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Unexpected Hypertensive Pneumothorax after Digestive Upper Endoscopy: A Case Report  [PDF]
Giovanni Zagli, Rosario Spina, Stefano Batacchi, Giancarlo Freschi, Manlio Acquafresca, Antonio Taddei, Adriano Peris
Open Journal of Anesthesiology (OJAnes) , 2012, DOI: 10.4236/ojanes.2012.24041
Abstract: We report an unexpected massive left pneumothorax at the end of a digestive upper endoscopy without evidences of perforation or airway over-pressure. The possible air passage through a diaphragmatic failing is discussed.
Therapeutic Drug Monitoring of Quetiapine: Effect of Coadministration with Antiepileptic Drugs in Patients with Psychiatric Disorders
Vincenza Santoro, Concetta D’Arrigo, Gaetana Migliardi, Maria Rosaria Muscatello, Umberto Micò, Rosario Cambria and Edoardo Spina
The Open Clinical Chemistry Journal , 2008, DOI: 10.2174/1874241600801010017]
Abstract: Antiepileptic agents, particularly those with mood-stabilizing properties, are increasingly used in the management of psychiatric disorders and may be prescribed in combination with antipsychotics. Aim of the present study was to evaluate the pharmacokinetic interaction between various antiepileptics and quetiapine, a second generation antipsychotic, in psychiatric patients, by using data from a therapeutic drug monitoring service. Steady-state plasma concentrations of quetiapine were compared in patients treated with quetiapine alone (controls, n=35) and in patients comedicated with valproic acid (n=19), lamotrigine (n=16), carbamazepine (n=6), topiramate (n=6) and oxcarbazepine (n=5). The six groups were matched for sex, age and daily dose of quetiapine. Dose-normalized plasma concentrations of quetiapine were significantly lower in the carbamazepine group than in the control group (p<0.001), while there were no differences in plasma quetiapine concentrations between the valproic acid, lamotrigine, topiramate or oxcarbazepine groups and the control group. In 5 patients assessed on and off carbamazepine comedication, dose-normalized plasma concentrations of quetiapine were significantly lower during combination therapy than on quetiapine alone (p<0.01). By contrast, no appreciable changes in plasma levels of quetiapine were found in the 8 and 6 patients assessed on and off valproic acid or lamotrigine comedication, respectively. These findings confirm that carbamazepine decreases markedly steady-state plasma concentrations of quetiapine, presumably by inducing its CYP3A4-mediated biotransformation. Conversely, concomitant administration of therapeutic doses of valproic acid, lamotrigine, topiramate or oxcarbazepine does not appear to affect significantly plasma levels of quetiapine.
Low central venous saturation predicts poor outcome in patients with brain injury after major trauma: a prospective observational study
Alessandro Di Filippo, Chiara Gonnelli, Lucia Perretta, Giovanni Zagli, Rosario Spina, Marco Chiostri, Gian Gensini, Adriano Peris
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2009, DOI: 10.1186/1757-7241-17-23
Abstract: This prospective, non-controlled study, carried out between April 2006 and March 2008, was performed in a higher level Trauma Center in Florence (Italy). In the study period, 121 patients affected by major brain injury after major trauma were recruited. Inclusion criteria were: 1. Glasgow Coma Scale (GCS) score ≤ 13; 2. an Injury Severity Score (ISS) ≥ 15. Exclusion criteria included: 1. pregnancy; 2. age < 14 years; 3. isolated head trauma; 4. death within the first 24 hours from the event; 5. the lack of ScvO2 monitoring within 2 hours from the trauma. Demographic and clinical data were collected, including Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Simplified Acute Physiologic Score II (SAPS II), Marshall score. The worst values of lactate and ScvO2 within the first 24 hours from trauma, ICU length of stay (LOS), and 28-day mortality were recorded.Patients who deceased within 28 days showed higher age (53 ± 16.6 vs 43.8 ± 19.6, P = 0.043), ISS core (39.3 ± 14 vs 30.3 ± 10.1, P < 0.001), AIS score for head/neck (4.5 ± 0.7 vs 3.4 ± 1.2, P = 0.001), SAPS II score (51.3 ± 14.1 vs 42.5 ± 15, P = 0.014), Marshall Score (3.5 ± 0.7 vs 2.3 ± 0.7, P < 0.001) and arterial lactate concentration (3.3 ± 1.8 vs 6.7 ± 4.2, P < 0.001), than survived patients, whereas ScvO2 resulted significantly lower (66.7% ± 11.9 vs 70.1% ± 8.9 vs, respectively; P = 0.046). Patients with ScvO2 values ≤ 65% also showed higher 28-days mortality rate (31.3% vs 13.5%, P = 0.034), ICU LOS (28.5 ± 15.2 vs 16.6 ± 13.8, P < 0.001), and total hospital LOS (45.1 ± 20.8 vs 33.2 ± 24, P = 0.046) than patients with ScvO2 > 65%.ScvO2 value less than 65%, measured in the first 24 hours after admission in patients with major trauma and head injury, was associated with higher mortality and prolonged hospitalization.Organ and tissue damages caused by a trauma impact lead to the development of systemic inflammatory response syndrome (SIRS) [1]. The local and systemic release of inflammation medi
Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria
Marco Ciapetti, Alessandro Circelli, Giovanni Zagli, Maria Migliaccio, Rosario Spina, Alessandro Alessi, Manlio Acquafresca, Marco Bartolini, Adriano Peris
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-61
Abstract: Trauma patients consecutively admitted to Intensive Care Unit (ICU) from Jan 2008 to Oct 2009 were considered for the study. Memphis criteria comprehend: basilar skull fracture with involvement of the carotid canal, cervical spine fracture, neurological exam not explained by brain imaging, Horner's syndrome, LeFort II-III fractures, and neck soft tissue injury. As single criteria modification, we included all patients with petrous bone fracture, even without carotid canal involvement. In all patients at risk of BCVI, 64-slice angio-CT-scans was performed.During the study period, 266 patients were admitted to the ICU for blunt major trauma. Among them, 162 presented traumatic brain injury or cervical spine fracture. In accordance with the proposed modified-Memphis criteria, 53 patients showed risk factors for BCVI compared to 45 using the original Memphis criteria. Among the 53 patients, 6 resulted as having carotid lesions (2.2% of all blunt major traumas; one patient more than when using Memphis criteria). Anticoagulant therapy with low molecular weight heparin was administered in all patients. No stroke or hemorrhagic complications occurred. Clinical examination at 6-months showed no central neurological deficit.A modification of a single criteria of Memphis screening protocol might permit the identification of a higher percentage of BCVI. Limited by sample size, this study needs to be validated.The incidence of Blunt Cerebrovascular Injuries (BCVI) varies from 0.5% to 1% of all admissions for blunt trauma, but this relatively small percentage of patients is affected by a stroke rate ranging from 25% to 58% and a mortality rate ranging from 31% to 59% [1-5].Although BCVIs are related to severe complications and high mortality rate, controversy exists in literature when defining the patient at risk for these injuries. Four-vessel angiography has been considered the gold standard diagnostic test for the presence of BCVI for a long time. With the increasing availabil
Língua portuguesa e pós-gradua o
Segismundo Spina
Alfa : Revista de Linguística , 2001,
Divaga es terminológicas
Segismundo Spina
Alfa : Revista de Linguística , 2001,
Midwives’ professionalization: a comparative approach. An interpretation of the phenomenon of childbirth medicalization
Spina, E.
Bulletin of the Transilvania University of Bra?ov. Series VII : Social Sciences and Law , 2010,
Abstract: The paper studies the problem of increasing medicalization of pregnancy and delivery, a phenomenon that started in Italy between the 1950s and the 1960s owing to deep political, social and cultural changes. The main aim of the study is the understanding of the origins of the phenomenon by investigating the causal relationships between medicalization and medical dominance.
