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Biomedical subjects

G Paolillo

Publications and source records attributed to G Paolillo.

14 recordsLinked to original sources
PubMed1994

Assisted circulation in postcardiotomy heart failure: experience with the Bio-Medicus centrifugal pump in ten patients.

Between January 1990 and September 1992, ten patients required assisted circulation for postcardiotomy heart failure which was unresponsive to inotropic drugs and aortic counterpulsation. All patients were supported by a Bio-Medicus centrifugal pump (biventricular assist in five, left ventricular in three, right ventricular in two); six had ischaemic heart disease, two a congenital ventricular septal defect, one an acute mitral valve incompetence and one an aortic type 'A' dissection. The mean duration of circulatory support was 5.1 days (range 2 hours to 8 days). Six patients were weaned from the device and four were discharged; the perioperative deaths among the patients weaned from support were the result of cerebral haemorrhage and multiorgan failure respectively. No late deaths occurred at a mean follow-up of 15 months. Common complications were bleeding (40%), acute renal failure (30%) and sepsis (30%). All patients who developed renal failure died. The high incidence of haemorrhagic complications makes the use of pre-heparinized circuits desirable as these patients do not then require additional anticoagulation.

Acute Kidney Injury↗
PubMed1994

Measurement of cardiac troponin T and myosin to detect perioperative myocardial damage during coronary surgery.

This study evaluated the use of monitoring blood levels of the isoenzyme of creatine phosphokinase, troponin T (tnT) and myosin in the detection of perioperative myocardial damage after coronary artery surgery. Serial blood samples were collected in 24 patients undergoing myocardial revascularization. The patients were retrospectively divided into three groups: group A with no changes in their electrocardiogram; group B showing non-specific signs of perioperative myocardial infarction such as deep and permanent T wave inversion; and group C with definite electrocardiographic signs of perioperative myocardial infarction (new persistent Q-waves and loss of R-waves). Group A (n = 17) demonstrated a mean(s.d.) troponin T peak blood level of 0.64(0.35) ng/ml at 12-24 h after surgery, a myosin peak of 1030(670) mu units/l at 3-6 days afterwards, and a creatine phosphokinase isoenzyme peak of 25.8(10.6) units/l. In group B (n = 5), mean(s.d.) troponin T levels were elevated to a peak of 4.8(3.9) ng/ml 24 h after intervention, while myosin rose to 2074(340) mu units/l 3-6 days after surgery and creatine phosphokinase isoenzyme reached 57.8(38) units/l. Group C (n = 2) had a mean(s.d.) troponin T peak of 4.8(2.6) ng/ml, a myosin peak of 2404(392) mu unit/l and a creatine phosphokinase isoenzyme peak of 88.5(20) units/l. Peak values of troponin T and myosin in groups B and C were statistically different from those in group A (P < 0.001). These results suggest that troponin T and myosin are reliable indicators of perioperative myocardial damage. In particular, troponin T may allow the differentiation of reversible from irreversible myocardial injury.

Biomarkers↗
PubMed1992

The role of transcranial Doppler in carotid artery surgery.

In order to evaluate the usefulness of transcranial Doppler (TCD) in carotid artery surgery, 90 patients who underwent carotid endarterectomy were studied. Transcranial Doppler was performed preoperatively with digital compression of the carotid artery and intraoperatively at the time of cross-clamping, together with routine EEG monitoring. The percentage residual middle cerebral artery velocity (%MCAV) during carotid artery compression or cross-clamping was considered. The intraoperative %MCAV at cross-clamping was compared with the values obtained in the preoperative examination during the compression test and with the EEG data; the EEG records were blindly reviewed by a neurologist and divided into three groups: group A, normal; group B, moderate anomalies and group C, major anomalies. There were no significant differences between preoperative %MCAV (compression test) and intraoperative %MCAV (cross-clamping) by separate analysis of the data related to systolic, diastolic and mean velocity. The systolic, diastolic, mean %MCAV and the Gosling index after cross-clamping were then compared with the EEG data: no significant differences were seen between groups A and B; on the other hand, in all patients with major EEG anomalies (group C) the %MCAV at TCD was reduced to 0. In conclusion, preoperative TCD associated with carotid artery compression appears a safe and useful way of identifying patients at risk of cerebral ischaemia during carotid artery cross-clamping. Patients with no residual flow at intraoperative TCD need to be considered as presenting a very high risk of ischaemia and in this group the use of a shunt is mandatory.

Aged↗
PubMed1990

Inhibition of cardiac phosphatidylethanolamine N-methylation by oxygen free radicals.

