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Biomedical subjects

L Dominioni

Publications and source records attributed to L Dominioni.

At least 19 recordsLinked to original sources
PubMed1991

Effects of high-dose IgG on survival of surgical patients with sepsis scores of 20 or greater.

Sixty-two consecutive septic surgical patients receiving standard multimodal intensive care unit treatment who developed a sepsis score of 20 or greater (day 0) were randomized to receive 0.4 g/kg of either intravenous IgG (29 patients) or human albumin (controls; 33 patients), repeated on days +1 and +5, in a prospective, double-blind, multicenter study. The two groups were similar in age, initial sepsis scores, and acute physiology and chronic health evaluation II score. A significantly lower mortality was recorded in the IgG-treated group (38%) than in controls (67%). Septic shock was the cause of death in 7% of IgG-treated patients and in 33% of controls. The results of this study indicate that high-dose IgG improves survival and decreases death from septic shock in surgical patients with a sepsis score of 20 or greater.

Adolescent↗
PubMed1991

Stapling techniques to facilitate resection of the head of the pancreas.

Thirteen patients underwent duodenocephalopancreatectomy (DCP) with the mechanical staplers to divide the pancreatic neck and to secure haemostasis of the retroportal pancreatic lamina. The stapling techniques used on the pancreas are described. In nine patients with DCP the stapled distal pancreas was anastomosed to the jejunum with Roux-en-Y drainage; one pancreatic complication and no deaths were observed. In four other patients undergoing DCP who were at high risk for severely compromised general conditions, reconstruction of the digestive tract was simplified by leaving the stapled distal pancreas definitively closed: pancreatic complications were recorded in two cases, with no deaths. Mechanical staplers considerably facilitated resection of the neck of the pancreas and of the retroportal pancreatic lamina. All 13 patients who underwent DCP with the use of stapler techniques on the pancreas, including four high-risk patients, were discharged to convalesce on an oral diet after a median postoperative hospital stay of 23 days (range 16-90 days).

Adult↗
PubMed1987

Sepsis score and acute-phase protein response as predictors of outcome in septic surgical patients.

In a series of 135 patients with severe surgical infections, we determined the sepsis score and the plasma level of the acute-phase proteins alpha-1-acid glycoprotein, alpha 1-antitrypsin, complement factor B, and C3. The initial sepsis score was a strong determinant of survival: in survivors it was significantly lower than in nonsurvivors. Only 8% of patients with a sepsis score above 20 survived. At the onset of severe sepsis, the plasma levels of all four acute-phase proteins were significantly lower in nonsurvivors. A significant elevation of C3a levels in the plasma of both surviving and nonsurviving patients indicated marked consumption of complement components in all patients with severe sepsis. A linear equation was developed to predict survival: sepsis index of survival (SIS) % = 121 + 0.26 (complement factor B) + 0.36 (alpha-1-acid glycoprotein)-6 (sepsis score). Based on our analysis, at the onset of severe sepsis, an SIS of 50% or more can correctly predict 88% of survivors and an SIS less than 50% can correctly predict 86% of nonsurvivors several days in advance of clinical outcome.

Adult↗
PubMed1986

Effect of a diet rich in branched chain amino acids on severely burned guinea pigs.

This study was performed to investigate the effects of dietary supplementation with branched-chain amino acids (BCAA) for postburn nutritional management. Seventy-one burned guinea pigs (30% TBSA) with previously placed catheter gastrostomies were divided into six groups. The first, second, and third groups received 10%, 20%, and 30%, respectively, of total calories as whey protein. The other three groups received BCAA supplementation to increase BCAA to 50% of total amino acids, compared to 21.5% BCAA content in whey protein. Groups I and IV received isonitrogenous intake, as did groups II and V, and III and VI, respectively. After an initial 3-day adaptation period, all animals in all groups received continuous isocaloric (175 kcal/kg/day) intragastric tube feeding until postburn day (PBD) 14. At PBD 14, although BCAA-supplemented groups showed very high plasma levels of BCAA (IV: 169%; V: 306%; VI: 770% of normal), no BCAA group showed evidence of any beneficial effect in various nutritional parameters when compared with the corresponding whey protein group with isonitrogenous intake. Cumulative nitrogen balance and mortality during 14 days were significantly worse in BCAA groups IV and VI than in control groups I and III, respectively. It is concluded that BCAA supplementation to enteral diets has no beneficial effect for postburn nutritional management following severe burn injury. It is further suggested that when nitrogen intake is too low or very high, BCAA supplementation may have an adverse effect.

Amino Acids, Branched-Chain↗
PubMed1986

Diagnosing malnutrition.

The measurement of selected anthropometric, biochemical and immunological variables, and clinical judgment can be used to assess nutritional state. Nutritional assessment has three main aims: to define the type and severity of malnutrition; to identify high risk patients; to monitor the efficacy of nutritional support. The problems associated with the various methods to assess the nutritional state and the applications of nutritional assessment in clinical practice are presented and discussed.

