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Biomedical subjects

Giorgio Berlot

Publications and source records attributed to Giorgio Berlot.

10 recordsLinked to original sources
PubMed2007

B-type natriuretic peptide in healthy subjects after exposure to hyperbaric oxygen at 2.5 ATA.

INTRODUCTION: B-type natriuretic peptide (BNP) is a cardiac hormone used as a marker of cardiac dysfunction with diuretic and vasodilating properties secreted by the ventricles in response to wall stress. Hyperbaric oxygen (HBO) exposure is known to induce hemodynamic effects in humans which can be complicated by acute pulmonary edema. The aim of this study was to investigate if HBO has any effects on the secretion of BNP in healthy human subjects. METHODS: Eight healthy volunteers underwent the following HBO protocol in a hyperbaric chamber: compression to 2.5 atmospheres absolute (ATA); 45 min breathing 100% oxygen; 5 min breathing air; another 45 min in 100% oxygen; then decompression to atmospheric pressure. A venous blood sample was drawn before entering the chamber (To), immediately at the end of the treatment (T1), and at 5 h from To (T2). BNP concentration was determined using a rapid point-of-care immunoassay. Non-parametric statistics were used to analyze data. RESULTS: No difference in BNP levels was found between T0 and T1 or T2. DISCUSSION: The findings of this preliminary study show that in healthy subjects a single HBO exposure does not significantly modify BNP plasma levels. We hypothesize that this can be the net result between the stimulating effect of the HBO-induced vasoconstriction and the direct inhibitory effect on BNP secretion of myocyte hyperoxia. We conclude that HBO does not modify BNP secretion in healthy volunteers and that the direct effect of extreme hyperoxia on BNP secretion deserves further investigation.

Adult↗
PubMed2006

Management of severe sepsis and septic shock: challenges and recommendations.

Sepsis and related aspects has become an area of active and intense research, leading to important advances for an early diagnosis and appropriate management useful to improve patient outcome. The septic response is an extremely complex cascade of events, including proinflammatory, anti-inflammatory, humoral, cellular, and circulatory involvement. The pathophysiology of this syndrome, its various and changing clinical aspects, and the vast variety of therapeutic options available, not always of well-proved efficacy, make its management a goal difficult to achieve.

Clinical Protocols↗
PubMed2006

Controversial aspects of the prehospital trauma care.

Despite decades of studies and experiences, an evidence-based medicine consensus on the more appropriate treatment of trauma patients in the out-of-hospital setting has not yet been achieved. Different approaches exist and no one has been demonstrated clearly superior over the others for all circumstances and for all patients. A number of factors likely account for this finding.

Airway Obstruction↗
PubMed2006

Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews.

OBJECTIVE: To evaluate the effectiveness and potential complications of simple thoracostomy, as first described by Deakin, as a method for prehospital treatment of traumatic pneumothorax. METHODS: Prospective observational study of all severe trauma patients rescued by our Regional Helicopter Emergency Medical Service and treated with on-scene simple thoracostomy, over a period of 25 months, from June 1, 2002 to June 30, 2004. RESULTS: Fifty-five consecutive severely injured patients with suspected pneumothorax and an average Revised Trauma Score of 9.6+/-2.7 underwent field simple thoracostomy. Oxygen saturation significantly improved after the procedure (from 86.4+/-10.2% to 98.5%+/-4.7%, P<0.05). No difference exists in the severity of thoracic lesions between patients with systolic arterial pressure and oxygen saturation below and above or equal to 90. A pneumothorax or a haemopneumothorax was found in 91.5% of the cases and a haemothorax in 5.1%. No cases of major bleeding, lung laceration or pleural infection were recorded. No cases of recurrent tension pneumothorax were observed. Forty (72.7%) patients survived to hospital discharge. CONCLUSIONS: Prehospital treatment of traumatic pneumothorax by simple thoracostomy without chest tube insertion is a safe and effective technique.

Adolescent↗
PubMed2004

Anticipating events of in-hospital cardiac arrest.

