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Biomedical subjects

G Facchetti

Publications and source records attributed to G Facchetti.

17 recordsLinked to original sources
PubMed2002

[Investigation on BLS among public hospital physicians in Abruzzo].

BACKGROUND: The aim of this study is to determine the proportion of public hospital physicians in Abruzzo capable of performing basic life support manoeuvres, according to the latest guidelines. METHODS: A questionnaire was formulated, in order to investigate whether the persons interviewed 1) had ever performed a cardio-pulmonary resuscitation; 2) had ever taken any BLS courses involving dedicated dummies; 3) believed to be competent in performing cardio-pulmonary resuscitation correctly and if affirmative, the physician was asked to answer three further questions to verify the level of competence. The questionnaire was to be filled in at the proper working place without the aid of books or other material. RESULTS: Of the 1540 public hospital physicians contacted, 57.6% had participated in cardiopulmonary resuscitation manoeuvres, while only 30% had practised on dedicated dummies. Nevertheless, 69.5% believed to be able to perform the BLS techniques correctly. Of the latter, merely 18% answered all three additional questions correctly. CONCLUSIONS: Cardio-pulmonary arrest is the emergency during which the timeliness of the first resuscitation manoeuvres and their correct performance are the decisive factors for a successful outcome. Without attending regular courses, qualified to teach the proper techniques in depth and recall the acquired procedures, the efficacy of BLS techniques risk to fall below a level of acceptance. Therefore, in the emergency field, it is essential to guarantee a continued training.

Cardiopulmonary Resuscitation↗
PubMed2001

Metabolic effects of intraportal nutrition in humans.

OBJECTIVE: We investigated the metabolic effects of intravenous nutrition through a portal (PN) or systemic (SN) peripheral vein. METHODS: Twenty patients were randomized to receive PN or SN nutrition after colorectal surgery. The daily regimen included 900 kcal and 100 g of amino acid (AA). Visceral proteins and hepatic enzymes were measured on days 0, 1, 3, 5, and 7, and plasma arterovenous differences and limb flux of AA were measured on days 0, 3, and 7; urinary nitrogen and 3-CH3-histidine were analyzed daily. RESULTS: Serum albumin on day 7 was still depressed (P = 0.01) in SN and fully restored in PN patients. Prealbumin levels increased significantly (P = 0.05) in the PN group only. Plasma levels of glutamine and asparagine were higher in PN than in SN patients, and this difference was statistically significant (P = 0.05). SN patients had significantly more negative limb-muscle balance of valine and tyrosine, whereas PN patients had a higher muscle release of citrulline and taurine. CONCLUSIONS: In conclusion, short-term PN is safe and has some metabolic benefits: it accelerates recovery from postoperative hypoalbuminemia and hypopnealbuminemia and is associated with a higher plasma level of glutamine and an AA plasma pattern that is closer to normal. PN blunts the catabolic response of the muscle, decreasing loss of proteins and release of some AA involved in hepatic gluconeogenesis.

Amino Acids↗
PubMed2000

Haemodynamic effects of intravenous clonidine on propofol or thiopental induction.

The study evaluated the effects of premedication with intravenous clonidine on thiopental or propofol requirements for induction and haemodynamic changes associated with both induction and endotracheal intubation. Clonidine administered intravenously before induction of anaesthesia reduced propofol or thiopental requirements. The association of clonidine and propofol caused, after injection of the induction drug, a decrease in mean arterial pressure which was significantly greater than with thiopental. Moreover, a major haemodynamic stability was registered before and after laryngoscopy in the clonidine-thiopental group. These findings might contraindicate the clonidine-propofol combination in patients with cardiovascular disease.

Adrenergic alpha-Agonists↗
PubMed1999

Intra-articular buprenorphine after knee arthroscopy. A randomised, prospective, double-blind study.

BACKGROUND: Demonstration of peripheral opioid receptors in inflamed synovia supports the concept of peripheral opioid analgesia. The aim of this study was to evaluate the analgesic effect of intra-articular administration of buprenorphine after knee arthroscopy. METHODS: In a double-blind randomised trial, 48 patients were assigned to four groups: group A patients received buprenorphine 100 micrograms i.a. and NaCl 0.9% i.m., group B patients received bupivacaine 0.25% 50 mg i.a. and NaCl 0.9% i.m., group C patients received NaCl 0.9% i.a. and buprenorphine 100 micrograms i.m., and group D patients received NaCl 0.9% i.a. and NaCl 0.9% i.m. Intensity of postoperative pain was evaluated by VAS at recovery (T0) and 1, 3, 6, 12, 24 h after operation (T1, T2, T3, T4, T5), at rest and during passive 10 degrees knee flexion. Total analgesic requirements and side effects related to study drugs were recorded. RESULTS: The VAS scores were significantly higher in groups C and D than in group A and B patients. The differences were significant at T0, T1, T2 and T3. At T1, group C and D patients had greater analgesic requirement than groups A and B. No patients developed side effects. CONCLUSION: Intra-articular buprenorphine and i.a. bupivacaine, both produced equally good postoperative pain control and allowed a significant reduction of analgesic requirement after knee arthroscopy.

