Therapeutic hypothermia in Italian intensive care units: a national survey.

BACKGROUND: The aim of this study was to investigate the use of therapeutic hypothermia (TH) in Italian Intensive Care Units (ICUs). DESIGN AND SETTINGS: After being contacted by phone, a structured questionnaire to evaluate the use of TH was sent to all Italian ICUs. The questionnaire was aimed at determining the extent of TH use (indications, methods employed, target temperature, side effects) as well as the reasons why some ICUs did not make use of TH for the treatment of cardiac arrest patients. RESULTS: Out of the 448 ICUs contacted, 90% (n=404) returned the questionnaire completely filled in. Sixty-six responders (16%) made use of TH for post-resuscitation care, and 4% used TH for other clinical scenarios (10 ICUs for traumatic brain injury; 5 ICUs for other reasons). More than half used TH not only for cardiac arrest subsequent to ventricular fibrillation (VF), but also for non-VF cardiac arrest with the duration of TH treatment being within the time suggested by advanced cardiac life support guidelines. On the other hand, 80% of questionnaire responders did not use TH, mainly because they felt they did not have enough data/experience (45%), or simply because they had never thought about it (18%). CONCLUSIONS: Despite authoritative data supporting its effectiveness and safety, use of TH as part of the therapy in a post-resuscitation period in Italian ICUs remains low. The reasons for not using it are not completely justified and suggest that an educational program is advisable in order to boost the utilization of TH in Italy.

Postoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone.

AIM: The incidence of postoperative nausea and vomiting (PONV) is high after laparoscopic surgery. A number of drugs have been used for prevention; in some studies a single dexamethasone dose before induction of anaesthesia has been effective. METHODS: To test the effectiveness of this therapy, we recruited 80 patients in a double-blind placebo-controlled study (dexamethasone 8 mg or placebo) scheduled for laparoscopic cholecystectomy. We measured nausea, vomiting, postoperative pain and length of stay. RESULTS: Patients who received preoperative dexamethasone had a reduction of PONV, but experienced the same degree of postoperative pain and remained in the hospital for the same duration. No apparent side effects were observed. CONCLUSION: Although only a small number of patients were tested, we confirm the efficacy of dexamethasone therapy for reduction of PONV. We suggest routine use of a single dose of dexamethasone for the prevention of PONV in laparoscopic cholecystectomy.

[Intubating laryngeal mask airway (ILMA) in otorhinolaryngology surgery. A case of failure]. / Maschera laringea per intubazione (ILMA) in chirurgia otorinolaringoiatrica. Un caso di insuccesso.

Intubating laryngeal mask airway (ILMA) is a very useful device for difficult airway management. The use of this device has not yet been studied in otorhinolaryngology surgery. The case of a 52-year-old man, weighing 104 kg, anesthetized for microlaryngoscopy due to aphonia occurred 6 months before, is reported. Traditional intubation was impossible. ILMA was easily positioned and the patient was ventilated. Intubation using ILMA was difficult and the operation postponed. Later, a bilateral false vocal chords hypertrophy was found. Impossible intubation using ILMA is a rare occurrence, less than 10% of cases. From previous evidence failed intubations are caused by anatomical anomalous formations, often predictables by clinical history. Blind intubation with ILMA is not, probably, the first alternative in these cases. Fiberoptic equipment intubation or use of ILMA with fiberoptic bronchoscope must be considered in these situations for possible better RESULTS. The use of ILMA in otorhinolarynogology surgery must be investigated with a specific study because there are only few experiences on this subject.

Prognostic significance of circulating immune complexes in a long-term follow-up of breast cancer patients.

The purpose of the present study was to investigate the prognostic value of circulating immune complexes (CIC) in surgically treated breast cancer patients as compared with other well-known prognostic factors. CIC of IgG and IgM classes were determined by a C1q immunoenzymatic assay in serum samples of 122 patients before mastectomy and 51 of them were found positive for IgG. The other class of CIC was virtually absent. No relevant differences of distribution of other prognostic parameters such as estrogen and progesterone receptors, histological grading, nodal and menopausal status were found according to CIC levels. Level of IgG CIC was affected by surgical removal of the tumor since significant reduction of it was observed 2 weeks after mastectomy; however, this reduction did not show prognostic significance. The patients included in the present study were subjected to a 7-year follow-up; eventually a significant association was observed between preoperative IgG CIC and relapse of the disease. Patients with positive values of immune complexes relapsed more frequently than those with negative values. Serial determinations of IgG CIC were carried out within the 24 months following mastectomy and statistically evaluated for their prognostic use. No significant association was found between increase of IgG CIC level and relapse of the disease.

