temperatures, presence or absence of 18 symptoms, and all tooth eruptions in their infants, from the 4-month well-child visit until the child turned 1 year old. RESULTS: Daily symptom data were available for 19 422 child-days and 475 tooth eruptions. Symptoms were only significantly more frequent in the 4 days before a tooth emergence, the day of the emergence, and 3 days after it, so this 8-day window was defined as the teething period. Increased biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation were all statistically associated with teething. Congestion, sleep disturbance, stool looseness, increased stool number, decreased appetite for liquids, cough, rashes other than facial rashes, fever over 102 degrees F, and vomiting were not significantly associated with tooth emergence. Although many symptoms were associated with teething, no symptom occurred in >35% of teething infants, and no symptom occurred >20% more often in teething than in nonteething infants. No teething child had a fever of 104 degrees F and none had a life-threatening illness. CONCLUSIONS: Many mild symptoms previously thought to be associated with teething were found in this study to be temporally associated with teething. However, no symptom cluster could reliably predict the imminent emergence of a tooth. Before caregivers attribute any infants' signs or symptoms of a potentially serious illness to teething, other possible causes must be ruled out.teething, tooth eruption, teeth, deciduous dentition.

Body Temperature↗
PubMed1998

Zinc gluconate lozenges for treating the common cold in children: a randomized controlled trial.

CONTEXT: The common cold is one of the most frequently occurring illnesses and is responsible for substantial morbidity and economic loss. Biochemical evidence suggests that zinc may be an effective treatment, and zinc gluconate glycine (ZGG) lozenges have been shown to reduce the duration of cold symptoms in adults. OBJECTIVE: To determine the efficacy of ZGG treatment of colds in children and adolescents. DESIGN: A randomized, double-masked, placebo-controlled study. SETTING: Two suburban school districts in Cleveland, Ohio. PATIENTS: A total of 249 students in grades 1 through 12 were enrolled within the first 24 hours of experiencing at least 2 of 9 symptoms of the common cold. INTERVENTION: Zinc lozenges, 10 mg, orally dissolved, 5 times a day (in grades 1-6) or 6 times a day (in grades 7-12). MAIN OUTCOME MEASURES: Time to resolution of cold symptoms based on subjective daily symptom scores for cough, headache, hoarseness, muscle ache, nasal congestion, nasal drainage, scratchy throat, sore throat, and sneezing. RESULTS: Time to resolution of all cold symptoms did not differ significantly between students receiving zinc (n = 124) and those receiving placebo (n = 125) (median, 9 days; 95% confidence interval [CI], 8-9 days; median, 9 days, 95% CI, 7-10 days, respectively; P=.71). There were no significant differences in the time to resolution of any of the 9 symptoms studied. Compared with controls, more students in the zinc group reported adverse effects (88.6% vs 79.8%; P=.06); bad taste (60.2% vs 37.9%; P=.001); nausea (29.3% vs 16.1%; P=.01); mouth, tongue, or throat discomfort (36.6% vs 24.2%; P=.03); and diarrhea (10.6% vs 4.0%; P=.05). CONCLUSIONS: In this community-based, randomized controlled trial, ZGG lozenges were not effective in treating cold symptoms in children and adolescents. Further studies with virologic testing are needed to clarify what role, if any, zinc may play in treating cold symptoms.

Adolescent↗
PubMed1998

Dexamethasone decreases the incidence of shivering after cardiac surgery: a randomized, double-blind, placebo-controlled study.

