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Biomedical subjects

F Lucchese

Publications and source records attributed to F Lucchese.

16 recordsLinked to original sources
PubMed2002

Systemic capillary leak syndrome. Case report.

We here report the case of a patient with systemic capillary leak syndrome (SCLS). This syndrome is a rare condition characterized by recurrent episodes of hypotension with hemoconcentration and hypoproteinemia. It is due to unexplained episodic capillary hyperpermeabilty that results in fluid and protein shift from the intravascular to the interstitial space: generalized edema, shock and renal failure follow. A 59 yo man was admitted to our intensive care unit because of unexplained shock with hemoconcentration, renal failure, and metabolic acidosis. Previous attemps to reverse shock in a medical ward with crystalloids and dopamine failed. An abdominal CT scan, a TEE, and chest X ray study were inconclusive. No sign or history of major infections or anaphylaxis were present. The patient was resuscitated with massive fluid infusions and norepinephrine on the guide of a Swan Ganz catheter. The diagnosis was made on the basis of a previous episode of severe shock complicated with renal failure and a compartment syndrome, the hemoconcentration, and the negative cardiopulmonary findings. A small amount of monoclonal immunoglobulin G, kappa chain, found in the serum confirmed the diagnosis. The SCLS should be considered in the differential diagnosis of idiopathic and anaphylactic shock. Patients may benefit from a prophylactic treatment with theophilline and terbutaline.

Capillary Leak Syndrome↗
PubMed2001

Postoperative necrotizing fasciitis of the thorax in cardiac surgery.

Necrotizing fasciitis is a rare soft tissue infection and a life-threatening emergency, often fatal. Its incidence and management are described plentifully in the medical literature regarding the most common anatomical sites involved like the abdomen, lower and upper limbs, and perineum. However, available data and case reports of chest wall necrotizing fasciitis after thoracic procedures are scarce, mainly after major cardiac operations. We report and discuss a case of necrotizing fasciitis of the chest wall occurring in the immediate postoperative period of a cardiac procedure, and include a brief review of the concepts, pathophysiology, and treatment reported in the medical literature. We emphasize the need for early diagnosis and urgent and effective surgical debridement. Of importance is the fact that we have not found any references in the literature to cases similar or equal to the one we describe here, which occurred in the postoperative period of a cardiac procedure.

Adult↗
PubMed2000

Serotonin depletion and barrel cortex development: impact of growth impairment vs. serotonin effects on thalamocortical endings.

Converging evidence supports a role of serotonin (5-hydroxytryptamine; 5-HT) in barrel cortex development. Systemic administration of 5-HT-depleting drugs reduces cross-sectional whisker barrel areas in the somatosensory cortex (SSC) of neonatal rats. Here we assess the relative impact on barrel pattern formation of (i) 5-HT depletion and (ii) decreased brain growth, which is often associated with pharmacological 5-HT depletion, by comparing the effects of 5-HT-depleting drugs with those of reduced protein intake. Left hemisphere 5-HT levels in the SSC and right hemisphere whisker barrel areas were assessed at postnatal day 6 (P6) in the same animal following injection of p-chloroamphetamine (PCA) or p-chlorophenylalanine (PCPA) at P0. Both drugs significantly reduced cortical 5-HT content and mean barrel areas at P6, but also body and brain growth. Differences in brain weight accounted for 84.4% of the variance in barrel size, with negligible contributions by cortical 5-HT content. PCPA-treated animals sacrificed at P14 yielded similar trends, albeit less pronounced. Finally, reduced protein intake resulted in lower body weight and cortical 5-HT levels at P6, but yielded no change in brain weight or mean barrel area. Barrel formation therefore appears markedly less sensitive to 5-HT depletion per se than to drug-induced growth impairment.

Aging↗
PubMed1999

Visual evoked potentials and heart rate during white noise stimulation.

Visual evoked potentials (VEPs) were recorded in 12 adult participants as a function of the temporal frequency of a phase-reversed checkerboard, with or without a simultaneously presented white noise. During the VEP recordings also the pulse rate was measured. VEP amplitude changed as function of temporal frequency, but it was not affected by noise. Pulse rate was stable during the session without noise, but it increased during the white noise stimulation at high temporal frequencies. Heart acceleration might be associated to conditions when processing at low levels of visual sensitivity (high temporal frequencies) is furthermore disturbed by interfering stimulation (noise).

Acoustic Stimulation↗
PubMed1998

End-stage heart failure: is there a role for the Batista procedure?

