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Biomedical subjects

G Mombelli

Publications and source records attributed to G Mombelli.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Alcohol and drug abuse: a retrospective analysis of incidence in a regional hospital 1993-1994].

This retrospective study analyzes and compares the incidence of admissions for alcohol and drug (i.e.: heroin and cocaine) induced diseases to the internal medicine service of Locarno Regional Hospital (61 beds plus intensive care unit) between January 1, 1993 and December 31, 1994. Of 4038 admissions, 298 (7.4%) were related to alcoholism and drug addiction. 4.2% of all hospital days were due to alcohol abuse, whereas 3.2% were related to drug abuse (of these 1.8% were for HIV-associated diseases and 0.9% for withdrawal treatment). The male/female ratio was 3:1 in both groups, the average age of women being significantly lower in the alcoholic group (50.5 +/- 14.4 years vs. 58.1 +/- 12.9; p = 0.003). Over 90% of the patients with alcohol-induced conditions continued to consume alcohol. On the contrary, only 16% of the HIV-positive patients were still drug-addicted. The in-hospital mortality was 6% (5% in the alcoholic group; 1.6% and 12%, respectively, in the HIV-negative and HIV-positive groups of drug addicts). This study confirms the high prevalence of diseases related to alcohol and drug abuse. Women are less affected, but show complications of alcohol abuse earlier. Despite the HIV epidemic in our area, the admissions of alcoholics to the hospital are more frequent than those of drug addicts. Most of the drug addicts with an HIV-associated condition are in remission, whereas alcoholics with alcohol-induced diseases continue, for the most part, to be alcohol-dependent.

Adolescent↗
PubMed1995

[Amoxicillin and clavulanic acid versus amoxicillin plus gentamicin in the empirical initial treatment of urinary tract infections in hospitalized patients].

We compared the fixed combination amoxicillin plus clavulanic acid with that of amoxicillin plus gentamicin in the empirical initial treatment of severe urinary tract infections. The study included 87 hospitalized patients (51 women and 36 men, mean age 58 +/- 22 years) with acute uncomplicated pyelonephritis (n = 48) or with complicated urinary tract infections (n = 39). 80 patients (92%) had fever and 31 patients (36%) positive blood cultures. 45 patients were randomly assigned to amoxicillin plus clavulanic acid and 42 to amoxicillin plus gentamicin. Overall, 18 patients (21%) were infected with organisms resistant in vitro to amoxicillin plus clavulanic acid, whereas no pathogen was isolated with resistance to amoxicillin plus gentamicin (p < 0.0001). At the end of the empirical treatment (4.2 +/- 1.5 days after the start), significant bacteriuria was present in 6/39 patients (15%) assigned to amoxicillin plus clavulanic acid, compared to 0/34 patients assigned to amoxicillin plus gentamicin (p < 0.05). The clinical response was satisfactory in both groups, and the time from start of therapy to resolution of fever was 2.2 +/- 1.4 days in the amoxicillin plus clavulanic acid group and 2.3 +/- 1.7 days in the amoxicillin plus gentamicin group. Although the in-vitro resistance did not result in a lower clinical efficacy of amoxicillin plus clavulanic acid compared to amoxicillin plus gentamicin in our relatively small sample of patients, the data indicate that the antimicrobial activity of amoxicillin plus clavulanic acid is inadequate to cover the spectrum of causative agents in hospitalized patients with pyelonephritis or complicated urinary tract infections. Amoxicillin plus clavulanic acid should therefore not be used in the initial empirical treatment of these infections.

Adult↗
PubMed1995

[Megaloblastic anemia: 30 cases in a district hospital].

The high incidence of megaloblastic anemia observed at our institution (2.1% of hospital admissions) prompted us to analyze the causes of cobalamin and/or folate deficiency in 30 patients admitted during the period 1983-1991 to the Medical Department of Locarno District Hospital. The study population includes 19 women and 11 men with a mean age of 69 years (range 28-91 years). All patients had severe macrocytic anemia (mean hemoglobin 74 +/- 23 g/l, MCV 121 +/- 12 fl), striking megaloblastic changes in aspirated marrow, and an elevated serum level of LDH (2170 +/- 2150 U/l). 19 patients had associated thrombocytopenia, 12 leukopenia and 11 both thrombocytopenia and leukopenia. Treatment led to prompt reticulocytosis and correction of megaloblastic changes in all patients, as well as to nearly complete resolution of the neurologic disorder in a patient with severe spastic ataxia. In 15 patients, megaloblastic anemia was caused by folate deficiency related to alcoholism (n = 6, mean age 55 years) and old age or poverty (n = 9, mean age 73 years). Cobalamin deficiency was present in 9 patients (mean age 69 years); it was due to pernicious anemia in 6 patients and to malabsorption in 2, while the cause remained unexplained in 1. The last patients (mean age 76 years) had deficiency of both cobalamin and folate, related to alcoholism (n = 3) or poverty (n = 3).