STUDY OBJECTIVES: To determine whether in-hospital cardiac arrests occurring in regular wards are preceded by some event(s), and the diagnostic and therapeutic measures adopted. METHODS: From 1 May 1999 to 31 December 2001, events occurring in the 6 h preceding cardiac arrest were reviewed by checking the medical and nurse records and interviewing the attending staff. Exclusion criteria were (a) location in the Coronary Care Unit, the Intensive Care Unit, the Emergency Department and the operating rooms; (b) the presence of rapidly fatal disease; (c) the lack of adequate documentation. RESULTS: Overall, 263 cardiac arrests occurred in the period under consideration. A total of 148 patients (61 women, 87 men, aged 74.3+/-1.2 years) fulfilled the entry criteria. Anticipating events were reported in 128 patients (86.4%). These included alterations in consciousness, cardiac arrhythmias, dyspnoea and chest pain. The restoration of cardiac rhythm was obtained in 23 patients (15.5%). Eight (5.4%) survived without major neurological sequelae. Survivors were significantly younger than non-survivors (survivors 44.3+/-6.8 years; non-survivors 76.7+/-2.1 years; P<0.005). In a substantial number of cases, ranging from 23 to 81%, according to the anticipating event, no diagnostic investigations were performed. CONCLUSION: Most in-hospital cardiac arrests are preceded by events that often go overlooked and whose correct interpretation could be associated with a reduced mortality rate.

Adult↗
PubMed2004

Odontogenic infections and descending necrotising mediastinitis: case report and review of the literature.

Descending necrotising mediastinitis is a rare complication secondary to oral surgery or odontogenic infections which ultimately spreads to the mediastinum through the anatomical cervical spaces. Delay in diagnosis, despite broad-spectrum antimicrobical therapy and extensive surgical intervention, results in an unacceptably high mortality rate (almost to 40%). A case study is presented as a rationale for a review of the current literature and to analyse the evolution in therapies, both medical and surgical from Pearse in 1938 to today.

Aged↗
PubMed2004

Abdominal ultrasonography and chest radiography are of limited value in the emergency room diagnostic work-up of severe trauma patients with hypotension on the scene of accident.

PURPOSE: To evaluate the reliability of chest radiograph (CR) and abdominal ultrasonography (US) performed in the Emergency Room (ER) in identifying life-threatening thoracic or abdominal lesions in a group of severely injured patients, who developed arterial hypotension immediately after a trauma. MATERIALS AND METHODS: The results of all abdominal US and CX performed in the ER in severe blunt trauma patients, with on-the-scene systolic blood pressure 90 mmHg, from November 2000 to November 2002, were analysed. When these initial investigations failed to identify a possible cause of hypotension, a computed tomography (CT) of the chest and abdomen was obtained. RESULTS: Overall, 54 patients were studied; twenty-two patients (40.8%) were hypotensive both on accident scene and on the arrival at the ER and 32 (59.2%) were hypotensive on accident scene, but not in the ER. Forty-five patients had an US in the ER, in 3 patients it was inconclusive, whereas 2 other patients died before the confirmatory investigations could be performed. Among the remaining 40 patients, 11 had a hemoperitoneum (HP) hat was diagnosed by US in 7 cases and missed in 4. Twenty-nine patients had no HP and their US was negative in 24 cases and positive in 5; the US had a sensibility of 63.6% and a specificity of 82.8% The CR was obtained in the ER in 39 patients and it was able to identify 6 pneumothoraces (PNX) out of 20 and 2 hemothoraces (HT) out of 17; the sensitivity for PNX and HT was 30.0% and 11.8%, respectively. One patient with an aortic dissection had a normal CX. CONCLUSIONS: Both CX and US are not reliable to identify possible PNX, HT and HP in hypotensive trauma patients and can delay the treatment of life-threatening conditions. In these patients, a CT of the torso is warranted.

Abdominal Injuries↗
PubMedDate not supplied

[Early identification of patients with acute pancreatitis at risk of critical deterioration: a multiparameter case-control study].

The aim of the study was the early identification of patients with acute pancreatitis who subsequently developed critical complications. All patients admitted to a surgical ward for acute pancreatitis were recruited into the study. The severity of acute pancreatitis was assessed using Ranson and Balthazar scores. Patients transferred to the intensive care unit (Group A) were matched with patients with the same scores who did not require intensive care treatment (Group B). Several clinical and biochemical variables were compared between the two groups. A total of 221 patients were recruited (110 m, 121 f; mean age: 60.6 years; range: 17-94 years). Group A included 13 patients (7 m, 6 f; mean age: 59.6 +/- 13.5 years; range: 35-76), whereas Group B included 27 patients (11 m, 16 f; mean age 60.8 +/- 5.5 years; range: 44-93). Only glycaemia, pH, white cell count and body mass index differed between the two groups. The mortality rates were 31% in Group A and 7.4% in Group B, respectively (P<0.005) In the logistic regression analysis, only body mass index continued to show a significant difference. In this population of patients with acute pancreatitis, only body mass index proved capable of identifying patients at risk of critical complications.

Acute Disease↗