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Biomedical subjects

G Torri

Publications and source records attributed to G Torri.

216 records · Page 12Linked to original sources
PubMedDate not supplied

High resolution NMR spectroscopy of physiological fluids: from metabolism to physiology.

High resolution NMR spectroscopy of physiological fluids provides quantitative, qualitative and dynamic information on the metabolic status of the interstitial and plasma compartments under a variety of pathophysiological conditions. The simultaneous detection and quantitation by NMR spectroscopy of numerous compounds of the intermediary metabolism offers a new insight in the understanding of the milieu intérieur. NMR spectroscopy of physiological fluids offers a unique way to define and monitor the global metabolic homeostasis in humans. The development of this analytical approach is still limited by the scarcity of pluridisciplinary teams able to fully exploit the wealth of information present on the NMR spectrum of a fluid. While application in pharmacology and toxicology is already established, the main areas of current development are cancer, hereditary metabolic disorders, organ transplantation and neurological diseases.

Body Fluids↗
PubMedDate not supplied

Frequency of hypotension during conventional or asymmetric hyperbaric spinal block.

BACKGROUND AND OBJECTIVES: The purpose of this randomized, double-blind study was to evaluate if use of an asymmetric spinal block affects the incidence of hypotension during spinal anesthesia. METHODS: With Ethical Committee approval and patient consent, 120 patients undergoing lower limb surgery were placed in the lateral position with the side to be operated on dependent, and received 8 mg 0.5% hyperbaric bupivacaine through a 25-gauge Whitacre spinal needle. Patients were randomized to one of two groups: (a) local anesthetic was injected with barbotage through a cranially directed needle orifice, then patients were immediately turned to supine (conventional, n = 60); (b) local anesthetic was injected without barbotage with the needle orifice turned toward the dependent side, then the lateral position was maintained for 15 minutes (unilateral, n = 60). A blind observer recorded noninvasive hemodynamic variables, as well as loss of cold and pinprick sensation and motor block on both sides. RESULTS: In the unilateral group, 31 patients (52%) showed a unilateral loss of cold sensation and 48 patients (80%) had no motor block on the nondependent side for the duration of the study, whereas all conventional patients had bilateral distribution of spinal block (P < .0001). The onset time and two-segment regression of sensory block on the dependent side were more rapid in the conventional group (18 +/- 7 minutes and 60 +/- 18 minutes) than in the unilateral group (22 +/- 8 minutes and 67 +/- 19 minutes) (P < .05 and P < .05, respectively). The incidence of hypotension (SAP decrease >30% from baseline) was higher in the conventional (22.4%) than unilateral group (5%) (P < .01). The maximum percentage changes from baseline values of systolic arterial blood pressure and heart rate were greater in conventional group (-28% +/- 16% and -19% +/- 10%) than in unilateral group (-8% +/- 16% and -12% +/- 18%) (P < .0001 and P < .01, respectively). CONCLUSIONS: Achieving an asymmetric distribution of spinal block by injecting a small dose of 0.5% hyperbaric bupivacaine through a Whitacre spinal needle into patients placed in the lateral position for 15 min reduces the incidence of hypotension during spinal anesthesia.

Adult↗
PubMedDate not supplied

Effects of speed of intrathecal injection on unilateral spinal block by 1% hyperbaric bupivacaine. A randomized, double-blind study.

BACKGROUND: To evaluate if the speed of intrathecal injection affects the lateral distribution of spinal block during unilateral spinal anaesthesia with 1% hyperbaric bupivacaine. METHODS DESIGN: prospective, randomized, double-blind study. SETTING: anaesthesia Department at a University Hospital. PATIENTS: 30 ASA physical status I-II patients, scheduled for elective orthopedic surgery involving one lower limb only (ankle and foot surgery). INTERVENTIONS: after placing the patients in the lateral decubitus position with the site to be operated on dependent, dural puncture was performed at L3-L4 interspace using a 25-Gauge Whitacre spinal needle. After the needle hole had been turned toward the dependent side, patients were randomized to receive 8 mg of 1% hyperbaric bupivacaine injected over either 40 sec (Group SLOW, n = 15) or 3 sec (Group FAST, n = 15). The lateral position was maintained for 15 min. MEASUREMENTS: a blind observer evaluated the evolution of sensory (pinprick test) and motor (modified Bromage scale) blocks on both the dependent and nondependent sides until the regression of motor block by one degree. RESULTS: No differences in the maximal sensory level on both the dependent and nondependent sides were observed in the two groups. Unilateral sensory block was onserved in 6 patients in group SLOW (40%) and in 5 patients in group FAST (33%), (p = not significant[NS]. Unilateral motor block was observed in 9 patients in group SLOW (60%) and in 10 patients in group FAST (66%) (NS). CONCLUSIONS: Extremely reduced speeds of intrathecal injection did not improve the lateral distribution of spinal block when injecting 8 mg of 1% hyperbaric bupivacaine through a pencil-point directional spinal needle.

