PubMed Health⌕ Search

Biomedical subjects

G Milano Manso

Publications and source records attributed to G Milano Manso.

17 recordsLinked to original sources
PubMed2005

[Drowning in pediatric patients].

OBJECTIVE: Immersion accidents are still an important cause of morbidity and mortality in children. We performed a retrospective study to identify the prognostic factors associated with outcome in children who experience near-drowning, which could serve to guide decision-making. Our data were compared with other published data. PATIENTS AND METHODS: The medical records of children treated for near-drowning in our hospital from January 1995 to April 2003 were reviewed. The data analyzed referred to the patient, the accident, the patient's clinical status in the emergency unit, the unit to which the patient was admitted, and outcome. RESULTS: Sixty-two patients were included. Of these, outcome was bad in 12 (death in seven and irreversible sequelae in five). Statistically significant predictors of bad prognosis were age > or = 4 years, female sex, immersion time > or = 5 min, cyanosis in the emergency room, cardiac arrest, apnea or severe distress, hypothermia (core temperature < 35 degrees C), metabolic acidosis (pH < or = 7.10) and neurologic damage (Glasgow coma Scale score 3; Conn C; nonreactive and mydriatic pupils) on arrival at the hospital. CONCLUSIONS: Outcome is closely related to the patient's clinical status on arrival at the hospital. Although data that can serve as a guide to the final outcome of the nearly-drowned patient are available, early models to predict the final clinical results of each case, which could be used to guide initial resuscitation and subsequent treatment, are lacking.

Child, Preschool↗
PubMed2005

[Use of activated factor VII in severe acute hemorrhage].

Acute hemorrhage is a sometimes serious complication that may arise in patients admitted to the intensive care unit with coagulopathy. The usual therapy is transfusion of blood components: fresh frozen plasma, platelets, fibrinogen, red cell concentrate and vitamin K. Tolerance or response can sometimes be poor. We present three patients aged 18 months, 4.5 and 10 years who suffered an acute episode of severe, life-threatening hemorrhage in the course of meningococcal sepsis (gastric hemorrhage), myelomonocytic leukemia (during splenectomy) and in the postoperative period after cardiovascular surgery. Traditional therapy was ineffective and activated factor VII was administered at doses of 50-70 microg/kg, with rapid control of bleeding.

Acute Disease↗
PubMed2004

[Deep venous thrombosis: an early manifestation of Behçet's disease in childhood].

Behcet's disease is a multisystemic vasculitis of unknown origin whose classical triad is oral and genital ulcers and uveitis. Deep venous thrombosis may sometimes be the first manifestation of this disease but is very rare in children. We report the case of a 14-year-old boy with deep venous thrombosis of the leg and a history of severe aphthous gingivostomatitis, perianal ulcers, Henoch-Schonlein purpura, ecchymotic lesions on the lower limbs and intermittent swelling of the left ankle. Complementary tests ruled out the main causes of thrombosis in children. HLA-B5 and B-51 study proved positive, which, together with the patient's history, suggested a diagnosis of Behcet's disease. This disease usually presents around the third decade of life and is very unusual in children. This case is exceptional because thrombosis as an early manifestation of Behcet's disease is very rare in children and because it led to the diagnosis of Behcet's disease in our patient.

Adolescent↗
PubMed2003

[Techniques and complementary techniques. Endotracheal aspiration, bronchial brushing and bronchoalveolar lavage].

The aim of endotracheal aspiration is to eliminate secretions in patients with an artificial airway. All children with mechanical ventilation must undergo this procedure periodically. The frequency of aspiration depends on the type and quantity of the respiratory secretions and on the patient's clinical status. Aspiration should be performed by two people to maintain a greater degree of asepsis and to optimize stability of the airway and ventilation. Closed aspiration systems are available that allow aspiration without the need to disconnect the patient through a single probe that is constantly protected by a plastic sleeve and isolated from external environment. The most important risks of endotracheal aspiration are hypoxemia, mucosal injury, bronchospasm, arrhythmias, perforation of the airway with development of pneumothorax, accidental extubation, and infections. Bronchial brushing with a protected catheter and brochoalveolar lavage are used to analyze pulmonary infections. These techniques can be performed blind or through fibrobronchoscopy. They can also be used for the diagnosis of noninfectious pulmonary diseases such as alveolar proteinosis, alveolar hemorrhage or histiocytosis. Their adverse effects are similar to those of endotracheal aspiration.

