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Biomedical subjects

F Baratto

Publications and source records attributed to F Baratto.

At least 19 recordsLinked to original sources
PubMed2004

[Use of protein C concentrate in adult patients with severe sepsis and septic shock].

AIM: The aim of this study is to describe the first experiences on the use of protein C concentrate (PC) in adult patients with severe sepsis and septic shock and clinical contraindications to activated protein C (APC). On the basis of the effectiveness demonstrated by the activated form in sepsis and of the encouraging results expressed in literature of protein C concentrate (PC) mainly about meningococcus fulminating infections, we carried out an observational study on protein C concentrate (PC) with 28-day follow-up and a daily analysis of the hemato-chemical and clinical parameters. Particular attention was paid to the variations in the PC plasma levels, to the modifications of the coagulation system, to the SOFA score as well as to the safety under bleeding risk conditions. METHODS: The study included 7 patients (5 females and 2 males) either with severe sepsis (2). or septic shock (5); one of them had DIC, with PC plasma levels less than 50%. APC could not be administered because of clinical reasons. Patients' mean age was 60.5 years (43-78), the average SAPS II 52.2 (36-72), the pathologies leading to sepsis were lung infections (3). and peritonitis (4). The average time elapsed between the onset of the organ failure and the beginning of treatment with PC was 27.7 hours (12-42). RESULTS: Mortality on day 28 was 42.8% (3 deaths), in all patients the PC plasma levels were brought again to the physiological values. Among the biochemical parameters recorded during the PC infusion, was observed in particular a significant decrease of PDFs, a general rise of the platelet count, and a reduction of the lactic acid levels. No adverse reaction or bleeding complication were seen, even if most of the patients' coagulation was altered or at risk due to neurological problems or repeated surgery. CONCLUSION: In our small number of patients, protein C concentrate has proven to be safe and particularly useful in the control of the coagulopathy triggered and sustained by sepsis.

Adult↗
PubMed2002

Role of short latency evoked potentials in the diagnosis of brain death.

OBJECTIVE: The aim of this study is to confirm the effectiveness of auditory brain-stem responses (ABRs) and somatosensory evoked potentials (SEPs) in the diagnosis of brain death (BD). METHODS: ABRs and SEPs were recorded at the same session in 130 BD patients (age range 8-77 years, 81 male and 49 female). Twenty-four cases were submitted to serial recordings from preterminal conditions through BD. RESULTS: ABRs were absent in 92 cases (70.8%), only waves I or I-II were present in 32 cases (24.6%), while in the remaining 6 patients (4.6%) waves V and/or III were still present, excluding the death of the brain-stem. In 4 cases (3.1%) SEPs showed the absence of all components following the cervical N9, preventing the diagnosis of BD. Among 126 cases (96.9%) with preserved cervical N9-N13 SEPs confirmed the absence of brain-stem activity in 122 cases (93.7%), in whom no waves following P11 or P13 were recordable. SEPs excluded the diagnosis of BD in the remaining 4 cases (3.2%) showing preserved P14 and/or N18. In all pre terminal patients the far-field P14-N18 were present, and their disappearance was closely related to the onset of BD. CONCLUSIONS: The combined us of ABRs and SEPs was able to confirm BD in almost all patients, providing an objective confirmation of the diagnosis, and to exclude it in 7 cases, thus improving the reliability of diagnosis.

Acoustic Stimulation↗
PubMed1999

[General anesthesia with remifentanil in a case of "sleep apnea syndrome"].

The authors report the case of a patient suffering from central sleep apnea (CSA) who underwent neurosurgery for ventriculo-peritoneal derivation under general anesthesia. Given the risk of postoperative hypoventilation in CSA, intraoperative anesthesia was induced using remifentanyl, an opiate with a plasma half-life of less than 5 minutes. Propofol (2 mg/kg) and remifentanyl at a dose of 0.5 microgram/kg was used during induction. The patient was curarised with vecuronium bromide, intubated and ventilated with a mixture of O2/N2O. During the operation, remifentanyl was administered as a continuous infusion at a starting dose of 0.2 microgram/kg/min, subsequently modified according to changes in arterial pressure and heart rate. At the end of surgery, which lasted approximately 120", decurarisation was carried out using prostigmin, and the infusion of remifentanyl was suspended, together with N2O. Reawakening times were recorded. Extubation took place 8' and 30" after the suspension of remifentanyl. Postoperative monitoring of SpO2 continued for 1 h and blood-gas analysis was satisfactory. No hypoventilation episodes were reported throughout the postoperative period and the patient was discharged from hospital after 7 days. The authors consider that remifentanyl should be the drug of choice to guarantee intraoperative analgesia in patients suffering from CSA requiring general anesthesia.

