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Biomedical subjects

G Berlot

Publications and source records attributed to G Berlot.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Leptospirosis. Description of a clinical case and review of the literature].

Leptospirosis is a world-wide diffused anthropozoonosis due to many strains of Leptospira. Initial symptoms may be mild, although in many cases severe systemic symptoms, including high fever, hypotension, etc. may be present since the beginning. In these latter circumstances, the diagnosis of leptospirosis can be very difficult because of the complexity of clinical picture especially when the history is lacking or incomplete. A case report of a 45 year-old man admitted to the hospital after severe jaundice and fever of unknown origin associated to altered mental status, renal failure and hypoxemia is presented. Because of the presence of septic shock and severe respiratory failure, the patient was transferred to the intensive care unit. The diagnostic hypothesis, based on clinical history, was confirmed by laboratory tests (leptospiral IgM antibodies detection). Therapeutical approach with the use of selected antibiotics (penicillin 24,000,000 U for day) and therapy of septic shock led to improvement of the patient's clinical conditions who was then transferred to a regular medical ward.

Humans↗
PubMed1997

Intravenous nicardipine in the treatment of postoperative arterial hypertension.

BACKGROUND: Calcium entry blockers are commonly used in the management of postoperative hypertension. The hemodynamic and blood gas effects of nicardipine, a dihydropyridine derivative available intravenously, were studied in patients after abdominal aortic surgery. METHODS: Sixteen patients (66 +/- 8 years) who developed arterial hypertension (mean arterial pressure, > 90 mmHg) after abdominal aortic aneurysm reconstruction were studied. Fourteen patients had already been treated with a sodium nitroprusside infusion, the doses of which were maintained constant (mean dose: 1.42 +/- 1.04 micrograms/kg/min). Hemodynamic and blood gas data were collected at baseline, 15 minutes, and 45 minutes after a slow bolus administration of 3 to 5 mg of nicardipine. RESULTS: After the nicardipine administration, mean arterial pressure decreased from 101 +/- 11 to 83 +/- 11 mmHg (p < 0.001), and the cardiac index acutely increased from 3.96 +/- 0.74 to 4.57 +/- 0.83 L/min/m2 (p < 0.05). Systemic vascular resistance significantly decreased. There were no significant changes in heart rate, stroke volume, cardiac filling pressures, pulmonary artery pressures, pulmonary vascular resistance, left ventricular stroke work, or right ventricular stroke work. One patient developed acute pulmonary edema, associated with a dramatic increase in cardiac filling pressures, and electrocardiographic signs of myocardial ischemia. Nicardipine administration was also associated with an acute reduction in Pao2 from 85.0 +/- 12.1 mmHg to 70.3 +/- 9.2 mmHg (p < 0.001), associated with an increase in venous admixture from 21.7% +/- 3.2% to 28.0% +/- 5.2% (p < 0.01). Oxygen delivery increased moderately and oxygen extraction decreased, but oxygen consumption was unchanged. CONCLUSION: This study confirms the excellent efficacy of nicardipine in the management of postoperative hypertension, but underlines the risk of poor cardiac tolerance in patients after major surgery. Although oxygen delivery to the cells is usually well preserved, nicardipine can also significantly after blood oxygenation by increasing ventilation/perfusion mismatch.

Aged↗
PubMed1997

Fatal Streptococcus viridans descending mediastinitis: case report and review of the literature.

Mediastinitis is a life-threatening complication of cardiac, neck and oesophageal surgery. It has also been reported following upper digestive and respiratory procedures and as a consequence of oesophageal perforation following the ingestion of foreign bodies. Much more infrequently, mediastinitis can occur in association with oropharyngeal or cervical infections. We describe the case of a patient with fatal mediastinitis and septic shock. The onset of mediastinitis was preceded by a 2-day course of sore throat and other flu-like symptoms.

Aged↗
PubMed1997

Hemodynamic effects of plasma exchange in septic patients: preliminary report.

