RESUMO
INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.
Assuntos
Serviço Hospitalar de Emergência/normas , Admissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde , Serviço Hospitalar de Emergência/organização & administração , Pesquisas sobre Atenção à Saúde , Humanos , Itália , TriagemRESUMO
The aim of this study was to determine the influence of radiographic contrast media (CM) on endothelial cells in order to compare the effects of non-ionic (Iomeron and Visipaque) and ionic (Hexabrix and Uromiro) CM on the endothelial cells (EC). Human and murine cells were exposed for 2, 4 and 24h to increasing concentrations (12.5, 25, 50 and 100mg/mL) of test compounds. Controls were incubated with complete growth medium or mannitol solution (osmotic control). MTT assay was used to evaluate the cell viability, LDH assay was used to evaluate the membrane damage. The results demonstrate a difference between non-ionic and ionic compounds in the effect on endothelium. Ionic CM show to strongly affect endothelial cells viability under all tested conditions, while non-ionic CM show effects only after prolonged exposure at 50 and 100mg/mL, which represent instant concentrations lasting just minutes after intravascular injection of CM. Taken together, these results confirm that the currently employed non-ionic contrast media are well tolerated by the vascular endothelium and have wide margins of safety.
Assuntos
Meios de Contraste/efeitos adversos , Células Endoteliais/efeitos dos fármacos , Animais , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Relação Dose-Resposta a Droga , Humanos , Iodamida/efeitos adversos , Iopamidol/efeitos adversos , Iopamidol/análogos & derivados , Ácido Ioxáglico/efeitos adversos , L-Lactato Desidrogenase/metabolismo , Camundongos , Ácidos Tri-Iodobenzoicos/efeitos adversosRESUMO
The intravascular ultrasound (IVUS) modality has rapidly gained acceptance for the measurement of arterial plaque thickness and for anatomical characterization. In view, however, of the growing interest in the direct assessment of plaque size after therapeutic modalities directly reducing plaque burden, a non-invasive method such as magnetic resonance imaging (MRI) may be of help for repeated evaluations. The two methods were compared directly on a focal plaque developed at the abdominal aortic level by a combination of local electric lesion followed by a hypercholesterolemic diet. The plaque was fully characterized histopathologically at intervals up to 120 days from lesion induction, and maximal plaque formation was detected at 90 days from electrical injury. Plaques could be well assessed by IVUS at each time point analyzed and data correlated very well to histopathologic findings (r = 0.969, P = 0.0014). The MRI technology provided reliable determinations only at 90 days after lesion induction, i.e. at maximal plaque formation, with excellent correspondence to IVUS determinations (r = 0.989, P = 0.0111). Altogether these findings indicate that the non-invasive MRI technology, when applied to the analysis of arterial plaques of adequate size, can be used successfully for plaque determination, with results comparable to the invasive IVUS technique.
