Biomedical subjects
Publications and source records attributed to A Gullo.
A diabetic patient who was taking an intermediate-acting insulin preparation developed sudden hypoglycaemic coma after epidural analgesia between T5 and L1. Several diagnostic possibilities are discussed. It is concluded that prophylactic intravenous infusion of glucose and small doses of local anaesthetic are always advisable in diabetic patients having epidural analgesia.
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Malignant hyperthermia may appear during surgery. It has at least three features: 1) an anesthesiological trigger, usually the association of halothane and succinylcholine; 2) rapid increase in body temperature; 3) widespread muscle hypertonia. The literature is reviewed in an assessment of the physiopathological mechanism underlying the syndrome, with particular reference to the part played by calcium. Experimental data are cited and their similarity with the clinical, laboratory, anatomical, and histopathological picture in man is discussed. A detailed account is also given of two personal cases. Lastly, questions associated with the prevention and treatment of malignant hyperthermia are examined.
Psychodiagnostic tests have been used in a study on patients undergoing general anaesthesia for minor surgery, the purpose being to evaluate patient recovery and autonomy prior to discharge. The patients considered were submitted prior to operation to the Peg board test, tre Trieger test and the Writing test to obtain standard reference values. These tests were repeated every 10-15 minutes from the end of operation as soon as patients recovered consciousness and were able to cooperate. The comparative study showed that patients who had been anesthetized with Ethrane recovered more rapidly, followed by those treated with Fluothane, Propanidide and Althesin.
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PURPOSE: The possible evolution of the usual CT signs in oncology makes the logical premise of our experience. Our goal was to transform instrumental findings in information richer in clinical yield, in compliance with the guidelines of the National Cancer Institute (Bethesda, Md, USA). MATERIAL AND METHODS: Our study was developed over a 3-year period and involved 432 selected patients with primary neoplasms. The lesions were in pulmonary, gastroenteric and genitourinary sites and stages differed (T2/T3, N0/N3, M0/M1); the Karnofsky score ranged 60-90. We integrated the tumor staging obtained with CT with gravitational tests by means of simple changes in the position of forced decubitus resulting in procubitus and triclinium-like positions (right and left lateral decubitus). We restudied only the cT class of each lesion, looking for a better depiction of the lesion-adjacent, fat, and compared the results the examinations in the standard versus the modified decubitus. Judgements were relative to the technical quality of the modified examination and to the potential impact of these findings on the following pTNM staging. RESULTS: In our 432 patients and only relative to the cT parameter, CT with standard decubitus correctly staged 312 lesions (mean accuracy: 72.2%) versus 352 for CT with modified decubitus (mean accuracy: 81.5%). Improvements were more marked in gastric (22.9% of 48 cases), vesical (23% of 26 cases) and colic (22.3% of 76 cases) lesions, and less marked in pulmonary (10.6% of 132 cases), ovarian (14% of 71 cases) and endometrial (17.1% of 70 cases) lesions. The routine application of pTNM verifications to CT staging helped show the most frequent causes of cTNM mistaging in solid lesions which, in most of the T2/T3 classes, involve the direct spread to an adjacent organ and the depth of invasion of adjacent structures. CONCLUSIONS: The combination and comparison of cTNM with pTNM are useful not only for final tumor staging but also to assess the pretreatment diagnostic accuracy of CT studies. Introducing gravitational tests and reading examinations in pairs improved lesion location, which is the most important technical information for subsequent prognosis and treatment and can help decrease pre-/post-treatment management costs.
Sepsis is a condition at high risk for the patients to develop organ(s) or system dysfunction/failure and represent a very limiting process for survival. Researchers and clinicians proposed standardization of terminology for sepsis and related problems to improve communication and to evaluate the efficacy of preventive measures and therapeutic interventions. Interrelationship among systemic inflammatory response syndrome (SIRS), infection and sepsis are surrounded by non infectious satellite events such as trauma, burns, pancreatitis, haemorrhagic shock, immune-mediated organ injury and infectious cause such as fungemia, parasitemia, viremia. The prevalence of infections among intensive care patients has been reported to vary from 15 to 40%. Usually indicators of sepsis are persistent hyperlactatemia and supranormal level of DO2. These conditions may progress as a sort of dynamic process known as endotoxaemia condition which is mediated by derangement of biohumoral factors inducing immunological dissonance and ultimately concomitant or sequential organs dysfunction/failure. Multiple sources of sepsis is a phenomenon clearly associated with poor prognosis and all the sepsis trials managed in the last decades have failed on reducing mortality rate in enrolled patients. Development of scoring system routinely used at bedside represent an important method to establish cost-effectiveness in this exiting area of study and clinical management. Controversial results on sepsis need a sort of consensus at different level from researchers to clinician experiencing new strategies for prevention and more appropriately therapeutic approach for the management of this syndrome.