Changes in vital signs before, during and after bed bathing in the critical ill patient: an observational study.

Aim: The aim of the study was evaluate the variability of the vital signs of patients hospitalized in intensive care unit (ICU) before, during and after bed bathing. Secondly to evaluate the possible relationship of vital signs changes and the perception of pain in patients ICU who do not have painkilling therapy. Materials and Methods: The study is cross-sectional. The critically ill patients, adults, hospitalized for at least 24 hours and daily bathing in bed were recruited. The socio-demographic information and clinical data were collected using the clinical record. The vital functions data trend was collected at four different times of the bad bathing: before (T0), during (T1), immediately after (T2), 20/30 minutes from the term (T3). For each patients three observations of the vital parmeters trend were detected. Results: 19 patients were enrolled. All vital functions show statistically variations during the follow-up (p <0.05), particularly between T0 versus T1. The trend of the all vital parameters in the subgroup of the females reported significantly changes (p<0.05) except for the pain score (p=0.390) and diastolic blood pressure (p=0. 183); the men reported significant differences in the trend of the all vital funcitons (p<0.05) except for the body temperature (p = 0.06) and diastolic blood pressure (p=0.123). Conclutions: This study confirms that the procedure for bed bathing modifies the parametric values of patients in a critical area; however, the potential influence of certain factors that may have compromised the data cannot be limited. The application of innovative techniques to minimize interference (control of the microclimate, use of electrodes resistant to shocks and water) was reccomnded, so too the adherence to the Evidence Based Care reduces the risk of complications and guides professional action in the best possible way.

Home-management of malignant pleural effusion with an indwelling pleural catheter: ten years experience.

BACKGROUND: More than one half of patients with cancer have a malignant pleural effusion (MPE) at some time during their life span. Recurrent malignant pleural effusions impair respiratory functions and worsen the quality of life. Once a patient develops MPE, only fluid drainage relieves pulmonary compression and dyspnea. Optimal treatment is however, still controversial. In patients not suitable for pleurodesis, or with recurrent MPE after pleurodesis, or with trapped lung, the outpatient intermittent drainage through a subcutaneous tunneled indwelling pleural catheter (IPC) is a possible choice. METHODS: In ten years, we treated 90 patients by outpatient insertion of IPC. Eligibility for IPC required previous thoracentesis with histological confirmation of malignancy and chest roentgenogram evidence of effusion. All patients treated were made aware of their malignancy and positive cytology in the pleural effusion. RESULTS: Mean survival was 197 days (range 23-296 days). Median time of draining interval was 7.0 days with maximum amount of effusion drained off being 1000 ml. Pleurodesis occurred in 37 (41.1%) patients with a mean time of pleurodesis of 51 days (range 34-78 days). No major complication was recorded. CONCLUSIONS: The IPC is a useful device in the management of recurrent MPE. Treatment can be entirely accomplished at home and the complication rate is low.

IIIB-T4 non-small cell lung cancer: indications and results of surgical treatment.

AIM: T4 non-small cell lung cancer (NSCLC) is commonly considered a contraindication to surgery, indeed chemo-radiotherapy achieves a poor survival rate. We have reviewed our experience with T4 NSCLC patients who underwent surgery with the aim of debating the indications and results of surgical treatment in this highly selected group of patients. METHODS: We investigated a cohort of 60 patients, 49 men and 11 women, who underwent surgery for NSCLC from January 1998 to December 2002 and whose pathological staging was T4N0-2M0. The median age was 65 years (range 46-82). The tumors were classified T4 for the following reasons: intralobar satellite metastasis in 24 cases, direct mediastinum invasion in 18 cases, malignant pleural effusion in 7 cases, involvement of the superior vena cava in 4 cases, marginal invasion of the vertebral body in 3 cases, involvement of the carena in 3 cases and invasion of the left atrium in 1 case. Thirteen patients had undergone neo-adjuvant chemotherapy while 39 underwent adjuvant therapies. RESULTS: Thirty-two patients resulted with N0 disease, 5 with N1 and 23 with N2 disease. Forty patients relapsed (27 systemic and 13 local relapses). The mean survival was 20 months. Of the examined parameters only metastatic nodal involvement was significantly associated with a worse prognosis (P=0.007). CONCLUSION: Surgery for T4 NSCLC may be effective in those patients without mediastinal (N2) lymph node involvement. The prognosis was neither affected by the subtype of T4 tumor nor by the use of adjuvant therapies and/or neoadjuvant chemotherapy but only by the N status. In the preoperative work-up, every possible effort should be made to achieve a careful evaluation of lymph-nodal status (primarily by mediastinoscopy and video operative staging).