Adult↗
PubMed1999

[Quality control in anesthesia. A new frontier].

For several years now, the need for improving healthcare quality has determined the adoption of a businesslike philosophy in American hospitals, through quality control and improvement systems. In Italy, the introduction of this business concept in public healthcare is recent, while quality assurance is still widely ignored. The anesthesiology wards have a central role in making the DRG mechanism work and therefore need computerised systems that can guarantee correct evaluation of results, analysis of efficacy and quality assurance. The development of a quality control and assurance system in anesthesiology, can be achieved by following a few simple guidelines: to identify the indicators, sensitise the personnel towards an attitude of improvement, adopt a computerised database, verify and elaborate data, correct the defects, verify the changes made to the system.

Anesthesia↗
PubMed1998

Increased retinol binding protein in the sera of patients with severe ischemic damage of the liver after transplantation.

OBJECTIVE: To study retinol binding protein variation in the serum of patients who have undergone liver transplantation. METHODS: Retinol binding protein was retrospectively determined by the immunonephelometric method on serum from 14 patients who had undergone orthotopic liver transplantation 2 weeks after the surgery and then once a month during the first year posttransplantation. The patients were divided into two groups on the basis of early (first 10 days) postoperative graft function: group I, 6 patients with severe ischemic damage; and II 8 patients with moderate-severe liver dysfunction. RESULTS: The men retinol binding protein level at one year of follow-up was persistently higher in group I than in group II (83.1 +/- 33.4 vs 44.6 +/- 20.7 mg/L, p < 0.001). Interestingly, retinol binding protein levels remained higher in patients of group I event when the other biochemical parameter of liver function returned to normal. The increase in retinol binding protein serum levels was independent of variation in other parameters of liver and kidney function, but was correlated with an increase in transthyretin and retinol levels. CONCLUSION: Our results show a close relationship between a permanent high retinol binding protein level and severe graft injury after liver transplantation. However, the mechanism underlying the increase remains to be defined.

Adult↗
PubMed1996

Amyotrophic lateral sclerosis: oxidative energy metabolism and calcium homeostasis in peripheral blood lymphocytes.

There is evidence of oxidative injury in postmortem brain, spinal cord, and CSF of patients with sporadic amyotrophic lateral sclerosis (SALS patients). We investigated the oxidative metabolism and calcium homeostasis in peripheral blood lymphocytes from such patients and did not find statistical differences in the basal oxygen consumption rate (QO2), cytochrome c oxidase activity, catalase activity, and lactate production. However the increase in QO2, induced by an uncoupler of oxidative phosphorylation, was depressed and the basal (resting) level of free cytosolic calcium ([Ca2+]in) was higher in lymphocytes from SALS patients (p < 0.01). Further increase in free [Ca2+]in challenged by a K+ channel blocker or by an uncoupler of oxidative phosphorylation was similar in SALS and control lymphocytes. The results show that systemic changes consistent with the presence of mitochondrial and of calcium metabolism dysfunction are present in SALS.

Adult↗
PubMed1996

Importance of pyridoxal-5'-phosphate addition to the assay medium for the measurement of catalytic concentrations of plasma aspartate and alanine aminotransferases in patients undergoing antineoplastic chemotherapy.

Using 98 plasma samples from cancer patients undergoing antineoplastic chemotherapy, we compared the activities of aspartate aminotransferase and alanine aminotransferase measured by two different methods, with and without the addition of pyridoxal-5'-phosphate to the assay medium. Pyridoxal-5'-phosphate caused an increase of 1 to 20 U/l in aspartate aminotransferase and alanine aminotransferase activity in 90 and 78 patient plasma samples, respectively. Increases of aspartate aminotransferase and alanine aminotransferase activity of more than 20 U/l were observed in 8 and 20 samples, respectively. In 8 cases, the increase in alanine aminotransferase activity was greater than 50 U/l, whereas a similar increase in aspartate aminotransferase activity was decreased in only 2 cases. The considerable pyridoxal-5'-phosphate activation in aminotransferase activity observed in the plasma of a significant number of patients suggests that the use of the method with pyridoxal-5'-phosphate is advisable for a correct measurement of the catalytic concentration of aminotransferases in the plasma of patients undergoing chemotherapy.

