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Biomedical subjects

P Di Mauro

Publications and source records attributed to P Di Mauro.

At least 19 recordsLinked to original sources
PubMed2004

Evaluating daily nursing use and needs in the intensive care unit: a method to assess the rate and appropriateness of ICU resource use.

BACKGROUND: We designed a tool to measure the rate and appropriateness of intensive care unit (ICU) nursing coverage as a proxy for the use of resources. METHODS: We tested the tool in 32 Italian ICUs during a cross-sectional study (4 days/week, October 2001 and April 2002). The level of care was classified as high or low. The appropriate patient-to-nurse ratio for both levels (2/1 and 3/1 in this ICU mix) was defined. The provided and theoretical nurse assistance was computed, the difference between the two quantifying the ICU use of personnel: a positive difference means over-utilization, a negative one under-utilization. We calculated the maximum number of high-level and low-level care days available for ICU and the relative utilization rates. These two rates quantify the appropriateness of resource use in relation to the planned use. RESULTS: Analysing 5783 treatment-days, the tool identified units using almost all available resources (five), overcrowded (14: too small units) or empty (16: too big). Units were overcrowded on account of the high-level of care required (five: utilization rate >100%) or reallocated too much of their residual high-care nursing capacity to low-level care (six). In empty units both utilization rates were lower than expected. CONCLUSIONS: The method quantifies the rate and appropriateness of resource usage and suggests the best management in units with fixed human resources or a fixed number of beds.

Cross-Sectional Studies↗
PubMed2003

Use of sedative and analgesic drugs in the first week of ICU stay in high-level-of-care.

AIM: The aim of this study was to update the current practice of pharmacological sedation and analgesia in Italian intensive care units. METHODS DESIGN: observational, prospective, cohort study involving consecutive patients admitted during 5 months in 1999. PATIENTS were evaluated for the first 7 days of high-level-of care. SETTING: 45 adult general intensive care units. PATIENTS: 388 fulfilling enrollment criteria: admission diagnosis out of non-traumatic cerebral hemorrage, stroke, respiratory failure in chronic obstructive pulmonary disease (COPD), acute lung injury/distress syndrome (ALI/ARDS), polytrauma, head trauma, cardiac failure and major abdominal surgery; unit stay longer than 47 hours and high-level-of care treatment. RESULTS: Sedation pattern was different among diagnosis-groups. No therapy was registered in 18.8% of overall days in polytrauma vs 67.6% of cardiac patients. Opioids supply ranged from 10.1% of overall days of acute on COPD patients vs 51.4% of polytrauma patients. Propofol was the more prescribed drug, followed by opioids and benzodiazepines. Propofol was at the top in cerebrovascular disease, ALI/ARDS and COPD; opioids in abdominal surgery and trauma, benzodiazepines in cardiac failure. The average number of prescribed drugs per day was 1.5 ranging from 1.2 on COPD to 1.7 in head trauma. CONCLUSION: Diagnosis influences the pattern of sedation-analgesia during high-level-of-care period. Sedation prevalence is reasonably prescribed in trauma groups while it remains low in ALI/ARDS, post-operative, cerebrovascular, COPD and hearth failure. Particularly opioid use remains limited in post-operative patients. This surveys shows a poorly standardised sedation approach to the different phases of the therapy: induction, short and long-term sedation phase.

Analgesia↗
PubMed2002

Endovascular treatment of iliocaval occlusion caused by retroperitoneal fibrosis: late results in two cases.

We report two cases of iliocaval occlusion caused by retroperitoneal fibrosis; one presented acute symptoms and one chronic. Both were treated by use of transluminal angioplasty and stenting with excellent clinical, hemodynamic, and imaging results at 36 and 51 months. These cases confirm the benefit of endovascular techniques in the treatment of nonmalignant obstructive disease of large veins, and specifically in the case of retroperitoneal fibrosis.

Aged↗
PubMed2001

Day surgery for mucosal-hemorrhoidal prolapse using a circular stapler and modified regional anesthesia.