UNLABELLED: Shivering after cardiac surgery is common, and may be a result of intraoperative hypothermia. Another possible etiology is fever and chills secondary to activation of the inflammatory response and release of cytokines by cardiopulmonary bypass. Dexamethasone decreases the gradient between core and skin temperature and modifies the inflammatory response. The goal of this study was to determine whether dexamethasone can reduce the incidence of shivering. Two hundred thirty-six patients scheduled for elective coronary and/or valvular surgery were randomly assigned to receive either dexamethasone 0.6 mg/kg or placebo after the induction of anesthesia. All patients received standard monitoring and anesthetic management. After arrival in the intensive care unit (ICU), nurses unaware of the treatment groups recorded visible shivering, as well as skin and pulmonary artery temperatures. Analysis of shivering rates was performed by using chi2 tests and logistic regression analysis. Compared with placebo, dexamethasone decreased the incidence of shivering (33.0% vs 13.1%; P = 0.001). It was an independent predictor of reduced incidence of shivering and was also associated with a higher skin temperature on ICU admission and a lower central temperature in the early postoperative period. IMPLICATIONS: Dexamethasone is effective in decreasing the incidence of shivering. The effectiveness of dexamethasone is independent of temperature and duration of cardiopulmonary bypass. Shivering after cardiac surgery may be part of the febrile response that occurs after release of cytokines during cardiopulmonary bypass.

Anti-Inflammatory Agents↗
PubMed1997

The effects of carotid sinus nerve blockade on hemodynamic stability after carotid endarterectomy.

OBJECTIVE: To determine whether intraoperative administration of bupivacaine reduces the incidence of hypotension after carotid endarterectomy (CEA). DESIGN: Prospective, double-blinded, randomized controlled trial. SETTING: A single-institute, tertiary-care medical center. PARTICIPANTS: Patients (n = 135) who were referred for CEA without prior ipsilateral CEA, diabetes mellitus, or allergies to local anesthetics. INTERVENTIONS: 2 mL of 0.25% bupivacaine or 2 mL NaCl (control) injected by the surgeon at the carotid sinus immediately after CEA. MEASUREMENTS AND MAIN RESULTS: Blood pressure and heart rate were measured before induction, before carotid reperfusion, 2 minutes after reperfusion, before carotid sinus injection, and every 15 minutes thereafter for 2 hours. Anesthesia was induced and maintained with fentanyl, pancuronium, and 0.5% to 1% enflurane. Hypertension was defined as a systolic blood pressure 30% above baseline or greater than 180 mmHg. Hypotension was defined as a systolic blood pressure 30% below baseline or less than 100 mmHg. Postoperative incidences of hypertension, hypotension, and the associated use of corrective medications were compared in both groups using the chi-squared test to determine statistical significance. Patients in the bupivacaine group (n = 61) had a similar incidence of postoperative hypotension as controls (n = 74) but a higher incidence of hypertension (40% v 24%; p = 0.043). The bupivacaine group required vasodilators more often (33% v 18%; p = 0.04). Baseline hypertension and preoperative use of beta-blockers also were predictive of postoperative hypertension. CONCLUSIONS: Carotid sinus area infiltration with bupivacaine after CEA does not reduce the incidence of postoperative hypotension but significantly increases the incidence of postoperative hypertension. Thus, its routine use cannot be recommended in carotid endarterectomy.

Aged↗
PubMed1996

Ultrasound-guided compression closure of postcatheterization pseudoaneurysms during concurrent anticoagulation: a review of seventy-seven patients.

