Ця стаття є частиною Європейських настанов з профілактики периопераційної венозної тромбоемболії.... more Ця стаття є частиною Європейських настанов з профілактики периопераційної венозної тромбоемболії. Для отримання деталей стосовно основ, методів та учасників робочої групи настанов з венозної тромбоемболії Європейської Спілки анестезіологів будь-ласка, зверніться до матеріалу Samama CM, Afshari A. Європейські настанови з профілактики периопераційної венозної тромбоемболії. Європейський анестезіологічний журнал 2018; X:000-000 Європейський анестезіологічний журнал 2017; 34:1-7 Переклад M-gate
March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successful... more March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent high-resolution CT (HRCT) of the lung in a complex follow-up program to identify specific abnormalities of acute and chronic rejection (bronchiolitis obliterans) and to monitor the resolution of the bronchial anastomosis. Twenty-two HRCT exams were performed. In patients with acute rejection HRCT failed to identify specific abnormalities of lung parenchyma. In contrast, in one patient with pathological evidence of early bronchiolitis obliterans HRCT showed decreased peripheral vascularization. In the study of the bronchial anastomosis, HRCT showed optimal anastomosis resolution in 4 patients, whereas in one patient with a granuloma demonstrated by fibrobronchoscopy it confirmed the lesion showing also a small pneumomediastinum. Even though the HRCT finding of decreased peripheral vascularization does not a...
Factors influencing nitrogen balance during total parenteral nutrition have been investigated in ... more Factors influencing nitrogen balance during total parenteral nutrition have been investigated in 34 critically ill injured patients studied during the first 6 days after trauma. Basal nitrogen balance was severely negative (-0.26 +/- 0.12 (SD) g X kg-1), but improved consistently during treatment. Nitrogen intake proved to be the major determinant of a positive, or less negative, nitrogen balance, only secondarily followed by total energy intake corrected to predicted basal energy expenditure, according to multiple regression analysis. The amount of non-protein calories and the non-protein calorie to nitrogen ratio appeared to have little significance on nitrogen balance, when corrected for the two former variables.
The metabolic effects of TPN were studied in a selected group of trauma patients. Nineteen patien... more The metabolic effects of TPN were studied in a selected group of trauma patients. Nineteen patients were randomly divided into two groups: the first was treated with glucose and insulin, the second with glucose, insulin and amino acids. Each patient in both groups received TPN isocaloric with respect to daily energy output and the treatment lasted five days. Each group was further divided into two subsets (severe or moderate catabolism) according to fasting energy output with respect to the expected energy expenditure. During the acute flow phase, both in moderate as well as in severe catabolism, glucose and insulin were effective for protein sparing; the maximum protein sparing effect was reached when giving a caloric intake equal to 130% of daily energy output. Glucose, insulin and amino acids were effective in replacement of nitrogen losses. In moderately catabolic patients nitrogen balance was significantly better than in severely catabolic patients. This study shows that early and short-term TPN is effective in controlling the flow phase of trauma. Glucose and insulin appear to be the determinants of the protein sparing effect when given in amounts equal to those needed; amino acids provided protein replacement when given in amounts equal to about 20~ of energy output. Energy supply higher than 120 -130% of daily energy output does not increase protein sparing and protein replacement, the only effect being a further increase in metabolism, which is possibly dangerous in critically ill patients.
using 2 ml or 5 ml syringes, the excess blood then being discarded along with the disposable syri... more using 2 ml or 5 ml syringes, the excess blood then being discarded along with the disposable syringes. By using the smalled and also less expensive insulin synringe, as well as educating our nurses and technicians, we were able to further reduce blood loss. As most blood tests require serum or plasma, one could further reduce blood wastage by centrifuging the samples and returning the cells to the patient. This requires strict asepsis is both time consuming and inconvenient, but may be useful when large amounts of plasma are required, such as with some research projects. In conclusion the use of microanalytic laboratory methods leads to as much as 90% reduction in blood loss from laboratory tests without compromising the accuracy of the results. All dialysis facilities are therefore urged to use these methods, which have reliably served pediatric populations for many years.
Following the exclusion of the ventilation of a lung, perfusion is arrested as a consequence of t... more Following the exclusion of the ventilation of a lung, perfusion is arrested as a consequence of the Von Euler and Liljestrand vasoconstrictive reflex. However it is as yet unknown how long this phenomenon takes to manifest itself in human beings. In order to verify whether hypoxic pulmonary vasoconstriction follows immediately on the arrest of ventilation or whether there is one some delay, in 21 candidates for pneumonectomy a bronchial block was provoked during fibrobronchoscopy and the hemogasanalytic modifications induced by the acute occlusion of the main bronchus have been studied. The analysis of the resulting data allows for the hypothesis that the exclusion of lung ventilation for 14 minutes is not sufficient to cause the complete manifestation of the hypoxic vasoconstrictive reflex.
Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung cond... more Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung conditioning, consisting of a series of prolonged inflations of the lungs at 35 cm H2O, followed by approximately 10 min of application of continuous positive airway pressure (CPAP) equal to 15-20 cm H2O, before umbilical cord interruption. The aim of this study was to evaluate, in a primate experimental model, the safety and efficacy in the prevention of neonatal RDS of a technique so far experimented on only in ovine models. Thoraco-pulmonary compliance exceeded the value of 0.2 ml (cm H2O)-1.kg-1 in only 1 animal out of 5 (20%), which didn't develop illness, versus 69% of positive results achieved with the same technique in lambs at 128-130 day gestation, an experimental model considered in the literature as equivalent to a 140 +/- 3 day gestation baboon as far as it concerns incidence and severity of RDS. The application of lung conditioning was easy and safe (as previously reported)...
Southern medical journal (Birmingham, Ala. Print), 1990
Within the past 15 years, the use of spinal opiates has gained acceptance as a means of achieving... more Within the past 15 years, the use of spinal opiates has gained acceptance as a means of achieving postoperative analgesia during various surgical procedures, though little has been reported concerning such use in head and neck surgery. Our experience with intrathecal morphine for eight patients who have had head and neck surgery is reviewed. Mechanisms of pain and possible sites of action of intrathecal morphine as they pertain to these patients are discussed. Adequate postoperative analgesia was achieved in seven of our eight patients. Only one patient required supplemental intravenous narcotics during the initial 24-hour postoperative period. This patient had a history of chronic narcotic use, suggesting that such patients may be tolerant to intrathecal narcotics as they are to narcotics given by other routes.
Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung cond... more Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung conditioning, consisting of a series of prolonged inflations of the lungs at 35 cm H2O, followed by approximately 10 min of application of continuous positive airway pressure (CPAP) equal to 15-20 cm H2O, before umbilical cord interruption. The aim of this study was to evaluate, in a primate experimental model, the safety and efficacy in the prevention of neonatal RDS of a technique so far experimented on only in ovine models. Thoraco-pulmonary compliance exceeded the value of 0.2 ml (cm H2O)-1.kg-1 in only 1 animal out of 5 (20%), which didn't develop illness, versus 69% of positive results achieved with the same technique in lambs at 128-130 day gestation, an experimental model considered in the literature as equivalent to a 140 +/- 3 day gestation baboon as far as it concerns incidence and severity of RDS. The application of lung conditioning was easy and safe (as previously reported)...
Blood stored in acid-citrate-dextrose (ACD) shows a progressive decrease in 2,3-diphosphoglycerat... more Blood stored in acid-citrate-dextrose (ACD) shows a progressive decrease in 2,3-diphosphoglycerate (DPG) content. Since the decrease in DPG increases hemoglobin oxygen affinity, which in turn may reduce tissue and venous PO2 and peripheral oxygen delivery, many efforts have been made to preserve or restore DPG levels in stored blood. An in vivo rejuvenating technique, employing fructose-1,6-diphosphate (FDP) at a mean dosage of 1 mmol kg-1 day-1 of phosphate, to increase the DPG circulating level in multi-transfused patients is proposed. Eighteen patients, who received at least one-third of their estimated blood volume (3990 +/- 480 (SEM) ml of ACD stored blood) in blood transfusion, were treated: nine with inorganic phosphate, and nine with FDP. Basal DPG was very low in both groups: 12.61 +/- 1.34 (SEM) and 10.42 +/- 0.98 (SEM) mumol g-1, respectively (normal value is 14.5 mumol g-1, at pH 7.40). However, DPG values increased significantly and promptly in patients receiving FDP, w...
Preterm fetal lambs of a gestational are highly susceptible to hyaline membrane disease were plac... more Preterm fetal lambs of a gestational are highly susceptible to hyaline membrane disease were placed on apneic oxygenation while keeping the umbilical circulation intact and still connected to the mother ewe for the removal of metabolically produced CO2. After 4-6 hrs the total lung compliance and the chest x-ray films had markedly improved, allowing normal pulmonary ventilation with a mechanical ventilator. Fetuses older than 135 days gestation were later extubated and allowed to breathe room air unassisted. Fetuses 134 days gestation and younger were kept on mechanical ventilation. None of the animals so treated developed hyaline membrane disease. We believe pulmonary conditioning is an important tool in the prevention and the treatment of hyaline membrane disease. In this animal model we have shown that hyaline membrane disease is a preventable and curable disease.
