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Biomedical subjects

J Pellegrini

Publications and source records attributed to J Pellegrini.

10 recordsLinked to original sources
PubMed2002

Intradermal ketorolac for reduction of epidural back pain.

Between 30 and 45% of all parturients receiving epidural laboring analgesia complain of postpartum back pain. Although long-term or chronic back pain has been reported, our study focuses on acute or short-term back pain that resolves within 72 h. The purpose of this randomized double-blind, placebo-controlled investigation was to determine if a ketorolac/lidocaine intradermal anesthesia combination could decrease post-epidural back pain. A total of 81 non-complicated parturients requesting epidural analgesia were approached for inclusion and randomized to receive either 3 mL of 1% lidocaine (control group) or 3 mL of 1% lidocaine with 6 mg ketorolac (experimental group) for dermal anesthesia. A 0-10 verbal numeric scale was used to assess pain at rest and with activity at 24 and 72 h. Demographics, mode of delivery, and duration of labor were noted. A chi2 test was used to analyse frequency data and a Student's t-test and generalized estimation equation were used to analyze ordinal and interval data. Demographics, mode of delivery and length of labor were similar between groups. Significantly lower verbal numeric scores were noted in the experimental group at the 24-h active measurements after vaginal delivery and at 24 and 72 h for both active and resting measurements after cesarean delivery. Based on these findings it can be recommended that intradermal ketorolac given at the time of epidural catheter placement may result in a reduction in post-epidural back pain in the parturient, especially in the event of cesarean delivery.

Clinical Trial↗
PubMed2001

Bone suture anchors versus the pullout button for repair of distal profundus tendon injuries: a comparison of strength in human cadaveric hands.

Avulsion or distal tendon laceration of flexor digitorum profundus (FDP) is classically repaired to the base of the distal phalanx via a pullout suture over a button. Bone suture anchors, used extensively in other surgical areas, have recently been proposed for reattachment of the FDP to the distal phalanx. The FDP tendons of the index, long, and ring fingers in 9 fresh frozen cadeveric hands were randomized to 1 of 3 repair techniques after simulated distal avulsion injuries. These were the pullout button using 3-0 monofilament nylon in a 2-strand Bunnell suture pattern, the 1.8 mm Mini QuickAnchor (Mitek Products, Norwood, MA) using 3-0 braided polyester in a 2-strand Bunnell suture pattern, and the Mitek micro anchor using 3-0 braided polyester with a modified 4-strand Becker suture pattern. Nine specimens were loaded to failure, noting maximum load and mode of failure. The 1.3 mm Micro QuickAnchor (Mitek) technique (69.6 +/- 10.8 N) was significantly stronger than the pullout button (43.3 +/- 4.8 N) or the Mini anchor technique (44.6 +/- 12.7 N). The Micro bone suture anchor provides a stronger tendon to bone repair than the pullout button or the Mini anchor. Given the disadvantages of the pullout button, the Micro bone suture anchor with the modified Becker technique is worth consideration as an alternative method to repair distal FDP avulsions.

Aged↗
PubMed2001

A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates.

UNLABELLED: Neonates who require a central venous catheter (CVC) for prolonged vascular access experience high rates of catheter-related bloodstream infection (CRBSI). PURPOSE: A multicenter randomized clinical trial was undertaken to ascertain the efficacy of a novel chlorhexidine-impregnated dressing (Biopatch Antimicrobial Dressing) on the CVC sites of neonates for the prevention of catheter tip colonization, CRBSI, and bloodstream infection (BSI) without a source. Setting. Six level III neonatal intensive care units. Patients Studied. Neonates admitted to study units who would require a CVC for at least 48 hours. METHODS: Eligible infants were randomized before catheter placement to 1 of the 2 catheter site antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol scrub followed by placement of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane dressing (Bioclusive Transparent Dressing) was used to cover the insertion site in both study groups. Primary study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without an identified source. RESULTS: Seven hundred five neonates were enrolled in the trial, 335 randomized to receive the chlorhexidine dressing and 370 to skin disinfection with PI (controls). Neonates randomized to the antimicrobial dressing group were less likely to have colonized CVC tips than control neonates (15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5-0.9). Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5-2.7) and BSI without a source (15.2% vs 14.3%, RR: 1.1, CI: 0.8-1.5) did not differ between the 2 groups. Localized contact dermatitis from the antimicrobial dressing, requiring crossover into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates weighing </=1000 g. No neonates in the PI group developed contact dermatitis. CONCLUSION: The novel chlorhexidine-impregnated dressing, replaced weekly, was as effective as cutaneous disinfection with 10% PI and redressing the site every 3 to 7 days for preventing CRBSI and BSI without a source in critically ill neonates requiring prolonged central venous access. The risk of local contact dermatitis under the chlorhexidine dressing limits its use in low birth weight infants who require prolonged central access during the first 2 weeks of life.

Administration, Cutaneous↗
PubMed2000

Induction of global anergy rather than inhibitory Th2 lymphokines mediates posttrauma T cell immunodepression.

Depressed mitogen-induced IL-2 and IFN-gamma responses after severe mechanical or thermal injury are postulated to result from an expansion of Th2 lymphocytes with concomitant excessive production of IL-4 and/or IL-10. Here, we simultaneously assessed proliferation and Th1 (IFN-gamma) versus Th2 (IL-10, IL-4) lymphokine production in trauma patients' isolated T cells stimulated in a costimulation sufficient, antigen presenting cell independent system (anti CD3 + anti-CD4). T cells with depressed proliferation and IL-2 production simultaneously lost IL-4, IL-10, and IFN-gamma protein and mRNA responses. Exogenous IL-12 addition did not restore IFNgamma responses, but exogenous IL-2 partially restored IL-4, IFN-gamma, and IL-10 production. Although initially partially restored by exogenous IL-2 or stimulation with PMA + ionomycin, patient T cells with persisting anergy progressively lost even these lymphokine and proliferative responses. Development of global T cell anergy was not a result of lost T cell viability or protein synthesis, since it corresponded to predominance of anergic T cells with upregulated expression of CD11b, but downregulated CD28 and CD3 expression. Thus, the subset of posttrauma patients whose isolated T cells become unresponsive experienced progressively worsening global anergy, mediated not by an increased production of Th2 lymphokines, but possibly by T cell incapacity to be activated through TCR triggering or Ca(2+) mobilization.

