PubMed Health⌕ Search

Biomedical subjects

L Boselli

Publications and source records attributed to L Boselli.

At least 19 recordsLinked to original sources
PubMed2003

Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000.

A one-day survey was carried out in 88 out of 113 public hospitals in Lombardy to obtain prevalence rates of hospital-acquired infections (HAIs) by hospital departments and to identify the pathogens more frequently involved. In total 18667 patients were surveyed, representing 72% of the average daily total of occupied beds in public hospitals in Lombardy. The overall prevalence of HAI was 4.9%. The highest prevalence was observed in intensive care units and in spinal units. The prevalence of bloodstream infections was 0.6%; pneumonia 1.1%; urinary tract infections 1.6% and gastrointestinal infections 0.4%. In surgical patients the prevalence of surgical site infections was 2.7%. The most frequently isolated pathogen from all sites of infections was Escherichia coli (16.8%), followed by Staphylococcus aureus (15.0%), Pseudomonas aeruginosa (13.2%) and Candida spp. (8.7%). Methicillin-resistant S. aureus accounted for 23% of all isolated S. aureus. The results provide baseline data for rational priorities in allocation of resources, for further studies and for infection control activities.

Candidiasis↗
PubMed1999

Altered blood pressure variability in patients with congestive heart failure.

OBJECTIVE: Congestive heart failure (CHF) is characterized by sympathetic overactivity but reduced variability of heart interval and sympathetic nerve activity; little information exists, however, about the alterations in blood pressure variability in this syndrome, especially during excitatory manoeuvres such as tilting or exercise. DESIGN AND METHODS: Nine patients with CHF (age 62+/-1 years, NYHA class II-III, ejection fraction 33+/-1%, peak VO2 14.1+/-3.2 ml/min per kg body weight [mean +/- SEM]) and eight healthy control subjects (age 58+/-1 years) with normal left ventricular function were studied. Blood pressure (Finapres), R-R interval (ECG) and respiration (nasal thermistor) were recorded during 15-min periods of supine rest, 70 degree head-up tilting, submaximal bicycling exercise and post-exercise recovery. Total variance and the power of the spectral components of blood pressure (HF, respiratory-related; LF, 0.03-0.14 Hz; and VLF, 0.02-0.003 Hz) were measured. RESULTS: Compared with control subjects, CHF patients have, first, a normal overall blood pressure variability during supine rest but a failure to increase this variability in response to head-up tilt and exercise; second, a suppressed LF spectral component of blood pressure at rest and in response to head-up tilt and exercise; and third, reappearance of LF blood pressure power during postexercise recovery. CONCLUSIONS: In CHF patients, overall blood pressure variability and its LF spectral component are altered at rest and during sympathoexcitatory manoeuvres. Somewhat paradoxically, however, the depressed LF blood pressure power is partially restored during a 15-min recovery period, indicating that at least part of the CHF-related alterations of blood pressure variability have the potential to revert back towards normal under appropriate physiological circumstances.

Bicycling↗
PubMed1998

[Anesthesia in early surgery and endovascular therapy for aneurysmic subarachnoid hemorrhage].

Early surgery after SAH is frequently performed. The most important problems for anesthesiologists are the risk of rebleeding, the alteration of autoregulation and CO2 responsiveness, cardiac, respiratory and electrolytic alterations. In this phase the brain may be ischemic-edematous or haemorrhagic-compressive and the choice of anesthetic agent is made on the basis of cerebral conditions. The main goal is to control ICP and maintain adequate CPP. The endovascular treatment with Guglielmi detachable coils is usually performed in patients with poor neurologic and/or medical conditions. General anaesthesia under aggressive monitoring is advisable to control systemic pressure and to avoid movements.

Anesthesia↗
PubMed1998

Prevention and treatment of vasospasm.

