Subarachnoid anesthesia vs monitored anesthesia care for outpatient unilateral inguinal herniorrhaphy.

AIM: Inguinal herniorrhaphy is one of the most commonly performed surgical procedures in a same-day surgery setting. The prerequisite of having to discharge the surgical outpatient on the same day has an influence on the choice of the anesthetic technique. METHODS: A randomized clinical trial was performed on 100 outpatients; 50 patients were enrolled in the subarachnoid anesthesia (SA) group and 50 patients in the monitored anesthesia care (MAC) group. Patients in the MAC group received local anesthesia plus target-controlled infusion propofol (LA+TCI). SA was performed using 7.5 mg 0.5% hyperbaric bupivacaine according to the selective technique. In the LA+TCI group, LA was performed with 20 mL 1% mepivacaine + 10 mL 1% ropivacaine; IV propofol sedation using TCI according to Schnider was used to obtain a Ramsay scale response of 4-5. Transferability from the operating room was evaluated based on an Aldrete score > or =9; ability to discharge from the health facility was evaluated based on a Post-Anesthesia Discharge Scoring System (PADSS) > or =9. RESULTS: Of the 100 total patients enrolled, five drop-outs were recorded in the SA group. By comparing the LA+TCI and SA groups, it was determined that the time to an Aldrete > or =9 score from the end of the procedure was 25+/-27 vs 34+/-54 min (P=0.330); the time to a PADSS 9 score was 113+/-58 vs 181+/-65 min (P<0.001); actual discharge occurred after 236+/-83 vs 289+/-78 min (P<0.01). CONCLUSIONS: LA+TCI was shown to be more effective than selective SA at low doses in terms of shorter time to recovery after unilateral inguinal herniorrhaphy procedures.

Diabetes mellitus e depressão: uma revisão sistemática / Diabetes mellitus and depression: a systematic review

A presença de depressão no paciente com diabetes mellitus (DM) parece relacionar-se a alterações no curso clínico da doença, O objetivo deste trabalho é realizar uma revisão sistemática sobre a associação entre o DM e depressão. Foi realizada uma pesquisa bibliográfica utilizando as bases de dados MEDLINE e LILACS para identificar artigos relevantes, publicados entre 1990 e 2001, que avaliassem esta associação. Foram analisadas informações referentes à prevalência, ao impacto e ao tratamento da depressão no DM. A prevalência de depressão no DM variou de 0 a 60,5 por cento, Sintomas depressivos relacionaram-se a um pior controle glicêmico, a um aumento e a uma maior gravidade das complicações clínicas, a uma piora da qualidade de vida e ao comprometimento de aspectos sociais, econômicos e educacionais ligados ao DM. O tratamento da depressão está relacionado à melhora dos níveis glicêmicos, podendo contribuir para um melhor controle de diversos aspectos relacionados ao DM.

[Lipolysis and ketosis during swimming in thermal water]. / Lipolisi e chetosi nel nuoto in acqua termale.

Plasma free fatty acids, blood glucose, beta-hydroxybutyrate and acetoacetate variations were studied in rats during swimming. Rats were forced to swim for 30 min in thermal water (source of Abano Terme) at 35 degrees and in normal water at 25 degrees. During swimming in thermal water plasma free fatty acids were increased, the glycemia remained unaffected, the beta-hydroxybutyrate and acetoacetate decreased. The swim in normal water induced a sharp increase of plasma free fatty acids, a decrease of blood glucose, an increase of blood beta-hydroxybutyrate and a marked decrease of acetoacetate. From these data, some indications of clinical interest are presented and discussed.

[Beneficial effect of swimming in thermal waters on muscle glycogen depletion]. / Benefico effetto del nuoto in acqua termale sulla deplezione del glicogeno muscolare.

The effect of swimming in the termal water on muscle glycogen stores was studied. After 30 min the muscle glycogen results in a diminution, but it is not depleted. On the contrary, 30 min of swimming in normal water results in a depletion of muscle glycogene stores. The glycemic homeostasis is well maintained in thermal water, and hypoglicemia occurs only after swimming in normal water.

[A systematic approach to the prediction of psychosomatic disease]. / Approccio sistematico alla previsione di malattia psicosomatica.

This paper is an introduction to the "philosophy" adopted in research on the influence of mental factors in the onset of psychosomatic diseases. The research is oriented to the construction and implementation on a computer of a model that makes it possible to formulate predictions regarding the onset and possibly the classification of the "type" of psychosomatic disease so as to be able to activate an appropriate prophylaxis.

Evaluation of tumor and trophoblastic marker concentration in breast cyst fluid.

