Search PubMed⌕ Search

Biomedical subjects

G Fanelli

Publications and source records attributed to G Fanelli.

At least 91 records · Page 5Linked to original sources
PubMed1997

Haemodynamic monitoring during alkalinized lignocaine epidural block: a comparison with subarachnoid anaesthesia.

Cardiovascular responses after epidural alkalinized lignocaine and subarachnoid hyperbaric bupivacaine administration were studied using a non-invasive cardiac output measurement in 32 ASA Grade I-II patients undergoing orthopaedic leg surgery (hip hemi-arthroplasty or Ender nailing). All patients achieved adequate surgical anaesthesia. The block onset time was faster (P = 0.003), and the range of final sensory level wider (P = 0.006) in patients receiving spinal anaesthesia compared with the epidural group. Diastolic arterial pressure was significantly reduced when compared with base-line (P = 0.002) only in the spinal group. No significant changes in stroke volume, systemic vascular resistance or left ventricular stroke work were observed in either group. Heart rate and cardiac index were significantly reduced in the spinal group when compared both with base line (P = 0.002; P = 0.04) and the epidural group (P = 0.001; P = 0.006). The results demonstrated that the block onset time and the cardiovascular effects produced by lumbar epidural anaesthesia, with alkalinized solutions, remain less than after spinal anaesthesia involving the same segments.

Anesthesia, Epidural↗
PubMed1997

[Perioperative thermal homeostasis. A duty of the anesthesiologist].

Anaesthesia, surgical procedures and operating room temperature can deeply alter the human thermoregulatory system. Unexpected and sometimes serious perioperative complications can occur. Many studies have been carried out in order to describe and evaluate the detrimental effects produced by different anaesthesia procedures (whether by general, regional or integrated anaesthesia) on thermic homeostasis. More recently it has also been reported that perioperative hypothermia significantly affects patients' outcome, increasing intraoperative blood losses, incidence of postoperative wound infection, and hospital stay. Italian anaesthetists have still a poor consideration about intraoperative body temperature monitoring and patients' warming as basic important skills for a better anaesthesiologic patients management. According with the literature, we do believe that this is not a right opinion. The purpose of the present paper would be to point out the most important knowledges concerning thermic homeostasis management, in order to increase anaesthesiologist's awareness in this essential field of patients perioperative care.

Anesthesia↗
PubMed1994

24-hour blood pressure profile in Addison's disease.

The purpose of this study was to evaluate the circadian blood pressure rhythmicity in patients with primary adrenal insufficiency. Ten newly diagnosed and untreated patients with Addison's disease, 17 addisonian patients (including the previous 10) following an adequate regimen of corticosteroid replacement therapy, and 15 healthy subjects as a control group were studied. Twenty-four-hour ambulatory blood pressure and heart rate were measured automatically every 30 min using a Takeda TM-2420 recorder. The runs test, used for detecting blood pressure diurnal rhythm, was compatible with a rhythm in 2 of 10 patients with untreated Addison's disease, in 13 of 17 patients with treated Addison's disease, and in 13 of 15 normals. Six of eight addisonian patients showing no evidence of blood pressure rhythm in the untreated state acquired circadian periodicity during therapy. An analysis of blood pressure readings by Fourier series with four harmonics showed that blood pressure mesor was lower in untreated than in treated addisonian and normal subjects (P < .05). The nocturnal fall was smaller for systolic and diastolic blood pressure in untreated than in treated addisonian and normal subjects (P < .05). Adrenocortical insufficiency is often characterized by loss of circadian blood pressure rhythm, and normal rhythm can be reestablished by replacement therapy. Lack of cortisol rhythm or persistent activation of the renin-angiotensin system and sympathetic tone may play a role in this phenomenon.

Addison Disease↗
PubMed1992

[Locoregional anesthesia for surgical arthroscopy of the knee].

A new technique for regional anaesthesia for arthroscopy of the knee is presented. The method includes sciatic nerve block according to the technique proposed by Labat, through a posterior approach and the block of the femoral and lateral cutaneous nerves using a single anterior approach. Results obtained in 30 patients are presented: they include good stability of the cardiovascular and respiratory parameters, high efficiency and duration of anaesthesia resulting in a satisfactory surgical procedure.

Adult↗
PubMed1980

An interesting case of pancreaticoduodenal trauma.

A case of severe duodenal trauma is described in which duodenal rupture occurred but relative integrity of the pancreas was maintained. Conservative surgical management with construction of a new papilla of Vater and with anastomotic protection by a gastrojejunostomy proved successful and obviated the need for pancreaticoduodenectomy.

Abdominal Injuries↗
PubMedDate not supplied

Glutamine transaminase K intranephron localization in rats determined by urinary excretion after treatment with segment-specific nephrotoxicants.

