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Biomedical subjects

P De Bellis

Publications and source records attributed to P De Bellis.

15 recordsLinked to original sources
PubMed2005

High epidural thoracic anesthesia for pericardial surgery.

Here are reported three cases involving patients (77, 61 and 58 years-old) with recurrent pericardial effusion who underwent pleuropericardial window using thoracic epidural anesthesia (T1-T2 o T2-T3) while fully awake, without endotracheal intubation. The operative and postoperative courses were uneventful. During the pneumothoracic phase the vital parameters and spontaneous ventilation patterns remained the same compared to the basic ones. Pain control was excellent. On the basis of this early experience the authors conclude that thoracotomy in awake patients to reach the cardiac structures is a reproducible technique.

Aged↗
PubMed2003

High-dose fluconazole therapy in Intensive Care Unit.

AIM: Fungal infections have become one of the emerging complications in intensive care patients and the morbidity and mortality linked to these infections underlines the importance of managing these pathologies. METHODS: The clinical and laboratory difficulties of diagnosing candidiasis prompted us to identify patients at risk and to intervene as soon as possible, where there was the "suspicion" of active infection, using adequate, so-called "empiric" treatment. The major risk factors include the use of invasive devices (central venous catheters), the administration of multiple antibiotic treatment and parenteral nutrition. In our Intensive Care ward (multi-purpose), we examined 1933 patients who had undergoing 1211 urine cultures (following consolidated clinical criteria). "Empiric treatment" was used in 378 high-risk patients with unstable clinical symptoms and positive urinary fungal colonisations using high-dose fluconazole (800 mg/die) according to the guidelines set down by BSAC. The mean duration of treatment was 12+2 days and urine cultures became negative in all patients after 1 or 2 weeks of treatment. RESULTS: We observed that fluconazole was generally well tolerated: only 10% of patients presented augmented hepatic transaminase. This phenomenon was always transient. Renal function remained unchanged (creatinine clearance). A severe infection with hematogenous dissemination was reported in 6 cases: "empiric treatment" was used in 5 cases with 800 mg/die of fluconazole and 1 case received amphotericin B 1 mg/kg/die (because no clinical improvement was observed after 48-72 hours of fluconazole treatment). Three of these 6 cases died, 2 of which were not directly linked to fungal infection, and 3 patient were discharged from the ward. CONCLUSIONS: We found that fluconazole offers a treatment option that is less toxic, less expensive and equally effective for these infections, provided that it is used at an adequate dose and that high-risk patients are identified for "empiric treatment". No significant increases in resistance were noted, as is demonstrated by the fact that only 1 case of candidemia required conversion to amphotericin B.

Adult↗
PubMed2002

[Experience with remifentanil in the ICU].

BACKGROUND: Analgesia and sedation are indispensable in patients admitted to intensive care for the following, principal reasons: to control their state of anxiety, induce amnesia, improve their adaptation to mechanical ventilation, make invasive manoeuvres tolerable. The purpose of the present retrospective analysis is to assess the effectiveness of remifentanil in a total of 1085 patients admitted to our Resuscitation and Intensive Care Department in 1997-2001. METHODS: A sample of 60 adults was taken from these patients. The group was homogeneous in terms of age (67.3+/-10.2 kg), weight (66.7+/-10.2 kg), duration of sedation (6.8+/-1.6 days) and index of gravity (SAPS 30.1+/-4.4). The patients were suffering from chronic obstructive bronchopneumopathy, subjected to mechanical ventilation and sedated with remifentanil. The sample was then compared with another 2 groups (homogeneous with the first) of 20 patients each, treated with propofol and midazolam as the only drug. Following an initial bolus of 2 mg/kg (+/-0.04) for propofol and 0.15 mg/kg (+/-0.03) for midazolam (no bolus for remifentanil), the doses of subsequent continuous infusion (initial doses in the case of remifentanil) were: 0.05 mcg/kg/m (+/-0.01) for remifentanil; 1 mg/kg/h (+/-0.04) for propofol; 0.03 mg/kg/h (+/-0.006) for midazolam. In order to assess the level and quality of sedation, 2 subjective evaluation scales (Ramsey score and the Sedation-Agitation Score: SAS) and one system of objective evaluation (Bispectral Index; BIS) were employed. The BIS is a direct measure of the effects of anaesthetics on the brain. It is represented by a single digit (between 100, state of arousal, and zero, EEG flat), derived statistically and empirically from the EEG. RESULTS: No significant differences were encountered as regards quality of sedation among the 3 groups but there was a significant difference in negative cardiovascular activity in patients treated with propofol (12% reduction in Cl, 13.8% reduction in SVR). A significant accumulation of the drug was observed in cases treated with midazolam, whereas there was no accumulation for remifentanil and propofol in relation to the duration of the infusion. CONCLUSIONS: Of the various sedation modalities employed, we prefer the one which uses remifentanil as the sole drug because a good level of sedation is obtained, there is no accumulation, little interference with cardiovascular parameters and lower costs in comparison with the others.

Adult↗
PubMed2001

Growth interactions during bacterial colonization of seedling rootlets.

Rootlet elongation and bacterial growth on rootlets were determined after inoculation of cucumber and spinach seedlings with Pseudomonas strains differing in production of siderophores and HCN. Siderophore producers grew more profusely than nonproducers on both species and promoted rootlet elongation on cucumber. Coinoculation of siderophore producers and nonproducers resulted in restricted growth of the latter. The total populations of nonproducers of HCN in the presence of HCN producers were not decreased, but the tenacity of their association with the rootlet surface was altered.

Colony Count, Microbial↗
PubMed1998

[Targets and prevention of complications in nursing of subarachnoid hemorrhage].

A qualified nursing care is mandatory in patients after SAH. Clinical and instrumental monitoring are basilar to assure the rapid control of dangerous ICP or CPP changes and of epileptic crisis. Prophylaxis of infections is greatly minimized when coherent treatments are applied to any invasive devices, patient body, patient bed and UTI area. Many drugs can be useful to avoid ICP increases by tracheal suctioning and other sensorial stimulations. Having a trained staff, patient outcome can be improved.

Humans↗
PubMed1984

Unexplained bilateral occipital calcification and reduced vision.

An eight year-old girl, investigated because of convulsions, was found to have isolated bilateral presumably cortical and subcortical calcification, reduced visual acuity and prolonged visual evoked response latencies. There were no clinical manifestations of a phakomatosis.

Calcinosis↗
PubMed1980

[Althesin in endocranial surgery of long duration].

The results of personal experience of Althesin in long-duration (from 4 to 11 hours) neurosurgery are presented. The drug was used as an induction agent and for maintaining anaesthesia in continuous perfusion. Considering the good results obtained, the simplicity of the technique and the lack of side effects, it is concluded that Althesin is useful in this type of surgery, particular stress being laid on the speed and quality of arousal, and the excellent tolerance assessed by exploring secretory and excretory function of the liver with enzymatic tests.

Adult↗
PubMed1980

[Althesin in surgery of the eyeball].

Evaluation of Althesin in open eyeball surgery is reported. The anaesthetic gave surgically very useful and stable hypotonia, comparable with that offered by pentothal. Its is felt that steroid anaesthesia is excellent for surgical purposes and that Althesin is ideal on account of its overall features: lack of toxicity, high therapeutic index, tranquil induction, rapid return to consciousness, excellent quality, absence of carryover effects, and easy regulation. It is, moreover, rarely responsible for coughing and vomiting. It is preferable in eye surgery to "heavy" anaesthetics, such as barbiturates and volatile halogenates, particularly in the aged.

Adult↗