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Biomedical subjects

C Martino

Publications and source records attributed to C Martino.

At least 19 recordsLinked to original sources
PubMed2003

Mixed dishomogeneous hemorrhagic brain contusions. Mapping of cerebral blood flow.

The aim of the study was to verify whether regional cerebral blood flow (rCBF) was distributed centrifugally in traumatic hemorrhagic contusions with multiple cores within an oedematous area. Seventeen traumatic brain contusions, from 14 patients with severe head injury (GCS < 9), were analyzed during 39 Xenon-enhanced computerized tomography (Xe-CT) studies. The CBF was measured in 3 concentric regions of interest (ROls): the hemorrhagic core, the intracontusional oedematous low density area and a 1 cm rim of pericontusional normal-appearing brain tissue surrounding the contusion. Differences between rCBFs in the three ROIs were found (p < 0.0001). rCBF in both the hemorrhagic core (21.4 +/- 19.4 ml/ 100gr/min) and the intracontusional low density area (28.4 +/- 19 ml/100gr/min) were lower than rCBF in pericontusional normal-appearing area (41.9 +/- 16 ml/100gr/min) (p < 0.0001). No significant differences were found between rCBF measured in the hemorrhagic core and intracontusional low density area (p = 0.184). Our study suggests that in the mixed density contusions with multiple hemorrhagic cores, the CBF is concentrically distributed, improving from the core to the periphery.

Adult↗
PubMed2003

Induced acute arterial hypertension and regional cerebral flow in intracontusional low density area.

Traumatic brain contusions have been associated with regional ischemia. We aimed to measure the effect of induced supra-normal values of cerebral perfusion pressure (CPP) on regional cerebral blood flow (rCBF) in the intracontusional low density area surrounding the contusional hemorrhagic core. In 7 severely head injured patients (GCS < or = 8) harbouring a contusion larger than 2 cm, the rCBF levels were measured, by means of Xenon-enhanced CT, in: 1) the intracontusional low density area: 2) contralaterally, in a normal brain symmetric area. CBF studies were performed at a baseline CPP of 65.3 mmHg +/- 7 and after 20 minutes of norepinephrine-induced CPP supernormal values (88.3 mmHg +/- 10.5) (p = 0.0013). A "paradoxical" reduction of rCBF levels was observed in both the intracontusional low density area (p = 0.07) and the contralateral "normal" area (p = 0.08). In particular, this decrease of rCBF in the intracontusional low density area (-25.7 + 10 ml/100gr/min) (p = 0.0009) was present in only 4 cases, having a mean rCBF at baseline of 25 +/- 16 ml/100gr/min. In the remaining 3 cases in which rCBF at baseline was abnormally low (12 +/- 7 ml/ 100gr/min), rCBF values improved slightly (3.6 +/- 2 ml/100gr/min) (p = 0.61). An acute increase of CPP seems to marginally affect rCBF in the intracontusional low density area having critically reduced initial values, but may greatly reduce rCBF in subjects starting from non-critical baseline values.

Acute Disease↗
PubMed2002

[Epidural analgesia during labor: intermittent bolus or patient controlled administration?].

BACKGROUND: The aim of the study was to compare efficacy and side effects produced by two techniques of epidural analgesia during labor: intermittent bolus and patient-controlled epidural analgesia. METHODS: Eighty parturients were enrolled in this study: forty received intermittent bolus analgesia (first bolus: 20 mg of ropivacaine 0.1% + 10 gamma of sufentanil, next bolus: 10 mg of ropivacaine 0.1% during the first 4 hours, and then 10 mg of ropivacaine 0.1% + 2.5 gamma of sufentanil each time they complained of pain), and forty parturients received PCEA (starting with a bolus of 20 mg ropivacaine 0.1% + 10 gamma sufentanil, followed by administration with a pump programmed to deliver a continuous background infusion of ropivacaine 0,1% + 0.25 gamma/ml of sufentanil at 5 ml/h and 5 ml patient-triggered boluses with a 15 min lock-out interval; insufficient analgesia was treated by extra boluses of the same ropivacaine solution). In each group the efficacy of the analgesia (verbal numerical pain scores, amount of local anesthetics consumption), labor duration, side effects and patient satisfaction have been studied. RESULTS: There were no differences between the two different epidural techniques. CONCLUSIONS: This regimen of PCEA proves a viable and safe alternative for epidural analgesia during labor.

Adult↗
PubMed2001

Changing concepts in long-term central venous access: catheter selection and cost savings.

