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Biomedical subjects

A Pierro

Publications and source records attributed to A Pierro.

At least 109 records · Page 6Linked to original sources
PubMed1995

The effect of major operations on heart rate, respiratory rate, physical activity, temperature and respiratory gas exchange in infants.

Perioperative changes in heart rate (HR), respiratory rate (RR), physical activity, body temperature, oxygen consumption (VO2), carbon dioxide production (VCO2) and resting energy expenditure (REE) were studied in fourteen infants (weight 3.1 +/- 0.2 kg) who had a major operation. VO2 and VCO2 were measured by indirect calorimetry preoperatively, and postoperatively for the first 12 hours continuously and at 24 hours, 48 hours and 5 days. HR, RR and physical activity were recorded on a minute to minute basis, and rectal temperature was recorded hourly. REE was calculated. HR, RR, VO2, VCO2 and REE increased postoperatively, peaking at 2-4 hours, and returned to baseline levels by 12-24 hours. In all of these variables, peak levels were significantly higher than Baseline levels (p < 0.001 for all variables). Physical activity and rectal temperature did not vary significantly throughout the study. This study demonstrates that newborn infants exhibit a short-lived postoperative increase in HR, RR, VO2, VCO2 and REE, which is not related to any alteration in physical activity or body temperature.

Body Temperature↗
PubMed1995

Gall bladder contractility in neonates: effects of parenteral and enteral feeding.

The gall bladder size was measured in 30 newborn infants: 18 had been fed parenterally and 12 enterally. The two groups were comparable for gestational age, birthweight, postnatal age and study weight. Exclusion criteria were haemodynamic instability, septicaemia, abdominal disease and opioid treatment. Gall bladder size was measured at 15 minute intervals for 90 minutes using real-time ultrasonography and the volume calculated using the ellipsoid method. Parenterally fed infants had further measurements at 120, 150, and 360 minutes. The gall bladder was significantly larger in parenterally fed infants than in enterally fed infants (p = 0.0001). In enterally fed infants a 50% reduction in gall bladder volume was observed 15 minutes after starting the feed with a return to baseline volume by 90 minutes. In parenterally fed infants there was no gall bladder contraction. Such information may give insight into the pathophysiology of hepato-biliary complications during parenteral nutrition in infants.

Enteral Nutrition↗
PubMed1995

Late onset undifferentiated seronegative spondyloarthropathy.

OBJECTIVE: To define the clinical spectrum of late onset undifferentiated seronegative spondyloarthropathy (uSpA) based on a large number of patients. METHODS: All consecutive patients older than 45 years at the onset of SpA and not meeting criteria for any of the definite categories of the SpA complex seen in the 1988-1993 period were entered in a special register and were followed prospectively. RESULTS: Twenty-three patients (mean age at onset 56.9, range 46-72; mean age at the last visit 61.7, range 48-79) were studied. Of these, 12 had 3 or more clinical and/or radiological manifestations of SpA, while 7 showed only 2, and 4 only one. Of the 10 patients with peripheral arthritis, only 3 had the large pitting edema of the lower limbs described by Dubost and Sauvezie. Of the 4 patients with only one manifestation, 2 had peripheral enthesitis and 2 acute anterior uveitis. CONCLUSION: The clinical spectrum of late onset uSpA is as wide as in children and young and middle aged adults.

Age of Onset↗
PubMed1994

Postoperative changes in resting energy expenditure and interleukin 6 level in infants.

The relationship was determined between resting energy expenditure (REE) and interleukin (IL)6 level following surgery in infants. Sixteen infants of mean(s.e.m.) weight 3.2(0.2) kg undergoing uncomplicated surgery were studied. The operative stress score was recorded and plasma IL-6 levels were measured before and 4, 8, 12 and 24 h after surgery. Respiratory gas exchange was measured by indirect calorimetry before and at 2, 4, 6, 8, 10, 12, 24 and 48 h. Urinary nitrogen excretion was measured and calculated. IL-6 levels increased significantly after surgery (P = 0.006) and were maximal at 12 h. There was a linear correlation between the increase in IL-6 level and operative severity score (r = 0.61, P = 0.012). REE increased significantly after operation (P < 0.001), peaking at 2-4 h, and returned to baseline levels by 12 h. The changes in REE preceded those in IL-6. IL-6 is a marker of the stress response in infants and may play a role in the subsequent modulation of this response.

