Biomedical subjects
Publications and source records attributed to M Rocco.
A patient with pancreatitis complicated by a pseudoaneurysm in the pancreatic head was treated with a radiologic-surgical approach. At surgery, the phlegmon was exposed and treated by means of direct puncture and embolization with Gianturco coils under color Doppler flow imaging guidance.
OBJECTIVE: The aim of this study was to examine variables for early prediction of successful weaning in chronic obstructive pulmonary disease (COPD) patients during pressure support ventilation weaning. DESIGN: Thirteen COPD patients were prospectively studied to compare the respiratory pattern (inspiratory time, expiratory time, total breath cycle duration, tidal volume, respiratory rate, minute ventilation), the respiratory drive (airway occlusion pressure at 0.1 sec, tidal volume/inspiratory time), and blood gases after 30 mins of pressure support weaning. SETTING: The study was performed in the 20-bed General Critical Care Unit of the Rome "La Sapienza" University Hospital. PATIENTS: We evaluated 13 consecutive COPD patients fulfilling the standard weaning criteria (including clinical status, blood gases, forced vital capacity, maximum inspiratory pressure, and spontaneous respiratory rate after a 30-min T-piece trial) in which we compared respiratory pattern, respiratory drive, and blood gases after 30 mins of pressure support weaning. MEASUREMENTS AND MAIN RESULTS: After 30 mins of pressure support ventilation weaning (pressure support level 20 cm H2O), we measured respiratory pattern (airway pressure and airflow tracing), airway occlusion pressure at 0.1 sec (occluding the inspiratory line during expiration with a rubber balloon), tidal volume/inspiratory time, maximal inspiratory pressure, and blood gases. According to the result of the weaning trial, the patients were divided into two groups (not weaned and weaned), and the statistical difference between the evaluated variables was analyzed in weaned and not weaned groups. We did not observe a significant difference in breathing pattern data and arterial blood gases between weaned and not weaned patients. By contrast, airway occlusion pressure at 0.1 sec and maximum inspiratory pressure measured after 30 mins of weaning trial appeared significantly (p less than .001) different in patients in whom the weaning trial succeeded or failed. Considering maximum inspiratory pressure, we could not separate weaned from not weaned patients, while all patients showing values of airway occlusion pressure at 0.1 sec less than 4.5 cm H2O were easily weaned. CONCLUSIONS: This study confirms that conventional weaning criteria are often inadequate in predicting successful weaning of COPD patients, while airway occlusion pressure at 0.1 sec during the first phase of pressure support ventilation weaning can represent a good weaning predictor.
Arrhythmogenic right ventricular cardiomyopathy presents a rather frequent familial occurrence. In the present study the cases of two brothers (25 and 30 years old, respectively) presenting with the peculiar finding of early involvement of right atrium, are described. Both subjects were investigated because of recurrent complex arrhythmias, including supraventricular (sustained atrial flutter, atrial tachycardia) and ventricular tachyarrhythmias (very frequent premature beats, nonsustained ventricular tachycardia). The associated echo-angiographic aspects of the right atrium and right ventricle were those typically described in arrhythmogenic right ventricular cardiomyopathy. The familial occurrence of simultaneous right atrial and ventricular involvement, to the best of our knowledge not previously described, can likely be due to the similar phenotypic expression of the same genotype. The prognostic significance of atrial involvement in right ventricular arrhythmogenic dysplasia is still to be defined and the clinical follow-up of these two cases may contribute to it.
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We describe a case of primary ovarian leiomyoma in a 16 year old patient; both ovaries were affected. Since at intervention normal tissue was found, the left ovary was preserved and a 30-months follow-up was carried out. Tumour markers (CA-125; alpha-fetoprotein; CEA and beta-HCG) were tested. Such a case has not previously been reported. Etiopathogenesis is also discussed.
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In recent years the use of devices called Heat and Moisture Exchangers (HME) has become widespread as gas conditioners for ICU patients requiring mechanical ventilation. As an important variation of the resistive properties of the HME, related to flow and duration of use, has recently been pointed out during "in vitro" studies, the use of these devices in COPD patients could increase the levels of auto PEEP and dynamic hyperinflation. In this study we have compared the levels of auto PEEP and difference in functional residual capacity (delta FRC) in a group of COPD patients, requiring controlled mechanical ventilation (CMV), at basal conditions and after the insertion into the circuit of three HMEs (Dar Hygrobac, Pall Ultipor, Engstrom Edith) at random: the results obtained excluded a significant increase of auto PEEP and delta (FRC) both with "new" HMEs and after 12 h of continuous use.
