PubMed Health⌕ Search

Biomedical subjects

P Carli

Publications and source records attributed to P Carli.

At least 19 recordsLinked to original sources
PubMed2000

[Marchiafava-Bignani disease of good prognosis. Two cases].

BACKGROUND: Marchiafava-Bignami disease or corpus callosum necrosis, is an uncommon complication of chronic alcoholism. Prognosis is severe. CASE REPORTS: Two young adults with chronic alcoholism who developed Marchiafava-Bignami disease initially improved clinically. DISCUSSION: Diagnosis has been facilitated with MRI. An MRI exploration should be performed in chronic alcoholic patients presenting chronic encephalopathy with dementia, dysarthria, hypertonia, and ataxia, or acute encephalopathy with confusion, dumbness, seizures, and hypertonia. Necrosis of the corpus callosum gives the diagnosis of Marchiafava-Bignami disease.

Adult↗
PubMed2000

[Effect of a lung contusion on the prognosis of severe head injury in the child].

OBJECTIVES: To assess the effects of a pulmonary contusion (PC) on the outcome of a severe head trauma (SHT) in children less than 15-year-old. STUDY DESIGN: Retrospective study. PATIENTS: The study included 30 severely head injured children with a Glasgow Coma Scale score (GCS) < or = 8, associated with a PC (PC+) diagnosed on a thoracic CT-scan and 30 severely head injured children without PC (PC-). METHODS: Outcome was assessed using the Glasgow Outcome Scale (GOS), on discharge and six months later. Age, body weight, gender, GCS, PTS, ISS, hypoxaemia, arterial hypotension, the results of the cerebral CT-scan, the main treatment administered, complications, the duration of tracheal intubation as well as the duration of stay in the intensive care unit (ICU) and in the hospital were compared between groups. RESULTS: GCS median was lower (6 vs 8, P = 0.001) and ISS median higher (25 vs 23, P = 0.0004) in the PC+ group. Hypoxaemia was more frequent in the PC+ group (n = 12 vs n = 0, P = 0.0001). There was no difference between groups regarding the results of cerebral CT scan. Blood transfusion was more frequently used in the PC+ group (n = 14 vs n = 5, P = 0.03). Median duration of tracheal intubation, and of stay in the ICU and in the hospital were shorter in the PC- group (respectively 8 vs 6 days, P = 0.03; 10 vs 7.5 days, P = 0.008; 13.5 vs 10.5 days, P = 0.01). No difference was observed regarding complications between groups. GOS on discharge was higher in the PC+ group (3 vs 2, P = 0.01). There was an increase in GOS at six months in the two groups, however GOS remained significantly higher in the PC+ group (median values 2 vs 1, P = 0.002). A favourable outcome occurred less frequently in the PC+ group on discharge and at six months (respectively n = 14 vs 25, P = 0.006; n = 20 vs 28, P = 0.02). CONCLUSION: The association of a PC to a severe head trauma is responsible for a poorer outcome in children, probably because, at least in part, a higher incidence of hypoxaemia.

Adolescent↗
PubMed2000

The role of pattern analysis and the ABCD rule of dermoscopy in the detection of histological atypia in melanocytic naevi.

BACKGROUND: Clinical features of melanocytic naevi correlate poorly with the presence, histopathologically, of architectural disorder and cytological atypia, making the detection of histological atypia by means of macroscopic appearance unreliable. OBJECTIVES: The aim of this study was to investigate the diagnostic effectiveness of dermoscopy in the non-invasive detection of histological atypia in naevi. METHODS: Observers blinded for histological diagnosis classified a series of 168 melanocytic naevi as common or atypical on the basis of their clinical features and on their dermoscopic profile. The diagnostic performance of both methods compared with the true (histopathological) diagnosis was assessed. RESULTS: Dermoscopy using pattern analysis showed better results than clinical examination in the non-invasive detection of naevi with architectural disorder with or without cytological atypia (diagnostic accuracy 45% vs. 28%). A statistically significant difference in the frequency of dermoscopic parameters between atypical and common naevi was found for atypical pigment network (39% vs. 17%, P = 0.001) and dermoscopic regression structures (13% vs. 2%, P = 0.008). Dermoscopic features, which best predicted histological atypia in naevi, were regression structures (white scar-like areas or peppering), irregular vascular pattern and grey-blue areas (positive predictive values 83%, 83% and 73%, respectively). In contrast, no statistically significant difference in the mean values of the ABCD score between common and atypical naevi was found. The best diagnostic performance of dermoscopy by means of the ABCD rule (cut-off point of 4.0 of total dermoscopy score) was not dissimilar to that of clinical diagnosis (diagnostic accuracy 30%). CONCLUSIONS: Dermoscopy by means of pattern analysis enhances the diagnostic accuracy of dermatologists in the prediction of histological atypia in melanocytic naevi as compared with clinical examination alone.

