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Biomedical subjects

G Della Rocca

Publications and source records attributed to G Della Rocca.

At least 19 recordsLinked to original sources
PubMed2006

Photosynthetic responses to elevated CO(2) and O(3) in Quercus ilex leaves at a natural CO(2) spring.

Photosynthetic stimulation and stomatal conductance (Gs) depression in Quercus ilex leaves at a CO(2) spring suggested no down-regulation. The insensitivity of Gs to a CO(2) increase (from ambient 1500 to 2000 micromol mol(-1)) suggested stomatal acclimation. Both responses are likely adaptations to the special environment of CO(2) springs. At the CO(2)-enriched site, not at the control site, photosynthesis decreased 9% in leaves exposed to 2x ambient O(3) concentrations in branch enclosures, compared to controls in charcoal-filtered air. The stomatal density reduction at high CO(2) was one-third lower than the concomitant Gs reduction, so that the O(3) uptake per single stoma was lower than at ambient CO(2). No significant variation in monoterpene emission was measured. Higher trichome and mesophyll density were recorded at the CO(2)-enriched site, accounting for lower O(3) sensitivity. A long-term exposure to H(2)S, reflected by higher foliar S-content, and CO(2) might depress the antioxidant capacity of leaves close to the vent and increase their O(3) sensitivity.

Adaptation, Physiological↗
PubMed2006

Sedation in the critically ill patient.

Critically ill patients who require intensive care need effective analgesia and sedation to control potentially unpleasant symptoms, such as pain and anxiety. Analgesics and sedatives are also used to allow patients to tolerate nursing procedures and tracheal intubation as well as to aid mechanical ventilation. Metabolism of traditional opioids is dependent on organ function, which is abnormal among critically ill patients. The use of a score system to ensure sufficient but not excessive sedation should be mandatory. Sufentanil and remifentanil are more predictable opioids that are suitable for either sedation or analgesia in critically ill patients to achieve an adequate Ramsay score from 2 to 4.

Analgesics↗
PubMed2005

Increased plasma levels of adrenomedullin, a vasoactive peptide, in patients with end-stage pulmonary disease.

AIM: To study adrenomedullin (AM) plasma levels in patients with severe lung disease and to analyze the relationship between AM and heart changes, hemodynamics and blood gases. METHODS: Case control study of 56 patients (36 men, 20 women) with severe lung disease and 9 control subjects (7 men, 2 women). Patients with end-stage pulmonary disease, including chronic obstructive pulmonary disease (COPD, n=11), cystic fibrosis (CF, 26), idiopatic pulmonary fibrosis (ILD, n=9), and idiopatic pulmonary arterial hypertension (PAH, n=10), who were evaluated for lung trasplantation between January 1997 and September 2000, and nine patients who underwent lung surgery for a solitary benign nodule. AM plasma levels in pulmonary artery (mixed venous blood, vein) and aorta or femoral artery (arterial, art), art and vein blood gases, pulmonary hemodynamics, systemic hemodynamics, two-dimensional transthoracic echocardiography and echo-Doppler study. RESULTS: Plasma AM (art and ven) levels were higher among patients' group compared to the controls (AMart p<0.02 and AMven p<0.04) for CF, ILD, PAH (AMart, pg ml(-1) Controls 13.7+/-3.6, COPD 22.8+/-6.2, CF 28.1+/-11.4, ILD 34.1+/-14.3, PAH 35.1+/-18.9; AMven, pg ml(-1) Controls 14.2+/-4.8, COPD 28.1+/-12.6, CF 31.7+/-14.1, ILD 38.7+/-16.5, PAH 40.1+/-4.4). We found with a trend towards higher concentration in ILD and PAH patients compared to COPD and CF but no statistical significant differences. Mixed-venous AM was higher than arterial AM in all groups resulting in AM uptake (AMPulmUp pg min(-1) Controls 4.8+/-22.6, COPD 21.1+/-44.9, CF 20.6+/-45.1, ILD 23.7+/-38.5, PAH 29.9+/-49.7). The univariate analysis showed a weak but significant correlation between AMart and mean systemic arterial pressure, heart rate, mean pulmonary arterial pressure and systemic vascular resistance. In the multivariate analysis, four variables emerged as independent factors of AMart including mean pulmonary arterial pressure, heart rate, mean systemic arterial pressure and left ventricular diastolic diameter (F=8.6, p<0.00001, r=0.60, r2=0.32). A similar weak correlation was apparent between AMven, systemic vascular resistance, and mean pulmonary arterial pressure. The results of multivariate analysis identify right atrial enlargement, mean right atrial pressure, heart rate and left ventricular dimensions as the only independent variables related to AMven (F=4.3, p<0.0004 r=0.56, r2=0.26). AM pulmonary uptake was significantly correlated with AMven (r=0.65), but not with hemodynamic, blood gas and echocardiographic variables. CONCLUSIONS: AM plasma levels are elevated in patients with severe lung disease in face of a preserved pulmonary uptake. These results suggest that the high AM plasma levels in patients with severe lung disease are not caused by a reduced pulmonary clearance, instead suggesting a systemic production.

