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排序方式: 共有125条查询结果,搜索用时 15 毫秒
1.
Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy 总被引:2,自引:1,他引:1
Fabio Minicucci †Giancarlo Muscas ‡Emilio Perucca §Giuseppe Capovilla Federico Vigevano ¶Paolo Tinuper 《Epilepsia》2006,47(S5):9-15
Summary: Status epilepticus (SE) is a medical emergency which can lead to significant morbidity and mortality and requires prompt diagnosis and treatment. SE is differentiated into generalized or partial SE on the basis of its electro-clinical manifestations. The guidelines for the management of SE produced by the Italian League against Epilepsy also distinguish three different stages of SE (initial, established and refractory), based on time elapsed since the onset of the condition and responsiveness to previously administered drugs. Treatment should be started as soon as possible, particularly in generalized convulsive SE, and should include general support measures, drugs to suppress epileptic activity and, whenever possible, treatments aimed at relieving the underlying (causative) condition. Benzodiazepines are the first line antiepileptic agents, and i.v. lorazepam is generally preferred because it is associated with a lower risk of early relapses. If benzodiazepines fail to control seizures, i.v. phenytoin is usually indicated, though i.v. phenobarbital or i.v. valproate may also be considered. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. In refractory SE, general anesthesia may be required. Propofol and thiopental represent first line agents in this setting, after careful assessment of potential risks and benefits. 相似文献
2.
Capovilla Giovanni Moletta Lucia Pierobon Elisa Sefora Salvador Renato Provenzano Luca Zanchettin Gianpietro Costantini Mario Merigliano Stefano Valmasoni Michele 《Annals of surgical oncology》2021,28(3):476-476
Annals of Surgical Oncology - 相似文献
3.
Capovilla M Lazure T Lorand I Carton E Rocher L Pelletier G Cucherousset J Bedossa P 《Gastroentérologie clinique et biologique》2005,29(1):79-81
Amputation neuroma of the common bile duct after surgery is a rare and mostly asymptomatic lesion. A 60-year old patient presented with obstructive jaundice three months after a cholecystectomy for symptomatic gallstones. Imaging investigations showed common extrahepatic bile duct stenosis. Surgical resection of the stricture with biliodigestive anastomosis was performed. Histological examination of the surgical specimen revealed an amputation neuroma. Despite its rarity, amputation neuroma of the common bile duct should be considered in patients with post-cholecystectomy syndrome following liver or extrahepatic bile duct surgical procedures. 相似文献
4.
Renato Salvador Mario Costantini Francesco Cavallin Lisa Zanatta Elena Finotti Cristina Longo Loredana Nicoletti Giovanni Capovilla Romeo Bardini Giovanni Zaninotto 《Journal of gastrointestinal surgery》2014,18(1):106-112
Introduction
Laparoscopic Heller-Dor surgery is the current treatment of choice for patients with esophageal achalasia, but elderly patients are generally referred for less invasive treatments (pneumatic dilations or botulinum toxin injections).Aim
To assess the effect of age on the surgical outcome of patients receiving laparoscopic Heller-Dor as primary treatment.Methods
Demographic and clinical findings were prospectively collected on patients undergoing laparoscopic Heller-Dor from 1992 to 2012. Patients were classified in three age brackets: group A (≤45 years), group B (45–70), and group C (≥70). Treatment was defined as a failure if the postoperative symptom score was >10th percentile of the preoperative score (i.e., >8). We consecutively performed the Heller-Dor in 571 achalasia patients, 305 (53.4 %) in group A, 226 (39.6 %) in group B, and 40 (7 %) in group C.Results
The mortality was nil; the conversion and morbidity rates were both 1.1 %. Group C patients had higher preoperative symptom scores (p?=?0.02), while the symptom duration was similar in all three groups. Mucosal tears occurred in 17 patients (3 %): 6 (2 %) in group A, 8 (3.5 %) in group B, and 3 (7.5 %) in group C (p?=?0.09). The postoperative hospital stay was slightly longer for group C (p?=?0.06).Discussion
The treatment failure rate was quite similar: 31 failures in group A (10.1 %), 19 in group B (8.4 %), and 3 in group C (7.5 %; p?=?0.80). These failures were seen more in manometric pattern III (22.2 %, p?=?0.002). Laparoscopic Heller-Dor can be used as the first therapeutic approach to achalasia even in elderly patients with an acceptable surgical risk. 相似文献5.
Paolo Rigotti Giovanni Capovilla Caterina Di Bella Cristina Silvestre Paola Donato Nicola Baldan Lucrezia Furian 《Clinical transplantation》2014,28(12):1433-1440
This study reports on a large series of 200 dual kidney transplantations (DKTs) from expanded criteria donors (ECDs) and proposes specific ways to optimize outcomes. Data concerning 200 DKTs performed in the last 14 yr were retrospectively analyzed. Kidneys from high‐risk ECD were allocated for use in DKTs on an old‐for‐old basis after histological assessment. Different surgical techniques and immunosuppressant regimens were used over time, and the outcomes are discussed. Donors and recipients were a median 73 (70–77) and a 62 (58–67) yr old, respectively. Delayed graft function occurred in 31.5% of cases, and acute rejection in 13.5%. Patient and graft survival at five yr were 90.4% and 85.8%, respectively. Unilateral kidney placement was preferred for 75% of patients, and was associated with a low rate of surgical complications. Our current standard therapy comprising low‐dose calcineurin inhibitors (CNIs) associated with mammalian target of rapamycin inhibitors (mTOR) and steroids appears to offer the best risk/benefit profile for elderly patients undergoing DKT. In our experience, outcomes after DKT can be improved by: (i) kidney clinical–histological assessment; (ii) unilateral kidney placement; (iii) minimal use of CNI associated with mTOR. 相似文献
6.
