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Biomedical subjects

J Fogliani

Publications and source records attributed to J Fogliani.

At least 19 recordsLinked to original sources
PubMed1993

[Voluntary barium poisoning].

A 45-year-old man attempted to commit suicide by ingesting a large amount of barium. In some hours, he experienced generalized muscle weakness with hypokalaemia, treated by large dose of potassium (440 mmol in the first day). This weakness resulted in difficulties in swallowing and respiratory failure requiring mechanical ventilation. An anuric renal insufficiency started early, requiring haemodialysis for three weeks. It was induced probably by renal toxicity of barium and recovered completely. Later, the patient experienced an extrapyramidal syndrome initiated by tremor and myoclonia. Hypertonia induced a parkinsonian rheumatism, fixing the two hands in an irreducible position. There was also a contracture of superior sphincter of oesophagus, with severe disturbance of deglutition, ending after three months only. MRI study showed a bilateral hypersignal in basal ganglia and thalamus. It remains unknown whether this neurological syndrome was toxic or ischaemic. This patient remained under mechanical ventilation for three months because of disturbances of deglutition. He was discharged to his home at the 6th month. One year later he was still adynamic, but able to carry our rather precise movements.

Acute Kidney Injury↗
PubMed1991

[Severe hypercalcemia after rhabdomyolysis and acute renal failure].

Two cases of rhabdomyolysis with renal failure followed by hypercalcaemia are reported. Both had major hyperphosphataemia and hypocalcaemia, requiring haemodialysis. Hypercalcaemia developed during the diuretic phase, when renal function was still abnormal, and before phosphate blood levels had returned to normal. Soft tissue calcifications occurred in one of the patients. The pathogenesis and treatment of this condition are discussed. Increased levels of serum calcitriol may play an important role in the genesis of hypercalcaemia, which may last for several months. Giving calcium salts and or vitamin D to these patients during the hypocalcaemic phase is dangerous, and should be avoided. The usual treatment for hypercalcaemia my remain ineffective. Mithramycin can lower the serum calcium concentration but the new diphosphonates (sodium etidronate) are very effective in the treatment of this hypercalcaemia. However, in serious or urgent cases, hypocalcaemic haemodialysis may be required, with the simultaneous administration of calcitonin and diphosphonates.

Acute Kidney Injury↗
PubMed1987

[Treatment of colectasia occurring in intensive care].

Acute false colonic obstruction occurred in one female and nine male patients aged between 51 and 82 years. They had been admitted to an intensive care unit for respiratory failure (thoracic trauma, pneumonia, chronic or postoperative respiratory failure, or neurological disease). Three patients were in terminal multiple organ failure. There was an associated potassium deficiency in six of the patients. Mechanical ventilatory support was required in eight patients. Plain abdominal X-rays showed caccal diameters greater than 8 cm, confirming the diagnosis. All these patients were initially treated with nasogastric suction, intravenous fluids, potassium replacement, but without success, except in one patient. One spontaneous caecal perforation and a case of impending perforation were treated surgically without prior endoscopy. Nine colonoscopies were carried out with great difficulties. Immediate colic deflation was achieved, but the colic distension resumed 24 h later in six patients. Normal bowel function restarted after colonoscopy in one patient, whilst another one perforated. The air introduced during colonoscopy in the already distended bowel may have speeded up the perforation. Surgery (caecostomy or colostomy) was followed by a return to normal bowel function in seven out of eight patients. One patient died as a result of his spontaneous caecal perforation; the death of three other patients was due to the underlying disease. Ogilvie's syndrome occurring in intensive care patients requires colonic decompression to avoid perforation. Colonoscopy helps to rule out true anatomic occlusion and confirms the diagnosis. However, it is often difficult to carry out, poorly efficient and sometimes dangerous.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

[Intravenous digital subtraction angiography in intensive care].

