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R Ragazzi

Publications and source records attributed to R Ragazzi.

At least 19 recordsLinked to original sources
PubMed2006

Randomized clinical trial of the effect of preoperative dexamethasone on nausea and vomiting after laparoscopic cholecystectomy.

BACKGROUND: Preoperative dexamethasone may reduce disabling symptoms such as pain, nausea and vomiting after laparoscopic cholecystectomy. METHODS: This was a randomized, double-blind, placebo-controlled trial. Between March and December 2004, 101 patients undergoing laparoscopic cholecystectomy were randomized to receive 8 mg dexamethasone (n = 49) or placebo (n = 52) intravenously before surgery. Six patients were excluded from the study. All patients received a standardized anaesthetic, surgical and multimodal analgesic treatment. The primary endpoints were: first, postoperative nausea, vomiting and pain; second, postoperative analgesic and antiemetic requirements. The pain scores (visual analogue and verbal response scales), the episodes of nausea (verbal response scale) and vomiting were recorded at 1, 3, 6 and 24 h, respectively, after the operation. Analgesic and antiemetic requirements were also recorded. RESULTS: No apparent drug side-effects were noted. Seven patients (14 per cent) in the treatment group reported nausea and vomiting compared with 24 (46 per cent) in the control group (P = 0.001). In the group of patients treated with dexamethasone, five (10 per cent) required antiemetics versus 23 (44 per cent) of those receiving placebo (P < 0.001). No difference in postoperative pain scores and analgesic requirements was detected between groups. CONCLUSION: Preoperative dexamethasone reduces postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy, with no side-effects, and may be recommended for routine use.

Analgesics↗
PubMed2005

Tumour staging, morphology and p53 overexpression concur in predicting survival in hepatocellular carcinoma.

BACKGROUND/AIMS: The prognosis of hepatocellular carcinoma (HCC) on cirrhosis is hard to predict as it depends on tumour stage, underlying liver disease, type of treatment and, possibly, biological factors of the tumour itself. METHODS: We prospectively evaluated the survival of 91 consecutive patients with HCC on cirrhosis, diagnosed between January 1998 and December 1999. Clinical features and histological/biological aspects, including histotype, grade, p53 overexpression, cytoproliferation and apoptotic markers were analysed. RESULTS: Child-Pugh (P = 0.01), Okuda (P < 0.0001), Cancer of the Liver Italian Program (CLIP) staging (P < 0.0001) and type of treatment (P = 0.0001) were significantly related to survival. In the Cox model, CLIP staging was included as independent predictor of survival at step 1 (P < 0.0001) with Okuda at step 2 (P = 0.013). Amongst the biological factors, p53 overexpression and histotype were significantly related with survival (P = 0.0044 and 0.017 respectively). When clinical and biological variables were examined together in the Cox model, CLIP and Okuda were confirmed as being statistically related with survival (P < 0.0001 and =0.012) followed by histotype and p53 overexpression (P = 0.019 and 0.02). CONCLUSIONS: CLIP, Okuda, histotype and p53 overexpression are the strongest predictors of survival in this series of patients. These data confirm that staging of the tumour and underlying liver disease are strictly related to prognosis but support the concurrent role of clinical and biological factors in upgrading our capacity of predicting the fate of HCC patients.

Aged↗
PubMed2005

The effect of volatile anesthetics on respiratory system resistance in patients with chronic obstructive pulmonary disease.

We examined the effect of isoflurane and sevoflurane on respiratory system resistance (Rmin,rs) in patients with chronic obstructive pulmonary disease (COPD). The diagnosis of COPD rests on the presence of airway obstruction, which is only partially reversible after bronchodilator treatment. Ninety-six consecutive patients undergoing thoracic surgery for peripheral lung cancer were enrolled. They were divided into two groups: preoperative forced expiratory volume in 1 s/forced vital capacity ratio <70% or >70%. Rmin,rs was measured after 5 and 10 min of maintenance anesthesia by using the constant flow/rapid occlusion method. Maintenance of anesthesia was randomized to thiopental 0.30 mg . kg(-1) . min(-1) or 1.1 minimum alveolar anesthetic concentration end-tidal isoflurane or sevoflurane. Eleven patients were excluded: two because anesthesia was erroneously induced with propofol and nine because of an incorrect tube position. Maintenance with thiopental failed to decrease Rmin,rs, whereas both volatile anesthetics were able to decrease Rmin,rs in patients with COPD. The percentage of patients who did not respond to volatile anesthetics was larger in those with COPD as well. In conclusion, we have demonstrated that isoflurane and sevoflurane produce bronchodilation in patients with COPD.

