A cluster of drug-resistant Streptococcus pneumoniae among nursing home patients.
Explore the source record for details and available documents.
Bacterial Vaccines↗
Biomedical subjects
S Conte
Publications and source records attributed to S Conte.
Technique to repair tetralogy of Fallot with absent pulmonary valve.
The syndrome of tetralogy of Fallot with absent pulmonary valve is characterized by aneurysmal dilatation of the pulmonary arteries causing tracheobronchial obstruction of varying degree. Relief of this obstruction is the main goal of the surgical repair and can best be achieved by appropriate pulmonary arterioplasty. We describe our current technique to repair this syndrome in infants and older children including pulmonary arterioplasty, ventricular septal defect closure, and right ventricular outflow tract reconstruction without valve insertion.
Aneurysm↗
One-stage repair of truncus arteriosus, CAVC, and TAPVC.
An infant with truncus arteriosus, complete atrioventricular canal, and total anomalous pulmonary venous connection successfully underwent one-stage complete repair. Residual mitral valve regurgitation required reoperation after 12 days. The patient is doing well at 6 months' follow-up. Echocardiography demonstrates no residual defects, competent atrioventricular valves, and normal pulmonary pressure. This case illustrates the potential for successful one-stage repair even of associated complex heart defects involving venous, intracardiac, and arterial pathways.
Abnormalities, Multiple↗
Successful repair of thoracic aortic aneurysm in a child with Ehlers-Danlos syndrome.
Explore the source record for details and available documents.
Aortic Aneurysm, Thoracic↗
Early experience with the Norwood procedure.
The improved results of the Norwood procedure have recently stimulated its widespread adoption in many centres. Since 1993, 19 infants with hypoplastic left heart syndrome or similar conditions underwent a first-stage Norwood procedure. Circulatory arrest time was significantly reduced by using a modified repair of the aortic arch. The early mortality rate was 31.5% (n = 6). The addition of CO2 to the inspired gas mixture resulted in less early postoperative instability. Nine patients have subsequently undergone bidirectional cavopulmonary shunt and one fenestrated total cavopulmonary connection. Overall there have been five late deaths, two as result of failure of cavopulmonary operations. All the eight survivors are presently in good condition. One is awaiting bidirectional cavopulmonary shunt and the other seven total cavopulmonary connection. This early experience encourages the continued offering of the Norwood procedure to patients with hypoplastic left heart syndrome or its variants. Increasing experience with the perioperative care and a more careful evaluation before cavopulmonary operations may determine further improvement in the outcome.
Aorta, Thoracic↗
Is the arterial switch operation still a challenge in small centers?
OBJECTIVE: In the last years, major changes as regards timing for operation, surgical technique, and perioperative care determined a great improvement in the arterial switch operation (ASO) allowing excellent mid-term results in a few leading centers. This stimulated the widespread adoption of ASO as procedure of choice for transposition of the great arteries (TGA), even in small institutions. We reviewed our early experience with ASO in an attempt to evaluate its safety in a small center. METHODS: Since April 1992, 39 consecutive patients underwent TGA repair by ASO in our department. There were 27 patients with simple TGA, 8 with TGA and VSD and 4 with Taussig-Bing heart and aortic coarctation. Median age and weight at operation were 7 days and 3.5 kg, respectively. Neonatal repair was performed in 34 patients. In accordance with the Planché coronary classification, type I was encountered in 21 patients, type II in 4 and type III in 14. Several modifications of the original technique were used, mainly regarding coronary relocation, pulmonary artery reconstruction and approaches for associated VSD closure and aortic arch repair. RESULTS: Early mortality was 2.6% (n = 1), the only operative death being related to unsatisfactory coronary relocation. Since modified ultrafiltration was adopted, mean ICU stay decreased from 5 +/- 4 days (n = 21) to 2 +/- 1 days (n = 17) (P < 0.05). Three patients required reoperation for residual ASD and/or VSD closure. There were no late deaths. After a mean follow-up of 26 +/- 15 months all survivors are thriving and are currently asymptomatic. CONCLUSIONS: Although this series is rather small, most of the major coronary anomalies and complex anatomic associations were encountered. This experience suggests that neonatal repair of TGA by ASO can be safely accomplished even in small centers. Modified ultrafiltration appears to improve the early outcome of neonates undergoing ASO.
Cause of Death↗
Double-homograft repair of truncus arteriosus with severe truncal valve dysfunction.
An infant with truncus arteriosus and severe dysfunction of the truncal valve including both stenosis and insufficiency successfully underwent primary repair. This included the insertion of two separate valved homograft conduits. Early outcome has been excellent and the patient is doing well after 6 months with only echocardiographic evidence of mild aortic valve regurgitation. Double-homograft repair is a realistic option in cases of truncus arteriosus with severe malformation of the truncal valve.
