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Biomedical subjects

A Sacchetti

Publications and source records attributed to A Sacchetti.

At least 37 records · Page 2Linked to original sources
PubMed1999

Primary cardiac arrhythmias in children.

OBJECTIVES: Primary cardiac arrhythmias are much less common in children than adults. This study was performed to identify the characteristics of primary arrhythmias in pediatric patients in the Emergency Department (ED). METHODS: Retrospective review of ED visits of patients <18 years of age presenting between January 1991 and November 1996 with an Emergency Department diagnosis of primary cardiac arrhythmia. Secondary cardiac arrhythmias, ie, sinus tachycardia resulting from a fever, were excluded. Clinically significant arrhythmias were defined as those capable of altering cardiovascular stability. SITE: 26 Community Hospital EDs. RESULTS: A total of 2.3 million ED visits were reviewed and 320 arrhythmias in children were identified in 0.58 million patients under 18 years of age. The overall incidence of arrhythmias was 13.9 per 100,000 ED visits and 55.1 per 100,000 pediatric ED visits. The incidence of clinically significant arrhythmias was 5.7 per 100,000 ED visits and 22.5 per 100,000 patients <18 years of age. The mean patient age was 113 (+/-0.31) years with a peak in infancy and a second peak in late childhood and adolescence. The most common arrhythmias were: Sinus tachycardia: 160 (50%); Supraventricular tachycardia (SVT): 42 (13%); Nonspecific arrhythmia (NSA): 34 (10.6%); Bradycardia: 19 (6%); and Atrial fibrillation (a-fib): 15 (4.6%). The most common clinically significant arrhythmias by age group were: [table in text]. Nine patients had an additional diagnosis of Wolf-Parkinson-White syndrome, eight with Sinus tachycardia and one with SVT. There were four cardiac arrests noted all with ventricular fibrillation as the recorded arrhythmia. CONCLUSION: Primary arrhythmias are unusual ED presentations in children and atrial tachyarrhythmias are the most common rate and rhythm disturbance in this population.

Adolescent↗
PubMed1999

Can sick children tell time?: emergency department presentation patterns of critically ill children.

OBJECTIVE: Children show a consistent pattern of ED use, with the majority of patients presenting during the late afternoon and evening hours. This study evaluated whether such a diurnal pattern also exists for critically ill children and the implications of such a presentation pattern on ED staffing. METHODS: A review was performed of the ED diagnoses and times of presentation for children less than 12 years of age at 28 nonpediatric hospitals over the six-year period from July 1990 to October 1996. In addition to total ED pediatric visits, a subset of critically ill children (CIC) were identified as those with an ED diagnosis of: meningitis, cardiac arrest, diabetic ketoacidosis, status epilepticus, meningococcemia, or epiglottitis, or those undergoing endotracheal intubation in the ED. A second group of non-critically ill children (NCIC) was composed of children with an ED diagnosis of otitis media, tonsillitis, or pharyngitis. Data collected on each patient included age, diagnosis, site of care, and time of service. Presentation patterns for all three groups were compared for time of day, with statistical analysis through chi-square, ANOVA, and Spearman's rho correlation. RESULTS: A total of 409,820 pediatric ED visits were examined, with 688 CIC children and 28,344 NCIC identified. Presentation patterns for NCIC visits mirrored those of the total pediatric population, with the traditional increase in the late afternoon and evening hours (correlation 0.96). CIC presented much more erratically, with a distribution spread more uniformly throughout the day compared with the total pediatric population (correlation 0.72). Thirty-seven percent of CIC presented during the evening hours of 16:00 to 24:00, compared with 49% for NCIC and 53% for the total pediatric population, while 22% of CIC presented from 24:00 to 08:00 compared with only 13% of NCIC and 10% of total pediatric patients (p < 0.001). CONCLUSION: Critically ill children present more uniformly throughout the day and do not have the same presentation patterns as ambulatory children. ED staffing should reflect this difference and not focus pediatric ED services simply on hours of peak pediatric visits.

Analysis of Variance↗
PubMed1998

Differentiation of HL-60 promyelocytic leukemia cells is accompanied by a modification of magnesium homeostasis.

