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Baldi E, Savastano S, Buratti S, Rordorf R, Vicentini A, Sanzo A, Petracci B, Demarchi A, Cornara S, Astuti M, Frigerio L, Marioni A, Oltrona Visconti L, De Ferrari GM. P5640How to decide to implant an ICD in out-of-hospital cardiac arrest survivors with bad neurological outcome. CPC is an option? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
According to the European Society of Cardiology guidelines secondary prevention ICD implantation is a class I indication only for those patients with an estimated survival >1 year with a good functional status. However, it is not specified how to assess the functional status and its evaluation could be quite difficult in the case of Out-of-Hospital Cardiac Arrest (OHCA) survivors. Cerebral Performance Category (CPC) scale is the most widespread scale to define the neurological and functional outcome, but it is not known if it can be used to guide ICD implantation.
Purpose
To evaluate whether the presence of a bad neurological outcome (CPC >2) in OHCA survivors at discharged could be used as a prognostic index in order to evaluate the implantation of an ICD.
Methods
We considered all the patients enrolled in the Cardiac Arrest Registry of our Province (55ehz746.0583 inhabitants in northern Italy) from the 1 October 2014 to the 31 January 2018 presenting a CPC >2 at discharge. We evaluated the survival and the neurological status variation at 1-year.
Results
In the study period CPR was attempted in 1565 confirmed OHCA (60.2% males, 73.4±15.8 years). Of these, 119 (7.6%) were discharged and 26 of them (21.8%) showed a CPC more than 2 (13 CPC = 3, 11 CPC = 4 and 2 CPC A). 1-year survival of CPC>2 patients was significantly lower than those with a CPC≤2 (46.1% vs 92.5% p<0.001). Only 12/26 patients discharged with a CPC >2 survived at 1 year; a good cerebral performance (CPC 1) was recovered in 2 of them, whilst a moderate cerebral disability (CPC 2) was present in 1 of them. A severe cerebral disability (CPC 3 or 4) persisted in the other 9 patients. The neurological prognosis of patients based on CPC at hospital discharge is presented in Figure 1.
Figure 1
Conclusions
Our results highlight that 1-year survival is quite low in patients with a CPC >2 at discharge and an improvement in cerebral performance occur in a minority of them. The prognosis of the patients was very variable and unpredictable for all the CPC scale values at hospital discharge. This evidence suggest that an ICD implantation should carefully evaluated in this kind of patients and a clinical and neurological re-evaluation can be reasonable some time after the event to decide if implant an ICD.
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - S Buratti
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - R Rordorf
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Vicentini
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Sanzo
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - B Petracci
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Demarchi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Cornara
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - M Astuti
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - L Frigerio
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - A Marioni
- Salvatore Maugeri Foundation IRCCS, Unità Risvegli, Pavia, Italy
| | - L Oltrona Visconti
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
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Bisciotti GN, Volpi P, Zini R, Auci A, Aprato A, Belli A, Bellistri G, Benelli P, Bona S, Bonaiuti D, Carimati G, Canata GL, Cassaghi G, Cerulli S, Delle Rose G, Di Benedetto P, Di Marzo F, Di Pietto F, Felicioni L, Ferrario L, Foglia A, Galli M, Gervasi E, Gia L, Giammattei C, Guglielmi A, Marioni A, Moretti B, Niccolai R, Orgiani N, Pantalone A, Parra F, Quaglia A, Respizzi F, Ricciotti L, Pereira Ruiz MT, Russo A, Sebastiani E, Tancredi G, Tosi F, Vuckovic Z. Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete. BMJ Open Sport Exerc Med 2016; 2:e000142. [PMID: 28890800 PMCID: PMC5566259 DOI: 10.1136/bmjsem-2016-000142] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/14/2022] Open
Abstract
The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.
