[Single lung transplantation retrospective analysis of intraoperative cardiovascular problems]. / Trapianto di polmone singolo. Analisi retrospettiva delle problematiche cardiovascolari intraoperatorie.

BACKGROUND: Analysis of haemodynamic problems during single-lung transplantation and of methodologies employed for their treatment. DESIGN OF THE STUDY: clinical retrospective study. SETTING: General University Hospital. PATIENTS: patients with irreversible lung disease, either parenchymal or vascular, undergoing single lung transplantation. INTERVENTIONS: recording of circulatory failure episodes and treatment with pharmacologic support or cardiopulmonary bypass. Modifications occurring during the study period with respect to drugs administered. Evaluation of the consequences of cardiopulmonary bypass on the postoperative outcome, namely on the duration of mechanical ventilation and length of stay in the intensive care unit. RESULTS: During the last 9 years 69 single-lung transplantations have been performed. In 50% of cases a pharmacologic support has been employed; the drug association dobutamine/nitroprusside has been gradually replaced by the association norepinephrine/nitric oxide for the treatment of right ventricular failure. Twenty patients required cardiopulmonary bypass and this caused a significant increase of the duration of mechanical ventilation and length of stay in the intensive care unit. CONCLUSIONS: Hemodynamic changes during lung transplantation are complex and often severe, leading to a clinical status of right ventricular failure, that sometime requires a mechanical circulatory support. The introduction of nitric oxide in clinical practice significantly contributed to the optimization of intraoperative cardiocirculatory profile of patients, leading to a reduction in the use of vasoactive drugs and cardiopulmonary bypass.

[Inhaled nitrous oxide (NO) for the treatment of ARDS]. / Ossido nitrico (NO) per via inalatoria nel trattamento dell'ARDS.

OBJECTIVE: To investigate the initial longterm effect of inhaled NO on hypoxemia in ARDS patients. DESIGN: Retrospective study. PATIENTS: Nine hypoxemic patients with ARDS (Murray Lung Injury Score, LIS, 2.8 +/- 0.3), treated with conventional mechanical ventilation. INTERVENTIONS: Continuous NO inhalation was started after a test of inhaled NO efficacy on gas exchange and hemodynamics. Long term effects of inhaled NO were evaluated daily in terms of arterial oxygenation and methemoglobin formation. RESULTS: The initial NO inhalation increased the PaO2/FiO2 from 141 +/- 64 mmHg to 216 +/- 70 mmHg (p < 0.0001) and decreased the mean pulmonary pressure from 38 +/- 7 mmHg to 32 +/- 5 mmHg (p < 0.01), the pulmonary venous admixture from 29 +/- 10% to 20 +/- 8% (p < 0.01) and the pulmonary vascular resistance from 325 +/- 97 dyne.s.cm-5 to 238 +/- 48 dyne.s.cm-5 (p < 0.01). Daily withdrawal of inhaled NO, which was administered for 14 +/- 16 days at 8 +/- 2 ppm, was associated with a decrease in PaO2/FiO2 by 61 +/- 32 mmHg (p < 0.0001). During prolonged NO inhalation the FiO2 was decreased, on average, by 0.34 +/- 0.19 (p < 0.01), the positive end-expiratory pressure by 4 +/- 2 cmH2O (p < 0.01) and the peak inspiratory pressure by 7 +/- 4 cmH2O (p < 0.01). Three patients died during the ICU stay. CONCLUSIONS: Our results confirm the interest for inhaled NO as an additional approach for the treatment of hypoxemia in ARDS. Inhaled NO seems to allow for a better control of gas exchange, rather than for a rapid reduction of the ventilatory support.

Circadian drinking pattern of Sardinian alcohol-preferring rats.

The present study was designed to assess the temporal pattern of ethanol intake over a 24 h period in selectively bred, Sardinian alcohol-preferring (sP) rats. Ethanol intake occurred under the two-bottle, free choice regimen. sP rats consumed ethanol in three distinct peaks, rather regularly distributed over the 12 h dark phase of the light-dark cycle and positively correlated with food intake episodes. The temporal distribution of ethanol intake and estimated blood alcohol levels are consistent with the hypothesis that sP rats voluntarily drink ethanol for its pharmacological effects.

Enterococcus flavescens sp. nov., a new species of enterococci of clinical origin.

Four yellow-pigmented group D enterococci of uncertain taxonomic position were isolated from several humans with severe infections. The results of DNA composition, DNA-DNA hybridization, fatty acid content, and biochemical property studies demonstrated that these organisms were slightly related to other previously described yellow-pigmented enterococcal species and constitute a new species, for which we propose the name Enterococcus flavescens. The type strain of E. flavescens is strain CCM 4239 [corrected].

Experimental cultivation of cannabis plants in the Mediterranean area.

In research carried out in 1982, which included the cultivation of cannabis plants with low, medium and high levels of delta 9-tetrahydrocannabinol (THC), the authors have determined the parameters for individualization and classification of cannabis plants according to their intoxicant potential. This can help to provide courts of law with valid supportive expertise on cannabis trafficking cases. The parameters are the percentages of THC in cannabinoids and in the dried substance of a plant, as well as the percentage of cannabinoids in the dried substance. On the basis of these parameters, the authors have found that a cannabis plant in which the percentage of THC exceeds 50 per cent of the total amount of cannabinoids of the extractable resin and 0.3 per cent of the total amount of dried substance, and in which the amounts of resin and cannabinoids are substantial, has a considerable intoxicant potential and is liable to be used for illicit production of cannabis for abuse. On the contrary, a plant with a THC level below 50 per cent of the cannabinoids and 0.3 per cent of the dried substance, in addition to a low level of total cannabinoids, has low intoxicant potential and can be used in industry for the production of oil and rope. On the basis of these parameters it is also possible to predict the intoxicant potential of a young cannabis plant harvested at a relatively early stage of its development.

Forensic considerations on the comparison of "serum gamma-glutamyltranspeptidase" ("gamma-GT) activity in experimental acute alcoholic intoxication and in alcoholic car drivers who caused road accidents.

The authors studied blood alcohol levels and serum gamma-GT activity in 18 drivers who caused car accidents while intoxicated, and in 20 young volunteer subjects without any hepatic damage, in which an acute alcoholic intoxication was present. In most of the drivers the serum gamma-GT activity was significantly higher than in the volunteers, which strongly suggests a chronic alcoholic intoxication. In the 20 volunteers, who were occasional drinkers, the serum gamma-GT activity did not show pathological values even in a state of heavy intoxication. According to the authors, the serum gamma-GT determination could be made obligatory by law, in order to differentiate between acute or chronic alcoholic intoxication. Should an intoxicated driver be found guilty of an offense, this fact could aggravate the circumstances. Furthermore serum gamma-GT activity determination could be used as an evaluating parameter in granting driving licences.