Optimization of injection molded parts by using ANN-PSO approach
R. Spina
Journal of Achievements in Materials and Manufacturing Engineering , 2006,
Abstract: Purpose: The aim of the work was the optimization of injection molded product warpage by using an integrated environment.Design/methodology/approach: The approach implemented took advantages of the Finite Element (FE) Analysis to simulate component fabrication and investigate the main causes of defects. A FE model was initially designed and then reinforced by integrating Artificial Neural Network to predict main filling and packing results and Particle Swarm Approach to optimize injection molding process parameters automatically.Findings: This research has confirmed that the evaluation of the FE simulation results through the Artificial Neural Network system was an efficient method for the assessment of the influence of process parameter variation on part manufacturability, suggesting possible adjustments to improve part quality.Research limitations/implications: Future researches will be addressed to the extension of analysis to large thin components and different classes of materials with the aim to improve the proposed approach.Originality/value: The originality of the work was related to the possibility of analyzing component fabrication at the design stage and use results in the manufacturing stage. In this way, design, fabrication and process control were strictly links.
Feasibility of inter-hospital transportation using extra-corporeal membrane oxygenation (ECMO) support of patients affected by severe swine-flu(H1N1)-related ARDS
Marco Ciapetti, Giovanni Cianchi, Giovanni Zagli, Cesare Greco, Andrea Pasquini, Rosario Spina, Stefano Batacchi, Manuela Bonizzoli, Massimo Bonacchi, Chiara Lazzeri, Pasquale Bernardo, Adriano Peris
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-32
Abstract: From September 2009 to January 2010, 18 patients with H1N1-induced ARDS were referred to our ECMO-centre from other hospitals. Six patients had contraindications to treatment with ECMO and remained in the local hospital. Twelve patients were transported to our centre and were included in this study. Four patients were transported on ECMO (Group A) and eight on conventional ventilation (Group B). The groups were compared on the basis of adverse events during transport, clinical characteristics and outcome.The PaO2/FiO2 ratio was lower in the patients of Group A (46.8 vs 89.7 [median]) despite the PEEP values being higher (15.0 vs 8.5 [median]). The Murray score was higher in Group A (3.50 vs 2.75 [median]). During the transfer there were no significant complications noted in Group A, whereas two patients in Group B were reported with hypoxia (SpO2 < 90%). One patient in Group A died. All the other patients of the two groups have been discharged from hospital.The creation of an ECMO team, with various experts in the treatment of ARDS, assured a safe transfer of patients with severe hypoxia, over long distances, when in other cases they wouldn't have been be transportable.Extra-corporeal membrane oxygenation (ECMO) is generally used in the treatment of patients with extremely severe but potentially reversible pulmonary disorders [1,2]. The new influenza A(H1N1) pandemic affected Italy during the 2009 winter. It caused an epidemic of critical illness with a large number of patients admitted to the intensive care unit (ICU) [3,4]. A proportion of these patients presented or developed severe acute respiratory distress syndrome (ARDS)[5,6]. Several reports described the need of ECMO for treatment of refractory hypoxaemia, hypercapnia which occurred despite mechanical ventilation and rescue ARDS therapy [1,2]. The patients should ideally be transported to an ECMO centre before respiration becomes critically unstable as it is thereafter impossible to transport them by conven
As origens da Embraer
Forjaz, Maria Cecilia Spina;
Tempo Social , 2005, DOI: 10.1590/S0103-20702005000100012
Abstract: the article analyses the emergence of organizations that originated embraer, i.e., the ministry of aeronautics, the aeronautics technological center (cta) and the aeronautics technological institute (ita), founded in the 1940's and 1950's. these organizations made it possible for the state enterprise to come into existence in 1969. this paper analyses the embraer's involvement with the aeronautics' national defense strategic project.
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