Adult↗
PubMedDate not supplied

Shortening the discharging time after total hip replacement under combined spinal/epidural anesthesia by actively warming the patient during surgery.

BACKGROUND: To compare passive thermal insulation by reflective blankets with forced-air active warming on the efficacy of normothermia maintenance and time for discharging from the recovery room after combined spinal/epidural anesthesia for total hip arthroplasty. METHODS DESIGN: Prospective, randomized study. SETTING: Inpatient anesthesia at three University Departments of orthopedic surgery. PATIENTS: 50 ASA physical status I-III patients, who were scheduled for elective total hip arthroplasty. INTERVENTIONS: Patients received combined spinal/epidural anesthesia (CSE) with intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine. All procedures started 8-10 a.m., and operating room temperature was maintained between 21-23 degrees C, with relative humidity ranging between 40-45%. As warming therapy patients received either passive thermal insulation of the trunk, the two upper limbs and the unoperated lower limb with reflective blankets (group passive, n = 25), or forced-air active warming of the two upper limbs (group active, n = 25). Core temperature was measured before CSE placement (baseline), and then every 30 min until recovery of normothermia. RESULTS: Demographic data, duration of surgery, intraoperative blood losses, and crystalloid infusion were similar in the two groups. Arterial blood pressure decreased in both groups compared with baseline values, while no differences in heart rate were observed during the study. Core temperatures in passive group patients decreased more markedly than in actively warmed patients, with a 1 degree C difference between the two groups at the end of surgery (p < 0.0005). At recovery room entry seven patients in group active (24%) and 16 patients in group passive (64%) showed a core temperature < 36 degrees C (p < 0.01). Achievement of both discharging criteria and normothermia required 32 +/- 18 min in active group and 74 +/- 52 min in passive group (p < 0.0005). CONCLUSIONS: Forced-air cutaneous warming allows the anesthesiologist to maintain normothermia during combined spinal/epidural anesthesia for total hip replacement even if the convective blanket is placed on a relatively small skin surface with reflex vasoconstriction. Maintaining core normothermia decreased the duration of postanesthesia recovery and may, therefore, reduce costs of care.

Aged↗
PubMedDate not supplied

[Percutaneous or surgical trachetomy. Prospective, randomized comparison of the incidence of early and late complications].

BACKGROUND: To compare early and late complications after either conventional surgical or percutaneous dilatational tracheostomy. DESIGN: Prospective, randomized study. SETTING: General intensive care unit and neuro-surgical intensive care unit in a university hospital. PATIENTS: 50 consecutive patients, requiring tracheostomy for prolonged mechanical ventilation. INTERVENTIONS AND MEASUREMENTS: Patients were randomly allocated to receive either surgical (surgical group, n = 25) or percutaneous dilatational tracheostomy (percutaneous group, n = 25). Occurrence of perioperative complication were carefully evaluated during ICU stay. Late complications were evaluated with both physical and endoscopic examination at 1, 3 to 6 months after tracheostomy. RESULTS: All surgical and percutaneous tracheostomies were successfully completed and no deaths directly related to the tracheostomy procedures were reported. Completion of the procedure required 41 +/- 14 min in the surgical group and 14 +/- 6 min in the percutaneous one (p < 0.0001). The incidence of early perioperative complications was higher in the surgical group (36%) than in percutaneous one (12%), (p < 0.05). The endoscopic follow-up demonstrated one segmental malacia and one stenosis of the trachea in the percutaneous group only (p = n.s.). Skin repair was better after percutaneous tracheostomy than in the surgical group (p < 0.01). CONCLUSIONS: In experienced hands, percutaneous dilatational tracheostomy is as safe and effective as the conventional surgical tracheostomy. The percutaneous technique is less time-consuming and has a lower rate of early infectious complications with better cosmetic results than the surgical technique.

Female↗
PubMedDate not supplied

[Role of inhalation anesthetics in current anesthesiological practice].