BACKGROUND: Medically refractory heart failure is traditionally managed with cardiac transplantation although some limited success has also been obtained in selected patients using dynamic cardiomyoplasty or mechanical assist devices. Recently, a new surgical alternative called partial left ventriculectomy (PLV) was introduced by Batista in 1995. The procedure attempts to relieve symptoms of congestive failure by reducing myocardial mass and restoring the normal mass-to-volume ratio of the left ventricle. Despite initial enthusiasm, the results of PLV are not yet known. The aim of this study was to determine survival and clinical outcomes in a group of patients submitted to PLV as a means of surgical treatment for end stage heart disease (ESHD) METHODS: From November 1994 to December 1995, 15 patients with ESHD and dilated cardiomyopathy (DCM) were operated on by the technique described by Randas Batista. We compared preoperative and postoperative assessments of NYHA Functional Class (FC), Quality of Life index (QOL), echocardiographic, ergometric, radioisotopic ventriculography and hemodynamic data at intervals of zero, one, three, six and nine, and twelve months postoperatively. Kaplan-Meier, student t-test and chi-square analysis were applied to the numerical and categoric variables. RESULTS: Survival was 80% at one month, 66% at three months, 53% at six months, 47% at nine months and 40% at one year. We also found that 6 of 7 patients (85%) with tricuspid regurgitation (TR) died compared to 4 of 8 patients (50%) without TR. This was the only risk factor indentified which influenced mortality. Post-operative echocardiographic evaluations demonstrated reduced left ventricular end-diastolic and end-systolic diameters at six months (LVESD 65.5 +/- 8.3 mm preoperatively versus 56.83 +/- 5.74 mm at six months, p=0.007 and LVEDD 73.84 +/- 8.25 mm preoperatively versus 65.33 +/- 5.72 mm at six months, p=0.009). Survivors enjoyed an improved clinical status according to both the NYHA functional class (preoperative Class IV=100% versus postoperative at six months : Class IV = 50%, Class III = 17% and Class II = 33%) and the Quality of Life index (100% were in grade 6 and 7 preoperatively versus 0% at six months). However, statistical significance was not reached in most of these data due to the small number of patients. CONCLUSIONS: Actuarial survival in this series of patients was 53% at six months and 40% at twelve months with survivors showing fewer symptoms and clinical events than preoperatively (100% hospitalized preoperatively versus no patient hospitalized at six months). Therefore, the Batista Operation improves the quality of life patients with dilated cardiomyopathy and can possibly be a new means for bridging to cardiac transplantation in severely ill patients who are not likely to survive long enough to recieve a donor heart. Additional improvements in late results will likely be seen after further experience, evolution of the surgical techniques and better patient selection.

Adult↗
PubMed1998

Technical considerations for partial left ventriculectomy (Batista operation).

The surgical technique for partial left ventriculectomy (Batista operation) as performed in two surgical centers is described. This surgical remodeling of the left ventricle restores the abnormal geometric configuration produced by the dilated failing heart. It accomplishes a reduction of the left ventricular end-diastolic diameter and end-diastolic volume with consequent increase in left ventricular function. This procedure represents the newest surgical approach in the management of patients with end-stage cardiomyopathy; it can be used as a bridge to transplantation or perhaps as a definitive form of therapy, particularly in those patients in whom heart transplantation is contraindicated. This report describes technical guidelines to avoid serious intraoperative and postoperative complications directly associated with this technique.

Cardiac Surgical Procedures↗
PubMed1997

Brain dopamine receptor plasticity: testing a diathesis-stress hypothesis in an animal model.

A wealth of clinical data supports a major role of genetic liability as well as of altered brain dopamine (DA) functioning in different types of behavioural disturbances. Genetic influence on behaviour involves multiple genes, rather than one or two major genes, as well as non-genetic sources of variance. Thus, in recent years, increasing attention has been devoted to the involvement of stressful experiences (life events) in the development and expression of psychopathology. Moreover, a diathesis-stress hypothesis has been proposed, which suggests that the environmental factors (stress) are not specific for a given pathology, whereas genetic factors (diathesis) are. Results obtained in an animal model offer support to this hypothesis. Indeed, mice of the C57BL/6 and DBA/2 inbred strains are equally susceptible to stress but develop different behavioural disturbances related to different alterations of brain DA receptors. Moreover, quantitative trait loci (QTL) associations in the C57 (B) x DBA (D) recombinant inbred (RI) strains indicate a number of provisional QTLs influencing the behavioural effect of stress. Finally, the results of this analysis suggest the involvement of regulatory factors related to stress response and neural or synaptic plasticity in the control of brain DA receptor plasticity.

Animals↗
PubMed1996

[Technology and algorithms for implantable dual chamber defibrillators].

