Neuroendoscopic septostomy: Indications and surgical technique.

BACKGROUND: Endoscopic septostomy is the treatment of choice for monolateral obstruction of the foramen of Monro. Common causes of this condition include: neoplasms, hemorrages, infections, congenital atresia, idiopathic occlusion. METHOD: All the steps for performing a safe endoscopic pellucidotomy are presented. A brief discussion about the most common technical variations and their rationale is added. CONCLUSION: Endoscopic pellucidotomy is a safe and effective treatment when a thorough understanding of anatomy is achieved.

Coenzyme Q10 in dilated cardiomyopathy.

The authors have tried to study the therapeutic efficacy of coenzyme Q10 (CoQ10) in patients with dilated cardiomyopathy (DCM). In fact, CoQ10 has been shown to be deficient in myocardial tissue biopsies taken from DCM hearts, compared to normal hearts. Thirty patients with histological diagnosis of DCM were orally treated with CoQ10 (100 mg/die) for 2 months. Before and after treatment a clinical examination with determination of NYHA class and an echocardiographic examination with determination of ejection fraction (EF) and of telediastolic (TDV) and telesystolic (TSV) volumes were performed, and blood was drawn for plasma CoQ10 determination. In seven patients the pretreatment endomyocardial level of CoQ10 was also assayed. Seven patients left the study because of poor therapeutic compliance. In 47% of patients the clinical symptomatology regressed, with improvement of NYHA class. The EF improved from 0.31 +/- 0.09 to 0.37 +/- 0.11 (p less than 0.001). The TDV passed from 262.2 +/- 85 ml to 203.3 +/- 83 ml (p less than 0.05), and the TSV from 166.13 +/- 75 ml to 126.9 +/- 56 ml (ns). The CoQ10 plasmatic levels improved in 95% of the patients: from 0.74 +/- 0.37 micrograms/ml to 2.27 +/- 0.99 micrograms/ml (p +/- 0.0001). The CoQ10 myocardial levels did not show univocal values, but the patients with lower myocardial levels seemed to have a better therapeutic response. These data suggest that the CoQ10 deficiency in DCM may be reversible and that the therapeutic effects depend on the basal plasmatic and myocardial levels. Therapy with coenzyme Q10 may be considered to be an efficacious aid in the traditional treatment of chronic cardiac failure.

Oxidative stress of red blood cells stored for transfusion use.

Some oxidative indexes and the level of reduced glutathione have been determined on red blood cells stored for transfusion use. Conjugated dienes show a concentration which increases until around the third week of storage and then comes back to lower values. On the contrary malonyldialdeyde shows a decreasing level until the third week and then rises rapidly to very high values. Reduced glutathione rises until about the end of the second week and then falls to very low values. Free haemoglobin continuously rises through the whole period of storage; from these data it is evident that a storage time not exceeding 21 days gives the best transfusion results.

[Products of lipid peroxidation in the blood and respiratory secretions in 3 patients with acute respiratory diseases]. / Prodotti della perossidazione lipidica nel plasma e nelle secrezioni respiratorie di tre pazienti affetti da ARDS.

Oxygen free radicals have been suggested to be involved in ARDS pathogenesis. Their production may be caused by leukocyte activation and by administration of high oxygen concentrations. Radicals can oxidize lipids with production of dienes. In order to gather an indirect proof of radical production, dienes were repeatedly assessed in plasma and bronchoalveolar lavage (BAL) samples from three patients affected by ARDS. Plasma levels resulted higher than normal ones in all the patients initially; concentrations in BAL samples were lower than in plasma. Successively dienes decreased progressively in the patient who survived, whereas an increase was observed in BAL samples from the other patients, who died. The last trend was accompanied by a smaller increase in plasma levels.

Peroxidative events in stored platelet concentrates.

Changes in metabolic and functional activity of platelets stored as platelet concentrates in plastic bags highly permeable to gases were investigated. The following parameters were measured daily: pH, pO2, pCO2, HCO3, glucose, lactic acid, lactic dehydrogenase, cellular ATP and platelet aggregation induced by different agents (collagen and ADP). As indexes of lipid peroxidative damage, the cellular levels of conjugated dienes, malonyldialdehyde and some antioxidant molecules such as coenzyme Q10 and vitamin E were determined. A marked increase in pO2, conjugated dienes, malonyldialdehyde, lactic acid and lactic dehydrogenase activity was observed during the preservation. Platelet ATP content was unmodified and a remarkable decrease in platelet aggregability was found. pCO2, cyclooxygenase activity, vitamin E, coenzyme Q10, bicarbonate and glucose showed a rapid fall. Our data seem to indicate a preservation of platelet metabolic activity and a correlation between increased lipid peroxidation and functional impairement.

Biochemical and functional changes of platelet stored for transfusional use.

A protocol for the biochemical study of platelet stored for transfusional use at 22 degrees C and under continuous shaking in a plastic bag highly permeable to gases and with a suitable area/volume ratio, is described. Plasmatic dextrose, lactic acid, lactic dehydrogenase activity, cellular ATP and malonyldialdehyde were monitored during the storage, as well as some acid-base indexes namely: pH, pCO2, HCO3-, pO2. The platelet functional status was checked as aggregating power induced by ADP and collagen and by beta-thromboglobulin release. The results obtained are indicative of a discrete maintenance of aerobic metabolism by platelets which are able to give up CO2 and take up O2 so that the plasmatic pH is constant during the storage. However, the malonyldialdehyde increase suggests that platelets become increasingly susceptible to peroxidative attacks. The aggregating response was dramatically reduced even on the third day of storage. The data obtained point out that, under the conditions reported, platelets can be transfused up to the third day of storage.