[Evoked potentials and headache]. / Potenziali evocati e cefalea.

The multiform clinical varieties of idiopathic headache still represent an unclearly defined nosological entity; what is more, there is still no definitive etiopathogenetic and clinical classification which is unanimously supported by specialists in this sector. Moreover, given that the physiopathological mechanism which triggers off the various forms of headache is still not completely clear, yet it is obvious that research is focused on the identification of a test which is valid in terms of clinical diagnosis but at the same time can contribute towards neurophysiological examination. In order for a test to be of practical use also in terms of neurophysiological research, as well as being diagnostic, it should be able to examine the patient's neurosensory function, offering advantages in clinical terms, and contribute to clarifying the role of neurotransmitters in pain genesis. The test must also be non-invasive, offer comparable results, be repeatable after short intervals and be well tolerated by children. These represent the fundamental characteristics of a test which is applicable to the heterogeneous population of headache sufferers. In this context evoked potentials (EPs), using various forms of sensorial stimulus, appear to represent the ideal test; by exploring the well known and anatomically well defined neuronal systems at various levels of the CNS, they also help to explore the neurotransmitter function of the former, providing further information regarding the genesis of the crisis. A review of the literature examined in the present study showed the validity of the tests both in discriminating the various clinical forms of headache and supplying important information regarding the neurotransmitter-related genesis of the chain of nervous and vascular alterations leading to cephalic pain.

[Emergency diagnostic imaging in thoracic trauma. A clinical case]. / Diagnosi d'urgenza per immagini nel trauma toracico. Caso clinico.

The authors report a case of thoracic trauma with pulmonary contusion in which chest X-ray was not significant, nevertheless severe clinical state. They underline the importance of CT in the early evaluation of pulmonary lesions and in their development.

[Automatic fluid control during high-flow continuous hemofiltration: the Equaline system]. / Il controllo automatico dei fluidi durante emofiltrazione continua ad alti flussi: il sistema Equaline.

OBJECTIVE: To describe the use of an automatic fluid control system, Equaline, during high flux continuous hemofiltration. DESIGN: Prospective descriptive study. SETTING: General intensive care unit in a general hospital. PATIENTS: 15 consecutive patients suffering from septic shock, hypercatabolic with acute renal failure. INTERVENTION: Pump driven continuous veno-venous hemofiltration (PDCVVH) with high flux was performed. All pts were intubated, under mechanical ventilation and treated with vasoactive agents for hemodynamic instability. Fluid balance was achieved with an automatic fluid control system, Equaline, on daily basis according to clinical needs. MEASURES: Length of treatment, daily amount of ultrafiltrate and urea removal, urea and creatinine blood level before and after the treatment were registered. RESULTS: Age was 59.1 years, SAPS 17.2. Patients were treated for an average period of 9 days obtaining a daily ultrafiltrate production of 21.4 L. In all pts, though the high catabolism (daily nitrogen production > 30 g), there was a significant decrease of urea and creatinine concentration. CONCLUSION: Equaline system was able to maintain intravascular volume in the face of high ultrafiltration rate avoiding clinically important discrepancies between ultrafiltrate formation and fluid replacement. We conclude that PDCVVH management is greatly improved with use of such servo-controlled feedback system.

Continuous veno-venous hemofiltration in critically ill patients with multiple organ failure.

18 critically ill patients, with multiple organ failure (MOF) (from shock either septic, n = 15, or cardiogenic, n = 3), oliguria and increase in BUN and creatinine were treated with pump driven, high flux continuous veno-venous hemofiltration (CVVH). Replacement fluids were administered in predilution mode. All patients were under respiratory support and vasoactive drugs, and received early nutritional support (N input: 0.2-0.3 g/kg/day). Mean duration of treatment was 9.2 days and mean ultrafiltrate production was 21.4 l/day; treatment resulted in a significant reduction of both urea nitrogen and creatinine blood levels (-20 and -40% of initial values respectively) in spite of a very severe catabolism. The total amount of urea nitrogen removed through CVVH ranged from 15 to 73 g/day (mean 33.5), the median value of urea nitrogen clearance was 12.8 ml/min with a median ultrafiltration coefficient of 0.8. The mean duration of hemofilters was 69 hours (38-108); the efficacy of filters remained stable throughout the entire lifespan and changes were made in case of sudden decrease of ultrafiltration (< ml/min). No major complication was observed in over than 4000 hours of treatment. Pump driven, high flux CVVH proved effective in the control of water electrolyte balance and metabolic homeostasis in a group of critically ill, hemodynamically unstable, catabolic patients with MOF and acute renal failure. In no case we had to add intermittent hemodialysis or to use hemodiafiltration. The constant extracorporeal blood flow and the stable efficacy of hemofilters allowed an easy control of the overall effectiveness of this technique.

[Acute polyneuropathy in the critical patient. Description of a clinical case]. / Polineuropatia acuta nel paziente critico. Descrizione di un caso clinico.

Polyneuropathy syndromes were described during prolonged sepsis and multiple organ failure. This kind of polyneuropathy should be discriminated from Guillain-Barré syndrome. The authors report their experience concerning a clinical case.