Post-operative elimination of sevoflurane anesthetic and hexafluoroisopropanol metabolite in exhaled breath: pharmacokinetic models for assessing liver function.

Sevoflurane (SEV), a commonly used anesthetic agent for invasive surgery, is directly eliminated via exhaled breath and indirectly by metabolic conversion to inorganic fluoride and hexafluoroisopropanol (HFIP), which is also eliminated in the breath. We studied the post-operative elimination of SEV and HFIP of six patients that had undergone a variety of surgeries lasting between 2.5 to 8.5 h using exhaled breath analysis. A classical three compartments pharmacokinetic model developed for the study of environmental contaminants was fitted to the breath data. We found that SEV kinetic behavior following surgery (for up to six days) is consistent across all subjects whereas the production and elimination of HFIP varies to some extent. We developed subject specific parameters for HFIP metabolism and interpreted the differences in the context of timing and dose of anesthesia, type of surgery, and specific host factors. We propose methods for assessing individual patient liver function using SEV as a probe molecule for assessing efficiency of liver metabolism to HFIP. This work is valuable not only for the clinical study of metabolism recovery, but potentially also for the study of the interaction of other manufactured and environmental compounds with human systems biology in controlled exposure and observational studies.

[Lipoemulsification. A histological study on the action of ultrasound, access site and adipose tissue]. / Lipoemulsificazione. Studio istologico sull'azione degli ultrasuoni, sulla via di accesso ed il tessuto adiposo.

A new mini-invasive technique for the lysis of subcutaneous adipose tissue has emerged in recent years. This directly applies ultrasounds to the tissue by titanium probes. Ultrasounds act on parenchyma tissues, saving the structure and integrity of the blood vessels. Our study show histological features of the subcutaneous adipose tissue evolution just ultrasound-treated up to 30 days after surgery. Five obese female patients underwent the treatment by anesthesia. Before surgery the sites to treat were topically injected with sterile, hypotonic, apyrogen saline solution added with adrenaline, Biopsies have been taken intraoperatively from the border cutis of the holes made for the introduction of the titanium probes and from the subcutaneous adipose tissue. Biopsies have also been taken during a follow-up at 2, 5, 15 and 30 days postoperatively. Drains were positioned in the treated sites for at least 72 hours. The same sites were sutured so at to make later follow-up biopsies easier. Histological specimens were considered according to three dying methods: eosin-haematoxylin, Gomori and acetic orcein. We observed, as a confirmation the safety of the adipose tissue blood vessels, and the substitution of the destroyed adipose tissue with a microfibrillar connective tissue not subject to a sclerogenic evolution.

[Lipoemulsification versus lipoaspiration. Comparison of intraoperative blood loss and surgery time]. / Lipoemulsificazione verso lipoaspirazione. Confronto fra le perdite ematiche intraoperatorie ed i tempi operativi.

Blood loss due to liposuction is one of the main problems in this kind of surgery, blood volume being up to 30%-35% of the whole liposucked volume. We studied the possible lower impact of ultrasound lipolysis in order to obviate this non negligible problem. For this purpose we treated 10 patients, females, aged between 28 and 55, such obese to overweight between 50% and 200%. These patients underwent ultrasound lipolysis surgery after any dietetic or any other treatment against obesity. No patient dropped out of the study. Each patient was treated, under general anesthesia, in a region included between an imaginary horizontal line passing through the umbilicus and another one through the middle of the femur. Thirty minutes after a bilateral infiltration with an epinephrine solution (1:500000 diluted, 28 C) 2 1 volume each side, the right side was treated with the liposucking cannula (0.4 cm diameter), the left one underwent ultrasound lipolysis with a titanium probe (0.5 cm diameter, SMEI Casale Monferrato, Italy). A liposucking probe every 10 minutes into the left side was inserted. Haemoglobin was detected (according to the method of Goodpasture) in the liposucked material. The result showed a statistically significant difference between the blood rate in the lipoaspirate and that one in the ultrasound lysed material. Ultrasound lipolysis is slower than lipoaspiration, but it also shows less risk of hemorrhage and fat embolism.

Hemophilus influenzae type b meningitis: pediatric overview.

The authors valued the incidence and clinical therapeutic aspects of Haemophilus influenzae type b (Hib) meningitis in children. They report a retrospective study, in children, with diagnosis of acute purulent meningitis, from January 1982 to December 1994, aged between 1 month and 14 years. Particular attention was direct to Haemophilus influenzae type b meningitis (20 cases). The incidence rate of Hib meningitis in the overall cases (89) was 22.47% (20), while among children younger than 5 years Hib was the most frequently pathogen isolated (20/58-34.47%). In 1/4 of cases, particularly in children younger than 1 years, exordium was aspecific and unclear. At admission culture and examination of Cerebrospinal Fluid (CFS) have been done. CFS was cultured on blood agar and chocolate plates. A latex agglutination test was used for rapid detection of the bacterial antigens. In some cases we looked for bacterial antigens in urine. 20% of children had complications and 10% had sequelae (1 years of follow-up). We didn't have any dead. Antibiotic treatment was principally with Ampicillin, Cephalosporin and Chloramphenicol. The results of this study confirm the Hib gravity and suggest that the administration of conjugate vaccine against Hib to all living in Italy is justified.