C-Reactive Protein↗
PubMed1994

A new equation to predict the resting energy expenditure of surgical infants.

It is essential that adequate calories are provided to newborns to cover their energy expenditure. This is difficult to measure and varies significantly between individuals. The aim of this study was to develop an equation to predict the basal energy requirements of stable surgical infants, using easily measurable parameters. Resting energy expenditure (REE) was measured using computerized open-circuit indirect calorimetry. One hundred twenty-two measurements were made on different days in 46 stable nonventilated infants. The measured REE was 34.41 +/- 0.46 cal/kg/min; (mean +/- SEM). Three body-size measurements correlated significantly with REE (cal/min): weight in kilograms (r = .87; P < .00001), body surface area in square meters (r = .86; P < .00001), and lean body mass in kilograms (r = .81; P < .00001). Five other independent variables correlated significantly with REE (cal/kg/min): heart rate in beats per minute (r = .60; P < .00001), postnatal age in days (r = .49; P < .00001) caloric intake in cal/kg/min (r = .44; P < .00001), gestational age in weeks (r = .43; P < .00001), and rectal temperature in degrees Celsius (r = .19; P = .04). Weight, heart rate, age, gestational age, and temperature were regarded as independent predictor variables of REE for the multiple stepwise regression analysis. Three variables entered this highly significant equation: REE (cal/min) = -74.436 + (34.661 x weight in kg) + (0.496 x heart rate in beats/min) + (0.178 x age in days) (r = .92; F = 230.07; significance, F < .00001).(ABSTRACT TRUNCATED AT 250 WORDS)

Body Surface Area↗
PubMed1994

Infantile myofibromatosis--a review.

Infantile myofibromatosis is a rare condition which usually presents in childhood. It has a wide spectrum of disease activity, ranging from a solitary cutaneous nodule, through to a multicentric form with widespread visceral involvement. We present four cases which demonstrate the diversity of this condition and its radiological findings, together with a review of the literature.

Child↗
PubMed1993

Glucose utilization in the surgical newborn infant receiving total parenteral nutrition.

Glucose is the main source of nonprotein calories in total parenteral nutrition (TPN). However, its use has been associated with various nutritional, metabolic, and respiratory complications. The aim of this study was to determine, in the stable surgical newborn infant, the characteristics of carbohydrate metabolism, in particular the maximum oxidative threshold for intravenous glucose and the thermogenic effect of glucose. Twenty-one studies were done on 11 infants (weight 2.82 +/- 0.19 kg) receiving TPN containing constant amounts of amino acids (2.5 g/kg/d) and fat (3.0 g/kg/d), and different amounts of glucose (range, 10 to 25 g/kg/d). Oxygen consumption (VO2), carbon-dioxide production (VCO2), and resting energy expenditure (REE) were measured by indirect calorimetry. Urinary nitrogen excretion rate was measured and substrate utilization calculated from the nonprotein respiratory quotient (NPRQ). There was a positive correlation between the predictor variable glucose intake and the dependent variables VO2 (r = .55; P < .05), VCO2 (r = .83; P < .0001), REE (r = .65; P < .005), NPRQ (r = .94; P < .0001), respiratory rate (r = .46; P = .06), and plasma triglycerides level (r = .67; P < .01). When glucose intake exceeded 18 g/kg/d the NPRQ was greater than 1.0, indicating glucose conversion to fat. Above this level of intake, the gradient of the correlation between the predictor variable glucose intake and the dependent variables VCO2 and REE increased. From this study we conclude that: (1) Glucose intake is the principal determinant of glucose utilization and exerts an influence on the metabolism of exogenous fat.(ABSTRACT TRUNCATED AT 250 WORDS)

Calorimetry, Indirect↗
PubMed1993

Indications for laparotomy after hydrostatic reduction for intussusception.

