Prevalence of exercise-induced oxygen desaturation after recovery from SARS-CoV-2 pneumonia and use of lung ultrasound to predict need for pulmonary rehabilitation.

BACKGROUND: Persistence of breathlessness after recovery from SARS-CoV-2 pneumonia is frequent. Recovery from acute respiratory failure (ARF) is usually determined by normalized arterial blood gases (ABGs), but the prevalence of persistent exercise-induced desaturation (EID) and dyspnea is still unknown. METHODS: We investigated the prevalence of EID in 70 patients with normal arterial oxygen at rest after recovery from ARF due to COVID-19 pneumonia. Patients underwent a 6-min walking test (6MWT) before discharge from hospital. We recorded dyspnea score and heart rate during 6MWT. We also investigated the possible role of lung ultrasound (LU) in predicting EID. Patients underwent a LU scan and scores for each explored area were summed to give a total LU score. RESULTS: In 30 patients (43%), oxygen desaturation was >4% during 6MWT. These patients had significantly higher dyspnea and heart rate compared to non-desaturators. LU score >8.5 was significantly able to discriminate patients with EID. CONCLUSION: In SARS-CoV-2 pneumonia, ABGs at discharge cannot predict the persistence of EID, which is frequent. LU may be useful to identify patients at risk who could benefit from a rehabilitation program.

[The effects of a dose of epidural clonidine combined with intrathecal morphine for postoperative analgesia]. / Effetti di una dose di clonidina epidurale associata a morfina intratecale sull'analgesia postoperatoria.

OBJECTIVE: To evaluate the effectiveness of a single bolus of epidural (ED) clonidine (C) associated with intrathecal morphine (M) on postoperative analgesia after cesarean section (CS). DESIGN: Prospective double-blind randomized study. SETTING: Obstetric department. PATIENTS: Fourty patients ASA 1-2 submitted to combined spinal-epidural block (CSE) for CS. INTERVENTIONS: A needle through needle set for CSE was used. The intrathecal block was induced with 2.7-3 ml of isobaric 0.5% bupivacaine (B) and 250 micrograms of M. After ED test with 0.5% B, a single bolus of C 150 micrograms in NS 10 ml (group C, n 20) or NS 10 ml as placebo (group P, n 20) was given through the ED catheter. METHODS: The observation for 36 hours evaluated analgesia (VAS until the first dose of additional analgesic, total amount of analgesic and time of first analgesic request) and side effects (variations of arterial pressure and heart rate, motor block, sedation, nausea, vomiting, itching, respiratory depression). Groups were statistically compared. RESULTS: In group C lower analgesic request (significantly between 12th and 18th hour) and significant delay of first request (22.5 +/- 4.1 h) were registered. VAS showed significant trend to opposite sign variations (downwards in group C, upwards in group P) at 1, 2 and 12 hours. In group C lower sistolic arterial pressure at 1 and 4 hours, denser motor block at 2 and 4 hours and mild sedation were observed. CONCLUSIONS: A single ED bolus of C 150 micrograms after CS significantly enhances and prolongs the analgesic effect of M 250 micrograms without important side effects.

Bronchiolitis obliterans organizing pneumonia in three children with acute leukaemias treated with cytosine arabinoside and anthracyclines.

Bronchiolitis obliterans organizing pneumonia (BOOP) is a clinicopathological entity with well-defined diagnostic criteria, which can be idiopathic or produced by a variety of biological processes. We describe the occurrence of BOOP in three children, one with acute lymphoblastic leukaemia and two with acute promyelocytic leukaemia. In the three patients, BOOP developed 10-20 days after a course of therapy with cytosine arabinoside and anthracyclines. The possible relationships between the small conducting airway lesions, lung toxic reaction to the drugs and/or nonidentified infectious agents are discussed.

Fiberoptic bronchoscopy and bronchoalveolar lavage for the evaluation of pulmonary infiltrates after BMT in children.

Thirty-one fiberoptic bronchoscopies and BAL performed within 4 days after the appearance of pulmonary infiltrates in 28 children who received BMT were reviewed. A causative agent was identified in 67% of patients with diffuse infiltrates (Cytomegalovirus in 8 cases, Pneumocystis carinii in 4) and in 31% of those with localized infiltrates (Aspergillus in 2, bacteria in 2). No relevant side effect was reported. The results obtained from cytological and microbiological testing provided relevant informations for the management of most cases, regardless to the identification of a specific pathogen. We conclude that BAL is a safe diagnostic procedure that should be considered early after the onset of pulmonary complications in BMT recipients.