Adrenomedullin↗
PubMed2005

Volumetric monitoring: principles of application.

The transpulmonary thermodilution indicator (TPID) technique has been recently introduced and diffuse in clinical practice. This "less-invasive" device measures intermittent cardiac output and, based on pulse contour method, continuous cardiac output, that agree with cardiac output obtained with pulmonary artery catheter in different clinical setting. Moreover it allowed stroke volume variation and pulse pressure variation experimental and clinically validate fluid responsiveness index in controlled mechanically ventilated patients. The TPID technique allowed an estimations of preload index such as intrathoracic blood volume and "lung edema" index as extra vascular lung water. We reviewed the principle of clinical application based on the current literature now available from this device. Cardiac output monitoring based on TPID technique is safe and accurate, as well as fluid responsiveness indicator (SVV and PPV). Intrathoracic blood volume seems to be a good preload index but the results reported in literature are not homogeneous in all its applications. Extra vascular lung water index is a very interesting parameter particularly in critically ill setting but its clinical application is not yet widely documented.

Blood Volume↗
PubMed2005

Nitric oxide in thoracic surgery.

Inhalation of nitric oxide has been reported to alter pulmonary blood flow in animal and human studies. This effect is related to the relaxant action of nitric oxide on arterial vascular smooth muscle cells. When nitric oxide is administered by inhalation, this effect is limited to the pulmonary vasculature as it is rapidly inactivated by hemoglobin as soon as it enters the blood stream. The effect of inhaled nitric oxide is more pronounced in well ventilated areas of the lung, where it promotes redistribution of pulmonary blood flow to regions with high ventilation-perfusion ratio decreasing pulmonary hypertension and improving oxygenation. Nitric oxide has been used to treat pulmonary hypertension and hypoxemia that occurred in thoracic surgery during one lung ventilation, postpneumonectomy pulmonary edema and lung transplantation. Inhaled nitric oxide may be a useful tool in patients with a low PaO2/FiO2 ratio during one lung ventilation. Further powered studies are still required to define the dose and timing of inhaled nitric oxide in patients who do have ischemia-reperfusion injury after lung transplantation.

Administration, Inhalation↗
PubMed2004

Fenoldopam mesylate and renal function in patients undergoing liver transplantation: a randomized, controlled pilot trial.

To test the relative effects on serum creatinine (CRE), blood urea nitrogen (BUN), and urine output of small-dose dopamine and fenoldopam in patients undergoing liver transplantation, we randomized 43 patients to 1 of 2 continuous infusions over 48 h, starting with anesthesia induction: fenoldopam, 0.1 microg . kg(-1) . min(-1) or dopamine, 2 microg . kg(-1) . min(-1). We used predetermined hemodynamic and intravascular volume goals (intrathoracic blood volume index 800-1000 mL/m(2), extravascular lung water index <7 mL/kg) to manage patients with an algorithm for use of mannitol and furosemide to maintain urine output >1 mL . kg(-1) . h(-1). At postoperative day 3, the median CRE increase was 0.2 mg/dL (interquartile range [IQR] -0.2-0.5) with fenoldopam and 0.5 mg/dL (IQR 0.3-0.9, P = 0.004) in the dopamine group. The BUN increase was median 2 mg/dL (IQR -2-8) versus 8.5 mg/dL (IQR 5-12, P = 0.01), respectively, with fenoldopam versus dopamine. Urine output was similar; however, significantly fewer fenoldopam patients required furosemide compared with dopamine patients (median 1 [IQR 0-3] versus 3 [IQR 2-4], respectively, P = 0.003). The hemodynamic effects of dopamine and fenoldopam were similar. Compared with dopamine, in the setting of liver transplantation, fenoldopam is associated with better CRE and BUN values.

