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Biomedical subjects

P Lago

Publications and source records attributed to P Lago.

At least 19 recordsLinked to original sources
PubMed2005

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease.

With the aim of investigating the presence of latent inflammatory process in the lungs of patients with Crohn's disease, 15 patients with Crohn's disease were evaluated by spirometry, the methacholine challenge test, induced sputum, and skin tests for inhaled antigens. Serum IgE, erythrocyte sedimentation rate and hematocrit were also determined. The patients were compared with 20 healthy controls by the Mann-Whitney and Fisher exact tests. Their respiratory physical examination was normal. None had a personal or family history of clinical atopy. None had a previous history of pulmonary disease, smoking or toxic bronchopulmonary exposure. None had sinusitis, migraine, diabetes mellitus, or cardiac failure. Four (26.6%) of the patients with Crohn's disease had a positive methacholine challenge test whereas none of the 20 controls had a positive methacholine test (P = 0.026, Fisher exact test). Patients with Crohn's disease had a higher level of lymphocytes in induced sputum than controls (mean 14.59%, range 3.2-50 vs 5.46%, 0-26.92%, respectively; P = 0.011, Mann-Whitney test). Patients with Crohn's disease and a positive methacholine challenge test had an even higher percentage of lymphocytes in induced sputum compared with patients with Crohn's disease and a negative methacholine test (mean 24.88%, range 12.87-50 vs 10.48%, 3.2-21.69%; P = 0.047, Mann-Whitney test). The simultaneous findings of bronchopulmonary lymphocytosis and bronchial hyperresponsiveness in patients with Crohn's disease were not reported up to now. These results suggest that patients with Crohn's disease present a subclinical inflammatory process despite the absence of pulmonary symptoms.

Adolescent↗
PubMed2004

Retrospective analysis of post-hemorrhagic ventricular dilatation in very low birth weight infants, short and long-term outcome.

AIM: The aim of this paper was to study the evolution of ventriculomegaly, the treatment and the developmental problems of a group of very low birth weight infants (VLBWI) born between 1985 and 1999 who met Levene's percentiles for post-hemorrhagic ventricular dilatation (PHVD). METHODS: A retrospective hospital-based study of a cohort of 66 VLBWI who fulfilled the diagnostic criteria for PHVD was performed. Measures of neurodevelopmental outcome were evaluated by analyzing neurosensorial patterns as well as mental and behavioral adjustment up to pre-school age in 35 survivors. RESULTS: The PHVDs initially (1985-1989) were due to a grade 4 intraventricular hemorrhage (IVH) (71.4%), and in the latter period (1995-1999) to IVH grade 2 (36.4%), grade 3 (31.8%) and grade 4 (31.8%). Acetazolamide has been used since the 90's in neonates with progressive PHVD. The 90s were characterized by an increasing incidence of tiny babies and rapidly-progressive PHVD. Taps were more frequent in the arrested dilatation group. Similarly, taps and acetazolamide were administered to newborns with persistent, slowly-progressive ventricular dilatation (PHVD > 4 weeks). The highest correlation was found for gestational age with the mental and psychomotor developmental indexes. Delayed performance and/or mental retardation were diagnosed in 71.4% of the survivors. CONCLUSION: Acetazolamide and lumbar puncture, associated with other risk variables (severity of IVH, PHVD evolution and associated parenchymal lesions) are harmful in terms of development, but they have a role in the short-term arrested and slowly progressive PHVD of the surviving babies, and not in the mortality incidence. Our retrospective data demonstrated that lower gestational age at birth increased the risk of lower mental and psychomotor developmental indexes.

Acetazolamide↗
PubMed1999

Impaired arterial baroreceptor sensitivity before tilt-induced syncope.

