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Biomedical subjects

A De Gasperi

Publications and source records attributed to A De Gasperi.

36 records · Page 2Linked to original sources
PubMed1996

[Laparoscopic cholecystectomy in patients previously treated with heart transplantation. A clinical case].

A 46-years old patient who had already undergone cardiac transplantation was scheduled for laparoscopic cholecystectomy following a diagnosis of cholelithiasis. In this particular case we were not faced with any problems even in presence of a denervated heart. Since the patient was immnosuppressed, we had to look for the best compromise between the need of monitoring closely the most important vital parameters and contemporarily reducing invasivity as much as possible. Capnometry was of paramount importance, enabling us to prevent and to correct high paCO2 values. The rapid recovery of the patient allowed us to begin with food intake and oral immunosuppressive therapy already 24 hours after the operation and to discharge the patient on the third day after surgery. Laparoscopic cholecystectomy represented a successful choice and a satisfying procedure both for the anaesthesiologist and for the patient, particularly regarding the minimal invasivity and the rapid recovery, which were considered of great importance in the immunodepressed patient.

Cholecystectomy, Laparoscopic↗
PubMed1994

Fentanyl pre-treatment does not affect the pharmacokinetic profile of an induction dose of propofol in adults.

The initial disposition of propofol was reported to change when the administration was preceded by fentanyl. The pharmacokinetic profile of the induction dose of propofol (2 mg kg-1 body weight) was studied in 20 ASA I patients randomly allocated to receive fentanyl 1.5 microgram kg-1 (n = 12) or not (n = 8). Anaesthesia was maintained with isoflurane in N2O/O2. Venous blood drawn from the contralateral arm was used to determine whole blood propofol concentrations. The mean propofol blood concentrations were comparable in the two groups and were best fitted by a three exponential equation in all the patients, conforming to a three-compartment open mammillary model. Distributions (T1/2 alpha) redistribution (T1/2(7)) and elimination (T1/2 beta half-lives were comparable in the groups, without significant differences in the total body clearance in the area under the time-concentration curve (zero-infinity) in the volume of distribution at steady-state, in the volume of distribution during the elimination phase or in the mean resident time. Our data support the conclusion that pretreatment with fentanyl does not affect the pharmacokinetic profile of the induction dose of propofol in ASA I patients.

Adult↗
PubMed1992

Somatomedin C (IGF I) plasma levels after orthotopic liver transplantation (OLT) in end-stage cirrhotic patients.

Insulin-like growth factors [IGF I and II or somatomedins (SMS)] are polypeptides chemically and biologically correlated with insulin. The main source of synthetic activity and secretion is the liver, although many other tissues have been demonstrated to synthesize SMS. In the circulation, they are not present in a free form, but are mostly bound to a specific carrier protein independently synthesized in the liver. Hepatic or extrahepatic storage organs have not been demonstrated; the half life of the SMS-binding protein complex is between 3 and 4. Synthesis of SMS is regulated by GH, insulin, thyroxine and nutrition (caloric and protein intake, and nitrogen balance). The role of corticosteroids is still a matter of debate: in patients treated with steroids SMS blood levels have been shown to be within normal limits, while biological activity has been demonstrated to be significantly reduced by SMS inhibitors, probably induced by corticosteroid therapy. The biological properties of SMS are related to their structural homology with insulin, and can be summarized as follows: A. Insulin-like activity (glucose oxidation, lipogenesis, glycogen synthesis, inhibition of lipolysis and glycogenolysis); B. Sulphation activity (incorporation of sulphate and leucine into glycosaminglycans of the cartilage); C. Stimulation of fibroblast multiplication; D. Amplification of other hormone activities (GH); E. Complementary anabolic activity with insulin. Low levels of SMS have been demonstrated in hypopituitarism (secondary) or in other diseases independent of GH reduced secretion (primary) such as malnutrition, malabsorption, acute or chronic liver failure and uraemia. Negative nitrogen balance, hypocaloric and/or low protein diets are usually correlated with low levels of SMS. Recently, Schalch et al. reported on the role of orthotopic liver transplantation (OLT) in normalizing SMS blood levels in a group of end-stage liver diseased patients. This preliminary paper deals with changes in IGF-I plasma levels (somatomedin C) in a group of patients affected by end-stage liver cirrhosis before and after OLT.

Bile↗
PubMedDate not supplied

Incidence of sepsis in central venous catheter-bearing patients with hematologic malignancies: preliminary results.

BACKGROUND: Indwelling central venous catheters (CVCs) are essential devices in the management of patients with hematological disorders treated with chemotherapy. However, their nature predisposes patients to unwanted complications. METHODS: CVC-related complications were retrospectively analyzed in 227 hematologic patients who were consecutively admitted to our hematology department between May 2002 and April 2004. Patients' diagnoses comprised acute myeloid leukemia (36.8%), acute lymphoid leukemia (7.3%), lymphoproliferative disorders (28.3%), multiple myeloma (19.5%), myeloproliferative syndromes (5%) and others (3.1%). The CVCs used were polyurethane three lumen 7-Fr (111 patients) for chemotherapy and 12-Fr (114 patients) for chemotherapy and peripheral blood stem cell apheresis, plus two tunneled catheters. RESULTS: The pathological events were: bacteriaemias (n=46); occlusions (n=10); exit tunnel infections (n=8); thrombosis (n=6); lung emboli (n=2). Among febrile patients the bacteriemia frequency was 20%, of which 13.6% were CVC-related (with a higher incidence in leukemia patients (p=0.027). Among the isolates, gram-positive bacteria were found in 29 cases (23 CVC-related cases), and gram-negative bacteria in 16 cases (8 CVC-related cases). Only one patient had Candida albicans sepsis. At univariate and multivariate analysis significant risk factors for infection (p<0.0001) were only the number of days/catheters and neutropenia duration. CONCLUSIONS: In our hematologic patients, the CVC complications were mainly septic, with only 10.1% of CVC-related bacteriemias, despite prolonged catheterization duration. Acute leukemia patients were at major risk for sepsis, probably due to a more severe neutropenia and prolonged catheterization duration.

Journal Article↗
PubMedDate not supplied

[Fulminant liver failure: intensive care, extracorporeal treatment and liver transplantation].

Fulminant liver failure is characterized by massive acute Hepatocyte dysfunction associated with severe coagulopathy, acute hyperdynamic circulatory failure and hepatic encephalopathy. According to the more recent classification, which takes into account the interval between the onset of jaundice and the hepatic encephalopathy, three are the main forms of ALF hyperacute, acute or subacute. Despite recent and relevant advances in intensive care management and organ support techniques (both artificial and bioartificial), mortality remains extremely high, early deaths being related to cerebral oedema and circulatory failure, whereas late deaths are associated with sepsis and multiple organ failure. Orthotopic liver transplantation has proven to be the only treatment modality able to change radically the ALF natural course. he experiences with artificial and bioartificial devices, in spite of being interesting and sometimes very promising, are far from giving a real impact on survival and remain, so far, important interim measures for patients eventually candidate to liver transplantation.

Artificial Organs↗
PubMedDate not supplied

Untunnelled central venous catheters in the treatment of acute leukemia.

Ninety-eight untunnelled central venous catheters were positioned in the subclavian or internal jugular vein in 42 patients with acute leukemia. The procedure was feasible at bedside and carried a risk of catheter-related infection of 21%, similar to that of tunnelled catheters. The persistence of exit-point infection is the main route of infection and requires catheter removal.

Acute Disease↗