Echocardiography, Doppler↗
Absent pulmonary valve syndrome: surgical treatment and considerations.
BACKGROUND: The operative management of absent pulmonary valve syndrome remains controversial regarding the need for pulmonary valve implantation and remodeling of pulmonary arteries. Moreover, symptomatic infants are considered to have a poor prognosis. This retrospective report summarizes the experience of a single institution. METHODS: Between May 1977 and May 1995, 37 consecutive patients underwent repair of absent pulmonary valve syndrome. Patients were divided into two groups according to age at operation: group A (10 infants less than 1 year old) and group B (27 patients older than 1 year). Mean age at operation was 5 +/- 4 months in group A and 72 +/- 42 months in group B. Initially, repair consisted of ventricular septal defect closure and relief of right ventricular outflow tract obstruction combined with pulmonary valve implantation. More recently, the concept of treatment has evolved with pulmonary arterioplasty without pulmonary valve insertion, except in patients with elevated pulmonary artery pressure. RESULTS: Of the 37 patients, 34 had successful repair. The overall in-hospital mortality rate was 8% (two deaths in group A and one in group B). No hemodynamic data were correlated with operative death. Death was associated with longer extracorporeal circulation time (p = 0.005) and longer aortic cross-clamping time (p = 0.019). In fact, these were clearly related to more complex anatomy (p = 0.001): multiple ventricular septal defects in 1, left pulmonary artery arising from the ductus in another, and left pulmonary artery arising from the aorta in the remainder. Follow-up was available in 22 of the 34 survivors. Mean follow-up time was 30 +/- 47 months in group A and 38 +/- 33 months in group B. All but 1 had no restriction of exercise, and most of them had pulmonary incompetence of Doppler echocardiography. One developed severe exercise intolerance because of pulmonary valve stenosis (xenograft), leading to uneventful reoperation 123 months after initial repair. One infant died suddenly of complete atrioventricular block 3 months after repair. The late mortality rate was 5%. CONCLUSIONS: Surgical treatment of absent pulmonary valve syndrome should include pulmonary arterioplasty to reduce bronchial obstruction, with no need for pulmonary valve insertion. This procedure is feasible and is recommended especially in markedly symptomatic infants.
Case-Control Studies↗
[Gastric carcinoid. A clinical case and review of the literature].
INTRODUCTION: Endoscopic examination of the gastrointestinal tract is very useful, because it allows a rapid diagnosis and, in some cases, a therapeutical effect. CLINICAL CASE: The authors have seen a woman, 72 years old, with epigastric pain, dryness of the mouth, diarrhoea and meteorism. She had an old simple gastritis (of two years standing) and her therapy, since the time of the diagnosis, is omeprazole (20 mg/die). The patient was submitted to gastroscopic examination that revealed two spot lesions and a polypous lesion on which was made a biopsy. The patient was submitted also to the following examination: 1) urinary dosage of 5 HIAA; 2) urinary dosage of 5 OHT; 3) Computed tomography of the abdomen; 4) Heart echography; 5) Endoscopy of the colon; 6) Endoscopy of the bronchus. DISCUSSION: Carcinoid tumors are usually small and rare lesions and they are in the following sites: A) between mouth and the second part of duodenum; B) between the second part of the duodenum and the transverse segment of the colon; C) between the latter and the anus. CLINICAL PICTURE: Patients are usually 50-60 years old, with other neoplasm. The picture is marked by flushing, diarrhoea, abdominal cramp and disease of the right heart valve. DIAGNOSIS: Diagnosis is based on urinary dosage of 5-HIAA (n.v. > 10 mg/24 h.) that is higher than the normal value. Computed tomography and echography are useful. THERAPY: The small neoplasm are treated by local surgical resection, while the biggest tumors have been treated by pharmacological therapy with useless results.
5-Hydroxytryptophan↗
Systemic obstruction in univentricular hearts: surgical options for neonates.
