[Reduced glutathione and L-cysteine in endotoxic shock in the rat]. / Glutatione ridotto e L-cisteina nello shock endotossinico nel ratto.

BACKGROUND: Reduced Glutathione (GSH) is a well known physiological antioxidant, that would protect against lethal effects of endotoxin. However, the site of the action of GSH can be intracellular (transmembrane passage of constitutive amino acids) or extracellular (membrane thiols). AIM OF THE WORK: To search if L-cysteine (one of three constitutive amino acids of GSH) protects against endotoxin as GSH and to search if inhibition of transmembrane passage of GSH and L-cysteine by Probenecid affects that protection. MATERIALS AND METHODS: Rats injected (n = 99) with a lethal dose of endotoxin (BACTO, DIFCO lab. 0111:B4 10 mg/kg ip) immediately after received: (a) Saline solution; (b) GSH 500 mg/kg; (c) L-Cysteine 0.25 g/kg; (d) Probenecid 25 mg/kg in 20% Ethanol plus GSH 500 mg/kg; (e) Probenecid 25 mg/kg in 20% Ethanol; (f) 20% Ethanol. The administration of Saline solution, GSH, L-cysteine was repeated two hours later. Injection volume was 0.5 ml ip. Survival rate of each group of rats was evaluated 6, 12 and 24 hours after endotoxin injection. Survival was compared with that of the control group by Fisher test. RESULTS: GSH and L-cysteine significantly increase survival if compared to all other treatments (respectively p < 0.002 and p < 0.001 at 12 hours; p < 0.005 and p < 0.0002 at 24 hours). Probenecid nullifies the survival increase caused by GSH. Probenecid alone or Ethanol alone show a survival rate not significantly different in respect to control group. CONCLUSIONS: Protection exerted by GSH against fatal effects of endotoxin is also provided by one of its constituent amino acids (L-cysteine) and is inhibited by Probenecid. So we can infer that such an antioxidant action happens at an intracellular site. Need of high doses of GSH and L-cysteine can be due to the necessity of a strong concentration gradient between extra and intracellular sites.

[Anesthesia with isoflurane in air and with isoflurane and nitrous oxide]. / Anestesia con isoflurano in aria e con isoflurano e protossido di azoto.

BACKGROUND: The aim of this study is to control the depth, the quality of recovery of total inhalation isoflurane anesthesia with or without nitrous oxide. DESIGN: Controlled comparative study was carried out on 51 patients, aged 40-54 yr, ASA 1, undergoing saphenectomy, in an University Clinic. METHODS: Induction: thiopental (3.5 mg kg), atracurium (0.6 mg kg) i.v. Patients were randomly assigned to: group 1 (26 patients), 5% isoflurane in air, by mask; group 2 (25 patients), 3% isoflurane and 60% N2O, by mask. Maintenance: group 1, 2% isoflurane in air; group 2, 1.2% isoflurane and 60% N2O. During anesthesia, consciousness and analgesia level were monitored by EEG Compressed Spectral Array, and clinical signs of pain by Evans' test; arousal time evaluation by "Time to correct response test". The subjective impressions, eventual dreams and recalls were collected using a standard set of questions one hour after the end of anesthesia and 24 hours later. One hour before anesthesia and two hours after the end of surgical procedures, a psychomotor performance recovery evaluation was performed using Zazzo's "deux barrages" test. DATA ANALYSIS: Student's "t" test. RESULTS: Adequate anesthetic depth was documented in all patients. Recovery time was statistically longer in isoflurane group (group 1 16.7 sd 2.2 minutes vs 10.3 sd 1.9 minutes group 2, p < 0.01). No patient reported recalls relative to anesthetic period. Two hours after recovery no significant differences in psychomotor performance tests were recorded. CONCLUSIONS: Isoflurane anesthesia in air, in adequate concentrations, provides a sufficient level of analgesia, hypnosis, amnesia, without clinical side effects.

[Quality of care at a regional emergency medical system]. / Qualità dell'assistenza in un sistema di emergenza medica territoriale.

The Emergency Medical System (EMS) in the district of Florence is based upon the activity of 13 Emergency Mobile Unit (EMU). The activity of such a huge system is difficult to evaluate: we have concentrated our attention upon the diagnostic process assuming that "correct diagnosis = correct treatment = benefit for the patient". Then we compared diagnoses set on EMU to diagnoses made in hospitals, giving to each comparison a score from 1 to 5. In terms of quality the services of the EMS in Florence seem to be effective, since in 72% of cases the Hospital Emergency Department has confirmed the diagnoses achieved under emergency conditions, and in 12% only there has been remarkable difference. Comparing the diagnoses made on EMU to that at the hospital discharge, in two thirds of cases there is excellent correlation.