Autonomic dysfunction seems to play a central role in the pathophysiology of neurocardiogenic syncope (NCS) but conflicting data have recently become available. We evaluated autonomic nervous system (ANS) function (heart rate variability (HRV), systolic blood pressure variability (SBPV) and baroreceptor gain (BRG)) and non-invasive haemodynamics (cardiac output and total peripheral resistance) in patients with neurocardiogenic syncope. Retrospectively, we evaluated 12 NCS patients (positive head-up tilt without pharmacological provocation) in the basal state and at initial tilt, 12 non-NCS patients with tilt-negative syncope and 12 aged-matched normal controls. Prospectively, we evaluated 16 NCS patients to analyse the haemodynamics and ANS activity throughout the tilt test (beginning of tilt and before syncope occurs). HRV and SBPV were accessed by fast Fourier transforms (FFT) and spontaneous BRG by temporal sequences, slope and a index. Modelflow was used to quantify the non-invasive haemodynamics. None of the autonomic and haemodynamic parameters at baseline or in the first 10 min of tilt was different among the respective NCS, non-NCS syncope and normal control groups, except for SBP, which was higher at baseline in controls. Throughout the tilt test in the prospective NCS group, the heart rate increased (88-95 beats x min(-1), P<0.05), systolic blood pressure decreased (123-109 mmHg, P<0.01), and arterial baroreceptor gain was reduced (7.6 to 5.5 ms mmHg(-1), P<0.01) and the absolute high frequency component of HRV (HF HRV) decreased (150-80 ms(-2), P<0.05), before syncope occurred. There was no change in the low frequency component of HRV (LF HRV), SBPV, cardiac output (CO) or total peripheral resistance (TPR). Tilt-induced syncope could not be predicted by non-invasive haemodynamic or autonomic parameters at rest or in the initial minutes of tilt. The decrease in arterial baroreceptor gain could be a precocious expression of the transient autonomic dysfunction that characterizes the occurrence of neurocardiogenic syncope.

Adult↗
PubMed1999

Is the CRIB score (clinical risk index for babies) a valid tool in predicting neurodevelopmental outcome inExtremely low birth weight infants?

The study aimed to assess how well the severity of clinical conditions in extremely low birth weight infants in the first 12 h of life, as measured by the CRIB (clinical risk index for babies), relates to hospital outcome and subsequent disability at 18 months of age. The CRIB was confirmed as a valid index of initial neonatal risk, even in extremely low birth weight infants, predicting hospital outcome (death or major brain lesions) more accurately than birth weight or gestational age. However, an adjustment of the CRIB score for gestational age might enhance its positive predictive value in relation to short-term developmental outcome in this particular population.

Birth Weight↗
PubMed1999

Hemoglobin near-infrared spectroscopy and surface EMG study in muscle ischaemia and fatiguing isometric contraction.

BACKGROUND: To assess how muscle ischaemia and isometric fatiguing contraction influence oxygen content in striated muscle. METHODS: We simultaneously measured changes in hemoglobin near-infrared (NIR) spectroscopy and in surface EMG before, during, and after muscle ischaemia and ischaemia plus muscle isometric fatiguing contraction. Seventeen healthy male subjects (age range: 19-40 yrs) were examined in our Clinical Neurophysiology Unit. Test I (9 subjects): hemoglobin NIR spectroscopy and stimulated surface EMG were measured for 2 minutes at rest, for 4 minutes during complete ischaemia of tibialis anterior muscle, and for twelve minutes during recovery. Test II (all subjects): hemoglobin NIR spectroscopy and surface EMG were measured for 2 minutes with the subjects performing brief non-fatiguing contractions, for 4 minutes with the subject performing maximal isometric contraction in complete ischaemia, and for twelve minutes during recovery. EMG parameters measured: median density frequency (MDF); muscle fiber conduction velocity (MFCV). NIR spectroscopy parameters measured: percentage of amplitude decrement (% AD) and nadir time (NT) during ischaemia and ischaemic effort; half-recovery time (1/2 RT) from ischaemia effort. RESULTS: At EMG, we observed a significant shift towards lower values of both MFCV and MDF during fatiguing isometric contraction. MDF recovery was faster then MFCV recovery. At NIR spectroscopy, the 1/2 RT slowed a fast pattern in twelve subjects and a slow pattern in five. A significant relationship was found between AD% and 1/2 RT values of test I and AD% and 1/2 values of test II. We found a positive relationship between NT and 1/2 RT in test II. CONCLUSIONS: Surface EMG and hemoglobin NIR spectroscopy can be applied simultaneously to evaluate both fatigue intensity and blood flow changes in striated muscle.

