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Biomedical subjects

A Carlucci

Publications and source records attributed to A Carlucci.

At least 19 recordsLinked to original sources
PubMed2001

Helium-oxygen in the postextubation period decreases inspiratory effort.

After tracheal extubation, upper and total airway resistances may frequently be increased resulting in an increase in inspiratory effort to breathe. We tested whether breathing a helium-oxygen mixture (HeO(2)) would reduce inspiratory effort in the period after extubation. Eighteen consecutive patients with no chronic obstructive pulmonary disease who had received mechanical ventilation (> 48 h) were successively studied immediately after extubation (N(2)O(2)), 15 min after breathing HeO(2), and after return to N(2)O(2). Effort to breathe, assessed by the transdiaphragmatic pressure swings (DeltaPdi) and the pressure-time index of the diaphragm (PTI), comfort, and gas exchange, were the main end points. The mean reduction of the transdiaphragmatic pressure under HeO(2) was 19 +/- 5%. All but three patients presented a decrease in transdiaphragmatic pressure under HeO(2), ranging from - 4 to - 55%, and a significant reduction in DeltaPdi was observed between HeO(2) and N(2)O(2) (10.2 +/- 0.7 versus 8.6 +/- 1.1 versus 10.0 +/- 0.8 cm H(2)O for the three consecutive periods; p < 0.05). PTI also differed significantly between HeO(2) and N(2)O(2) (197 +/- 19 versus 166 +/- 22 versus 201 +/- 23 cm H(2)O/s/min for the three periods; p < 0.05). Breathing HeO(2) significantly improved comfort, whereas gas exchange was not modified. We conclude that the use of HeO(2) in the immediate postextubation period decreases inspiratory effort and improves comfort.

Administration, Inhalation↗
PubMed2001

Noninvasive versus conventional mechanical ventilation. An epidemiologic survey.

A prospective survey was performed over a period of 3 wk among 42 intensive care units to assess the incidence of use and effectiveness of noninvasive mechanical ventilation (NIV) in clinical practice. All patients requiring ventilatory support for acute respiratory failure (ARF), either with endotracheal intubation (ETI) or NIV, were included. Ventilatory support was required in 689 patients, 581 with ETI and 108 (16%) with NIV (35% of patients not intubated on admission). Reasons for mechanical ventilation were coma (30%), cardiogenic pulmonary edema (7%), and hypoxemic (48%) and hypercapnic ARF (15%). NIV was never used for patients in coma (who were excluded from further analysis), but was used in 14% of patients with hypoxemic ARF, in 27% of those with pulmonary edema, and in 50% of those with hypercapnic ARF. NIV was followed by ETI in 40% of cases. The incidence of both nosocomial pneumonia (10% versus 19%, p = 0.03), and mortality (22% versus 41%, p < 0.001) was lower in NIV patients than in those with ETI. After adjusting for differences at baseline, Simplified Acute Physiology Score (SAPS) II (odds ratio [OR] = 1.05 per point; confidence interval [CI]: 1.04 to 1.06), McCabe/Jackson score (OR = 2.18; CI: 1.57 to 3.03), and hypoxemic ARF (OR = 2.30; CI: 1.33 to 4.01) were identified as risk factors explaining mortality; success of NIV was associated with a lower risk of pneumonia (OR = 0.06; CI: 0.01 to 0.45) and of death (OR = 0.16; CI: 0.05 to 0.54). In NIV patients, SAPS II and a poor clinical tolerance predicted secondary ETI. Failure of NIV was associated with a longer length of stay. In conclusion, NIV can be successful in selected patients, and is associated with a lower risk of pneumonia and death than is ETI.

Aged↗
PubMed2000

Effect of a water-soluble fiber (galactomannans)-enriched formula on gastric emptying time of regurgitating infants evaluated using an ultrasound technique.

BACKGROUND: Milk formulas enriched with water-soluble fibers are a first-line measure for infants with gastroesophageal reflux. However, it has been reported that these compounds could affect gastric emptying. The aim of this study was to evaluate the effects of these thickeners on gastric emptying time in infants with frequent regurgitation or vomiting. METHODS: Forty-seven infants, aged 1 to 12 months, with uncomplicated gastroesophageal reflux underwent two ultrasound evaluations of gastric emptying time after receiving either a standard formula or a formula enriched with 0.4 g galactomannan per 100 ml diluted milk. Gastric emptying time was calculated by measuring the antrum area at baseline and at defined intervals over the next 3 hours. RESULTS: The gastric emptying time (mean +/- SD) for the standard and the thickened formula was 136 +/- 33 and 133 +/- 34 minutes, respectively. There was no significant difference in the gastric emptying patterns of the two formulas. Gastric emptying time was longer after the standard formula in 15 of the 47 subjects, shorter in 15 of the 47, and the same in 17 of the 47. CONCLUSIONS: The ingestion of a water-soluble fiber-enriched formula does not have any significant influence on the gastric emptying time of infants with frequent regurgitation or vomiting.