PURPOSE: Data from our institution and elsewhere have demonstrated that ultrasound-guided compression closure (UGCC) is an effective method of treating postcatheterization pseudoaneurysms. Whereas patients receiving anticoagulation do not have as high a success rate as those not receiving anticoagulants, there have been no large series evaluating the factors associated with success or failure in patients receiving anticoagulation. The purpose of this study is to determine whether uninterrupted anticoagulation interferes with successful UGCC of pseudoaneurysms and to identify factors associated with success or failure. METHODS: From May 1991 to September 1994, 238 cases of attempted UGCC of pseudoaneurysms were performed in our vascular laboratory. Only patients who received uninterrupted heparin, warfarin, or both at the time of pseudoaneurysm compression were eligible for inclusion into the study. Seventy-seven patients were identified who met the study criteria. RESULTS: Successful pseudoaneurysm compression was obtained in 56 (73%) patients, whereas 21 (27%) patients had a failed UGCC. In the successfully treated group, seven (12.5%) required between two to three compression attempts to induce sustained thrombosis. There was no statistical difference in age, sex, sheath size, days after procedure, location of pseudoaneurysm, or number of chambers in the pseudoaneurysm between those patients who had a successful repair and those who did not. If the pseudoaneurysm was less than 4 cm in diameter, 51 of 65 patients (78%) had a successful repair compared with 5 of 12 patients (42%) with a pseudoaneurysm of 4 cm or greater (p = 0.013). There was no statistical difference between success and failure in patients receiving warfarin alone (3.73 mean international normalized ratio, 72% success rate), heparin alone (mean activated partial thromboplastin time of 63 seconds, 92% success rate), or heparin and warfarin (mean activated partial thromboplastin time of 70 seconds, mean international normalized ratio of 4, success rate of 67%). No arterial or venous thrombosis occurred during pseudoaneurysm compression. CONCLUSION: Successful UGCC of pseudoaneurysms occurred in a large percentage of patients receiving full-dose, uninterrupted anticoagulation. The only factor influencing success was the size of the pseudoaneurysm.

Adult↗
PubMed1996

Heparin administration via nomogram versus a standard approach in venous and arterial thromboembolic disease.

To determine whether heparin administered by continuous intravenous infusion using a nomogram is superior to a random dosing scheme, we performed a prospective, randomized comparative trial in 161 patients. Patients were prospectively randomized to one of three groups. Group I received an intravenous bolus of 5000 IU of heparin followed by heparin administration according to a modification of a previously published nomogram. Group II patients received a 5000 IU intravenous bolus of heparin followed by continuous intravenous heparin infusion with dosage adjustment at the discretion of the treating physician. Group III patients received a continuous intravenous heparin infusion with dosage adjustments at the discretion of the treating physician without the prior administration of a bolus dose. Activated partial thromboplastin time (APTT) was obtained at baseline, 6 h after each heparin dose adjustment and every morning. The mean percent of each patient's APTTs in the subtherapeutic range (< 50 sec) over the course of treatment was 9% for group I and 24% for groups II and III, p = 0.0001. The three groups had a similar percentage of each patient's APTTs within the therapeutic range (50-80 sec). There was a larger percentage of APTTs > 80 sec in group I (46%) compared to group II (31%) or group III (32%), p = 0.01. There were no clinically recurrent deep venous thrombi or arterial thromboemboli in any of the groups. Two patients had documented pulmonary emboli during heparin therapy (one in group I; one in group II). There was no difference in the complication rates of heparin therapy or the need for blood transfusions among the three groups. Patients randomized to the heparin nomogram (group I) achieved an APTT > 50 sec more frequently than patients in the other two groups. Overall, fewer patients in the nomogram group were subtherapeutic, and, when APTT levels fell in the subtherapeutic range, the nomogram restored APTTs to the therapeutic range faster than the standard methods. The heparin nomogram was clearly more effective as a method of heparin dosing than standard methods of anticoagulation dosing.

Aged↗
PubMed1995

Objective criteria for reporting language dominance by intracarotid amobarbital procedure.

We propose a standardized method for reporting language lateralization by intracarotid amobarbital procedure (IAP). We retrospectively reviewed 165 IAPs, and classified language lateralization as left, right, or bilateral by three different methods, all based on the duration of speech arrest following each injection: absolute duration, side-to-side difference, and a "laterality index" defined as (L-R/L+R). Cutoff values were obtained by studying a pure subgroup of left hemisphere dominant right-handed subjects. In 142 patients (86%), the classification remained unchanged among all three methods: left in 112 (79%), right in 19 (13%), and bilateral in 11 (8%). In the other 23 patients (14%), language classification varied among the three criteria used. The change of category was never between left and right, and always involved bilateral language. Thus, this index may be helpful in standardizing and comparing IAP results from different series.