PURPOSE: In 1993, prolapse reduction using the circular stapler for the treatment of hemorrhoidal disease was proposed. The procedure is characterized by minimal postoperative pain. In this study we evaluated the above technique using regional anesthesia to identify the advantages and feasibility of stapled hemorrhoidectomy, with special focus on the efficacy of same-day discharge. METHODS: From December 1997 to November 1999, we performed 70 consecutive reduction corrections of mucosal hemorrhoidal prolapse using the circular stapler with regional anesthesia (a technical modification of Marti's posterior perineal block). Our series included 41 males and 29 females with a mean age of 43.4 (range, 25-74) years. Three patients were affected by second-degree hemorrhoids and 67 by third-degree hemorrhoids. RESULTS: Sixty-two patients were discharged three hours after the operation in good general condition and without pain, whereas eight patients were discharged the day after for early complications, consisting of two cases of early bleeding, three cases of urinary retention, and three cases of persistent severe pain requiring prolonged medical treatment. CONCLUSION: Our study shows that, in selected cases, it is possible to perform day surgery for patients with hemorrhoidal disease using a circular stapler device when combined with regional anesthesia.

Adult↗
PubMed2001

Leptin levels in diabetic and nondiabetic subjects.

The role of leptin in human pathophysiology elicits considerable interest in view of its potential role as a treatment tool for obesity and other insulin resistant states, like type 2 diabetes mellitus (T2DM). Leptin has been extensively studied in obese humans, and much less so in other pathologic conditions. Leptin level has been reported to correlate with percent body fat mass (%FM), fasting serum insulin (FPI), insulin sensitivity and blood pressure. The aim of this study was to compare the leptin concentration, and its relationship with some anthropometric and biochemical parameters related to insulin resistance in 140 moderately obese type 2 diabetics (T2DM) and 160 age and weight matched non-diabetic controls in order to get a better insight into the possible role of leptin in the metabolic abnormalities of diabetes. The leptin levels were lower in the diabetic population only when both sexes were combined (p < 0.05) and were higher in the females of both groups. Among the nondiabetics, the leptin levels appeared to be related to BMI, %FM, HDL and FPI, while this was not the case in the diabetics. After correction for BMI, leptin appeared to be correlated with the FPI levels only in the non-diabetic females. When plasma leptin was included in a multiple linear regression model with plasma leptin as a dependent variable, BMI, W:Hr and FPI levels were significantly related to leptin in the non diabetic population, while no relationship reached the level of statistical significance among the diabetics, with the exception of the borderline value for the FPI (p = .052). In conclusion, leptin levels were independent of any of the parameters examined in our diabetic population, possibly due to the progressive loss of the normal mechanisms of leptin regulation with advancing disease. Conclusive data can only be obtained from the longitudinal study of a cohort of newly diagnosed diabetic subjects.

Aged↗
PubMed1999

Surgical venous thrombectomy.

Rehabilitation of the technique of venous thrombectomy is justified, but, in order for this technique to be effective, it must only be performed in selected cases. In the authors' view it is of the utmost value in young patients when the venous thrombosis occurs accidentally, after traumatism or surgery and when a diagnostic is made without delay.

Female↗
PubMed1998

Bilateral dissection of the internal carotid artery at the base of the skull due to blunt trauma: incidence and severity.

