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N Latronico

Publications and source records attributed to N Latronico.

At least 19 recordsLinked to original sources
PubMed1998

Acute quadriplegia with delayed onset and rapid recovery. Case report.

The authors describe a patient with severe head injury and sepsis who became acutely quadriplegic 3 days postinjury because of a critical illness polyneuropathy (CIP) and critical illness myopathy (CIM), which resolved rapidly after treatment of the underlying infection. In only 3 days the patient developed septic shock together with flaccid quadriplegia and absent deep tendon reflexes with no clinical or radiological evidence of central nervous system deterioration. Neurophysiological studies showed an acute axonal sensorimotor polyneuropathy, whereas the clinical course strongly suggested a concurrent myopathy. A severe Staphylococcus epidermidis infection accompanied by bacteremia was treated and the patient recovered fully within a few days. Although the case described here is unique because of its very early onset and rapid resolution, CIP and CIM are frequent complications of sepsis and multiple organ failure. The authors suggest that severely head injured patients with sepsis should be evaluated for CIP and CIM when presenting with unexplained muscle weakness or paralysis.

Acute Disease↗
PubMed1996

Critical illness myopathy and neuropathy.

BACKGROUND: Critically ill patients may develop muscle weakness or paralysis during the course of sepsis and multiple-organ failure. We studied peripheral nerve and muscle disorders (NMD) in comatose patients. METHOD: Comatose patients who developed paralysis associated with absent deep-tendon reflexes had electroneuromyography (ENMG) and muscle-nerve biopsy specimens taken. Onset and duration of sepsis, multiple-organ dysfunction and failure, biochemical alterations, and drugs potentially interfering with nerve-muscle function were recorded. FINDINGS: 24 patients became quadriparetic or quadriplegic; muscle changes were found in 23. Axonal neuropathy was found in eight of 22 patients examined. All patients had prolonged sepsis and multiple-organ dysfunction, but only 14 had multiple-organ failure. Drugs such as steroids, neuromuscular-blocking agents, and aminoglycosides were not responsible for paresis, and the part played by hyperglycaemia and hypoalbuminaemia is uncertain. Attending physicians predicted a fatal outcome in all cases, although six of seven survivors fully recovered within 115-210 days from the onset of paralysis. INTERPRETATION: Comatose patients may become completely paralysed because of NMD. The diagnosis is important to avoid unnecessary investigations and unreasonably pessimistic prognosis. ENMG is essential for the diagnosis and for planning further clinical management. Biopsy needs to be done only when it is necessary to properly classify NMD.

Biopsy↗
PubMed1996

Making sense.

Explore the source record for details and available documents.

Humans↗
PubMed1996

Bedside burr hole for intracranial pressure monitoring performed by intensive care physicians. A 5-year experience.

OBJECTIVE: To assess the results of a 5-year experience with bedside burr hole for intracranial pressure (ICP) monitoring performed by intensive care physicians. DESIGN: Prospective, observational study in 120 patients. SETTING: A general-neurologic Intensive Care Unit in a University Hospital. PATIENTS: Patients admitted for acute neural lesion requiring ICP monitoring. METHOD: A 2.71 mm burr hole was made with positioning of a subarachnoid screw, through which a miniaturized fiberoptic, tip transducer device (Camino) was advanced and inserted 2 mm in the frontal cortex. MAIN RESULTS: Over a 5-year period 120 patients, mainly with severe head trauma, underwent ICP monitoring. None of the planned patients was excluded because of technical difficulties. No life-threatening complications were reported, and the overall morbidity rate related to the ICP monitor was 3.3%. Complications were infectious in nature, with 2.5% wound infections and 0.8% meningitis. Although seven patients bled when opening the dura, no intracranial hematomas were recorded due to the ICP monitor. The fiberoptic device was left in place for 5 +/- 1.6 (SD) days (range 1-12 days). Five patients (4.1%) required catheter substitution due to breakage of the system components (fiberoptics). CONCLUSIONS: Bedside insertion of a ICP monitor performed by intensive care physicians is a safe procedure, with a complication rate comparable to other series published by neurosurgeons. The overall morbidity rate is comparable to, or even lower than, that caused by central vein catheterization.

Adolescent↗
PubMed1995

[Evaluation of the hemodynamic effects of pipecuronium bromide. Absence of adverse hemodynamic effects].