We investigated the levels of auto-PEEP and dynamic hyperinflation during high frequency jet ventilation (HFJV) and controlled mechanical ventilation (CMV) in six patients with chronic obstructive pulmonary disease within the first 36 h of acute exacerbation. The comparative evaluation was performed at similar conditions of gas exchange in HFJV and CMV: PaO2 77.6 +/- 11 mmHg vs 80.8 +/- 12 mmHg; PaCO2 46.8 +/- 2.5 mmHg vs 47 +/- 2.8 mmHg; pH 7.38 vs 7.38. In this situation, the values of auto-PEEP and dynamic hyperinflation, expressed as delta over the apneic functional residual capacity (FRC) did not differ: (auto-PEEPHFJV 8.9 +/- 3.8 cmH2O; auto-PEEPCMV 8.8 +/- 4.7 cmH2O; delta FRCHFJV 0.56 +/- 0.19 l; delta FRCCMV 0.54 +/- 0.2 l). This result suggests that, with a suitable machine setting and similar gas exchanges, HFJV produces the same level of auto-PEEP and dynamic hyperinflation as CMV in patients with chronic obstructive pulmonary disease.
The aim of this study was to evaluate the influence on cerebral and cutaneous vascular regions of PaO2 reduction during acetate dialysis, by monitoring conjunctival oxygen tension (PcjO2) and transcutaneous oxygen tension (PtcO2) during hemodialysis (HD) treatment. The study was performed on 23 patients with end-stage renal disease in chronic HD. All patients underwent dialytic treatment with cuprophan membranes and acetate containing dialysate. PcjO2 and PtcO2 were recorded and PaO2 and arterial carbon dioxide tension (PaCO2) were also measured. Results of the study show that hypoxemia during acetate dialysis with cuprophan membranes is not accompanied by changes of PcjO2 and therefore by changes in cerebral oxygenation. Moreover, PtcO2 remains constant during dialysis treatment. Furthermore, maintenance of normal oxygen tension at the conjunctival level is not obtained at the expense of the peripheral region of the skin.
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When V79 cells are incubated in the presence of radiolabeled retinol, a small but consistent amount of radioactivity remains associated with nuclear DNA. Chromatographic analysis of enzymatic hydrolysates of DNA shows that no irreversible changes, such as adducts, have taken place on DNA. We present evidence that this radioactive incorporation may occur via a metabolic conversion of retinol, leading mainly to the formation of radiolabeled thymidine, which is then incorporated into newly made DNA. Mutagenic effects by retinol, given at concentrations well above physiological levels, have been also excluded.
We report a case of hyperinflation induced isorythmic atrio-ventricular dissociation with circulatory failure in a patient with chronic obstructive pulmonary disease. The arrythmia was successfully treated by applying "pressure support ventilation" (PSV: 20 cmH2O) which, by decreasing the respiratory rate and increasing the expiratory time reduced the level of auto-PEEP. In order to explain this result the Authors recorded, in the same patient, the level of auto-PEEP and delta FRC obtained with Intermittent Positive Pressure Ventilation (IPPV), Intermittent Mandatory Ventilation (IMV) and PSV at the same gas exchange values. PSV showed a dramatic reduction of both these parameters. (Auto-PEEP: IPPV 12 cmH2O, IMV 17 cmH2O, PSV 7 cmH2O).
Left coronary arteries of 30 human hearts, obtained at autopsy, were injected with contrast medium. A control group was formed from anterior descending coronary arteries free of atherosclerosis and a study group from anterior descending coronary arteries with areas of atherosclerotic injury. The following differences in the two groups were noted. The control group did not show successfully injected vessels in intima and media, while cases with atherosclerotic injury have them; the number of injected vessels in presence of atherosclerotic injury was three times greater than in healthy coronary arteries; there was a decreasing gradient from outside to in, in the number of injected vessels in both groups; and finally in atherosclerotic vessels we noted a lack of balance between parietal thickening and the residual lumen (conspicuous thickening was accompanied by a small reduction in the lumen). We interpret centrifugal thickening as a possible compensatory mechanism in the major branches for an inadequate canalization of vessel, and suggest possible formation, of coronary collateral circulation from vasa vasorum by a process of neovascularization.
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