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Biomedical subjects

P Modugno

Publications and source records attributed to P Modugno.

9 recordsLinked to original sources
PubMed2000

Combined Surgery for cardiac and carotid disease: management and results of a rational approach.

OBJECTIVES: The aim of the present study was to apply a rational plan for simultaneous cardiac and carotid surgery in high-risk patients. MATERIALS AND METHODS: A consecutive series of 89 patients with coexisting severe cardiac and carotid disease were operated on during a 5-year period with routinary carotid shunting, moderate hypothermia and balanced anaesthesia. The combined surgical procedures were coronary artery by-pass grafts (CABG) + carotid endarterectomy (CEA) in 81 patients, CABG + CEA + aortic valve replacement (AVR) in four patients, and four cases of CEA + AVR. RESSULTS: Two deaths (2%), three acute myocardial infarctions (3%) and one (1%) major stroke occurred in five patients during the perioperative (30 days) period for a combined rate of death and/or disabling stroke of 3%. There were five reversible neurological deficits. Carotid and aortic mean clamping times were 9 and 60 min respectively. Patients were discharged after a mean length of stay in Intensive Care Unit (ICU) of 131 h and 7 days of hospitalisation post-ICU. CONCLUSIONS: Based on our results, combined interventions of CEA and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic cardiac disease. The management of these patients needs careful and appropriate pre-intra and post-operative assessment and timing aimed to reduce the ischaemic injuries, both cardiac and cerebral, especially during CBP time.

Aged↗
PubMed1983

[Use of local cryotherapy in the treatment of humeral epichondylitis].

The efficacy of cryotherapy, following the use of an ice bag, is evaluated in 21 patients of both sexes suffering from epicondilitis of the humerus. This treatment improved the clinical syndrome (pain and functional limitation) in 67% of the patients. Good results (4 cases - 19%) and negative results (3 cases - 14%) were also found, with the possibility of a relapse in the latter group.

Adult↗
PubMedDate not supplied

[Vascular cysts of the adrenals. Association with aneurysm of the abdominal aorta].

A rare case of an adrenal vascular cyst associated to an abdominal aorta aneurysm is reported. Adrenal cysts are an uncommon clinical finding, in most cases incidentally discovered for nonspecific abdominal pain, during US, TC or RM evaluation or at autopsy. Small adrenal mass are clinically silent. They may be symptomatic (lumbar tension, pain) for dimensions over 10 centimetres. Cysts of large size can cause displacement and compression of adjacent organs. They present a difficult problem of differentiation between benign and malignant lesions. Non-neoplastic adrenal cysts have been divided into four categories: parasitic (7%), epithelial (9%), endothelial (45%) and haemorrhagic or pseudocystic (39%). Vascular adrenal cysts may be a traumatic consequence of an hamartomatous vascular anomaly. The aim of this paper is to discuss, on the basis of the literature, the etiology, diagnosis and treatment of the adrenal mass. Surgical timing is discussed for the concomitant vascular lesion. The elective treatment was left adrenalectomy performed through transperitoneal approach. Surgery for abdominal aorta aneurysm was differed because the adrenal mass was suspected to be an infected neoplastic lesion and for the feasibility of endovascular procedure. The adrenal specimens contained a cystic structure with fluid blood, fibrin and calcifications. Normal adrenal cortical tissue was found in the cystic wall. This lesion (arising from vascular anomalies) require separation from haemorrhagic adrenal neoplasm. Awareness of adrenal pseudocysts and careful attention to the hystological features aids this distinction.

Adrenal Gland Diseases↗
PubMedDate not supplied

[Drainage in thyroid surgery].

Bleeding represents a rare complication of thyroid surgery but when it occurs it may be life-threatening. To prevent this complication drainage is widely used. However no study has demonstrated the drains' value and recent reports have questioned its benefits. Therefore we have analyzed our experience of a 10 year-period in which 1.217 thyroidectomies were performed by the same surgical team and prophylactic routine drainage was always adopted. In 13 patients (1.06%) a benign hematoma occurred with spontaneous remission. In 6 patients the bleeding was severe and compressive hematoma occurred; it required surgical re-exploration. Such a complication is unusual in the neck surgery (0.49% in the authors' series) performed by experienced surgeons and when life-threatening hematomas do occur they depend on various uncontrolled factors and drainage is often not helpful. Otherwise a meticulous haemostatic technique is necessary and patients should be observed very closely during the few first hours following surgery on the thyroid gland. Therefore on the basis of the analysis of their series, although it is not always possible to prove the benefit of the drainage, the authors suggest its indication in the neck surgery, as in other fields with dead space, to remove blood and secretions reducing postoperative complications. They have never observed wound infections and patients were discharged within 72 hours.

Adolescent↗
PubMedDate not supplied

Surgery of differentiated thyroid carcinoma, lymph node metastases and locoregional recurrence.

Surgery of differentiated thyroid carcinoma is burdened with risk factors that significantly impact on prognosis, as age at diagnosis and tumor stage. Problems involved concern the extent of surgical resection and the indication for regional lymphadenectomy. As for the former, the most popular approach is total thyroidectomy "on principle" with neck lymphadenectomy. Lobectomy may represent an alternative to total thyroidectomy in low risk patients with unifocal papillary carcinoma 1 cm or less in size, or minimally invasive follicular carcinoma. As for lymphadenectomy, most authors do not agree with surgery "on principle" but rather "of necessity", that is, in presence of clinically evident lymphadenopathy and neck lymphadenectomy is the preferred surgical strategy. In most cases surgery is the treatment of choice of locoregional recurrence. Careful preoperative work-up and accurate surgical procedure are mandatory.

Carcinoma↗
PubMedDate not supplied

[Effects of aprotinin on the endochondral ossification process in growing rabbits].

Present study demonstrated that aprotinin, a natural inhibitor of proteases, interfered with the ossification process of epiphyseal and metaphyseal cartilages of growing rabbits. This biological effect may be induced by inhibition of tissue proteases, that acts on cartilage matrix to produce a substance which is an important component of the calcifying mechanism during enchondral ossification.

Animals↗
PubMedDate not supplied

[The effect of epsilon-aminocaproic acid on the normalization of embolizing fatty matter in the rabbit lung following experimental fractures. A polarized light study].

It has been confirmed that epsilon-aminocaproic acid (EACA), an inhibitor of fibrinolysis, reduced the incidence of fat embolism in the lung of rabbits with experimental bone fractures. Microscopic specimens of lungs, examined under polarized light, demonstrated the reduced amounts of lipoid materials that were prevalently undergraded. The action of the drug is owed to the inhibition of some primary mechanisms, involved in the genesis and diffusion of post-traumatic fat embolism.

Aminocaproates↗