Intravenous digital subtraction angiography (IVDSA) was performed in 11 patients aged from 23 to 62 yr to visualize vascular disease that required to be treated without delay: 7 were in shock preceded by a cardiac arrest in 5 of them; 4 suffered from acute renal failure, 8 from acute respiratory failure and one from brain death. 5 pulmonary, 2 thoracic aortic, 3 abdominal aortic, 1 right subclavian and 1 renal arterial angiographies were carried out by this method. In all the cases described, we either confirmed the diagnosis (rupture of thoracic aorta, type I aortic dissection, aneurysm of abdominal aorta, complete occlusion of the distal abdominal aorta, pulmonary embolism) or set aside diagnosis (lesion of the subclavian vessels, pulmonary embolism) or visualized the renal vasculature before removing the organ. No incident was observed. Conventional angiography remained a reference method but it presented risks which were not to be neglected in critically ill patients. Despite the theoretical limits set by the technical demands (absolute motionlessness, apnoea) and few other restrictions found in the literature, IVDSA seemed to offer distinct advantages under such conditions. Only requiring an injection using a catheter placed in a peripheral vein, this method was fast, safe and easy; it gave a close enough approach to the diagnosis to be able to help decide on specific treatment or on orientation towards a specific hospital department.

Adult↗
PubMed1982

[Legionnaires' disease with digestive tract lesions. One case].

In the case reported pulmonary Legionella infection was diagnosed by sputum cultures even though immunofluorescence tests were negative. The patient had positive Coomb's test due to circulating auto-antibodies which disappeared after he recovered. The course of the disease was prolonged by perforation of the coecum requiring excision of the colon and terminal ileostomy. Erythromycin had to be given intravenously. Pathological examination of the digestive tract lesions showed inflammatory colitis with presence of Legionella pneumophilia which seemed to have been responsible for the complication. This is the first time a digestive lesion caused by this organism is described, adding yet another extrapulmonary visceral involvement to those already reported and suggesting that Legionella may spread throughout the body.

Autoantibodies↗
PubMed1981

[Method for prolonged hemodynamic and respiratory monitoring. I. Technical study involving 45 patients].

The authors describe a method for haemodynamic and respiratory surveillance which they applied to 45 severely ill patients in circulatory and/or respiratory distress. Only an arterial and central venous catheter are necessary. They are used to measure arterial and venous blood gas levels as well as cardiac output by dye dilution. Long term surveillance is made possible by the absence of a Swan-Ganz catheter. Periods were as 7 to 35 days with a mean of 12.6 days, during which 910 assessments were made with the use of 64 arterial catheters and 71 venous catheters. The method reduces the prevalence of itrogenic accidents complicating the course of these severely ill patients and considerably lowers the cost of such surveillance. No specifically related complications were seen, problems being limited to the usual percentage of complications due to arterial and venous catheters.

Adult↗
PubMed1980

[A story about water].

On the basis of one case, the authors review the symptoms and signs of alcoholic ketoacidosis. This occurs in general in a middle aged woman during the abundant ingestion of alcohol. It presents as drowsiness, headache and vomiting. Laboratory examinations reveal slight hyperglycaemia, hypokalaemia and a metabolic acidosis with the presence of ketones in the blood and urine. Blood alcohol level is nil. No other cause of ketoacidosis is found. The course is rapidly favourable. The biochemical mechanism is poorly understood.

Acidosis↗
PubMed1979

[Reintervention on heart valve prostheses. Apropos of 78 cases].

78 patients with one or more prosthetic heart valves were reoperated on between 1972 and 1978, and comprised 12% of the work load of valvular surgery. There were two postoperative periods in which the incidence of reoperation was high: the first year, 38%, and the period between the 5th and the 8th year, 41%. The main causes of reoperation could be divided into two groups: those common to all valves with paravalvular leaks (25%), endocarditis (12%) being the principal causes, and those associated with particular valves: deterioration of Beall prosthesis 33%, and thrombosis mainly affecting the Bjork and Beall prostheses (25%). The operative mortality was 12%. The fact that urgent operation is required in severe cases is underlined. In the light of these results, the surgical indications of reoperation should be discussed at an earlier stage. These indications are based essentially on the clinical condition of the patient and objective confirmation by further investigation should not delay the operation, which, in our experience, has never been unnecessary.

Adolescent↗