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R Spirito

Publications and source records attributed to R Spirito.

46 records · Page 3Linked to original sources
PubMed1983

[Cimetidine versus ranitidine in the treatment of peptic esophagitis].

A double blind test with cimetidine and ranitidine conducted on 60 patients with acid reflux oesophagitis revealed cimetidine to be the more effective. Its success is felt to lie more in the drug's ability to activate defensive factors than in its inhibition of acid secretion.

Adult↗
PubMedDate not supplied

Early and late results of ascending aorta surgery: risk factors for early and late outcome.

This study was designed to evaluate risk factors for in-hospital mortality and midterm survival in patients undergoing ascending aorta surgery at a single institution during an 11-year period. Between 1984 and 1994 a total of 158 patients underwent an ascending aorta procedure at our institution. Their mean age was 59.6 +/- 12.3; 115 (73%) were male, 33 (21%) had a history of congestive heart failure, 61 (39%) had an acute type A dissection, 21 (13%) underwent redo operations, and 55 (35%) were operated on an emergency basis. In-hospital mortality was 9.7% (10/103) for elective procedures and 36.4% (20/55) for emergency operations (p < 0.0001). Multivariable stepwise logistic regression analysis identified the cardiopulmonary bypass time [odds ratio (OR) = 1.01/min, p = 0.0021], emergency operation (OR = 2.27, p = 0.0022), arch replacement (OR = 2.71, p = 0.0067), and the need of femoral vein cannulation at intervention (OR = 1.89, p = 0.0375) as independent predictors of in-hospital death. When this kind of analysis was performed, evaluating only the variables known before surgery, acute type A dissection (OR = 2.21, p = 0.0009) and preoperative NYHA class (OR = 1.88 per class, p = 0.0290) were independent risk factors for in-hospital death. Follow-up ranged from 10 to 126 months (median 42 months), with Kaplan-Meier survivals of 69 +/- 4%, and 60 +/- 5% at 5 and 7 years, respectively; survival rates for hospital survivors were 85 +/- 4% and 67 +/- 7% at 5 and 7 years, respectively. Cox regression analysis has identified arch replacement [relative risk (RR) = 2.48, p < 0.0001], perioperative myocardial infarction (RR = 2.44, p = 0.0003), preoperative NYHA class (RR = 1.97 per class, p = 0.0009), acute type A aortic dissection (RR = 1.44, p = 0.0238), the need of femoral vein cannulation at intervention (RR = 1.55, p = 0.0332), and redo operation (RR = 1.44, p = 0.0851) as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy (p = 0.0003, RR = 3.42), reexploration for bleeding (p = 0.0003, RR = 3.77), and the occurrence of postoperative ventricular arrhythmias (p = 0.0007, RR = 2.45) emerged as risk factors. Multiple factors affect the early and late outcome after ascending aorta surgery; our data suggest that the preoperative clinical status of the patients and the priority of surgery and aortic dissection are the main determinants of the early results; on the other hand, the early postoperative course is the main determinant of the late outcome of hospital survivors.

Aortic Dissection↗
PubMedDate not supplied

Abdominal aortic aneurysm in chronic thoracic dissection. Report of two cases.

Two cases of lower abdominal aortic aneurysm in association with chronic thoracic dissections are reported. These infra-renal aortic aneurysms, superimposed on an abdominal extension of the dissection, always require surgical treatment because of their well known tendency to enlarge and rupture. The authors report their experience and discuss the management of this complication in chronic dissections treated surgically.

Adult↗
PubMedDate not supplied

Aortic dissection type A surgery: Doppler sonography to evaluate correct carotid artery perfusion during cardiopulmonary bypass.

In the surgery of acute aortic type A dissection we have employed preoperative and intraoperative Doppler sonography, to check safe and correct perfusion of the carotid arteries by the cardiopulmonary bypass before instituting cardiac arrest. Ten patients, operated upon for acute aortic type A dissection, were evaluated by means of Doppler sonography and in two patients a very abnormal flow pattern was found in the carotid arteries at the moment of aortic cross-clamping; immediate unclamping allowed temporary antegrade carotid perfusion, while the perfusion technique was readjusted. We report our experience with preoperative and intraoperative Doppler sonography, which appears to be a valuable new method of improving the surgical management of acute aortic type A dissection.

Acute Disease↗
PubMedDate not supplied

Extracranial carotid artery aneurysms. Report of two cases.

Two cases of extracranial carotid artery aneurysm are reported. Treatment of this uncommon but interesting vascular disorder is still under discussion even if the present tendency is to treat them actively, by reconstructive techniques. We present our surgical experience and discuss the diagnostic problems and management.

Aged↗
PubMedDate not supplied

[Retrospective study of the efficacy of aprotinin in heart valve surgery in adults].

Aprotinin effects on postoperative bleeding, redo operations due to excessive bleeding and postoperative blood products use have been retrospectively evaluated on a population of 894 consecutive patients operated upon between 1987 and 1991 for valvular surgery. In this period, aprotinin has been routinely used following the "High Dose" protocol starting from January 1990. To analyse results, all the patients considered (Group I) were divided into subgroups, following the heart valve operated upon, in "mitral" patients (391 patients, 43.7%, Group II), "aortic" patients (375 patients, 41.9%, Group III) and "mitro-aortic" patients (128 patients, 14.3%, Group IV). Each of these Groups has been subsequently split depending on whether or not they received aprotinin (Subgroups IA, IIA, IIIA, IVA with aprotinin, subgroups IB, IIB, IIIB, IVB without aprotinin). Considering the whole population (Group I), aprotinin determined a significant reduction of post-operative bleeding (499 +/- 634 ml Group IA versus 713 +/- 572 Group IB, p = 0.000), redo operations for bleeding (15/410, 3.7% Group IA versus 45/484, 9.3% Group IB, p = 0.0000) and consequently the percentage of patients exposed to blood products transfusion (37/410, 9% Group IA versus 163/484, 54.3% Group IB p = 0.0000). When the other Groups (II, III and IV) were considered, aprotinin determined a significant reduction of postoperative bleeding and of donor blood transfusions, while redo operations for bleeding, although less in total number, were not significantly reduced. Moreover, aprotinin has been effective in reducing postoperative blood losses, redo-operation for bleeding and blood use independently of the kind of oxygenator used: bubble vs hollow fibers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