To assess the effects of plasma exchange on the hemodynamic performance of septic patients, we studied 12 septic patients (11 males and 1 female, age range 19-64, mean 39 +/- 17 years). After cardiovascular stabilization, plasma exchange was performed in the spontaneous mode via a femorofemoral arteriovenous shunt; during the treatment the infusion rate of cardiovascular drugs and the mechanical ventilation setting were not modified. Heart rate, pulmonary artery occlusion pressure, and peripheral vascular resistance did not change significantly. The stroke volume index increased significantly (from 49 +/- 9 to 60 +/- 9 ml/min/m2; p < 0.05) as well as the cardiac index (from 5.5 +/- 1.2 to 6.3 +/- 0.8 liters/min/m2, the oxygen delivery (from 785 +/- 166 to 872 +/- 118 ml/min/m2; p < 0.05), and the left ventricular stroke work index/pulmonary artery occlusion pressure ratio (from 4.03 +/- 1.92 to 5.07 +/- 2.54; p < 0.05). The oxygen consumption did not change. Four patients survived. In conclusion, in our patients plasma exchange was associated with an improvement in cardiac function, possibly due to the elimination of some sepsis mediator(s) with negative inotropic properties.

Adult↗
PubMed1997

Postoperative Wernicke's encephalopathy.

We report the case of a patient in whom Wernicke's encephalopathy occurred after a prolonged postoperative starvation. The pathophysiology of WE and the possible differential diagnoses of neurologic disturbances occurring in the postoperative phase are reviewed and discussed.

Diagnosis, Differential↗
PubMed1996

Ingredients of organ dysfunction or failure.

The simultaneous dysfunction of several organs (MODS, or multiple organ dysfunction) represents the most challenging task for the intensivist. In recent years more and more patients have been diagnosed as suffering from MODS due to several causes, including better immediate treatment of injuries that only a few years ago would have been considered incompatible with life or with consequent reduced organ reserve. Even if initially MODS has been associated with infections and sepsis, because of its similarity with a generalized inflammatory reaction mediated by a wide array of mediators, it is now clear that noninfectious insults, such as multiple trauma, acute pancreatitis, and retroperitoneal bleeding, can start a chain reaction ultimately leading to the onset of MODS. A specific trigger factor has not yet been identified, but experimental and clinical evidence suggests that the gut, endothelium, and immune system interact to produce the altered metabolic and cardiorespiratory patterns commonly observed in patients with MODS. It is thus possible that a target-oriented approach, including rapid correction of intestinal underperfusion, supply of specific nutrients, and down-regulation of the inflammatory cascade, can act as either a preventive measure for subjects at risk or as a main treatment for patients with full-blown MODS.

Bacterial Translocation↗
PubMed1996

Traumatic blunt carotid injury: clinical experience and review of the literature.

To evaluate the symptoms, the associated lesions, the treatment and the outcome of patients with blunt carotid injury (BCI), we reviewed the records of all patients admitted to our intensive care unit with head trauma between May 1991 and May 1995. A patient's assessment included the commonly used severity scores and cranial computed tomography (CT). Other diagnostic investigations were performed according to the clinical setting. Four patients (2 males, 2 females, age 29 +/- 13 years) out of 145 were diagnosed to have BCI. At admission, the Glasgow Coma Scale (GCS) was > or = 12 in all patients, and was associated with hemiparesis in three of them; the fourth became paretic 48 hours later. No pathological elements were demonstrated at the initial CT scan, whilst subsequent examinations showed signs of ischaemia after a variable interval from admission. In every patient the radiologic investigations demonstrated a thrombotic obstruction of the internal carotid artery (ICA), associated with an intimal dissection in two cases. Three patients were discharged with only minor neurologic symptoms. The fourth patient was referred to our ICU after the development of a massive hemispheric infarction, and died 3 days after admission.

Adolescent↗
PubMed1996

[Use of the laryngeal mask in general anesthesia. Clinical experience].

