Biomedical subjects

Sergio Vesconi

Publications and source records attributed to Sergio Vesconi.

3 recordsLinked to original sources

PubMed2007

Giant intracranial aneurysms treated with deep hypothermia and circulatory arrest.

The use of deep hypothermic circulatory arrest (DHCA), using groin cannulation with the chest closed (CCDHCA), has improved the surgical treatment of large and giant cerebral aneurysms. Twelve consecutive ASA I-II patients (10 women and 2 men), with a mean age of 35 years (range 14 to 55 y) underwent DHCA for clipping or trapping of their aneurysm (giant, n=10; large, n=2; 42% posterior circulation), under balanced general anesthesia. Intraoperative standard monitors were completed with jugular oxygen saturation, pulmonary artery, pulmonary artery occlusion, central venous pressures, electroencephalography, evoked potentials, and cerebral (subdural), and core temperature. At the start of circulatory arrest, brain temperature was 15.1+/-1.1 degrees C (range 13.5 to 17.5), and core temperature 14.1+/-1.1 degrees C (range 12.7 to 17.0). Mean circulatory arrest time was 26.5+/-13.9 minutes (range 9 to 54) and anesthesia lasted 14+/-1 hours. Only one patient underwent DHCA with standard sternotomy, because of aortic insufficiency. Follow-up (up to 70 mo) revealed no deaths and Glasgow Outcome Scale at 6 months revealed good recovery in 9, moderate disability in 1, and severe disability in 2 patients. Selected patients with large/giant intracranial aneurysms, deemed unapproachable by conventional surgical techniques, were successfully treated using CCDHCA. Mortality rate was 0% and neurologic complications occurred in 25% of the patients.

Adolescent↗

PubMed2006

Preventable trauma deaths: from panel review to population based-studies.

Preventable trauma deaths are defined as deaths which could be avoided if optimal care has been delivered. Studies on preventable trauma deaths have been accomplished initially with panel reviews of pre-hospital and hospital charts. However, several investigators questioned the reliability and validity of this method because of low reproducibility of implicit judgments when they are made by different experts. Nevertheless, number of studies were published all around the world and ultimately gained some credibility, particularly in regions where comparisons were made before and after trauma system implementation with a resultant fall in mortality. During the last decade of century the method of comparing observed survival with probability of survival calculated from large trauma registries has obtained popularity. Preventable trauma deaths were identified as deaths occurred notwithstanding a high calculated probability of survival. In recent years, preventable trauma deaths studies have been replaced by population-based studies, which use databases representative of overall population, therefore with high epidemiologic value. These databases contain readily available information which carry out the advantage of objectivity and large numbers. Nowadays, population-based researches provide the strongest evidence regarding the effectiveness of trauma systems and trauma centers on patient outcomes.

Journal Article↗

PubMed2005

Study protocol: the DOse REsponse Multicentre International collaborative initiative (DO-RE-MI).

INTRODUCTION: Current practices for renal replacement therapy in intensive care units (ICUs) remain poorly defined. The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) will address the issue of how the different modes of renal replacement therapy are currently chosen and performed. Here, we describe the study protocol, which was approved by the Scientific and Steering Committees. METHODS: DO-RE-MI is an observational, multicentre study conducted in ICUs. The primary end-point will be the delivered dose of dialysis, which will be compared with ICU mortality, 28-day mortality, hospital mortality, ICU length of stay and number of days of mechanical ventilation. The secondary end-point will be the haemodynamic response to renal replacement therapy, expressed as percentage reduction in noradrenaline (norepinephrine) requirement. Based on the the sample analysis calculation, at least 162 patients must be recruited. Anonymized patient data will be entered online in electronic case report forms and uploaded to an internet website. Each participating centre will have 2 months to become acquainted with the electronic case report forms. After this period official recruitment will begin. Patient data belong to the respective centre, which may use the database for its own needs. However, all centres have agreed to participate in a joint effort to achieve the sample size needed for statistical analysis. CONCLUSION: The study will hopefully help to collect useful information on the current practice of renal replacement therapy in ICUs. It will also provide a centre-based collection of data that will be useful for monitoring all aspects of extracorporeal support, such as incidence, frequency, and duration.

Blood Pressure↗