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Biomedical subjects

L Bertini

Publications and source records attributed to L Bertini.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Continuous brachial plexus blockade for shoulder surgery].

Continuous brachial plexus block is the technique of choice for postoperative shoulder pain treatment. The localization of the plexus is usually obtained drawing landmarks on the skin and using the electrical nerve stimulator; these and other different modalities are applied in order to reach safely and precisely nerve roots to be blocked with an anaesthetic solution. The Author presents a new anatomical perspective to guide the localization of the brachial plexus. It is shown how it is possible to detect the pathway of the brachial plexus from the cutaneous surface, linking between each other various landmarks: a) the apex of the scalene triangle, at the cross of a line leaving from the cricoid process and directed posterior to the posterior border of the sternocleidomastoid muscle, b) the midline of the clavicle c)the deltoid-pectoral sulcus d) the midpoint between the coracoid process and the chest profile e) the pulsation of the artery in the axylla. Following the guide of the so formed anesthetic line, is possible to place the needle, with a direction from distal to proximal, in a tangential route towards the interscalenic groove, thus allowing to perform a block of the plexus in a simple and efficacious way.

Brachial Plexus↗
PubMed2001

[Peripheral blocks for the lower limb: lumbar plexus].

BACKGROUND: The techniques of continuous peripheral blockades have shown to be efficient in postoperative pain control, in the various orthopaedic procedures of the limbs. The aim of this study is to evaluate the existing data about the use of a continuous blockade of the lumbar plexus or femoral nerve, together with the indications for technique and therapy. METHODS: We considered the principal results of prospective, randomised studies described in literature about the assessment of a continuous peripheral blockade of the lumbar plexus or the femoral nerve in limb surgery. Furthermore we described the principal techniques for positioning the perinerval catheters in the considered sites, and the advised dosage regimen. RESULTS: The various studies report an adequate costs/benefits relation concerning the used techniques. The analysed studies not only report an adequate efficacy of the postoperative pain control, but often show an important benefit in terms of functional recovery of the operated limbs and on final outcome of the patient. CONCLUSIONS: The use of continuous blockades of the lumbar plexus or femoral nerve shows to be an important and effective instrument not only in terms of positive effects on postoperative pain control, but also in terms of relevant advantages concerning final outcome after surgery. Nevertheless these techniques should not be considered as the only approach to postoperative pain in the orthopaedic patient, but have to be included in a global, multidisciplinary and multimodal approach.

Humans↗
PubMed2001

Continuous peripheral block in foot surgery.

Peripheral neural blockade techniques are commonly used procedures to provide perioperative anesthesia and analgesia. Several continuous infusion catheter techniques have been described to extend the use of peripheral neural blockade into the postoperative period as an effective method of providing pain management. The analgesic benefit of continuous local anesthetic peripheral block in the management of postoperative pain is primarily related to the properties of providing intense analgesia thereby reducing perioperative opioid requirements and opioid-related side effects and promoting early recovery of postoperative activity. Continuous peripheral nerve blockade seems to be effective in allowing major foot and ankle surgery to be done particularly on an outpatient basis with greater pain relief. The sciatic nerve is the largest nerve in the body and it lies deep in the posterior thigh. According to its anatomy, the sciatic nerve can then be reached at different levels from the parasacral space to the popliteal fossa, ideally identifying a sciatic line running from the inferior border of the gluteus maximus muscle between the greater throcanter and the ischiatic tuberosity to the popliteal fossa. A variety of continuous peripheral blocks have been described in this paper including continuous sciatic block at several levels (para-sacral nerve block, subgluteal sciatic nerve block) and popliteal nerve block.

Foot↗
PubMed2001

Pain free hospital: organisation aspects.