This study was undertaken to examine the effects of oxygen free radicals on phosphatidylethanolamine (PE) N-methylation in rat heart sarcolemmal (SL) and sarcoplasmic reticular (SR) membranes. Three catalytic sites involved in the sequential methyl transfer reaction were studied by assaying the incorporation of radiolabeled methyl groups from S-adenosyl-L-methionine (0.055, 10, and 150 microM) into SL or SR PE molecules under optimal conditions. In the presence of xanthine + xanthine oxidase (superoxide anion radicals generating system), PE N-methylation was inhibited at site I and III in the heavy SL fraction isolated by the hypotonic shock-LiBr treatment method. In the light SL fraction isolated by sucrose-density gradient, a significant inhibition of PE N-methylation was seen at all three sites. These inhibitory effects of xanthine + xanthine oxidase on PE N-methylation were prevented by the addition of superoxide dismutase. Hydrogen peroxide showed a significant inhibition of PE N-methylation at site I in the heavy SL fraction, and at site I and II in the light SL fraction. Catalase blocked the inhibitory effects of hydrogen peroxide. The effects of both xanthine + xanthine oxidase and hydrogen peroxide on the SR membranes were similar to those seen for the heavy SL fraction. These results suggest that, in addition to lipid peroxidation, the oxygen free radicals may affect the function of cardiac membranes by decreasing the phospholipid N-methylation activity.

Animals↗
PubMed1989

Discrete interactions between phosphatidylethanolamine-N-methylation and phosphatidylinositolbisphosphate hydrolysis in rat myocardium.

Both phosphatidylethanolamine(PE)-N-methylation and phosphatidyl-inositol bisphosphate (PI-bisphosphate) breakdown potentially modify the microdomains in the sarcolemmal lipid bilayer. In this study the possibility of a mutual interaction between the enzymes responsible for these phospholipid reactions is examined. In sarcolemma purified from rat heart, prior hydrolysis of PI lipids by exogenous specific phospholipase C inhibited (to 75, 59 and 78% of control for sites I, II and II, respectively) the PE-N-methyltransferase system. In cultured rat cardiomyocytes the addition of L-methionine, a precursor for the methyl donor S-adenosylmethionine, stimulated PE-N-methylation in a concentration (0.2-300 microM)-dependent manner. Methionine (50 microM) decreased the basal rate of PI-bisphosphate hydrolysis (to 72% of control), but had no effect on the phenylephrine-stimulated PI-bisphosphate hydrolysis. Maximal activation of the PI-bisphosphate breakdown by 30 microM phenylephrine did not affect the rate of PE-N-methylation in the presence of exogenous methionine (50 microM). These findings support the existence of interactions, although discrete, between the enzymes involved in the PE-N-methylation and PI turnover.

Adrenergic Agonists↗
PubMedDate not supplied

[Monitoring of pediatric patients undergoing magnetic resonance diagnosis with a superconducting magnet].

Magnetic resonance imaging (MRI) has presented to anesthesiologists as unique challenge in patient monitoring because of its construction and principles of operation. Ferromagnetic materials within or near the scanner can distort the magnetic field, and monitoring wires act as antennae and this may result in image degradation. Nevertheless, monitoring is mandatory during MRI, especially in a child sedated or in general anesthesia. A monitoring system, made up of commercially available components, was assessed, and its effects on MR (1.5 tesla unit) image quality system determined. Variables monitored included: electrocardiogram and heart rate, (Sirecust 404, ECG cable set MR; Siemens, Enlanger, West Germany); blood pressure via automated sphygmomanometry (Press Mate BP-8800; Colin, Komaki, Japan); and continuous arterial saturation via pulse oximetry (Nellcor 100 E; Nellcor, Inc., Haywood, California). Fluid infusion rate was controlled by means of a plastic deliver (Dial-a-flo; Abbott Labs., Chicago, Illinois). Body temperature was maintained with a heat insulator blanket (Thermadrape, OR Concepts, Inc., Dallas, Texas). The monitoring technique described did not interfere with MRI function or produce image degradation.

Anesthesia↗
PubMedDate not supplied

Continuous intra-arterial blood gas monitoring. A clinical experience.

