A case of fatal emphysematous pyelonephritis presenting as lower limb gaseous gangrene.

The aim of this paper was to focus on emphysematous pyelonephritis (EPN), which is a severe disease that is rarely described in intensive care literature, although it is well-considered in urology and radiology journals, with numerous case reports. A 61 year-old diabetic and obese woman admitted to the Intensive Care Unit (ICU) was diagnosed with gas gangrene of the left lower limb. Within a few hours, the patient needed mechanical ventilation and high inotropic support. The abdominal computed tomography (CT) scans showed bilateral renal calculi and gas within the renal parenchyma extending towards the lower limb. Despite aggressive antibiotic therapy, supportive intensive treatment and nephrectomy, the patient died after 5 days. EPN is a rare but severe disease whose early recognition is fundamental for a favorable outcome. Intensivists should reasonably suspect it whenever diabetic patients develop septic conditions and signs of gas collection in the abdomen, pelvis, retroperitoneal space or even in the lower limbs.

[Tracheal intubation: increase of arterial pressure and cerebral blood flow velocity. Effect of thiopentone and propofol]. / Intubazione tracheale: aumento della pressione arteriosa e della velocità del flusso ematico cerebrale. Ruolo del TPS e del propofol.

Induction of anaesthesia in intracranial surgery, especially for vascular diseases, must minimize haemodynamic changes: blood pressure and cerebral blood flow must not be increased to a high degree. Our work compares increases in blood pressure and in the speed of cerebral blood flow during endotracheal intubation in two groups of patients, who received propofol or thiopentone for the induction of anaesthesia. We studied 30 patients, without intracranial diseases, who underwent lumbar slipped disk surgery. Half of the patients received thiopentone and curare before intubation and the other half propofol and curare. Increase in blood pressure after intubation was lower with propofol than with thiopentone in a statistically significant way. Also the increase in the speed of cerebral blood flow, measured with doppler technique, was lower when induction with propofol was used, though not statistically relevant.

[Infective complications of external ventricular shunts]. / Complicanze infettive nelle derivazioni ventricolari esterne.

Since the sixties at our Department of Neurosurgery, we use an original method for external ventricular shunts. To verify the effectiveness for reduction of infections risks the Authors have retrospectively analyzed 95 patients: only 4 cases of meningitis have been observed. The Authors consider the utility of the proper method and the importance of the duration of ventriculostomy placement.

[Cerebral pathology and hyponatremia. Cerebral damage with central pontine myelinolysis after rapid correction]. / Patologia cerebrale ed iponatremia. Danno cerebrale con mielinolisi centrale pontina dopo rapida correzione.

Hyponatremia is a state of relatively common observation among neurosurgical patients and it may determine or precipitate a condition of brain swelling in the head-injured. The quick reversal to normal values of serum sodium concentration may cause relevant neurological disturbances: they are related to peculiar neuropathological changes, the most representative of which is central pontine myelonilysis. Two cases (one in pediatric age) of head injured patients with brain damage resulting from rapid correction of a SIADH related hyponatremia are presented.