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Biomedical subjects

G Domenighetti

Publications and source records attributed to G Domenighetti.

71 records · Page 4Linked to original sources
PubMed1981

[Mechanical ventilation in the treatment of acute respiratory insufficiency in asthma].

The purpose of this study was to evaluate the results of mechanical ventilation in life-threatening status asthmaticus. 16 patients were treated for a total of 22 episodes of acute respiratory acidosis, with coma in 11 cases. Controlled mechanical ventilation was maintained from 10 to 196 hours and involved only minor complications without sequelae. All patients survived. These favourable results are attributed to a new strategy: the aim of mechanical ventilation is to relieve hypoxemia with hyperoxic mixtures without seeking rapid correction of hypercapnia, which is obtained later when bronchial desobstruction provides better conditions of VA/Q distribution. This allows low tidal volumes and low frequency, avoids high airway pressures and so decreases the danger of barotrauma and cardio-circulatory complications.

Acidosis, Respiratory↗
PubMed1981

Oxygen delivery in acute exacerbation of chronic obstructive pulmonary disease. Effects of controlled oxygen therapy.

The hemodynamic response to controlled oxygen administration was investigated in 35 patients who presented with acute decompensation of chronic obstructive pulmonary disease. Gasometric and hemodynamic data were successively measured under inspiratory fractions in oxygen of 0.21 (room air) and 0.28. Response to oxygen therapy was characterized by a decrease in cardiac output and an increase in oxygen delivery because of a sharp increase in arterial oxygen content. The coefficient of oxygen delivery (oxygen delivery/oxygen consumption) increased in each patient. All these changes were highly significant (p les than 0.001). Somewhat unexpectedly, there was no change in pulmonary artery pressures, so that pulmonary arteriolar resistance even increased (p less than 0.05). Further analysis individualized 2 types of hemodynamic response to oxygen therapy. In 15 patients who presented with severe hypoxemia, oxygen therapy resulted in a significant increase in oxygen delivery without change in cardiac output. By contrast, in 20 patients with moderate hypoxemia, oxygen therapy induced a significant decrease in cardiac output (p less than 0.001) without change in oxygen delivery. Patients in whom cardiac output was unaffected by oxygen administration presented with a lower mixed venous oxygen tension (less than 35 mmHg) and a lower coefficient of oxygen delivery (less than 3.5). This study demonstrated that oxygen therapy does not always increase oxygen delivery in acute decompensation of chronic obstructive pulmonary disease.

Adult↗
PubMed1980

[Changes in the hemodynamics of the lung and the right ventricle during rest and exertion in 2 groups of patients with chronic broncho-obstructive syndrome of different severity].

Forty patients with chronic obstructive pulmonary disease (COPD) underwent right heart and central catheterization at rest and during exercise when not in a state of acute exacerbation. They were divided into 2 groups of different functional gravity: group I: FEV1 less than or equal to 1250 ml, RV/TLC greater than or equal to 55% (24 patients); group II: FEV1 > 1250 ml, RV/TLC < 55% (16 patients). At rest, group I had mean pulmonary artery pressure, pulmonary arteriolar resistance, and arterial PCO2 significantly higher, and arterial PO2 significantly lower, than group II. There was no difference in cardiac index, mean atrial pressure and pulmonary wedge pressure between the two groups. During exercise, mean right atrial and pulmonary wedge pressure increased markedly in group I and showed a significant difference from the values of group II. For pooled data of groups I and II, there was a correlation between FEV1 and mean right atrial pressure under exercise and between arterial PO2 and right atrial pressure under exercise. It is concluded that (1) subdividing patients with COPD, as reported here, determines two different blood gases and pulmonary hemodynamic subsets when taken at rest; (2) during exercise, group I patients have "abnormal" right and left ventricular function; (3) FEV1 and arterial PO2 on physical exertion serves to predict mean right atrial pressure under exercise.

Blood Pressure↗
PubMed1980

[Hemodynamic investigation, a logical approach to the treatment of acute myocardial infarction].

The prognostic and therapeutic significance of different haemodynamic variables and subsets in acute myocardial infarction are analyzed. Eighty-eight patients underwent bedside catheterization by the Swan-Ganz technique. They were subdivided into 4 groups according to initial mean pulmonary wedge pressure (PWP) and cardiac index (CI). In group I (PWP less than 18 mm Hg; CI greater than 2.21/min/m2) in-hospital mortality was 2%, in group II (PWP less than 18 mm Hg; CI less than 2.21/min/m2), 8%; in group III (PWP greater than 18mm Hg; CI greater than 2.21/min/m2), 25% and in group IV (PWP greater than 18 mm Hg; CI less than 2.21/min/m2), 67%. Group I corresponds to minimal or mild ventricular dysfunction and group IV to severe ventricular failure or shock. In group III, despite a higher CI, mortality was three times that observed in group II, which suggests that in the absence of clinical signs of hypoperfusion and shock a subnormal cardiac index is not detrimental provided it is not accompanied by tachycardia and increased left ventricular end-diastolic pressure. The hemodynamic patterns of acute myocardial infarction are very variable. Bedside monitoring to evaluate short-term prognosis and form a logical approach to medical therapy represents a major advance in coronary care. The mechanical consequences of acute necrosis may be promptly and often effectively treated, the final goal being the preservation of ischemic myocardium.

