Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy

Effect of age on the performance of bispectral and entropy indices during sevoflurane pediatric anesthesia: a pharmacometric study

Bispectral index (BIS) and entropy monitors have been proposed for use in children, but research has not supported their validity for infants. However, effective monitoring of young children may be even more important than for adults, to aid appropriate anesthetic dosing and reduce the chance of adverse consequences. This prospective study aimed to investigate the relationships between age and the predictive performance of BIS and entropy monitors in measuring the anesthetic drug effects within a pediatric surgery setting

Physiological Effects of the Open Lung Approach in Patients with Early, Mild, Diffuse Acute Respiratory Distress Syndrome: An Electrical Impedance Tomography Study

To test the hypothesis that in early, mild, acute respiratory distress syndrome (ARDS) patients with diffuse loss of aeration, the application of the open lung approach (OLA) would improve homogeneity in lung aeration and lung mechanics, without affecting hemodynamics

A Prospective, Randomized Comparative Study of Respiratory and Hemodynamic Monitoring during Colonoscopy using Remifentanyl Versus Propofol/Fentanyl

Objective: We hypothesized that remifentanil continuous infusion during colonoscopy in spontaneous respiration may give benefits in terms of quality of sedation and recovery compared to propofol, and that patients’ ventilatory drive and consciousness could be accurately evaluated by the continuous measurement of end-tidal CO2 (EtCO2), and of Bispectral Score (BIS) respectively. Methods: One-hundred and eighty patients scheduled for colonoscopy were randomized in two groups: 76 patients were included in Groupcontrol (propofol 0.5 mg/kg bolus plus infusion 1 mg/kg/h) and 78 patients in Gruopremi (0.5 mcg/Kg/1 min bolus plus infusion 0.08 mcg/kg/min, progressively reduced to 0.03 mcg/kg/min). Cardiovascular and respiratory variables were measured before induction and every 3 min throughout the procedure. Sedation level was estimated by BIS and Observer’s Assessment of Alertness/Sedation Scale (OAA/S). Respiratory function was evaluated by arterial oxygen saturation (SaO2) and EtCO2. Recovery from sedation and hospital discharge criteria were assessed by Modified Aldrete Score System (APRS) 30 min after colonoscopy completion. Results: Remifentanil was effective and well tolerated during colonoscopy. Hemodynamic parameters remained stable throughout the study steps in both groups. In Groupremi OAA/S and BIS score were higher (p<0.001), and EtCO2 (p<0.5) lower that in Groupcontrol. Recovery time was faster in the Groupremi (p<0.01). Conclusions: Our data show that analgosedation with remifentanil allowed to obtain a good quality colonoscopy without respiratory and hemodynamic impairment and with faster recovery than moderate sedation propofol/fentanyl. Moreover, BIS and EtCO2 monitoring proved to be well suited to evaluate the trend variations of patients’ sedation level and respiratory drive

Proposal for an MRPC system with high-precision timing in the LVD structure

The purpose of this paper is to present a project in order to verify -without the need of knowing the distance CERN-Gran Sasso- the discovery made by the OPERA Collaboration concerning the speed of the CERN neutrinos. The project consists of two parts. A simple one and a less simple one. Both have the great advantage of being totally independent of the knowledge of the distance, ≃ 732 km, between the two Labs, CERN and LNGS, where the neutrinos are produced and detected, respectively. The "simple" version of this project is based on the high-energy horizontal cosmic muons, which traverse LVD and OPERA detectors, thus allowing to cross-calibrate the timing systems of both experiments in a way which is totally independent of the TOF measurements of CNGS. This component of the project is being studied in collaboration with the OPERA group, as the time stabilities of both experiments are needed. In fact it is since a long time that the two groups are engaged with this problem. In this paper we will present and discuss the "less simple" part which allows to establish, at the highest possible level of accuracy, if (v > c) effects really exist. © Società Italiana di Fisica/Springer-Verlag 2012