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Biomedical subjects

G Tulli

Publications and source records attributed to G Tulli.

At least 19 recordsLinked to original sources
PubMed2002

The abdominal compartment syndrome. Clinical relevance.

Increased intra-abdominal pressure (IAP) may occur in a number of different situations encountered by intensivists, such as tense ascites, abdominal hemorrhage, use of military antishock trousers, abdominal obstruction, during laparoscopy, large abdominal tumors and peritoneal dialysis.1-3 Both clinical and experimental evidence indicate that increased IAP may adversely affect cardiac, renal, respiratory and metabolic functions.1-5 Despite this, increased IAP is rarely recognized and treated in Intensive Care Unit (ICU) settings. There appears to be two reasons for this: the physiologic consequences of increased IAP are not well know, to most physicians and, more importantly, the capability of easily measuring IAP has not been well documented. In this chapter, we will discuss: 1) the different methods proposed to evaluate IAP in ICU; 2) the physiopathological consequences of increased IAP; 3) the existing clinical data about IAP in critically ill patients. Considering overall our data, we can conclude that: 1) different techniques are available at the bedside to estimate the IAP; 2) the IAP ranges between 10 and 20 cmH2O, substantially increased compared to normal subjects. Most of the patients have IAH, while few of them (<5%) present clinical characteristics of ACS; 3) the IAP is different among different categories of patients and its increase is not limited to surgical patients only; 4) the increase in IAP appears to influence respiratory function, homodynamic, kidney, gut and brain physiology; 5) the IAP seems to be correlated with severity scores but its relation to mortality is controversial; 6) the routine measurements of IAP by means of bladder pressure are not associated with an increased rate of urinary tract infections.

Abdomen↗
PubMed2000

Lethal late onset cblB methylmalonic aciduria.

OBJECTIVE: To alert the physicians to the possibility of a late-onset inborn error of metabolism in an apparently previously healthy patient with acute clinical presentation. DESIGN: Case report. SETTING: Pediatric unit and general intensive care unit. PATIENT: An apparently previously healthy 12-yr-old female presented acutely with vomiting, fever, bronchopneumonia, and progressive loss of consciousness associated with ketoacidosis, hyperglycemia, and hyperammonemia. She died 3 days later with a diagnosis of insulin-dependent diabetes mellitus. INTERVENTIONS: Intravenous hydration, glucose and insulin, mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Organic acid analysis on a postmortem sample of aqueous humor revealed high levels of methylmalonic acid. Enzymatic studies on cultured fibroblasts were consistent with the diagnosis of cblB methylmalonic aciduria. CONCLUSIONS: The diagnosis of cblB methylmalonic aciduria was made in a postmortem patient who died with a misdiagnosis of insulin-dependent diabetes mellitus. Unclear biochemical findings and positive family history should strongly lead to suspicion of an inborn error of metabolism in an apparently previously healthy critically ill patient.

Adaptor Proteins, Signal Transducing↗
PubMed1997

[Description of a case of Reye's-like syndrome with fatal outcome].

A Reye Like Syndrome case occurred in a twelve year-old little girl with a previous familiar history is reported. The little patient was admitted in the pediatric ward for fever, vomiting and aspecific respiratory symptoms and developed very quickly a severe metabolic acidosis, alterations of consciousness, hypoxia, tissular hypoperfusion, multiple organ failure (MOF) and a fatal outcome. The postmortem diagnosis pointed out a methyl malonic acidaemia, a fairly frequent cause of acute metabolic distress, which may occur also in prepuberal age. The correct diagnostic and therapeutic approach of these cases is stressed since they need a prompt and careful monitoring in intensive care unit and a close cooperation among pediatricians, intensive care specialists and the nearest centre for the study of metabolic diseases.

Child↗
PubMed1994

[A case of HELLP syndrome with dramatic course successfully treated with early plasmapheresis].

A case of Hellp syndrome occurred in postpartum of a pregnancy elapsed without signs of preeclampsia is described. The evolution was particularly dramatic. Early plasmapheresis was the key treatment for a complete recovery in order to avoid Multiple Organ Dysfunction System (MODS). Emphasis on a multidisciplinary approach between Gynecologist, Anesthetist, Nephrologist and Hematologist is pointed out.

Adult↗
PubMed1993

[Propofol-midazolam in continuous infusion for sedation in intensive care].