[Blood lead levels in a non-professionally-exposed population from six Tuscan provinces]. / Livelli ematici di piombo in popolazioni non professionalmente esposte residenti in sei provincie toscane.

We report the results obtained in 1992 concerning the determination of blood lead levels (PbB) in 1321 subjects of the general population living in ten villages/towns of the Florence district characterised by the presence of artistic ceramic factories. We reported also the PbB values found in 2330 adults, 280 children, 39 pregnant women and their correspondent umbilical cords, who were examined during the second biological monitoring campaign against the risk of lead intoxication according to the DPR 496/82. Median PbB values were 92.5 micrograms/l (range 15-520 micrograms/l) for males and 62.5 micrograms/l (range 11-343 micrograms/l) for females. The lower PbB median values were found in the district of Livorno (76.25 micrograms/l and 48.25 micrograms/l in males and females, respectively) and Arezzo (80.5 micrograms/l and 52 micrograms/l in males and females, respectively). In comparison with the results obtained for the general Italian population during the previous biological monitoring campaign carried out in 1985-86 we observed PbB median values about 40% lower for both males and females and PbB median values about 55% lower for children. A significant statistic correlation (r = 0.53) was found between PbB of pregnant women and their umbilical cords.

Measurement of the resistance to fluid flow within the lacrimal outflow system.

BACKGROUND: Although the presence of complete obstruction within the human lacrimal drainage system can be easily determined with diagnostic techniques currently available, it is not possible to quantitate degrees of partial obstruction. The authors have developed a new instrument that directly measures pressures associated with fluid flow, allowing the calculation (pressure : flow) of resistance within the tear drainage system. The authors believe that the ability to measure the degree of partial lacrimal stenosis quantitatively will be clinically useful, allowing the diagnosis of lacrimal disease before complete obstruction. Of course, it is first necessary to establish normal values, which was the goal of the study. METHODS: A constant flow rate of distilled water was irrigated into the lacrimal system through the lower canaliculus, and pressure was measured continuously. Resistance then was calculated as the differential of pressure to flow rate (pressure : flow). In the first stage of a two-part study the authors determined the resistance to fluid flow in 43 tear ducts of 24 healthy patients. In this group, the resistance within the entire lacrimal system was obtained. In the second stage of this study, the authors measured the resistance in 28 tear ducts of 26 patients after successful lacrimal bypass surgery (dacryocystorhinostomy). Because dacryocystorhinostomy byasses the lower drainage system (sac and nasolacrimal duct), the resistance measured in this group of patients was determined only by the upper (canalicular) system. RESULTS: The mean resistance within the normal lacrimal system is 49.5 +/- 17.0 mmHg.seconds/ml. Just more than half of the resistance, 26.8 +/- 13.1 mmHg.seconds/ ml (54%), comes from the canaliculi, leaving 22.7 mmHg.seconds/ml (46%) attributable to the lower system. The authors comment on comparisons between these values and theoretical values calculated using information on average dimensions obtained from casts of the lacrimal drainage system. CONCLUSION: The authors have developed a new instrument to measure the resistance to fluid flow within the human lacrimal outflow system, and resistance values in control subjects have been documented.

Responses of atrial natriuretic peptide and other fluid regulating hormones to long distance swimming in the sea.

