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Biomedical subjects

A Chieregato

Publications and source records attributed to A Chieregato.

29 records · Page 2Linked to original sources
PubMed1997

Cerebral arteriovenous PCO2 difference and early global cerebral ischemia in a patient with acute severe head injury.

We report a case of acute head injury with severe diffuse brain swelling in which early global cerebral ischemia was followed by brain death. Global cerebral ischemia was detected by cerebral arteriovenous lactate content difference, cerebral arteriovenous carbon dioxide tension (PCO2) difference, and cerebral arteriovenous hydrogen ion content difference. Physiopathological aspects of cerebrovenous hypercarbia are discussed.

Acute Disease↗
PubMed1997

Isofenphos poisoning: prolonged intoxication after intramuscular injection.

We report a unique case of attempted suicide by intramuscular injection of the organophosphate isofenphos which resulted in a muscarinic and nicotinic syndrome lasting 15 days and requiring prolonged mechanical ventilation and hospitalization. The patient, who demonstrated no signs of delayed polyneuropathy on hospital day 25, subsequently died of pneumonia. Toxicological investigations showed isofenphos plasma decay and confirmed the intramuscular route of poisoning. We believe continuous isofenphos absorption resulted in the prolonged intoxication observed in this patient.

Aged↗
PubMed1996

Limitations of jugular bulb oxyhemoglobin saturation without intracranial pressure monitoring in subarachnoid hemorrhage.

We report a case of subarachnoid hemorrhage in which, even after having obtained a normal jugular bulb oxyhemoglobin saturation, cerebrovenous desaturation developed, and brain death occurred. The limitations of jugular bulb oxyhemoglobin saturation without intracranial pressure monitoring are discussed. We conclude that if increased intracranial pressure is suspected, use of jugular bulb oxyhemoglobin saturation monitoring alone would appear to be substantially limited.

Female↗
PubMed1996

Circadian and circannual rhythmicity in the occurrence of subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Inconsistent data are available on the temporal pattern of onset of subarachnoid hemorrhage (SAH). We investigated the possible influence of vascular risk factors. METHODS: Of a consecutive series of 217 cases of SAH, precise determination (within 30 minutes) of the time of symptom onset was possible in 199 (91.7%). Partial Fourier series with up to six harmonics were applied to hourly and monthly data, and the best-fitting curves for circadian and annual rhythmicity were calculated. The amplitude-MESOR (rhythm-adjusted mean over the time period analyzed) ratio was used as a measure of temporal variability. RESULTS: In the total population, a significant circadian pattern of occurrence was demonstrated with major peaks in the morning (approximately 9 AM) and evening (approximately 9 PM) hours and a nocturnal trough (approximately 3 AM). Younger, male, and hypertensive subjects had lower amplitude-MESOR ratios; smokers had no significant rhythmicity. The annual pattern showed a 6-month periodicity with two major peaks in March and September and minor differences in the subgroups studied. CONCLUSIONS: Our study indicates that the temporal distribution in onset of SAH may be influenced by variable combinations of environmental and vascular risk factors.

Age Factors↗
PubMedDate not supplied

Propofol 1% and propofol 2% are equally effective and well tolerated during anaesthesia of patients undergoing elective craniotomy for neurosurgical procedures.

BACKGROUND: The 2% formulation of the intravenous anaesthetic agent, propofol (Diprivan), delivers half the amount of lipid compared with the original 1% formulation. This may provide an acceptable alternative for patients who have an impaired ability to metabolise lipids. METHODS: This study was a multicentre, randomised, open comparison of parallel groups. Seventy-three adult patients undergoing elective craniotomy in neurosurgery were randomised to receive either propofol 1% (10 mg/ml) or propofol 2% (20 mg/ml) for induction and maintenance of anaesthesia. RESULTS: Analysis of induction time (199 s, 1%; 202 s, 2%; p > 0.05) and induction dose (1.13 mg/kg, 1.12 mg/kg; p > 0.05) shows that propofol 1% and propofol 2% are pharmacodynamically equivalent. Both formulations were similar regarding overall administration rates, recovery times, haemodynamic variables and tolerability. Plasma triglyceride levels, were lower in the propofol 2% group compared with the propofol 1% group, and significantly lower (p < 0.05) from 1 to 4 hours after induction. CONCLUSIONS: We conclude that propofol 2% is as effective and as well-tolerated as propofol 1% for anaesthesia and is an acceptable alternative to propofol 1% in patients undergoing elective craniotomy in neurosurgery. The lower lipid load suggests it may be of particular benefit to patients with disorders of lipid metabolism.

Adult↗
PubMedDate not supplied

[Neurosheet: an electronic sheet for neurosurgical intensive care].

PURPOSE: A growing number of monitoring and diagnostic instruments has considerably increased the amount of information available in the intensive care unit. A data collection system which can be useful in highlighting and processing the most relevant data for the care of head-injured patients (Neurosheet) has been set up. The purpose of this study is to describe Neurosheet and to analyse the results achieved through its use. ENVIRONMENT: Neurosurgical Intensive Care Unit. METHODS: Neurosheet consists of a data sheet which follows the course of some "key" variables in head-injured patients who undergo ICP monitoring for a period of more than 48 hours. SURVEY: Through a questionnaire distributed to the medical staff, the learning period and the opinion of the staff concerning the clinical usefulness of this instrument has been evaluated. The amount of time needed to compile Neurosheet has been measured and some criteria indicating its completeness identified. RESULTS: It has been found that Neurosheet can be learned quickly and is rather easy to use. Data resulting from the study of the learning curve and from the answers to the questionnaire, suggest that its learning period is quite short (10 to 20 minutes). Among the 28 eligible patients, Neurosheet was used for 24 (86%). The data collected show 1,912 hours of monitoring, with an average of 112.8 (+/- 55) hours per patient. Neurosheet was completed in 83% of the cases. CONCLUSIONS: The aim of Neurosheet is to provide an answer to the overload of information using computerised systems able to simplify and support the daily clinical work.

Critical Care↗