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Biomedical subjects

L Bonetti

Publications and source records attributed to L Bonetti.

At least 19 recordsLinked to original sources
PubMed2004

Regression of left ventricular hypertrophy and improvement of diastolic function in hypertensive patients treated with telmisartan.

OBJECTIVES: The study was designed to test whether or not the angiotensin II receptor blocker telmisartan brings about regression of left ventricular (LV) concentric hypertrophy and whether or not these changes are associated with improved diastolic filling. METHODS: An echocardiographic follow-up study was performed in 85 hypertensive patients (systolic blood pressure [SBP] >140 mmHg, diastolic blood pressure [DBP] >90 mmHg) and mild-to-moderate LV hypertrophy (LV mass index related to body surface area [LVMI] 117-150 g/m2 for men and 105-150 g/m2 for women) treated with telmisartan monotherapy 40-80 mg once daily for 1 year. Blood pressure, LVMI, left atrial (LA) volumes, and diastolic function were determined at baseline and after 3, 6, 9, and 12 months of treatment. Blood pressure was also monitored at all visits. Diastolic function was assessed by examination of transmitral inflow and pulmonary vein flow patterns. RESULTS: Telmisartan reduced blood pressure; after 12 months, the mean+/-S.D. SBP and DBP were reduced from 144+/-10 to 126+/-8 mmHg (p<0.001) and from 98+/-8 to 86+/-7 mmHg (p<0.001), respectively. The LVMI was decreased from 119+/-7 to 109+/-3 g/m2 (p<0.001) after 12 months' telmisartan treatment. All patients had diastolic dysfunction at baseline. After 12 months' telmisartan treatment, a normal pattern of transmitral inflow was present in 21% of patients. The regression of LV hypertrophy observed after 12 months was associated with increased peak early diastolic velocity/peak late diastolic velocity ratio from 0.60+/-0.18 to 0.83+/-0.20 (p<0.001), shortened isovolumic relaxation time (IVRT) from 110+/-13 to 105+/-13 ms (p<0.001), and decreased deceleration time from 229+/-30 to 215+/-28 ms (p=0.002). Univariate analysis showed that shortened IVRT was related to a reduction in the LVMI and LA maximal and minimal volumes. In the multivariate analysis, the reduction in LVMI and the reduction in LA maximal and minimal volumes were independently associated with IVRT reduction. CONCLUSIONS: Telmisartan 40-80 mg is effective in LV hypertrophy regression in hypertensive patients. The reduction in LVMI due to telmisartan monotherapy was associated with a significant improvement of diastolic filling parameters and with a significant reduction of LA volumes.

Benzimidazoles↗
PubMed2000

Monitoring of heavy metal deposition in Northern Italy by moss analysis.

A survey of heavy metal deposition in the mountainous territories of Northern Italy was carried out in 1995-96. Moss samples (mainly Hylocomium splendens) were collected in a dense network of sites (about 3.2 sites/1000 km(2)) and the data of metal concentrations in moss tissues were statistically correlated with environmental and climatic factors, as well as with bulk deposition of elements and elemental concentrations in the soil. Three main geographic patterns of metal concentration in mosses could be defined: (1) Fe, Ni, and Cr, all derived both by soil particulates and anthropogenic emissions connected with ferrous metal manufacturing, were mostly concentrated in Northwestern Italy; (2) Cu and Zn, as typical multi-source elements, showed rather high concentrations with little ranges of variation over the whole area and small peaks reflecting local source points; (3) Cd and Pb reflected long-distance transport and showed highest concentrations in the regions with highest precipitation, especially in the Eastern Alps.

Journal Article↗
PubMed2000

Heparin-induced thrombocytopenia in patients treated with unfractionated heparin: prevalence of thrombosis in a 1 year follow-up.

BACKGROUND: Patients with unstable angina are usually treated with unfractionated heparin and aspirin, but very little is known about the prevalence of heparin-induced antibodies and their relation to thrombotic complications some time after the acute phase of unstable angina. The aim of the present study was to establish the prevalence of heparin-induced thrombocytopenia and the prevalence of heparin-dependent platelet-reactive antibodies in patients treated with unfractionated heparin and the occurrence of thrombosis in a 1 year follow-up. METHODS: Patient population included 124 consecutive patients with unstable angina treated with unfractionated heparin for almost 5 days. The prevalence of heparin-dependent platelet-reactive antibodies using an ELISA assay was measured before the beginning of heparin therapy and after 7 and 40 days. The platelet count was measured at the same time and the presence of thrombotic occurrences was checked. Clinical follow-up lasted 1 year. RESULTS: At baseline no one patient was positive for heparin-induced antibodies. On day 6, 38 patients (30%) produced a positive heparin-induced antibody result and 30 patients (24%) had an intermediate result. The majority of patients (74%) who developed antibodies became positive after 6 days of heparin therapy. The combined incidence of death, myocardial infarction, recurrent angina, urgent revascularization and stroke was 66% in patients with antibodies and 44% in patients without antibodies during a 1 year follow-up. The incidence of combined primary end points was statistically higher in patients positive for antibodies. The log-rank test was statistically significant (chi2 = 4.39, p < 0.01). CONCLUSIONS: No one patient developed a clinical evidence of thrombocytopenia. Nevertheless thrombotic events during follow-up were more common in patients who developed heparin-induced antibodies. These patients need a more accurate evaluation and surveillance after hospital discharge.