Valentina Franco Giuliana Gatti Iolanda Mazzucchelli Roberto Marchiselli Cinzia Fattore Paola Rota Carlo Andrea Galimberti Giuseppe Capovilla Francesca Beccaria Valentina De Giorgis Cecilie Johannessen Landmark Emilio Perucca 《Epilepsia》2020,61(7):e79-e84
The assay of saliva samples provides a valuable alternative to the use of blood samples for therapeutic drug monitoring (TDM), at least for certain categories of patients. To determine the feasibility of using saliva sampling for the TDM of rufinamide, we compared rufinamide concentrations in paired samples of saliva and plasma collected from 26 patients with epilepsy at steady state. Within-patient relationships between plasma rufinamide concentrations and dose, and the influence of comedication were also investigated. Assay results in the two tested fluids showed a good correlation (r2 = .78, P < .0001), but concentrations in saliva were moderately lower than those in plasma (mean saliva to plasma ratio = 0.7 ± 0.2). In eight patients evaluated at three different dose levels, plasma rufinamide concentrations increased linearly with increasing dose. Patients receiving valproic acid comedication had higher dose-normalized plasma rufinamide levels than patients comedicated with drugs devoid of strong enzyme-inducing or enzyme-inhibiting activity. Overall, these findings indicate that use of saliva represents a feasible option for the application of TDM in patients treated with rufinamide. Because rufinamide concentrations are lower in saliva than in plasma, a correction factor is needed if measurements made in saliva are used as a surrogate for plasma concentrations. 相似文献
7.
Federico Zara Nicola Specchio Pasquale Striano Angela Robbiano Elena Gennaro Roberta Paravidino Nicola Vanni Francesca Beccaria Giuseppe Capovilla Amedeo Bianchi Lorella Caffi Viviana Cardilli Francesca Darra Bernardo Dalla Bernardina Lucia Fusco Roberto Gaggero Lucio Giordano Renzo Guerrini Gemma Incorpora Massimo Mastrangelo Luigina Spaccini Anna Maria Laverda Marilena Vecchi Francesca Vanadia Pierangelo Veggiotti Maurizio Viri Guya Occhi Mauro Budetta Maurizio Taglialatela Domenico A. Coviello Federico Vigevano Carlo Minetti 《Epilepsia》2013,54(3):425-436
8.
9.
Granata T Fusco L Gobbi G Freri E Ragona F Broggi G Mantegazza R Giordano L Villani F Capovilla G Vigevano F Bernardina BD Spreafico R Antozzi C 《Neurology》2003,61(12):1807-1810
The authors investigated immunomodulatory treatments in 15 patients with Rasmussen encephalitis (RE) (14 with childhood and one with adolescent onset RE). Positive time-limited responses were obtained in 11 patients using variable combinations of corticosteroids, apheresis, and high-dose IV immunoglobulins. Although surgical exclusion of the affected hemisphere is the only treatment that halts disease progression, immunomodulation can be considered when early surgery is not feasible, in late-onset patients with slower disease progression, and in the few cases of bilateral disease. 相似文献
10.
Topiramate as add-on drug in severe myoclonic epilepsy in infancy: an Italian multicenter open trial 总被引:1,自引:0,他引:1
Coppola G Capovilla G Montagnini A Romeo A Spanò M Tortorella G Veggiotti P Viri M Pascotto A 《Epilepsy research》2002,49(1):45-48
PURPOSE: This study was to evaluate the efficacy and safety of topiramate (TPM) in patients with severe myoclonic epilepsy in infancy (SMEI) and refractory seizures. METHODS: We performed a prospective multicentric open label add-on study in 18 patients (age 2-21 years, mean 9 years) with SMEI and refractory seizures of different types. TPM was added to one or two other baseline drugs and the efficacy was rated according to seizure type and frequency. RESULTS: TPM was initiated at a daily dose of 0.5-1 mg/kg, followed by a 2-week titration at increments of 1-3 mg/kg/24 h up to a maximum daily dose of 12 mg/kg. After a mean period of 11.9 months (range 2-24 months), three patients (16.7%) had 100% fewer seizures and ten patients (55.5%) had a more than 50% seizure decrease. In no patient there was a seizure worsening. Mild to moderate adverse events were present in four patients (22.2%), represented by weight loss, hypermenorrhoea, renal microlithiasis, nervousness and dysarthric speech. CONCLUSION: TPM may be a useful drug in patients with SMEI, being particularly effective against generalized tonic-clonic seizures. Further studies are needed to evaluate the early use of this drug in such a severe syndrome. 相似文献