Dietary Fiber↗
PubMed2000

Noninvasive ventilation with helium-oxygen in acute exacerbations of chronic obstructive pulmonary disease.

The use of helium-oxygen (HeO(2)) was tested in combination with noninvasive ventilation (NIV) in 10 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Effort to breathe as assessed by the respiratory muscle pressure-time index (PTI), work of breathing (WOB), and gas exchange were the main endpoints. Results of NIV-HeO(2) were compared with those obtained with standard NIV (AirO(2)), at two levels of pressure-support ventilation (PSV), 9 +/- 2 cm H(2)O and 18 +/- 3 cm H(2)O. Significant reductions in PTI were observed between HeO(2) and AirO(2) at both the low PSV level (n = 9; 160 +/- 58 versus 198 +/- 78 cm H(2)O/s/ min; p < 0.05) and the high PSV level (n = 10; 100 +/- 45 versus 150 +/- 82 cm H(2)O/s/min; p < 0.01). WOB also differed significantly between HeO(2) and AirO(2) (7.8 +/- 4.1 versus 10.9 +/- 6.1 J/min at the low PSV level, p < 0.05; and 5.7 +/- 3.3 versus 9.2 +/- 5. J/min, p < 0.01 at the high PSV level). HeO(2) reduced Pa(CO(2)) at both the low PSV level (61 +/- 13 versus 64 +/- 15 mm Hg; p < 0.05) and the high PSV level (56 +/- 13 versus 58 +/- 14 mm Hg; p < 0.05), without significantly changing breathing pattern or oxygenation. We conclude that use of HeO(2) during NIV markedly enhances the ability of NIV to reduce patient effort and to improve gas exchange.

Administration, Inhalation↗
PubMed2000

[Obstructive syndrome caused by trichobezoars: historical disease or disease still current? Description of a case in adolescence].

Trichobezoars are masses of entangled material, found in the stomach and intestines, composed of hair ingested by the patient. When the mass grows, symptoms of intestinal occlusion can appear. Trichobezoars in pediatrics are usually found in adolescent females presenting personality disorders and trichophagia. This work describes a case of trichobezoar diagnosed in a 13 year-old girl, wearing a brace for serious scoliosis but absolutely normal from the emotional and psychical point of view, with normal scholastic and familiar situation. Already hospitalized three months before for pneumonia from mycoplasma, the girl comes to our observation for the appearance of vomiting and constipation. The clinical examination reveal an epigastric mass as big as an orange. General conditions and hematochemical tests are good. Lab tests are performed (abdomen echography and upper abdomen MNR) but is the oesophago-gastroscopy which allows the diagnosis. A big trichobezoar is then surgically removed and the gastroenteric symptoms completely disappear.

Adolescent↗
PubMed2000

[It is not so difficult to carry out simple things properly!].

This report is about the results of the experience we did, since 1996, in the nursing unit of a first level mountain hospital in which we work, where we followed a new childbirth and postpartum assistance protocol aimed to humanizing birth and postpartum, promoting exclusive breastfeeding and reducing childbirth risks. The results show that, since the beginning of our experience, we had an evident reduction of preterm childbirth (newborns with less than 36 weeks of gestational age). We also had a reduction of cesarian sections and of neonatal transferrals in second level neonatal units. Furthermore, we had a progressive growth of exclusive breastfeeding. The report also shows that, since 1996, the newborns discharged from our hospital are exclusively breastfed for a time longer than before and that, at 1 year, 11 percent of our children are still breastfed.

Birthing Centers↗
PubMed2000

[Symptomatic congenital cytomegalovirus infection: report of a clinical case with very severe onset].

This document is about a serious congenital CMV case in a 36 weeks' gestation female newborn with intrauterine growth retardation delivered by cesarean section whose mother was drug addicted. At birth the newborn showed petechiae and bloody blisters all over the body, serious hepatosplenomegaly and microcephaly. Laboratory tests showed thrombocytopeny (platelets count 24.000/mm3) requiring platelets and fresh frozen plasma transfusions during stay in the hospital; echoencephalography showed brain cyst in occipital area, dilated ventricles and calcification in the periventricular area; cardiac echography showed congenital cardiopathy with ventricular and atrial septal defect and patent ductus arteriosus. Urinary presence of CMV-DNA and then CMV-DNA in maternal blood and milk were found. The newborn was given 4 days of endovenous iperimmune immunoglobulin, but the treatment with ganciclovir was impossible for her serious hepatopathy. The newborn was discharged at 45 days and followed monthly with a day hospital program. Now she's 10 months old and she has serious neuromotory problems with left emiparesis and she's following a program of neuromuscular re-education at our hospital.