Adult↗
PubMed1998

Pain management of arteriovenous fistula cannulation in haemodialysis children: efficacy of EMLA anaesthetic cream.

The aim of the present study was to evaluate the efficacy of EMLA cream (containing a eutectic mixture of local anaesthetics) in controlling pain due to arteriovenous fistula cannulation in teenagers undergoing chronic haemodialysis. The study was conducted in two phases, one prospective, the other a blind randomized trial, at the Paediatric Haemodialysis service of the Paediatrics Department of Padua University, Italy. It involved six teenagers, aged 12-18 years. Pain was measured using the visual analogue scale, indirect evaluation by nurses and a four-category verbal rating scale. Results showed that: (1) the visual analogue scale calls for an adequate training period; and (2) the EMLA cream might be effective in controlling cannulation-related pain but emotional factors, such as uncontrolled fear and stress, can interfere with the global efficacy of the analgesic approach. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.

Journal Article↗
PubMed1998

Randomised controlled trial of low dose fentanyl infusion in preterm infants with hyaline membrane disease.

AIM: To evaluate the effects of low dose fentanyl infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in premature infants ventilated for hyaline membrane disease. METHODS: Twenty seven ventilated preterm infants were randomly assigned to receive a mean fentanyl infusion of 1.1 (0.08 SE) micrograms/kg/h for 75 (5) hours, and 28 untreated infants were considered a control group. A behavioural sedation score was used to assess the infants' behaviour. Urinary metanephrine and the normetanephrine:creatinine molar ratio were determined at 0, 24, 48 and 72 hours. Outcome data and ventilatory indexes were recorded for each infant. RESULTS: The fentanyl group showed significantly lower behavioural stress scores and O2 desaturations than controls and lower urinary concentrations of metanephrine and normetanephrine at 24, 48, 72 hours. The two groups showed no significant difference in ventilatory variables or short term outcome. CONCLUSIONS: A short course of low dose fentanyl infusion reduces behavioural sedation scores, O2 desaturations and neuroendocrine stress response in preterm ventilated infants.

Analgesics, Opioid↗
PubMed1997

Circadian heart rate variability rhythm in shift workers.

The objective of this study was to assess the influence of day-night cycle and sleep-awake period on the circadian pattern of heart rate variability (HRV). Twelve male oil refinery security shift workers, aged 39 +/- 7 years, were studied with 24-hour Holter monitor recordings during morning and night work periods. Hourly HRV parameters in the time and frequency domains were evaluated. For both shifts, all HRV parameters during awake or work periods were found not to be statistically different. In both day and night work shifts, the very low frequency and high-frequency components of HRV and the proportion of differences in successive R-R intervals greater than 50 ms increased during the sleep period, while the low frequency/high frequency ratio decreased. The low-frequency component in absolute units and the SD of the R-R interval did not show any variation in either shifts for the different periods. These results suggest that the circadian pattern of HRV seems to be predominantly related to sleep (supine) and wakefulness (standing) and remains independent of night-day cycle.

Adult↗
PubMed1997

[Is autonomic control of the heart rate at rest altered by detraining? A study of heart rate variability in professional soccer players after the pretraining period and after the preparatory period for competitions].