Ця стаття є частиною Європейських настанов з профілактики периопераційної венозної тромбоемболії.... more Ця стаття є частиною Європейських настанов з профілактики периопераційної венозної тромбоемболії. Для отримання деталей стосовно основ, методів та учасників робочої групи настанов з венозної тромбоемболії Європейської Спілки анестезіологів будь-ласка, зверніться до матеріалу Samama CM, Afshari A. Європейські настанови з профілактики периопераційної венозної тромбоемболії. Європейський анестезіологічний журнал 2018; X:000-000 Європейський анестезіологічний журнал 2017; 34:1-7 Переклад M-gate
March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successful... more March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent high-resolution CT (HRCT) of the lung in a complex follow-up program to identify specific abnormalities of acute and chronic rejection (bronchiolitis obliterans) and to monitor the resolution of the bronchial anastomosis. Twenty-two HRCT exams were performed. In patients with acute rejection HRCT failed to identify specific abnormalities of lung parenchyma. In contrast, in one patient with pathological evidence of early bronchiolitis obliterans HRCT showed decreased peripheral vascularization. In the study of the bronchial anastomosis, HRCT showed optimal anastomosis resolution in 4 patients, whereas in one patient with a granuloma demonstrated by fibrobronchoscopy it confirmed the lesion showing also a small pneumomediastinum. Even though the HRCT finding of decreased peripheral vascularization does not a...
Factors influencing nitrogen balance during total parenteral nutrition have been investigated in ... more Factors influencing nitrogen balance during total parenteral nutrition have been investigated in 34 critically ill injured patients studied during the first 6 days after trauma. Basal nitrogen balance was severely negative (-0.26 +/- 0.12 (SD) g X kg-1), but improved consistently during treatment. Nitrogen intake proved to be the major determinant of a positive, or less negative, nitrogen balance, only secondarily followed by total energy intake corrected to predicted basal energy expenditure, according to multiple regression analysis. The amount of non-protein calories and the non-protein calorie to nitrogen ratio appeared to have little significance on nitrogen balance, when corrected for the two former variables.
The metabolic effects of TPN were studied in a selected group of trauma patients. Nineteen patien... more The metabolic effects of TPN were studied in a selected group of trauma patients. Nineteen patients were randomly divided into two groups: the first was treated with glucose and insulin, the second with glucose, insulin and amino acids. Each patient in both groups received TPN isocaloric with respect to daily energy output and the treatment lasted five days. Each group was further divided into two subsets (severe or moderate catabolism) according to fasting energy output with respect to the expected energy expenditure. During the acute flow phase, both in moderate as well as in severe catabolism, glucose and insulin were effective for protein sparing; the maximum protein sparing effect was reached when giving a caloric intake equal to 130% of daily energy output. Glucose, insulin and amino acids were effective in replacement of nitrogen losses. In moderately catabolic patients nitrogen balance was significantly better than in severely catabolic patients. This study shows that early and short-term TPN is effective in controlling the flow phase of trauma. Glucose and insulin appear to be the determinants of the protein sparing effect when given in amounts equal to those needed; amino acids provided protein replacement when given in amounts equal to about 20~ of energy output. Energy supply higher than 120 -130% of daily energy output does not increase protein sparing and protein replacement, the only effect being a further increase in metabolism, which is possibly dangerous in critically ill patients.
using 2 ml or 5 ml syringes, the excess blood then being discarded along with the disposable syri... more using 2 ml or 5 ml syringes, the excess blood then being discarded along with the disposable syringes. By using the smalled and also less expensive insulin synringe, as well as educating our nurses and technicians, we were able to further reduce blood loss. As most blood tests require serum or plasma, one could further reduce blood wastage by centrifuging the samples and returning the cells to the patient. This requires strict asepsis is both time consuming and inconvenient, but may be useful when large amounts of plasma are required, such as with some research projects. In conclusion the use of microanalytic laboratory methods leads to as much as 90% reduction in blood loss from laboratory tests without compromising the accuracy of the results. All dialysis facilities are therefore urged to use these methods, which have reliably served pediatric populations for many years.
Following the exclusion of the ventilation of a lung, perfusion is arrested as a consequence of t... more Following the exclusion of the ventilation of a lung, perfusion is arrested as a consequence of the Von Euler and Liljestrand vasoconstrictive reflex. However it is as yet unknown how long this phenomenon takes to manifest itself in human beings. In order to verify whether hypoxic pulmonary vasoconstriction follows immediately on the arrest of ventilation or whether there is one some delay, in 21 candidates for pneumonectomy a bronchial block was provoked during fibrobronchoscopy and the hemogasanalytic modifications induced by the acute occlusion of the main bronchus have been studied. The analysis of the resulting data allows for the hypothesis that the exclusion of lung ventilation for 14 minutes is not sufficient to cause the complete manifestation of the hypoxic vasoconstrictive reflex.
Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung cond... more Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung conditioning, consisting of a series of prolonged inflations of the lungs at 35 cm H2O, followed by approximately 10 min of application of continuous positive airway pressure (CPAP) equal to 15-20 cm H2O, before umbilical cord interruption. The aim of this study was to evaluate, in a primate experimental model, the safety and efficacy in the prevention of neonatal RDS of a technique so far experimented on only in ovine models. Thoraco-pulmonary compliance exceeded the value of 0.2 ml (cm H2O)-1.kg-1 in only 1 animal out of 5 (20%), which didn't develop illness, versus 69% of positive results achieved with the same technique in lambs at 128-130 day gestation, an experimental model considered in the literature as equivalent to a 140 +/- 3 day gestation baboon as far as it concerns incidence and severity of RDS. The application of lung conditioning was easy and safe (as previously reported)...
Southern medical journal (Birmingham, Ala. Print), 1990
Within the past 15 years, the use of spinal opiates has gained acceptance as a means of achieving... more Within the past 15 years, the use of spinal opiates has gained acceptance as a means of achieving postoperative analgesia during various surgical procedures, though little has been reported concerning such use in head and neck surgery. Our experience with intrathecal morphine for eight patients who have had head and neck surgery is reviewed. Mechanisms of pain and possible sites of action of intrathecal morphine as they pertain to these patients are discussed. Adequate postoperative analgesia was achieved in seven of our eight patients. Only one patient required supplemental intravenous narcotics during the initial 24-hour postoperative period. This patient had a history of chronic narcotic use, suggesting that such patients may be tolerant to intrathecal narcotics as they are to narcotics given by other routes.
Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung cond... more Preterm baboons at 140 +/- 3 day gestation (term 182 +/- 7 days) have been subjected to lung conditioning, consisting of a series of prolonged inflations of the lungs at 35 cm H2O, followed by approximately 10 min of application of continuous positive airway pressure (CPAP) equal to 15-20 cm H2O, before umbilical cord interruption. The aim of this study was to evaluate, in a primate experimental model, the safety and efficacy in the prevention of neonatal RDS of a technique so far experimented on only in ovine models. Thoraco-pulmonary compliance exceeded the value of 0.2 ml (cm H2O)-1.kg-1 in only 1 animal out of 5 (20%), which didn't develop illness, versus 69% of positive results achieved with the same technique in lambs at 128-130 day gestation, an experimental model considered in the literature as equivalent to a 140 +/- 3 day gestation baboon as far as it concerns incidence and severity of RDS. The application of lung conditioning was easy and safe (as previously reported)...
Blood stored in acid-citrate-dextrose (ACD) shows a progressive decrease in 2,3-diphosphoglycerat... more Blood stored in acid-citrate-dextrose (ACD) shows a progressive decrease in 2,3-diphosphoglycerate (DPG) content. Since the decrease in DPG increases hemoglobin oxygen affinity, which in turn may reduce tissue and venous PO2 and peripheral oxygen delivery, many efforts have been made to preserve or restore DPG levels in stored blood. An in vivo rejuvenating technique, employing fructose-1,6-diphosphate (FDP) at a mean dosage of 1 mmol kg-1 day-1 of phosphate, to increase the DPG circulating level in multi-transfused patients is proposed. Eighteen patients, who received at least one-third of their estimated blood volume (3990 +/- 480 (SEM) ml of ACD stored blood) in blood transfusion, were treated: nine with inorganic phosphate, and nine with FDP. Basal DPG was very low in both groups: 12.61 +/- 1.34 (SEM) and 10.42 +/- 0.98 (SEM) mumol g-1, respectively (normal value is 14.5 mumol g-1, at pH 7.40). However, DPG values increased significantly and promptly in patients receiving FDP, w...
Preterm fetal lambs of a gestational are highly susceptible to hyaline membrane disease were plac... more Preterm fetal lambs of a gestational are highly susceptible to hyaline membrane disease were placed on apneic oxygenation while keeping the umbilical circulation intact and still connected to the mother ewe for the removal of metabolically produced CO2. After 4-6 hrs the total lung compliance and the chest x-ray films had markedly improved, allowing normal pulmonary ventilation with a mechanical ventilator. Fetuses older than 135 days gestation were later extubated and allowed to breathe room air unassisted. Fetuses 134 days gestation and younger were kept on mechanical ventilation. None of the animals so treated developed hyaline membrane disease. We believe pulmonary conditioning is an important tool in the prevention and the treatment of hyaline membrane disease. In this animal model we have shown that hyaline membrane disease is a preventable and curable disease.
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