Cytomegalovirus Infections↗
PubMed1999

Oligosaccharides in human milk during different phases of lactation.

Twenty-one oligosaccharides of human milk were quantified by high-performance anion-exchange chromatography. Milk samples were collected from 18 mothers during the first 3 mo of lactation. The data show that the highest amount of all oligosaccharides is present at day 4 postpartum (20 g l(-1)) and then decreases by about 20% at day 30 of lactation. The protective role played by these substances against different infectious agents, in different organs and systems of the breastfed baby, is emphasized.

Adult↗
PubMed1998

Slow compartment features and gas exchange impairment in mild asthma: effects of beta agonist inhalation.

Static and dynamic lung volumes, arterial blood gases, alveolar ventilation and ventilation-perfusion (VA/Q) relationships were studied in 14 mild asthmatic patients and in 7 normal subjects (as controls) before and after fenoterol inhalation. Multiple nitrogen washout curves were analyzed by a bicompartmental distribution model, in order to assess the distribution of ventilation and VA/Q mismatch. At baseline, asthmatics showed mild airway obstruction and gas exchange impairment [forced expiratory volume in 1 s (FEV1) = 79% pred; PaO2 = 87.4; alveolar-arterial oxygen tension gradient (AaPO2) = 22.9 mm Hg]. By analysing nitrogen washout curves, an alveolar slow space representing 45.1% of total lung volume (vs. 36.8% in normals; p = 0.044) was identified; its alveolar ventilation per minute per unit lung volume (VA2/L2) was lower than in normals (p = 0.01). beta-Agonist inhalation by the asthmatics, which reversed airway obstruction (FEV1 = 98% pred.; p < 0.001) and improved gas exchange (PaO2 = 92.6 mm Hg, p < 0.001; AaPO2 = 16.8 mm Hg, p = 0.003), led to a highly significant increase in VA2/L2 (p = 0.001). The improvement in PaO2 was associated with the increase in VA2/L2 (r2 = 0.39; p = 0.017), but not with the increase in FEV1. Lastly, the changes in FEV1 and VA2/L2 were not correlated with each other. We conclude that even in mild stable asthma there is substantial unevenness of ventilation, detectable by bicompartmental analysis of nitrogen washout curves, which is responsible for gas exchange impairment and is not related to common spirometric parameters. In addition, the improvement in gas exchange is probably due to the effect of fenoterol on the tributary airways of the alveolar slow compartment. This effect can be assessed by this simple method, which can be used in clinical pharmacology studies and in the follow-up of asthmatic patients.

Administration, Inhalation↗
PubMed1997

Lactose, oligosaccharide and monosaccharide content of milk from mothers delivering preterm newborns over the first month of lactation.

BACKGROUND: Monosaccharide, lactose and oligosaccharide content of milk from mothers delivering prematurely (PT milk) was studied to evaluate whether changes occur during lactation, as observed in milk from mothers delivering at term (T milk). METHODS: To study a homogeneous population, women having the most common phenotype (secretory both Lewis and A, B, or H phenotype) were selected. Milk samples from 26 mothers who delivered between the 27th and 35th week of gestation were collected at the 4th, 10th, and 30th post-partum days. Monosaccharides, lactose and oligosaccharides were measured by high-pressure liquid chromatography. RESULTS: Lactose concentration increased significantly (p < 0.05) from 52.81 +/- 8.2 g/L on day 4 to 69.24 +/- 9.36 g/L on day 30. During the same period of time oligosaccharide content decreased significantly (p < 0.05) from 25.61 +/- 5.19 g/L to 15.83 +/- 6.05 g/L. Monosaccharides did not show statistically significant variations. CONCLUSIONS: Our results indicate that PT milk contains in addition to lactose, a substantial amount of oligosaccharides and a lower percentage of monosaccharides. Compared to T milk, in the colostral phase PT milk presents significantly lower lactose concentration (p < 0.0001); on the contrary its oligosaccharide content is significantly higher (p < 0.0001). The physiological role of human milk carbohydrates in view of the peculiar needs of the preterm newborn is also discussed.

Female↗
PubMed1995

Intestinal permeability changes during the first month: effect of natural versus artificial feeding.