Adult↗
PubMed1980

[Acute respiratory distress syndrome after mycoplasma infection].

The natural and treated course of Mycoplasma pneumoniae is generally satisfactory. Only a few cases with fatal outcome have been reported, mainly in immunosuppressed and debilitated patients. The case is reported of a healthy young woman admitted with acute respiratory failure, who developed diffuse interstitial fibrosing pneumonia followed by refractory hypoxemia. The diagnosis of Mycoplasma pneumoniae pneumonia was at first suspected from an elevated specific titer in the standard complement fixation test, and then confirmed in the immunofluorescence study by the presence of granular deposits (mycoplasma) in the macrophages of lung tissue. The functional impairments associated with this unusually malignant evolution are discussed.

Adult↗
PubMed1980

Intraventricular conduction disturbances in acute myocardial infarction: short- and long-term prognosis.

Short- and long-term prognosis were analysed in 59 patients admitted in the coronary care unit with an acute myocardial infarction, complicated with acute intraventricular (IV) conduction defects. In-hospital mortality of patients with IV conduction disturbances was more than twice (30%) the mortality of patients without IV conduction defects (13%; P less than 0.001). Mortality rate was very high among patients with all forms of incomplete trifascicular block or complete right bundle-branch block. Among survivors of the group with conduction defects, late death rate was significantly higher than in survivors of the group without IV blocks (25 vs 8%; P less than 0.01). Short-term prognosis of conduction defects in myocardial infarction depends on the extent of the necrosis. The conflicting results in long-term prognosis could be ascribed to variations in patient material and to different criteria used to define the acute nature of a block. Lastly the variable prognosis could correspond to differences in the site of the lesions within the conduction pathway.

Arrhythmias, Cardiac↗
PubMed1979

[Massive heroin intoxication. Hemodynamic studies].

Acute hemodynamic changes during heroin overdose have not been frequently reported. We observed 2 male patients aged 24 and 21 years admitted in coma and shock and presenting severe mixed acidosis, with, respectively, pH 6.80, PaCO2 72 mm Hg, PaO2 70 mm Hg, BE -18 mEq/l, lactic acid 16.5 mmol/l, and pH 6.86, PaCO2 94 mm Hg, PaO2 46 mm Hg, BE -16 mEq/l, lactic acid 5.45 mmol/l. The hemodynamic data of the first patient showed a low output failure state associated with high filling pressures, suggesting biventricular heart failure. In the second case, clinically and radiologically marked pulmonary edema was associated with a hyperdynamic state and moderately elevated pulmonary artery pressure, but normal pulmonary capillary pressure. The possible pathophysiological mechanisms of those different, hemodynamic patterns are discussed.

Acidosis↗
PubMed1979

[Isoelectric electroencephalography approximately 6 hours after ventricular fibrillation due to myocardial infarct. Apropos of a case with favorable development].

A 59-year-old patient was resuscitated after ventricular fibrillation due to anterior myocardial infarction. Ventilatory and cardiac arrest lasted for more than 20 minutes. 5 h 50 min later the EEG was isoelectric. The evolution was nevertheless favourable and the patient was able to leave hospital one month later and to resume work half-time 5 months later. The problems of anoxic ischemic encephalopathies, isoelectric EEG and their treatment are discussed.

Aged↗
PubMed1979

[Correlations between hemodynamic measures and respiratory functions in patients with chronic obstructive lung syndromes].

Fourteen patients with chronic obstructive pulmonary disease underwent right catheterization with a Swan-Ganz catheter to correlate lung function with hemodynamic features at rest and on exercise. There appears to be a good correlation between some pulmonary function tests (FEV1, RV/TLC, PaO2 at rest and on exercise) and mean pulmonary artery pressure at rest and on exercise in these patients.

Blood Pressure↗
PubMed1978

[Short and long-term prognosis of intraventricular conduction disorders in the acute stage of myocardial infarct].

