Biomedical subjects

R Valeri

Publications and source records attributed to R Valeri.

21 records · Page 2Linked to original sources

PubMedDate not supplied

Excimer laser lamellar keratoplasty of augmented thickness for keratoconus.

PURPOSE: We describe a modified surgical technique for the treatment of patients in the early stage of keratoconus, when it is still possible to correct the astigmatic ametropia with contact lenses. METHODS: Excimer laser lamellar keratoplasty of augmented thickness (ELLKAT) is a procedure in which a deep plano excimer laser ablation is done on the host cornea and a donor lamellar button--with or without an excimer laser refractive ablation on the posterior surface--is sutured into the recipient bed. In 12 of 20 eyes, the homoplastic button, which had parallel faces and was devoid of any dioptric power, was treated refractively on its stromal face with a Chiron Keracor 116 excimer laser to correct the axial and/or induced myopia present due to the weakened cornea. RESULTS: The 8 eyes that received donor buttons without excimer laser ablation had improved spectacle-corrected visual acuity from a mean preoperative value of 20/100 (no eye saw 20/40 or better before surgery) to a mean postoperative value of 20/30 after 18 months. Mean refractive astigmatism was reduced from 4.84 +/- 2.34 D to 1.00 +/- 0.46 D. Mean keratometric power was reduced from 56.75 +/- 8.01 D to 44.21 +/- 2.12 D. The associated mean spherical equivalent refraction was reduced from -4.75 to -3.00 D. Mean corneal thickness increased from 422.25 +/- 83 microns preoperatively to 562.87 +/- 57.81 microns postoperatively. The 12 eyes that received donor lamellar buttons treated with excimer laser also had improved spectacle-corrected visual acuity from a mean preoperative value of 20/100 to a mean postoperative value of 20/30 after 18 months. Astigmatism was reduced from a mean 4.84 +/- 2.77 D to 1.66 +/- 1.30 D; mean keratometric power was reduced from 56.08 +/- 7.00 D to 45.31 +/- 2.08 D; and the associated mean spherical equivalent refraction was reduced from -8.75 to -1.75 D. Corneal thickness increased from a mean 414.25 +/- 64.75 microns preoperatively to 576.75 +/- 28.23 microns postoperatively. CONCLUSION: Compared to penetrating keratoplasty, excimer laser lamellar keratoplasty of augmented thickness for keratoconus has the advantage of preserving the host endothelium and of reducing the refractive error in keratoconus.

Adult↗

PubMedDate not supplied

[Laparoscopic approach versus laparotomy for suspected acute appendicitis].

Acute appendicitis is one of the most common surgical disease but, in spite of the progression diagnostic imaging, a definite diagnosis is frequently difficult and often is based in essentially clinical grounds. The Authors retrospectively analyze the results of conventional laparotomic appendectomy (CLA) and videolaparascopic appendectomy (VLA) as performed by two teams of their Department of Surgery. Between January 2000 and November 2001, 156 patients, age ranging from 3 to 67 yrs, underwent surgery because suspected acute appendicitis; 96 patients underwent VLA and 60 patients underwent CLA; a diagnosis of acute appendicitis was confirmed in 142 cases (91%). The patients who had a confirmed diagnosis of acute appendicitis were grouped according to clinical-pathologic criteria into follicular, gangrenous and complicated appendicitisi; operating time, complications and length of hospital stay were compared among the three groups. VLA resulted superior to CLA in terms of diagnostic performance: among the patients with suspected acute appendicitis, VLA allowed to establish a different diagnosis in 41% as compared to 13% with CLA. In two cases (2.08%) VLA was turned into CLA. There were non differences between VLA and CLA in terms of surgical operating time and hospital stay. A significantly higher incidence of surgical complications, such as wound infections and pelvic abscesses, was observed in the CLA group as compared to VLA. The Authors conclude that VLA allows a complete exploration of the abdomen, a better localization of the appendix and an easier diagnosis of unexpected conditions or pathologic processes associated with the clinical appendicitis; further, VLA is gravated by fewer complications.

Acute Disease↗

PubMedDate not supplied

Catabolic response and parenteral nutrition after simultaneous kidney-pancreas transplantation.

The aim of the study was to quantify the catabolism rate induced by simultaneous kidney-pancreas transplantation and to evaluate the impact of parenteral nutrition (PN) on recovery of graft function. Twenty-six diabetic uremic patients were studied. The average urea nitrogen production (UNP) was 5.2 +/- 1.7 g during the first 24 h after transplantation, while patients did not receive energy and nitrogen support. Energy (30 kcal.kg-1.day-1) and nitrogen (0.15 g.kg-1.day-1) intake started 24 h after surgery. In 14 patients, a mixed regimen was adopted (70% carbohydrates, 30% lipids), and 12 patients received only hypertonic glycidic solutions. The recovery of kidney function was immediate in all cases, with a prompt decrease in blood urea nitrogen and serum creatinine levels. C-peptide levels rose immediately after the revascularization of the pancreas graft and remained within the normal range during the PN period. No significant difference was observed in UNP or glucose tolerance between the mixed-regimen and glycidic groups. However, on average 6.6, and 1.5 hyperglycemic episodes occurred during the 1st wk of PN in the glycidic and mixed-regimen groups, respectively. The posttransplantation catabolism rate was similar to that induced by an elective major surgical procedure. Eucaloric PN did not affect the recovery of kidney and pancreas graft function. A mixed energy regimen seems to be most suitable for kidney-pancreas transplant patients because it prevents hyperglycemia which might be misdiagnosed as rejection.

Adult↗