BACKGROUND AND OBJECTIVES: Long-term central venous access is becoming an increasingly important component of health care today. Long-term central venous access is important therapeutically for a multitude of reasons, including the administration of chemotherapy, antibiotics, and total parenteral nutrition. Central venous access can be established in a variety of ways varying from catheters inserted at the bedside to surgically placed ports. Furthermore, in an effort to control costs, many traditionally inpatient therapies have moved to an outpatient setting. This raises many questions regarding catheter selection. Which catheter will result in the best outcome at the least cost? It has become apparent in our hospital that traditionally placed surgical catheters (ie, Hickmans and central venous ports) may no longer be the only options. The objective of this study was to explore the various modalities for establishing central venous access comparing indications, costs, and complications to guide the clinician in choosing the appropriate catheter with the best outcome at the least cost. METHODS: We evaluated our institution's central venous catheter use during a 3-year period from 1995 through 1997. Data was obtained retrospectively through chart review. In addition to demographic data, specific information regarding catheter type, placement technique, indications, complications, and catheter history were recorded. Cost data were obtained from several departments including surgery, radiology, nursing, anesthesia, pharmacy, and the hospital purchasing department. RESULTS: During a 30-month period, 684 attempted central venous catheter insertions were identified, including 126 surgically placed central venous catheters, 264 peripherally inserted central catheters by the nursing service, and 294 radiologically inserted peripheral ports. Overall complications were rare but tended to be more severe in the surgical group. Relative cost differences between the groups were significant. Charges for peripherally inserted central catheters were $401 per procedure, compared with $3870 for radiologically placed peripheral ports and $3532 to $4296 for surgically placed catheters. CONCLUSIONS: Traditional surgically placed central catheters are increasingly being replaced by peripherally inserted central venous access devices. Significant cost savings and fewer severe complications can be realized by preferential use of peripherally inserted central catheters when clinically indicated. Cost savings may not be as significant when comparing radiologically placed versus surgically placed catheters. However, significant cost savings and fewer severe complications are associated with peripheral central venous access versus the surgical or radiologic approach.

Catheterization↗
PubMed2000

Assessment of posttraumatic stress disorder four and one-half years after the Iraqi invasion.

In the earliest formulations of posttraumatic stress (PTS) and even posttraumatic stress disorder (PTSD), it was clear that war could engender PTSD within both primary and secondary victims. The clinical course of PTS and PTSD is not always clear, but the disorder may persist months and even years after the precipitating traumatic event. The current study was undertaken in an effort to assess the prevalence of PTSD in a sample of 404 Kuwaiti citizens 4.5 years after the invasion and occupation of Kuwait by the Iraqi Army. Results indicate a psychometrically assessed prevalence of PTSD of 28.4%. A subsample of 195 students revealed a prevalence of 45.6%. If correct, these data are worrisome indeed and point to 1) a significant public health challenge facing the government of Kuwait, as well as, 2) the increased sensitivity of the young to traumatic stress, both personally and vicariously. Based upon the current data, there may exist a virtual epidemic of posttraumatic stress disorder within the Kuwaiti population 4.5 years after the end of the Iraqi occupation. These data argue the need for a comprehensive confirmatory epidemiological investigation in the current prevalence of posttraumatic stress disorder within the Kuwaiti population so that appropriate resources may be further directed to address what may be a significant public health problem.

Adult↗
PubMed1999

Sluggish small bowel motility is involved in determining increased biliary deoxycholic acid in cholesterol gallstone patients.

OBJECTIVE: Our aim was to establish whether small intestine transit time is defective in subjects with cholesterol gallstones. METHODS: We enrolled 10 patients (eight women, two men; mean age, 48.7 yr; mean body mass index [BMI], 22.4 Kg/m2) with recently diagnosed cholelithiasis, with no liver pathology, who were not taking any drugs, and 11 comparable healthy volunteers (eight women, three men; mean age, 46.2 yr; mean BMI, 22.7 Kg/m2), who served as controls. All subjects underwent orocecal (by starch breath test technique and serum assays of salazopyrin), oroileal (by serum assays of tauroursodeoxycholic acid), and duodenoileal (by serum assays of taurocholic acid) transit times; cholesterol saturation index; and bile acid composition and gallbladder motility studies (by ultrasound). For serum assays, blood samples were collected over a period of 7 h. Gallbladder motility and orocecal transit time were evaluated simultaneously. RESULTS: All four means of assessing transit time gave longer times in cholesterol gallstone patients than in controls: orocecal transit time (salazopyrin) = 366 +/- 13 vs 258 +/- 16 min, p < 0.0005; orocecal transit time (starch breath test) = 415 +/- 139 vs 290 +/- 15 min, p < 0.01; duodenoileal transit time: 272 +/- 23 vs 205 +/- 23 min, p < 0.03; and oroileal transit time: 308 +/- 18 vs 230 +/- 19 min, p < 0.009. Cholesterol gallstone patients showed an increase in percent molar biliary deoxycholic acid (30% +/- 4.5% vs 16% +/- 1.3%, p < 0.02) and a decrease in percent molar cholic acid 32% +/- 2.2% vs 40% +/- 1.3%, p < 0.03) and chenodeoxycholic acid (34% +/- 3% vs 41% +/- 1.8%, p < 0.03), compared with controls; patients also had greater percent molar biliary cholesterol. A linear relationship (r2 = 0.6324, p = 0.0012) between biliary deoxycholic acid and small bowel transit time was found. Residual gallbladder volumes were larger in cholesterol gallstone patients (11.38 +/- 1.27 vs 7.55 +/- 0.39 ml, p < 0.04), whereas basal gallbladder volumes, although higher, did not reach statistical significance (24.25 +/- 2.41 vs 19.98 +/- 1.63 ml; p = ns). CONCLUSIONS: This study confirms that patients with cholesterol gallstones have delayed small bowel transit, defective gallbladder motor function, and increased biliary deoxycholic acid. Delayed small bowel transit may contribute to supersaturation of bile with cholesterol by increasing deoxycholic acid production.