Incidence of bacterial colonization in the throat and in urines at paediatric age with evaluation of sensitivity to common antibiotics.

OBJECTIVES: To evaluate the incidence of bacterial colonization in the throat and in urines of children admitted to a paediatric ward in the year 1994. To test the sensitivity of isolates on the most common antibiotics used in therapy. METHODS: The investigation was carried out on a group of 270 children (125 male and 145 female), aged between 3 months and 12 years, hospitalized with feverish infectious pathology in the department of infectious and Tropical Diseases of the University "La Sapienza" of Rome. The cultures of the throat swabs and on urines were performed on the admission of the children before the beginning of the therapy. RESULTS: The throat-swab cultures showed pathogenous microrganisms in 232 samples (85.9%) with a slight prevalence of Gram-negative bacteria (122) with respect to Gram-positive (110) and saprophytic microbial flora (38). The urine cultures proved to be positive in 81 cases (30%) with a prevalence of Gram-negative (56) above Gram-positive isolates (25). CONCLUSIONS: The two/thirds of paediatric patients hospitalized in an Infectious Diseases Department appeared to be colonized in the upper respiratory tract, whereas in about 10% of them a marked bacteriuria was clearly evident, often in the absence of specific symptoms. A few isolates either from the throat or from urines, showed resistance to the common antibacterial agents.

Antioxidant vitamins and immunodeficiency.

On the plasma of 20 children from 1 to 6 years old with HIV infection, the following analyses were carried out: vitamin assays (vitamin E and beta-carotene), hematochemical assays, and immunoassays. From the body of our results it emerged that in the seropositive children considered, in addition to the already well-known alterations of the hematic and immune situation, there is a state of hypovitaminosis involving the most important antioxidant vitamins.

[Seroepidemiologic study of the prevalence of anti-HAV antibodies in children in Rome]. / Studio sieroepidemiologico della prevalenza degli anticorpi anti HAV nei bambini di Roma e Provincia.

The authors evaluated the incidence of infection by hepatitis A virus (HAV) in a paediatric population through a seroepidemiological investigation in a group of 278 children (0-12 years old), apparently healthy. The determination of anti-HAV antibodies was carried out by ELISA-test. Of the 287 examined sera, 27 cases turned out HAV positive antibodies (9.7%), with the following distribution, according to the groups of age: 0-3 months: 2 of 6 children were positive (mother's antibodies); 3 months-2 years: 6 of 112 (5.35%); 2-6 years: 10 of 93 (10.75%); 6-12 years: 11 of 67 (16.41%). With regard to distribution of anti-HAV antibodies by sex, 23 (15.03%) males of 153 resulted positive, whereas 4 (3.2%) females of 125 resulted positive. The decline of HAV infection in the paediatric age involves a possible shift of the risk to the adult age. It's advisable that the vaccination against hepatitis A in first period should be reserved for the subjects at risk and later both for unweaned and children in order to eradicate the infection.

[Acyclovir in the treatment of varicella in immunocompetent children]. / L'acyclovir nel trattamento della varicella nei bambini immunocompetenti.

We evaluated safety and tolerance of acyclovir ACV per os in immunocompetent children affected by chicken-pox admitted to our department from January 1993 to December 1994. 183 subjects (102 males and 81 females) aged between 0 and 14 years were treated by ACV (80 mg/kg/daily in 4 divided doses): 88 children were treated within 24 hours and 95 subjects within 48 hours from the onset of symptoms. The control group consisted of 83 children (52 males and 31 females) aged between 0 to 14 years. In all patients routine blood-test were performed and in those with respiratory illness Chest-Rx was also done. We evaluated clinical course, degree of eruption, the appearance and kind of complications, duration of hospitalization, the compliance and the potential consequences on specific antibody response. Our results show a faster improvement of clinical symptoms in treated patients with respect to the control group with shortening of the period of the fever, itch and appearance of new vescicles. The percentage of complications was lower in treated than in untreated patients. 16 cases tested for specific antibody response showed protective titers six months after treatment. In conclusion, ACV administered per os within 48 hours from onset of exanthema causes reduction of the period and the degree of general symptoms and exanthema, a lower incidence of complications even if non statistically significant. The drug is safe and well-tolerated.

[Ultrasonic suction lipectomy. A mini-invasive treatment of obesity]. / La liposcultura con ultrasuoni. Un trattamento miniinvasivo dell'obesità.