Aged↗
PubMed2003

Visceral artery aneurysms: a single center experience.

BACKGROUND: Splanchnic artery areurysm is a rare but clinically relevant disease, showing a high mortality rate in emergency surgery. Reports on splanchnic aneurysms are rare and often anecdotal. The aim of this study is to discuss data obtained from 16 patients in a single vascular surgery center. MATERIALS AND METHODS: Between January 1987 and December 2000, 16 patients underwent surgery for splanchnic artery aneurysms. In 13 patients the localization was single (in two associated with an infrarenal abdominal aortic aneurysm) and in 3 patients multiple. The arteries involved were: splenic (8), hepatic (4), celiac (3), superior mesenteric (3), ileocolic (2), and pancreatoduodenal (1). 13 patients were asymptomatic and 3 presentec with abdominal pain. All patients underwent CT scan, and abdominal aortic and selective visceral artery angiography. Before surgery, all patients underwent cerebral MR or cerebral CT scan. 13 patients underwent open vascular surgery; 3 patients (2 splenic and 1 hepatic) underwent endovascular procedure (angioembolization). Histological examination of the aneurysmal wall was obtained in 14 patients. Ultrasound examination was performed after 6 months, then yearly. 14 patients underwent abdominal CT scan during the long-term follow-up. RESULTS: Perioperative mortality was absent. 12 cases were classified as displastic, with minor or major secondary atherosclerotic changes, and in many cases severe calcications. 2 cases were classified as atherosclerotic. Cerebral MR did not show any cases of intracerebral displastric aneurismal disease. One patient was lost at follow-up after 9 years. One patient showed a recurrence at 6 years (superior mesenteric artery): the patient underwent a new surgical procedure and died 20 days after surgery for intestinal infarction. All abdominal follow-up CT scans show good results of the vascular reconstruction and escluded other new visceral or aortic aneurysms. CONCLUSIONS: Visceral artery aneurysms are an uncommon form of abdominal vascular disease showing a high postoperative mortality rate in emergencies. Surgery, and in selected cases, endovascular treatment, can successfully manage splanchnic artery aneurysms with few complications and low recurrence.

Aged↗
PubMed2003

Spontaneous recanalization of internal carotid artery occlusion evaluated with color flow imaging and contrast arteriography.

AIM: In strokes of embolic origin a partial recanalization of the intracranial occluded vessel occurs with a high incidence (as high as 80%). In the literature, we find few cases of revascularization, detected with color flow imaging (CFI) or with arteriography (AGF), at carotid siphon or at the origin of an occluded internal carotid artery (ICA). Up to now there have been no reliable data on the incidence and clinical consequences of SR of an extracranial ICA occlusion. In this case-report we document 8 cases of SR of occluded ICA observed in the last 10 years in our Care Unit. METHODS: We observed 8 complete ICA occlusion at the origin, detected with CFI (8 of 8) and with AGF (7 of 8). All symptomatic patients and 2 of 5 asymptomatic patients underwent CT scan in the acute phase of stroke. All patients underwent CFI follow-up (every 6-12 monhts) to evaluate contralateral CCA and ICA and the presence of new focal neurological symptoms. All patients assumed BMT (antiplatelet or anticoagulant therapy). RESULTS: SR occurred in 6 patients between 24 and 96 months, in 1 patient within 8 months and 1 patient within 6 months from the diagnosis of ICA occlusion. Diagnosis of SR was based in all patients with CFI and in 4 patients confirmed with AGF. Five patients underwent CT scan that excluded haemorrhagic transformation of previous ischemic areas or new ischemic events (2 patients did CT scan only after SR). All patients underwent CFI follow-up in a 3-88 months period. There were no new focal neurological symptoms in 7 of 8 patients, 1 patient presented aspecific neurological symptoms. CONCLUSION: Diagnosing SR of occluded extracranical ICA seems to be more frequent than expected. SR is an event that has to be researched in follow-up of these patients; besides, it seems to have a relatively benign outcome with respect to the onset of new neurological symptoms.

Aged↗
PubMed2002

Early experiences with a porcine hepatocyte-based bioartificial liver in acute hepatic failure patients.

