[Remarks on the prevention and treatment of tetanus].
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Biomedical subjects
Publications and source records attributed to M Seveso.
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Seventy-six patients with severe isolated head trauma (GCS score of 7 or less) were prospectively studied in order to valuate the prognostic power of the APACHE II system. In nonsurvivor patients the APACHE II score was higher than in survivor patients (24.7 +/- 3.2 (SD) vs 18.7 +/- 3.1; p less than .001). With an APACHE II cut-off point of 20 the sensitivity was 100% and the specificity was 70% while a cut-off point of 21 the sensibility decreased to 97.2% but the specificity increased to 72.5%. We conclude that the APACHE II is an effective mean to predict the prognosis of severe brain-injured patients.
The immunocompetent cells from peritoneal effluent in 22 stable CAPD patients were studied for surface phenotype distribution and for phagocytic properties by flow cytometry. The following monoclonal antibody couples were employed with direct dual color immunofluorescence: HLA-DR/CD 4, CD 8/CD 11c, Leu 7/CD 16, CD 14/CD 13, and Anti-Leucocyte/CD33. The phagocytic properties of peritoneal macrophages and polymorphs (PMN) were evaluated by the ingestion of 2.02 microns O fluoresceinated microspheres. The same analyses were also performed in peripheral blood. A FACStar laser-operated flow cytometer was employed. A remarkable heterogeneity of CAPD fluid cells was demonstrated, even in the absence of any obvious infection, suggesting the possible occurrence of aborted inflammatory processes. Activated T helper cells, T suppressors (CD8+/CD11+) and Fc gamma+ cells prevailed among lymphocytes, whereas variable amounts of monocytes and PMNs were present. The phagocytic activity of CAPD fluid phagocytes ranged from very depressed to normal values, whereas it was only moderately reduced in blood, suggesting local blocking phenomena, possibly due to interfering metabolites. Flow cytometry is the method of choice for a rapid and accurate analysis of phenotypic and functional properties of cells recovered from various body fluids. This study may be helpful in evaluating local immune response mechanisms in CAPD patients.
A randomized prospective clinical trial was conducted to determine the influence of dexamethasone therapy on nitrogen metabolism in patients with isolated head trauma without any pathologies. One group of 12 patients was not given steroids (groups NS). To the 12 patients of the second group, a dose of 0.36 mg/kg/day of dexamethasone was administered for the first nine days of stay (group S) in hospital. At the beginning of the study, between the two groups, there were no differences in age, sex, Glasgow Coma Scale Score, type of injury. In order to avoid bias, phenytoin, barbiturates and muscle-relaxant drugs were not given and the same caloric and protein intake was prefixed for both groups. The urea excretion, nitrogen output, nitrogen balance and cumulative nitrogen balance were not statistically different in the two groups throughout the period of study. Similar were also weight losses, blood glucose, blood urea nitrogen, albumin and creatinine levels. The outcome, evaluated at 3 months, was also similar. The incidence of sepsis, pulmonary and urinary infections, gastric reflux duration and quantity, was not higher in the steroid group compared with non-steroid treated patients.
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The Authors have studied five coagulation parameters (platelets count, prothrombin time, activated partial thromboplastin time, fibrinogen and fibrinogen degradation products) in 60 head traumatized patients. These parameters were alterated in a high percentage of patients. Moreover 5 patients presented laboratory values indicative of disseminated intravascular coagulation (DIC). DIC could be an important factor of mortality in the head traumatized patients. So coagulation system must be carefully evaluated in any patient with head injury.
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