[Brain vulnerability and its modulation]. / Vulnerabilità del cervello e suo adattamento.

Clinical and experimental studies revealed that the injured brain is highly vulnerable to a subsequent insult. Surfery of the literature pertinent to clinical and experimental traumatic brain injury (TBI) is made. Increased vulnerability of the traumatically injured brain to an additional sub lethal ischemic, hypoxic, excitotoxic, or mechanical insult has been clearly demonstrated. Compared to traumatic brain injury alone, the double insult paradigm dramatically increases the brain damage. Brain vulnerability following TBI can be explained by a reduced ability to compensate for a reduction of cerebral blood flow (CBF) and oxygen (O(2)) delivery to the brain or inability to meet an increased metabolic demand. In addition, there is a specific increased sensitivity to delayed insults induced by the first injury. Potential mechanisms of the increased sensitivity to a second insult might be related to post-traumatic gene expression alterations leading to changes in neurotransmitters release, density of receptors and reduced thresholds for activation of pathways leading to delayed cell death. The brain is vulnerable to repetitive injuries. Derangements of compensatory mechanisms are responsible, in part, for this vulnerability. Additional work is needed to better understand the molecular pathways leading to secondary damage and to find novel therapeutic strategies to modulate the brain response to TBI.

[Ciaglia's percutaneous dilatative tracheostomy in intensive care. Perioperative complications and long-term results]. / Tracheostomia percutanea dilatativa secondo ciaglia in terapia intensiva. Complicanze perioperatorie ed esiti a distanza.

BACKGROUND AND AIM: The introduction of percutaneous tracheostomic techniques using dilatation (PDT) has led to the gradual disuse of conventional methods of surgery. The aim of this study was to evaluate ventilatory function in critical patients during the execution of PDT using Ciaglia's method as well as, in the postoperative phase, the long-term results, namely endotracheal lesions and cosmetic deformities of the stoma. EXPERIMENTAL DESIGN: A prospective study was carried out on a consecutive series of adult patients. SETTING: The intensive care ward of a 600-bed teaching hospital. PATIENTS: A group of 50 critical patients undergoing PDT from 1993 to 1996. Valuations of ventilatory function: expiratory volume (EV), PaO2 and PaCO2, were calculated in 40 patients undergoing PDT. Endoscopic controls of the trachea were performed in 21 surviving patients 60 days after the removal of the tracheostomic tube and a cosmetic evaluation of the tube insertion site was also made in the same patients. RESULTS: During PDT a mean reduction of EV was observed of 1.41/min and PaO2 values also diminished 15% accompanied by a 14.2% increase in PaCO2. The endoscopic control performed after 60 days in 21 out of 50 patients revealed a subglottal stenosis in 1 patient, the presence of nonstenosing cicatricial granuloma in 2 patients, edema in 2 patients and dysepithelisation of the tracheal mucosa in a further 2 patients. The remaining 66% showed flattening of the mucosa and complete restitutium ad integrum. No usurpations and cicatricial tractions of the tube insertion site were observed. CONCLUSIONS: This prospective study of intraoperative ventilatory function and the final outcome of PDT according to Ciaglia confirms that this is a reliable technique for the ventilatory management of critical patients with a low percentage of long-term complications.

Ovarian fibroma. A report of three cases.

The authors report three cases of ovarian fibroma in women in advanced menopause (mean age: 70 years). The neoplasm was bilateral in one patient. Early symptoms were pelvic pain, and, in one patient, menorrhagia without histologic alterations of the atrophic endometrium. The histology was typical of ovarian fibromas, except for one case which was characterized by a dense pseudofibrosarcomatous pattern and by the presence of numerous sex cord elements.

Krukenberg tumor. A report of six cases.

The Authors present six cases of ovarian neoplasm with histological characteristics of typical Krukenberg tumor. Usually, Krukenberg Tumor is bilateral and often secondary to gastrointestinal carcinomas. Secondary ovarian neoplasms often become evident a short time after the diagnosis of primary tumor. Moreover, the post ovulatory rearrangement of the ovarian surface could favour the metastatic spread of cancerous cells. In four cases TAG 72 serum levels were useful in the monitoring of relapsing disease.

[A new reconstructive model after total proctectomy]. / Un nuovo modello ricostruttivo dopo proctectomia totale.

The Authors describe a new reconstructive model after total proctectomy: the S-E colo-anal anastomosis (S-E CAA). The technical requisites of this variant are discussed and compared with more traditional reconstruction models. At a first evaluation of the results, the S-E CAA seems to be able to sensibly ameliorate the course and the outcome of the anastomosis and to hasten the recovery of the normal sphincteric function.