The rational approach to acute pain management is to use the highest quality evidence available. Acute pain management is more than a collection of interventions. It is a package of care that needs to be examined as a whole as well as in its parts. In the context of acute pain management, this comes from systematic reviews of valid randomised trials. We still have to adapt to the circumstances of the individual, but our policies will be more discerning. Acute pain is not confined to postoperative wards but it is a problem in many clinical settings. Educational programs for allied health professionals are equally important because they play the key role in the management of acute pain. Accreditation and educational programs in individual institutions would enable the nurses to identify their learning needs, to acquire appropriate knowledge and skills to ensure that they are adequately prepared for the responsibilities involved in pain management. The key of successful pain management is education, not new drugs or high-tech delivery systems. Existing tools can do the job if doctors and nurses are educated, both to dispel the myths and misconceptions and to take responsibility for providing pain control. It is much easier to dispel myths when you have the evidence. In 1846, the first anaesthetic provided pain-free surgery - 150 years later patients should not have to endure unrelieved pain anywhere in the hospital.

Evidence-Based Medicine↗
PubMed2001

[Technical difficulties in epidural blocks and spinal bleeding complications].

The clinical cases of two patients with neurological complications following neuroaxial blocks are reported. The events took place in different institutions where thousands of central blocks were yearly performed. In both instances the blocking procedures presented technical difficulties needing repeated lumbar punctures. The first case concerns a patient receiving anticoagulant and fibrinolytic therapy for vascular pathology. This 89 year-old female experienced severe cord compression requiring surgical decompression and laminectomy. The second case regards a patient with previous minor surgical procedure requiring postoperative antiinflammatory treatment. This 74 year-old male experienced subarachnoid hemorrhage and spinal/epidural hematoma as shown by NMR. The symptoms regressed with steroid therapy. The authors emphasise the risks of mechanical trauma of epidural or spinal anesthesia both during positioning or removal of an epidural catheter. The problem related to the compatibility between central blocks and antithrombotic/anticoagulant prophylaxis/therapy is now of primary concern and has led to publications about guide lines on this topic. If central block is carried out in patients with bleeding diathesis it is mandatory to co-ordinate multidisciplinary assistance for early detection of significant symptoms of the above described complications and subsequent treatment.

Aged↗
PubMed2000

Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Italian Study Group on Unilateral Spinal Anesthesia.

PURPOSE: To compare unilateral and conventional bilateral bupivacaine spinal block in outpatients undergoing knee arthroscopy. METHODS: One hundred healthy, premedicated patients randomly received conventional bilateral (n = 50) or unilateral (n = 50) spinal anesthesia with 8 mg hyperbaric bupivacaine 0.5%. A lateral decubitus position after spinal injection was maintained in unilateral group for 15 min. Times from spinal injection to readiness for surgery, block resolution, and home discharge were recorded. RESULTS: Three patients in each group were excluded due to failed block. Readiness for surgery required 13 min (5 - 25 min) with bilateral and 16 min (15 - 30) with unilateral spinal block (P = 0.0005). Sensory and motor blocks on the operated limb were T9 (T12 - T2) with a Bromage score 0/1/2/3: 0/2/0/45 in the unilateral group and T7 (T12 - T1) with Bromage score 0/1/2/3: 4/1/6/36 with bilateral block(P = 0.026 and P = 0.016, respectively). Vasopressor was required only in five bilateral patients (P = 0.02). Two segment regression of sensory level and home discharge required 81+/-25 min and 281+/-83 min with bilateral block, and 99+/-28 min and 264+/-95 min with unilateral block (P = 0.002 and P = 0.90, respectively). CONCLUSION: Seeking unilateral distribution of spinal anesthesia provided more profound and longer lasting block in the operated limb, less cardiovascular effects, and similar home discharge compared with bilateral spinal anesthesia, with only a slight delay in preparation time.

Adult↗
PubMed1999

Probing the modelled structure of wheatwin1 by controlled proteolysis and sequence analysis of unfractionated digestion mixtures.

We set up a method to get rapid information on the three-dimensional structure of peptide and proteins of known sequence. Both native and alkylated polypeptide is hydrolyzed with a number of proteases at different digestion times and the resulting mixtures are compared by HPLC analysis to establish the differences in the hydrolysis pathways of the folded and unfolded molecule. Then, the unfractionated digestion mixtures of the native polypeptide are submitted to automatic sequence analysis to identify the hydrolysis sites. The sequence of each fragment present in the mixtures is reconstructed and its amount determined by quantitative data of the sequence analyses. We used this approach to determine the amino acid surface accessibility of wheatwin1, a pathogenesis-related protein from wheat, and constructed a predictive three-dimensional model based on the knowledge of the tertiary structure of barwin, a highly homologous protein from barley. The procedure allowed us to quickly identify and quantify the hydrolysis at the susceptible bonds which could be classified as exposed, partially hidden, or inaccessible. The results were useful to evidentiate and discuss concordances and differences between experimental and model predicted accessibilities of amino acid residues. Proteins 1999;36:192-204.