[Course and regression of HELLP syndrome]. / Evoluzione e regressione della sindrome HELLP.

The authors reported the outcome of a retrospective study of patients with HELLP syndrome to verify whether this pathology is a clinical entity with models of evolution, regression and well defined treatment. A total of 20 individual cases were reported at the Division of Obstetrics and Gynecology at the G. Gaslini Institute during the period from January 1990 to September 1995. All cases showed the normalisation of the various clinical and hematochemical parameters within a maximum of 8 days after birth. The rapid diagnosis, the immediate extraction of the fetus and appropriate medical treatment led to the prompt resolution of this severe pathology without the need for demolitive surgery frequently used in the past.

[Oral pathology in autologous bone marrow transplantation (ABMT). Its prevention and local treatment]. / Patologie orali nel trapianto autologo di midollo osseo (ABMT). Prevenzione e terapia locale.

The level of chemo-radiotherapy that patients must undergo in the course of ABMT treatment causes a direct toxic mucous damage and serious medulla aplasia with subsequent neutropenia. Both factors significantly affect the appearance of oral complications. These represent one of the most frequent (congruent to 85%) postoperative problems. Particular attention must be paid to the conditions of the oral cavity during the phase immediately preceding the transplantation, owing to the fact that serious aplasia that patient show, may have potentially lethal consequences. Therefore, the authors of this study followed the patients during the pre-transplantation and post-transplantation phase, putting into practice a whole range of procedures whose aim is the prevention of oral lesions or the limitation of their seriousness and duration. The Hematology Department of San Martino Hospital admitted 30 patients, 22 with LNH and 8 with LLA, 10 men and 20 women. 10 patients represented the control group. The patients were visited approximately one month before the transplantation; they underwent x-ray examination and an objective examination of the oral cavity. On the basis of the results of these first examinations, each patient would be assigned to different therapeutic protocols so that all the patients would be surgically treated only when the state of the oral cavity was sufficiently good. Since admittance to hospital for ABMT, the patients were followed 3 times a week, then different protocols of prophylaxis and local therapy were applied, according to the presence of bacteriological, viral or fungal localized or diffused oral lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

[The oral status of HIV+ patients. The clinico-statistical results with reference to 2 examination check-ups]. / Lo stato orale in pazienti HIV+. Risultanze clinico-statistiche a seguito di 2 campagne di visita.

The authors describe experience during 2 cycles of examinations of HIV+ patients in an outpatient department devoted to seropositive screening. The results were statistically evaluated in order to seem up the typical characteristics of oral health in this population.

[Inhibition of the immune response due to the volatile fatty acids produced by anaerobic bacteria in the periodontal pocket]. / Inibizione della risposta immunitaria da parte degli acidi grassi volatili prodotti dai batteri anaerobi della tasca parodontale.

Short-chain fatty acids produced by anaerobic bacteria of the periodontal pockets inhibit lymphocytes activation. The highest degrees of immunosuppressive activity is produced by butyric acid.

[Inhibition of the adhesiveness and proliferation of gingival fibroblasts induced by short-chain fatty acids produced by anaerobic bacteria]. / Inibizione dell'adesività e della proliferazione dei fibroblasti gengivali indotta dagli acidi grassi a catena corta prodotti dai batteri anaerobi.

Short-chain fatty acids produced by anaerobic bacteria inhibit attachment and proliferation of gingival fibroblasts. Butyric acid, at concentration normally present in periodontal pockets, produced the highest degree of activity.

[Dynamic phonocardiography in the study of mitral valve prolapse. Our experience]. / La poligrafia dinamica nello studio del prolasso della mitrale. Nostra esperienza.

The purpose of this paper is to check the usefulness of dynamic phonocardiography for mitral valve prolapse (MVP) diagnosis, especially in apparently silent cases, or with late-systolic click. In fact, possible MVP or mitral valve regurgitation can be shown. 148 patients (58 males, 90 females) have been examined by basal and dynamic phonocardiography and M-echocardiography. Patients were recruited for routine medical examination or during investigations for other causes or to explain evocative MVP troubles. Provocative tests by amyl nitrite, isoproterenol and methoxamine registered a late-systolic click in 17 normal cases and a late-systolic murmur in 22. M-echo demonstrated MVP in 142 cases (96%), with a slight prevalence of late-systolic MVP; tricuspid valve prolapse coexisted in 8 cases and aortic regurgitation in 12. Today echocardiography is the most important examination, but all our data point to the usefulness of dynamic phonocardiography for MVP diagnosis: in our opinion, the integration of both techniques represents the most correct approach.