INTRODUCTION: Pipecuronium bromide is a new non depolarising muscle relaxant with a long duration of action; we considered its haemodynamic effects during general anaesthesia. MATERIALS AND METHODS: Eight surgical patients (4 males, 4 females), mean age 44 years (range 29-65 years), ASA I-II, were studied. All patients were undergoing elective neurosurgical procedures (Hunt-Hess I-II). A radial artery-cannula was put in for blood pressure monitoring and a Swan-Ganz volumetric/ejection fraction fiber optic catheter was put in pulmonary artery via right internal jugular vein (EFV/OTDC-Baxter). A diazo-analgesic high dose fentanyl anaesthesia was given. All patients received pipecuronium bromide 0,1 mg/kg during stable haemodynamic conditions. Haemodynamic determinations were performed over following three times: T0 before the pipecuronium administration, T1 and T2, 3 and 15 minutes after administration respectively. These parameters were analysed: HR, MAP, MPAP, RAP, PCWP, CI RVEDVI, RVESVI, RVEF, SVRI, LVWI, RVWI, SvO2, DO2I, VO2I, O2ER, Qs/Qt (statistics: analysis of variance (two ways ANOVA) and orthogonal decomposition; for all statistical comparison, differences were considered significant when p < 0.05). RESULTS: Only MAP and SVRI showed significant changes (p = 0.02 and p = 0.04), even if clinically modest. No other parameter showed any change at all. CONCLUSIONS: Pipecuronium bromide did not show adverse haemodynamic effects; its haemodynamic repercussions are clinically negligible. The drug could be considered as first choice in long lasting operations for patients with potential cardiovascular instability.

Adult↗
PubMed1994

Impact of heat and moisture exchangers on ventilatory pattern and respiratory mechanics in spontaneously breathing patients.

The upper airways warm and saturate inspired air with water vapour. In intubated or tracheotomized patients, this function is replaced either by hot water humidifiers or by heat and moisture exchangers (HMEs). The aim of this study was to quantify the modifications of ventilatory mechanics and patients' work when two different HMEs were added to spontaneously breathing patients. We studied nine consecutive patients with no previous history of chronic obstructive lung disease. All patients had been weaned from mechanical ventilation. They were breathing through devices supplying positive end-expiratory pressure and/or O2 enrichment. Two different HMEs were used: Icor Mediflux 1 and Icor Mediflux 2. These HMEs have identical chemical composition and configuration, but the Mediflux 1 is larger than the Mediflux 2. The humidification of the inspired gases was obtained alternatively by an active humidifier and the two HMEs. Data regarding ventilatory pattern and respiratory mechanics were collected by pulmonary monitor CP100 (Bicore). Tidal volume, work of breathing and pressure-time product were greater with Mediflux 1 than with Mediflux 2 or active humidifier. There were no significant differences in respiratory rate, intrinsic positive end-expiratory pressure (PEEPi), rapid shallow breathing index, arterial CO2 and O2 partial pressure. The larger HME (Mediflux 1) increased patient's effort, with no evidence of patient discomfort. However, the smaller HME (Mediflux 2) did not add a detectable load and provided adequate humidification. In conclusion, the smaller HME appears to be preferable for the management of spontaneously breathing patients.

Adolescent↗
PubMed1993

Ischaemic pontomedullary transection with incomplete locked-in syndrome. A case report with MRI.

We describe a case of incomplete locked-in syndrome (LIS) due to basilar artery thrombosis, in which MRI showed a complete, sharply demarcated infarct at the pontomedullary junction. This supports experimental data showing that the lower reticular formation is not critical for the maintenance of consciousness. To our knowledge, this is the first reported case of ischaemic pontomedullary transection with LIS.

Brain Ischemia↗
PubMed1990

Free radical-induced lipoperoxidation and severe head injury. A clinical study.

Ten severely head injured patients (GCS less than or equal to 8), aged 17-62 years, were studied in order to investigate the role of lipoperoxidation in secondary brain damage. No patients had intracranial mass lesions, shock, hypoxemia, fever or sepsis. Blood samples were taken from the jugular bulb and from the right atrium, and thiobarbituric acid reacting substances (TBARS) were measured in plasma by spectrophotometry. Arterio-jugular venous oxygen differences (AVDO2) were obtained in seven patients, in order to estimate cerebral blood flow. Jugular TBARS (TBARSj) were always elevated (from To, to 2 h after injury) and correlated in a linear fashion with TBARS of right atrium (TBARSv): r = 0.74, p less than 0.001. TBARSj and AVDO2 are closely correlated, in accordance with an exponential function (R = 0.45, p less than 0.001) which describes how any cerebral perfusion derangement determines high levels of TBARSj, confirming lipoperoxidation as a key factor in the final common pathway of secondary posttraumatic brain damage.

Adult↗