Optic nerve sheath diameter ultrasound evaluation in intensive care unit. possible role and clinical aspects in neurological critical patients' daily monitoring

Background. The increase of the optic nerve sheath diameter (ONSD) is a reliable, noninvasive sonographic marker of intracranial hypertension. Aim of the study was to demonstrate the efficacy of ONSD evaluation, when monitoring neurocritical patients, to early identify malignant intracranial hypertension in patients with brain death (BD). Methods. Data from ultrasound ONSD evaluation have been retrospectively analyzed in 21 sedated critical patients with neurological diseases who, during their clinical course, developed BD. 31 nonneurological controls were used for standard ONSD reference. Results. Patients with neurological diseases, before BD, showed higher ONSD values than control group (CTRL: RT  cm; LT  cm; pre-BD: RT  cm; LT  cm; ) even without intracranial hypertension, evaluated with invasive monitoring. ONSD was further significantly markedly increased in respect to the pre-BD evaluation in neurocritical patients after BD, with mean values above 0.7 cm (RT  cm; LT  cm; ), with a corresponding dramatic raise in intracranial pressure. Logistic regression analysis showed a strong correlation between ONSD and ICP ( 0,895, ). Conclusions. ONSD is a reliable marker of intracranial hypertension, easy to be performed with a minimal training. Routine ONSD daily monitoring could be of help in Intensive Care Units when invasive intracranial pressure monitoring is not available, to early recognize intracranial hypertension and to suspect BD in neurocritical patients

Spermatogonial kinetics in humans

The human spermatogonial compartment is essential for daily production of millions of sperm. Despite this crucial role, the molecular signature, kinetic behavior and regulation of human spermatogonia are poorly understood. Using human testis biopsies with normal spermatogenesis and by studying marker protein expression, we have identified for the first time different subpopulations of spermatogonia. MAGE-A4marks all spermatogonia, KITmarks all Bspermatogonia and UCLH1 all Apale-dark (Ap-d) spermatogonia. We suggest that at the start of the spermatogenic lineage there are Ap-d spermatogonia that are GFRA1High, likely including the spermatogonial stem cells. Next, UTF1 becomes expressed, cells become quiescent and GFRA1 expression decreases. Finally, GFRA1 expression is lost and subsequently cells differentiate into B spermatogonia, losing UTF1 and acquiring KIT expression. Strikingly, most human Ap-d spermatogonia are out of the cell cycle and even differentiating type B spermatogonial proliferation is restricted. A novel scheme for human spermatogonial development is proposed that will facilitate further research in this field, the understanding of cases of infertility and the development of methods to increase sperm output

A comparative evaluation of thermodilution and partial CO2rebreathing techniques for cardiac output assessment in critically ill patients during assisted ventilation

Objective: To evaluate the reliability and clinical value of partial noninvasive CO(2) (NICO(2)) rebreathing technique for measuring cardiac output compared with standard thermodilution in a group of intensive care nonpostoperative patients. Design and setting: Clinical investigation in a university hospital ICU. Patients: Twelve mechanically ventilated patients with high (n =6) and low (n =6) pulmonary shunt fractions. Measurements and results: Thirty-six paired measurements of cardiac output were carried out with NICO(2) and thermodilution in patients ventilated in pressure-support mode and sedated with a sufentanil continuous infusion to obtain a Ramsay score value of 2. The mean cardiac output was: thermodilution 7.27+/-2.42 1/min; NICO(2) 6.10+/-1.66 1/min; r(2) was 0.62 and bias -1.2 1/min+/-1.5. Mean values of cardiac output were similar in the low shunt group (Qs/Qt 35%) the mean was 9.32+/-1.23 l/min with thermodilution and a mean NICO(2)CO value was 6.97+/-1.53 l/min, with r(2) of 0.38 and a bias of -2.31+/-1.2 min. Conclusions: The partial CO(2) rebreathing technique is reliable in measuring cardiac output in non-postoperative critically ill patients affected by diseases causing low levels of pulmonary shunt, but underestimates it in patients with shunt higher than 35%

Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial

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Noninvasive ventilation by helmet or face mask in immunocompromised patients: A case-control study

Objective: To compare the efficacy of noninvasive positive pressure ventilation (NPPV) by helmet and face mask in immunocompromised patients with hypoxemic acute respiratory failure (ARF). Design: Case-control study. Setting: The general ICU of a university hospital. Patients: Nineteen immunocompromised patients (hematologic malignancies [n = 8], solid-organ recipients [n = 8], AIDS [n = 3]) with hypoxemic ARF, fever, and lung infiltrates were treated with NPPV delivered by a helmet. Nineteen immunocompromised patients matched for diagnosis, age, simplified acute physiology score II, and PaO 2/fraction of inspired oxygen (FIO2) receiving NPPV through a facial mask served as case-control subjects. Results: The use of NPPV delivered via helmet was as effective as NPPV delivered via face mask in avoiding endotracheal intubations (intubation rate, 37% vs 47%, respectively; p = 0.37) and improving gas exchange; 14 patients (74%) in the helmet group showed a sustained improvement in PaO2/FIO2 ratio (ability to increase PaO2/FIO2 ratio > 200, or an increase > 100 from the baseline) in comparison with 7 patients (34%) in the mask group (p = 0.02), whose PaO2/FIO2 at treatment discontinuation was higher (p = 0.02) and had fewer complications related to NPPV (ie, skin necrosis, p = 0.01). Moreover, the patients receiving ventilation via helmet required significantly less NPPV discontinuations in the first 24 h of application (p < 0.001) than patients receiving ventilation via face mask. Conclusions: The helmet may represent a valid alternative to a face mask in immunocompromised patients with lung infiltrates and hypoxemic ARF, increasing the patient's tolerance (ie, the number of hours of continuous NPPV use without interruptions) and decreasing the rate of complications directly related to the administration of NPPV

Non invasive ventilation in the trearment of FUdr-induced lesional Ppulmonary oedema

2-deoxy-5-fluorouridine, also known as floxuridine (FUdr) is a fluoropyridine antimetabolite, used in the treatment of metastatic renal cell carcinoma. We report the first case of lesional pulmonary oedema developed after receiving Fudr, recently treated in our unit. The patient refused endotracheal intubation, and was successfully treated associating noninvasive ventilation (NIV) with full-face mask to steroid treatment. The authors conclude that mechanical ventilation via face-mask can be an effective, comfortable, dignified method of support for patients with end-stage disease and acute respiratory failure

An observational electro-clinical study of status epilepticus: From management to outcome

Status epilepticus (SE) is a neurological emergency associated with a high morbidity and mortality. A prospective 3-year study was conducted in our hospital on 56 consecutive inpatients with SE. Demographic and clinical data were collected. EEG and clinical SE features were considered for the SE classification, both separately and together. The etiology of SE was determined. Patients were treated according to international standardized protocols of guidelines for the management of epilepsy. Response to treatment was evaluated clinically and electrophysiologically. Outcome at 30 days was considered as good, poor or death. Convulsive SE (CSE) was observed in 35 patients and non-convulsive SE (NCSE) in 21. Patients with CSE, in particular focal-CSE, were older than those with NCSE. As regards etiology, patients with SE secondary to cerebral lesions were the oldest, followed by patients with anoxic SE and those with toxic dysmetabolic SE. A first-line treatment was usually sufficient to control seizure activity in lesional and epileptic SE, while more aggressive treatment was necessary in all anoxic SE patients. Outcome was good in 35 patients, poor in 12, while 9 died. A prompt neurophysiological EEG evaluation, combined with the clinical evaluation, helps to make a rapid prognosis and take therapeutic management decisions. First-line treatments may be sufficient to control electro-clinical status in lesional and epileptic SE, while intensive care unit management, a more aggressive therapeutic approach and continuous EEG monitoring are recommended for refractory SE. (C) 2011 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved