TNF-alpha and doxorubicin in hyperthermic perfusion for limb sarcomas.

Eighteen patients, subdivided into groups of three, were perfused for 90 min with escalating doses of TNF-alpha (0.5-3.3 mg) and standard doses of doxorubicin (bolus 0.7-1.4 mg/kg) at a tumor temperature of at least 41 degrees C, with the aim to ascertain the maximum tolerable dose (MTD) and the activity of TNF-alpha combined with doxorubicin in hyperthermic antiblastic perfusion (HAP) for patients with limb sarcomas, candidates for amputation. Tumor response was assessed both pathologically and radiologically. Severe systemic toxicity (WHO) was observed in only 2 patients. Locoregional toxicity (Wieberdink's) was grade I in 3 patients, grade II or III in 10 and grade IV in 5. A strict correlation between the TNF dosage and the grade of limb reaction was found, grade IV being retrieved only with TNF dose >1 mg and/or muscular temperature >41.5 degrees C. Tumor necrosis was evaluated in 16 patients: in 11 (68.8%) it scored more than 75% while in 5 it was 25 to 75%. Four cases (25%) had 100% tumor histological necrosis. Limb sparing surgery was feasible in 13 (81%). Our findings suggest that this is a well-tolerated and highly active regimen in HAP.

Adjustable Silicone Gastric Banding (ASGB): the Italian experience.

Adjustable silicone gastric banding (ASGB) is a recently introduced gastric restrictive procedure. From April 1990 to April 1992, 85 patients underwent ASGB at our Department. Patients' characteristics were: 65 females, 20 males, mean age 39.6 years (range 17-60 years); body weight (BW) 127.9 +/- 23 kg; % ideal body weight (%IBW) 205 +/- 29; body mass index (BMI) 46 +/- 7; morbidly obese 68, super-obese 17. Mean follow-up is 353 days. Twelve months after the operation BW was 95.2 +/- 23 kg, % loss of excess BW 52.1 +/- 22, and % IBW 152.2 +/- 30 (45 patients). Mortality rate was zero and postoperative morbidity was insignificant. As late morbidity, we experienced two slippages of the band and six stoma-stenosis with pouch dilatation. Therefore, a surgical revision without removal of the band was performed in eight patients. The band was removed in one patient because of band erosion. In conclusion, ASGB is a safe and effective bariatric procedure. The weight loss is comparable to that produced by more extensive operations. Moreover, ASGB is fully reversible and adjustable to the patients' needs.

The Post-anaesthetic Recovery in Obesity Surgery: comparison between two anaesthetic techniques.

Forty morbidly obese patients, scheduled for restrictive gastric surgery, were anaesthetized with two different techniques. In group A (20 patients) anesthesia was induced and maintained with Propofol (total intravenous anesthesia, TIVA); in group B (20 patients) anesthesia was induced with Thiopental and maintained with Isoflurane (balanced anesthesia). At the end of surgery, recovery time (RT) and recovery score (RS) were assessed according to a modified Aldrete score. There was no difference of RS between group A and group B. RT was shorter (though not statistically significant) in group A than in group B. Our experience suggests that both techniques can be safely used in these patients, but with TIVA, patients appeared more awake and cooperative earlier. Such an advantage may be useful to prevent serious complications (thromboembolism and pulmonary failure) in the postoperative period.

[Cardiocirculatory responses to tracheal intubation in the heart patient]. / Réactions cardio-circulatoires à l'intubation trachéale chez le cardiaque.

Laryngo-tracheal nebulization with 10% lidocaine was performed in 10 patients undergoing cardiosurgery for substitution of mitral valve, five min. before induction of anesthesia with 0.007 mg . kg-1 of Fentanyl. Hemodynamic studies of these cases were compared to similar observations without nebulization. It appears tha laryngotracheal lidocaine nebulization reduces circulatory disturbances and attenuates the adrenosympathetic response to intubation.

Sample research of hospitalized acute intoxication cases using an epidemiological form.

A form for recording acute toxicological cases has been preliminarily applied to a sample of 436 subjects admitted during 1978 into the hospitals of two districts of the Venetian Region. One was predominately manufacture and industry, and the other a mountain-agricultural area. The latter had medical facilities less uniformly distributed. Through epidemiological analysis, the acute poisoning cases from psychoactive drugs (benzodiazepines, barbiturates, antipsychotic agents, and tricyclic antidepressants) prevailed (37.9%). They were followed by acute cases from street heroin or other opiates in addicts (25.7%) that only occurred in the main town of the more industrialized district. The incidence of the other poisoning cases were in the following decreasing order: household poisons (9.8%), nonnarcotic analgesics (5.1%), agricultural poisons (4.1%), cardiovascular drugs (3.7%), miscellaneous drugs (1.4%), food and plants (1.4%), oral contraceptives (1.0%), viper envenomization (0.7%), and insect bites (0.7%). A rate of 8.5% was due to unidentified compounds. Mortality was 0.9% and death occurred after exposure to corrosives, carbon monoxide, or undetermined substances. Between the two districts there were no marked differences in emergency and general measures that mainly consisted in supportive treatment with forced diuresis (13.9%) and gastric lavage (only 21.4%).