Aged↗
PubMed1995

Closed circuit anesthesia: preservation of the environment.

Closed circuit anesthesia must be considered as a primary contributor enabling to reduce the damaging effect of anesthetic agents on the environment. Halogenated vapors and nitrous oxide damage both the macro-environment, i.e. the earth's atmosphere layer and the micro-environment, i.e. the operating room ambience. As nitrous oxide is one of the most toxic agents, and as pure oxygen is harmful to the lungs, a technique of closed circuit anesthesia has been developed which employs oxygen/air (0.35:0.35 l/min) as a carrier of isoflurane. The safety of this oxygen-air technique of closed circuit anesthesia has been demonstrated by the greater stability of oxygen concentrations in the circuit in comparison to the more extensively used oxygen-nitrous oxide technique.

Air Pollutants, Occupational↗
PubMed1995

[Variations of esophageal temperature during general anesthesia with a low-flow circuit].

BACKGROUND: Anaesthesia drugs cause the cutaneous vasodilatation that produces core temperature lowering at the beginning of general anaesthesia; when the thermal threshold for vasoconstriction is reached the cutaneous heat losses are decreased. Furthermore, the soda lime begins to produce water and heat after 40 minutes of closed circuit ventilation. WORK HYPOTHESIS: The technique of inhalatory anaesthesia affects the thermal loss of patients after some hours of ventilation. DESIGN: Prospective randomized clinical trial. SETTING: Surgical Clinical operating theatre of the University of Florence. PATIENTS: 50 patients submited to abdominal non vascular surgery, for longer than 2 hours, with xifo-pubic cut, subdivided into two groups with the same anthropometric characters and age; the first ventilated with open system, the second with low flow circuit (fresh gas flow 700 ml/min). STATISTIC: "t" Student test; MEASURES: Lower one third oesophageal and inspiratory jaw of the circuit temperatures recorded for three hours. MAIN RESULTS: The savings of low flow anaesthesia begin to be significant in the third hour of anaesthesia. CONCLUSIONS: The thermal saving of closed circuit anaesthesia is, very probably, related to the humidifying and the warming of inspired air by soda lime reaction; the effect is more evident if cutaneous losses are reduced.

Anesthesia, General↗
PubMed1995

[Unexpected accumulation of nitrogen in a circuit during low-flow anesthesia. Presentation of two clinical cases].

The authors report two cases of unexpected nitrogen accumulation in the circuit during low flow anaesthesia with a fresh gas flow of 600 ml/min (O2:N2O = 1.1). Though the presence in the anaesthesia circuit of nitrogen eliminated by the patient is a common feature of closed circuit and low flow techniques, the magnitude and the speed of increase of inert gas concentration (compared with data from previous experiences) were highly suspicious for an external source. This was readily identified as a "mini" leak (30 ml/min of N2) from the air flowmeter, although his valve was in fully closed position. The report depicts an uncommon cause of air entry in the anaesthesia circuit and confirms the need for monitoring gases and vapours when closed circuit and low flow techniques are employed.

Anesthesia↗
PubMed1993

[Respiratory mechanics and gas exchange in anesthesia for laparoscopic cholecystectomy].

OBJECTIVE: To evaluate the influence of endoabdominal CO2 insufflation during anaesthesia for laparoscopic cholecystectomy on airway pressure, gas exchange and their relationships. DESIGN: Perspective; clinical investigation. SETTING: Operating room at a central general hospital. PATIENTS: 14 patients (3 males and 11 females) ASA 1-2, non smokers, without lung disease, scheduled for elective laparoscopic cholecystectomy. INTERVENTIONS: During balanced anaesthesia (N2O/O2, Fentanyl, Isoflurane), with fixed minute ventilation, endoperitoneal insufflation of CO2 held at constant pressure (21 cm H2O). MEASUREMENTS: Serial measurements of: Airway pressure, near-static compliance, ETCO2, CO2 minute production, blood gas analysis and derived data: P(a-A)O2, P(a-ET)CO2, Vd/Vt. MAIN RESULTS: During insufflation peak and pause pressures increased by 6 cm H2O and mean pressure; by 3 cm H2O; Compliance was reduced by 48%; PaO2 decreased evenly with time (p > 0.05) irrespective of the airway pressure. PaCO2, PECO2, VCO2 and Vd/Vt after a sharp increase stabilized at 30% (mean value) over the baseline. P(a-ET)CO2 and Vd/Vt fluctuate in the physiological range except for two short but significant changes (p > 0.05) at insufflation and desufflation time. CONCLUSIONS: Laparoscopic technique for cholecystectomy, at least in healthy patients, produces relevant changes in airway pressures but only minor modifications of gas exchange, similar to those seen during general anaesthesia. This technique can be safely used for routine operation with standard monitoring equipment.