Miniaturized sensors, based upon the principles of optical fluorescence, can measure in vivo the pH, pCO2 value and pO2 value of blood. In this report we studied continuous intra-arterial blood gas monitoring in 27 patients undergoing cardiac surgery (no. 16 coronary artery by-pass grafting, no. 2 valvular surgery) and major vascular surgery (no. 9 abdominal aortic aneurysms). Total duration of continuous intra-arterial blood gas monitoring was 677 hours, with a ratio of 25.0 +/- 14.8 hours/patient (range 4-96 hours). The in vitro values of pH, pCO2 and pO2 were compared to simultaneous records from the fiberoptic sensor for each of the 283 arterial blood gas samples obtained, by means of linear regression and Bland-Altman method, in order to test the correlation and the agreement between the two methods of measuring. For pH average bias was -0.023 and intersensor precision was 0.028, with a strong correlation (R = 0.92; p < 0.001) and agreement. For pCO2 the average bias was 0.91 and the inter-sensor precision was 2.65, with a slight decrease in correlation (R = 0.89; p < 0.001) and agreement. For pO2 average bias was -2.69 and the intersensor precision was 12.16, with a strong correlation (R = 0.97; p < 0.001) and agreement. In addition, we tested the reliability of the system for values of pO2 above 100 mmHg and we found a strong correlation (R = 0.96; p20.001) and agreement even for these clinical conditions, largely out of physiologic parameters. This study demonstrates the feasibility and reliability of continuous intra-arterial three-component PB 3300 (Puritan Bennett) blood gas monitoring.

Aged↗
PubMedDate not supplied

[The effectiveness of enoximone in patients with serious left ventricular dysfunction submitted for aorto-coronary bypass].

BACKGROUND: The purpose of this study was to investigate whether the combined positive inotropic and vasodilating properties of enoximone have a short-term benefit when used in patients who underwent open heart surgery. METHODS: From 7/1994 to 1/1995 twenty-six patients with severe myocardial dysfunction (ejection fraction < 35%) were enrolled into a prospective trial before undergoing coronary artery bypass graft. They were randomly selected into two study groups: the first treated with enoximone (group E) and the other one with dopamine (group D). Anaesthesia was the same for both groups using high-dose fentanyl. Buckberg cardioplegia was used. All patients were followed by: conventional monitoring, Swan-Ganz catheter and transesophageal echocardiography. measurements (hemodynamic parameters, end-systolic and diastolic area and left ventricular wall motion) were recorded: after induction of anesthesia, after loading-dose and an intensive care unit. Enoximone- and dopamine infusions were started during weaning from cardiopulmonary bypass and tailored to hemodynamic parameters (cardiac index > 2.8 l/min, wedge pressure < 16 mmHg, mixed venous blood saturation > 65%). Major events were defined as: endotracheal intubation > 36 h, using intraortic balloon pump or centrifugal pump, intensive care timer > 48 h, in hospital cardiac death. Prices, were established by DRG-tables (diagnosis related groups). Statistical analysis were performed by X and "t" Student tests. RESULTS: Cardiac index increased more significantly in group E (CI 1.9-->3.9 vs 2.3-->3.3; p 0.05) thanks to a higher reduction of vascular systemic (SVRI 2889-->1447 vs 2536 -->1565; p 0.005) and pulmonary resistances (PVRI 271-->193 vs 288-->218; p 0.05). Fewer major cumulative events and intensive care costs were observed in group E rather than group D. CONCLUSIONS: Enoximone administer immediately after open heart surgery had more beneficial hemodynamic and clinical effects than dopamine in patients with severe left ventricular dysfunction.

Cardiotonic Agents↗
PubMedDate not supplied

[Diastolic dysfunction in cardiac surgery intensive care. Study methods, changes and prognosis].

The natural history of patients with coronary artery disease and diastolic dysfunction who underwent coronary artery bypass grafting (CABG) is not well known. The aims of our study were to evaluate the incidence of diastolic dysfunction, its evolution after CABG and its possible correlation with adverse in-ICU prognosis. We studied 88 consecutive patients scheduled for CABG with not severely depressed left ventricular function (ejection fraction > 35%) and multivessels disease. Buckberg cardioplegia was used for myocardial protection. Diastolic function was investigated by recording mitral and venous pulmonary flow by transesophageal Doppler echocardiography (TEE). TEE examination was performed in operative room pre and post-bypass, at ICU arrival and after three months. Diastolic dysfunction was defined as mild, moderate and severe. Adverse in ICU events were defined as: use of inotropic drugs or ventricular mechanical support, an ICU stay > 24 hours, perioperative myocardial infarction and death. The study group was compared with a control group. T-Student test was used; a p < 0.05 was considered significant. A reduced diastolic function was present in 77% of patients at baseline examination. Diastolic dysfunction did not worsen significantly after hypothermic cardiac arrest and reperfusion. It persisted during ICU stay and normalized after three months from CABG in the majority of patients (85%). Diastolic failure was not associated with an adverse ICU prognosis (adverse events: 18 versus 13%; p = ns).

Aged↗