Immune complexes of IgG1 and IgG3 subclasses in human breast cancer sera detected by monoclonal antibodies in an indirect immunoenzymatic assay.

Circulating immune complexes (CIC) of the IgG class were detected in sera from 37 (35.58%) out of 104 of the preoperated breast cancer patients studied using a CIq solid-phase enzymatic assay. Sera of positive patients were then tested to identify the IgG subclasses which are part of the complexes with the aim of showing a better correlation between CIC and disease evolution. IgG1- and IgG3-CIC were indirectly detected by the above test using monoclonal antibodies against the mentioned subclasses. Curves obtained with aggregated IgG1 and/or IgG3 showed good sensitivity and specificity of the test. Complexes containing both IgG1 and IgG3 were present in sera from the majority of patients; however, the relative amounts of these subclasses varied from patient to patient.

C1q solid-phase enzymatic microassay for detection of circulating immune complexes: its application in human breast cancer.

Circulating immune complexes (CIC) were detected and quantitated in human breast cancer to monitor the efficiency of mastectomy. For this aim a microimmunoenzymatic test was set up, applying a solid-phase C1q. Features of this assay can be summarized as follows: ability to estimate as low as 10 ng of aggregated human IgG (delta IgG), good reproducibility and simplicity of execution, and small serum sample required. A group of women with breast cancer at different stages (TNM classification) was tested for CIC, and 31.75% were positive. Almost all patients submitted to surgery showed a reduction of this parameter thereafter. A parallel study was carried out in another group of women with benign breast disease, and a significant incidence of CIC was found.

Influencia del Corynebacterium parvum sobre la fagocitosis de coloides de 198-Au en la rata. / Influence of Corynebacterium parvum on phagocytosis of 198-Au colloids in the rat

Se ha estudiado la cinetica de fagocitosis de coloides de 198Au protegidos con gelatina en ratas Wistar previamente tratadas con Corynebacterium parvum (CBP), con el fin de dilucidar su mecanismo de inmunomodulacion. Para ello se utilizo la tecnica de canulacion carotideo-carotidiana y se analizaron las variaciones de la velocidad de fagocitosis, v, posteriores a la administracion de CBP, obtenidas con una dosis de coloides de 198Au menor o mayor que Ks. En el primer caso no se observaron cambios significativos de v, mientras que en el segundo se determinaron incrementos significativos de v, que se hicieron maximos a los 6 dias luego de la inyeccion de CBP. El analisis cinetico de los datos obtenidos permite deducir que la accion del CBP se ejerce en la etapa de entrada de la particula coloidal al interior de la celula reticuloendotelial

Influencia del Corynebacterium parvum sobre la fagocitosis de coloides de 198-Au en la rata. / Influence of Corynebacterium parvum on phagocytosis of 198-Au colloids in the rat

Se ha estudiado la cinetica de fagocitosis de coloides de 198Au protegidos con gelatina en ratas Wistar previamente tratadas con Corynebacterium parvum (CBP), con el fin de dilucidar su mecanismo de inmunomodulacion. Para ello se utilizo la tecnica de canulacion carotideo-carotidiana y se analizaron las variaciones de la velocidad de fagocitosis, v, posteriores a la administracion de CBP, obtenidas con una dosis de coloides de 198Au menor o mayor que Ks. En el primer caso no se observaron cambios significativos de v, mientras que en el segundo se determinaron incrementos significativos de v, que se hicieron maximos a los 6 dias luego de la inyeccion de CBP. El analisis cinetico de los datos obtenidos permite deducir que la accion del CBP se ejerce en la etapa de entrada de la particula coloidal al interior de la celula reticuloendotelial