Bile↗
PubMed1998

Effect of norepinephrine on fetal breathing in sheep.

We tested the hypothesis that the surge of norepinephrine at birth is associated with the establishment of continuous breathing. Therefore, we studied whether the administration of norepinephrine could enhance fetal breathing during administration of oxygen, or 100% O2 plus cord occlusion, and if phenoxybenzamine would reverse these changes. Fetal sheep were instrumented in late gestation to measure electrocortical activity and diaphragmatic electromyography. These parameters and blood gases were measured before and during in utero administration of nitrogen, 100% O2, 100% O2 plus umbilical cord occlusion, and subsequently during umbilical reperfusion and recovery. Nine fetuses (14 experiments) received continuous norepinephrine (0.13 microgram/kg/min) throughout the experiment while 9 other fetuses (18 experiments) underwent the same treatment without the hormonal infusion. We found that norepinephrine inhibited the breathing induced by 100% O2 plus cord occlusion, despite a significant increase in the duration of low-voltage electrocortical activity; phenoxybenzamine reverted these changes. The findings suggest that the surge of norepinephrine at birth is probably not the primary mechanism for establishment of continuous breathing.

Adrenergic alpha-Agonists↗
PubMed1998

Familial atrial septal defect with atrioventricular conduction defects.

Atrial septal defect of the ostium secundum type is almost always sporadic, with multifactorial inheritance. We report a case of a family in which atrial septal defects of the ostium secundum type with atrioventricular conduction defects were observed in four generations: five proven cases and two probable cases. Ten families have been reported as showing atrial septal defect of the ostium secundum type and atrioventricular conduction defects with dominant inheritance. Moreover, in our family the transmission model can also confirm autosomal dominant inheritance. We believe that cardiologists should take a familial approach to atrial septal defect of the ostium secundum type for both research and genetic counseling purposes. In a patient with ASD II, the AV conduction defects should prompt a detailed family history and clinical evaluation of first-degree relatives.

Adult↗
PubMed1993

Magnetic resonance imaging to avoid laparotomy in pregnancy.

OBJECTIVE: To determine whether magnetic resonance imaging (MRI) in pregnancy would help define a benign pelvic mass, thereby avoiding laparotomy. METHODS: During a 2-3-year period, five pregnant women with adnexal masses suspected to be leiomyomas underwent MRI. RESULTS: Four patients had evidence of leiomyoma and one had a benign cystic teratoma. All avoided laparotomy because of the almost certain radiologic findings of a benign process. In two women, there was an important effect on the pregnancy; one had fetal growth retardation and the other an outlet obstruction precluding vaginal delivery. Four of the patients underwent cesarean delivery. CONCLUSIONS: Magnetic resonance imaging can be used in the differential diagnosis of an adnexal mass in pregnancy. This will enable some pregnant patients to avoid laparotomy and its concomitant risks.

Adnexal Diseases↗
PubMed1992

The effects of 21 or 30% O2 plus umbilical cord occlusion on fetal breathing and behavior.