Magnesium homeostasis in HL-60 promyelocytic leukemia cells was compared to that in neutrophyl-like HL-60 cells obtained by 1.3% DMSO treatment. Magnesium homeostasis was studied by the characterization of magnesium efflux, the identification of intracellular magnesium pools, and the regulation of intracellular ionized Mg2+. In both undifferentiated and neutrophyl-like HL-60 cells, magnesium efflux occurred via the Na-Mg antiporter which was inhibited by imipramine and stimulated by db cAMP and forskolin. Receptor-mediated signals such as ATP, IFN-alpha, or PGE1, which can trigger cAMP-dependent magnesium efflux, were ineffective in undifferentiated HL-60 cells but induced 60-70% increase of magnesium efflux in neutrophyl-like HL-60 cells. Selective membrane permeabilization by the cation ionophore A23187 induced a large magnesium release when cells were treated with rotenone. In both cell populations, the addition of glucose to rotenone-treated cells restored magnesium release to the control level. Permeabilization by 0.005% digitonin provoked the release of 90% cell total magnesium in both cell types. Intracellular [Mg2+]i was 0.15 and 0.26 mM in undifferentiated and neutrophyl-like HL-60 cells, respectively. Stimuli that triggered magnesium efflux, such as db cAMP in undifferentiated and IFN-alpha in neutrophyl-like HL-60 cells, induced a slow but consistent increase of [Mg2+]i which was independent from Ca2+ movements. Overall, these data indicate that magnesium homeostasis is regulated by receptor-mediated magnesium efflux which was modified during differentiation of HL-60 cells. Stimulation of magnesium efflux is paralleled by an increase of [Mg2+]i which reflects a release of magnesium from the bound cation pool.

Adenosine Triphosphate↗
PubMed1998

Human Trop-2 is a tumor-associated calcium signal transducer.

Trop-2/EGP-1/GA733-1 is a recently identified cell surface glycoprotein highly expressed by human carcinomas. The cytoplasmic tail of Trop-2 possesses potential serine and tyrosine phosphorylation sites and a phosphatidyl-inositol binding consensus sequence. Thus, we investigated whether Trop-2 might be a functional signaling molecule. Using the fluorescent probe Fura-2, we assayed the cytoplasmic calcium levels in human cancer cells stimulated with anti-Trop-2 or control antibodies. Three anti-Trop-2 MAbs, Rs7-7G11, MOv16 and 162-46.2 specifically induced a transient intracellular calcium level increment in up to 40% of the experiments performed. Polyclonal antisera recognizing recombinant Trop-2 molecules possessed a much lower stimulation efficiency. The average latency of antibody-induced Ca2+ rise for OvCa-432 cells was 64+/-26 sec. Internal Ca2+ concentrations reached peaks of 190+/-24 nM vs. basal levels of 61+/-4 nM and returned to baseline within 193+/-37 sec. Similar values were obtained in MCF-7 cells. For comparison, stimulation of P2-purinergic receptors on MCF-7 and OvCa-432 cells induced a Ca2+ rise in most cases, leading to average internal Ca2+ concentrations of 297+/-41 and 391+/-39 nM, respectively. Our findings show that Trop-2 transduces an intracellular calcium signal, are consistent with the hypothesis that it acts as a cell surface receptor and support a search for a physiological ligand.

Adenosine Triphosphate↗
PubMed1998

Release of the mitogen lysophosphatidylinositol from H-Ras-transformed fibroblasts; a possible mechanism of autocrine control of cell proliferation.

Lysophosphatidylinositol (LysoPtdIns) is formed by a constitutively-active phosphoinositide-specific phospholipase A2 in Ras-transformed cells and can stimulate cell proliferation. To evaluate whether LysoPtdIns could function as an autocrine modulator of cell growth, we examined whether LysoPtdIns can be released in the medium of Ras-transformed FRT-Fibro fibroblasts and thyroid cells. Here, we report that LysoPtdIns accumulates in the extracellular space of these lines and reaches levels up to tenfold higher than in the case of normal cells. Moreover, the ionophore A23187 increased the levels of the lysolipid in the extracellular medium. Extracellular LysoPtdIns was rapidly hydrolyzed to inositol 1:2-cyclic phosphate. LysoPtdIns induced thymidine incorporation in FRT-Fibro Ha-Ras fibroblasts, whereas inositol cyclic 1:2-cyclic phosphate did not affect cell growth per se, nor did it interfere with the LysoPtdIns mitogenic activity. We hypothesize that in Ras-transformed fibroblasts the formation and release of LysoPtdIns may function as an autocrine mechanism that participates in the Ras-dependent stimulation of cell growth.