Inhalational anesthetic agents represented for long time the sole or mainly anesthetic technique in general anesthesia. In the last twenty years, however, their use has been also related to toxicity among operating room personnel, chronically exposed to the volatile agents. This toxicity could induce the anesthesiologist to give up the volatile anesthetic agents in favour of a total intravenous anesthetic technique. Nevertheless well constructed prospective studies have clearly demonstrated that there is no significant correlation between morbidity index and chronic exposure to inhalational anesthetics. Furthermore a valid air exchange in the operating room, as well as more appropriate anesthesiologic procedures, have significantly reduced the concentration of volatile anesthetic agents in the operating areas. Nowadays inhalational anesthetic agents represent one of the different choices to perform general anesthesia. The anesthesiologist, however, according to patient's physical status and surgical procedure, must choose the anesthetic technique compatible with minimal risk both for patient and operating room personnel.

Abnormalities, Drug-Induced↗
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[Monitoring of pediatric patients undergoing magnetic resonance diagnosis with a superconducting magnet].

Magnetic resonance imaging (MRI) has presented to anesthesiologists as unique challenge in patient monitoring because of its construction and principles of operation. Ferromagnetic materials within or near the scanner can distort the magnetic field, and monitoring wires act as antennae and this may result in image degradation. Nevertheless, monitoring is mandatory during MRI, especially in a child sedated or in general anesthesia. A monitoring system, made up of commercially available components, was assessed, and its effects on MR (1.5 tesla unit) image quality system determined. Variables monitored included: electrocardiogram and heart rate, (Sirecust 404, ECG cable set MR; Siemens, Enlanger, West Germany); blood pressure via automated sphygmomanometry (Press Mate BP-8800; Colin, Komaki, Japan); and continuous arterial saturation via pulse oximetry (Nellcor 100 E; Nellcor, Inc., Haywood, California). Fluid infusion rate was controlled by means of a plastic deliver (Dial-a-flo; Abbott Labs., Chicago, Illinois). Body temperature was maintained with a heat insulator blanket (Thermadrape, OR Concepts, Inc., Dallas, Texas). The monitoring technique described did not interfere with MRI function or produce image degradation.

Anesthesia↗
PubMedDate not supplied

[Arthropathy and deformity of the hemophiliac knee in children, with particular reference to femoral-rotular articulation. Evaluation and results].

The Authors analise the main pathogenetic factors in the knee arthropaty and deformity of the young hemophilic patients. They attach particular importance to the patello-femoral joint in the stability of the knee, and describe its typical modifications in the hemophilic knee. Concepts of valuation and prevention for the young patients are indicated and underlined.

Child↗
PubMedDate not supplied

[Thermographic monitoring of the evolution and therapy of chronic synovitis and cysts in hemophiliacs].

The authors have studied the evolution of chronic synovitis and of cysts in hemophilic patients, through measurement of the articular circumference or of the cyst. To obtain this, they have used a folding rule and liquid cristal strips, that have the characteristic, that they change colours from braunish to orange, from greenish to bluish according to the thermic gradient revealed. The authors have studied 21 hemophilic patients, affected from chronic synovitis for a total of 23 articulations and 5 patients with cyst. All patients have undergone several controls reporting dates revealed at 2,6 and 12 months from beginning of disease. The authors conclude, underlining the usefulness of this simple methodic that permits: - a reliable valutation of the therapeutic (profilatic) scheme applied to every single patient and gives a prognostic precision; - distinguishing, in fact, the recovery from the clinical recovery of the synovitis in order to avoid the appearance of unpleasant relapses.

Adolescent↗
PubMedDate not supplied

Comparison between hemodynamic changes after single-dose and incremental subarachnoid anesthesia.

BACKGROUND AND OBJECTIVES: The depressant activity on sympathetic tone of subarachnoid anesthetic block is well known. The aim of this study was to compare cardiovascular response to an incremental dose of subarachnoid anesthesia administered through a small-bore microcatheter with the response to single-dose spinal anesthesia. METHODS: The 26 ASA I or II patients, 45-65 years old, who were undergoing elective gynecologic, urologic, or orthopaedic surgery, were randomized into two groups of 13 each: the first group (SSA) underwent single-shot spinal anesthesia with 1% hyperbaric bupivacaine (0.27 mg/kg), while the second group (CSA) received an incremental 5-mg bolus of the same solution via a subarachnoid 32-gauge microcatheter every 10 minutes. All patients were premedicated and prehydrated with Ringer's acetate 8-10 mL/kg, infused over a 30-minute period. Heart rate, systolic, mean, and diastolic arterial blood pressure, arterial blood gas analysis, and cardiac index (measured by the noninvasive indirect Fick method) were recorded prior to preoperative subarachnoid anesthesia and then 15, 30, and 45 minutes after the first local anesthetic administration. RESULTS: The anthropometric parameters of the patients were homogeneous. No problems regarding anesthetic procedures occurred during the study, and none of the patients developed neurologic sequelae prior to discharge from the hospital. No relevant changes in blood gas parameters were found during the study in either the CSA or the SSA group. With regard to hemodynamic parameters, a significant reduction of systolic, diastolic, and mean arterial blood pressure was found in the SSA group following subarachnoid local anesthetic injection, while arterial pressures did not decrease in the CSA group. Cardiac index showed a nonsignificant increase with respect to baseline values in both groups, with no differences between groups during the study. CONCLUSIONS: In well-hydrated, healthy patients incremental local anesthetics offer adequate subarachnoid anesthesia with minimal hemodynamic effects.