Two groups of 11 ICU respiratory patients ventilated with PSV have been sedated with propofol (group I) or with midazolam (group II). After the endovenous administration of the induction dose (propofol 1.5 mg/kg; midazolam 0.15 mg/kg) sedation was obtained with continuous infusion of the drugs (propofol 2 mg/kg/h; midazolam 0.24 mg/kg/h). In this setting the Authors evaluated the level of sedation (Ramsey scale) and the side effect of the two drugs. At induction midazolam caused a reduction of tidal volume for some minutes and a greatest sedation in comparison with propofol, while propofol caused reduction of MAP (p < 0.01) and transitory apnoea. Even if during the infusion of propofol the level of sedation decreased with time (p < 0.05; y = -0.0357 x + 3.07) it was more stable in comparison with that registered during continuous infusion of midazolam (p < 0.01; y = -0.2018 x + 5.19.

Aged↗
PubMed1993

[Acute carbamazepine poisoning treated with plasmapheresis. Description of a clinical case].

A case of severe Carbamazepine poisoning initially misdiagnosed is reported. Treatment consisted in plasmapheresis (3.5 liters exchanged) repeated for 3 consecutive days, in conjunction with activated charcoal and advanced life support. It was obtained a rapid decay in Carbamazepine plasmatic level (with rebound phenomenon only after first treatment day) and a contemporary improvement in clinical conditions. The patient was discharged without complications after 6 days stay in ICU. Taking pharmacokinetic characteristics into account, it is suggested that plasmapheresis may be useful in this kind of poisoning.

Acute Disease↗
PubMed1992

[Gastric tonometry. Experience of a polyvalent intensive care unit].

Tonomitor NG tube was positioned in the stomach of 11 critical ill patients during their stay in ICU and 48 measurements of intramucosal pH (pHi) have been performed. In 7 patients haemodynamic measurement were performed in concomitance with each pHi measure. The Authors looked for statistical relations between pHi and SAPS, pHa, HCO3-a, MAP, DO2/BSA, VO2/BSA, SvO2, diuresis and outcome. A good correlation was found between pHi and MAP (r = 0.47). Dividing the considered parameters into 2 groups in agreement with pHi values < or = and > 7.32 significant relations (p < 0.05) results between pHi and SAPS, MAP, pHa. More significant relations were found between pHi and outcome (p = 0.0015) and between the mean of the pHi values obtained from each patient (pHi-m) and outcome (p = 0.0005). The pHi-m of the surviving patients was always > 7.32 while the pHi-m of the deceased patients was always < 7.32. This results confirm the importance of the pHi measured during the stay in ICU as a prognostic index and suggest that the MAP may be the most important haemodynamic parameter which correlate with pHi values.

Adult↗
PubMed1992

[Hypoxia and oxygen content during dialysis].

In a study of 72 patients treated with acetate and bicarbonate dialysis, the Authors verified if hypoxic hypoxia caused by dialysis depends on a deficit in oxygen content with an inherent risk of tissue hypoxia. PO2uv (uncompensated venous oxygen partial pressure) and CQ (cardiac compensation factor) derived from the oxygen absorption curve were studied by a new Ole Siggard-Andersen algorithm. The results do not show a risk of tissue hypoxia in the postdialytic period.

Humans↗
PubMed1992

[Tetanus disease. Experience with 2 intensive treatments during 13 years].

The Authors present a retrospective analysis of 58 cases of tetanus hospitalized in two ICU in 13 years of activity. The mortality reported (39.7%) is comparable to other Authors or statistical analysis but it is better if correlated to patient age. Patients of the highest classes (III and IV classes of Edmonson e Flowers) had the highest mortality but no significant variation was seen between patients of the III and IV class. The most frequent cause of death has been cardiac arrhythmia. Cardiac arrhythmias happened in most cases in the first 15 days of hospitalization. 37.9% of patients developed pneumonia: prolonged hospitalization (more than 15 days) and high classes of the disease have been the most important risk factors for Hospital-acquired pneumonia in tetanic patients.

Aged↗
PubMed1992

[The use of Opticath in the correct measurement of the pulmonary capillary wedge pressure].

The Authors assess the utility of the on-line monitoring of SvO2 during 156 measurements of pulmonary capillary wedge pressure (PCWP) done on 52 Intensive Care Unit patients. The measurement was always right when the SvO2 increased more than 90%. The Authors found a good correlation between the SvO2 monitored during the measurement of the PCWP and the saturation of pulmonary capillary blood measured by cooximeter. These data suggest that the complex procedure to confirm the reliability of the measurement recommended by Gardner can be simplified by the observation of the trend of SvO2 on the monitor oximetrix. This allows to obtain saving time for the staff, saving blood for the patients, reduction of risk for the transmission of infective diseases due to the handling of blood and guarantees a further routinary control of reliability on the measure of PCWP.

Catheterization, Swan-Ganz↗