Adolescent↗
PubMed1994

Risk factors influencing survival in ICU acute renal failure.

Factors influencing survival in ICU patients with acute renal failure (ARF) requiring dialysis were analysed from data collected prospectively in an ARF registry. A total of 363 patients were analysed. Overall mortality was 79.1% and did not differ between medical and surgical patients. Factors associated with an increased risk of dying included the development of any concomitant organ system failure, the number of failed organs, APACHE II score at the time of renal consultation for medical patients, pre-existing chronic liver disease, and the number of days from ICU admission to institution of dialysis. Male gender reached borderline significance. Survivors recovered renal function and discontinued dialysis in 65.7% of cases. We conclude that mortality rates for ARF in ICU patients continues to be high. Multi-system organ failure (MSOF) occurs frequently and is the major cause of death.

Acute Kidney Injury↗
PubMed1994

Primary isolated coronary artery bypass in left ventricular dysfunction: survival and predictors of survival.

Coronary angiograms of 462 patients with ejection fractions below 51% who underwent primary isolated coronary artery bypass at the Cleveland Clinic from 1981 to 1985 were available for review. They were divided into two groups: group 1 (n = 166) with severe ventricular dysfunction (ejection fraction less than 30%) and group 2 (n = 296) with moderate ventricular dysfunction (ejection fraction 31 to 50%) at a median follow-up of 5.8 years/patient. The actuarial survival was 64.3% in group 1 and 80.6% in group 2 (P = 0.0001). By multivariate analysis, congestive heart failure (P = 0.0001) was the single most important factor affecting survival for both groups. In addition, in group 1 the preoperative use of inotropes (P = 0.03) and in group 2 the presence of peripheral vascular disease (P = 0.001) affected long term survival.

Actuarial Analysis↗
PubMed1993

Estimating glucose absorption in peritoneal dialysis using peritoneal equilibration tests.

To determine peritoneal dialysis patients' dietary energy requirements, the glucose absorbed from the dialysate needs to be quantified. The currently accepted method of estimating glucose absorption is based on the average glucose absorption of 7 continuous ambulatory peritoneal dialysis (CAPD) patients (Grodstein, 1981). Peritoneal equilibration test curves have shown that modality and transport characteristics affect glucose absorption. To test a more accurate procedure for estimating glucose absorption, we compared two different methods of determining the actual glucose absorption: Grodstein formula: (11.3 xa-10.9) liters of dialysate, where xa is the average glucose concentration, and the D/D0 formula: (1-D/D0)xi, where xi is the initial glucose instilled, using 4-hour D/D0 for CAPD and dwell time D/D0 for automated peritoneal dialysis (APD). Twenty-four-hour glucose absorption was measured in 50 CAPD patients and 17 APD patients. Absorption was calculated from the glucose remaining in the 24-hour spent dialysate. Wilcoxon sign rank statistical analysis showed the D/D0 formula results to be closer to actual glucose absorbed (CAPD: p = 0.0153; APD: p = 0.0001). The D/D0 formula is individualized for patients' modality and membrane characteristics and easy to calculate from readily available information.

Absorption↗
PubMed1993

Morbidity and mortality following abdominoperineal resection for rectal adenocarcinoma.

From 1979 through 1986, 56 patients, 38 males (68%) and 18 females (32%), underwent an abdominoperineal resection with a wide perineal dissection for primary adenocarcinoma of the rectum. The open perineal wounds required a mean time of 6 months to completely heal. Estimated blood loss by the surgeon ranged from 200 ml to 4200 ml with a mean of 1112 ml and a median of 1000 ml. Twenty-six patients (46%) developed postoperative or intraoperative complications. Nineteen patients (34%) underwent incidental surgery with no associated morbidity. The most commonly occurring complication was impotence in 69% of male patients. The next most common complication was bladder dysfunction with urinary retention in 14 patients (25%) and urinary incontinence in five patients (9%). There were two postoperative deaths (4%). Although the morbidity was significant, greater than 90% of the complications were treatable and resolved without major sequellae.