A criterion for successful hydrostatic reduction of intussusception is reflux into the terminal ileum. In our practice, absence of reflux into the terminal ileum is not an indication for laparotomy if the radiographic appearances suggest edema of the ileocecal valve. The aim of this study was to validate our approach. We reviewed the case notes of patients with a diagnosis of intussusception (n = 107; age 11.74 +/- 1.48 months; mean +/- SEM) treated from 1987 to 1991. Eleven required primary laparotomy for peritonitis. Ninety-six patients who had a contrast enema were studied. Edema of the ileocecal valve was defined as a persistent filling defect in the cecum after apparently complete hydrostatic reduction, without reflux of contrast into the distal small bowel. In 59 patients hydrostatic reduction was successful: 11 (18.6%) had edema of the ileocecal valve and no reflux contrast into the terminal ileum (group B). All improved clinically after the enema and needed no further treatment. In 37 patients hydrostatic reduction of the intussusception was unsuccessful and an operation was performed: 26 (70.3%) required manual reduction of the intussusception (group C) and 11 (29.7%) underwent bowel resection (group D). None of the patients with edema of ileocecal valve required further treatment or developed recurrent intussusception. In none of the patients who had an operation was the intussusception found to have been reduced by the contrast enema. There were no deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Barium Sulfate↗
PubMed1993

Necrotizing enterocolitis complicating the management of posthemorrhagic hydrocephalus.

The case notes of all newborn infants with posthemorrhagic hydrocephalus (PHH) operated over the past 10 years at our institution were reviewed to establish the incidence and the effect of necrotizing enterocolitis (NEC) on morbidity and mortality following cerebrospinal fluid (CSF) shunting. Thirteen neonates had both PHH and NEC (group A); 7 of these patients were initially treated by ventriculoatrial (VA) shunt and six by ventriculoperitoneal (VP) shunt. Seventy-five patients had PHH alone (group B); all were treated by VP shunt. Eight patients in group A required an abdominal operation for NEC. The two groups were comparable for birth weight, gestational age, and other complications of prematurity. Episodes of shunt malfunction (infection and/or obstruction) and deaths occurring within 12 months from shunt insertion, in the two groups were compared. Shunt malfunction was more frequent in group A (72%) than in group B (27%) (P < .001). Shunt infection was observed in 39% of group A patients versus 14% in group B (P = .03). Distal shunt obstructions occurred in 28% of group A patients and only 3% of group B patients (P = .001). There were more deaths in group A (62% v 9%; P < .001). Thirty-one percent of group A patients and 4% of group B patients died following shunt complications (P = .006). In group A, there was no significant difference in mortality and shunt malfunction between patients with VA or VP shunts. The method of treatment and the stage of NEC did not influence morbidity and mortality after internal drainage for PHH.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Hemorrhage↗
PubMed1993

The metabolic response to operative stress in infants.

The aim of this study was to characterize energy metabolism and substrate utilization in infants following an operation. Nineteen infants (weight 3.2 +/- 0.2 kg) who had an operation were studied. Anesthesia was standardized and operative stress score (OSS) was recorded. Five infants had a minor operation (OSS < 7), and 14 infants had a major operation (OSS > or = 7). Energy and nitrogen intake were constant during the 48-hour study period. Respiratory gas exchange was measured by indirect calorimetry preoperatively, and postoperatively for the first 12 hours continuously and at 24 hours, 48 hours, and 5 days. Urinary nitrogen excretion rate was measured for the first 48 hours following the operation. Physical activity was scored. Resting energy expenditure (REE) and nonprotein respiratory quotient (NPRQ) were calculated. REE increased postoperatively, peaking at 2 to 4 hours, and returned to baseline levels by 12 to 24 hours. Peak REE was significantly higher than baseline REE (P < .001). Substrate utilization was not altered by operation. The increase in REE was significantly greater in infants having a major operation than in infants having a minor operation (P < .05). Among infants having a major operation, the increase in REE was significantly greater in those infants more than 48 hours old, than in those infants less than 48 hours old (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Calorimetry, Indirect↗
PubMed1993

A method for urine collection in infants.

A simple, inexpensive, non-invasive method for urine collection was used in 28 consecutive infants for periods of 48 hours (n = 10) and 72 hours (n = 18). The incidence of urine collector detachment was low on the first and second days (< 4%) and increased significantly on the third day (28%). Volume of urine leaked was < 4% of the total volume collected daily. This method is applicable to both sexes and is reliable for up to 48 hours.

Evaluation Studies as Topic↗
PubMed1992

[Early ECG changes after experimental focal cerebral ischemia. A pathogenetic hypothesis of the brain-heart syndrome].

