[Contrast media in ultrasonography. Vascular anatomy of the transplanted kidney].
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Adult↗
Biomedical subjects
R Poggi
Publications and source records attributed to R Poggi.
Tubercular epididymitis and orchitis: US patterns.
For several decades tuberculosis has been adequately under control in this country, but there has been recent concern that this disease might be coming back to the forefront, due to the influx of immigrants from developing countries where tuberculosis is still rampant. In the years to come we are expecting an increase in cases of genitourinary lesions of tubercular origin, a disease which had practically disappeared in the Western world. The aim of this pictorial essay is to provide an outline of the typical US images of tubercular epididymitis and orchitis.
Epididymitis↗
Effects of inspiratory flow waveforms on arterial blood gases and respiratory mechanics after open heart surgery.
The clinical usefulness of inspiratory flow pattern manipulation during mechanical ventilation remains unclear. The aim of this study was to investigate the effects of different inspiratory flow waveforms, i.e. constant, sinusoidal and decelerating, on arterial blood gases and respiratory mechanics, in mechanically ventilated patients. Eight patients recovering after open heart surgery for valvular replacement and/or coronary bypass were studied. The ventilator inspiratory flow waveform was changed according to a randomized sequence, keeping constant the other variables of the ventilator settings. We measured arterial blood gases, flow, volume and pressure at the proximal (airway opening pressure (Pao)) and distal (Ptr) ends of the endotracheal tubes before and after 30 min of mechanical ventilation with each inspiratory flow waveform. We computed breathing pattern, respiratory mechanics (pressures and dynamic elastance) and inspiratory work, which was then partitioned into its elastic and resistive components. We found that: 1) arterial oxygen tension (Pa,O2) and arterial carbon dioxide tension (Pa,CO2) were not affected by changes in the inspiratory flow waveform; and 2) peak Pao and Ptr were highest with sinusoidal inspiratory flow, whilst mean Pao and Ptr and total work of breathing were least with constant inspiratory flow, mainly because of a concomitant decrease in resistive work during constant flow inflation. The effects of the inspiratory flow profile on Pao, Ptr and total inspiratory work performed by the ventilator were mainly due to the resistive properties of the endotracheal tubes. We conclude that the ventilator inspiratory flow waveform can influence patients' respiratory mechanics, but has no impact on arterial oxygen and arterial carbon dioxide tension.
Adult↗
A hypermedia radiological reporting system.
Report is the main phase of a diagnostic process by images. The product of the process is the diagnostic report. We are proposing an hypermedia structure of diagnostic report in radiology, in order to facilitate exchange between radiologist and clinician (specialist in internal medicine or surgeon) on a clinical case, without anymore charge on the side of the radiologist but with an 'off-line' consultation. An hypermedia radiological report software will produce further advantages in many aspects: radiologist and clinician could access patient's data directly from DB on patients; radiologist could check DB on exemplary cases real-time; clinician could read preliminary and final reports available in network and make requests online. The proposed hyper-report system is modular. Starting from the 'report text' writing, edited by the radiologist on the basis of most significative images, it is possible to insert comments in text, drawing and 'external' images form.
Humans↗
[A case of the adult respiratory distress syndrome induced by a methadone overdose].
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Adult↗
Flow-triggering reduces inspiratory effort during weaning from mechanical ventilation.
OBJECTIVE: To investigate whether a new flow-triggered (FT) system can reduce the patient's inspiratory effort compared to a traditional pressure-triggered (PT) system during weaning from mechanical ventilation. DESIGN: Prospective study. SETTING: Intensive care unit of a General Hospital. PATIENTS AND PARTICIPANTS: 10 mechanically ventilated patients, without chronic airway disease, ready to wean. MEASUREMENTS: Minute ventilation, breathing pattern, lung mechanics, inspiratory work of breathing (WI) and pressure time product (PTP) of Ppl were obtained in two conditions: 1) unsupported spontaneous breathing through the ventilator circuit (SB); 2) spontaneous breathing with continuous positive airway pressure set at 5 cmH2O (CPAP). Two triggering systems, namely PT and FT, were used in each condition. RESULTS: Though there was no change in breathing pattern, minute ventilation, and lung mechanics, the magnitude of the inspiratory effort decreased significantly with FT compared to PT in both instances. The added resistance (total flow resistance minus pulmonary resistance) decreased by 37% on average when FT replaced PT. PTP decreased, on average, 27% and 15% during SB and CPAP, respectively, with FT compared to PT (p < 0.05). A similar significant decrease was observed in WI. CONCLUSION: The new FT system, i.e. flow-by system, reduces the unintentional ventilatory workload upon the patients' inspiratory muscles compared to traditional PT system during weaning from mechanical ventilation.
