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Biomedical subjects

G Domenighetti

Publications and source records attributed to G Domenighetti.

At least 37 records · Page 2Linked to original sources
PubMed1997

Treatment with N-acetylcysteine during acute respiratory distress syndrome: a randomized, double-blind, placebo-controlled clinical study.

PURPOSE: Intravenous N-acetylcysteine (NAC) has been reported to improve systemic oxygenation and reduce the need for ventilatory support in patients with an acute lung injury. In the more serious form, namely established adult respiratory distress syndrome (ARDS) (PaO2/FIO2 < or = 200 mm Hg), we tested the hypothesis that treatment with intravenous NAC may be beneficial. MATERIALS AND METHODS: Respiratory dysfunction was graded daily according to the need for mechanical ventilation and FIO2 and to the evolution of the lung injury score (LIS) and the PaO2/FIO2 ratio in 42 patients with established ARDS receiving either NAC 190 mg/kg/day or placebo as a continuous intravenous infusion over the first 3 days of their clinical course. RESULTS: NAC and placebo groups (22 and 20 patients, respectively) were comparable for demographic characteristics, ARDS categories, severity of illness (simplified acute physiology score [SAPS II]) LIS and PaO2/FIO2 ratio. Mortality rate was 32% for the NAC and 25% for the placebo group (difference not significant). At admission (day 1), 91% of patients in the NAC and 95% in the placebo group required ventilatory support; at days 2, 3, 5, and 7 after admission, the percentage of patients receiving ventilatory support was not significantly reduced for both groups in comparison with day 1. Moreover, there were no differences between the two groups at the same observation days. In both groups, the FIO2 was significantly lower and the PaO2/FIO2 ratio was significantly higher than the initial values during the evolution (FiO2 at day 3, P < .01 for NAC and P < .05 for placebo; PaO2/FIO2 at day 3: P < .01 for NAC and P < .02 for placebo), but this improvement was similar for both groups and, moreover, the between-group comparison was never significantly different at the various collection days. The LIS decreased significantly in NAC group between days 1 and 3 (2.23 +/- 0.62 v 1.76 +/- 0.17; P < .05), whereas no changes were observed in the placebo group; at day 5, there was a significant difference between the two groups (1.53 +/- 0.21 for the NAC v 2.15 +/- 0.19 for the placebo group; P < .05). In the prevalent sepsis category (10 patients in the NAC and 9 in the placebo group), the mortality rate, the need of ventilatory support, the intensive care unit stay, and the PaO2/FIO2 evolution did not differ significantly in both subgroups. CONCLUSIONS: In this relatively small group of patients presenting with an established ARDS subsequent to a variety of underlying diseases, intravenous NAC treatment during 72 hours neither improved systemic oxygenation nor reduced the need for ventilatory support.

Acetylcysteine↗
PubMed1997

Lung function and long term exposure to air pollutants in Switzerland. Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) Team.

The effect of long-term exposure to air pollutants was studied in a cross-sectional population-based sample of adults (aged 18 to 60 yr; n = 9,651) residing in eight different areas in Switzerland. Standardized medical examination included questionnaire data, lung function tests, skin-prick testing, and end-expiratory CO concentration. The impact of annual means of air pollutants on FVC and FEV1 was tested (controlling for age and age squared, sex, height, weight, educational level, nationality, and workplace exposure). Analyses were done separately for healthy never-smokers, ex-smokers (controlling for pack-yr), for current smokers (controlling for cigarettes per day and pack-yr smoked), and for the whole population. Significant and consistent effects on FVC and FEV1 were found for NO2, SO2, and particulate matter < 10 microm (PM10) in all subgroups and in the total population, with PM10 showing the most consistent effect of a 3.4% change in FVC per 10 microg/m3. Results for ozone were less consistent. Atopy did not influence this relationship. The limited number of study areas and high intercorrelation between the pollutants make it difficult to assess the effect of one single pollutant. Our conclusion is that air pollution from fossil fuel combustion, which is the main source of air pollution with SO2, NO2, and PM10 in Switzerland, is associated with decrements in lung function parameters in this study.