Primary CVT alterations and arrhythmias, occurring one hour after embolization were detected in several experiments about focal cerebral ischaemia in rabbits. 62 animals were fed on a standard diet and 15 on an atherogenic diet. Primary CVT alterations and arrhythmias occurred in 4 rabbits fed on a standard diet and in 6 rabbits fed on an atherogenic diet. These results gave statistic evidence of a relationship between more frequent and serious electrocardiographic alterations and an atherogenic diet. The information coming out of these experiments are discussed. Considering the data coming out of other experiments and the data of the literature it is supposed that the pathogenesis of "the cerebro-cardiac syndrome" is linked to several biohumoral alterations occurring after the stroke. If these alterations occur in animals (or in subjects) with damaged coronary arteries cardiac alterations occurring after the stroke are greater and more important than the cardiac alterations occurring in the same conditions in the animals in which coronary arteries are not jet damaged.

Animals↗
PubMed1991

Esophageal atresia, choanal atresia, and dysautonomia.

Patients with esophageal atresia (EA) or choanal atresia (CA) manifest similar clinical and pathophysiological features. To determine the significance of this observation, the clinical records of 80 patients with EA and 57 with CA were reviewed. This survey showed that similarities between the two conditions included inspiratory and expiratory dyspnea, episodes of reflex apnea and/or bradycardia, oropharyngeal dysphagia, vomiting, convulsions, hyperhydrosis, hyperthermia, sialorrhea, and sudden death. After the second year of life most symptoms disappeared spontaneously. In both conditions, respiratory effort resulted in partial or complete obstruction affecting both the inspiratory and expiratory phases of the respiratory cycle. Support for this finding was obtained by studying the breathing pattern of 3 patients with EA and 3 with CA, before and during postural respiratory loading. The data suggest that patients with EA are similar to those with CA, having upper airway instability that may result in obstructive hypopnea or apnea associated with expiratory grunting. It is possible that this upper airway instability is a manifestation of more general maturational dysautonomia previously not recognised in patients with EA.

Apnea↗
PubMed1991

Partition of energy metabolism in the surgical newborn.

Variations in energy expenditure (EE) and substrate utilization were investigated in 12 surgical neonates (body weight, 2.81 +/- 0.15 kg) receiving total parenteral nutrition (TPN) at an energy intake of 66.34 +/- 2.16 kcal/kg/d in a thermoneutral environment of 32 degrees C to 34 degrees C. Respiratory gas exchange was continuously recorded for 12 hours by a computerized, open-circuit indirect calorimeter. Physical activity was monitored on a modified Freymond scale. Urine was collected over 3 days, including the time of the calorimetry study to determine the urinary nitrogen excretion rate. Oxygen consumption, carbon dioxide production, nonprotein respiratory quotient, and EE were calculated according to the principles of indirect calorimetry for each 30-minute period and for the entire 12 hours. During the indirect calorimetry study the patients were receiving a fat-free TPN mixture consisting of 10% glucose and 2% amino acids (GL/AA) for 8 hours. The fat-free TPN was interrupted by an isocaloric and isovolemic infusion of intralipid 10% (IL) for 4 hours. The effect of physical activity on EE was evaluated separately according to the macronutrient intake (GL/AA for 8 hours v IL for 4 hours) and then combined throughout the 12 hours of intravenous alimentation. The neonates were resting during 80% of the 12-hour study time (range, 38% to 90%). The partition of EE expressed as mean +/- SEM in kcal/kg/d was: total EE 48.5 +/- 2.1; resting EE 43.9 +/- 1.6; energy cost of activity 4.6 +/- 1.3.(ABSTRACT TRUNCATED AT 250 WORDS)

Calorimetry, Indirect↗
PubMed1991

The brain-heart syndrome: remarks on early ecgraphic changes following focal cerebral ischemia in healthy and in experimentally hyperdyslipidemic rabbits.

Early cardiac effects of focal cerebral ischemia in two groups of rabbit, one of which made hyperdyslipidemic with an atherogenic diet, were detected in several experiments. In the group of 62 animals fed on a standard diet, primary CVT alterations and arrhythmias occurred in 4 rabbits (6.4%), in the group of 15 animals fed on an atherogenic diet the same cardiac alterations occurred in 6 rabbits (40%). A marked statistically significant prevalence of ECGraphic changes was observed in hyperdyslipidemic group. These results and the data coming out of other experiments and literature suggest that the pathogenesis of the "cerebro-cardiac syndrome" is linked to several biohumoral alterations occurring after the stroke. If these events affect functionally damaged endothelia, or occur in the presence of atherosclerotic plaques, cardiac alterations occurring after the stroke are greater than cardiac alterations observed in the same condition when coronary are intact or little damaged.

Acute Disease↗