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Biomedical subjects

M Porcellini

Publications and source records attributed to M Porcellini.

48 records · Page 3Linked to original sources
PubMedDate not supplied

The role of ranitidine infusion on glucose, insulin and C-peptide serum levels induced by oral glucose tolerance test in healthy subjects.

In 9 healthy subjects we evaluated the effect of a constant ranitidine infusion (100 mg) on glucose (mg/dl), insulin (microU/ml) and C-peptide (ng/ml) serum levels promoted by oral glucose tolerance test (75 g). Ranitidine significantly increased the area under concentration/time curves for glucose and insulin but not that of C-peptide. Our data indicate that ranitidine does not affect pancreatic insulin release nor peripheral glucose utilization and are consistent with the hypothesis that ranitidine influences the hepatic clearance of glucose and insulin both of which undergo high first-pass liver extraction.

Administration, Oral↗
PubMedDate not supplied

Intestinal ischemia after aortic surgery.

Intestinal ischemia after abdominal aortic surgery is a highly lethal complication. In order to evaluate the pathogenesis, the diagnostic modalities and the best management, in a retrospective review, 12 patients undergoing postoperative small bowel or colonic ischemic lesions were identified between 1983 and 1995. Preoperative occlusion of IMA was present in nine patients, while a selective angiography of SMA demonstrated occlusive disease of peripheral branches in two asymptomatic diabetic patients. No patent IMA was ligated. When possible, hypogastric circulation was preserved by distal anastomosis into iliac bifurcation (4 cases). Postoperative leukocytosis or elevated LDH values were present. Colonscopy showed a suspected ischemic colitis in two patients and necrotic lesions in three cases. One patient died and diagnosis was made at autopsy. Nine patients were submitted to reoperation and a bowel resection with a proximal stoma was performed in seven of them. In two patients, the aorta or iliac artery below the proximal anastomosis and hypogastric artery suffered acute thrombosis, while prosthetic grafts were patent. A coagulation disorder caused thrombosis of intramural arterioles of the small bowel while peripheral branches of SMA were pulsatile. Eight of the patients submitted to relaparotomy died; non-operative management resulted in a left colon late stricture, while the remaining patient survived without sequelae. Overall mortality rate was 66.6%. Symptoms of this complication are not specific and diagnosis is delayed; consequently surgical repair is often unsuccessful. One patient with small bowel necrosis after elective AAA resection survived, which is extremely rare.

Adult↗
PubMedDate not supplied

[Carotid endarterectomy: what postoperative care is needed?].

With the introduction of the diagnosis-related groups system (DRGs), hospital cost containment without compromising quality of care is recommended. Carotid endarterectomy is an effective stroke prevention treatment; the need for routine postoperative intensive care unit (ICU) admission is questionable and is herein evaluated. Between January 1994 and November 1995, 68 patients underwent 79 carotid endarterectomies (CEAs), under general anesthesia, and were postoperatively monitored in a post-anesthesia care unit. 13 patients presented postoperative hypertension and 3 arrhythmia, while 5 patients (7.3%) experienced postoperative complications. Only 8 patients (11.7%) were admitted in ICU for treatment of persistent hypertension (3 cases) with continuous vasoactive drug infusion or because of postoperative complications. One patient (1.4%) died of post-CEA hyperperfusion syndrome. The use of a step down unit for monitoring patients undergoing CEAs is safe and cost-effective and also may identify patients requiring ICU admission.

Aged↗
PubMedDate not supplied

[Hand ischemia due to "steal syndrome" in vascular access for hemodialysis].

Among complications of vascular access operations, symptomatic steal syndrome is uncommon, but may lead to ischemia of the hand. Between 1983 and 1995, 5 patients with hemodialysis fistulas presented rest pain of finger necrosis with a wrist-brachial index of 0.56 (range 0.35 to 0.63) improving to 0.96 (range 0.72 to 1.05) after digital pressure of the fistula. Ligation of distal radial artery was performed in 3 patients with side-to-end radiocephalic fistula, while basilic vein was distally ligated in a case of side-to-side brachiobasilic fistula. A vein "banding" procedure reduce fistula flow and improved distal perfusion in one patient, while a true venous aneurysm of the cephalic vein was treated by excision and replacement with a tapered PTFE graft. Hemodynamic assessment is required during surgical correction, but it may also be useful in pre- and intra-operative evaluation of patients undergoing therapeutical AVFs to prevent arterial insufficiency of the hand.

Adult↗
PubMedDate not supplied

Aneurysms of the lower limbs: evaluation and management.

In order to evaluate the results of the conservative follow up vs surgical management of infra-inguinal aneurysms, a retrospective review of 23 patients with 28 peripheral aneurysms of the lower limbs was undertaken. Among them, common femoral (5 cases) and popliteal (16 cases) aneurysms were most frequent; superficial femoral (1) and tibial (1) aneurysms were isolated; 5 patients had bilateral aneurysms. The majority of symptomatic aneurysms presented local discomfort (4), acute (4) or chronic (8) ischaemia. Symptoms of nerve (2) or view (1) compression were less common. Duplex or Color-Doppler Scanning, angio-TC and MR confirmed the clinical diagnosis; arteriography demonstrated the number of patent distal vessels. Nine arterial aneurysms were kept under clinical and ultrasonographic observation; three patients were submitted to delayed surgical repair; a major amputation was required and two of these died of cardiac diseases. In the remaining sixteen cases, early elective surgical repair was performed, with resection or ligation of aneurysms. Two cases of acute limb ischaemia were submitted to successful limb-salvage procedures. A primary amputation was necessary in a case with irreversible ischaemia; a lumbar sympathectomy was performed in a patient with a poor run-off. Dacron (5 cases), PTFE (5 cases) or autologous saphenous vein (11 cases) grafts were used. No post-operative complications or limb-loss occurred. Three patients died of myocardial infarction during the follow up period (mean 28 months). Authors' results suggest that early surgical repair of peripheral aneurysms of the lower limbs is the safest and most effective management.

Aged↗
PubMedDate not supplied

Aortic blisters: diagnosis and evolution.

In order to evaluate the incidence, the diagnostic modalities and significance of blisters of the abdominal aortic aneurysm wall, in a retrospective review, 14 patients (2.6%) having these lesions were identified between 1983 and 1995. At preoperative examination, aortography had less accuracy (1 case = 20%) than CT scan (3 cases = 27.2%) or MRI angiography (6 cases = 85.7%) to detect blisters; others were discovered intraoperatively in the remaining four patients. Most blisters were located on the anterior or antero-lateral wall of aneurysms; its area ranged from 0.8 to 2.6 cm2. One patient with a suspected blister diagnosed at aortography, during chest physiotherapy for his COPD, presented sudden abdominal pain: at urgent laparotomy, an acute contained rupture of a large blister, without extraluminal blood loss, was found. All patients underwent aneurysm repair, with no postoperative deaths. Occurrence of rupture in one patient clearly indicates the natural course of aortic blisters. MRI angiography may accurately detect these lesions; surgical treatment is necessary for preventing imminent rupture.

Aged↗