Adolescent↗
PubMed1997

Haemodynamic effects of ketanserin either alone or with oxygen in COPD patients with secondary pulmonary hypertension.

To indirectly test the hypothesis whether serotonin (5-HT) might have a role in the increase in pulmonary vascular resistance, we evaluated the haemodynamic and gas exchange response of intravenous ketanserin (K), a 5-HT receptor inhibitor, in eight severe but stable patients with chronic obstructive pulmonary disease with secondary pulmonary hypertension (mean pulmonary artery pressure (Ppa) 30.3 +/- 7.3 mmHg). Measurements were done at baseline, after oxygen breathing (2 L.min-1), K bolus (6-15 mg) and finally during oxygen breathing (2 L.min-1) added to K infusion (3-6 mg.h-1). K bolus induced a significant reduction of mean Ppa (p < 0.05), mean systemic arterial pressure (p < 0.01) and total systemic resistance (p < 0.01). Cardiac index (+7%), oxygen delivery (+7%) and pulmonary vascular resistance (magnitude of the reduction: -12%) did not change significantly. When oxygen was added to K infusion, the cardiac index significantly dropped when compared to K bolus (p < 0.05), but oxygen delivery remained stable because of the resulting increase in arterial oxygen concentration; against baseline, the mean Ppa showed the same magnitude of reduction as with oxygen breathing or K bolus alone (p < 0.05). Ventilation and gas exchange were not significantly influenced by K bolus. When we individually analysed the changes of pulmonary vascular resistances by plotting the driving pressure through the pulmonary circulation against the cardiac output, we observed that an active vasodilating effect on the pulmonary circulation occurred with K in only one patient, while in three other patients there was rather a recruitment effect of the pulmonary vessels due to the systemic effects of the drug. In conclusion, this study of a small number of patients with severe chronic obstructive pulmonary disease associated with pulmonary hypertension shows that the parenterally given serotonin antagonist ketanserin predominantly affects the systemic circulation. Our results do not support the hypothesis that in stable chronic obstructive pulmonary disease patients with pulmonary hypertension, serotonin might have a role in the increase of pulmonary vascular tone.

Female↗
PubMed1995

[Health care economics, uncertainty and physician-induced demand].

The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.

Economic Competition↗
PubMed1994

Acute effects of ambient ozone on respiratory function of Swiss schoolchildren after a 10-minute heavy exercise.

This study was conducted in Switzerland between May and October 1989 to assess possible decrements in lung function occurring as a result of 10 minute exposure to ambient air containing different ozone concentrations. Once a month, 128 children in two different areas of Southern Switzerland (Chiasso and Aurigeno) had a pulmonary function test before and after a standardized 10 minute exercise (pulse rate, 170/min) on a cycle ergometer, outdoors. Ozone concentrations were similar in both areas, ranging from 40 to 157 micrograms/m3 (1/2h means) during the exercise tests. The two communities differed with respect to long-term average pollution levels. The mean NO2 concentration over the six months study period was 70 micrograms/m3 in Chiasso and 18 micrograms/m3 in rural Aurigeno. Of the eligible children 85% participated and attended 4-6 tests. Parents completed a standardized questionnaire on family background, home characteristics and the child's early and present illness history. A total of 500 acceptable pairs of spirograms and corresponding ozone concentrations (average 3.8 per child) were available for analysis. Regressions of each individual's pre-post differences of FVC, FEV1 and peak flow on ozone concentrations measured during the outdoor exercise indicated that elevated ozone levels significantly reduced peak flow values. Adjustments for temperature and relative humidity increased the magnitude of the peak flow slopes. The average adjusted regression coefficient for delta-peak flow on ozone was -2.28 mL/s/micrograms/m3 (95% CI, -0.57 -3.99). It is noteworthy that the observed relationships occurred at ozone concentrations below 160 micrograms/m3 and after an exercise duration of only 10 minutes.

Atmosphere↗
PubMed1994

N-acetylcysteine enhances recovery from acute lung injury in man. A randomized, double-blind, placebo-controlled clinical study.