The aim of the study was to investigate the effect of age and feeding pattern on intestinal permeability during the first month of life. The subjects were 72 full-term, healthy neonates who were (a) exclusively breast-fed (BF group, n = 36) or (b) artificially fed (CM group, n = 36) with either an adapted formula (AF group, n = 17) or a partly hydrolyzed (hypoantigenic) formula (HA group, n = 19). A lactulose/mannitol (lac/man) intestinal permeability test was performed at 1 and 7 days (steady-state method, n = 72), then at 30 days of life (single oral load, n = 47). Urinary lactulose and mannitol were measured by HPLC. The mean lac/man urinary ratio dropped from 1.27 +/- 0.73 (day 1) to 0.34 +/- 0.36 at day 7 and to 0.22 +/- 0.21 at day 30. At 7 days BF infants showed a significantly lower lac/man urinary ratio (0.22 +/- 0.25) than the CM group (0.47 +/- 0.41). The human neonate shows a developmental pattern of sugar intestinal permeability that resembles gut closure observed in other mammals. Intestinal permeability decreases faster in breast-fed babies than in those fed with adapted or HA formulas.

Breast Feeding↗
PubMed1993

[Hypersecretive congenital hydrocephalus due to choroid plexus villous hypertrophy associated with controlateral papilloma].

The authors present a case of a nine month-old baby with hypersecretive congenital hydrocephalus. The CSF overproduction was the result of a rare abnormality of the choroid plexus, a villous hypertrophy of the right ventricular choroid plexus and a left ventricular plexus papilloma. Surgical removal of the plexus papilloma and the plexectomy of the hypertrophic ventricular structure did not ameliorate the hydrocephalus, which has been controlled after a biventricular-peritoneal shunt. The physiopathological relationship between hydrocephalus and choroid plexus abnormalities are reported. The importance of an early diagnosis and treatment is stressed. Both hydrocephalus and choroid plexus pathology may represent a cause of psychomotor delay, for the little patient the effects of which is investigated in this paper.

Cerebral Angiography↗
PubMed1993

Changes in carbohydrate composition in human milk over 4 months of lactation.

This study aimed to examine the carbohydrate content (monosaccharides, lactose, and oligosaccharides) of human milk over 4 months of lactation to determine whether any changes occurred over time. Milk samples from 46 mothers, who delivered at term, were collected at 4th, 10th, 30th, 60th, 90th, and 120th days after delivery. Carbohydrates were measured by high-pressure liquid chromatography. Mean lactose concentration (+/- SD) increased from 56 +/- 6.06 g/L on day 4 to 68.9 +/- 8.16 g/L on day 120. Oligosaccharide level decreased from 20.9 +/- 4.81 g/L to 12.9 +/- 3.30 g/L, respectively. Monosaccharides represented only 1.2% of total carbohydrates. The changes in carbohydrate composition found indicate that carbohydrate synthesis by the mammary gland is a dynamic process. The physiological and biological relevance of human milk oligosaccharides is also discussed.

Carbohydrates↗
PubMed1992

[Respiratory inductive plethysmography in the functional evaluation of patients undergoing coronary by-pass surgery].

The functional respiratory changes following coronary by-pass surgery were previously evaluated with the traditional spirometric method. Aim of this work is to introduce the respiratory inductive plethismography (RIP), a well known non-invasive technique, into the study of those volumetric and ventilatory modifications. Eight cardioischemic patients were selected: all but one were free from pulmonary disorders. The tidal volume, the respiratory rate, the minute ventilation, the vital capacity and the relation between the abdominal and the thoracic part of the ventilatory act, were measured in the pre-intervention session and in the 1st, 3rd and 7th day after the operation of coronary by-pass. In the same sessions, except the 1st day after surgery, the maximal respiratory pressures were evaluated with traditional manometers. The functional changes of the examined parameters, statistically studied with the variance analysis, closely resemble the spirometric modifications registered by other authors. Furthermore the relative contributions of the thoracic and abdominal compartments of the pulmonary ventilation were evaluated, thanks to the non-invasive plethysmographic method. Rip makes it possible to measure the ventilatory pattern and some pulmonary volumes in the very early phases after thoracic surgery, without any trouble for the patient and in a non-collaborative state of consciousness, too.

Aged↗
PubMed1992

[Toxocariasis (visceral larva migrans). A report of a case in an adopted child].

A case of asymptomatic toxocariasis in a Brazilian adopted child with hypereosinophilia is described. The diagnosis is confirmed by measuring specific IgG antibodies anti-Toxocara and, in the light of growing adoptions of children coming from low standard of living extra-European countries, the authors note the importance of investigating also on those parasitosis until today rather infrequent in our country.

Adoption↗
PubMed1989

[Cohen syndrome. Description of a new case and study of the central nervous system using nuclear magnetic resonance].

The Cohen syndrome is characterized by dysmorphic face, obesity, narrow hands and feet and mild mental retardation. So far only 42 cases have been described in literature. The Authors describe a patient who presented some cerebral anomalies at the MRI examination. In particular the MRI showed a large sellar cavity compared to the size of the hypophysis.

Abnormalities, Multiple↗