[Validity of computer simulation in closed circuit anesthesia]. / Validità della simulazione computerizzata dell'anestesia in circuito chiuso.

Developing a computer program to simulate the uptake, distribution, and elimination of inhalational anesthetics allow the anesthesiologist to address specific problems, but intense skills are required to translate the involved process first into a set of mathematical equations and then into a satisfactory computer program. The first step is facilitated by solutions offered in the literature. The second step by personal computer program now currently available as Gus, this program simulates anesthetic uptake and distribution using a numerical model with 12 compartments. Transport of anesthetic agents among the compartment occurs via convection of gas and blood during discrete iteration of the simulation. As initial clinical validation of the linear 12 compartment basic model the current study examined the predictive performance in 20 patients by comparing quantitatively the predicted and the measured alveolar concentration-time profiles after achievement of end tidal concentration of isoflurane (C-alv%) injected into a heated chamber (75 degrees) and then transported in closed circuit system during mechanical ventilation. With regard to the use of isoflurane 20 patients were adequately anesthetized with only 88 ml of liquid isoflurane and that is the same in simulation achieved by computer.

[Obstetric complications associated with DIC. Importance of D-dimer in the diagnosis and treatment. A clinical case]. / Complicanze ostetriche associate a DIC. Importanza del D-dimero nella diagnosi e nel trattamento. Caso clinico.

The case of a 32-year old woman with 36-week pregnancy presented at hospital because of spontaneous vaginal bleeding, anemia and mild hypotension is reported. Fetal mors in utero, abruptio placentae and diffuse intravascular coagulation were diagnosed. The patient subsequently underwent cesarean section and large retroplacental hematoma was removed and obviously fetum. The DIC was easily controlled by means of recently introduced method of determination of fibrin D-dimer.

[The use of intravenous nifedipine for the treatment of severe hypertensive crisis. A clinical case]. / Uso della nifedipina per via endovenosa per il trattamento di una grave crisi ipertensiva. Caso clinico.

Nifedipine is a calcium channel antagonist. Hypertensive crisis during anaesthesia may be elicited during the induction period or by the surgical manipulating of intrapelvic viscera. We report a case in which nifedipine given intravenously (currently an investigational dosage form) was effective in controlling a severe hypertensive crisis at dose averaging 3.4 mcg/kg/min initially and half as much for maintenance. Arterial pressure was controlled as quickly as with nitroprusside, but with no change in heart rate or cardiac output and without other untoward effects during anaesthesia.

[Comparison of 2 techniques of anesthesia induction in modern closed-circuit anesthesia]. / Raffronto tra due tecniche di induzione anestesiologica nella moderna anestesia in circuito chiuso.

The application of low flow anesthesia goes back already for more than 65 years when Ralph Waters introduced and applied cyclopropane with a very simple canister technique. The guide-lines for the clinical use of the closed circuit anesthesia were published in Chicago and Los Angeles by Professor Lin and Professor Lowe 15 years ago. We examined and followed these procedures on a modern anesthesia machine and easily achieved a good clinical performance. Our results were consistent with the modern anesthesia standard in closed circuit t.i.: economical benefits, environment savage of waste gases, heat production and humidification and last but not least in both techniques a quick anesthesia plane on 10-12 minutes that was consistent with theoretical considerations.

[Hydrothorax as a complication of subclavian vein catheterization. Pathogenetic mechanism and description of a clinical case]. / Idromediastino come complicanza dell'incannulazione della succlavia. Meccanismo patogenetico e descrizione di un caso clinico.

We report a case of possible detouring and malfunctioning of the left subclavian catheter in the homolateral internal mammary vein or of perforation form its tip of the wall of the left innominate vein. The tip of the catheter was rigid and sharp, may be the contractions of the heart or turbulent flow impinged it against the vein wall and have enhanced the perforation. The result was a hydrothorax that allowed a severe cardiac simile tamponed syndrome. The pathophysiology was also discussed.

[Poisoning with shoe dye. A clinical case]. / Intossicazione da tintura da scarpe. Caso clinico.

The paper reports the case of a young male which was severely poisoned by anilyne shoe black. After a few hours, he was in a semicomatose state, accompanied by "very dark" arterial blood gases with oxygen tension in excess of 100 mmHg. Following the administration of intravenous methylene blue (2 mg/kg), methemoglobin was reduced to hemoglobin and the level of consciousness immediately improved.

[Hemofiltration and dialysis in a case of rhabdomyolysis]. / Emofiltrazione e dialisi in un caso di rabdomiolisi.

The effect of CAVDH was evaluated in a patient with rhabdomyolysis due to extreme low temperature and also to carbon monoxide poisoning. Since renal failure im myoglobinuria has a relatively good prognosis, we recommend in this case the use of a soft technique such as continuous arteriovenous hemofiltration with dialysis.

[Continuous arteriovenous hemofiltration and hemofiltration using dialysis. Presentation of clinical cases]. / Emofiltrazione arterovenosa continua (CAVH) ed emofiltrazione con dialisi (CAVDH). Presentazione di casi clinici.

The authors describe case reports in which the CAVH and the CAVDH was of paramount importance in improving hemodynamic parameters in ARDS and MOF and various cardiac failure. The technique was very simple and results good in intensive care.

[Septic shock in a case of purulent pericarditis. Usefulness of hemodynamic study with Swan-Ganz catheterization]. / Shock settico in un caso di pericardite purulenta. Utilità dello studio emodinamico con catetere di Swan-Ganz.

In a case of cardiac tamponade the hemodynamic study with Swan-Ganz catheter was useful to confirm the diagnosis and to assess the correct therapy, otherwise the case was complicated with septic shock by purulent pericarditis and could mislead the diagnosis.