Adult↗
Determinants of maximal transdiaphragmatic pressure in adults with cystic fibrosis.
To investigate whether diaphragmatic strength could be reduced in cystic fibrosis (CF), and to examine possible mechanisms leading to diaphragmatic weakness, we measured transdiaphragmatic pressure (Pdi), together with lung mechanics, including dynamic "intrinsic" positive end-expiratory pressure (PEEPi,dyn), ventilation, lung volumes, and nutritional status in 15 adult patients with CF in stable clinical condition. Diaphragmatic strength was assessed as the maximum Pdi (Pdimax). Nutritional assessment included the calculation of weight as a percentage of ideal weight for height (Wt/Ht). On average, our 15 CF patients had airway obstruction (FEV1 = 59 +/- 28% predicted) and a small PEEPi,dyn (1 +/- 0.7 cm H2O). Functional residual capacity average 52 +/- 9% of the predicted total lung capacity. The Wt/Ht was normal on average (95%), but with a large range from malnutrition to a good nutritional status (76 to 109%). We found that Pdimax decreased with increasing FRC/TLC percent predicted (r = 0.55, p < 0.05), but more significantly with decreasing Wt/Ht (r = 0.76, p < 0.001). The multiple linear regression analysis for these factors was significant (R2 = 0.70, p < 0.05); however, the partial regression coefficient was significant only for Wt/Ht (p < 0.01). These results suggest that in CF patients, diaphragmatic strength decreases with the progression of the disease, increasing lung volume and worsening nutritional status, and that malnutrition is the strongest determinant of diaphragmatic weakness.
Adolescent↗
Acute respiratory failure.
Respiratory failure is a severe impairment of pulmonary gas exchange, consequence of lung failure leading to hypoxaemia and/or pump failure causing hypercapnia. Acute respiratory failure (acute lung injury and asthma) or acute on chronic respiratory failure (COPD and chest wall disorders) are the two terms proposed to characterize different onset and development. Mechanical ventilation, is often a necessary life-saving treatment in many critically ill patients, it is associated with complications such as infection or barotrauma. Other innovative techniques are mask ventilation and proportional assist ventilation (PAV). The major aim of mask ventilation is to prevent complications related to tracheal intubation, particularly respiratory tract infections and barotrauma.
Acute Disease↗
Vinorelbine monochemotherapy in non-small-cell lung cancer: experience in patients with low performance status.
The aim of this study was to investigate the activity and safety of vinorelbine in patients with low performance status. From March 1992 to June 1993 we studied 14 untreated patients with Stage IV non-small-cell lung cancer (NSCLC) and a "performance status" lower than 70% of the Karnofsky score. Treatment was by means of an intravenous administration of vinorelbine (30 mg.m-2) repeated weekly. On the whole, the toxicity was mild. Of 150 cycles administered, we observed 10 cases of Grade 3 leucopenia and 4 cases of Grade 4 leucopenia. A peripheral neurotoxicity (Grade 2-3) was reported in two patients. The objective response rate was 36% partial response. Our data suggest that vinorelbine could be an active and safe treatment for those patients who cannot receive polychemotherapy because of low performance status, and justify further larger studies comparing vinorelbine, either as a single agent or in combination, to other analogues or to assess its efficacy in supportive care.
Adult↗
COPD patients and mechanical ventilation with positive end expiratory pressure (PEEP).
Application of positive and expiratory pressure (PEEP) is widely used in mechanically ventilated patients with acute respiratory failure (ARF) due to adult respiratory distress syndrome. Recent studies have suggested that application of PEEP can be useful in patients with chronic obstructive pulmonary disease (COPD) to reduce the mechanical inspiratory load due to intrinsic positive and expiratory pressure (PEEPi). In any ventilatory mode (controlled mechanical ventilation, assisted mechanical ventilation) and during weaning, application of moderate levels of PEEP replace in part PEEPi without adding to it and without significantly increasing lung volume.
Humans↗
[Metachronous tumors of the breast. Mammographic findings].