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Affiliation(s)
- G N Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
| | - P Volpi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy.,FC Internazionale, Milan, Italy
| | - R Zini
- Azienda Ospedaliera "Ospedale San Salvatore", Pesaro, Italy
| | - A Auci
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | - A Belli
- FC Internazionale, Milan, Italy
| | | | | | - S Bona
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - D Bonaiuti
- Fisioclinic Centro Medico Polispecialistico, Pesaro, Italy
| | - G Carimati
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - G Cassaghi
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - S Cerulli
- Institute of Sports Medicine of Turin, Italy
| | - G Delle Rose
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Di Marzo
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - L Felicioni
- Ospedale della Misericordia, Grosseto, Italy
| | | | - A Foglia
- Studio di fisioterapia Riabilita, Pesaro, Italy
| | - M Galli
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - L Gia
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - A Guglielmi
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - A Marioni
- Azienda Policlinico Università di Bari, Bari, Italy
| | | | | | - N Orgiani
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Parra
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - A Quaglia
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - F Respizzi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - L Ricciotti
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | | | | | | | - F Tosi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Z Vuckovic
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
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Fornai M, Colucci R, Antonioli L, Ippolito C, Segnani C, Buccianti P, Marioni A, Chiarugi M, Villanacci V, Bassotti G, Blandizzi C, Bernardini N. Role of cyclooxygenase isoforms in the altered excitatory motor pathways of human colon with diverticular disease. Br J Pharmacol 2016; 171:3728-40. [PMID: 24758697 DOI: 10.1111/bph.12733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/14/2014] [Accepted: 04/10/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE The COX isoforms (COX-1, COX-2) regulate human gut motility, although their role under pathological conditions remains unclear. This study examines the effects of COX inhibitors on excitatory motility in colonic tissue from patients with diverticular disease (DD). EXPERIMENTAL APPROACH Longitudinal muscle preparations, from patients with DD or uncomplicated cancer (controls), were set up in organ baths and connected to isotonic transducers. Indomethacin (COX-1/COX-2 inhibitor), SC-560 (COX-1 inhibitor) or DFU (COX-2 inhibitor) were assayed on electrically evoked, neurogenic, cholinergic and tachykininergic contractions, or carbachol- and substance P (SP)-induced myogenic contractions. Distribution and expression of COX isoforms in the neuromuscular compartment were assessed by RT-PCR, Western blot and immunohistochemical analysis. KEY RESULTS In control preparations, neurogenic cholinergic contractions were enhanced by COX inhibitors, whereas tachykininergic responses were blunted. Carbachol-evoked contractions were increased by indomethacin or SC-560, but not DFU, whereas all inhibitors reduced SP-induced motor responses. In preparations from DD patients, COX inhibitors did not affect electrically evoked cholinergic contractions. Both indomethacin and DFU, but not SC-560, decreased tachykininergic responses. COX inhibitors did not modify carbachol-evoked motor responses, whereas they counteracted SP-induced contractions. COX-1 expression was decreased in myenteric neurons, whereas COX-2 was enhanced in glial cells and smooth muscle. CONCLUSIONS AND IMPLICATIONS In control colon, COX-1 and COX-2 down-regulate cholinergic motility, whereas both isoforms enhance tachykininergic motor activity. In the presence of DD, there is a loss of modulation by both COX isoforms on the cholinergic system, whereas COX-2 displays an enhanced facilitatory control on tachykininergic contractile activity.