Between January 1, 1992 and December 31, 1996, a total of 1095 head trauma vicims were admitted in our intensive care unit. If CT scans demonstrated ischemic brain lesions, arteriography to visualize supraaortic vessels was performed. Carotid artery dissection was observed in ten patients (0.91%) and was bilateral in eight patients (0.73%). In the bilateral carotid artery dissection (BCAD) group, there were five women and three men, with a mean age of 35.2 years (range: 17 to 54 years). Injuries resulted from traffic accidents in seven patients and a fall in one patient. Upon admission, six patients presented with alteration of consciousness and three with hemiplegia or hemiparesia, associated with aphasia in two cases. In two other cases, hemiplegia occurred 24 hr and 13 days after the accident. All patients had brain infarction, which was unilateral in five cases and bilateral in three cases. The severity of lesions was graded on the basis of arteriographic findings as follows: Type I, wall involvement without significant stenosis or dilation; Type II, arterial dissection with stenosis >70% (Type IIA) or dilatation >50% (Type IIB) and the normal diameter of the proximal or distal internal carotid artery; and Type III, thrombosis of the internal carotid artery. Lesions were asymmetrical in six patients, including two with Type II and III lesions and four with Type I and II lesions, and symmetrical in two patients, including one with bilateral Type III lesions and one with bilateral Type II lesions. Surgery was performed in two patients with Type II lesions, including one case associated with contralateral carotid thrombosis. The intrapetrous carotid artery was exposed by an ear-nose-throat (ENT) surgeon and repaired by interposition grafting. Follow-up in these two surgical cases was 28 and 31 months. In the remaining six cases, medical treatment was performed. Outcome in nonsurgical cases was variable: death in two cases at 31 and 43 days after the accident, severe permanent hemiplegia in two cases, and minimal or no sequels in two cases. Following blunt trauma, arteriography of supraaortic vessels should be performed to detect BCAD in any patient with immediate or delayed neurologic symptoms that cannot be explained by CT-scan findings. To better understand the natural course of these lesions and define the indications for surgery, we propose a three-grade classification according to arteriographic findings. If surgery is undertaken, vein grafting should be performed following resection of the carotid artery lesions.

Adult↗
PubMed1998

Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM.

OBJECTIVE: ACE inhibitors and calcium antagonists may favorably affect serum lipids and glucose metabolism. The primary aim of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) was to compare the effects of fosinopril and amlodipine on serum lipids and diabetes control in NIDDM patients with hypertension. Prospectively defined cardiovascular events were assessed as secondary outcomes. RESEARCH DESIGN AND METHODS: Inclusion criteria included a diagnosis of NIDDM and hypertension (systolic blood pressure of > 140 mmHg or diastolic blood pressure of > 90 mmHg). Exclusion criteria included a history of coronary heart disease or stroke, serum creatinine > 1.5 mg/dl, albuminuria > 40 micrograms/min, and use of lipid-lowering drugs, aspirin, or antihypertensive agents other than beta-blockers or diuretics. A total of 380 hypertensive diabetics were randomly assigned to open-label fosinopril (20 mg/day) or amlodipine (10 mg/day) and followed for up to 3.5 years. If blood pressure was not controlled, the other study drug was added. RESULTS: Both treatments were effective in lowering blood pressure. At the end of follow-up, between the two groups there was no significant difference in total serum cholesterol, HDL cholesterol, HbA1c, fasting serum glucose, or plasma insulin. The patients receiving fosinopril had a significantly lower risk of the combined outcome of acute myocardial infarction, stroke, or hospitalized angina than those receiving amlodipine (14/189 vs. 27/191; hazards ratio = 0.49, 95% CI = 0.26-0.95). CONCLUSIONS: Fosinopril and amlodipine had similar effects on biochemical measures, but the patients randomized to fosinopril had a significantly lower risk of major vascular events, compared with the patients randomized to amlodipine.

Amlodipine↗
PubMed1997

Iliac transluminal angioplasty and distal surgical revascularisation can be performed in a one-step technique.

PURPOSE: A few authors have suggested treating double-level atherosclerotic lesions in high risk patients by an association of iliac transluminal angioplasty (ITA) and distal surgical restoration in a two-step technique with an interval of one to three weeks between the two procedures. Previous reports of ITA showed the influence of the quality of the outflow on early results, we therefore decided to perform the two procedures mentioned above during the same operation. METHODS: During a five-year period, 51 patients (42 men, 9 women) underwent an isolated ITA in 32 cases (group I) or associated with a simultaneous surgical reconstruction (group II) in 19 cases. Mean age (56.4+/-12 years versus 63.9+/-11.8 years, p<0.01), frequency of limb-threatened ischaemia (2.6% versus 42.1% p<0.001), and of an ipsilateral thrombosed or severely stenotic femoral artery (20% versus 100%, p<0.001) were significantly higher in group II. In group I (n=32), 45 unique or double iliac lesions (unilateral=25, bilateral=7) including 42 stenosis (>75%) and three thrombosis were treated. In group II (n=19), ITA was performed on unique and unilateral iliac stenosis (>75%) in association with a femoro-femoral bypass (n=4), an ipsilateral femoro-popliteal bypass (n=5) or femoro-tibial bypass (n=3) or an ipsilateral deep or common femoral reconstruction (n=7). RESULTS: Early complications consisted of one haematoma (group I), one death and one iliac restenosis (group 2). After a mean follow-up of 20 months, cumulative patency of groups I and II was respectively 81% and 88% (p=ns), with an increase in the ankle/brachial systolic pressure ratio from 0.73+/-0.14 to 0.92+/-0.14 (p<0.001) in group I, and from 0.57+/-0.15 to 0.84+/-0.12 (p<0.001) in group II. CONCLUSIONS: Early and mid-term results of the one-step technique are similar to those obtained with patients who underwent ITA with good initial outflow. This technique can therefore be recommended in high-risk patients with double-level atherosclerotic lesions including severe iliac stenosis.