Aged↗
PubMed1998

99mTc-HMPAO SPECT in the diagnosis of brain death.

OBJECTIVE: To evaluate the effectiveness of single proton emission tomography (SPECT) with 99mTc-HMPAO in the diagnosis of brain death (BD). DESIGN: Prospective study in comatose and brain-dead patients. SETTING: Neurologic ICU. PATIENTS AND METHODS: Fifty comatose patients (age range: 10 days-75 years) were submitted to SPECT study. In 21 of them (42%) reversible factors (e.g., influence of drugs affecting the central nervous system) were present. Thirty-eight patients were clinically brain-dead, while the remaining 12 were tested both in pre-terminal conditions and after the clinical onset of BD. INTERVENTIONS: Brain SPECT following i.v. injection of 99mTc-HMPAO (300-1100 MBq), using a 4-headed gamma-camera (20 min, 360 degrees, 88 images). MEASUREMENTS AND RESULTS: All patients tested in pre-terminal conditions showed preserved brain perfusion. Two of them had flat EEGs despite the absence of any reversible cause of coma; three patients survived, but remained in persistent vegetative states. SPECT confirmed the diagnosis of BD in 45 out of 47 patients (95.7%), clearly showing the arrest of brain perfusion (picture of "empty skull"); in two clinically brain-dead children (aged 10 days and 12 months, respectively) weak perfusion of the basal ganglia, thalamus and/or brain stem was still present, precluding the diagnosis of BD; both of them died a few days later. CONCLUSIONS: Our results confirm the reliability of SPECT in the diagnosis of BD. A problem arises about its effectiveness in brain-dead children, but this seems to be a matter of definition of BD and cerebral viability, rather than a limit of SPECT.

Adolescent↗
PubMed1998

Auditory and somatosensory evoked potentials in coma following spontaneous cerebral hemorrhage: early prognosis and outcome.

The aim of this study was to check the prognostic power of auditory brain-stem responses (ABRs) and somatosensory evoked potentials (SEPs) in coma following spontaneous cerebral hemorrhage. Seventy patients comatose following subarachnoidal or hypertensive hemorrhage were submitted to ABR and SEP recordings during the acute phase of clinical course. Twenty-one patients survived (30%), two remained vegetative (2.9%) and 47 died (68.1%). The Glasgow Coma Score (GCS) was significantly related to the outcome (P < 0.001), but showed a low sensitivity, since about 50% of patients with GCS = 5-8 died or remained vegetative. ABRs and SEPs showed a much closer correlation with outcome (P < 0.001): their combined use allowed there to be a sensitivity of 96%, a specificity of 90% and a predictive power of 96%; the relative risk of poor outcome in patients with at least one abnormal modality was equal to 223 times the one for patients with normal evoked potentials. Moreover, in surviving patients a significant relationship appeared to exist between abnormalities of SEPs during the acute phase and the severity of disability. Our results confirm the prognostic effectiveness of short latency evoked potentials in cerebral hemorrhage: they are far superior to clinical data, being able to yield a marked decrease of falsely optimistic predictions.

Adult↗
PubMed1998

[Anesthesia with propofol and atracurium in a case of porphyria cutanea tarda].

The conduction of anaesthesia in a patient with a diagnosis of porphyria cutanea tarda is described. The aim of this paper is to provide further evidence for safety of TIVA (Total Intra Venous Anaesthesia) paying particular attention to propofol and atracurium (there are not sufficient data about it in the literature) in patients with porphyria cutanea tarda and high levels of uroporphyrin. The study of the anaesthetic management of a patient suffering from Porphyria Cutanea Tarda (PCT), the most common form of porphyria, can offer useful indications. Due to the fact that PCT is less severe than the acute forms, there is less risk for the patient under anaesthesia. In this particular case preoperative, intraoperative and postoperative urinary porphyrin are compared and furthermore, the liver function and the eventual development of skin lesions are monitored. A not significant increase of urinary porphyrin levels after surgery, no skin lesions and no modifications of liver function have been observed. TIVA proved to be safe in this case of PCT.

Anesthesia, Intravenous↗
PubMed1996

Regional cerebral blood flow (rCBF) in migraine during the interictal period: different rCBF patterns in patients with and without aura.