Diagnosis, Differential↗
PubMed2000

Complications of emergency tracheal intubation in severely head-injured children.

A high incidence of unsuccessful attempts and complications has been reported when emergency tracheal intubation (ETI) is performed outside the hospital in severely injured children. The aim of this prospective series was to analyse the incidence and related risk factors of complications of emergency tracheal intubation. The time to complete successful ETI and occurrence of incidents, e.g. cough reflex, hypoxia or spasm were related to the experience of the physician performing intubation and the use of drugs to facilitate ETI. The incidence of hypoxia, hypercarbia, postintubation complications such as extubation stridor and long-term sequelae were noted. Of the 188 children, 78% were successfully intubated at the site of the accident, 10% upon arrival at a local hospital from where they were secondarily transferred and 12% upon admission to our trauma centre. The most severely injured children were intubated in the field in 98% of cases without failure, nor life-threatening complications related to ETI. The experience of the operator influenced the number of attempts and the time to complete successful intubation. Immediate incidents were noted in 25% of children, e.g. cough in 18%. The regimen of drugs, but not level of consciousness, influenced the incidence of immediate incidents; without drugs, more than 67% experienced incidents. Early tracheal intubation and controlled ventilation resulted in adequate ventilation upon arrival (mean PaO2 of 35.8+/-24 kPa, mean PaCO2 of 4.35+/-1 kPa). Long-term complications, including transient stridor upon extubation in 33% of the cases, and laryngeal granuloma or tracheal stenosis, were comparable to those in other series. ETI in shocked patients and pulmonary infection in hospital, but not the technique of ETI, increased the risks of long-term complications. Emergency tracheal intubation can be performed safely in the field, and results in adequate ventilation during transportation of severely injured children, provided that it can be performed by trained physicians using adequate drugs to facilitate intubation.

Child↗
PubMed1999

[Post-traumatic vena cava thrombosis].

BACKGROUND: Post-traumatic thrombotic events are exceptional in the caval system. We report a case of inferior vena cava thrombosis in a traffic accident victim. CASE REPORT: A 53-year-old male victim of a traffic accident suffered multiple trauma including blunt trauma of the abdomen. Three months after the accident, the patient was hospitalized with signs of pulmonary embolism proven by angiopneumography. Phlebocavography evidenced a thrombus floating in the inferior vena cava. DISCUSSION: We found 9 other cases of caval thrombus secondary to abdominal trauma in the literature. Tht thrombus usually developed due to endothelial damage secondary to shear forces. Computed tomography of the abdomen with contrast injection contributes greatly to diagnosis. Treatment is a matter of debate due to the prognosis dominated by the risk of massive embolism.

Abdominal Injuries↗
PubMed1999

[Pre-hospitalization reanimation in cardiac arrest].