Abdomen↗
PubMed1992

Cryptorchidism in newborns with gastroschisis and omphalocele.

A retrospective study was undertaken to determine if there exists an association between cryptorchidism and the intra-abdominal wall defects of gastroschisis and omphalocele. The records of 25 newborn male infants (13 with omphalocele, 12 with gastroschisis) were examined. In this sample there was no statistically significant association between these defects and cryptorchidism in either the premature or the full-term infants, when compared with a healthy population. Further clinical studies with larger numbers of patients are recommended.

Abdominal Muscles↗
PubMed1991

Early and late results of coronary angioplasty and bypass in octogenarians.

Early and late results were evaluated for octogenarians undergoing first time revascularization with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). The study group consisted of 142 patients with CABG and 53 with PTCA. The groups with PTCA and CABG differed with respect to number of patients with angina class III to IV (92 and 67%, respectively; p less than 0.001), number with 3-vessel disease (34 and 77%, respectively; p less than 0.001), presence of left main trunk disease (2 and 24%, respectively; p less than 0.001) and number with normal or mildly impaired left ventricular function (82 and 65%, respectively; p less than 0.034). The groups with PTCA and CABG had similar procedural complications, including myocardial infarction (6 and 4%, respectively) and stroke (0 and 4%, respectively). Hospital mortality was low (6% with CABG and 2% with PTCA). Three year survival, excluding hospital mortality, was 87% in patients with CABG and 81% in those with PTCA (p = 0.493). Octogenarians underwent revascularization procedures with relatively low morbidity and mortality. In regard to the excellent long-term survival, "very" elderly patients with severe coronary artery disease should be considered for revascularization despite advanced age.

Aged↗
PubMed1991

Morbidity and survival of liver resection for colorectal adenocarcinoma.

Sixty-two patients underwent hepatic resection for isolated colorectal metastases from 1963 to 1988. The numbers of hepatic resections were: lobectomy, 24 (39 percent); wedge resection, 23 (37 percent); and segmentectomy, 15 (24 percent). The median number of intraoperative blood transfusions was 3.0 units (range, 0-16 units). The median number of days in the hospital following hepatic resection was 13 (range, 4-51 days). There were 19 patients (30 percent), who developed a total of 23 complications. Surgery was required for complications in nine patients. Surgical mortality occurred in 5 of 62 (8 percent) patients. The estimated median survival in 56 patients with one to three metastases was 26 months, with a 28 percent estimated 5-year survival. The median size of the metastases was 4.0 cm (range, 0.7-13 cm). The estimated median survival in 27 patients with metastases less than 4 cm in diameter was 26 months, with a 24 percent estimated 5-year survival. The estimated median overall survival from the time of hepatic resection was 25 months.

Adenocarcinoma↗
PubMed1991

Prospective trial of cisplatin, adriamycin, and dacarbazine in metastatic mixed mesodermal sarcomas of the uterus and ovary.

Twenty-four patients with advanced or recurrent uterine (13) and ovarian (11) mixed mesodermal sarcomas received a combination of cisplatin. Adriamycin and dacarbazine (PAD) as initial therapy after surgical debulking. Of the 13 patients with metastatic uterine sarcoma, six (46.1%) remained without evidence of disease (NED) from 8 to 36 months from the start of PAD. The estimated 1-, 2-, and 3-year survivals for these patients were 68%, 68%, and 51%, respectively. Of the 11 ovarian sarcoma patients, five (45.4%) were NED at 5, 7, 32, 56, and 59 months from the start of PAD. The estimated 1-, 2-, and 3-year survivals for these patients were 70%, 35%, and 35%, respectively. The PAD regimen is an active regimen in patients with metastatic uterine and ovarian mixed mesodermal sarcomas and progression-free survival may be improved by maximum debulking surgery prior to the initiation of PAD chemotherapy.

Aged↗