Glutamine transaminase K(GTK) excretion assessed in urine and by kidney histology was evaluated in rats after single treatment with 1.0 mg/kg i.p. of mercuric chloride, 100 mg/kg i.p. of hexachloro-1:3-butadiene (both S3, pars recta, segment-specific nephrotoxicants) and 25 mg/kg s.c. of potassium dichromate (S1-S2, pars convoluta, segment-specific nephrotoxicant). The aim was to correlate segment-specific injury and enzyme excretion in order to assess, using non-vasive methods, localization of GTK along the proximal tubule. Mercuric chloride and hexachloro-1:3-butadiene produced early focal damage in the pars recta (focal necrosis was shown 10 h after treatment, and diffuse necrosis appeared later at 34 and 24 h after treatment). Changes of the pars convoluta were occasional and delayed (72 h after treatment for both substances). On the contrary, potassium dichromate induced damage of the pars convoluta (vacuolar degeneration and focal necrosis were evident 24 h and 48 h after treatment, respectively), whereas the pars recta was affected later (focal vacuolar degeneration was observed 72 h after treatment). Increase urinary GTK excretion was early after treatment with mercuric chloride and hexachloro-1:3-butadiene (significant increase was observed within 10 h), with a peak for both substances 24 h after treatment, in agreement with the necrosis of the pars recta. Potassium dichromate induced a significant increase of enzyme excretion in urine also 24 h after injection, according to histological features showing vacuolar degeneration of the pars convoluta; the peak of excretion was reached 48 h after treatment (delay was due, probably, to s.c. administration). The results show that GTK increased in urine after treatment with S3 and S1-S2 specific nephrotoxicants; the combination of histological examination and urinary enzyme supports the evidence that the enzyme is distributed along the whole of the proximal tubule.

Animals↗
PubMedDate not supplied

Glutamine synthetase activity in rat urine as sensitive marker to detect S3 segment-specific injury of proximal tubule induced by xenobiotics.

The possibility of detecting segment-specific injury of the proximal tubule by means of urinary enzymes was investigated in rats. Urinary glutamine synthetase, an enzyme exclusively localized in the S3 segment, and N-acetyl-beta-D-glucosaminidase, prevalently a S1-S2, but S3 enzyme also, were determined after single treatment with 100 mg/kg body wt. of hexachloro-1:3-butadiene (HCBD; i.p.), toxic for the S3 segment, or 25 mg/kg body wt. of potassium dichromate (s.c.), toxic for the S1-S2 segments. Excretion of total urinary proteins was also measured. In addition, a dose-response relationship was determined between three doses (50, 100 and 200 mg/kg body wt.) of HCBD and glutamine synthetase activity in urine. Glutamine synthetase activity, measured according to a new assay for urine based on modification of methods developed for organs, increased in the urine only when the S3 segment of the proximal tubule was damaged, as demonstrated by histological findings of the kidneys. HCBD caused early excretion of the enzyme related to the necrosis of the S3 segment, whereas potassium dichromate caused a slight increase only when the resulting lesion to this segment (vacuolization) began to develop. On the contrary, N-acetyl-beta-D-glucosaminidase activity showed the peak of excretion 24 and 34 h after treatment with HCBD or potassium dichromate, respectively, according to the histological findings of necrosis of the S3 segment (the former) and vacuolization of the S1-S2 segments (the latter). Excretion of total urinary proteins reached the peak 24 h (HCBD) and 48 h (potassium dichromate) after treatment. HCBD at 200 mg/kg body wt, caused a peak of glutamine synthetase activity in urine 10 h after injection, whereas the peak caused by doses of 50 and 100 mg/kg body wt. occurred 24 h following treatment. The peak of enzyme activity in urine significantly increased with the dose. The results suggest that the measurement of urinary activity of S3 segment-specific enzyme as glutamine synthetase allows us to detect early S3 segment-specific injury of the proximal tubule. In addition, the method for urinary enzyme activity appears sensitive, simple and fast.

Acetylglucosaminidase↗
PubMedDate not supplied

A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia.

BACKGROUND AND OBJECTIVES: The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. METHODS: With Ethical Committee approval and patient's consent, 120 patients were randomized to receive CSE by the needle-through-needle (SST; n=60) or the double-segment technique (DST; n=60). A blind observer measured the time required from skin disinfection to readiness for surgery (loss of pinprick sensation up to T10), failure of dural puncture, need for epidural top-up before surgery, patient acceptance, and occurrence of complications. RESULTS: No neurologic complications were observed in either group. Time to readiness for surgery was 22.7+/-8.2 minutes in the SST group and 29.8+/-8.31 minutes in the DST one (P < .001). Dural puncture was unsuccessful in three patients in the SST group (5%) and in one patient in the DST group (1.6%) (ns); inadequate spread of spinal anesthesia was observed in five patients in the SST group (8.3%) and in eight patients in the DST group (13.3%) (ns). No difference in the incidence of hypotension, postdural puncture headache, and back pain was observed between the two groups. Acceptance of anesthetic procedure was better in the SST (85%) than in the DST group (66.6%) (P < .05). CONCLUSIONS: The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.

Anesthesia, Epidural↗