Adult↗
PubMed1993

Low incidence of GvHD and rejection after pharmacological ex vivo modulation of bone marrow in 2-3 antigens mismatched BMT.

2-3 antigens mismatched BMT were performed on 32 children without a matched sibling donor. In the light of previous in vitro studies, which suggested a role of Vincristine and Methilprednisolone ex vivo treatment in modulating alloreactivity of T cells, bone marrow was treated with such a pharmacological cocktail before being infused. Acute GVHD 2 degrees to 4 degrees degree occurred in 46% of cases, chronic GVHD in 28%, graft failure in 13%. There was no significant difference between 2- and 3-antigens mismatched BMT as far as GVHD and graft failure are concerned.

Bone Marrow↗
PubMed1992

[Inhalation anesthesia in low-flow systems. Clinical evaluation of the kinetics of isoflurane in induction phase].

Closed circuit and low flow anaesthesia offer numerous advantages such as reduction of gas consumption, low cost, and less pollution in both the operating theatre and the environment. These procedures also offer increases in inspired gas humidity and temperature. However the time needed to attain the alveolar concentration MAC 95, is too long. Prefilling the whole circuit, the bellow and the bag with anaesthetic vapours shortens that time without overdosage.

Anesthesia, Closed-Circuit↗
PubMedDate not supplied

Ketoacidosis and hyperosmolarity as first symptoms of type 1 diabetes mellitus following ingestion of high-carbohydrate-containing fluids.

The concomitant occurrence of diabetic ketoacidosis and hyperosmolarity is reported in two children, as early symptoms of misdiagnosed type 1 diabetes mellitus. The precipitating factor for both severe metabolic abnormalities was the ingestion of a large amount of high-carbohydrate-containing fluids, a few days before admission. A similar situation has never been reported before in the literature. A successful therapeutic scheme is described.

Blood Glucose↗
PubMedDate not supplied

[The nurse educator: an experience among immigrants from developing countries].

Immigration from developing countries to Italy is a recent fact; however, it is causing different problems, even to health. Among these, tuberculosis holds a position of prominence; it is usually endemic in its original countries, but it finds good condition to become acute again in the discomfort and poverty of home countries. The purpose of the work is to test and confirm the promoting and defensive function of health in nursing profession, thanks to a health education project for immigrants which aims at reducing tuberculosis presence. The instrument used is a lesson about tuberculosis characteristics which the proposal to make the tubercular test, right instrument for a precocious diagnosis. The positive results achieved, show us the right evidence that the nurse is an educator: immigrants have also been offered the possibility to defend their health.

Developing Countries↗
PubMedDate not supplied

Bone metastases in the hip region: surgical treatment.

Subjective factors of the patient such as age, weight, occupation, expectations, etc. must be carefully evaluated in terms of surgery. It is always important to remember life expectancy, and the choice of a surgical procedure must be based on it. Limited survival and possible radiation therapy must eliminate methods that require long healing times: we no longer use bone grafts because the risk of healing time taking up too much of the time left for the patient is too high. Reconstructions must have an immediate solidity allowing early use of the limb. Thus, in the proximal femur, we above all use protheses (traditional or modular RPS); in acetabular lesions that do not involve the joint surface, our treatment of choice is curettage with liquid nitrogen and cement, armed with screws and nails. Prostheses, which are always cemented, are assembled using bipolar cups; cases where lysis is so wide on the cotyloid side as to require THR are rare. The cotyles, in cases such as these, are those that allow for anchoring with several sites (Octopus type), the McMinn or, at times, common cotyles in PE.

Adult↗
PubMedDate not supplied

Resection of the proximal humerus for metastases and replacement with RPS prosthesis.

In the surgical treatment of metastatic lesions of the proximal humerus it is important to find solutions that eliminate pain and solve the mechanical problem in a short time and with reduced costs. In 90% of cases, intralesional curettage, freezing with liquid nitrogen and cement enhanced intramedullary instrumentation is capable of brilliantly solving the problems of these patients. When, instead, osteolysis involves the greater tuberosity and/or the joint region, resection of the proximal humerus followed by reconstruction with a modular prosthesis is indicated. Of those available on the market, the RPS system (LIMA) has features that make it equivalent to others, but at costs considerably lower. However, in reconstructions with prostheses, active abduction is significantly limited. A personal series of 20 patients is presented.

Adult↗