Acute Kidney Injury↗
PubMed2004

Hemodynamic-volumetric monitoring.

Maintenance of adequate cardiac preload is of paramount importance in the treatment of patients undergoing major surgical surgery and in the critically ill setting. The end point is to maintain the organ perfusion through volume replacement and therapy to optimize cardiac output, oxygen deliver. Various methods have been introduced into clinical practice to estimate cardiac preload. In the last 10 years the transpulmonary indicator dilution technique showed to be accurate as hemodynamic-volumetric monitoring. We briefly review the intra thoracic blood volume index as a preload index and the fluid responsiveness indexes, stroke volume variation and pulse pressure variation, available as novel parameters at the bed-side. The optimization of fluid balance and vasoactive drugs administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system where intravascular volume management is a primary objective.

Blood Volume↗
PubMed2003

Clinical and neurological abnormalities in adult celiac disease.

We assessed the occurrence of neurological signs and symptoms in adult patients with celiac disease and evaluated the correlation between neurological features and diet. A total of 176 patients and 52 age-matched controls underwent a semistructural interview and a neurologic examination. The effect of gluten-free diet was evaluated by comparing the prevalence of signs and symptoms among patients adhering to a gluten-free diet and patients on an unrestricted diet. The occurrence of headache, dysthymia and signs of peripheral neuropathy was significantly higher in patients with celiac disease than in control subjects. Adherence to a strict gluten-free diet was associated with a significant reduction of headache, dysthymia, cramps and weakness, but did not modify the occurrence of paresthesia or hyporeflexia. Neurological signs and symptoms are associated with celiac disease and can be ameliorated by a gluten-free diet.

Adolescent↗
PubMed2002

Preload and haemodynamic assessment during liver transplantation: a comparison between the pulmonary artery catheter and transpulmonary indicator dilution techniques.

BACKGROUND AND OBJECTIVE: Liver transplantation is characterized by several changes in intravascular blood volume due to vasodilatation based on neurohumoral mediators, intraoperative bleeding and anaesthesia technique effects. Today, with the transpulmonary indicator dilution technique, cardiac index (CIart) can be evaluated and preload assessed in terms of the intrathoracic blood volume index (ITBVI). The aim was to analyse in patients undergoing liver transplantation two preload variables, pulmonary artery occlusion pressure (PAOP) and ITBVI with respect to cardiac index (CIpa) and stroke volume index (SVIpa), the correlation between ITBVI and PAOP, and secondary the relationship between the changes (delta) of ITBVI and PAOP and the changes of CIpa and SVIpa, and the relationships between deltaITBVI and deltaPAOP. The reproducibility and precision of all CIart and CIpa measurements were also evaluated. METHODS: A prospective study was performed in 60 patients monitored with a pulmonary artery catheter and with the PiCCO system. The variables were evaluated with a linear regression model. RESULTS: Linear regression analysis between ITBVI-CIpa and ITBVI-SVIpa were r2 = 0.47 (P < 0.0001) and r2 = 0.55 (P < 0.0001) respectively, while PAOP poorly correlated to CIpa (r2 = 0.02), SVIpa (r2 = 0.015) and ITBVI (r2 = 0.002). Only changes in ITBVI were correlated with changes in CIpa (delta1, r2 = 0.37; delta2, r2 = 0.32), and SVIpa (delta1, r2 = 0.60; delta2, r2 = 0.47). The mean bias between CIart and CIpa was 0.13 L min(-1) m(-2) (2 SD = 1.04L min(-1) m(-2)) (r2 = 0.86, P < 0.0001). CONCLUSIONS: In comparison with PAOP, ITBVI seems a more reliable indicator of cardiac preload in patients undergoing liver transplantation.