BACKGROUND: The surgical management for bridging patients with univentricular heart and systemic obstruction to a Fontan procedure remains controversial. METHODS: Twenty-seven of 96 patients with univentricular heart and unobstructed pulmonary blood flow referred for surgical palliation were seen with systemic obstruction. Twenty-six were neonates with coarctation of the aorta in 21 and subaortic stenosis in 5. In 8 other patients, subaortic stenosis developed after initial pulmonary artery banding. Four different palliative procedures were performed: coarctation repair with pulmonary artery banding (group I, n = 15); Norwood or Damus-Kaye-Stansel or arterial switch operation (group II, n = 9); coarctation repair with pulmonary artery banding and bulboventricular foramen enlargement (group III, n = 2); and orthotopic heart transplantation with coarctation repair (group IV, n = 1). RESULTS: The mortality rate was 34.3% (n = 12) for all patients, 53.3% in group I, 33.3% in group II (p = 0.003 versus group I), and 50% in group III. Nine patients (8 in group I and 1 in group II) had development of subaortic stenosis and underwent a subsequent procedure: Damus-Kaye-Stansel operation in 5, arterial switch operation in 3, and bulboventricular foramen enlargement in 1. Three had a concomitant or subsequent Fontan procedure and 2, a bidirectional Glenn procedure. In group II, 1 patient underwent a subsequent Fontan procedure and another, a bidirectional Glenn anastomosis. Six of the 8 patients with subaortic stenosis after initial pulmonary artery banding underwent a second stage consisting of a Damus-Kaye-Stansel procedure (n = 3), bulboventricular foramen enlargement (n = 2), or creation of an aortopulmonary window (n = 1). Three had a concomitant Fontan procedure and 2, a bidirectional Glenn procedure. Actuarial 4-year survival was 65.5% +/- 8.4% (70% confidence limits) for all patients; it was 40% +/- 13.3% in group I and 66.6% +/- 16.3% in group II (p < 0.05). CONCLUSIONS: Initial management of patients with univentricular heart and systemic obstruction by Norwood-like procedures provides a better outcome. Success of the Fontan operation relies on the ability to provide timely relief of subaortic stenosis.
Aortic Coarctation↗
Ultradian rhythms in the N1-P2 amplitude of the visual evoked potential in two inbred strains of mice: DBA/2J and C57BL/6.
Ultradian rhythmicity has been showed in many behavioural parameters in animals as well as in humans. We investigated the existence of a Basic Rest-Activity Cycle (BRAC) rhythm in amplitude fluctuations of mice's visual evoked potential (VEP) primary component. Two inbred strains of mice, C57BL/6 and DBA/2J, were used to verify the influence of genetics on biological rhythm as well. Results revealed the existence of an evident rhythm in the parameter under study and confirm previous reports of a 20 min. BRAC in avoidance behavior in DBA mice. This rhythm shows similar period within each strain, but significatively different periods between strains. Observed periods are near to species-specific reported BRAC cycle. Genetic hypothesys is suggested to explain differences between strains in expression of ultradian rhythm.
Animals↗
Ultradian rhythms of reaction times in performance in vigilance tasks.
This study examined the presence of rhythmic fluctuations in vigilance tasks. The hypothesis was that individual attentional performance is subject to rhythmic variation beyond a linear decrease over time. In the first study the reaction times to an acoustic stimulus were recorded. The analysis of the individual periodograms indicated a rhythm in attentional capacity with periods ranging from 5 to 30 min. These findings indicate that considerable individual variation can be accounted for by considering individual periodicity in performance. Although marked individual differences between subjects are present, the rhythmic fluctuations are stable within each subject and between experimental sessions.
Activity Cycles↗
Surgical management of neonatal coarctation.
Between 1983 and 1994, 307 consecutive neonates underwent coarctation repair by a single surgical technique: extended end-to-end anastomosis. Mean age at operation was 13 +/- 8 days. Isolated coarctation was present in 95 patients (group 1), 102 patients had associated ventricular septal defect (group 2), and 110 patients had associated complex intracardiac lesions (group 3). Aortic arch hypoplasia was present in 81% of the patients (62% in group 1 versus 85% in group 2 and 93% in group 3: p < 0.001). In 271 patients, the aortic arch reconstruction was performed via a left thoracotomy with normothermia (100% of group 1, 95% of group 2, and 72% of group 3); in the other 36 patients, undergoing one-stage repair or palliation of the associated lesion, it was performed via a midline sternotomy during a short period of deep hypothermia and circulatory arrest (5% of group 2 and 28% of group 3). Pulmonary artery banding was performed in 94 patients. Spontaneous ventricular septal defect closure was observed in 39% of the patients of group 2 operated on via thoracotomy. Early mortality rates in groups 1 (2%) and 2 (2%) were significantly lower than in group 3 (17%) (p < 0.001). There were 29 late deaths, all related to associated cardiac lesions or their subsequent repair. The overall total mortality was 16.9%. In group 3 this rate was significantly higher in patients undergoing two-stage procedures (47%) than in those undergoing one-stage repair (23%) (p < 0.05). All but 14 survivors were followed up for a mean of 61 +/- 36 months. Actuarial survivals at 10 years were 98% in group 1, 94% in group 2, and 60% in group 3. The recoarctation rate was 9.8%, leading to 21 reoperations and three angioplasties without mortality. Patients with a more extended or severe form of aortic arch hypoplasia had a significantly higher risk of recoarctation (p < 0.001). Actuarial freedom from reoperation for recoarctation at 10 years was 93%. The findings of this study suggest that extended end-to-end anastomosis provides an adequate and safe repair of neonatal coarctation. Low recoarctation rate, owing to effective relief of the obstruction created by aortic arch hypoplasia and to complete resection of ductal tissue, freedom from major morbidity, and feasibility via both lateral and anterior approaches are the main advantages of the extended end-to-end anastomosis.(ABSTRACT TRUNCATED AT 400 WORDS)
Aortic Coarctation↗
Rhythmic variations in reaction times and evoked potentials.