Bronchi↗
PubMed2003

[Techniques and complementary techniques. Fiberoptic bronchoscopy in mechanically ventilated children].

Fiberoptic bronchoscopy can be performed at the patient's bedside. This technique allows direct visualization of the upper and lower airways up to the segmental and subsegmental bronchi. Its most frequent indications are airway examination ot evaluate damage produced by toxins or the endotracheal tube, patency of the endotracheal tube and extubation failure. It is also used to obtain microbiological samples, facilitate intubation when difficult, aspirate airway sections or mucus plugs, perform bronchoalveolar lavage and administer drugs. With prior preparation, adequate monitoring and sedation, material according to the size of the patient and correct techniques, there are few complications. However, the procedure can produce trauma and obstruction of the airway, bronchial hemorrhage, barotrauma, loss of alveolar recruitment, bronchospasm, hypoxemia, bradycardia, and bronchopulmonary infection.

Bronchi↗
PubMed2001

[Adrenal function in children with sepsis and septic shock].

OBJECTIVES: To assess adrenal function in children with sepsis and septic shock with petechiae and to investigate the possible relationship between adrenal hypofunction, sonographic diagnosis of massive bilateral adrenal hemorrhage, and other factors available early in this disturbance. PATIENTS AND METHODS: Prospective observational study of 24 patients (14 boys, 10 girls), aged 2.9.24 years, admitted to the pediatric intensive care unit with sepsis and septic shock with petechiae during a 1.5-year period. The control group included 26 healthy children (13 boys, 13 girls), aged 8.8.6.4.2 years. Plasma cortisol and adrenocorticotropic hormone (ACTH) were measured by radioimmunoassay and adrenal ultrasonography was performed. RESULTS: Plasma cortisol and ACTH levels were 243.7 ng/ml and 135.0 pg/ml in the patient group and 145.4 ng/ml and 21.1 pg/ml in the control group (p<0.01 in both). Adrenal insufficiency was found in four patients. Children with insufficiency more frequently required noradrenaline than did those with normal adrenal function (4/4 vs 2/20). Necrotic purpura (2/4 vs 2/20), massive adrenal hemorrhage (2/3 vs 1/20), lower platelet count (69.500 vs 212.895/l), lower prothrombin activity (19.0 vs 49.2%), lower fibrinogenemia (51.2 vs 304,4 mg/dl), higher pediatric risk of mortality III (PRISM III) scores (11.7 vs 2.7) and higher mortality rate (3/4 vs 1/20) were found in children with adrenal insufficiency than in those with normal adrenal function. CONCLUSIONS: Plasma cortisol and ACTH levels were increased in children with sepsis and septic shock. Adrenal insufficiency was uncommon. Adrenal insufficiency was associated with severe hemodynamic failure, necrotic purpura, disseminated intravascular coagulopathy, massive bilateral adrenal hemorrhage and high mortality rate.

Adrenal Gland Diseases↗
PubMed2000

[Admissions of patients with AIDS to pediatric intensive care units].

OBJECTIVE: To describe the most significant clinical features of children with acquired immunodeficiency syndrome who required admission to a pediatric intensive care unit (PICU). METHODS: Retrospective study of 12 patients with AIDS who required 13 admissions, between January 1988 and December 1997. RESULTS: Mean age at admission was 15 months (1 month-6 years). Seven patients were under 1 year of age; four were diagnosed during their stay in the unit. The most common reason for admission was respiratory failure (six patients), followed by cardiac failure. Six patients needed mechanical ventilation (5 for respiratory failure). Two patients died during their stay, one of pneumonia due to Pneumocystis carinii infection and one of septic shock. CONCLUSIONS: One-third of patients was diagnosed with HIV Infection during their stay at the PICU. Opportunistic infection was the initial manifestation of the disease. Consequently, with this type of infection, clinical suspicion should be high. The survival rate of up to 84.6% of the admissions to our unit as well as the new, highly active antiretroviral therapy, generally make HIV-infected children suitable for treatment in intensive care units.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[Etiology of central diabetes insipidus in children].