Adult↗
PubMed1994

Spontaneous biliothorax (thoracobilia) following cholecystopleural fistula presenting as an acute respiratory insufficiency. Successful removal of gallstones from the pleural space.

A patient presented to the emergency department with tachypnea, fever, a right pleural effusion, and lung consolidation. The computed tomographic guided thoracentesis yielded a greenish fluid with bilirubin. The ultrasound examination demonstrated a distended gallbladder with stones, positioned on the ventral face of the liver and a free communication between the fundus and the pleural cavity. The cholecystopleural fistula was confirmed at operation.

Acute Disease↗
PubMed1993

[Fever with chills].

Abrupt onset of fever with chills represents a body response to various stimuli called exogenous pyrogens. These substances interact with monocytes and macrophages, thus releasing various cytokines including interleukin-1 and tumor necrosis factor (endogenous pyrogens). Endogenous pyrogens act centrally on the thermosensitive neurons in the hypothalamus to increase the core body temperature by increasing heat production and decreasing heat loss. In addition, endogenous pyrogens trigger a non-specific inflammatory response and amplify the specific immune response through activating the T- and B-cell system. Pyogenic infections are the most frequent and most important cause of abrupt onset of fever with chill, but a similar pattern of fever may occur in many other situations. In many instances, a thorough history and a complete physical examination will produce a presumptive diagnosis. Further management decisions depend on the clinical conditions and on the localization of the infection. Patients with compromised vital functions, with involvement of the central nervous system, with chills associated with prolonged fever without localizing symptoms or physical findings, or with symptoms of intraabdominal sepsis, must be promptly hospitalized. The most important aspects of treatment should be directed at the cause of fever, and antipyretic drugs should be used after evaluation of relative risks in the individual case.

Adolescent↗
PubMed1993

Fibrinopeptide A in liver cirrhosis: evidence against a major contribution of disseminated intravascular coagulation to coagulopathy of chronic liver disease.

To test the hypothesis that disseminated intravascular coagulation contributes to hemostatic failure in liver cirrhosis, fibrinopeptide A and fibrin(ogen) degradation fragment E were measured in 69 patients with stable liver cirrhosis and compared with fibrinopeptide A and fibrin(ogen) degradation fragment E in 32 healthy subjects, 33 patients with thromboembolism, and 10 patients with hypofibrinogenemic disseminated intravascular coagulation. Mean fibrinopeptide A in cirrhosis was slightly increased compared with healthy subjects (2.4 vs. 1.8 ng/ml, p < 0.005), but fourfold lower than in thromboembolism (mean fibrinopeptide A 9.7 ng/ml; p < 0.0001), and tenfold lower than in disseminated intravascular coagulation (mean FPA 24.3 ng/ml; p < 0.0001). Single fibrinopeptide A levels in cirrhosis were within the normal range in 75% of the patients, marginally increased in 9%, and definitely increased in 16%. A definite increase in both fibrinopeptide A and fibrin(ogen) degradation fragment E, which characterized the groups of patients with thromboembolism and disseminated intravascular coagulation, was found in 10% of the cirrhotic patients. Among 17 patients with cirrhosis and hypofibrinogenemia, mean fibrinopeptide A (2.7 ng/ml) was tenfold lower compared with mean fibrinopeptide A in patients with hypofibrinogenemic disseminated intravascular coagulation (p < 0.0001), whereas the frequency of increased single fibrinopeptide A levels (29%) was not significantly different compared with the 52 cirrhotic patients without hypofibrinogenemia (single levels elevated in 23% of the cases). Moreover, the frequency of hypofibrinogenemia, thrombocytopenia, or abnormal clotting times was not significantly different in cirrhotic patients with normal fibrinopeptide A level when compared with cirrhotic patients with increased fibrinopeptide A. These findings do not support an important contribution of disseminated intravascular coagulation to coagulopathy of liver cirrhosis.

Adult↗
PubMed1991

[Fatal voluntary poisoning by parenteral paraquat].