Animals↗
PubMed1997

Synthesis, antimicrobial and genotoxic properties of some benzoimidazole derivatives.

A number of 1H-benzoimidazol-2-ylamine and of 1-methyl-1H-benzoimidazol-2-ylamine derivatives were synthesized and the crystal and molecular structure of N-[4-(2-amino-benzoimidazole-1-sulfonyl)-phenyl] acetamide was determined by X-ray diffraction analysis. The compounds obtained were investigated for antimicrobial and genotoxic activities.

Anti-Infective Agents↗
PubMed1996

Family member presence during pediatric emergency department procedures.

OBJECTIVE: Exclusion of family members (FM) during pediatric procedures in the emergency department (ED) is an accepted practice. This study questions the validity of such a practice. SUBJECTS: FM of ED pediatric patients undergoing procedures and ED staff performing procedures. SITES: ED of a tertiary care university-affiliated community hospital and the pediatric ED of a university hospital. METHODS: Post-procedure surveys were obtained from FM remaining with their child during an ED procedure and from the ED personnel performing the procedures. FM activity during the procedure was also recorded. RESULTS: Ninety-six children (average age 20 months) underwent a total of 127 procedures. ED procedures included: vascular access 91, lumbar puncture 23, urethral catheterization 9, nasogastric tube placement 1, rapid sequence intubation 1, fluid resuscitation from shock 1, and removal of foreign body from eye 1. Three children were critically ill during performance of procedures. ED staff answered 98 surveys concerning the performance of the 127 procedures. FM ACTIVITIES INCLUDED: Stood at bedside 35 (31%), soothed child 21 (19%), and helped restrain child 55 (55%). In 55 (57%) cases the FM was the only adult present with the ED staff member performing the procedure(s). FM MEMBER OPINIONS OF PRESENCE DURING PROCEDURES WERE: Good idea 101 (91%), bad idea 6 (5%), and did not care 4 (4%). ED staff opinions were: good idea 92 (93%), bad idea 2 (2%), and did not care 4 (5%). FM presence made four (5%) members of the ED staff nervous. CONCLUSION: FM presence during ED procedures is a practice favored by both parents and ED staff at our institutions. This practice should not be limited to minimally invasive procedures in stable patients but should be considered for procedures such as lumbar punctures and intubations even in critically ill patients.

Adult↗
PubMed1995

Familial arteriovenous malformations in children.

Cerebral arteriovenous malformations are uncommon in children. Familial incidence of these lesions is reported in only 10 families. We report a family in which the two youngest siblings had this anomaly, and we review the literature. These cases represent a clinical situation that emergency physicians may encounter.

Adolescent↗
PubMed1994

Pediatric analgesia and sedation.

Sedation and analgesia are essential components of the ED management of pediatric patients. Used appropriately, there are a number of medications and techniques that can be used safely in the emergency care of infants and children. Emergency physicians should be competent in the use of multiple sedatives and analgesics. Adequate equipment and monitoring, staff training, discharge instructions and continuous quality management should be an integral part of the ED use of these agents.

Analgesia↗
PubMed1994

Hand-held metal detector identification of ingested foreign bodies.

The study purpose was to determine the ability of hand-held metal detectors (HHMDs) to identify the presence of ingested metallic foreign bodies (MFBs). Twenty-three children presenting to the emergency department with a complaint of MFBs ingested were enrolled. Sixteen of 23 patients had radiographically proven foreign bodies. The MFBs comprised coins (n = 11), a button battery (n = 1), a medallion (n = 1), a token (n = 1), a needle (n = 1), and a marble (leaded glass) (n = 1). The HHMD correctly detected 15 of 16 radiographically positive MFBs (93%) and correctly excluded a potential MFB in six of six radiographically negative cases. The only foreign body not detected was an ingested needle. One radiograph was equivocal. Radiographic localization of the ingested objects was as follows: esophagus, n = 4; stomach, n = 9; and intestines, n = 3. The HHMD correctly localized all detected MFBs. The HHMD had a sensitivity of 94%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 86%. HHMDs are effective screening devices for possible ingested MFBs. Positive studies localized to the stomach and lower gastrointestinal tract do not require confirmatory radiographic studies.

Adolescent↗
PubMed1993

ED management of acute congestive heart failure in renal dialysis patients.