Alkylation↗
PubMed1999

A new pair of primers designed for amplification of the ITS region in Tuber species.

The alignment of the 28S gene of several species of Pezizales allowed to select two pairs of primers able to amplify the internal transcribed spacer region of ribosomal DNA in mycorrhizal fungi, such as truffles. The higher yield of the amplification product demonstrates a better annealing of the new primers to the rDNA, as compared to the universal primers internal transcribed spacer 1 and internal transcribed spacer 4. Therefore, the new primers can be used as an easier and more sensitive tool for the identification of truffle species in any stage of their life cycle, including the mycorrhizal phase.

Ascomycota↗
PubMed1999

Isolation and characterisation of wheat cDNA clones encoding PR4 proteins.

Two cDNA clones encoding the previously characterised PR4 proteins wheatwin 1 and wheatwin2 from wheat (Triticum aestivum cv. S. Pastore) have been identified and named wPR4a and wPR4b, respectively. The clones have been isolated by screening a cDNA library with a specific cDNA probe obtained by RT-PCR. The wPR4a and wPR4b cDNAs contain open reading frames of 441 and 447 bp that encode for wheatwin1 and wheatwin2, respectively.

Amino Acid Sequence↗
PubMed1998

Restriction fragment length polymorphism species-specific patterns in the identification of white truffles.

A molecular method for the identification of ectomycorrhizae belonging to five species of white truffle is described. The polymerase chain reaction (PCR) and universal primers were used to amplify internal transcribed spacers and 5.8S rDNA, target sequences present in a high number of copies. The amplified products were digested with restriction enzymes in order to detect interspecific polymorphisms. Species-specific restriction fragment length polymorphism patterns were determined for all five species. The use of PCR in conjunction with restriction enzymes provides a sensitive and efficient tool for use in distinguishing ectomycorrhizal species and monitoring inoculated seedlings or field mycorrhizal populations.

Ascomycota↗
PubMed1996

Structural and antifungal properties of a pathogenesis-related protein from wheat kernel.

We have purified and characterized a protein from the water-soluble fraction of wheat kernel (Triticum aestivum cv. S. Pastore) consisting of a single polypeptide chain blocked at its N-terminus by a pyroglutamate residue; the complete amino acid sequence has been determined by automated sequence analysis performed on peptide fragments obtained by enzymatic hydrolyses of the protein. Homology studies have shown that this protein is very similar (97% sequence identity) to the previously characterized wheatwin1 as well as to other members of the pathogenesis-related (PR) proteins of class 4; in analogy with wheatwin1, we have termed this protein wheatwin2. Both wheatwin1 and wheatwin2 have specific antifugal activity toward the wide-host-range pathogen Botrytis cinerea and the wheat-specific pathogenic fungi of wheat Fusarium culmorum and Fusarium graminearum of groups 1 and 2. On the basis of their structural and functional properties, wheatwin1 and wheatwin2 can be classified as members of the PR4 protein family; this represents the first report concerning the presence of this kind of protein in wheat.

Amino Acid Sequence↗
PubMedDate not supplied

Unusually prolonged duration of spinal anesthesia following 2% mepivacaine.

BACKGROUND AND OBJECTIVES: Spinal mepivacaine has been reported as a reliable anesthetic for ambulatory anesthesia. Its pharmacologic properties are midway between those of bupivacaine and lidocaine, and it can be used in intermediate duration ambulatory surgical procedures. METHODS: A patient taking clonidine transdermal patches (TTS) to control high blood pressure received spinal mepivacaine for surgical repair of a ruptured meniscus with arthroscopy. RESULTS: The resulting duration of sensory and motor block were 12 and 8.5 hours, respectively. These are more than four times as long as the reported mean durations with this spinal local anesthetic. We hypothesized that the use of clonidine via TTS for the previous 16 months contributed to this unusual delay of recovery from spinal anesthesia. CONCLUSIONS: Clonidine can increase the duration of spinal anesthetics. Even though this well-known effect has been considered mostly beneficial, it can be an adverse effect when spinal ambulatory anesthesia is given to patients receiving clonidine TTS or clonidine in other forms for long-term treatment of hypertension or other diseases.