Cerebral vasospasm is a frequent and severe complication of SAH. Angiographic vasospasm may be seen in 70% of patients and delayed cerebral ischemic deficits are observed in 30% of patients. Since vasodilator drugs cannot reverse cerebral vasospasm, treatment is directed to prevent vasospasm and to prevent or reverse ischemic deficits. The mainstay of treatment of vasospasm is the hypertensive hypervolemia dilution (triple H therapy); the mainstay of prevention is the calcium channel blocker nimodipine. The efficacy of triple H therapy has not been demonstrated in randomized clinical trials, while several randomized trials have demonstrated that nimodipine reduces poor outcome due to vasospasm in all grades of patients. Some randomized, clinical trials are recently performed on the efficacy of rTPA (on the basis of the correlation between the amount of cisternal blood and the incidence and severity of vasospasm) and of tirilazed (on the basis of the role of lipidic peroxidation and free radical generation in the pathogenesis of spasm). Balloon angioplasty and/or super-selective intra-arterial infusion of papaverine can be considered when patient is refractory to medical and pharmacological treatment.

Calcium Channel Blockers↗
PubMed1998

Contribution of the neuro-intensivist in the choice of treatment of patients with aneurysm.

During the last years embolization with Guglielmi detachable coils has provided a new alternative of treatment of intracranial aneurysms. Neuroanesthesiologists and neurointensivists have an important role in the selection of the patients to traditional surgical treatment or endovascular treatment. This selection must be a team decision on the basis of the patient's conditions. The main contribution of neuroanesthesiologists is to evaluate the patient's medical and neurologic conditions and to prospect the anesthesiological problems in each technique, especially when the patient is treated in acute phase after SAH.

Anesthesiology↗
PubMed1996

EGF stimulates lamellipod extension in metastatic mammary adenocarcinoma cells by an actin-dependent mechanism.

Changes in lamellipod extension and chemotaxis in response to EGF were analysed for MTLn3 cells (a metastatic cell line derived from the 13762NF rat mammary adenocarcinoma). Addition of EGF produced a cessation of ruffling followed by extension of hyaline lamellipods containing increased amounts of F-actin at the growing edge. A non-metastatic cell line (MTC) derived from the same tumor did not show such responses. Lamellipod extension was maximal within 5 min, followed by retraction and resumption of ruffling. Maximal area increases due to lamellipod extension occurred at about 5 nM EGF. Chemotactic and chemokinetic responses, measured using a microchemotaxis chamber, were also greatest at 5 nM. Cytochalasin D inhibited EGF-stimulated responses including lamellipod extension, increases in F-actin in lamellipods, and chemotaxis. Nocodazole affected chemotaxis at higher concentrations but not EGF-induced lamellipod extension. We conclude that polymerization of F-actin at the leading edges of lamellipods is necessary for extension of lamellipods and chemotaxis of MTLn3 cells in response to EGF. The motility and chemotaxis responses of this metastatic cell line have strong similarities to those seen in well-characterized chemotactic cells such as Dictyostelium and neutrophils.

Actins↗
PubMed1996

Peri-operative prophylaxis with phenytoin: dosage and therapeutic plasma levels.

Early postoperative epilepsy is a frequent complication of supratentorial intracranial surgery. The lack of consensus on prophylaxis of early postoperative seizures with phenytoin (PHT) may be due to the different dosages used in several studies, owing to inadequate therapeutic plasma level. The aim of this study was to evaluate which dosage of PHT can maintain the therapeutic range in the early postoperative period. Twenty patients operated on for supratentorial neoplasms were randomly allocated to receive, during the last hour of the surgical procedure, loading doses of either 10 mg/kg (group A, n = 10) or 15 mg/kg (group B, n = 10) of PHT. PHT infusion rate never exceeded 30 mg/min. Six hours after the loading dose, PHT maintenance treatment (250 mg, i.v., every 8 hours) was started in all patients. PHT plasma levels were evaluated from the end of the intra-operative loading infusion up to 24 h. During the first six hours after the loading dose, phenytoin plasma levels fell below the therapeutic range (10-20 mg/l) in 7 out of the 10 patients receiving 10 mg/kg, while in the patients treated with 15 mg/kg, PHT plasma levels were always in the therapeutic range (P < or = 0.0001). PHT maintenance dose was sufficient to keep plasma levels within the therapeutic range in 8 patients in group A, and in all the patients in group B. It is concluded that a loading dose of 15 mg/kg, followed by postoperative treatment, is necessary to guarantee therapeutic plasma levels of phenytoin in the immediate postoperative period, when seizure risk is very high.