GOAL OF THE STUDY: To evaluate the use of the laryngeal mask during general anesthesia. STUDY DESIGN: We prospectively studied patients undergoing surgery with general anesthesia in spontaneous breathing. ENVIRONMENT: Urologic and general surgical ward, with standard monitoring equipment. PATIENTS: We studied consecutively 100 patients (ASA 1-3, 80 males, 20 females, age 64 +/- 15 years, range 19-98 years); 59 patients had a preexisting cardiopulmonary or metabolic disease. Monitoring included ECG, the arterial pressure (noninvasive), the CO2 capnography (EtCO2), the pulsossimetry (SpO2), the respiratory rate (RR) and the tidal volume/kg (TVi). The double product (DP = heart rate X systolic arterial pressure) was used as an index of cardiac stress. These parameters were recorded at 10-minute intervals throughout the procedure. RESULTS: The heart rate, the systolic arterial pressure remained stable during the anesthesia, whereas the DP significantly decreased at t10, t20, t30 and t40. The EtCO2 decreased slightly (from 41 +/- 6 to a 36 +/- 4 mmHg; p.n.s.), SpO2 did not change (from 97 +/- 2% to 96 +/- 2%; p:n.s.). The RR significantly increased at t30 and t40 and the TVi significantly increased during the first hour. No relevant complications have been reported. CONCLUSIONS: Anesthesia with laryngeal mask was not associated with any detrimental cardiovascular and respiratory effect.

Adult↗
PubMed1995

Combined measurements of blood lactate concentrations and gastric intramucosal pH in patients with severe sepsis.

OBJECTIVE: To compare the prognostic value of blood lactate concentrations, gastric intramucosal pH, and their combination in patients with severe sepsis. DESIGN: Prospective, noninterventional study. SETTING: Medical/surgical intensive care unit of a university hospital. PATIENTS: The study included 35 consecutive patients (44 to 82 yrs) with severe sepsis as defined by fever or hypothermia (rectal temperature > 38.3 degrees or < 35.5 degrees C), tachycardia (heart rate > 100 beats/min), tachypnea (respiratory rate > 20 breaths/min) or mechanical ventilation, abnormal white blood cell count (> 10 or < 6 x 10(3) cells/mm3), hypotension (systolic arterial pressure < 90 mm Hg), and evidence of organ dysfunction (oliguria or deterioration of mental status). INTERVENTIONS: Arterial lactate concentration and intramucosal pH were measured at the time of study entry, and at 4 and 24 hrs later. Hemodynamic data and oxygen-derived variables were determined at the time of study entry and 24 hrs later. Arterial blood and balloon saline gases were also determined to obtain the pH gap (arterial pH-intramucosal pH) and the PCO2 gap (intramural PCO2-PaCO2). MEASUREMENTS AND MAIN RESULTS: Of the 35 patients, 19 survived the intensive care unit stay. At the time of study admission, 23 (66%) patients had an increased lactate concentration (> 2 mEq/L) and 26 (74%) had a low intramucosal pH (< 7.32). Initially, there were no significant differences in blood lactate concentrations between nonsurvivors and survivors (3.2 +/- 1.5 vs. 2.8 +/- 2.3 mEq/L). Lactate concentrations remained high in nonsurvivors and progressively decreased in survivors (4 hrs: 3.3 +/- 1.1 mEq/L in nonsurvivors vs. 2.2 +/- 0.9 mEq/L in survivors [p < .01]; 24 hrs: 3.5 +/- 2.0 mEq/L in nonsurvivors vs. 1.9 +/- 1.1 mEq/L in survivors [p < .05]). Intramucosal pH was lower in the nonsurvivors than in the survivors initially (7.19 +/- 0.15 in nonsurvivors vs. 7.30 +/- 0.14 in survivors [p < .05]), at 4 hrs (7.18 +/- 0.17 in nonsurvivors vs. 7.29 +/- 0.13 in survivors [p = .06]), and at 24 hrs (7.19 +/- 0.31 in nonsurvivors vs. 7.30 +/- 0.17 in survivors [p < .05]). Of the 23 patients with initially high lactate concentrations, 12 (60%) of the 20 patients with low intramucosal pH died, as compared with one (33%) of the three patients with normal intramucosal pH (p = .052). Of the 14 patients with persistently high lactate concentrations at 24 hrs, all nine (100%) patients with low intramucosal pH, but only two (40%) of five patients with normal intramucosal pH died (p < .001). No significant relationship was found between lactate or intramucosal pH and oxygen-derived variables. Intramucosal pH correlated better with gastric intramural PCO2 (r2 = .58) than with arterial bicarbonate or base deficit/excess. Intramural PCO2 was a more specific predictor of mortality than intramucosal pH. When compared with patients with normal lactate concentrations, those patients with high lactate concentrations had a higher pH gap (0.22 +/- 0.22 vs. 0.07 +/- 0.13 [p < .01]) and PCO2 gap [21.0 +/- 33.9 vs. 1.8 +/- 9.8 torr [2.79 +/- 4.5 vs. 0.24 +/- 1.34 kPa]; p < .01). CONCLUSIONS: Both lactate concentrations and intramucosal pH represent reliable prognostic indicators in severe sepsis, and their combination improves the prognostic assessment in these patients. Both variables are better prognostic indicators than oxygen-derived variables. Intramural PCO2 appears to be a more specific variable than intramucosal pH, which partially reflects systemic metabolic acidosis. Combined determinations of blood lactate concentrations and intramucosal pH or intramural PCO2 may help to predict outcome from severe sepsis.