Orthotopic liver transplantation (OLT) is the only effective therapeutic modality in severe acute hepatic failure (AHF). The scarcity of organs for transplantation leads to an urgent necessity for temporary liver support treatments in AHF patients. A hepatocyte-based bioartificial liver (BAL) is under investigation with the main purpose to serve as bridging treatment until a liver becomes available for OLT, or to promote spontaneous liver regeneration. We developed a novel radial-flow bioreactor (RFB) for three-dimensional, high-density hepatocyte culture and an integrated pumping apparatus in which, after plasmapheresis, the patient's plasma is recirculated through the hepatocyte-filled RFB. Two hundred thirty grams of freshly isolated porcine hepatocytes were loaded into the RFB for clinical liver support treatment. The BAL system was used 8 times in supporting 7 AHF patients in grade III-IV coma, all waiting for an urgent OLT Three patients with no history of previous liver diseases were affected by fulminant hepatic failure (FHF) due to hepatitis B virus, 3 by primary non-function (PNF) of the transplanted liver, and one by AHF due to previous abdominal trauma and liver surgery. Six out of 7 patients underwent OLT following BAL treatment(s), which lasted 6-24 hours. All patients tolerated the procedures well, as shown by an improvement in the level of encephalopathy, a decrease in serum ammonia, transaminases and an amelioration of the prothrombin time, with full neurological recovery after OLT Our initial clinical experience confirms the safety of this BAL configuration and suggests its clinical efficacy as a temporary liver support system in AHF patients.

Adolescent↗
PubMed2001

Responsiveness to intravenous administration of salbutamol in chronic obstructive pulmonary disease patients with acute respiratory failure.

OBJECTIVE: In chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF), bronchodilating agents administered by inhalation have, in general, little effect on dynamic hyperinflation and concurrent static intrinsic positive end-expiratory pressure (PEEPi,st). Since in COPD the severely obstructed segments of the lung may not be reached by inhaled medication, we reasoned that drug efficiency may be enhanced by intravenous administration of the agent. DESIGN: Physiological study. SETTING: Two four-bed surgical-medical ICUs of a university hospital. PATIENTS: Fourteen COPD patients were studied within 36 h from the onset of ARF. MEASUREMENTS AND RESULTS: Static compliance (Cst,rs), minimal (Rmin,rs) and additional (DeltaRrs) resistance of the respiratory system, and PEEPi,st were measured before and after intravenous administration of salbutamol. All patients had limitation of air flow before and after salbutamol administration. On average, after salbutamol there was a small, though significant, decrease in Rmin,rs (-9%), DeltaRrs (-12%) and PEEPi,st (-8%). CONCLUSION: The changes in resistance and PEEPi,st after intravenous administration of salbutamol were too small to be of clinical significance.

Acute Disease↗
PubMed2000

Predictors of weaning outcome in chronic obstructive pulmonary disease patients.

Several threshold values for predicting weaning outcome from mechanical ventilation have been proposed. These values, however, have been obtained in nonhomogeneous patient populations. The aim of the present study was to determine the threshold values in chronic obstructive pulmonary disease (COPD) patients and compare them to those reported for nonhomogeneous patient populations. The initial weaning trial included 81 COPD patients. Fifty-three of them underwent a successful weaning trial, whereas 28 failed it. The latter were enrolled into the present investigation, and were restudied during a subsequent successful trial. The weaning indices used were those reported in the literature. The threshold values obtained were within 10% of those reported for a nonhomogeneous patients population only for tidal volume and effective compliance. The classification error was <20% for maximal inspiratory pressure (MIP), occluded inspiratory pressure swing (deltaPI)/MIP, rapid and shallow breathing (respiratory frequency/tidal volume), and compliance, rate, oxygenation, pressure index (CROP), whereas the area under the receiver operating characteristic curves was >0.9 only for deltaPI/MIP and CROP. In conclusion, the threshold values obtained in chronic obstructive pulmonary disease patients who failed the first weaning attempt differed from those previously reported. Although a gold standard weaning index is not available for chronic obstructive pulmonary disease patients, the occluded inspiratory pressure swing/ maximal inspiratory pressure and compliance, rate, oxygenation, pressure index may be candidates for such a role.

Acute Disease↗
PubMed1999

Respiratory mechanics during and after anaesthesia for major vascular surgery.