In breast carcinoma patients the risk to develop a second lesion in the contralateral breast is two to six times higher than in control subjects. The second lesion is called metachronous and classified among bilateral breast cancers. This kind of lesion affects the patients who were mastectomized for breast carcinoma; it may be a primary lesion, when the histologic type is different from that of the first breast cancer or secondary, when the histologic type is the same as that of the first tumor and the second lesion is therefore a metastasis. This study was made to assess the incidence of metachronous lesions and the average time between the first and the second tumor and to investigate the value of mammographic followup. We selected 375 patients who had undergone mastectomy for different histologic types of breast carcinoma and examined the contralateral breast with mammography 6 months after surgery and then every 12 months, January 1990 through January 1992. Mammography showed metachronous lesions in 23 cases: 15 infiltrating ductal carcinomas, 6 infiltrating lobular carcinomas and 2 in situ carcinomas, the latter with histologic confirmation in the patients operated on for benign breast lesions. The incidence of metachronous tumors was 6%, including both the primary and the metastatic lesions; the average time between the first and the second tumors was 20 months. Mammography allowed metachronous lesions to be diagnosed in a very early stage, much earlier than in other studies not including mammography. Prognosis is definitely improved by the early diagnosis of primary breast cancer, when no metastatic spread is present, and also in case of primary metachronous lesions, which are very uncommon.
Adult↗
[Cystic neurinoma of the axilla. A case report].
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Axilla↗
Inspiratory workload in acute respiratory failure and during weaning from mechanical ventilation.
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Acute Disease↗
Dose-response effects and time course of effects of inhaled fenoterol on respiratory mechanics and arterial oxygen tension in mechanically ventilated patients with chronic airflow obstruction.
To investigate the dose-response relationship and the time course of the effects of fenoterol (a selective beta 2-adrenergic agonist) on respiratory function in mechanically ventilated patients with acute respiratory failure due to exacerbation of chronic airflow obstruction (CAO), seven consecutive acutely ill patients were studied within 3 days of the onset of mechanical ventilation. Airflow, airway pressure, and changes in lung volume were measured with the transducers of the 900 C Servo Ventilator, the last by electronic integration. The end-expiratory lung volume (EELV), the intrinsic positive end-expiratory pressure (PEEPi), the static respiratory compliance (Cstrs), maximum and minimum respiratory resistance (Rrsmax and Rrsmin), and arterial oxygen tension (PaO2), were measured under control conditions (all patients were receiving aminophylline infused at a constant rate) 5, 15, and 30 min after administration of 4 ml aerosolized saline solution and 5, 15, and 30 min after inhalation of 0.4, 0.8, and 1.2 mg fenoterol. After the last dose, measurements were repeated at 60, 120, and 180 min. We found that, on average, while saline did not cause any significant change in respiratory mechanics, a low dose (0.4 mg) of inhaled fenoterol was followed by a rapid (5 min) and significant decrease in Rrsmax (-33%), Rrsmin (-28%), EELV (-34%), and PEEPi (-44%), with a slight but not significant further fall with higher doses. However, changes were short-lasting, and by 2 h after the end of administration were no longer significant. PaO2 dropped significantly on average, with a maximum mean fall of 15 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Inhalation↗
"Intrinsic" positive end-expiratory pressure in stable patients with chronic obstructive pulmonary disease.
We have assessed "intrinsic" positive end-expiratory pressure (PEEPi), during quiet breathing in 18 patients with chronic obstructive pulmonary disease (COPD) in stable condition. Ventilatory flow, lung volume, oesophageal (Poes), gastric (Pga), and transdiaphragmatic pressure (Pdi) were measured. PEEPi was measured as the pressure difference (delta Poes) between the onset of the inspiratory effort, indicated by the start of the Pdi swing, and the point corresponding to zero flow. PEEPi was present in all of the 18 COPD patients, and averaged 2.4 +/- 1.6 cmH2O. The maximum transdiaphragmatic pressure (Pdi,max) was also measured and averaged 81.5 +/- 17.4 cmH2O. Following a randomized sequence, ten patients then inhaled an adrenergic agonist (fenoterol 1.6 mg), and eight patients the corresponding placebo. Fenoterol, but not placebo, caused a significant increase in forced expiratory volume in one second (FEV1) (+34%, on average), associated with a significant decrease in PEEPi (-63%, on average) and a significant improvement in Pdi,max (+19%, on average). We conclude that: 1) intrinsic PEEP can be present in stable COPD patients due to increased airflow resistance; 2) fenoterol improved diaphragmatic strength (Pdi,max) in our COPD patients, possibly due to a decrease in lung volume.
Aged↗
Doxofylline and respiratory mechanics. Short-term effects in mechanically ventilated patients with airflow obstruction and respiratory failure.