APACHE↗
PubMed1995

Drug-induced hyperthermia in a patient with persistent vegetative state. Case report and review of the literature.

The case of posttraumatic patient with persistent vegetative state and severe and prolonged hyperthermia (T = 39-40 degrees C for more than 20 days), in absence of infection, is described. Diffuse muscular rigidity, treated with L-dopa, slightly preceded the onset of hyperthermia, which was treated with several antipyretics, including phenotiazines. The withdrawal of these drugs and the administration of dantrolene and bromocriptine was followed by the restoration of the normal body temperature.

Adult↗
PubMed1994

Impact of emergency medical helicopter service on mortality for trauma in north-east Italy. A regional prospective audit.

The hypothesis that high level on-the-field ATLS could influence mortality in severe trauma patients was tested by means of a prospective study. During a 7 month period, data of all the victims of severe involuntary trauma (road traffic accidents, work and sport accidents) in 3 Provinces of north-east Italy were entered in a database and analysed. The whole area is covered by a single emergency service which has direct control over all the ambulances and the Emergency Helicopter Service (EMHS). The area concerned by the study has a surface of 7,300 kmq with a population of 1 million inhabitants and is served by 12 first level hospitals and 4 second level institutions (trauma centres). All the patients who were still alive at the time of arrival of the first rescuers were considered, but only severe trauma patients with ISS > 15 were enclosed into the study. All the patients were followed up to their discharge from the ICUs (end point). There were three different rescue approaches: 82 Patients (GROUP A) were rescued by EMTs with BLS training, transported to the nearest level 1 hospital for stabilisation and subsequently transferred to a trauma center; 98 Patients (GROUP B) were rescued by EMTs and directly transported to a trauma centre which was the nearest institution; 42 Patients were rescued on the scene by the EMHS team including an anaesthesiologist with 10 years experience in trauma care and directly transported to a trauma centre after full on-the-field stabilisation (GROUP C) RESULTS: 222 severe trauma patients (ISS > 15) were considered. Mean ISS was 35.1 +/- 18.2 in group A, 33.4 +/- 19.6 in group B and 36.0 +/- 17.8 in group C. 67 patients died previous to ICU discharge (31%). 31 over the 82 pts in Group A (38%) died. 23 of them died even before reaching the trauma centre. The mean time elapsed between the first emergency call and the arrival at the trauma centre was 162 min (90'-300'). Mean ICU stay for patients who survived was 15 days. In Group B 31 over 98 patients (32%) died before ICU discharge. The mean time between the emergency call and hospital admission was 27'. Mean ICU stay for patients who were discharged, was 13 days. 5 over 42 patients rescued by the EMHS (Group C) died, none of them in the pre-hospital setting. Stabilisation included tracheal intubation in 34 cases (81%) and thoracic drainage in 6 (14%). All the patients arrived at the hospital with 2 i.v. line. The average amount of infused fluids were 600 mls of colloids and 810 mls of crystalloid. 13 patients with hypotension received and average of 1000 mls of colloids and 1200 mls of crystalloid. The average time elapsed between the emergency call and the final admission to the definitive care institution was 55'. Mean ICU stay was 11 days. Mortality rate in this group was 12%, significantly lower than in group A (p < 0.005) and group B (p < 0.05).

Air Ambulances↗