THE SURVIVAL CHAIN: The delay to restoration of spontaneous circulation is the key to prognosis of cardiac arrest occurring outside the hospital. Among the many etiologies of cardiac arrest, sudden onset ventricular fibrillation is the number one cause of sudden death in adults. Better prognosis depends on effective organisation founded on the concept of a "survival chain". ALERT AND RESUSCITATION: By alerting the emergency units and performing the basic gestures of cardiopulmonary resuscitation (freeing the airways, mouth-to-mouth ventilation and closed chest cardiac massage) those witnessing the event take the first steps in the survival chain while waiting for the paramedical and medical teams to arrive. DEFIBRILLATION: In case of ventricular fibrillation, prognosis is directly related to the delay to defibrillation. Defibrillators used by specially trained paramedics before a physician arrives on the scene have considerably improved prognosis. SPECIALIZED RESUSCITATION: Precise algorithms help guide treatment in accordance with the observed cardiac rhythm. Tracheal intubation and artificial ventilation are fundamental. Among the useful drugs, epinephrine is by far the most important for improving myocardial and cerebral perfusion, improving the chances of recovering spontaneous circulation. The only anti-arrhythmic drug currently used is lidocaine. Infusion of alkaline fluid is only useful in specific cases of prolonged resuscitation. Expired CO2 monitoring may be a useful guide, but discontinuing resuscitation is strictly a medical decision. AFTER RESUSCITATION: When spontaneous circulation has been achieved, the patient must be transported to a cardiac hospital for specialized care and etiological treatment.

Adult↗
PubMed1999

Cutaneous melanoma histologically associated with a nevus and melanoma de novo have a different profile of risk: results from a case-control study.

BACKGROUND: Histopathologic association between melanocytic nevus and melanoma has been reported in approximately 10% to more than 50% of melanoma cases. Whether melanomas in contiguity with a nevus have a different natural history and pathogenesis from melanomas without a nevus is still to be determined. OBJECTIVE: The present study was undertaken to clarify whether melanocytic nevus-associated melanomas (MN[+]) have a different risk factor profile from cases without histopathologic evidence of melanocytic nevus association (MN[-]). METHODS: The study population consisted of 131 invasive melanoma cases with a thickness of 4.00 mm or less and 174 control cases without melanomas. The whole series was evaluated for the following risk factors: phenotypic traits; the number of common, atypical, and congenital nevus-like nevi; and freckling and history of sunburns. Melanoma cases were revised for the presence of associated melanocytic nevi. The analysis of risk factors was performed by a case-control approach comparing cases, classified by histologic association with nevus, to the group of controls. Possible differences in risk factor distribution between MN(+) cases and MN(-) cases were evaluated with a polychotomous logistic regression model and a likelihood ratio test for heterogeneity. RESULTS: Histopathologic association between melanocytic nevus and melanoma was found in 27 cases (20.6%). Phenotypic traits were shown to be more powerful predictors of risk for MN(-) than for MN(+) cases (blond/red hair; odds ratio, 7.4 and 1.2, respectively; likelihood ratio test for heterogeneity, 4.13; P < .05). Conversely, history of frequent sunburn was a risk factor only in MN(+) cases (more than 5 sunburns; odds ratio, 6.7; 95% confidence interval, 1.3-33.7), but not in MN(-) cases (odds ratio, 1.2; 95% confidence interval, 0.3-4.0; likelihood ratio test for heterogeneity, 4.2; P < .05). Where melanocytic nevi are concerned, an increased number of common nevi was a predictor of melanoma risk in both MN(+) and MN(-) cases, but with a different magnitude of risk, higher for MN(+) cases (number of common nevi, 10-30; odds ratio, 14.4 and 4.7, respectively; likelihood ratio test for heterogeneity, 3.7; P = .055). CONCLUSION: This study showed that, although MN(+) and MN(-) melanomas share many risk factors, there is a different strength of association between the 2 groups. The effect of a history of sunburn as a predictor of risk was found only for nevus-associated melanomas, suggesting a possible role of sunburns in the neoplastic transformation of nevi.

Adult↗
PubMed1999

Clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness.