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Affiliation(s)
- M Fornai
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Alves A, Gritsch K, Villle V, Drevon-Gaillotl E, Bayon Y, Clermont G, Boutrand JP, Grosgogea B, Cox T, Huntington C, Blair L, Prasad T, Augenstein V, Heniford BT, Lalán JG, Vázquez LL, Di Marzo F, Ipponi PL, Marioni A, Felicioni L, Pieralli F, Sergi A, Forni S, Darienzo S, Vannucci A, Reinpold W, Samartsev VA, Gavrilov VA, Parshakov AA, Chistyakova DM, Sidorenko AY, Dietz U, Kyle-Leinhase I, Muysoms F, Asti E, Sironi A, Bonavina L, Rogmark P. Abdominal Wall: Register & Miscellaneous. Hernia 2015; 19 Suppl 1:S139-43. [PMID: 26518791 DOI: 10.1007/bf03355341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Alves
- NAMSA, Chasse Sur Rhone, France
| | - K Gritsch
- Laboratoire des Multimateriaux et Interfaces UMR CNRS 5615, Université Lyon, Lyon, France
| | | | | | - Y Bayon
- Covidien Sofradim Production, Trevoux, France
| | | | | | | | - T Cox
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - C Huntington
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - L Blair
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - T Prasad
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - V Augenstein
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | - B T Heniford
- Department of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, USA
| | | | - L Luna Vázquez
- Hospital Universitario Ambrosio Grillo Portuondo, Santiago de Cuba, Cuba
| | - F Di Marzo
- General Surgery Dept., Pontremoli Hospital, Pontremoli, Italy
| | - P L Ipponi
- General Surgery Dept., San Giovanni di Dio Hospital, Florence, Italy
| | - A Marioni
- DAI Gastroent-Infect disease, Az. Osp-Universitaria, Pisa, Italy
| | | | - F Pieralli
- Hygiene and Preventive Medicine, Univ. Florence, Florence, Italy
| | - A Sergi
- Regional Health Agency, Florence, Italy
| | - S Forni
- Regional Health Agency, Florence, Italy
| | | | | | - W Reinpold
- Gross Sand Hospital Hamburg, Hamburg, Germany
| | - V A Samartsev
- Perm State Medical University named after ac. E.A. Wagner, Perm, Russia
| | - V A Gavrilov
- Perm State Medical University named after ac. E.A. Wagner, Perm, Russia
| | - A A Parshakov
- Perm State Medical University named after ac. E.A. Wagner, Perm, Russia
| | - D M Chistyakova
- Perm State Medical University named after ac. E.A. Wagner, Perm, Russia
| | - A Y Sidorenko
- Perm State Medical University named after ac. E.A. Wagner, Perm, Russia
| | - U Dietz
- University of Wuerzburg, Wuerzburg, Germany
| | | | | | - E Asti
- IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - A Sironi
- IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - L Bonavina
- IRCCS Policlinico San Donato, San Donato, Milanese, Italy
| | - P Rogmark
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
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Fornai M, Antonioli L, Colucci R, Ghisu N, Buccianti P, Marioni A, Chiarugi M, Tuccori M, Blandizzi C, Del Tacca M. A1 and A2a receptors mediate inhibitory effects of adenosine on the motor activity of human colon. Neurogastroenterol Motil 2009; 21:451-66. [PMID: 19019012 DOI: 10.1111/j.1365-2982.2008.01213.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Experimental evidence in animal models suggests that adenosine is involved in the regulation of digestive functions. This study examines the influence of adenosine on the contractile activity of human colon. Reverse transcription-polymerase chain reaction revealed A(1) and A(2a) receptor expression in colonic neuromuscular layers. Circular muscle preparations were connected to isotonic transducers to determine the effects of 8-cyclopentyl-1,3-dipropylxanthine (DPCPX; A(1) receptor antagonist), ZM 241385 (A(2a) receptor antagonist), CCPA (A(1) receptor agonist) and 2-[(p-2-carboxyethyl)-phenethylamino]-5'-N-ethyl-carboxamide-adenosine (CGS 21680; A(2a) receptor agonist) on motor responses evoked by electrical stimulation or carbachol. Electrically evoked contractions were enhanced by DPCPX and ZM 241385, and reduced by CCPA and CGS 21680. Similar effects were observed when colonic preparations were incubated with guanethidine (noradrenergic blocker), L-732,138, GR-159897 and SB-218795 (NK receptor antagonists). However, in the presence of guanethidine, NK receptor antagonists and N(omega)-propyl-L-arginine (NPA; neuronal nitric oxide synthase inhibitor), the effects of DPCPX and CCPA were still evident, while those of ZM 241385 and CGS 21680 no longer occurred. Carbachol-induced contractions were unaffected by A(2a) receptor ligands, but they were enhanced or reduced by DPCPX and CCPA, respectively. When colonic preparations were incubated with guanethidine, NK antagonists and atropine, electrically induced relaxations were partly reduced by ZM 241385 or NPA, but unaffected by DPCPX. Dipyridamole or application of exogenous adenosine reduced electrically and carbachol-evoked contractions, whereas adenosine deaminase enhanced such motor responses. In conclusion, adenosine exerts an inhibitory control on human colonic motility. A(1) receptors mediate direct modulating actions on smooth muscle, whereas A(2a) receptors operate through inhibitory nitrergic nerve pathways.