The aim of this study was to evaluate the rCBF (133Xe clearance method) in migrainous patients free from attack. Fifty patients suffering from migraine without aura (group M) and 20 suffering from migraine with aura (group MA) (age range 20-50 years) were submitted to 32 channel rCBF mapping during the interictal period. The rCBF data of patients were compared with those obtained from 60 healthy control subjects (group C) and 21 patients suffering from tension-type headache (group TH). The mean (average of all channels) rCBF values were: group M = 70.5 +/- 13.7 ml/100g/min; group MA = 56.6 +/- 11.4 ml/100g/min; group C = 62.3 +/- 8.3 ml/100g/min; group TH = 62.1 +/- 8.4 ml/100g/min (F = 11.93; p < 0.001). As expected, patients belonging to group TH had a normal rCBF. The mean rCBF of group M was significantly higher than that of groups C and TH, while in group MA it was significantly lower than in groups C and TH. Group M showed a diffuse hyperemia, while group MA showed rCBF values significantly lower than normal in posterior regions, according to aura. Our results suggest that: (a) the rCBF pattern in migrainous patients is different from that in both controls and TH patients, even during the interictal period; (b) patients suffering from migraine with and without aura are two distinct subpopulations with opposite rCBF deviations.

Adult↗
PubMed1993

Multimodality evoked potentials (auditory, somatosensory and motor) in coma.

Auditory brainstem responses (ABRs) have proved to be significantly related to outcome, both in severe head injury and brain hemorrhage. Nevertheless, the usefulness of ABR is limited by the anatomic extent of the investigated pathways. The combined use of ABRs and somatosensory evoked potentials (SEPs) improves the outcome prediction in comparison to the use of only one modality. It mainly decreases the rate of false negatives, since patients with severe hemispheric damage sparing the brain stem may have a poor outcome despite normal ABRs. The use of motor evoked potentials (MEPs) from magnetic transcranial stimulation is also significantly related to outcome: it appears to be far superior to the clinical evaluation of motor responses, while the combined use of MEPs and SEPs gives a new opportunity of checking sensorimotor dysfunction. ABRs and SEPs may also be useful tools in the confirmation of brain death, the kernel of which is the assessment of brainstem death: they allow to check lemniscal pathways, which cannot be properly evaluated by clinical examination, and provide an objective confirmation of absence of brain stem activity.

Acoustic Stimulation↗
PubMed1992

EEG monitoring of carotid endarterectomy with routine patch-graft angioplasty: an experience in a large series.

Four hundred and thirty-nine carotid endarterectomies (CEAs) with routine use of patchgraft angioplasty were performed in 375 patients; the indwelling shunt was used only in patients showing clamp-related EEG abnormalities. Five patients showed EEG abnormalities just after head positioning, which reversed after removal of head hyperextension; three cases suffered EEG flattening due to severe bradycardia or cardiac arrest before carotid clamping, which promptly reversed after treatment. Clamp-related EEG abnormalities appeared in 106 operations (24.2%) and all reversed after the insertion of the indwelling shunt; patients with occlusion of the contralateral internal carotid artery showed a 68.8% rate of EEG clamp-related changes. The short term follow-up (one month after the operation) showed six minor strokes with complete recovery (1.37%), one intraoperative stroke (0.23%), three delayed major strokes (0.69%) and three neurological deaths (0.69%). The long-term follow-up over an average of 42 months showed a 3.7% rate of relevant neurological complications (ie permanent deficits + death) and a 3.16% rate significant restenosis or occlusion of the operated carotid artery. Our results show that the routine use of EEG monitoring and patch-graft angioplasty allow to perform CEAs with a very high degree of safety, improving the clinical course of the disease.

Adult↗
PubMed1991

Spatial mapping of SEP in comatose patients: improved outcome prediction by combined parietal N20 and frontal N30 analysis.

The aim of this study is to evaluate whether SEP spatial mapping can improve outcome prediction in comparison to the conventional SEP recordings. Twenty patients comatose as a result of head injury or cerebral vascular disorders were submitted to 19-channel SEP mapping from median nerve stimulation. SEP recording were performed within the 4th hospital day in 18 cases and over one month from the insult in the remaining two. Nine patients (45%) showed a good recovery or a mild disability, 3 (15%) a severe disability and the rest (40%) died or remained in a vegetative state. Five patients (28%) had bilaterally normal SEP, 5 (28%) the absence of both parietal N20 and frontal N30, while the others (44%) had a dissociation N20/N30 (namely, preserved N20 with absent N30). The SEP mapping was significantly related to the outcome (P = 0.0087) and improved the outcome prediction in comparison to the conventional SEP recordings, allowing to check the presence of frontal N30: in patients with bilaterally present N20 the outcome appeared to depend upon the N30. SEP mapping proved to be a far superior prognostic indicator than the Glasgow Coma Scale. In 3 patients with midline shift on CT scan an abnormal spatial distribution of N20 was disclosed by SEP mapping. Our preliminary results suggest that SEP mapping may improve the assessment of comatose patients in comparison to the use of parietal derivations only.

Adolescent↗