Paraquat is a potent herbicide, very toxic in the concentrated liquid form as supplied to farmers. Suicidal poisoning represents a serious emergency with a known high mortality rate. Suicidal poisoning following the parenteral route has been rarely reported. A 16-year-old girl was admitted to our emergency unit after subcutaneous injection of gramoxone 20% (about 400 mg of paraquat). Despite immediate surgical excision and revision, and subsequent antioxidant treatment with N-acetylcysteine (400 mg/kg/day during 48 hours), she died 17 days later from refractory hypoxemia following pulmonary fibrosis. From this observation and from the literature, it appears that an effective treatment does not depend on changes in the toxicokinetics of the herbicide (hemoperfusion, antidotes, drugs).

Adolescent↗
PubMed1990

[Poisoning with oleander leaves].

After ingestion of seven leaves of oleander (Nerium oleander) in a suicide attempt, a 37-year-old woman was admitted to hospital with symptoms of digitalis intoxication. The serum digoxin level on arrival was 5.69 nmol/l. The course was uneventful. The usefulness of digoxin radioimmunoassay to demonstrate poisoning with oleander (but not to predict the degree of toxicity) and the potential use of digoxin-specific Fab-antibody fragments in this situation are discussed.

Adult↗
PubMed1989

[247 episodes of sepsis at a medical department of a district hospital].

In a retrospective study some epidemiologic and clinical aspects of 247 sepsis episodes observed during the period 1983-88 in the Medical Department of Locarno District Hospital are analyzed. 61% of the 233 patients were aged over 70 and 48% had one or more underlying diseases predisposing them for infection. The commonest sepsis pathogens were gram-negative bacilli (59% of all isolates), followed by pneumococci (15%) and staphylococci (14%). Over 99% of gram-negative pathogens were sensitive to gentamicin, 92% to ceftriaxone. 78% to amoxycillin clavulanate, 74% to cotrimoxazole and 59% to ampicillin; 19% of staphylococcus strains were methicillin-resistant. The most frequent sites of entry for the pathogens were urinary tract (39% of all episodes), the lower respiratory tract (22%) and the gastrointestinal tract (12%). Infection-related mortality was 9% and total hospital mortality 18%. The least favourable prognostic factors were severity of the underlying disease, initial circulatory shock and pulmonary localization of infection (especially where the causative agents were other than pneumococci).

Adult↗
PubMed1988

[Plasmapheresis therapy in Guillain-Barré polyneuroradiculitis].

The outcome of Guillain-Barré polyneuritis is not always benign. Since no therapy of proven effectiveness is available and an immunologic etiology is presumed, plasma exchange treatment has been repeatedly used. We report on three patients with severe polyneuritis who were unable to walk. Two were also in acute respiratory failure. All the cases exhibited surprisingly good improvement correlating in time with plasma exchange. A review of the literature suggests that plasma exchange can at least be recommended in severe cases of Guillain-Barré acute polyneuritis with inability to walk. Treatment should be started within 1-2 weeks of onset of the disease.

Adult↗
PubMed1987

Relationship between fibrinopeptide A and fibrinogen/fibrin fragment E in thromboembolism, DIC and various non-thromboembolic diseases.

Increased fibrinopeptide A (FPA) levels have been reported in various non-thrombotic disorders, including cancer, acute myocardial infarction, liver cirrhosis and collagen vascular diseases. To investigate the significance of these findings, the present study combined the radioimmunoassay of FPA with that of fibrinogen/fibrin degradation fragment E (FgE) in the aforementioned disorders and compared the results with those observed in healthy subjects as well as in patients with thromboembolism and overt disseminated intravascular coagulation (DIC). Mean FPA and FgE in malignancy were 6.3 and 305 ng/ml, in myocardial infarction 5.6 and 98 ng/ml, in liver cirrhosis 2.7 and 132 ng/ml and in collagen vascular diseases 5.6 and 142 ng/ml. All these values were significantly higher than in healthy controls (mean FPA 1.6 ng/ml, mean FgE 49 ng/ml) but significantly lower than in thromboembolism (mean FPA 10.7 ng/ml, mean FgE 639 ng/ml). and DIC (mean FPA 22.0 ng/ml, mean FgE 1041 ng/ml). The overall correlation between FPA and FgE was highly significant. However, different disorders showed peculiar patterns in FPA, FgE and fibrinogen levels. In malignancy, a definite increase of FPA, FgE and plasma fibrinogen levels was observed. This finding probably indicates a compensated state of (intra- or extravascular) fibrin formation and lysis. Acute myocardial infarction was characterized by a high FPA to FgE ratio, which is interpreted to reflect acute thrombin generation and fibrin formation. FPA in cirrhosis was only marginally elevated with most single values within the normal range, indicating that intravascular coagulation was infrequent and unimportant in quantitative terms.