Angioplasty, Balloon↗
PubMed1997

Pregnancy and delivery in Ehlers-Danlos syndrome type V.

Ehlers-Danlos syndrome (EDS) is a hereditary dysplasia of connective tissue with an abnormal collagen synthesis. It is characterized by hyperelasticity and fragility of the skin, joint hyperlaxity and fragility of the blood vessels. We describe the problems reported during pregnancy and delivery in women with EDS. Our patient had a type V syndrome. Accurate monitoring during the course of pregnancy is necessary. We believe cesarean section more appropriate than vaginal delivery in order to avoid the risks related to the rupture of the pelvic and perineal vessels which may be difficult to suture.

Adult↗
PubMed1997

[Recurrence following surgery of the gastrocnemius veins].

Routine preoperative investigation of chronic venous insufficiency of the lower limbs with echo-Doppler has brought to light the presence of reflux into the gastrocnemius veins in almost 30% of the patients. Surgical treatment to stop this reflux consists in dividing the gastrocnemius vein flush to the popliteal vein. Early postoperative investigation of patients operated on in this way, who are symptomless and with no residual varices, has revealed the presence of persistent, symptomless, postoperative reflux into the gastrocnemius veins. One hundred and six patients were checked six months postoperatively by Duplex Doppler scanning. On the basis of the anatomical and functional findings, postoperative incompetence of the gastrocnemius veins could be classified into several types according to the cause: 1. Persistence of a complete and incompetent gastrocnemius vein, probably missed at operation: 16 patients (15%). 2. Neoangiogenesis: 11 patients (10%). 3. Persistence of an incompetent lower gastrocnemius perforating vein: 17 patients (16%). Thus, echography has revealed that in 44 lower limbs out of 106 (42%) in which the gastrocnemius veins were operated on, six months postoperatively evidence of reflux into the gastrocnemius venous network was present. All these patients were asymptomatic. In a sub-group of 48 lower limbs which had an interval Doppler check at 2 months: 6 already showed a reflux (12.5%), in 11 the gastrocnemius reflux appeared between the second and the sixth months (23%), 31 showed no reflux at 6 months (64.5%). From these findings, certain rules on the surgery of the gastrocnemius veins have been drawn up.

Adult↗
PubMed1997

[Surgery of the perforating veins of the leg: open and endoscopic techniques].

Surgical treatment of incompetent perforating veins of the leg is best carried out through a sub-aponeurotic approach after localisation by coloured Duplex-Scanning. Open techniques are long established. When there is only one perforator, a short 5 cm approach is centred over the previously localised perforator. In the presence of multiple perforators, an extensive approach is necessary. This usually means a single long incision, situated para-tibially in the Linton approach, postero-medially in the Dodd approach or posteriorly in the Felder approach. The advantage of the last two approaches is that they are situated at a distance from any eventual cutaneous lesion. The approach can also be through several separate oblique incisions (De Palma). More recently introduced, endoscopic techniques have the advantage of reducing the incidence of cutaneous complications such as necrosis or infections and of shortening the duration of hospitalisation. Some authors work with re-usable instruments. The perforators are divided after coagulation (Hauer, Sattler). Others use disposable instruments, insufflate the sub-aponeurotic space and clip the perforators to prevent bleeding (Gloviczki). These techniques are currently undergoing evaluation.