Adult↗
PubMed2002

Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique.

BACKGROUND: Cardiac output (CO) can be measured intermittently by bolus thermodilution methods in the pulmonary artery (COpa) or in the aorta (COart). A continuous thermodilution method (CCO) and a method for continuous estimation using the arterial pulse wave (PCCO) are also available. METHODS: We compared two methods of intermittent CO measurements in patients during liver transplantation: COpa, regarded as the current clinical standard, and an aortic transpulmonary thermodilution technique (COart) performed with the PiCCO system. We also compared CCO and PCCO. Measurements were made in 62 patients at three stages: after the induction of anaesthesia, after caval clamping phase, and at the end of surgery. We used Bland-Altman and correlation analysis. RESULTS: We found close agreement between the techniques. Mean bias between COart and COpa and PCCO and CCO was 0.15 (2SD of differences between methods=1.74) litre min(-1) and -0.03 (1.75) litre min(-1), respectively. Mean bias between CCO and COpa and PCCO and COpa was 0.02 (1.48) litre min(-1) and 0.04 (1.69) litre min(-1), respectively. CONCLUSIONS: Measurement with the aortic transpulmonary thermodilution technique gives continuous and intermittent values that agree with the pulmonary thermodilution method.

Adult↗
PubMed2002

Post-thoracotomy analgesia: epidural vs intravenous morphine continuous infusion.

BACKGROUND: We compared thoracic morphine epidural analgesia (TEA) and I.V. analgesia (IVA) with morphine, in respect to the time to extubation, the quality of postoperative analgesia, side effects, complications, postoperative hospital length of stay in patients having thoracotomy lung resection. METHODS: We prospectively studied 563 consecutive patients, undergoing thoracotomy (lobectomy, bilobectomy or pneumonectomy), randomized in two groups: TEA 286 patients and IVA 277 patients. In the epidural group, before the induction of anesthesia, continuous infusion of 15 mg of morphine in 250 mL of normal saline at 5 mL/h was started. In the IVA group a continuous infusion of 30 mg of morphine associated with 180 mg ketorolac in 250 mL of normal saline at 5 mL/h was started before the induction of anesthesia. The pain degree was evaluated on an analogic scale by Keele modified at 1 (end of anesthesia) 6, 12, 24, and 48 postoperative hours, at rest and after movements. Data obtained were analysed by means of the analysis of variance for repeated measures. RESULTS: The time from the end of surgery to tracheal extubation was similar in both groups. Significantly lower numeric verbal pain scores at rest and after movements were found in the epidural group (p<0.001). Postop complications, nausea and vomiting were higher in the IVA group (p<0.05). Postoperative mean hospital length of stay was 9+/-4 days in TEA and 11+/-4 in the IVA group (p<0.05). CONCLUSIONS: In our study the epidural root was superior in terms of analgesia, side effects, length of stay and postoperative complications after thoracotomy.

Analgesia, Epidural↗
PubMed2001

Pediatric renal transplantation: anesthesia and perioperative complications.