Assuntos
Arteriosclerose/diagnóstico por imagem , Arteriosclerose/patologia , Angiografia por Ressonância Magnética/métodos , Ultrassonografia de Intervenção/métodos , Análise de Variância , Animais , Aorta/patologia , Técnicas de Cultura , Modelos Animais de Doenças , Imuno-Histoquímica , Masculino , Probabilidade , Coelhos , Sensibilidade e EspecificidadeRESUMO
RATIONALE AND OBJECTIVES: Because contrast agent (CA) formulations are injected intravenously to patients who may have a disrupted blood-brain barrier, their neurotolerability should be tested by using appropriate animal models. In the present study, a model of rat brain ischemia evaluated in terms of the electroencephalogram (EEG) was validated and then used to compare the neurotolerability of gadobenate dimeglumine to that of gadodiamide, a well-documented CA for brain MRI. METHODS: Rats were prepared for EEG recording about 15 days before ischemia induction. Ischemia was induced in the right hemisphere by 2-hour middle cerebral artery (MCA) occlusion and 3-day reperfusion. Model validation in terms of EEG, on day 3 after MCA occlusion, was performed by using iopromide, a poorly neurotolerated iodinated CA in rats, intravenously injected at 7 g iodine/kg. The EEG recording was analyzed for pathological tracings and for changes in spectral content in terms of the frequency index (FI) at 1, 2, and 3 hours after test compound injection. The comparative study between gadobenate dimeglumine and gadodiamide was performed at 2.0 mmol/kg. D-Mannitol was used as a control compound. The presence of CA in the rat brain was verified by measuring the total gadolinium content by using inductively coupled plasma-atomic emission spectrometry analysis. Given the absence of metabolism for both CAs, the values of gadolinium content can be interpreted as representing unmetabolized CA. RESULTS: On days 1, 2, and 3 after transient MCA occlusion, the lesioned hemisphere of rats presented a decreased FI value with respect to the basal value. The unlesioned hemisphere, after a slight, nonsignificant decrease in the FI value on the first 2 days, presented a normal FI value on day 3. Thus, ischemic rats on day 3 after transient MCA occlusion were chosen for these neurotolerability studies. Iopromide injected intravenously into ischemic rats at a dose 10 times higher than the maximum clinical dose caused bilateral spikes on the EEG and increases in FI values for the unlesioned hemisphere without affecting the lesioned hemisphere. Gadobenate dimeglumine, like gadodiamide when injected into ischemic rats, did not cause spikes or further changes in the FI value of the lesioned hemisphere and did not modify the normal FI value of the unlesioned hemisphere. Furthermore, no significant differences between gadobenate dimeglumine, gadodiamide, and D-mannitol were found when postinjection FI values were compared. Finally, higher levels of gadolinium were found in the lesioned hemisphere with respect to the unlesioned hemisphere after both gadobenate dimeglumine and gadodiamide administration. CONCLUSIONS: We can therefore conclude that (1) on the EEG, ischemia induced by transient MCA occlusion is an appropriate model for evaluating CA neurotolerability because ischemic and CA effects can be clearly differentiated; (2) the higher level of CA in the lesioned hemisphere compared with the unlesioned one (two to three times), even 3 hours after injection, demonstrates that the CA effectively penetrated the brain; if it were neurotoxic, any negative effects would have been detected; and (3) gadobenate dimeglumine, like gadodiamide, injected intravenously at a dose 20 times higher than the intended clinical dose for brain MRI is well tolerated and, also like gadodiamide, is suitable for use in neurological diseases for which contrast-enhanced MRI is indicated.
Assuntos
Arteriopatias Oclusivas/fisiopatologia , Isquemia Encefálica/fisiopatologia , Encéfalo/efeitos dos fármacos , Doenças Arteriais Cerebrais/fisiopatologia , Meios de Contraste/efeitos adversos , Eletroencefalografia , Gadolínio DTPA/efeitos adversos , Meglumina/efeitos adversos , Artéria Cerebral Média , Compostos Organometálicos/efeitos adversos , Animais , Arteriopatias Oclusivas/complicações , Isquemia Encefálica/etiologia , Doenças Arteriais Cerebrais/complicações , Masculino , Meglumina/análogos & derivados , Ratos , Ratos Sprague-DawleyRESUMO
The gadobenate ion is an intravascular paramagnetic contrast agent for magnetic resonance imaging. An HPLC method for assaying gadobenate ion in plasma, urine, faeces, bile and tissue samples is described. The analysis is based on the reversed-phase chromatographic separation of gadobenate ion from the endogenous components of biological matrices and detection by UV absorption at 210 nm. The selectivity of the method was satisfactory. The mean absolute recovery was greater than 95%. The precision and accuracy of the analytical methods were in the range 0.1-6.5% and -12 to +9.3%, respectively. The detection limits in plasma (0.1 ml), urine (0.05 ml), dried faeces (200 mg suspended in 4 ml water), bile (0.5 ml), and dried liver tissue (100 mg suspended in 1 ml water) were, respectively, 0.24, 0.47, 2.6, 0.63 and 2.8 nmol ml(-1) (corresponding to 0.16, 0.31, 1.7, 0.42 and 1.9 microg ml(-1)).