Endoscopy↗
PubMed1996

Blunt injury to the internal carotid artery at the base of the skull: six cases of venous graft restoration.

PURPOSE: Blunt injuries to the internal carotid artery (ICA) at the base of the skull are uncommon but potentially dangerous lesions whose management remains unclear. We report a new surgical approach of the intrapetrosal portion of the ICA that was used in six patients with the help of an ear, nose, and throat surgeon. METHODS: During a 70-month period, seven consecutive patients (four women, three men; mean age, 35.7 years; range, 21 to 59 years) were admitted, six after a motor vehicle accident and one after a cervical manipulation. All patients had a neurologic deficit. An arteriographic scan revealed four unilateral ICA lesions: two false aneurysms, one tight stenosis, and one dissection; two cases of bilateral ICA dissection were mentioned, and one case of ICA dissection was associated with a contralateral ICA thrombosis. RESULTS: One patient died before surgery, and six patients underwent a unilateral venous graft restoration, reaching the vertical portion of the intrapetrosal ICA in two patients and the horizontal portion in four. A shunt was used in one patient. Failure to recognize the end of the ICA lesion was responsible for one postoperative asymptomatic graft thrombosis (17%), but this difficulty was overcome by using intraoperative angioscopy in the other patients. No deaths and no new strokes were noted during postoperative and midterm follow-up (mean follow-up, 34 months). Five postoperative facial pareses occurred and were totally regressive within 3 to 6 months in four patients; one total deafness was recorded. CONCLUSION: Venous graft restoration of traumatic ICA lesions at the base of the skull can safely be performed with such an approach, thus producing highly satisfactory results. Before undergoing surgery, the patient must be aware of the risk of facial and auditive disorders, which are generally temporary.

Accidents, Traffic↗
PubMed1996

[Manipulations of cervical vertebrae and trauma of the vertebral artery. Report of two cases].

Vertebrobasilar-distribution stroke is a rare but sometimes severe complication of chiropractic neck manipulation. We report two patients with dissections of the vertebral arteries authenticated two and six days after the cervical manipulation. In the first case, a Wallenberg's syndrome occurred due to a dissection of the right intracranial vertebral artery; the patient was treated with anticoagulant therapy but little improvement of the disorder was noted. The second patient had transitory neurologic manifestations which led to the discovery of an intimal tear of the ostium of the right vertebral artery with a floating clot. Further embolic complications were avoided by performing a venous bypass between the right common carotid and the vertebral artery at the base of the skull. Therapists should be aware of vertebrobasilar complications after spinal manipulations and should ask for early explorations (brain CT, cerebral angiography) to institute rapidly the most appropriate treatment.

Aortic Dissection↗
PubMed1994

Endometrial hyperplasia: efficacy of a new treatment with a vaginal cream containing natural micronized progesterone.

Seventy-eight premenopausal women affected by benign endometrial hyperplasia (60 simple and 18 complex) were treated from the 10th to the 25th day of the menstrual cycle with a vaginal cream containing 100 mg of natural micronized progesterone in polyethylene glycol base. The treatment lasted 3 months in 58 patients and 6 in the other 16 patients. Four patients were lost from the study. We observed a total of 67 complete regressions (90.5%) of which 58 (78.3%) occurred in the first 3 months and 9 (11.5%) after 6 months of treatment. Simple hyperplasia showed a significantly higher response to treatment in comparison with the complex type (P < 0.001). The most frequent endometrial pattern detected in the patients in whom hyperplasia regressed was of a secretive type. Recurrence of hyperplasia occurred in 1 out of 58 (1.72%) patients at the 3rd month and in 3 out of 49 (6.1%) patients at the 6th month after treatment. There were no significant differences between the two hystological groups in the percentage of recurrence. During treatment we observed a significant reduction of the amount, duration and frequency of the menstrual bleeding. Minimal side-effects were observed. In conclusion, for its effectiveness and safety, vaginal administration of natural micronized progesterone seems to be an interesting approach to benign endometrial hyperplasia, particularly indicated in women also affected by metabolic disorders.

Administration, Intravaginal↗