In our study we have examined 314 samples of cyst fluid taken from women suffering from fibrocystic breast disease (gross cystic disease). We have subdivided the cyst fluid with respect to epithelial coating and we have related trophoblastic protein content of the cyst fluid with age, seriousness of illness, and cytology of epithelial lining. We have performed RIA analysis of the trophoblastic proteins betahCG, beta1-SP-1, and alphahCG and in a smaller (n=84) group of specimens we have also tested for CEA, TPA, and ferritin. Trophoblastic proteins were positive in cystic fluids but the biological meaning of this is not known and the values are not related to clinical manifestations, except in a group of patients with apocrine metaplasia in which we tried to find a relationship between fertile age and increased betahCG. This finding presumably has a prognostic meaning that can be further understood by epidemiologic studies (of dietary intake and evaluation of lipid metabolites) and by information about inflammatory state of cystic fluid.

Effect of swimming in thermal water on skeletal muscle, liver and heart glycogen.

Skeletal muscle, liver and heart glycogen variations, induced by swimming in thermal water (at 35 degrees C) as a model of physical exercise for clinical use, were studied. Muscle and liver glycogen moderately decreases after a 30-min period of swimming and comes near to depletion after 60 min. Heart glycogen decreases only slightly after 60 min. Blood glucose and plasma insulin decrease only after 60 min of swimming. A 30-min swim in thermal water, cooled to 25 degrees C, depletes muscle and liver glycogen and slightly decreases heart glycogen. Under these conditions, plasma insulin decreases and hypoglycemia occurs. The results seem to indicate some advantages of swimming in hot thermal water in order to prevent glycogen store depletion as the physiological prerequisite for a physical exercise of clinical interest to obtain therapeutical benefits, avoiding premature fatigue and exhaustion.

[Internal medicine and psychosomatic medicine between dualism and monism]. / Medicina interna e medicina psicosomatica tra dualismo e monismo.

This paper investigates the possibility that psychosomatics could overcome the dualistic concept of a human being divided into mind and body. According to S. Freud's theories about the individual uniqueness and to G. A. Kelly's personal construct theory, the authors try to determine a monistic concept of the human being also from the clinical standpoint.

Experimental cerebral "no-reflow phenomenon".

The authors describe an experimental model of transient (15 min). unilateral, cerebral ischemia followed by 60 min of reperfusion in anesthetized rats. Zones of non perfusion are recorded and referred to as the "no-reflow phenomenon". The authors believe that vascular changes which interfere with postischemic reperfusion are due to ischemia-induced swelling of perivascular glia. The effects of the intracarotid injection of dexamethasone, furosemide and escina are evaluated in the attempt to show the importance of brain edema in ischemic cerebral damage.

[Clinical and statistical evaluation of the hypotensive effectiveness of 3 therapeutic plans in essential hypertension]. / Valutazione clinico-statistica dell'efficacia ipotensiva di tre schemi terapeutici nell'ipertensione essenziale.

The analysis of variance and Student's "t" test were applied in an assessment of the hypotensive effectiveness of three hypotensive protocols: a) diazepam + amitryptiline; b) reserpine + chlorthalidone; c) all drugs in 57 and 32 patients with stabilised essential hypertension. Diazepam + amitryptiline proved effective, both alone and in protocol b).

[Epidemiological studies of blood levels of cholesterol and triglycerides in a school-age population of Veneto]. / Indagine epidemiologica sui livelli ematici del colesterolo e trigliceridi in una popolazione scolare del Venet.

During the school year 1974-75 serum cholesterol has been evaluated in the whole school population (520 subjects, 268 males and 252 females, age ranging from 6 to 14 years) of Saccolongo, a village which is about 20 kilometers from Padova (Italy) and serum triglycerides have been further evaluated in a random population of 161 subjects (90 males and 71 females, age ranging from 6 to 11 years). Serum cholesterol values did not show any significant difference between males and females. Analysis of serum cholesterol in the various age groups revealed that it was significantly higher in females at age 6 (t = 2.2296; p less than 0.05). A significant reduction in serum cholesterol values has been found at age 11 both in males (t = 4.7810; p less than 0.001) and in females (t = 5.6134; p less than 0.001). Serum cholesterol and triglycerides values did not correlate (r = 0.404). Serum triglycerides were higher in girls than in boys (t = 2.1360; p less than 0.05). Analysis of the serum triglycerides values in the various age groups were constant in males (F = 0.4161) and inconstant in females (F = 3.8844; p less than 0.01) where age groups 8 (t = 3.5127; p less than 0.005) and 11 (t = 3.5238; p less than 0.005) showed higher than normal values.

[Ankylosing hemorrhagic arthropathy in a patient with Von Willebrand's disease (angiohemophilia A)]. / Artropatia emorragica anchilosante in paziente con malattia di Von Willebrand (angioemofilia A)

A case of von Willebrand's disease with unusual clinical manifestations is described. The disease was characterized by the presence of insistently recurring haemarthroses, starting from infancy, involving a number of joints, ending in ankylosis. Bleeding time was lengthened and the patient presented antihaemophilic globulin deficiency and decreased platelet adhesiveness.