Changes in neutrophil oxidative potential in patients undergoing cardiopulmonary bypass with polypropylene hollow fiber oxygenators.

Neutrophil oxidative metabolism, C3d and beta 2 microglobulin levels, were assessed in nine consecutive patients undergoing cardiopulmonary bypass surgery with polypropylene hollow fiber oxygenators for open cardiac operations. Generation of oxygen free radicals by neutrophils was measured as luminol-enhanced chemiluminescence after stimulation with opsonized Zymosan and phorbol myristate acetate. A significant increase in light emission was detected by using both of the chemiluminescence stimulators. Moreover, a remarkable and significant increase in C3d levels was found already at 10 min. Conversely minimal changes in levels of beta 2 microglobulin were detected during cardiopulmonary bypass surgery. These data suggest that the impact of the patient blood with the foreign surface of cardiopulmonary bypass results in activation of phagocyte cells with increased potential in oxygen consumption. These effects could be partially complement-mediated.

Activation of neutrophil oxidative metabolism during cardiopulmonary bypass with membrane oxygenators.

Neutrophil oxidative metabolism was prospectively assessed in 9 consecutive patients undergoing cardiopulmonary bypass (CPB) with polypropylene hollow fiber oxygenators for open cardiac operations. Blood samples were collected at 10, 20, and 30 min of CPB. The generation of oxygen-free radicals by neutrophils was measured as luminol-enhanced chemiluminescence after stimulation with opsonized Zymosan and Phorbol Myristate Acetate. A significant increase in light emission was detected by using both the chemiluminescence stimulators. These data suggest that the contact of patient blood with foreign surfaces during cardiopulmonary bypass results in activation of phagocyte cells.

Myocardial protection by perioperative diltiazem drip: a clinical evaluation.

This study was undertaken to evaluate the potential role of a perioperative calcium-channel blocker (Diltiazem) infusion in improving myocardial preservation. Forty consecutive CAD patients were randomly assigned to a control (C; n = 20) and a treated (D; n = 20) group. In patients in the latter group diltiazem was continuously infused at 0.5 to 2.0 mcg/kg/min i.v. from anesthesia induction until the aortic cross-clamping, and from myocardial reperfusion till the 48th postoperative hour. During the preCPB phase hypertension occurred less frequently in group D (3 vs 12 cases, p = 0.0033). In the immediate postischemic period, depression of contractility and the need for inotropic support were observed in 3 cases in group D and in 9 in group C (p = 0.0384). Postoperatively, group D patients had a lower incidence rate of hyperkinetic arrhythmias or conduction disturbances (p = 0.0218), as well as of ECG signs of ischemia (p = 0.0016). Significant CK enzyme level increase was noted in 13 patients in group C versus 4 in group D (p = 0.0040). Two perioperative myocardial infarctions were diagnosed, both in group C. These clinical data show that continuous perioperative infusion of diltiazem can effectively increase myocardial preservation during ischemic arrest, without unfavorable effects on the hemodynamics, electrical activity or mechanical performance of the heart.

[Total parenteral nutrition in resuscitation. A study of 31 cases]. / Nutrizione parenterale totale in rianimazione. Studio di 31 casi.

The authors analyse the results obtained above study of 31 patients managed with total parenteral nutrition for a period variant from 3 to 18 days. From these dates result importance of caloric and nitrogen administration both qualitatively and quantitatively. The authors analyse the nutritional requirements in the seriously patients, particularly with renal insufficiency.

Traumatic rupture of the thoracic aorta. (Report of two unusual cases).

Two unusual cases of traumatic aneurysm of the aorta are described. Both presented several days after thoracic trauma sustained in a car accident. The presenting features were progressing dysphagia and displacement of the oesophagus in the first case and a coarctation-like syndrome in the second. Diagnosis was confirmed in each case by aortography and emergency resection of the aneurysm with a dacron prosthesis was carried out. Aortic rupture should be considered in all cases of thoracic trauma, especially when severe, even several days after the trauma itself. Patients should be evaluated with serial chest roentgenograms and an aortography should be performed in any suspicious case. Treatment is surgical and the operative mortality and morbidity is acceptably low.

[Chemical rhizotomy using phenol in the treatment of perineal pain of neoplastic origin]. / Rizotomia chimica con fenolo nel trattamento delle algie perineali di origine neoplastica.

The Authors report the results obtained in 53 patients treated with intrathecal injections of 5% phenol in glycerin for the control of serve pain caused by rectal and genital cancer. The method used for determining the sensory roots to be blocked and the technique of drug administration are described. The effects of subarachnoid phenol blockade have been evaluated on the basis of pain relief (measured by the visual analogue test) and improved general well being. The observed results indicate that this is one of the most effective and safest procedures in the management of perineal cancer cancer pain.

[Clinical experience with etomidate]. / Esperienza clinica con l'etomidate.

The effects of Etomidate, a new intravenous anaesthetic agent, were studied in 138 cases which underwent different procedures of variable duration under general anaesthesia. The effects on different organs and systems of this drug, alone or in association with other anaesthetics or adjuvants, were analyzed in this series. Clinical signs, plethysmography and electroencephalography were the main parameters studied. It was shown that Etomidate has a rapid, transient action and a high therapeutic index without any cumulative effects. In conclusion this drug is recommended as an excellent induction agent which could also be advantageously employed for short surgical procedures.

[Althesin-induced EEG changes in patients with central nervous system lesions]. / Modificazioni EEG indotte dall'althesin nei pazienti con lesioni del sistema nervoso centrale.

The EEG changes produced by Althesin (75 microliter/kg intravenously administered over 60 sec) were evaluated in 18 unpremedicated patients wih CNS diseases who were scheduled for cerebral angiography. Three parameters were analyzed: the EEG patterns of anaesthesia, the appearance of a fast activity during stabilized burst suppression (Level V), and enhancement of the registered epileptiform abnormalities. The EEG depth of anaesthesia was correlated with the EEG pattern at rest and the preexisting neurological signs. The 15 Hz fast activity which occurred during the suppression phase of Level V was recorded unilaterally over the healthy hemisphere, while it was observed bilaterally in a case involving lesion of the midline structures. The exaltation of the epileptiform EEG discharges following Althesin administration suggests that this agent might be utilized as a convenient provocative test in the diagnosis of epilepsy.