Administration, Cutaneous↗
PubMedDate not supplied

0.75% and 0.5% ropivacaine for axillary brachial plexus block: a clinical comparison with 0.5% bupivacaine.

BACKGROUND AND OBJECTIVES: Although ropivacaine has been extensively studied for epidural anesthesia, very few reports exist on brachial plexus block. We therefore decided to investigate the clinical features of axillary brachial plexus anesthesia with two different concentrations of ropivacaine (0.5% and 0.75%) and to compare the results with those obtained with 0.5% bupivacaine. METHODS: Three groups of patients were randomized and prospectively studied. They received, in a double-blind fashion, 32 mL of the local anesthetic solution into the midaxilla, by a nerve-stimulator technique. Onset time in each of the stimulated nerves was recorded both for the sensory and motor block. Peak time (ready to surgery), rate of supplemental blocks, need for intraoperative opioids, duration of sensory and motor block, postoperative analgesic requirements, and patient satisfaction were also recorded. RESULTS: The rate of complete sensory and motor block observed with both ropivacaine groups was higher at 10, 15, and 20 minutes postinjection (P < .001). The mean peak time was shorter with ropivacaine than with bupivacaine (R50 = 16.37 minutes, R75 = 14.7 minutes, B = 22.3 minutes, P < .05). The quality of the anesthesia was higher with ropivacaine, as measured by the intraoperative needs for opioids and the overall patient's satisfaction (P < .05). No significant differences were noted with all the other studied parameters. CONCLUSION: Ropivacaine showed advantages over bupivacaine for axillary brachial plexus block. Because no statistical differences were found between the two ropivacaine groups, we therefore conclude that 0.75% does not add benefit and that 0.5% ropivacaine should be used to perform axillary brachial plexus blocks.

Adolescent↗
PubMedDate not supplied

[Retinal vein occlusions: diseases for the internist?].

Retinal vein occlusion is a relatively common disease, usually associated with the presence of diseases related to internal medicine. Central retinal vein occlusion is the most frequently-occurring and clinically relevant type. In addition to the well-known classic risk factors, new hemostasis-related ones have been investigated in patients affected by central retinal vein occlusion. While data concerning a number of parameters remain contradictory, high levels of type 1 plasminogen activator inhibitor (PAI-1) and lipoprotein(a) and hyper-homocystinemia appear to play a significant role in the pathogenesis of this disease. Although based on a limited number of studies, this new knowledge could eventually provide important indications regarding prognosis and therapeutic strategies.

Hemostasis↗
PubMedDate not supplied

Activated protein C resistance is a risk factor for central retinal vein occlusion.

Central retinal vein occlusion is one of the most common retinal vascular disorders. Few and contrasting data are available on the prevalence of hemostatic risk factors in patients with central retinal vein occlusion. The aim of this study was to investigate the most common hemostasis-related inherited risk factors for venous thrombosis in a group of 53 central retinal vein occlusion patients (median age 59 years, range 18-77 years) and in 53 comparable control subjects (median age 57 years, range 22-84 years). No difference was found in antithrombin III, protein C and protein S plasma levels between patients and controls. At univariate analysis, activated protein C resistance (odds ratio 5.8) and factor V Leiden (odds ratio 4.4) were significantly associated with central retinal vein occlusion whereas G20210A polymorphism of the prothrombin gene was not. After adjustment for sex, age, and the other classic vascular risk factors (hypertension, diabetes, hypercholesterolemia, smoking) activated protein C resistance remained the only independent risk factor for central retinal vein occlusion (odds ratio 11.5). These data indicate that activated protein C resistance may play a role in the pathophysiology of central retinal vein occlusion.

Activated Protein C Resistance↗