OBJECTIVE: To determine the effects of intravenous N-acetylcysteine (NAC) on the development of severe adult respiratory distress syndrome (ARDS) and mortality rate in patients with mild-to-moderate acute lung injury and to analyze the duration of ventilatory support and FIO2 required as well as the evolution of the lung injury score. SETTING: Three university hospital ICUs and one regional ICU in Switzerland. PATIENTS: Sixty-one adult patients presenting with mild-to-moderate acute lung injury and various predisposing factors for ARDS received either NAC, 40 mg/kg/d, or placebo intravenously for 3 days. MEASUREMENTS: Respiratory dysfunction was assessed daily according to the need for mechanical ventilation and FIO2, the evolution of the lung injury score, and the PaO2/FIO2 ratio. The cardiovascular state, liver function, and kidney function were also monitored. Data were collected at admission (day 0), during the first 3 days, and on the day of discharge from the ICU. RESULTS: The NAC and placebo groups (32 and 29 patients, respectively) were comparable at ICU admission for severity of illness assessed by the simplified acute physiology score (SAPS) (10.8 +/- 4.6 vs 10.9 +/- 4.8) and lung injury score (LIS) (1.39 +/- 0.95 vs 1.11 +/- 1.08) (mean +/- SD). Three patients in each group developed ARDS. The 1-month mortality rate was 22 percent for the NAC group and 35 percent for the placebo group (difference not statistically significant). At admission, 22 of 32 patients (69 percent) in the NAC group were mechanically ventilated compared with 22 of 29 (76 percent) in the placebo group. At the end of the treatment period (day 3), 5 of 29 (17 percent) in the NAC group and 12 of 25 (48 percent) in the placebo group were still receiving ventilatory support (p = 0.01), The FIO2 was 0.37 less than admission value (day 0) in the NAC group, and 0.20 less in the placebo group (p < 0.04); the oxygenation index (PaO2/FIO2) improved significantly (p < 0.05) from day 0 to day 3 only in the NAC-treated group. The LIS showed a significant regression (p = 0.003) in the NAC-treated group during the first 10 days of treatment: no change was observed in the placebo group. No adverse effects were observed during the treatment with NAC. CONCLUSIONS: Intravenous NAC treatment during 72 h improved systemic oxygenation and reduced the need for ventilatory support in patients presenting with mild-to-moderate acute lung injury subsequent to a variety of underlying diseases. Development of ARDS and mortality were not reduced significantly by this therapy.

Acetylcysteine↗
PubMed1994

Spontaneous biliothorax (thoracobilia) following cholecystopleural fistula presenting as an acute respiratory insufficiency. Successful removal of gallstones from the pleural space.

A patient presented to the emergency department with tachypnea, fever, a right pleural effusion, and lung consolidation. The computed tomographic guided thoracentesis yielded a greenish fluid with bilirubin. The ultrasound examination demonstrated a distended gallbladder with stones, positioned on the ventral face of the liver and a free communication between the fundus and the pleural cavity. The cholecystopleural fistula was confirmed at operation.

Acute Disease↗
PubMed1993

Revisiting the most informed consumer of surgical services. The physician-patient.

Little is known about the consumption of medical and surgical services by the most informed consumer in the health care market: the physician-patient. Such knowledge should be important for the understanding of the role of information on consumption, supplier-induced demand, the doctor-patient relationship, unnecessary medical services, and the adequacy of professional practices to the renal health needs of the "ordinary patient." We measured by questionnaire the standardized consumption of seven common surgical procedures. Except for appendectomy, the age- and sex-standardized consumption for each of the common surgical procedures was always significantly higher in the general population than for the "gold standard" of physician-patients. The data suggest that (a) contrary to prior research, doctors have much lower rates of surgery than does the general population; and (b) in a fee-for-services health care market without financial barriers to medical care, less-informed patients are greater consumers of common surgical procedures.

Adolescent↗
PubMed1992

[Prevention of cardiovascular diseases is effective. Initial program evaluation of the canton Tessin (1984-1989)].