Adult↗
PubMed1997

Only a subset of trauma patients with depressed mitogen responses have true T cell dysfunctions.

Many studies have demonstrated depressed mitogenic responses in trauma/burn patients' peripheral blood mononuclear cells (PBMC). However, data attributing the relative contribution of secreted inhibitory factors versus a true T cell dysfunction to these depressed mitogenic responses have been conflicting. We have characterized the T cell dysfunctions in posttrauma mitogen depression by simultaneously assessing patient T cell proliferation in the phytohemagglutinin-stimulated PBMC and in the purified T cell population induced with anti-CD3 + anti-CD4. Patients' samples showed three distinct patterns or progressive phases of T cell responses: (i) normal or elevated T cell proliferation in both the whole PBMC and the isolated T cell population (phase I); (ii) depressed T cell proliferation in the PBMC but normal, or even elevated, proliferation in the isolated T cell population (phase II); and (iii) depressed T cell proliferation in both the PBMC and the isolated T cell population (phase III). Patients whose T cells exhibited only a phase I response experienced no major complications with a positive clinical outcome. Patients whose T cell alterations progressed to phase II experienced infectious episodes and some complications, but all had positive clinical outcomes. In contrast, patients whose T cells progressed to phase III dysfunction had severe clinical complications (multiple organ failure), with a negative clinical outcome (80% mortality). Patients whose T cells had a phase I or phase II response pattern had no true T cell dysfunctions in the absence of monocytes. However, patients whose T cells had a true T cell dysfunction (phase III) response pattern were at high risk for mortality. Thus, a true T cell dysfunction, though occurring in only a minority of trauma patients, is predictive of clinical outcome.

Adolescent↗
PubMed1988

[Parathyroid hormone: perinatal aspects].

Authors have measured parathormone levels in 28 mothers at delivery and their respective newborns at 40-50 hours after birth. They also quantified these levels in umbilical vessels. Control groups was formed by 48 healthy non pregnant women. PTH levels in pregnant women were similar to controls. In umbilical artery these values were higher than in umbilical vein and in both, lower than other groups. Newborns at 40-50 hours after birth showed higher PTH levels than controls and pregnant women at delivery. A positive correlation between the PTH levels of the mother and those of the umbilical vessels is found. PTH levels of the neonate at 40-50 hours after birth correlated with levels of umbilical artery and umbilical vein. They do not observe a hyperparathyroidism at the delivery, although there is a slight decrease in Ca levels. Newborns at 40-50 hours after birth did show an increase in their PTH levels in parallel with hypocalcemia correlation found between PTH levels of the mother and those of the umbilical vessels could suggest a placental transfer for this hormone.

Calcium↗
PubMed1986

Ionic calcium levels during pregnancy, at delivery and in the first hours of life.

Free calcium ion concentration (mmol/l) and pH were determined in whole blood using a semiautomatic electrode system (ICA-1 Radiometer, Copenhagen, Denmark) in 37 normal women, 90 pregnant women (30 from each trimester of gestation), 28 mothers at delivery and their respective newborns. The blood samples from normal controls, pregnant women, umbilical cord and 40-50-hour-old infants were collected anaerobically in vacuum tubes. Duplicate samples drawn from newborns shortly after birth by heel puncture were collected in special heparinized capillary tubes. We observed that Ca2+ concentrations in the second (1.20 +/- 0.04) and third (1.20 +/- 0.05) trimesters of pregnancy, and at delivery (1.18 +/- 0.05), were lower than in the control group (1.23 +/- 0.04). The [Ca2+] in samples from the umbilical vein (1.44 +/- 0.11) and artery (1.45 +/- 0.08) and from newborns 2-5 min after birth (1.34 +/- 0.12) was greater than in control samples. The [Ca2+] in newborns 40-50 hours after birth was lower (1.16 +/- 0.14) than in the control group.

Adult↗
PubMedDate not supplied

Phrenic nerve palsy after topical cardiac hypothermia.

Evidence of phrenic nerve paralysis was found in 16 of 172 (9.3%) consecutive adult cardiac surgical patients who survived surgical procedures using topical cardiac hypothermia; two patients had bilateral phrenic nerve paralysis and 14 had left phrenic nerve paralysis. One or more pulmonary complications occurred in 13 of 16 patients (81.3%) with phrenic nerve paralysis while 80 of 156 (56%) had one or more pulmonary complications among patients who had no hypothermic phrenic nerve injury. Average postoperative hospital stay was 13.6 days for patients with left phrenic nerve paralysis, and 22.5 days for patients having bilateral phrenic nerve paralysis. This postoperative complication predominated in males; 15 of 16 (93.8%) of those in our series with phrenic paralysis were males, while 118 of 172 (68.6%) patients were males. Phrenic paralysis did not correlate with the length or degree of systemic hypothermia on cardiopulmonary bypass. No deaths were attributed to phrenic nerve injury. With a minimum of one year follow-up, 12 of 16 patients had return of normal diaphragmatic motion, four had residual paralysis when examined between 12 and 19 months postoperatively.

Adult↗