Alanine Transaminase↗
PubMed1995

Effect of a ubiquinone-like molecule on oxidative energy metabolism in rat cortical synaptosomes at different ages.

Persistent stimulation of energy consumption, induced by depolarization with veratridine, mimics a condition of abnormally enhanced energy demand and causes an increase in the oxygen consumption rate (QO2) and in the interconversion of pyruvate dehydrogenase complex (PDHc) into its active form. Wistar rats at the age of 26 months do not show alterations of QO2 and the ability of veratridine to increase QO2 in comparison with 6 month-old animals whereas the active form of PDHc is slightly but significantly reduced. Idebenone, a ubiquinone-like molecule (1 microM), does not affect the QO2 or PDHc activation state in resting conditions but attenuates the veratridine-challenged increase in QO2 at all the ages tested and attenuates the increase in the percentage of PDHa reaching statistical significance in 26-month-old rats. At higher concentration (10 microM) idebenone totally abolishes the veratridine-induced increase in PDHa also in the 6 month-old rats. At the lower concentration, the drug does not affect the increase in QO2 induced by an uncoupler of oxidative phosphorylation. The results obtained suggest a protective effect of idebenone on the cerebral tissue against stressful conditions; this action may be exerted at the level of some mitochondrial component and/or on the Na+ homeostasis.

Adenosine Triphosphate↗
PubMed1990

Comparison of glucose vs. Glucose fat solutions in cancer patients: A controlled crossover study.

The purpose of this investigation was to evaluate in a randomised crossover study the effects on nutritional status of two isonitrogenous-isocaloric regimens of total parenteral nutrition (TPN) in 12 severely cachectic cancer patients. The regimens consisted of (1) G: 50 kcal of glucose.kg(-1).day(-1) + 2g amino-acids.kg(-1).day(-1) (2) GL: 30 kcal glucose and 20 kcal lipids.kg(-1) + 2g amino-acids.kg(-1).day(-1). Regimens G and GL were delivered sequentially for a period of 10 days each. Six patients (Group A) were randomised to receive regimen G first and regimen GL subsequently. In Group B patients the regimens alternated in the opposite way. The following nutritional variables were measured before TPN, after regimen G and after regimen GL: weight, arm circumference, arm muscle circumference, triceps skin fold, serum proteins, serum albumin, cholinesterase, transferrin, pre-albumin, retinol-binding protein, peripheral lymphocytes, cumulative nitrogen balance and mean urinary excretion of creatinine and 3-methylhistidine. The data showed that body weight and retinol-binding protein significantly increased with both G and GL regimens. No difference was found in the remaining variables, not even when comparing regimen G to GL. Increase in retinol-binding protein and in nitrogen balance were significantly better in the first period of treatment than in the second. These results show that the two regimens had a similar impact on the nutritional status of the cachectic cancer patients and choice between a glucose or a glucose-fat TPN should depend mainly on tolerance of the patients, duration and cost of therapy.

Journal Article↗
PubMed1987

Total parenteral nutrition prevents further nutritional deterioration in patients with cancer cachexia.

The effects of total parenteral nutrition (TPN) on some nutritional variables were prospectively investigated in 12 severely cachectic patients with advanced cancer. The following variables were determined before and at 5-day intervals during the 20-day administration of TPN: anthropometric indices (body weight, arm circumference, triceps skinfold, arm muscle circumference, arm muscle area, arm fat area, total body muscle mass); biochemical indices (total protein, albumin, cholinesterase, total iron binding capacity, thyroxin-binding prealbumin, retinol binding protein, urinary 3-methylhistidine and creatinine excretion, nitrogen balance); and peripheral lymphocyte count. TPN was delivered at 49.5 nonprotein kcal/kg-1/day-1 (80% as dextrose and 20% as fat) and amino acids 1.9 g/kg-1/day-1. A significant increase was obtained in body weight, triceps skinfold, arm fat area, and retinol binding protein. All remaining anthropometric and biochemical parameters did not show any significant positive or negative change, although nitrogen balance remained positive. No significant liver toxicity was apparent after the TPN period. It was concluded that although TPN is unable to completely reverse some nutrition-related variables in cachectic patients with cancer, most patients were kept within a normal range and some improved. Therefore, further deterioration of the nutritional state, which is characteristic of this phase of disease, was at least prevented.