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Affiliation(s)
- M Fornai
- Division of Pharmacology and Chemotherapy, Department of Internal Medicine, University of Pisa, Pisa, Italy
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Ricotti S, Petrucci L, Carenzio G, Marioni A, Klersy C, Calcaterra V, Larizza D. [Spinal defects in Turner's syndrome]. Minerva Pediatr 2001; 53:481-2. [PMID: 11668279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- S Ricotti
- IRCCS Policlinico S. Matteo, Servizio di Recupero e Rieducazione Funzionale, Università degli Studi, Pavia, Italy
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7
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Ceragioli T, Nervi M, Marrucci G, Marioni A, Giuliani L. [Colorectal carcinoma in the elderly. Assessment of prognostic factors]. MINERVA CHIR 1995; 50:185-9. [PMID: 7659251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Between 1976 and December 1992 a total of 80 patients aged 80 or over underwent surgery for colorectal cancer at the Surgical Clinic of Pisa University. Twelve patients died, 18 presented non-lethal complications and 48 had a normal postoperative recovery. The type of surgery did not appear to be correlated with mortality. Urgency, associated with the advanced stage of cancer (according to Duke's classification modified by Aster-Coller), was the factor which most severely influenced mortality. A marked prognostic improvement can be obtained by an early diagnosis and careful evaluation of the patient's overall conditions.
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Affiliation(s)
- T Ceragioli
- Istituto di Clinica Chirurgica Generale, Università degli Studi, Pisa
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8
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Nervi M, Marioni A, Ceragioli T, Pelosini M, Marrucci G, Giulliani L. [Importance of endoscopic follow-up in the diagnosis of metachronous colorectal cancer]. MINERVA CHIR 1995; 50:23-7. [PMID: 7617256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Between 1976 and December 1992 a total of 748 patients with colorectal cancer were observed at the Surgical Clinic of Pisa University; in 9 of these a second colorectal tumour appeared between 30 months and 18 years after the original tumor. Coloscopy is the treatment of choice for evaluating the colon operated due to cancer since it allows an early diagnosis of any metachronous tumours, reveals synchronous tumours which have been overlooked prior to the operation and performs a therapeutic and prophylactic function in terms of the endoscopic removal of adenomatous polyps which have appeared in the meantime.
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Affiliation(s)
- M Nervi
- Clinica Chirurgica Generale, Università degli Studi, Pisa
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9
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Casadio M, Marioni A, Melotti B, Ramini R, Pannuti F. Cisplatinum (CDDP) and etoposide (VP16) in “poor risk” small cell lung carcinoma (SCLCA). Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91496-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Marioni A, Castelletti I, Gagliardi M, Destefanis S, Martello A. [Cerebral hemorrhage in pregnancy]. Minerva Anestesiol 1991; 57:1765-73. [PMID: 1795843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Marioni
- Servizio di Anestesia e Rianimazione, Ospedale Ostetrico e Ginecologico Sant'Anna, Torino
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11
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Margaria E, Notario PL, Marioni A. [Intensive postoperative treatment in obstetrics and gynecology: proposal for a score system for medico-surgical assessment of the abdominal surgery patient]. Minerva Anestesiol 1980; 46:607-15. [PMID: 7219747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
It is often necessary in routine clinical practice to take a decision on therapeutic conduct regarding patients with abdominal type postoperative complications. A score system has been devised which increases with the gravity of objective findings and the laboratory data most frequently observed in this pathology. The theoretical score is applied a posteriori to 12 serious cases of abdominal surgery. The values suggest an appropriate therapeutic approach: in effect, a score of less than 50 would point to wait-and-see medical treatment, not to be prolonged beyond 72 hours; values higher than 50 point to medical treatment preparatory to indispensable surgery.
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12
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Margaria E, Palieri Furlan L, Marioni A, Magro M, Lovera C. [Endogenous intoxications of pregnancy: jaundice of pregnancy]. Minerva Anestesiol 1979; 45:109-15. [PMID: 95211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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