The present work aimed to assess the existence of a regular ultradian cyclicity underlying the variations in amplitude of the N1-P2 component of acoustic EP during a relatively long recording session and investigate its relationship with behavioral measure as RT to the same stimulus. 128 tones were presented to each subject; 128 RTs and the associated EPs to target stimuli were recorded. N1-P2 amplitude has been measured at a single trial level through Woody adaptive filter modified by Wastell. Results showed that there are ultradian rhythmic variations of N1-P2 and RT, with a periodicity from about 5 to 40 min and these variations have similar patterns in the two measures in most of the subjects.
Activity Cycles↗
Ultradian rhythms in avoidance behavior of DBA mice.
This study investigates ultradian rhythm in avoidance behavior of mice, which may constitute a basic rest activity cycle (BRAC). Reaction times (RTs) of an avoidance response to a visual warning stimulus that preceded an electric shock were measured by the use of a computer-controlled shuttle box. The male naive DBA mice were brought to a criterion of 98% correct responses in numerous training sessions. For each subject, all the temporal sequences of the RTs in the trials following achievement of the criterion were examined with discrete Fourier transform. Periodograms were obtained from three sessions for each of the two animals in the first experiment and from 15 subjects in the second experiment. Analysis of the periodograms reveals a stable rhythm in avoidance behavior of mice, with a period of about 14 min. The presence of these periodicities could show the existence, also in small rodents, of a BRAC rhythm.
Activity Cycles↗
Event-related potentials and recognition memory: the effects of word imagery value.
Event-related potentials (ERPs) were recorded from 11 subjects during a recognition memory task. Subjects were auditorily presented with 160 target words and, after about 10 min, they were engaged in a recognition task. Subjects were required to determine on each of 320 trials if the word was 'new' (never before presented) or 'old' (heard previously). In the recognition test, 160 target words and 160 non-target words were used as stimuli. To assess the effect of word imagery value, 160 stimuli (80 target and 80 non-target) were high imagery words (HI) and the remaining 160 stimuli were low imagery words (LI). Word frequency was balanced across target and non-target words. Results showed that the old/new effect was reflected by a negative component (belonging to the N400 family, Cz maximum) which was larger for new words in the 400-700 ms range. The imagery effect was also present in the 250-550 ms range of the N400, which was larger for HI stimuli. The imagery effect was present at 400-550 ms only for target words. These results confirmed the hypothesis that negative components as N400, could reflect processes occurring during the memory retrieval of items.
Adult↗
Amodal completion in mouse vision.
The question of whether phenomena of human perception such as amodal completion are also present in visual perception in the mouse was investigated. Three experiments based on a simultaneous-discrimination task were carried out with the aid of a jumping-stand similar to the one used by Lashley. The subjects were 36 male mice (DBA/J); 12 took part in each experiment. After reaching the learning criterion (87% correct responses), the mice performed 15 test trials which were interpolated between the learning trials. The test trials were constructed so as to allow the observation of any perceptual phenomena similar to amodal perception. Of the 36 subjects, 23 reached the criterion necessary to access the test phase. A significant number of them (17 out of 23, chi 2 = 5.261, p = 0.021) adopted a decisional strategy that seemed to indicate the occurrence of phenomena similar to amodal completion, and a trend in the same direction was observed in the performance of the other 6 subjects. The results allow the conclusion that a perceptual phenomenon which is similar to amodal completion in humans is present even at this phylogenetic level. Alternative interpretations are discussed.
Animals↗
Event-related potentials and recognition memory within the 'levels of processing' framework.
Event-related potentials (ERPs) were recorded from nine subjects during an incidental memory paradigm. During the study phase subjects were engaged in two tasks requiring semantic and rhyming decisions. During the test phase, subjects were required to decide on each of 320 trials if the word was 'new' (never before presented) or 'old' (seen previously). Results showed that semantic old words were more often recognized than rhyming ones. ERPs to new words were more negative than ERPs to old words in the 400-800 latency range. ERPs to semantic old words were more positive than ERPs to rhyming ones in the same latency range. The difference between ERPs to semantic and rhyming old words confirms a relationship between ERPs and memory.
Adult↗