BACKGROUND: Melanoma thickness measured according to the Breslow method is used to determine surgical margin and in patient selection for sentinel node biopsy. Previous studies did not confirm the reliability of melanoma palpability for clinical prediction of tumor thickness. Recently we reported the usefulness of epiluminescence microscopy (dermatoscopy) for in vivo detection of the phases of melanoma progression, as well as tumor depth. OBJECTIVE: Our purpose was to determine whether the combination of clinical and dermatoscopic criteria could increase the accuracy in preoperative evaluation of melanoma thickness with respect to the clinical elevation and dermatoscopic assessments considered separately. METHODS: In a blind retrospective study, 122 cutaneous melanomas were studied to evaluate the presence of several clinical and dermatoscopic criteria and their relation with the histologic thickness. An algorithm of combined criteria was constructed and statistically assessed. RESULTS: Combinations of palpability, diameter of more than 15 mm, pigment network, gray-blue areas, and atypical vascular pattern allowed correct prediction of thickness in 89% of melanomas when categorized in two groups of less than 0.76 mm and more than 0.75 mm thickness, compared with 75% using palpability, and 80% using dermatoscopic criteria. Lower values were obtained in the further subdivision of melanomas into groups of 0.76 to 1.5 mm and more than 1.5 mm thickness. CONCLUSION: The combination of clinical and dermatoscopic criteria is a more precise guide for the preoperative evaluation of melanoma thickness than either is alone. However, further studies are needed to verify its applicability in establishing the surgical approach to cutaneous melanoma.

Adolescent↗
PubMed1999

[Antiphospholipid antibody syndrome in pediatric neurosurgery: a hemostasis problem].

The case of a 11-year-old boy under anticoagulant therapy for a familial antiphospholipid antibody syndrome (SAAPF), who underwent surgery for a cerebrovascular malformation responsible for an intracerebral haematoma, is reported. Antivitamins K (AVK) were changed for unfractioned heparin (HNF), three days before. Heparin was discontinued two hours prior to surgery to obtain a normal peroperative coagulation. A vascular dural fistula was removed without any haemostatic problem. The neurological status rapidly returned to normal and tomodensitometry at day 1 showed a normal intracranial status. Heparin was readministered at h 16. Thrombocytopenia occurred at day 4 of heparin treatment. The change for a low weight molecular heparinoid, danaparoid (Orgaran), normalized the platelet count. The platelets aggregation tests were negative during thrombopenia. However, the test for antibodies against the PF4-heparin complex with the Elisa technique, was in favour of a heparin induced thrombocytopenia (TIH). In spite of its anecdotic occurrence due to cumulative thrombotic risks from the association of immunologic disorders (TIH and SAAPF), this case report underlines the value but also the risks of anticoagulant therapy in neurosurgery, when patients are at high risk for thrombosis.

Antiphospholipid Syndrome↗
PubMed1999

Naevus-associated melanomas: cause or chance?

Controversies exist regarding the true incidence and significance of the histological association between melanocytic naevi and melanomas. The current study was undertaken to determine the incidence of melanocytic naevi histologically associated with melanomas, to compare the clinicopathological profiles of melanomas associated with a naevus (MN+) and melanomas not associated with a naevus (MN-), and to verify the interobserver reliability of classifying the naevus remnants as congenital or acquired. We evaluated 131 patients with invasive melanoma < or = 4 mm in thickness with a Clark's level < V. Histological evidence of an associated melanocytic naevus was found in 27 out of 131 melanoma cases (20.6%). MN+ were significantly more frequent among males compared with MN-(P = 0.002) and were predominantly located on the trunk (P =0.001). No significant differences between MN+ and MN- were found in the distribution of histotype, Clark's level and thickness. Among MN-, the naevus component showed acquired features in 14 cases (51.8%), whereas 12 cases (44.5%) had features of small superficial congenital naevi; in one case (3.7%) a confident distinction between congenital and acquired naevus could not be made. Overall, there was concordance among the three observers in the diagnosis of the type of naevus remnants in 81.4% of cases (kappa = 0.78; P<0.0001). We conclude that, although the majority of cutaneous melanomas arise de novo, in approximately 20% of cases an associated melanocytic naevus is found. Our observation that MN+ and MN- have different clinicopathological profiles suggests that, at least for some cases, a causal relationship between the two lesions may be present. However, when the naevus is histopathologically adjacent to the melanoma, the possibility of a collision event cannot be ruled out. Finally, we documented a significant concordance among examiners in the diagnosis of the congenital versus acquired nature of the associated naevus. This suggests that the histopathological criteria generally employed to distinguish between congenital and acquired naevi have good reproducibility.

Adult↗