The safety of ultrasounds lipolysis in the treatment of local obesity and lipodystrophies versus suction lipectomy (less blood loss because of a lower impact on blood vessels network, and less mortality) induced us to combine these mini-invasive techniques in the treatment of obese patients. Between 1991 and 1994 we treated 205 patients (146 females, 59 males, 18-59 range age), affected by 1st degree obesity (44.4%), 2nd degree obesity (27.3%) and 3rd degree obesity (28.3%), accordingly to the following schedule: 1) general anesthesia; 2) subdermal infiltration of the operating sites of a cold sodium chloride (0.9%) epinephrine solution (1:10(5), 8 degrees C); 3) 0.5 cm cutaneous incisions; 4) introduction of titanium tips as ultrasounds source; 5) insertion of suction lipectomy probes to remove the adipose tissue destroyed by ultrasounds; 6) drainage of the wide subcutaneous space; 7) setting of elastic bandages. Mortality was zero and very low side effects have been observed. We report an improvement of blood glucose and triglycerides level and blood pressure 30 days after surgery. Fair late postoperative improvement of the blood glucose tolerance test have been seen in 3 cases.

[Clinical-statistical analysis of patient admissions to the emergency services of the Bambino Gesù Hospital in Rome in the year 1992]. / Analisi clinico-statistica dell'accesso dei pazienti al pronto soccorso dell'Ospedale Bambino Gesù in Roma nell'anno 1992.

The Authors present relevant information concerning the activity carried on in 1992 in the Emergency Department of the Pediatric Hospital Bambino Gesù in Rome. Out of 34,328 cases arrived at the first aid station, only 21.17% of them needed an emergency service. This significant percentage suggests that the pediatric medical staff in service may be better employed for children who really need urgent care.

[Clinical-therapeutic considerations in a case of miliary tuberculosis in an indonesian girl]. / Considerazioni clinico-terapeutiche su un caso di tubercolosi diffusa ad evoluzione grave in una bambina indonesiana.

The authors describe the case of widespread miliary tuberculosis, that arose in a ten year-old Indonesian girl of middle-class, who has been living in Italy from about three years. The girl was probably contaminated by a subject belonging to the same ethnic-social community, who was affected with tubercular disease. The diagnosis was effected on the ground of: clinical picture including continued-remitting fever, a loose cough, asthenia, anorexia, weight reduction, aching tumefaction on the left side of the neck; isolation of Mycobacterium tuberculosis from the expectoration, blood, urine, and a lymph node located on the left side of the neck; radiological picture that revealed a widespread miliary tuberculosis. In spite of polychemotherapy with isoniazid , rifampicin, pirazinamide, and streptomycin that was subsequently replaced by ethambutol, the course of the illness worsened and it was characterized with fever, cachexia, respiratory insufficiency and repeated episodes of pneumothorax. For such reasons on the ground of susceptibility to the antibiogram amikacin and ciprofloxacin, as well as glucocorticoids to limit the fibrousness, were added to the specific therapy that was already being out. For persisting of relapsing pneumothoraxes, the patient underwent a thoracoscopy and plerodesis with talcum powder. After four months of antitubercular therapy, the research of M. tuberculosis resulted negative in the expectoration, urine, bronchus-alveolar washing liquid and blood, in addition to improvement in general state of health with remission of fever was noticed.

[Clinical-therapeutic considerations in pertussis]. / Considerazioni clinico-terapeutiche sulla pertosse.

One-hundred and seventy-one cases of pertussis were observed at the Institute of Infections Diseases and at the 2nd Division of Infectious Diseases of the Policlinico Umberto I in Rome from January 1, 1987 to June 30, 1991. All subjects were treated according to a therapeutic protocol consisting of macrolides (erythromycin or myocamicin) at doses of 40-50 mg/die, betamethasone 0.1 mg/kg/die, specific immunoglobulin G at doses of 0.5 ml/kg repeated after 24 hours (new born babies and babies still unweaned) and oxygen therapy during the paroxystic fits. In 20 patients who were over the first year of life and who had serious asphyxiated fits, bronchodilators (trimetochinol or salbutamol) were added to the previous therapeutic scheme. Our data show both efficacy of therapeutic protocol and importance of early starting the treatment to shorten the length of disease, the strength of asphyxiated fits, and the risk of contagion.

[Clinical evaluation of the use of teicoplanin for staphylococcal infections in immunocompetent and immunodepressed patients]. / Valutazione clinica dell'impiego della teicoplanina nelle infezioni stafilococciche in soggetti immunocompetenti ed immunodepressi.

The authors have evaluated the efficacy and tolerance of teicoplanin against Gram-positive infections in 8 patients (four with endocarditis, one with cholangitis, one with purulent arthritis, one with gathered fistula and one with general pyoderma), arose both in the immunocompetent and immunodepressed subjects. All patients received IM teicoplanin at a dosage of 200-400 mg/die, according to the severity of the infectious process. Teicoplanin proved to be an effective and well-tolerated drug in the treatment of staphylococcus infections, both for immunocompetent and with serious deficit of the immune system subjects.