The aim of this study was to assess the influence of detraining and training on the autonomic control of heart rate (HR), using time and frequency (spectral analysis) domain components of heart rate variability. Sixteen professional football players (26.7 +/- 3.8 years; 74.9 +/- 4.1 kg; 177 +/- 6.3 cm) were analysed at the end of a 1 month holiday (detraining) and after a 6 week training period (training). HR was recorded over 15 minutes with Holter equipment. The athletes rested in a supine position, in a quiet place and all test were performed between 8 and 10 AM. The subjects were requested to refrain from meals or caffeine for 12 hours before testing. In spite of the high intensity of the training period, there was no significant change in results from detraining condition to training condition. These results can have two possible explanations: (i) the high level of cardiovascular capacity in the detraining trial originated by the recreative physical activity that the players underwent during their holidays, and/or (ii) the training period was not long enough to promote any relevant effect on the autonomic control of HR.

Adaptation, Physiological↗
PubMed1996

Heart rate variability in brain death.

The sensitivity and specificity of heart rate variability (HRV) in the corroboration of brain death diagnosis in patients with acute traumatic intracranial lesions was evaluated in 20 patients with clinical criteria of brain death, nine patients in deep coma (Glasgow scale < 7) and 18 normal controls, all age matched. The electrocardiogram was sampled at 650 Hz and several parameters of HRV were calculated, in both time and frequency domains. The HRV parameters were significantly lower in the brain death group compared with the deep coma group. Linear discriminant analysis between brain death and deep coma patients was performed on a data set made of nine randomly selected patients with clinical criteria of brain death and nine patients in deep coma. Cross-validation was performed on the remaining 11 patients with clinical criteria of brain death. All patients in the data set were correctly classified (sensitivity and specificity of 100%). All patients in the cross-validation set were correctly classified (sensitivity of 100%). Further studies are necessary to evaluate the specificity of the method in the independent set of deep coma patients and in the follow-up of comatose and vegetative patients to identify irreversibility of HRV. Nevertheless, these results suggest that HRV analysis constitutes a fully sensitive and specific method for assessing brain death in potential organ donors with acute traumatic lesions of the brain. This fast, quantitative and bedside method seems very promising for the early confirmation of brain death, which is an important factor for the success of transplantation procedures and could have a high predictive value of brain death in comatose patients with brain injuries without fully diagnostic criteria.

Adolescent↗
PubMed1996

Evaluation of noise in the neonatal intensive care unit.

This study evaluated the noise level inside the incubators in a neonatal intensive care unit and identified its sources in order to attempt to reduce it. Although noise is not a proven risk factor as far as the sensory integrity of newborns is concerned, it is certainly an important cause of stress to them and a source of serious and dangerous changes in their behavioral and physiologic states. Noise recorded inside the incubators had two components. The first was background noise from the incubator motors, which varied from 74.2 to 79.9 dB, and was similar to environmental noise. The second source was impulsive events beyond 80 dB. These events were the result of voluntary and involuntary contact with the incubators' Plexiglas surface or to the abrupt opening and closing of their access ports. Considering its decibel levels and frequency, this latter component is undoubtedly an important source of stress to newborns. Moreover, these data reveal the need to train health care personnel on how to reduce such noise by taking more care in the handling of infants.

Environmental Exposure↗
PubMed1996

[Basic concepts on the assessment of arterial baroreceptor sensitivity with non invasive methods. Estimate of the spontaneous gain of the arterial baroreceptor].

