[Catheterization of the subclavian vein through the cannulation of the external jugular vein. Our experience]. / Il cateterismo della vena succlavia mediante incannulazione della vena giugulare esterna. Nostra esperienza.

UNLABELLED: The cannulation technique of the subclavian vein by the external jugular vein is described. OBJECTIVE: To point out this simple and safe method without complications deriving from the direct needle-prick of the subclavian vein. METHODS: Experimental plan. The comparative study includes 30 patients in the resuscitation department during the second half-year in 1996. Place. Resuscitation Department of the University Polyclinic in Palermo. Patients. 30% of these patients were male and 70% were female; coagulative serious disorders were present in some patients, in others the coagulative picture was unknown. Interventions and observations. The modified Seldinger technique has ben used, introducing a J wire through the needle cannula put in the external jugular vein, taking care not to exceed the length of the latter with the J wire. Less rigid and small catheters have been used which can fluctuate in the running blood and be carried in the superior vein cava. Once the subclavian vein has been cannulated, a Rx graph control of the thorax was made, showing the excellent position of the catheter. RESULTS: Only one failure, but this technique has not showed complications. CONCLUSIONS: This technique finds applications in all situations of extreme emergency, in which on the one hand it needs a central blood vessel, on the other there are hemorrhagic problems or there isn't any possibility to do a coagulative screening in short time.

Magnetic resonance findings in scuba diving-related spinal cord decompression sickness.

Scuba diving is associated with risk of severe decompression sickness (DCS type II), which results from rapid reduction of the environmental pressure sufficient to cause the formation into tissue or blood of inert gas bubbles previously loaded within tissues as a soluble phase. DCS type II constitutes a unique subset of ischemic insults to the central nervous system (CNS) with primarily involvement of the spinal cord. Ten patients with diving-related barotrauma underwent neurologic examination. Two of them presented progressive sensory and motor loss in the extremities at admission and were presumed affected by spinal cord DCS. Magnetic resonance imaging (MRI) demonstrated abnormalities in the white-matter tracts of the spinal cord in these patients, in each case corresponding to an area of the cord believed to be clinically involved. After a course of therapeutic recompressions, one patient was able to stand and walk a short distance, and MRI revealed a decreased extension of areas of spinal cord abnormalities. MRI has proved to be reliable in the detection of pathologic changes of spinal cord decompression sickness that were previously undetectable by other neuroimaging methods and also has proved to be useful in the follow-up during therapeutic hyperbaric recompressions.

[Role of oxygen venous saturation monitoring and CAVH in the multiple organ failure syndrome. Description of a clinical case]. / Ruolo della SvO2 e della CAVH nella sindrome da scompenso multiorgano (MOFS). Descrizione di un caso clinico.

A 42 year old man was admitted to the intensive Care Unit with signs and symptoms of septic shock, associated with adult respiratory distress syndrome (ARDS), jaundice and acute renal failure. In order to support different organs failures mechanical ventilation (IPPV, PSV, CPAP), continuous arteriovenous hemofiltration were affected, and continuous intravenous infusion of dopamine and dobutamine was started. After and during application of these therapeutic measures, continuous monitoring of mixed venous blood oxygen saturation (SvO2) was applied by Swan-Ganz fiber optic catheter in the pulmonary artery. Monitoring of SvO2 represented a useful means to guide inotropic therapy and to assess the hemodynamic effects of CAVH and mechanical ventilation. The case reported emphasized the role of continuous venous oximetry in multiple organ failure syndrome.

[Efficacy and safety of amrinone in the treatment of heart insufficiency in intensive care]. / Efficacia e tollerabilità dell'amrinone nel trattamento dell'insufficienza cardiaca in terapia intensiva.

The authors describe the results obtained treating with amrinone for 48 hours 11 patients with acute heart failure. The patients (4 males and 7 females), age range between 50 and 82 years) received an initial bolus of 0.75 mg/kg followed by and infusion which on average was of 5.82 +/- 1.06 (SD) micrograms/kg/min. Besides a subjective and objective clinical improvement they could observe a quick and remarkable improvement of the main hemodynamic parameters (cardiac index, cardiac output, pulmonary capillary wedge pressure, mean pulmonary pressure). The tolerability of the drug was good, except for a decrease in platelet, already described in literature. In conclusion, the Authors consider amrinone a very interesting drug for its positive inotropic and vasodilating activity and because it does not cause an increase of the myocardial oxygen consumption.

[Mixed venous oxygen saturation as optimization of the therapeutic response in low output syndrome]. / SvO2 come ottimizzazione della risposta terapeutica nella sindrome da bassa gittata.

The Authors report on their experience about SvO2 continuous monitoring in order to find out the best therapeutic answer to inotropic drugs, knowing that, at constant values of SaO2 and Hb, possible variations of SvO2 reliably correspond with parallel variations of cardiac index (IC). Two groups of 15 patients each, suffering from low out-put syndrome, have been studied; patients have been treated with inotropic therapy based on Dobutamina and Amrinone. The 2 groups only differed from each other for the kind of monitoring: the first group was exposed to intermittent measurements of the cardiac out-put, while the second group was exposed to continuous monitoring of SvO2. Analysing the obtained results, the Authors notice not only a close correlation between the improvement of SvO2 and IC, but also a significant rediction in time required to dose drugs, owing to the constant help provided by on-line monitoring of SvO2. (table; see text)