To assess the short-term effects of a methylxanthine (doxofylline) on respiratory mechanics in mechanically ventilated patients with airway obstruction and respiratory failure, nine consecutive patients were examined within three days from the onset of mechanical ventilation. Flow, changes in pulmonary volume, and Paw were measured using a ventilator (Servo 900C). End-expiratory and end-inspiratory airway occlusion was performed to measure PEEPi, Cstrs, Rrsmax, and Rrsmin. Measurements were performed before and at 5, 15, and 30 minutes after an intravenous loading dose of doxofylline (5 to 6 mg/kg). We found that doxofylline determined, on the average, a marked decrease in respiratory resistance (Rrsmax and Rrsmin, -27.2 percent and -36.5 percent, respectively) without significant changes in Cstrs and Pmax. The PEEPi, reflecting pulmonary dynamic hyperinflation, was also significantly decreased by doxofylline (-41 percent, on the average). The Pmax was not reliable for evaluation of a single patient, since changes in the elastic pressure can offset changes in the resistive one. No patient experienced significant side effects due to doxofylline. We conclude that (1) the effects of therapy can be assessed noninvasively at bedside in critically ill patients; (2) doxofylline is a rapid and efficient bronchodilator in mechanically ventilated patients with ARF and airflow obstruction; and (3) the decrease in the respiratory resistance and PEEPi, associated with an improved mechanical efficiency of the respiratory muscles at a lower pulmonary volume, can provide better conditions for the patient-ventilator interaction and for weaning.
Bronchodilator Agents↗
Respiratory mechanics during the first day of mechanical ventilation in patients with pulmonary edema and chronic airway obstruction.
We investigated the early changes of respiratory mechanics in mechanically ventilated patients with acute respiratory failure (ARF): 8 patients after acute exacerbation of chronic airway obstruction (CAO), 8 patients with cardiogenic pulmonary edema (CPE), and 8 patients with adult respiratory distress syndrome (ARDS). The patients were studied within the first day from the onset of mechanical ventilation. Flow, changes in lung volume, and airway pressure were measured using the 900C Servo Ventilator. End-inspiratory and end-expiratory occlusions of the airway were performed to obtain respiratory compliance and resistance. We found that: (1) acute exacerbation of CAO was characterized by high respiratory resistance (reflecting in part time-constant inequalities within the lung) and severe pulmonary hyperinflation, with "intrinsic" PEEP (PEEPi) up to 22 cm H2O (mean [SD], 13.5 [6.7] cm H2O); (2) PEEPi, even if not high, was present in almost all patients with pulmonary edema, averaging 3.8 and 3.0 cm H2O in ARDS and CPE, respectively; (3) respiratory resistance was increased in patients with CPE and ARDS who had no history of airway disease; (4) patients with ARDS were characterized also by low compliance (mean [SD], 0.035 [0.005] L/cm H2O) and high resistance, the latter also reflecting a substantial component caused by time-constant inequalities; (5) in all 24 patients, static respiratory compliance (and its reciprocal, elastance) was significantly correlated with the pulmonary oxygenation index, i.e., the PaO2/PAO2 ratio. We conclude that early assessment of respiratory mechanics in mechanically ventilated patients with ARF can provide better understanding of the patients' conditions as well as guidelines for therapeutic approach and weaning attempts.
Airway Resistance↗
Respiratory resistance and intrinsic positive end-expiratory pressure (PEEPi) in patients with the adult respiratory distress syndrome (ARDS).
Fourteen consecutive ARDS patients were examined within 24 h from the onset of mechanical ventilation to determine respiratory resistance (Rrs) and compliance (Cstrs), and to assess the influence of "intrinsic" positive end-expiratory pressure (PEEPi) on the measurement of Cstrs. Flow, pressure, and changes in lung volume were measured with the transducers of the Servo 900C Siemens ventilator. Airway occlusion was performed with the end-inspiratory and end-expiratory buttons of the ventilator. We found PEEPi (3.0 +/- 2.6 cm H2O) in ten of the fourteen patients. Without the correction for PEEPi, Cstrs was underestimated by 13.9 +/- 10% on average in the group as a whole (fourteen patients), and by 19.5 +/- 5.9% in the ten ARDS patients with PEEPi. Maximum and minimum respiratory resistance (Rrsmax and Rrsmin), and frequency-dependence of Rrs were also measured. On average, there was a marked frequency-dependence of resistance, as manifested by the difference between Rrsmax and Rrsmin, with an increase of both Rrsmin (7.7 +/- 4.2 cm H2O.l-1.s) and Rrsmax (14.3 +/- 5.0 cm H2O.l-1.s). The added resistance of the endotracheal tubes and ventilator tubings was flow dependent, and averaged 13.2 +/- 2.9 cm H2O.l-1.s.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