Anthropometry↗
PubMed1984

Monoclonal gammopathy (IgM-k) in a patient with Burkitt's type lymphoblastic lymphoma.

We report a Burkitt's type lymphoblastic lymphoma (B-LL) case characterized by an abnormal IgMk immunoglobulin secretion and referred to us on February 12, 1982. The diagnosis has been histologically documented and the pathological stage of the disease (IV B) was determined according to the diagnostic criteria usually employed for the non-Hodgkin's lymphoma (NHL). Serum proteins were determined by electrophoresis and immunodiffusion. The review of the literature has allowed us to ascertain that the presence of a monoclonal IgM peak can be associated with NHL, particularly with those of B cell type and in adult subjects. Up to now, only six IgM B-LL secreting cases have been described. The biological and prognostic significance of this elevated Ig secretion is uncertain; therefore it may be important for the future to evaluate, in B-LL this immunological parameter.

Adolescent↗
PubMedDate not supplied

Does portal nutrition benefit liver protein synthesis?

There are only a few experimental investigations on the feasibility and potential advantages of intraportal nutrition in animals and only two uncontrolled studies in humans. The purpose of this study was to compare some metabolic variables in patients who received portal or systemic nutrition after elective surgery for colorectal cancer. Twenty patients were randomized to receive postoperatively for a week a hypocaloric, "protein sparing" standard infusion via the portal (catheter in the gastroepiploic vein) (10 patients) or systemic (10 patients) route. We evaluated the basal concentrations of some visceral and acute-phase proteins and their variations in the first postoperative week and the nitrogen balance. Statistical analysis was performed by the two-tailed Student t test. There was no difference in the daily changes of the visceral and acute-phase proteins after surgery in the two groups of patients, but in the portal group there was a significantly better recovery of the level of total protein, albumin, and cholinesterase at the end of the portal infusion vs the systemic group (p < or = .005, .03, and .02, respectively). In regard to the nitrogen balance, although there was no difference in the overall balance between portal and systemic nutrition, if we separate the acute phase of the injury from the later one we do not see any significant difference in the first period but we do see a highly significant advantage for the portal group during the last 2 days (p < or = .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[The current status of obstetric analgesia and anesthesia in Italy].

BACKGROUND: There is a more and more vivid interest regarding methods of obstetric analgesia and anesthesia while there is a lack of epidemiological data about the Italian reality. Aim of the study was to evaluate the current state of obstetric analgesia and anesthesia and create an interest for anesthesiologists in a professionally and scientifically interesting field. METHODS DESIGN: transversal study of clinical observation of the Italian situation based on questionnaires composed of 20 multiple choice and closed questions, addressed to chief anesthesiologists of 220 randomized Italian hospitals. SETTING: 220 Italian hospitals having a capacity of more than 100 beds. RESULTS: Out of the 220 questionnaires, 91 were returned. Merely 17 hospitals guaranteed a permanent peridural analgesic service. To improve this situation, anesthesiologists call for introducing chargeable services and increasing the medical staff. In spite of the widely documented advantages that regional anesthesia offers for maternal and fetal well-being, this technique is practised in only 26% of cesarean sections. This percentage is greatly higher than that obtained from a similar experience in 1991, where the use of regional anesthesia technique was of 3-4%. In 11 hospitals postoperative analgesia is not carried out on a regular basis. CONCLUSIONS: Even though the general opinion is showing a growing interest for obstetric analgesia and anesthesia, it has not yet reached the same dignity as in other countries.

Analgesia, Obstetrical↗
PubMedDate not supplied

Alteration of complex IV and acetylcholine-related enzymes in experimental spinal cord injury.

Acute, severe injury of the rabbit spinal cord, induced by the weight-drop method, causes alterations of the enzyme activities related to cholinergic and energy metabolism. Morphological examinations at the trauma site show degenerative processes in neurons 0.5 hr posttrauma and a marked decrease in the number of living cells 24 hrs later. Both biochemical and cytochemical findings show that the tissue metabolic and morphologic derangement, caused by severe spinal cord injury, is mostly confined to the gray matter at an early stage (0.5 hr), whereas 24 hrs later the white matter is also involved. The decrease in choline acetyl-transferase and acetylcholinesterase activities in the gray matter parallels the impairment of complex IV (cytochrome c oxidase) of the respiratory chain and the presence of morphological alteration in neurons. The dramatic drop in the enzyme activities, observed 24 hrs after the induction of the severe trauma is clearly associated with the loss of cells.

Acetylcholinesterase↗