This is a descriptive report of the management techniques used effectively in the emergency department (ED) treatment of acute congestive heart failure (CHF) in renal dialysis patients. Study design included a prospective case series of consecutive renal dialysis patients who presented to the ED of a regional dialysis center in acute CHF. Clinical presentation, ED management, and outcome were recorded. Forty-six patients (38 hemodialysis and 8 peritoneal dialysis) were included in this study. Presentation classifications for these patients were minimal distress (13 patients), moderate distress (16 patients), and severe distress (17 patients). In addition to supplemental oxygen, treatment focused on pharmacological preload and afterload reduction. Patients received sublingual nitroglycerin (NTG) (30 patients), transdermal NTG (36 patients), captopril sublingual (10 patients) nifedipine oral (nine patients), nitroprusside (four patients), morphine sulfate (one patient), NTG infusion (one patient), and clonidine (one patient). There were no deaths in the study group, and 32 of the patients were able to be dialyzed and discharged, including seven patients in the severe group. Six patients required intubation, one of whom was extubated and discharged from the ED after dialysis. Intravascular access was obtained in 29 patients but was used in only six. All patients on nitroprusside drips were weaned during the course of their dialysis. Effective ED management of acute CHF in renal dialysis patients can be accomplished through preload reduction with nitrates and afterload reduction with captopril, nifedipine, and, in severe cases, nitroprusside.

Acute Disease↗
PubMed1992

Resident management of emergency department patients: is closer attending supervision needed?

STUDY OBJECTIVE: To determine the extent of supervision necessary for emergency medicine residents practicing in the emergency department. SETTING: ED of a university-affiliated tertiary care facility with an annual census of 32,000 visits. STUDY POPULATION: All ED patients presenting during study hours during a four-month period. DESIGN: A prospective study was conducted of changes made by emergency medicine attendings in the management of ED patients seen initially by second-year emergency medicine residents. Second-year emergency medicine residents presented all patients seen by them to a specified emergency medicine attending, who also interviewed and examined these patients. Initial patient care was designed by the resident and modified by the emergency medicine attending. Attending modification was recorded by the emergency medicine attending in the study log. Modifications of the residents' proposed care were designated as major (change resulted in an alteration in patient disposition, detection of unsuspected pathology, or marked revision of intended treatment); minor (change resulted in lesser modification of patient management); or no change. RESULTS: Four hundred eight patient encounters were included in the study. Sixteen patients (4%) had major modifications of their care, 134 (33%) had minor modifications, and 258 (63%) had no change. CONCLUSION: Supervision is required for all patients managed by second-year emergency medicine residents, regardless of complaints. This evaluation should include a direct patient interview and examination by the emergency medicine attending and should not be limited to a case discussion or ED record cosignature.

Emergency Medical Services↗
PubMed1992

Pediatric EMS transport: are we treating children in a system designed for adults only?

Unlike adults, small children and infants do not require stretchers or ambulances for transport from a prehospital scene to the emergency department (ED). This study was designed to determine the importance of this difference in patient transport needs. A Macintosh Classic computer was programmed to compare the time to intubation (TTI) of a child with impending respiratory arrest treated in a standard paramedic/ambulance transport system versus that of a child treated in a system in which a patrolling police car transports the child directly to an ED. The dependent variable TTI was determined, with travel times from the scene to the ED and paramedic intubation success rates as the independent variables. Utilizing this model, police transports demonstrate shorter TTIs for brief scene-to-ED travel times or limited paramedic success rates, while paramedic intubations produced shorter TTIs for long scene-to-ED transports. These results suggest that nonambulance transport of pediatric patients be considered in the development of urban or suburban pediatric Emergency Medical Services.

Acute Disease↗
PubMed1992

HCV infection occupational hazard at dialysis units and virus spread, among relatives of dialyzed patients.

It was the purpose of this study to evaluate the spread of HCV infection among the staff at Dialysis Units and among relatives of anti-HCV-positive hemodialysis patients. 122 health-care workers and 52 relatives were screened for presence of anti-HCV Ab. The control groups consisted of 100 health-care workers from other wards and 30 relatives of anti-HCV-negative subjects. 2.45% of the health-care staff and 5.8% of the relatives were found to be anti-HCV Ab carriers. None of the subjects in the control groups were positive. In conclusion, the results of this study indicate that there is a real possibility of HCV spread through occupational exposure although the corresponding percentage in less than that presumably due to within-the-family contagion by the virus.

Adult↗