Adult↗
PubMed1996

Propofol anaesthesia in spontaneously breathing paediatric patients during magnetic resonance imaging.

BACKGROUND: The aim of this study was to evaluate the use of propofol to induce and maintain anaesthesia in spontaneously breathing paediatric patients (age 2 weeks-11 years) during Magnetic Resonance Imaging (MRI) of the CNS. METHODS: All patients were spontaneously breathing, without intubation, and received supplemental O2. Pulse rate, blood pressure (BP), electrocardiogram and EtCO2 were recorded in all patients, and in 38 subjects SpO2 was also monitored. Patients were divided in 2 groups according to their body weights: Group A (n = 34, bwt < or = 10 kg), and Group B (n = 48, bwt > 10 kg). RESULTS: Dosage of propofol during the time of induction (from insertion of the i.v. cannula to positioning on the MRI table) was significantly higher in smaller children (Group A; 5.4 +/- 2.2 (SD) mg/kg) as compared to children with bwt above 10 kg (Group B; 3.7 +/- 1.6 mg/kg). Propofol dosage for maintenance of anaesthesia was significantly higher in smaller children (Group A: 10.1 +/- 5.7 vs Group B: 7.1 +/- 3.0 mgkg-1 h-1, P = 0.003). During the time of induction, transient episodes of reduced BP (< or = 20%) occurred in 6 patients in Group A and 2 patients in Group B. During anaesthesia in Group B there was 1 episode of oxygen desaturation (95%), and 3 episodes of short and mild increases of EtCO2(< or = 52 mmHg). No other side effects occurred in any patient. MRI studies were successfully completed, only 3 sequences (Group A) had to be restarted. CONCLUSION: Propofol can be safely used for total intravenous anaesthesia in children undergoing MRI.

Anesthesia Recovery Period↗
PubMed1995

Cardiac and carotid structure in arterial hypertension and in hypertrophic cardiomyopathy.

The aim of this study was to measure intima-media thickness (IMT) of the common carotid artery (CCA) in patients with hypertrophic cardiomyopathy (HCM) and in hypertensive patients with left ventricular hypertrophy (LVH). We studied 73 subjects: 20 normotensive healthy subjects as control group (I); 20 patients with essential hypertension without LVH (II); 20 hypertensives with LVH (III), and 13 normotensive patients with HCM (IV). Each subject underwent a complete echocardiographic and vascular ultrasonographic study in order to assess left ventricular parameters and the IMT at the level of the CCA. Left ventricular mass index (LVMI) was significantly higher in groups III and IV than in groups I and II (156 +/- 18 and 157 +/- 31 vs. 94 +/- 14 and 98 +/- 10 g/m2, respectively, p < 0.01), while IMT was significantly greater in group III but not in the others [0.88 +/- 0.04 vs. 0.61 +/- 0.03 (I), 0.64 +/- 0.03 (II) and 0.61 +/- 0.04 (IV) mm, p < 0.01]. The correlation between LVMI and IMT was statistically significant within all the hypertensive patients (r = 0.48, p < 0.01) but not in the HCM group (r = 0.17, p = NS). The hypertensive patients with LVH showed structural alterations (related to hemodynamic and humoral factors) both at cardiac and vascular level while in patients with HCM the cardiac alterations (due to a genetic disorder) were not associated with changes at the level of the large arteries.

Adult↗
PubMed1994

Nicotinamide methylation in patients with cirrhosis.

