L Tullo

University of Foggia

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Gilda Cinnella

University of Foggia

M. Dambrosio

Azienda ULSS 9 TREVISO

Jesús F. Bermejo-Martín

Universidad de Salamanca

MÁ

Miguel Á. González‐Gay

Universidad de Cantabria

Niels P. Riksen

Radboud University Nijmegen

Francesco Mojoli

University of Pavia

Bo Van den Bulcke

Ghent University Hospital

E. Morawiec

Pitié-Salpêtrière Hospital

F Duska

Charles University

Bülent Ergin

Erasmus MC

Cooperative Institutions

Inserm

Assistance Publique – Hôpitaux de Paris

Istituti di Ricovero e Cura a Carattere Scientifico

University of Amsterdam

Academic Medical Center

Université Paris Cité

Sorbonne Université

University College London

Universitat Autònoma de Barcelona

University of Milan

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[Hemodynamic and respiratory changes during hip and knee arthroplasty. An echocardiographic study].

PubMed (2002)

M. Dambrosio L Tullo Biagio Moretti Vincenzo Patella C. Simone

The "bone cement implantation syndrome" is a rare but severe complication observed especially during the insertion of cemented prostheses in hip and knee replacement surgery. Several mechanisms are involved: effects of methylmethacrilate, embolism of fat, air and bone marrow, and release of tissue thromboplastin during acetabular and femoral reaming. Aim of this study was to detect embolic events, right heart impairment, hemodynamic and respiratory changes during hip and knee replacement surgery.Prospective study, between February-May 2001.Orthopedic Operative room.Twenty-one patients who underwent total hip or knee arthroplasty under general anesthesia. Patients were divided in methylmethacrylate cemented prostheses groups (CEM, n=10) and totally uncemented prostheses (NON CEM, n=11).Standard anesthesia monitoring and omniplane TEE were performed. TEE probe was positioned in order to obtain "inflow-outflow" views of right heart. Measurements were obtained after anesthesia induction (T1), during femoral realing (T2) at prostheses insertion (T3), and at the end of surgery (T4).Hemodynamic and respiratory parameters measured in different phases of surgical procedures were not different within groups and between groups. Fourtheen patients had TEE evidence of emboli, and the phenomenon was more evident in CEM group (Z= -347; p<0.001). During prostheses insertion, a slight, not significant increase in right ventricular dimensions was observed in both groups, without any right ventricular wall kinetic abnormality. No difference was observed between groups. No adverse cardiac or cerebrovascular events in intra- and postoperatory period were observed.In normal patients total hip or knee arthroplasty is associated with embolic phenomena, without any significant change in systemic and right heart hemodynamics. Insertion of cemented prostheses does not modify hemodynamic profile. It remains to be elucidated if the occurrence of emboli has a critical role in patients with cardiorespiratory disease.

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Transesophageal Echocardiography for Diagnosis of Traumatic Aortic Injury: An Appraisal of the Evidence

Journal of Trauma and Acute Care Surgery (2004)

Gilda Cinnella M. Dambrosio Nicola Brienza L Tullo Tommaso Fiore

Backgrounds: An overview of the validity of transesophageal echocardiography (TEE) in patients suspected to have traumatic aortic injury (TAI). Methods: Computerized bibliographic search of trials from 1994 to 2002 evaluating the use of TEE to confirm the diagnosis of TAI. Seven relevant studies out of 204 were identified, involving 758 patients. The accuracy of TEE was analyzed by constructing summary receiver-operating characteristic (sROC) curves and computing areas under the sROC curve. Results: No prospective randomized trial was found. Although accuracy varied greatly, summary ROC curve found that TEE enjoyed a high diagnostic performance. Some study characteristics can affect accuracy. Conclusions: Our findings seems to indicate that TEE is a valuable tool for diagnosing TAI, and its use as first-line evaluation of such patients can be supported; however, given the lack of randomized trials, no standard of care can be drawn from the present overview: future studies should look at this problem more carefully, and should be methodologically rigorous.

10.1097/01.ta.0000133576.35999.00

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A185 Infrared thermal imaging of the hand during vascular occlusion in healthy volunteers

Michael Charlton Louise Tonks L. Mclelland Tim Coats Jonathan P. Thompson

Vascular occlusion

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[Respiratory emergencies in the extra-hospital environment].

PubMed (2000)

M. Dambrosio Claudia Pignataro L Tullo

Prehospital care is a fundamental element for the patient's outcome, in the field of medical and surgical emergencies. There are different strategies about it, defined "scoop and run" and "stay and play". The choice among the different strategies, in our opinion, must be well-suited to the underlying pathophysiology of the illness. The best approach to the care of Acute Respiratory Failure is chosen on the ground of the possible and rapid reversibility of the pathology. Nowadays, classical semeiology is integrated by portable devices that allow the real time monitoring of pulse oximetry, electrocardiography, arterial pressure and heart rate, capnometry, blood gas analysis, serum electrolites, etc. Maintenance of airway patency can be achieved by many devices, according to the patient's neurological conditions. In common opinion the early respiratory support reduces patient's stay in hospital and his outcome.

Pulse Oximetry

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