This study measures and evaluates the effects of the CVD prevention programme which has been underway in the Canton of Tessin (Switzerland) since 1984. The programme was designed with the following objectives: --high blood pressure: each Tessin inhabitant should be aware of the admissible blood pressure limits, the consequences of surpassing the norm, as well as know his or her own blood pressure count and have it measured at least once a year; --tobacco consumption: a positive image of non-smokers is promoted, as well as the respect of non-smoker's rights. The population, particularly the young, are "invited" not to smoke; eating habits: each Tessin inhabitant will be provided with the information necessary to enable him/her to make rational choices concerning content in order to ensure a balanced diet, rich in fibres and low in saturated fats; activity: physical activity, at least 20 minutes three times a week, is promoted for all age groups; early warning symptoms:information will be provided to enable inhabitants to recognize indications of cardiac distress in order to diminish the time between the first pain and hospitalisation; A vast and varied information campaign was set up to pursue these objectives. Much of the campaign was implemented through use of various media (television, radio, daily and weekly press), and seconded with the periodic distribution of information tracts to all the households of the district. The mass media campaign was complemented with a variety of activities for all ages: from poster competitions, to the edition and sale of recipe books, to specific activities with professional and voluntary associations are a few examples.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular Diseases↗
PubMed1991

[Fatal voluntary poisoning by parenteral paraquat].

Paraquat is a potent herbicide, very toxic in the concentrated liquid form as supplied to farmers. Suicidal poisoning represents a serious emergency with a known high mortality rate. Suicidal poisoning following the parenteral route has been rarely reported. A 16-year-old girl was admitted to our emergency unit after subcutaneous injection of gramoxone 20% (about 400 mg of paraquat). Despite immediate surgical excision and revision, and subsequent antioxidant treatment with N-acetylcysteine (400 mg/kg/day during 48 hours), she died 17 days later from refractory hypoxemia following pulmonary fibrosis. From this observation and from the literature, it appears that an effective treatment does not depend on changes in the toxicokinetics of the herbicide (hemoperfusion, antidotes, drugs).

Adolescent↗
PubMed1991

[Home mechanical ventilation in Switzerland in 1990. Future developments].

Home mechanical ventilation (HMV) was initiated in polio centers in the mid-50s (iron lung). Ten years ago, chronic respiratory insufficiency patients began to be treated with positive pressure ventilation via tracheostomy tube. Survival of kyphoscoliotic and myopathic patients was impressive in uncontrolled studies. Today it appears that similar results may be obtained with a new non-invasive technique, nasal mechanical ventilation. The present situation of HMV in Switzerland (number of patients and their location) and the results of this treatment are described. In addition, we report on a short series of 24 Swiss patients collected in 4 centers. We show that HMV is possible in Switzerland and that the results in survival and quality of life are excellent, provided that the indications for this technique are consistent with the recommendations in the literature.

Adolescent↗
PubMed1991

Psychoactive drug use among medical doctors is higher than in the general population.

We surveyed a representative sample of practising physicians and a representative sample of subjects from the Swiss general population (SOMIPOPS Survey) concerning their annual use of sleeping pills and tranquillizers. 77% of the physicians (n = 466) and 72% of the general population (n = 4255) responded. After adjustment for age and sex 37.1% of the doctors (general population 21.1% P less than 0.001) claimed to have taken these drugs for therapeutic purposes. The proportion of psychiatrists who reported taking sleeping pills and tranquillizers daily (10.6%) were significantly greater than for the population of doctors as a whole and for the general population (P less than 0.05). Regular users (i.e. subjects taking one mood altering drug at least once a week) accounted for 11.1% of the medical population compared with 6.8% of the general population (P less than 0.01). This over-consumption was wholly due to the greater number of regular users of psychoactive drugs amongst doctors less than 50 years of age relative to the general population or to subjects in higher management (from P less than 0.05 to P less than 0.001). Without this specific over-use, members of the medical profession would not have been found to use more psychoactive drugs than the general population and the executives. This result suggests that it would be worth investigating the mechanisms of response and adjustment (coping) to the specific stress that appears to be inherent in the exercise of medical practice.

Adaptation, Psychological↗