Collagen Diseases↗
PubMed1986

Fibrin formation and platelet aggregation in patients with acute myocardial infarction: effects of intravenous and subcutaneous low-dose heparin.

Fibrinopeptide A (FPA) and beta thromboglobulin (BTG) were measured in 42 patients with acute myocardial infarction (AMI) allocated on admission to one of three groups: 14 patients received a heparin bolus injection of 5000 IU intravenously followed by a 2-hour intravenous infusion (830 IU/hr) (group 1), 14 patients received a heparin bolus of 5000 IU subcutaneously (group 2), and the remaining 14 patients received no anticoagulant treatment (group 3). In group 1 the initially elevated FPA level of 5.8 +/- 1.8 ng/ml dropped to 2.0 +/- 1.5 ng/ml 30 minutes after the intravenous heparin bolus injection of 5000 IU (p less than 0.001) and returned to normal (1.9 +/- 0.8 ng/ml) in 8 of 14 patients. The initially elevated BTG level of 64 +/- 21 ng/ml did not change significantly during intravenous heparin treatment, whereas there was a rapid but only transitory increase in platelet factor 4, (PF4) from 25 +/- 9 to 74 +/- 16 ng/ml (p less than 0.01) after the intravenous heparin bolus. In group 2 the initial FPA of 5.0 +/- 2.3 ng/ml was similarly elevated as in group 1 and dropped to 2.7 +/- 1.7 and 3.3 +/- 1.5 ng/ml 2 and 4 hours after 5000 IU subcutaneously (p less than 0.05), whereas 6 and 8 hours after subcutaneous heparin bolus the mean FPA levels were 4.2 +/- 1.7 and 5.5 +/- 2.0 ng/ml and no more significantly different from the initial FPA values. BTG and PF4 did not change significantly after the subcutaneous heparin bolus. In group 3 the initially elevated mean FPA level of 4.9 +/- 2.4 ng/ml did not change significantly during the first 8 hours after admission, whereas the FPA level 24 hours after admission was 8.4 +/- 3.9 ng/ml and higher than the initial value (p less than 0.01). We conclude that heparin may reduce the elevated FPA level in plasma found in patients with AMI; however, neither subcutaneous nor intravenous heparin in a dosage frequently used is sufficient to consistently normalize the elevated rate of fibrin formation found in these patients.

Aged↗
PubMed1985

[Aminoglycoside levels in bronchial secretions].

Aminoglycosides are of limited clinical efficacy in gram-negative bacillary pneumonia, although they are commonly employed to treat this infection. This poor efficacy has been related in part to host factors (abnormalities in the lung, immunocompromise) and in part to pharmacologic factors. In particular, aminoglycoside levels in bronchial secretions are often borderline or inadequate in relation to the minimal inhibitory concentrations for most gram-negative strains. The low aminoglycoside concentrations result from poor penetrance into the respiratory tract or from local inactivation of these drugs, but basically reflect their low therapeutic-to-toxic ratio. The endotracheal injection of aminoglycosides resulted in high bactericidal activity within the bronchial lumen and in increased clinical efficacy, without increasing systemic toxicity. In view of the potential dangers of topical antibiotics, however, endotracheal treatment should be confined to selected patients.

Administration, Topical↗
PubMed1985

Campylobacter fetus subspecies fetus bacteremia.

Eight patients with Campylobacter fetus bacteremia, six of them with serious underlying diseases, were seen in a two-year period. Besides fever, which was observed in all cases, the most frequent clinical manifestation was lower extremity phlebitis and cellulitis (four patients). In one of these patients, it had the peculiar aspect of bilateral pretibial cellulitis. One patient had vertebral osteomyelitis, a complication, to our knowledge, not yet described. Two patients, both with advanced underlying diseases, died. The five patients who completed a two- to three-week course of erythromycin gluceptate, all had initial clinical improvement. However, one patient suffered a relapse at the end of treatment, and progression of vertebral osteomyelitis while on erythromycin therapy was observed in another patient. These clinical and bacteriologic failures occurred despite the in vitro sensitivity to erythromycin of the two strains. This suggests that erythromycin might not be adequate therapy for C fetus septicemia.

Adult↗