We have shown previously that continuous fetal breathing can be induced by 100% O2 alone or combined with umbilical cord occlusion (Baier, Hasan, Cates, Hooper, Nowaczyk & Rigatto, 1990). To know whether it could also be induced by lower O2 concentrations plus cord occlusion, we studied 9 chronically instrumented fetal sheep (16 experiments) using our window model. After a baseline cycle [1 low voltage + 1 high voltage electrocortical activity (ECoG) epoch] the fetal lung was distended via an endotracheal tube to about 30 cm H2O. Inspired N2 (control) and 21 or 30% O2 were given for one cycle each. While on 21% or 30% O2 the umbilical cord was occluded (balloon cuff). In 10 out of 16 experiments breathing output (% maximum of integral of EMGdi x f) increased after cord occlusion from 80 +/- 48 (N2) to 2871 +/- 641 (SEM; P < 0.01); in 7 of them breathing became continuous. Arterial PO2 increased from 14 +/- 1 (N2) to 33.5 +/- 5 Torr (occlusion; P < 0.01). In the other 6 experiments breathing output decreased from 319 +/- 116 (N2) to 86 +/- 38 (occlusion; P < 0.01) and arterial PO2 changed from 18 +/- 1 (N2) to 22 +/- 5 Torr (occlusion; P = 0.4). Arterial PCO2 increased similarly after occlusion in both groups, those which did respond with increased breathing (to 46 +/- 2 Torr) and those which did not respond (to 48 +/- 3 Torr; P = 0.6). The percent low voltage ECoG and the behavioral score increased after occlusion in the responder group only.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Differential roles of splanchnic and peripheral tissues in determining diurnal fluctuation of glucose tolerance.

To identify the mechanisms and the sites of the diurnal fluctuation in glucose tolerance in humans, we selectively quantitated the components of net splanchnic glucose balance, i.e., splanchnic glucose uptake and hepatic glucose output, as well as peripheral glucose uptake, by combining tritiated glucose infusion with hepatic and femoral venous catheterization. The studies were carried out in 11 healthy volunteers at 8:00 A.M. and at 6:00 P.M. on different days after 12 h of fasting. After intravenous glucose infusion (6.5 mg.kg-1.min-1 for 120 min) blood glucose rose twofold at 8:00 A.M. and threefold at 6:00 P.M. (P less than 0.01). Insulin levels did not differ significantly between the two series of tests. Splanchnic glucose balance switched from the net output of the basal state to a net uptake in both morning and afternoon studies. However, this effect was more marked at 6:00 P.M. than at 8:00 A.M. (at 60-120 min, P less than 0.05). The different pattern of splanchnic glucose balance was entirely accounted for by a greater rise in splanchnic glucose uptake in the afternoon, as the suppression of endogenous glucose output by the glucose load was practically complete in both series of studies. In contrast, glucose uptake by leg tissues increased less at 6:00 P.M. than at 8:00 A.M. (at 30-60 min, P less than 0.05; at 75 and 90 min, P less than 0.01; at 105 and 120 min, P less than 0.005). These data indicate that the mechanism responsible for the reduced glucose tolerance later in the day resides in the peripheral tissues whose ability to dispose of a glucose load is drastically decreased.

Adult↗
PubMed1988

Somatostatin response to glucose before and after prolonged fasting in lean and obese non-diabetic subjects.

Insulin, glucagon, and somatostatin concentrations were measured in 7 lean and 7 obese non-diabetic subjects over 7 days of fasting. In addition each subject was given a 75 g oral glucose tolerance test after fasts of 12 h and 7 days. In lean subjects complete food deprivation induced a significant decrease in the circulating levels of both insulin and somatostatin, while glucagon nearly doubled by 48 h and then remained constant for the duration of starvation. Refeeding with oral glucose suppressed the increased plasma glucagon, but insulin and somatostatin responses were enhanced in comparison with the prefast values, as assessed by the integrated areas of change. In obese subjects peripheral insulin and somatostatin levels were significantly lowered, but plasma glucagon level was unchanged at the end of the starvation period. In the same group glucose-induced insulin and somatostatin release were greater than in the fed state. Suppression of plasma glucagon by glucose appeared less complete in obese than in lean subjects. It is concluded that prolonged starvation enhances D-cell responsiveness to glucose in lean and obese subjects.

Adult↗
PubMed1988

Malignant hyperthermia in myotonia congenita.

We report a family in which two sisters with myotonia congenita (MyC) were referred for malignant hyperthermia (MH) evaluation after each developed muscle rigidity with anesthesia. Halothane contracture testing of skeletal muscle in both was consistent with MH susceptibility. A third sister without clinical evidence of MyC was negative on contracture testing. These results suggest an association between MyC and MH susceptibility.

Adult↗
PubMed1988

Long-term correction of hyperglycemia and progression of retinopathy in insulin dependent diabetes. A five-year randomized prospective study.