The appropriate choice of anesthesia for patients (pts) undergoing renal transplantation (Ktx) requires minimal toxicity and accurate monitoring for pts at high risk for metabolic, cardiovascular, and respiratory perioperative complications. We evaluated the anesthetic management and postoperative follow-up in pediatric Ktx performed in the last 12 years in our institution. From 1988 to 1999, 75 ASA class II-III pts (45 males, 22 females) younger than 18 years scheduled for Ktx were studied: 49 received a graft from a cadaveric donor (CD) and 26 from a living donor (LD). All pts were treated with dialysis within 24 h before the procedure. Standard monitoring consisted of an electrocardiogram, central venous pressure, non-invasive arterial pressure, pulse oximetry, and inspiratory and expiratory gas analysis. If necessary, an arterial cannula and pediatric pulmonary catheter were introduced. Anesthesia was induced with sodium thiopental, propofol, halothane, or sevoflurane and maintained with isoflurane and/or fentanyl and droperidol in O2:N2O (FiO2 0.4%). As muscle relaxants atracurium or cisatracurium besilate were used, except in allergic pts, in whom vecuronium or rocuronium bromide was administered. Dopamine, 20% mannitol, and furosemide were used to increase diuresis. Continuous morphine and ketoralac infusions were used for postoperative pain relief. The surgical technique was the same in all cases. Complications and renal-function (RF) recovery were evaluated relating to CD and LD using the chi-square test; differences in mean anesthesia and surgical time were evaluated by Student's t-test; survival curves were calculated from the day of Ktx to death or last follow-up and estimated by the Kaplan-Meier method. Values of P below 0.05 were considered significant. Postoperative immunosuppressive therapy was based on cyclosporine together with other conventional drugs. Mean anesthesia time was 228 +/- 65 min. Mean kidney ischemia time for CD was 16.5 +/- 4 h. Four pts (3 CD, 1 LD) died within 72 h postoperatively: 3 due to cardiac failure and 1 to metabolic coma. Six pts showed cardiovascular and 3 had infective complications, all successfully treated. Three pts (2 CD, 1 LD) died within 2 to 12 months after, surgery; 10 (6 CD, 4 LD) had graft failure and are still alive on dialysis; 58 (38 CD, 20 LD) are alive in good health after a mean follow-up of 57.6 +/- 36.6 months (range 12-120 months). Fifteen of 26 pts younger than 12 years (21 CD and 5 LD) recovered RF intraoperatively (10 CD, 5 LD); 1 with CD and 1 with LD showed postoperative graft failure and 2 with CD died within 72 h postoperatively, 22 (18 CD and 4 LD) are alive in good health. This group showed no statistical difference compared to pts older than 12 years. Of 16 pts (15 CD and 1 LD) with body weight (BW) less than 25 kg, 6 showed intraoperative (5 CD, 1 LD) recovery of RF. The 3 deaths were all in CD pts, 2 within 72 h and one 2 months after surgery; only 1 LD had postoperative graft failure. Twelve pts (75%) (12 CD, 80%) are alive in good health. Compared to pts with BW of 25 kg or more, this group showed lower intraoperative recovery of RF (P < or = 0.05). No peri- and postoperative complications occurred in all 26 LD pts (100%). Recent advances in surgery, anesthesia, immunosuppression, and antimicrobial prophylaxis have made Ktx a more predictable procedure even in pediatric pts. For high-risk pts, mortality and morbidity can be controlled by accurate surgical, anesthetic, and postoperative management. Pts younger than 12 years and with BW less than 25 kg are more likely to develop peri- and postoperative complications.

Adolescent↗
PubMed2001

Role of pre-emptive analgesia in reduction mammaplasty.

Pre-emptive analgesia is an antinociceptive treatment that prevents altered central excitability from high intensity noxious stimuli. The aim of this study was to evaluate the efficacy of pre-emptive analgesia in patients due to have elective breast reduction that usually requires drugs for postoperative pain control. Sixty women, ASA grades I-II, were randomly divided into two groups: 30 patients were given ropivacaine infiltration 1.5 mg/ml plus adrenaline 1/200,000 in normal saline 100 ml before the skin incision, and 30 had normal saline 100 ml plus adrenaline 1/200,000 infiltrated. Postoperative pain was evaluated by an observer who was unaware of the treatment given, and scored on a visual analogue score (VAS) during the first 72 hours postoperatively. Analgesic requirements were recorded. There was a statistically significant difference between groups in the amount of additional pain control required during the early postoperative period, which suggests that pre-emptive analgesia reduces pain after reduction mammaplasty.

Adult↗
PubMed2001

[Anesthesia for lung volume reduction surgery].