OBJECTIVE: The aim of this report were to document the etiology of central diabetes insipidus (CDI) in children under fourteen years of age and to describe the time of onset of CDI after its cause. PATIENTS AND METHODS: A descriptive-retrospective study using the records of 33 children diagnosed of CDI between January 1988 and December 1997 was performed. RESULTS: Brain death produced CDI in seventeen patients, intracranial tumors in five (after excision of the tumor) and seven had other causes. No etiology was detected in four. Time interval from the cause, when known, to the onset of CDI was always less than seven days. CONCLUSIONS: The most frequent etiology of CDI in children was brain death (51%). In all of our patients, the time of onset of CDI was less than one week.

Adolescent↗
PubMed1999

[Usefulness of fiberoptic bronchoscopy in critical pediatric care].

UNLABELLED: Fiberoptic bronchoscopy (FB) is being applied increasingly in pediatrics as a therapeutic and diagnostic technique. OBJECTIVE: To analyze the contribution of FB to the diagnosis and treatment of respiratory disease in patients admitted to the pediatric intensive care unit (PICU). PATIENTS AND METHOD: We reviewed FB performed with 3.5 and 2.2 mm external diameter instruments between January 1989 and October 1998 in patients admitted to the PICU. Underlying disease and purpose of and indications for FB were analyzed. We also analyzed route of insertion, findings of airway inspection and bronco-alveolar lavage (BAL), complications and the contribution of FB to patient management. RESULTS: A total of 51 procedures in 47 patients aged between ten days and 12 years old were performed. Twenty-one children (41%) were under one year old. The initial indications for FB were diagnostic in 73% and therapeutic in 27%. Airway inspection showed abnormality in 65%. BAL was performed in 18 cases, with microbiological findings in 8 of the 18. The patients benefited directly from the technique in 75% of cases. CONCLUSIONS: FB is useful diagnostic and therapeutic procedure in PICU patients and is generally well tolerated.

Age Factors↗
PubMed1996

[Acute respiratory failure secondary to Pneumocystis carinii pneumonia in children].

OBJECTIVE: The objective of this study was to ascertain the clinical and epidemiological characteristics of Pneumocystis carinii pneumonia (PCP) cases admitted to the Pediatric Intensive Care Unit (PICU). PATIENTS AND METHODS: A retrospective study was carried out on the 8 PCP cases admitted to the PICU from July 1991 to September 1994. The variables studied were: age, sex, geographic origin, associated pathology, immunological status, clinical manifestations, biochemical data, radiology, findings in bronchoalveolar lavage fluid (BAL), response to therapy and clinical follow-up. RESULTS: Age of the patients varied between 3 months and 9 years and there were 5 males and 3 females. Associated pathologies included AIDS (4 cases), severe combined immunodeficiency (SCID), Job's syndrome, and immunodeficiencies secondary to non-Hodgkin's lymphoma (NHL) and acute lymphoid leukemia (ALL), one case of each. Four cases appeared in a 22 day period. All cases but one suffered acute respiratory failure and needed mechanical ventilation. Diagnosis was established by means of BAL in every case. All cases showed a bilateral diffuse alveolo-interstitial pattern on chest films. Treatment was trimethoprim-sulfamethoxazole. In the acute illnesses, 2 patients died (cases of terminal SCID and NHL). CONCLUSIONS: To date, epidemic presentation of PCP has not been reported in our community. Four of our cases, with no demonstrable previous relation, appeared over a short period of time. We have not found a relationship between LDH levels and severity, as expressed by mechanical ventilation time. Every AIDS case survived the acute episode and CD4 counts were normal in most cases.

Child↗
PubMed1992

[Fibro-bronchoscopy without general anesthesia in pediatric patients].

Flexible bronchofiberoscopy is at present an indispensable technique in pediatric pulmonology departments. The fact that it can be used outside of the operating theater without general anesthesia or additional oxygen has greatly increased its field of pediatric applications. Thirty-three fibrobronchioscopies were performed during a period of one year on a group of children under 14 years of age. The most common indications for the procedure were atelectasis (27.3%), recurrent pneumonia (15.1%) and a possible foreign body (15.1%). The most usual sedation (82%) was the combination of Diazepan with Ketamine. Sixteen patients did not require oxygen and only one suffered a serious complication. The benefit of this technique was shown since the treatment of 22 children (67%) was changed following this procedure.

Adolescent↗
PubMed1989

[Apnea attacks in infants: study of 7 cases].

Authors study seven young infants suffering from apneic spells, without clear origin. Diagnosis was gastroesophageal reflux in the two most torpid evolution: others had hyponatremia. RVS infection, inborn cytomegaly and prematurity apnea.

Apnea↗