Humans↗
PubMed1986

Predictive indices for the identification of high-risk patients.

In this article, the predictive indices which have been developed during the last decade to assess the risk of complications during hospitalization are reviewed. These indices are based on the evaluation of nutritional and immunological parameters and are particularly suitable for the identification of the surgical patient at risk for postoperative septic complications. The authors also review the methods which have been proposed for the classification of the severity of disease in critically ill subjects and the sepsis score method for the prediction of clinical outcome in severely septic surgical patients.

Health Status Indicators↗
PubMed1985

Sepsis score and complement factor B for monitoring severely septic surgical patients and for predicting their survival.

Sepsis score and complement factor B (FB) have been measured in 66 severely septic surgical patients in the intensive care unit, with the aim of monitoring their clinical course and predicting their outcome. Sepsis score correlated well with clinical course. 82% of patients with initial sepsis score less than 20 progressively improved and survived. Only 6% of patients with sepsis score greater than or equal to 20 survived. FB plasma level was significantly higher (p less than 0.01) in patients who subsequently survived. Two indices were identified which could predict patient outcome several days in advance with 100% accuracy: (1) the index of survival from sepsis defined as the combination of sepsis score less than 20 and FB greater than or equal to 45 mg/dl, and (2) the index of death from sepsis defined as sepsis score greater than or equal to 20 and FB less than 40 mg/dl.

Adolescent↗
PubMed1978

Postoperative immunologic monitoring of cancer patients undergoing radical surgery.

Immunologic parameters of cellular immunity in vitro and circulating immunoglobulin levels were evaluated before and after radical surgery in twenty-five patients with localized primary solid tumors. Peripheral blood lymphocyte counts, T-lymphocyte counts and lymphocyte blastogenesis after optimal stimulation with phytohemagglutinin were found significantly depressed at the time of diagnosis. Sequential determinations of immunologic parameters during the postoperative period showed a slight fall of lymphocyte counts and T-lymphocyte counts; subsequently these cell counts progressively returned to preoperative values. The blastogenic response of lymphocytes sharply decreased following surgery and then slowly returned to preoperative levels in one month. No significant alterations of circulating immunoglobulins were detected at diagnosis or during the postoperative period. These findings indicate that patients with localized tumors present impairment of some parameters of cellular immunity preoperatively and that postoperative immunodepression lasts about one month.

Adult↗
PubMed1977

The effects of total parenteral nutrition on immunodepression due to malnutrition.

An experimental study was performed in 16 dogs to investigate the effects of sub-acute malnutrition on humoral and cellular immunity and phagocytic functions and, subsequently, to investigate the ability of total parenteral nutrition (TPN) to restore abnormal immunological variables. Deficiencies of IgG, C3, primary immune response to sheep red blood cells (SRBC),lymphocyte counts, lymphocyte response to phytohemagglutinin (PHA), and neutrophi chemotaxis were found to be caused by malnutrition. Nutritional repletion by means of TPN resulted in a return to normal or supranormal serum concentrations of IgG, IgM, and C3, and the primary immune response to SRVC was prompter and higher. Moreover, TPN resulted in restoration of normal neutrophil chemotactic responses. TPN did not improve lymphocyte response to PHA in these experiments. The study demonstrates that subacute malnutrition results in broad based deficiencies of the immunological response of the type that predispose to infection and that the proper use of TPN can correct most of these abnormalities.

Animals↗
PubMed1976

Histopathological studies on dog lymphoid structures during malnutrition and total parenteral nutrition.

Lymphoid tissues of six malnourished dogs were histologically evaluated and compared to the same lymphoid structures of dogs nutritionally repleted by means of total parenteral nutrition (TPN). The results show that thymus, spleen, lymph nodes and Peyer's patches are markedly atrophic and severely cell depleted in malnourished dogs, and provide evidence that subsequent TPN therapy stimulates and supports lymphoid cell prolipheration, leading to cell repopulation of previously depleted lymphoid structures.

Animals↗
PubMedDate not supplied

Proposed definitions for diagnosis, severity scoring, stratification, and outcome for trials on intraabdominal infection. Joint Working Party of SIS North America and Europe.

Analysis of the experience with scientific studies on patients with secondary intraabdominal infection has revealed that problems of interpretation and comparability between studies exist as they relate to variable diagnostic criteria, unmeasured severity of disease, and unclear outcome measures. A consistent system of definitions has been developed to address these deficiencies. Intraabdominal infection is defined as clinical peritonitis requiring both operative and microbiological confirmation for proof of infection. The APACHE II system is proposed for grading the severity of the infection and for stratification of patient risk of mortality. Mortality and time until death, on one hand, and recovery and time until recovery, on the other, are proposed as the main outcome measures, both being independently and positively defined. It is anticipated that this system of minimum rules will produce studies that can be compared, hence, accelerating knowledge and understanding about intraabdominal infection and its best treatment.

Abscess↗