BACKGROUND: Lung volume reduction surgery (LVRS) has become a novel palliative procedure for a subgroup of patients with advanced non-bullous emphysema. METHODS: Seventy-six patients with severe emphysema were evaluated: ten patients were considered for lung transplantation and only 24 underwent LVRS. In all patients an epidural catheter was inserted between the T5-T9 space. During one lung ventilation (OLV), ventilatory setting was adjusted to avoid air trapping and/or dynamic hyperinflation and high frequency jet ventilation was used when PaO2/ FiO2 was lower than 60 mmHg in 5 patients. Permissive hypercapnia (PaCO2=53 mmHg) was allowed to avoid hyperinflation and reach hemodynamic stability. RESULTS: During OLV PaO2/FiO2 was 148+/-80 mmHg, PaCO2 53+/-11 mmHg, mPA 27+/-2 mmHg and Qsp/Qt was 38+/-6%. Although the high risk patients, there were no complications due to hypercapnia during surgery. Twenty-three patients were extubated successfully at the end of the surgery (PaO2/FiO2 179+/-34 mmHg and PaCO2 59+/-11 mmHg) and only one patient was not extubated because of air leakage and died for postoperative respiratory failure after 20 days. Another patient died because of sepsis after 15 days. Numeric Ordinal Verbal Scale (by Keele modified) was used for postoperative pain degree at 0, 12th and 24th hours. No patients had pain>2. CONCLUSIONS: In conclusion, a careful anesthesia technique with an accurate intraop monitoring associated with thoracic epidural analgesia even in Video Assisted Thoracic Surgery is suggested in LVRS patients; 12 months postoperative data confirm the validity of the procedure (FEV1 24 AE 36%, FVC 53 AE 70%, RV 265 AE 199% and 6MWT 213 AE 330 m).

Adult↗
PubMed2000

Effect of diabetes on some primitive reflexes.

Primitive reflexes (PRs) are present in newborns; they disappear as the brain matures and increase in frequency in healthy elderly individuals. Primitive reflexes are more frequent in some neurological disorders than in age-matched controls. The aim of this study was to investigate the effect of diabetes on some PRs. We examined three PRs (glabellar tap, snout and palmomental reflexes) in 376 subjects: 111 normal age-matched controls, 60 patients with cerebrovascular disease (CVD) and 205 patients with type 2 diabetes mellitus. The latter patients were divided into three groups: (1) diabetics without neurological complications (D); (2) diabetics with cerebrovascular disease (D-CVD); and (3) diabetics with polyneuropathy (D-PN). The frequency of PRs was increased in CVD, unchanged in D-CVD (except palmomental) and greatly reduced in D and D-PN. It is possible that the vascular lesions in perforating arteries of the pons in diabetic subjects, previously studied in some pathological reports, can account for the reduced occurrence of primitive reflex responses.

Aged↗
PubMed2000

[Anesthesia in single and bilateral sequential lung transplantation. Lung Transplantation Group].

BACKGROUND: Anesthesia for lung transplantation: intraoperative complications and long term results. METHODS: 52 patients were scheduled for 16 single lung transplantations (SLT) (9 fibrosis and 7 emphysema) and 36 bilateral sequential lung transplantations (DLT) (4 bronchiectasis, 6 emphysema, 3 fibrosis, 22 cystic fibrosis and 1 pulmonary hypertension). Anesthesia was induced with propofol or midazolam, and fentanyl or alfentanil. As muscle relaxant vecuronium bromide was used. Anesthesia was maintained with isoflurane, fentanyl in boluses or sufentanil continuous infusion in O2 100%. Prostaglandin E1 (20-300 ng/kg/min), inhaled nitric oxide (10-40 ppm), dobutamine (5-15 mcg/kg/min), norepinephrine (0.05-3 mcg/kg/min) and ephedrine (5-10 mg per bolus) were used for hemodynamic management. In 2 patients inhaled areosolized prostacyclin were administered. RESULTS: Mean pulmonary arterial pressure (mPA) and pulmonary vascular resistance (PVRI) increased after pulmonary artery clamping during first lung (mPA: 3347 nel DLT, 3643 nel SLT; PVRI; 375488 nel DLT, 377420 nel SLT) and second lung implantation (mPA: 3746; PVRI: 263553) and decreased after reperfusion of the first (mPA: 4737 nel DLT, 4329 nel SLT; PVRI: 488263 nel DLT, 420233 nel SLT) and the second lung (mPA: 4629; PVRI: 553260). Only in 9 cases (7 DLT and 2 SLT) C-P bypass was used. CONCLUSIONS: With a strong drug support with pulmonary vasodilators, positive inotropic and systemic vasoconstrictor drugs, in most patients we transplanted C-P bypass can be avoided. Intraoperative deaths were not observed. Two years actuarial survival is 65% for DLT and 60% for SLT.

Adolescent↗