The plasma hormonal response following a swimming competition in the sea (18 km) was evaluated in 12 top level male endurance swimmers. At the end of the effort, while plasma renin activity (PRA) and aldosterone concentration (ALDO) were unchanged, a significant increase in plasma atrial natriuretic peptide (ANP) and antidiuretic hormone (ADH) concentrations were recorded. These changes were associated with a decrease in haematocrit and an increase in Na+ and Cl- plasma concentrations. The individual variations of ANP (difference between the final and initial concentrations) were inversely correlated with the corresponding individual variations of PRA and ADH. The results suggest that, during prolonged swimming, ANP may exert an inhibitory effect on the PRA-ALDO axis and have a modulatory role with regard to ADH secretion.

Intraocular pressure during mechanical ventilation with different levels of positive end-expiratory pressure.

OBJECTIVE: To determine the effect of positive end-expiratory pressure (PEEP) on intraocular pressure. DESIGN: Prospective, controlled, longitudinal, dual center study. In one group, patients served as their own control. In the second group, isolated determinations of intraocular pressure were made in mechanically ventilated patients receiving PEEP. SETTING: Adult intensive care units of two university hospitals. PATIENTS: Intraocular pressures were measured serially in eight patients during the recovery phase of different clinical conditions and in 22 patients receiving mechanical ventilation with PEEP > or = 10 cm H2O for > 24 hrs. INTERVENTIONS: Group A) In eight patients, a PEEP dose-response curve was established (PEEP 0, 5, 10, 15, and 0 cm H2O every 15 mins). Intraocular pressures were measured at the end of each period. Group B) In 22 patients, measurement of intraocular pressures were done while the patients received mechanical ventilation with PEEP > or = 10 cm H2O for at least > 24 hrs. MEASUREMENTS AND MAIN RESULTS: In both groups, there was a positive correlation between the PEEP level and the central venous pressure (p < .05 in group A, and p < .03 in group B). No relationships between intraocular pressure and PEEP or central venous pressure were observed. However, there was a correlation between intraocular pressure and length of PEEP therapy (p < .03). We found ocular hypertension in only one patient (right eye intraocular pressure = 26 mm Hg; left eye intraocular pressure = 24 mm Hg). CONCLUSIONS: Short-term therapy with PEEP of < or = 15 cm H2O does not present a clinically important significant risk for intraocular pressure increase in a population with normal basal ocular tonometry. During prolonged mechanical ventilation with PEEP, increments in intraocular pressure may occur, but these increments appear to not be of a clinically relevant magnitude.

Atrial natriuretic peptide and acute myocardial infarction: critical reappraisal.

The present investigation was designed to assess the correlation of atrial natriuretic peptide (ANP) with the ordinary markers of acute myocardial infarction (AMI). In 15 patients with uncomplicated AMI, no remarkable variation in ANP plasma levels was found. On the other hand, serum myoglobin and cardiac enzymes behaved as usual. Our results show that ANP is not correlated with serum myoglobin, creatine-phosphokinase and its isoenzyme MB, being completely independent from these markers of myocardial injury. These observations suggest that the plasma ANP variations observed in AMI by other investigators are probably dependent on hemodynamic dysfunction.

Changes in the exercise-induced hormone response to branched chain amino acid administration.

It was the aim of the present experiment to detect possible effects of branched-chain amino acids (BCAA) on the endocrine response to 1 h of continuous running. Blood samples were collected from 14 long-distance runners (age 24-42 years) in two different trials performed at 1-week intervals. In both trials (E and P) blood samples were collected at the following times: 9 a.m. (basal values sample), 10.30 a.m. (sample 90), 11.30 a.m. (sample 150), 12.30 p.m. (sample 210); the athletes performed 1 h of running at a constant predetermined speed between samples 90 and 150. Following the basal sample a mixture containing BCAA (E trial), or not containing BCAA (P trial) was ingested. In both trials no hormone basal concentrations, except insulin, were changed before exercise. In P trial, following exercise (sample 150), human growth hormone (HGH), prolactin (PRL), adrenocorticotropic hormone (ACTH) and cortisol (C) increased, while testosterone (T) decreased. In sample 210, after 1 h of rest, while ACTH, PRL and HGH had recovered to basal concentrations, C remained elevated and T displayed a further decrease. In the E trial a similar pattern of change was observed in sample 150 for HGH, PRL, ACTH and C; in sample 210 HGH and PRL displayed significantly lower values than in the corresponding P trial samples. The T was not modified by the running exercise and increased during the recovery period. It is, therefore, suggested that BCAA administration before exercise affects the response of some anabolic hormones, mainly HGH and T.