The short- and long-term prognosis of acute intraventricular (iv) conduction defects is analyzed in 59 patients admitted to the coronary care unit with acute myocardial infarction. In-hosptial mortality of patients with iv conduction disturbances was more than twice (30%) the mortality of patients without iv conduction defects (13%; p less than 0.001). Mortality was very high among patients with all forms of incomplete trifascicular block or complete right bundle branch block. Among survivors of the group with conduction defects, the late death rate was significantly higher than in survivors of the group without conduction disturbances (25% and 8% respectively: p less than 0.001). The short- and long-term prognosis of acute conduction defects in myocardial infarction depends on the extent of necrosis. Permanent endocardial pacing is therefore indicated only among patients whose death risk is related to conduction disturbances.

Acute Disease↗
PubMedDate not supplied

Effect of information campaign by the mass media on hysterectomy rates.

The annual frequency of hysterectomy was monitored in the Canton Ticino, Switzerland, from 1977 to 1986. From February to October, 1984, there was a public information campaign in the mass media about rates of and need for hysterectomy. After the start of the campaign and during the following year the annual rate of operations per 100,000 women of all ages dropped by 25.8%, whereas in the reference area (Canton Bern), where no information was given to the public, hysterectomy rates increased by 1%. In the same period the hysterectomy rate per 100,000 women aged 35-49 declined by 33.2%, and the number of hysterectomies performed annually per gynaecologist decreased by 33.3%. In Canton Bern these rates were unchanged. The decline began 2 months after the start of the information campaign. The reduction in the number of hysterectomies was greater (p less than 0.001) in non-teaching hospitals (31.9%) than in teaching hospitals (18.1%). Information on regional rates and on the need for hysterectomy given through the mass media to the general population can change professional practices.

Adult↗
PubMedDate not supplied

Mosaicism of dynein in spermatozoa and cilia and fibrous sheath aberrations in an infertile man.

Male patients displaying an immotile or almost immotile sperm population are the object of an interdisciplinary study concerning a ciliary mutant that induces the "Immotile-Cilia Syndrome". Development and function of both sperm flagella and cilia are normally affected because of disturbances of the 9 + 2-arrangement. During this program, clinical, physiological, genetical and ultrastructural investigations were done. The ultrastructure of immotile spermatozoa of an infertile man did not reveal inner and outer dynein arms. Lack of the ATPase dynein which is essential for movement of the 9 + 2-axoneme, is typical for the above syndrome. In addition, symmetry of the fibrous sheath of the spermatozoa was very abnormal. The pneumologist examined normal lung function, where the ultrastructure of the cilia of the nasal mucosa displayed the dynein arms. Analysis of family tree and chromosomes by the geneticist also gave a normal result. As revealed by this infertile patient it seems likely that expression of dynein must not be identical in both germ cells and somatic cells. Such variations are therefore regarded as additional forms of the "Immotile-Cilia syndrome". Asymmetric fibrous sheaths are thought to be a result of immotile spermatid flagella, leading to an abnormal arrangement of the accessory axonemal structures. Normal early spermatid flagella of man and rat show specific movements.

Adenosine Triphosphatases↗
PubMedDate not supplied

[Impact of mass media on the use of health services. A systematic review of the literature].

BACKGROUND: Mass media may influence the use of health services either through campaigns promoting the use of specific procedures or through the coverage of health related issues outside the context of a planned intervention. To assess their effect on the utilization of health services a systematic overview of primary research was undertaken. METHODS: Experimental and quasi experimental studies meeting pre defined entry criteria and providing information on the impact of mass media on objective measures on health services utilization were searched through Medline, Embase, Psychlit, Eric, as well as handsearching key journals. Data on the detail and content of interventions were abstracted and raw data describing health services utilization obtained. Effect sizes were calculated for each study and then pooled across studies on the same topic using a random effects model. RESULTS: Out of 69 papers providing information on the impact of mass media on aspects of health services utilization, 17 interrupted time series met our quality criteria. Fourteen evaluated the impact of formal mass media campaigns, 3 of media coverage of health related issues. The overall methodological quality was rather variable, with 6 studies not performing any statistical analysis, and 7 using inadequate statistical tests (i.e. not taking into account the effect of time trend). All the studies but the concluded positively on the effect of mass media. These positive findings were confirmed by our re-analysis in 7, while in the remaining the effect of mass media was not statistically significant. The direction of effect was consistent across individual studies and the pooled effect sizes revealed an effect upon the utilization of health services that could not be explained by chance alone, ranging from -1.96 (95% CI: -1.19, -2.73) for campaigns promoting immunization programs, to -1.12 (95% CI: -0.49, -2.46) for those concerning cancer screening. CONCLUSIONS: Despite the overall limited quality of primary research, this review supports the view that these channels of communication may have an important role in influencing the use of health care interventions. Mass media should be considered as one of the tools that may encourage the use of effective services and discourage those of unproved effectiveness.

Data Interpretation, Statistical↗