Methylation reactions play an important role in the transformation of endogenous and exogenous substances. Up to 85% of all transmethylation reactions occur in the liver. Several studies have shown that these metabolic processes are greatly influenced by the presence of hepatic diseases. We investigated the methylation of nicotinamide in 16 control subjects and in 29 patients with cirrhosis (19 Child A, 10 Child B). The basal serum value of N-methyl-nicotinamide was measured in all subjects. In seven controls and in nine patients with cirrhosis (5 Child A and 4 Child B), the serum levels and urinary excretion (5 and 24 h) of N-methyl-nicotinamide were also evaluated after oral administration of nicotinamide (1.5 mg/kg body weight). The basal serum levels of N-methyl-nicotinamide were significantly (p < 0.05) higher in patients with cirrhosis (Child A: median 34 ng/ml, 16th percentile 24, 84th percentile 61; Child B median 45, 16th percentile 34, 84th percentile 81) than in controls (median 22, 16th percentile 13, 85th percentile 28). After the nicotinamide load the urinary excretion and the time course of serum N-methyl-nicotinamide in cirrhosis were also higher (p < 0.05) than in controls (24 h urinary excretion = 66.2 mg +/- 5 S.D. in cirrhosis; 47.2 +/- 10.3 in controls) (area under the serum concentration versus time curve = 68 micrograms.ml-1.min-1 +/- 22 S.D. in cirrhosis; 32 +/- 15 in controls). In conclusion, our results show that cirrhosis does not impair the efficiency of nicotinamide methylation.

Female↗
PubMed1993

Ultrasonographic evaluation of cardiac and vascular changes in young borderline hypertensives.

We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 20 borderline hypertensives (age 24 +/- 4 years) and in 20 normotensive subjects (age 23 +/- 6 years), as a control group. Both carotid axes have been scanned from different views on a transversal and longitudinal section. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. In borderline patients blood pressure (147.8 +/- 10.5/90.7 +/- 6.6 mm Hg) and left ventricular mass index (102.5 +/- 15.3 g/m2) were significantly higher than in normotensive subjects (blood pressure 120.5 +/- 11.5/78.0 +/- 5.4 mm Hg; left ventricular mass 90.5 +/- 14.3 g/m2, p < 0.01 and p < 0.05 respectively). The intima-media thickness of both the CCA and BIF was significantly higher in borderline hypertensives than in normotensives (CCA 0.6 +/- 0.08 vs. 0.4 +/- 0.05 mm, p < 0.01; BIF 0.7 +/- 0.08 vs. 0.5 +/- 0.08, p < 0.01). In the whole population there was a statistically significant correlation between the carotid wall thickness and the left ventricular mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Cardiac and vascular hypertrophy in juvenile borderline hypertension: echocardiographic and ultrasonographic study].

BACKGROUND: High resolution ultrasonography is a noninvasive technique that allows us to investigate the cardiovascular system, in particular the wall thickness and the lumen diameter of the arteries, with accuracy and reproducibility. METHODS: We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 20 borderline hypertensive (age 24 +/- 4 years) and in 20 normotensive subjects (age 24 +/- 4 years), as a control group. Both carotid axes were scanned from different views (anterior, lateral, posterior) on a transversal and longitudinal section using a high resolution steerable linear array of 5 MHz. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. RESULTS: In borderline patients blood pressure (147.8 +/- 10.5/90.7 +/- 6.6 mmHg) and left ventricular mass index (102.5 +/- 15.3 g/m2) were significantly higher than in normotensive subjects (blood pressure 120.5 +/- 11.5/78.0 +/- 5.4 mm Hg; left ventricular mass 90.5 +/- 14.3 g/m2). The intima-media thickness of both the CCA and BIF was significantly higher in borderlines than in normotensives (CCA 0.6 +/- 0.08 vs 0.4 +/- 0.05 mm, p < 0.001; BIF 0.7 +/- 0.08 vs 0.5 +/- 0.08, p < 0.001). In the whole population there was a statistically significant correlation between the carotid wall thickness and the left ventricular mass. CONCLUSIONS: Our data show that ultrasonography provides direct evidence that in young borderline hypertensives the increased left ventricular mass is associated with vascular hypertrophy.

Adult↗