Thirty-eight patients with insulin dependent diabetes mellitus who had background retinopathy and no residual endogenous insulin secretion as assessed by plasma C-peptide determinations, were randomized to either conventional insulin treatment or to more intensive glucose control using ultralente insulin as basal cover and soluble insulin at mealtimes and were followed for five years. Plasma glucose profile and glycosylated hemoglobin were determined every eight weeks. Eye examinations were performed at the start of the study and after one, three and five years. Age, duration of diabetes, insulin dosage, glycemic control were comparable in the two groups. The mean plasma glucose profile was similar at entry in both groups and did not change in the conventionally-treated group. Mean plasma glucose profile 11.2 +/- 1 mmol/l with glycosylated hemoglobin level 10.7 +/- 0.3% fell to 7.9 +/- 0.4 mmol/l and 8.7 +/- 0.5% respectively during intensive treatment. Retinal morphology deteriorated during the follow-up with no significant differences between patients under unchanged conventional treatment and intensive insulin regimen. Proliferative retinopathy developed in six patients--three of these were under intensive insulin treatment. These data suggest that substantial long-term improvement of glycemic control does not affect progression of background retinopathy even when it is mild. The evolution of established retinopathy in insulin dependent diabetic patients is not only a function of poor glycemic control; other factors, either intrinsic or environmental, must also be important.

Adult↗
PubMed1986

Circulating somatostatin concentrations in healthy and cirrhotic subjects.

Plasma insulin, glucagon, somatostatin, and glucose concentrations were measured in the fasting state as well as after mixed meals (breakfast, lunch, and dinner) in 10 cirrhotic patients and 10 control subjects during a 24-hour period. Cirrhotic patients had fasting glucose values higher than controls (at -15 min: 5.2 +/- 0.2 mmol/L v 3.9 +/- 0.5 mmol/L, P less than 0.05; at 0 min: 5.5 +/- 0.3 mmol/L v 4.3 +/- 0.5 mmol/L, P less than 0.01). After meals blood glucose values remained higher in cirrhotics than in controls. Insulin levels did not differ between the groups in the fasting state, but cirrhotics showed a lower response to meals. Corresponding glucagon concentrations were greater in cirrhotics than in controls before and after meals throughout the 24-hour period (from -15 min to 24 hour: P less than 0.01). BAsal plasma somatostatin levels in the cirrhotic group were significantly higher than in control subjects (at -15 min and at 0 min: P less than 0.05) and further increased after meals. Plasma somatostatin was heterogeneous in normal and cirrhotic group, but the increase in its concentrations in patients with chronic liver disease was for the most part a consequence of elevations in the 1600 and 3500 molecular weight components. The half-life of exogenously infused somatostatin in cirrhotics was comparable to that of controls. These results indicate that in liver cirrhosis elevated levels of circulating somatostatin are associated with hyperglucagonemia and impaired insulin release. The high plasma somatostatin levels observed in cirrhotic patients are the result of hypersecretion of the D cell rather than impaired removal of the peptide.

Adult↗
PubMed1985

Prolactin response to sulpiride in non insulin dependent diabetes mellitus.

Blood glucose, insulin and prolactin concentrations were determined before and after sulpiride injection (50 mg i.m.) in 20 non-insulin-dependent diabetic patients (10 with retinopathy and 10 without evidence of retinal damage) and 10 subjects with normal glucose tolerance. Prolactin response to sulpiride was significantly higher in diabetics than in controls (at 20 min., p less than 0.01; at 30 and 60 min., p less than 0.005; at 90 min., p less than 0.01; at 120 min., p less than 0.05). The sulpiride induced hyperprolactinemia did not influence blood glucose and plasma insulin levels in controls as well as in diabetic patients. Prolactin response to sulpiride was the same in diabetics with and in those without retinal changes. We conclude that acute hyperprolactinemia seems to have no influence on glucose homeostasis in normal and non insulin-dependent diabetic subjects.

Adult↗
PubMed1978

Immunogenicity of N-[-4-(5-nitro-2-furyl)-2-thiazolyl]formamide-induced bladder cancer.

Five transplantable TCC initially induced by the carcinogen FANFT were systematically tested for individual immunogenicity and then for the presence of cross-reacting tumor antigens. The classic amputation challenge technique was used. Three of the 5 tumors were immunogenic, as determined by their ability to reduce the growth of a challenge tumor dose in mice immunized with the same bladder tumor. Prior immunization with one of the immunogenic tumors failed to reduce the incidence or growth of primary bladder tumors induced by the ingestion of 0.1% FANFT in C3H/HeJ mice. The lack of cross-reacting tumor antigens has important implications for the use of allogeneic tumor cells as an antigen source in immunotherapy.

Animals↗