[Auxological data and definitive height in short patients without hormonal deficiencies. A longitudinal study]. / Dati auxologici e statura definitiva in pazienti iposomici senza deficit ormonali. Studio longitudinale.

61 children (49 males and 12 females) with stature before puberty less than 3. centile were studied. They had been previously diagnosed with the various GH stimulation tests as "constitutional short" and they were measured after reaching final adult height. During longitudinal follow-up, the following auxological data were calculated: height for chronological and bone age sds (HCAsds, HBAsds), height age/bone age ratio (HA/BA), bone age sds (BA sds); all the latter were calculated both in prepuberty and in puberty (mean 1.24 years after the onset of puberty). Target height and predictable height according to Bayley and Pinneau were also calculated. Final height for males was 152-175 cm (mean 162.3) and for females 144-163 cm (mean 151.5). These values were lower than expected with both target height and Bayley and Pinneau prediction, especially if the values of Bayley and Pinneau had been calculated before puberty. In females there was a significant positive correlation with target and final height. In males final height was positively correlated with Target height, with prepuberal data of HCA sds and with pubertal data of HBA sds and HA/BA. A negative correlation was found with final height in males and BA sds during puberty. A delay in bone age, probability, represented a positive factor in increasing final height only if it was maintained during puberty. Bayley and Pinneau's method overestimated final height, in particular when it was used before puberty or with a severe bone delay. Subject with pubertal delay are 2.42 cm taller than normal pubertal children. This difference had been acquired before puberty.

Central and peripheral endocrine correlates of the immobility reaction in the toad Bufo bufo.

The immobility reaction, which may be regarded as an innate fear response, has been observed in several animal species including Amphibians. Its endocrine correlates were established in the newt Triturus cristatus and in the toad Bufo bufo, in which the duration of immobility is influenced by sex and mating. The aim of the present study was to investigate the possibility of a relation between immobility reaction and central hormonal receptors. Testosterone (T) binding capacity in the brain and plasma sex steroids were studied in four groups of male and female sexually active and inactive toads in which the immobility reaction was induced by inversion (A) and by inversion +pressure (B). Females were found to be more susceptible than males to immobility A, whereas males were more susceptible to B. Sexually active animals with higher plasma levels of sex steroids were less susceptible than inactive ones. Lower T binding capacity in the brain and higher affinity is associated with sexual activity. Susceptibility to the immobility was negatively correlated with plasma sex steroids and positively correlated with T binding capacity. A reciprocal effect was found to exist between endocrine parameters at central and peripheral level, both controlling immobility behaviour. Mating may influence susceptibility to immobility through an endocrine mechanism.

Development of interstitial lung fibrosis by long-term treatment with collagen breakdown products in rabbits.

We recently demonstrated that collagen breakdown products derived from elastase digestion (CDP) can stimulate "in vivo" lung collagen synthesis. The present work deals with the morphological and biochemical characteristics of an experimental model of lung fibrosis developed in rabbit by long-term treatment with CDP. Stimulation of collagen synthesis by CDP resulted in a significant thickening of alveolar septa due to accumulation of fibroblasts and a marked deposition of collagen fibrils as revealed by light as well as electron microscopy. Biochemical analysis confirmed the increase in lung collagen deposition. Total collagen content as determined by hydroxy-proline analysis was increased in CDP-treated animals of about 56% in respect to control animals. A relative increase of type I collagen in respect to type III was also observed. An additional interesting observation was a progressive hyperplasia of type II pneumocytes. Unlike other experimental models of lung fibrosis, the collagen deposition in our condition is not preceded or associated with inflammatory or degenerative processes. This fact renders this model very suitable to study matrix-cell interactions in pulmonary fibrogenesis.

In vivo stimulation of lung collagen synthesis by collagen derived peptides.