Aged↗
PubMedDate not supplied

Block distribution and cardiovascular effects of unilateral spinal anaesthesia by 0.5% hyperbaric bupivacaine. A clinical comparison with bilateral spinal block.

BACKGROUND: A low dose of hyperbaric local anaesthetic solution, pencil point needle and slow speed of intrathecal injection have been reported to obtain a unilateral distribution of spinal anaesthesia. This should also minimize cardiovascular effects of spinal block. The aim of this prospective, randomized, parallel group study was to evaluate cardiac performance during unilateral subarachnoid block and to compare it with that produced by standard bilateral spinal anaesthesia. METHODS: With Ethic Committee approval and patients' consent we studied 30 ASA I-II patients scheduled for one leg surgery. Dural puncture was performed by 25-G Whitacre needle with patients lying in the lateral position and the side to be operated on dependent. Patients then randomly received 8 mg of 0.5% hyperbaric bupivacaine injected over 80 sec with needle hole orientated towards the dependent side (Unilateral, n = 15), or 15 mg of the same solution injected over 6 sec with needle bevel cranially directed (Control, n = 15). Only patients of the Unilateral group remained in the lateral position for 15 min. Noninvasive Arterial blood pressure, heart rate, stroke volume index and cardiac index were measured before spinal block (baseline) and then at 5, 15, 30 and 45 min; while sensory and motor blocks were evaluated at 15, 30 and 45 min on both sides. RESULTS: Unilateral spinal anaesthesia was observed in 11 patients of the Unilateral group (73%). Three patients of the Control group (20%) required colloids for intraoperative hypotension. Mean arterial blood pressure and heart rate decreased from baseline only in the Control group (p = 0.001 and p = 0.0003 respectively), while heart rate was decreased in Control even when compared to Unilateral group (p = 0.01). The stroke volume index was unchanged in the two groups (p = 0.22), while the cardiac index showed a 15-20% decrease from baseline in Control group (p = 0.001), with a significant decrease at 30 and 45 min when compared to Unilateral (p = 0.01). DISCUSSION: The use of 8 mg of 0.5% hyperbaric bupivacaine slowly injected through a directional needle provided a spinal block relatively restricted to the operative side with minimal effects on cardiovascular homeostasis.

Aged↗
PubMedDate not supplied

Rapid turnover proteins in critically ill ICU patients. Negative acute phase proteins or nutritional indicators?

BACKGROUND: Rapid turnover proteins are often used as metabolic indicators in patients receiving nutritional therapy. However, their plasmatic concentration can be influenced by activation of acute phase reaction due to stress. The aim of this prospective, observational study was to evaluate changes of positive and negative acute phase proteins in mechanically ventilated ICU patients with acute stress. METHODS: Plasmatic concentrations of prealbumin (PRA), retinol-binding protein (RBP), c-reactive protein (CRP) as well as resting energy expenditure (REE) and nitrogen balance were measured in thirty ICU patients before starting nutritional support (Baseline) and then after 3 and 8 days of parenteral nutrition (TPN). RESULTS: Plasmatic concentrations of CRP were high at baseline and did not change (p = 0.47), while RBP and PRA were low and progressively increased during the study (p = 0.0001 and p = 0.004). Percentage changes from baseline of both PRA and RBP were significantly correlated with nitrogen balance (p = 0.01 and p = 0.009); while no significant correlation was observed between changes of rapid turnover proteins and CRP (p = 0.72 and p = 0.10). CONCLUSIONS: All the variables involved in the study are known to be influenced by both metabolic state and resolution of inflammation. However, the observed changes of rapid turnover proteins significantly correlate with nitrogen balance in the face of a persistent inflammation, as documented by CRP plasmatic concentrations. This suggests that RBP and PRA monitoring may be used as complement clinical evaluation of nutritional therapy also in ICU patients with ongoing inflammation.

Acute-Phase Proteins↗