The next generation of implantable cardioverter/defibrillators (ICDs) will have the capability for sensing and defibrillating in both chambers of the heart. These devices, which are presently being developed, will thus be able to differentiate between ventricular and supraventricular tachycardias, and to respond accordingly. The burden of stress on the patient will therefore also be further reduced by avoiding unnecessary shock treatment of supraventricular tachycardias. In addition, the new generation of ICDs can also be used for the treatment of chronic atrial tachyarrhythmias. With the dual-chamber IEGM-recording capability, these ICDs will also provide the physician with an important diagnostic tool. The present article describes such an ICD.

Algorithms↗
PubMed1994

Aprotinin in children undergoing correction of congenital heart defects. A double-blind pilot study.

Thirty children undergoing surgical repair for congenital heart defects were randomly selected for a double-blind study on the anti-hemorrhagic and blood-saving properties of aprotinin. The treatment group comprised 14 patients who received aprotinin 7 mg/kg of body weight until the end of perfusion. The placebo group (n = 16) received an infusion of the corresponding volumes of saline. Patients treated with aprotinin bled less during the operation (12.6 ml/kg versus 18.1 ml/kg, p = 0.25) and in the first 24 postoperative hours (chest drainage 12.1 ml/kg versus 17.7 ml/kg, p = 0.07). Hemoglobin loss into chest drainage was reduced in the treated group by half (0.66 versus 1.21 gm in 24 hours, p = 0.07). Fewer blood donors were needed during hospitalization by patients receiving aprotinin (1.07 versus 2.75 donors per patient, p = 0.04). Postoperative transfusion was unnecessary in 64.2% of patients receiving aprotinin compared with only 25% of the placebo group (p = 0.03). Aprotinin increased diuresis significantly during perfusion (4.3 ml/kg versus 1.0 ml/kg, p = 0.005). Other parameters are evaluated, and considerations are made regarding adequacy of the dosage regimen. The drug seems to be safe and easy to handle in children.

Aprotinin↗
PubMed1991

[Use of implantable pacemaker in the treatment of paroxysmal supraventricular tachycardia refractory to pharmacologic therapy].

PURPOSE: To evaluate the results with the use of an automatic antitachycardia pacemaker in patients with refractory paroxysmal supraventricular tachycardia. PATIENTS AND METHODS: Nine patients aged 32 to 63 years with symptoms from 2 to more than 40 years and prophylactic treatment with several antiarrhythmic drugs that had failed to control tachycardia. The frequency of attacks in the year before the implant was from 1 per month to 3 daily and 4 of patients required direct counter current cardioversion at least once. The electrophysiologic studies demonstrated atrioventricular (AV) nodal reentry in 6 and AV reentry utilizing an accessory AV connection in 4 patients (in one patient both mechanisms were present). The patients have been followed from 2 to 18 months. RESULTS: All patients experienced new episodes of the arrhythmia that were successfully terminated by the pacemaker. Two patients presented episodes of tachycardia not terminated by the pacemaker. These events were successfully treated by reprogramming the unit. The drug treatment was discontinued in 7 patients. CONCLUSION: The antitachycardia pacemaker proved to be an effective therapeutic tool in reentrant supraventricular tachycardia refractory to pharmacologic therapy.

Adult↗
PubMed1985

[Inhibition of Plasmodium berghei in rats infested with Strongyloides ratti or Trichinella spiralis; role of high blood corticosterone in reaction to the development of helminths].

The plasma corticosterone induced in the rat by the development of Strongyloides ratti or Trichinella spiralis reaches a sufficient level of intensity to determine reticulocytopenia. The latter is linked chronologically to the inhibition of parasitemia in Plasmodium berghei, which occurs when this protozoa develops at the same time as the Nematodes, and seems to be the causal factor. This hypothesis may be verified by replacing the helminths with the corticotropic action of A.C.T.H. which causes a decrease in the number of reticulocytes.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

[Evaluation of an indirect hemagglutination test for the serodiagnosis of amebiasis].

167 sera have been tested to appreciate the value of an indirect hemagglutination test (Amibiase HAI FUMOUZE) comparatively to an agglutination test of sensibilized particles of latex (Bichro latex Amibe Fumouze BLA) Amibiase HAI test comes out as sensitive and specific for the detection of antibodies in patients suffering from visceral amoebiasis. But some antibodies are also detected in patients with an antecedent of amoebiasis, as it is usually the case with some other techniques. A high positivity of the indirect hemagglutination test, and the concordance between the test HAI and the BLA one are in favour of a visceral amoebiasis. While lower rates or discrepancy between the two tests may evoke an hidden infestation in patients coming out or originated from endemic zones.

Amebiasis↗