In the present work we examined the "in vivo" effects of collagen breakdown products derived from elastase digestion on lung collagen synthesis in rabbits. It was found that i.v. injection of collagen peptides greatly enhances the collagen synthesis rate while does not affect the synthesis of non collagenous proteins. The increase of incorporation of 3H-proline in lung collagen parallels that of prolyl hydroxylase activity. The collagen synthesis, expressed as fractional rate (% day), amounted to 15% day in treated animals, resulting in a significant increase with respect to controls (11.7% day). The observations reported provide evidence that collagen breakdown products stimulate lung collagen synthesis and may play a role in collagen homeostasis.

Hormonal changes after supine posture, immersion, and swimming.

This study was undertaken to evaluate the effects of the supine posture, immersion, and swimming on hormones involved in the regulation of hydrosaline equilibrium. Plasma levels of atrial natriuretic peptide (ANP), arginine vasopressin (AVP), plasma renin activity (PRA), and aldosterone (ALDO) were measured by radioimmunoassay in eight untrained young subjects (five males and three females). Blood samples were collected on different days: control morning samples in a relaxed standing posture before each test; after 20 min in a supine position; after 20 min of horizontal immersion in water at 28 degrees C; after 20 min of backstroke swimming (speed about 1 m/s). No changes occurred in AVP levels after each test. ALDO and PRA increased significantly only after swimming and were directly correlated. ANP increased significantly after immersion, but no further increase was observed after swimming. The hematocrit, which increased after swimming, was inversely correlated with ANP levels in the post-exercise samples. These data show that while ALDO and PRA increase only in response to swimming, even at moderate intensity, ANP probably requires more prolonged and intense exercise to reach a significantly higher level than in immersion.

Korsakoff's psychosis due to massive beer intake provoked by diabetes insipidus.

Posttraumatic diabetes insipidus, acute pancreatitis, and Wernicke's encephalopathy and Korsakoff's psychosis in a 33-year-old white male alcohol abuser resulted in near-fatal cardiovascular collapse. The Wernicke's encephalopathy and Korsakoff's psychosis resulted from drinking massive quantities of beer to satisfy the thirst induced by diabetes insipidus. Although the diabetes insipidus was controlled with vasopressin, and the need for vasopressin resolved two months after diagnosis, the Wernicke-Korsakoff syndrome had not resolved by six months.

DNA synthesis and interferon release by human peripheral lymphocytes exposed to high potassium medium.

Lymphocytes have their membrane potential changed during transition from the resting to the active state. On these grounds, we investigated the response of human peripheral lymphocytes to a depolarizing high-potassium (102.7 mM) medium, by assaying cellular incorporation of labeled thymidine and interferon (IFN) release in the culture medium. The greatest effect is evident 3-4 days after preincubation for 120 min in high K+ medium. A temporal correlation has been observed between rate of DNA synthesis and IFN production. The IFN activity is shown to be gamma-type.

Hormonal and metabolic effects following a football match.

Hormonal and metabolic parameters were studied for two teams after a football match. Blood samples were collected before the start, at half-time, at the end, and 45 and 90 min after the end of the game. In the first team, ACTH, cortisol, and lactate levels increased significantly during the whole match to resume basal levels in the fourth sample (45 min after the end of play). HGH, prolactin, and blood glucose were found to be increased only at half-time. The second team had an intense and long warm-up period before the match and the lactate concentrations were already elevated in the first sample. All the other parameters, except ACTH and glucose, displayed a pattern similar to that of the first team. The differences in the time courses of the hormonal and metabolic values are discussed.

Effect of exercise on plasma interferon levels.

The effect of exercise on plasma interferon activity was studied on eight male subjects before and after exercise on a bicycle ergometer for 1 h at 70% of their maximal O2 consumption (VO2 max). Acid-labile interferon, alpha-type according to immunological characterization, rose significantly from a preexercise value of 3 +/- 1 to 7 +/- 2 IU/ml postexercise. Negligible changes were recorded for plasma protein, lipid, and glucose concentrations, whereas blood lactate slightly increased only at the end of exercise. According to hematocrit and plasma protein values before and after exercise, hemoconcentration did not occur. These data provide evidence that plasma interferon activity increased following a bout of submaximal exercise.