Assuntos
Meios de Contraste/análise , Gadolínio/análise , Meglumina/análogos & derivados , Compostos Organometálicos/análise , Animais , Bile/química , Bovinos , Cromatografia Líquida de Alta Pressão , Meios de Contraste/farmacologia , Fezes/química , Gadolínio/sangue , Gadolínio/farmacologia , Gadolínio/urina , Humanos , Fígado/química , Imageamento por Ressonância Magnética/métodos , Meglumina/análise , Meglumina/sangue , Meglumina/farmacologia , Meglumina/urina , Compostos Organometálicos/sangue , Compostos Organometálicos/farmacologia , Compostos Organometálicos/urina , Ratos , Espectrofotometria UltravioletaRESUMO
Iofratol is currently under evaluation as a potential X-ray contrast medium for angiography and myelography. An HPLC method for assaying iofratol in rat and human plasma and urine samples is described. The analysis is based on the reversed-phase chromatographic separation of iofratol and the internal standard (iopamidol) from the endogenous components of biological fluids, and detection by UV absorption at 242 nm. The selectivity of the method was satisfactory. The mean absolute recovery was greater than 90%. The precision and accuracy of the analytical methods were in the range 0.8-7.4 and -7.8 to +9.7%, respectively. The detection limits in plasma (0.1 ml) and urine (0.5 ml) were 0.1 and 0.4 microg (iofratol)/ml, respectively. The analyte was stable in the different biological matrices when stored at room temperature (20 degrees C) for at least 1 day, 4 degrees C for 1 month and -20 degrees C for 1 year.
Assuntos
Benzamidas/sangue , Benzamidas/urina , Meios de Contraste/análise , Iodobenzenos/sangue , Iodobenzenos/urina , Animais , Cromatografia Líquida de Alta Pressão , Estabilidade de Medicamentos , Humanos , Ratos , Sensibilidade e Especificidade , Espectrofotometria UltravioletaRESUMO
Depigmentation due to contact dermatitis, presents itself in most of the cases as a professional disease, and in only few reports it is shown to be caused by the use of personal items. From June 1982 to March 1983, six patients were observed with a symmetrically distributed contact dermatitis, located on the upper side of the feet, showing the marks of rubber sandal straps, know as "Hawaiian sandals". All patients were exposed to standard patch tests, containing 31 elements among which, there are seven substances that are related to the rubber manufacturing process, such as: potassium dichromate, mercaptobenzothiazole, diphenylguanidine, thiuram-rubber-mixture, colophony, p-phenylenediamine, hydroquinone. The interpretation of the patch tests was done after 48 an 72 hours, following the criteria that were established by the International Contact Dermatitis Research Group (ICORG). Five patients showed sensitiveness to at least, two of the suspected substances. Mercaptobenzothiazole and/or thiuram rubber mixture were the substances most frequently related to these cases of depigmentation. Two patients who had a positive patch test for the thiuram-mix, developed a depigmentation area on the site of the test after two weeks. Depigmentation produced by the thiuram-mix had not been related formerly and though our study it became evident that this substance can lead to it.
Assuntos
Dermatite de Contato/etiologia , Dermatoses do Pé/etiologia , Borracha/efeitos adversos , Sapatos , Vitiligo/induzido quimicamente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Testes do Emplastro , Borracha/análiseRESUMO
Os autores apresentam uma revisäo das principais açöes do níquel sobre o organismo humano, apontando desde a fase de mineraçäo até a fase de refino do níquel, nas quais säo analisados os riscos de câncer, afecçöes pulmonares e dermatoses. A disidrose pelo níquel é discutida estudando-se sua relaçäo com a ingestäo de níquel através da cocçäo de alimentos em utensílios niquelados e outros. A reaçäo sistemica e local apresentadas em virtude do uso de próteses metálicas com níquel säo também discutidas, sendo ainda analisadas as incidências do niqueal como produtor de dermatoses em ambos os sexos. Medidas preventivas säo discutidas, com a apresentaçäo de sugestöes práticas