Last 3 months of life in home-ventilated patients: the family perception.

We studied the family's perception of care in patients under home mechanical ventilation during the last 3 months of life. In 11 respiratory units, we submitted a 35-item questionnaire to relatives of 168 deceased patients exploring six domains: symptoms, awareness of disease, family burden, dying, medical and technical problems. Response rate was 98.8%. The majority of patients complained respiratory symptoms and were aware of the severity and prognosis of the disease. Family burden was high especially in relation to money need. During hospitalisation, 74.4% of patients were admitted to the intensive care unit (ICU). 78 patients died at home, 70 patients in a medical ward and 20 in ICU. 27% of patients received resuscitation manoeuvres. Hospitalisations and family economical burden were unrelated to diagnosis and mechanical ventilation. Families of the patients did not report major technical problems on the use of ventilators. In comparison with mechanical invasively ventilated patients, noninvasively ventilated patients were more aware of prognosis, used more respiratory drugs, changed ventilation time more frequently and died less frequently when under mechanical ventilation. We have presented good points and bad points regarding end-of-life care in home mechanically ventilated patients. Noninvasive ventilation use and diagnosis have impact on this burden.

Gene transfer in vivo with DNA-liposome complexes: safety and acute toxicity in mice.

DNA can be introduced into a variety of cell types after formation of liposomal complexes with cationic lipids. In this report, conditions have been established to optimize the production of DNA-liposome complexes that efficiently transfect cells. The safety and toxicity of this method of gene delivery have been assessed after in vivo administration, either by intravenous or direct intratumor injection. Nine to eleven days after intravenous injection, DNA was found primarily in heart and lung tissue by PCR analysis. No abnormalities were evident from histologic examination of tissue, examination of tissue-specific serum enzymes, routine biochemical parameters, or electrocardiographic monitoring. DNA-liposome complexes can therefore be used for the delivery of recombinant genes in vivo with minimal toxicity.

[Antithrombin III and fibrinogen after surgical interventions on the abdomen and heart]. / Antitrombina III (AT III) E fibrinogeno (FG) dopo interventi chirurgici all'addome e al cuore.

We have explored the changes of plasma concentrations of antithrombin III and fibrinogen in patients recovering from major abdominal and cardiac surgery. In one group of patients subjected to major abdominal surgery we detected a statistically significant reduction of antithrombin III in the second and third postoperative day, followed by return to normal values in the fourth or fifth day. Fibrinogen, instead, increased to as much as 180% of the preoperative value in the first four postoperative days and reverted slowly to preoperative values between the fourth and the eighth day. In another group of patients subjected to cardiac surgery procedures utilizing the heart-lung machine, however, we found no significant reductions of antithrombin III in the early postoperative period. These results suggest the possible influence of local tissue factors affecting the plasma levels of antithrombin III differently in the two types of surgery under discussion. The patients subjected to extracorporeal circulation, on the other hand, showed a depletion of plasma fibrinogen down to less than 30 or 40% of preoperative values. This may reflect activation of coagulation processes and the considerable sequestration of fibrin at some interfaces of the heart-lung machine.