To evaluate the effects of major vascular surgery on respiratory mechanics, 11 patients undergoing general anaesthesia for abdominal aortic surgery were studied. Before aortic cross-clamping, chest wall elastance and resistance both increased (by 126% and 58%, respectively) when surgical retractors were placed. After aortic cross-clamping, lung elastance increased by 29%, accompanied by a decrease in cardiac index (22%) and an increase in pulmonary (17%) and systemic (15%) vascular resistance. After aortic unclamping, lung elastance decreased, although it remained higher than baseline values (by 12%). All cardiovascular variables returned to the values obtained before aortic cross-clamping.

Aged↗
PubMed1997

[Respiratory circuits and infections of the airway].

OBJECTIVE: To study the effects of ventilator circuit changes on the rate of airway infections and to investigate the relationship between the microorganisms responsible for circuit colonization and those responsible for infection. DESIGN: Prospective study, carried out in two different periods, of one year duration each. SETTING: General Intensive Care Units (ICUs) in a University Hospital. PATIENTS: Seventy-eight patients, requiring mechanical ventilation (VAM) for more than 5 days, were enrolled. They were divided into two groups: in the first (group I, n. 36, 1st period) the ventilator circuit was changed every 5 days; in the second (group II, n. 42, 2nd period) every 10 days. INTERVENTION: Ventilator circuit change every 5 or 10 days. Daily culvert and filling of cascade humidifiers with sterile irrigation water. Daily replacement of mount catheter. MEASUREMENTS: Qualitative cultures of tracheobronchial aspirate and of fluid from the humidifying cascades and the expiratory tubing traps. RESULTS: The two groups were similar. Pneumonia and tracheobronchitis were found in the 25% and 11% of patients of group I and in 26% and 12% of those of group II respectively. The VAM duration was 26.5 +/- 15 days in patients who developed airway infection, and 12.9 +/- 11.6 days (p < 0.001) in patients who did not. The Gram+ organisms were predominant. An identical microorganism was found both in the tracheo-bronchial aspirate and in the circuit in 44 of 78 (56%) patients; no difference was found between infected (16 of 29) and non infected (28 of 49) patients. CONCLUSIONS: Changing the ventilator circuit every 10 days rather than every 5 days, does not increase the incidence of airway infections and result in considerable savings in the expenses of tubing and personnel time. The infection or colonization rates due to the same microorganisms are quite low and it seems not useful to make routine cultures of fluid from humidifying cascades and the expiratory tubing traps in order to characterize in time the microorganism that could be responsible of airway infections.

Adult↗
PubMed1994

Correlation of testicular volume, histology and LHRH test in adolescents with idiopathic varicocele.

Testicular growth failure as well as a well-documented histological damage have been reported in adolescents with varicocele. However, the proper management of this disorder in childhood is still debated due to the lack of seminal data and to the large number of adults with varicocele who have no fertility problems. In order to identify the subset of patients who are at risk of developing impaired testicular function and thus candidates for early varicocelectomy, we have studied 15 adolescents 10-17 years old with a grade II-III left-sided varicocele. Testicular volume and gonadotropin response to LHRH stimulation were evaluated preoperatively and compared to the histological findings from bilateral testicular biopsies. An abnormal left testicular histology was observed in 7 boys (46.6%) but only 3 of them (20%) showed severe testicular damage. The difference in size between the right and the left testis was never significant and was of no value in detecting subjects with abnormal histology. A good correlation was found between testicular injury and an increased response of both gonadotropins to the administration of LHRH. Decreased testicular volume does not seem to be a reliable predictor of early testicular damage. The assessment of gonadotropin response to LHRH may provide an additional objective means of evaluating adolescents with varicocele.

Adolescent↗
PubMed1994

[Survival in intensive care of patients with chronic obstructive bronchopneumopathy and acute respiratory failure undergoing mechanical ventilation. Retrospective study].

OBJECTIVE: To collect valuable informations for the evaluation of the patients' clinical evolution and to perform a cost-effectiveness analysis on the utilization of resources in the management of patients with chronic obstructive pulmonary disease (COPD) undergoing mechanical ventilation (MV) for acute respiratory failure (ARF). SETTING: General ICU. University Hospital. PATIENTS: 87 BPCO patients (mean age: 69.6 +/- 8.5) undergoing MV for ARF due to non surgical or traumatic events, for a total of 108 consecutive ICU admissions between January 1983 and December 1993. METHODS: Retrospective study in which the following data were collected: severity of the underlying chronic respiratory disease before the occurrence of ARF. For this aim patients have been divided into five classes (O-IV) according with ATS classification of dyspnea; causes of ARF; SAPS score; TISS score; OMEGA score; complications occurred in ICU; duration of MV; duration of stay in ICU; ICU and hospital outcome. RESULTS: In 48 cases (44.4%) clinical history was positive for a severe dyspnea (classes III-IV). Slight airway flogosis or infection were responsible of ARF in 78 cases; pneumonia was present in 24 cases while in 6 cases ARF was due to congestive heart failure. The study population was divided into two groups according with outcome. No statistically significant difference was observed in mean SAPS and TISS scores between the two groups (12.5 +/- 3 vs 13 +/- 4.8 and 18.4 +/- 2.3 vs 19 +/- 4.2). Mean OMEGA score was 155 +/- 11.7 (ES). With reference to ICU outcome the utilization rate or resources was 72.15% with a mean loss of resources of 43.2. Compli-cations were manly due to airway infection (16 cases) which was responsible in one case of the patient's death. Overall incidence of complications was relatively low and five of them led to patients' death in ICU. Mean duration of MV did not differ between the two groups (13.4 +/- 11.7 vs 14.3 +/- 11.7) but it was significantly longer in those patients whose clinical history was positive for severe dyspnea (classes III and IV) than in patients without this report (16.6 +/- 14.9 vs 10.9 +/- 6.9; p < 0.05). Mean stay in ICU did not differ significantly between survivors and non-survivors (21.4 +/- 18.6 vs 19.7 +/- 13). ICU mortality rate was 6.48% (7 patients) and hospital mortality rate was 20.3% (22 patients). CONCLUSIONS: Our results demonstrate that hospital outcome in COPD patients with ARF requiring mechanical ventilation is quite good. Prolonged mechanical ventilation and--severity of underlying chronic respiratory disease do not affect significatively the prognosis. The high costs of the treatment of these patients are counterbalanced by a good efficiency of utilization of resources and appreciable clinical results.

Aged↗
PubMed1992

[Transplantation of the left lung in a 2-month-old piglet. The Study Group for Lung Transplantation].

Experimental surgery in animals remains an irreplaceable model for the clinical application of a new technique. We performed a single lung allotransplantation in young pigs. The pigs were organized into groups: 1) 6 to assess the surgical anatomy; 2) 10 to receive left transplantation; 3) 3 to study the pathophysiology of the transplanted lung. The preliminary results demonstrated that the surgical model is useful.

Animals↗
PubMed1991

[Intestinal occlusion caused by ileal phytobezoar].

The paper reports a case of occlusion of the small intestine by phytobezoar which was treated surgically by means of enterectomy and removal; the Authors underline that gastric and/or ileal phytobezoar are formed by vegetables with a high percentage of indigestible fibres and fruit with many seeds; predisposing conditions include inadequate mastication in gastroresected and vagotomised patients. If the latter follow the rule of chopping high-risk vegetables before eating them, occlusion of the small intestine due to phytobezoar and emergency surgery can be avoided.

Adult↗
PubMedDate not supplied

[The use of intra-arterial lipiodol in assessing hepatocarcinomas treated by percutaneous alcoholization. The initial experience].

Eight patients with inoperable hepatocellular carcinoma were treated by means of percutaneous alcoholization of the malignancy (11 nodular lesions less than 5 cm O). Upon treatment completion they were all given intraarterial injection of lipiodol, which was followed, a week later, by a CT scan. At angiography, during the parenchymal phase, 7 of 11 nodules appeared as avascular areas, whereas in the remaining 4 cases an intense parenchymal effect was seen within the previously treated areas. Lipiodol CT scans revealed intense uptake of oily material in the 4 hypervascular lesions as well as in 1 of those with avascular appearance. In 4 lesions, pathology of bioptic specimens obtained from the areas with contrast pooling was consistent with the persistence of viable neoplastic tissue. In these patients alcoholization had therefore to be continued. Lipiodol accumulation within previously treated nodules has proved to be related to the presence of residual neoplasm. Moreover, in 2 cases, focal retention of lipiodol was very helpful for biopsy under CT guidance. According to our experience, we believe lipiodol administration followed by CT to be very useful in evaluating and staging HCCs. We nevertheless believe that the procedure should be performed only after alcoholization has been completed: this would inform us of treatment effectiveness and subsequently enable us to decide whether treatment can be discontinued.

Angiography, Digital Subtraction↗