Arterial baroreceptors are sensitive to variation in both blood and pulse pressure. When there is an increase in those pressures, the baroreceptors increase the rhythm in which electric impulses are discharged. The impulses are transmitted by the receptors to the nervous centres of the brainstem. Once processed, these signals turn into sympathetic and vagal impulses. The vagal efferents control heart rate and the sympathetic efferents control heart rate, myocardial contractility and peripheral resistance. If there is an increase in blood pressure, then there will be a reflex decrease in the sympathetic activity and an increase in the parasympathetic one. The cardiac cronotropic response to blood pressure variation is very fast-with a delay of one or two beats. The amplitude of the response is a sigmoidal function. The greatest inclination of the response curve, that is to say, the area of greatest variation of the RR interval per unit of pressure, characterises the gain of the baroreceptors. The traditional method for obtaining the gain of the baroreceptor is a pharmacological one. Generally, the patient is given phenilephrine intravenously, in bolus and then the correlation between heart rate and the increase in intra-arterial blood pressure (reflex bradycardia) is calculated. Lately, it has been used the calculation of the spontaneous gain of the baroreceptor starting from a study carried out on the normal fluctuations in blood pressure and in the pulse interval both in time and frequency domain. The first case deals with the calculation of the gain of the function of transfer between the variations both in blood pressure and the RR intervals in the LF and the HF bands. The second case deals with the analysis of the occurrence of sequences of three beats with successive increases or decreases in blood pressure and in the RR interval. The gain is obtained from the linear regression of all the sequences. The application of these techniques to the recordings of blood pressure obtained by non-invasive methods (Finapress) makes possible that this procedure be followed under real conditions since it requires no previous stimulation of the cardiovascular system, which would probably interfere with the mechanisms to be evaluated, and requires no equipment in the condition which is normally required by experimental methodology.

Blood Pressure↗
PubMed1995

MRI, MRA, and neurodevelopmental outcome following neonatal ECMO.

Cranial magnetic resonance imaging (MRI) of 31 newborn infants treated with venoarterial cardiopulmonary bypass for severe but reversible respiratory failure, revealed major focal parenchymal lesions in 7 of 31 infants (23%) and demonstrated abnormal enlargement of extra-axial and ventricular cerebrospinal fluid spaces in 16 of 31 (51%). No preferential left versus right lateralization of focal injury was observed in conjunction with right common carotid artery and jugular vein ligation. No statistically significant relationships were found between major brain lesions on MRI scans and the clinical characteristics of the pre-extracorporeal membrane oxygenation (ECMO), ECMO, and post-ECMO course. Major focal brain lesions were significantly associated with an asymmetric cerebrovascular response to carotid ligation of the right versus left middle cerebral arteries as detected by magnetic resonance angiography (P < .05). Enlarged cerebrospinal fluid spaces were not significantly related to the presence of parenchymal MRI lesions, but were associated with lower Bayley neurodevelopmental scores for mental (MDI) and psychomotor evaluations (PDI) at 6 and 12 months (P < .05). It is concluded that asymmetries of cerebral vascular adaptation detected by magnetic resonance angiography after ECMO may be associated with major brain lesions revealed by MRI. Thereafter, the presence of enlarged cerebrospinal fluid spaces on MRI is associated with a poor shortterm developmental outcome.

Brain↗
PubMed1995

Serum prolactin in neonates with seizures.

We studied serum prolactin (PRL) in 28 newborn infants with acute encephalopathy. Six patients had electrographically confirmed seizures. Twenty-two patients comprised the nonictal group. In the seizure group, PRL was determined at the first onset of the seizure (baseline) and at 15 and 30 min postictal. In the nonseizure group, PRL was determined at the end of the EEG and 15 min later. EEGs were visually analyzed for the presence of seizures and background abnormality (normal or mildly, moderately, or markedly abnormal). Etiologic diagnoses included congenital heart disease (12), hypoxic-ischemic encephalopathy (4), sepsis (4), respiratory distress syndrome (5) meconium aspiration (1), and metabolic disease (2). Serum PRL was significantly higher (p < 0.05) at baseline and 15 min postictally in the patients with seizures than in the nonictal group. However, PRL levels 15 and 30 min postictally were not statistically different from baseline values. Baseline PRL correlated significantly (p < 0.001) with EEG background abnormality in both groups; therefore, patients with the most abnormal EEG backgrounds had higher levels of PRL than those with a relatively normal EEG background. We conclude that newborns with EEG-confirmed seizures, particularly if seizures are not associated with clinical signs, have high baseline serum PRL levels that do not increase significantly in the immediate postictal period. Serum PRL levels correlate with the severity of the brain insult as evaluated by EEG background. Further studies are needed to enhance our understanding of the dynamics of PRL secretion in newborns with seizures and acute encephalopathy.

Acute Disease↗