[Prevalence of nosocomial infections in Intensive Care Units in Triveneto area, Italy]. / La prevalenza delle infezioni nosocomiali nelle Unità di Terapia Intensiva del Triveneto in Italia.

BACKGROUND: Nosocomial infection is one of the most common complications affecting patients admitted in intensive care units (ICU). The aim of this study is to evaluate rates of ICU-acquired infections, potential risk factors for these infections, causative microorganisms and antibiotic resistance patterns. METHODS: A 1-day point-prevalence study was conducted in 39 ICUs in Triveneto area (Italy) in November 1998. The overall study population included 188 patients with mean age of 61.4+/-19.3 years; the mean SAPS II score at entry into the ICU was 44.4+/-16.8 and the median duration of hospitalization was 9 days (range 2-636). RESULTS: A total of 59 patients (31.4%) had 79 episodes of ICU-acquired infections; pneumonia (45.5%), bloodstream infection (30.4%), and urinary tract infection (11.4%) were the most frequent types of infection. The leading causative microorganisms were S. aureus (24.4%, 77% of them were resistant to methicillin), Enterobacteriaceae (24.4%), P. aeruginosa (23.2%), fungi (12.2%), coagulase-negative staphylococci (7.3%) and Enterococcus spp (4.9%). Independent risk factors for nosocomial infections were duration of hospitalization >7 days (OR 4.29, 95% CI 1.82-10.1), SAPS II score >30 (OR 3.34, 95% CI 1.0-11.18), total parenteral nutrition (OR 2.69, 95% CI 1.19-6.07) and tracheostomy (OR 1.88, 95% CI 0.84-4.20). CONCLUSIONS: Nosocomial infections are relatively frequent in Triveneto area ICUs. The predominance of pneumonia and bloodstream infection, and the high frequency of antibiotic-resistant pathogens indicate that resources had to be assigned towards the implementation of control programs of those infections, monitoring of antibiotic resistance and prescription, and antibiotic therapy guidelines.

Prospective evaluation of combined carotid and coronary surgery.

In order to evaluate the effectiveness of combined carotid and coronary surgery in reducing the incidence of neurological disturbances after coronary artery bypass grafting (CABG), 144 consecutive candidates for CABG (group I) were screened for carotid disease noninvasively with Doppler ultrasonography (duplex). Twenty-six (18%) were considered at risk for stroke because of a severe (above 50% diameter reduction) stenosis; 20 (4 symptomatic and 16 asymptomatic) underwent combined surgery. Forty-seven other patients (group II) underwent CABG surgery without previous Doppler investigation. Only three patients (1.5% of the survivors) developed transient neurological disturbances after surgery; two who had normal internal carotid arteries belonged to group I, and one to group II. None of the six patients at risk for stroke who underwent only CABG developed neurological symptoms. The incidence of intra- and postoperative cardiac complications of the group who had CABG only compared to that of the group with combined surgery. We conclude that, although safe, combined surgery is not to be performed systematically on candidates for CABG with a significant internal carotid artery stenosis.

[Prevalence of atherosclerotic lesions of the carotid bifurcation found with echo-doppler (duplex) technic in patient candidates for aortocoronary bypass]. / Prevalenza di lesioni aterosclerotiche della biforcazione carotidea rilevate con tecnica eco-doppler (duplex) in pazienti candidati ad intervento di by-pass aortocoronarico.

The association of an overt coronary artery disease with a cerebrovascular disease is frequently reported. However the real prevalence of atherosclerotic lesions at the carotid bifurcation in coronary patients is not well established. The aim of our study was to evaluate the prevalence of atherosclerotic involvement of the extracranial carotid arteries in a group of 141 patients undergoing coronary artery by-pass graft (CABG) and to verify whether any correlations between coronary and carotid artery disease exist. The extracranial carotid arteries have been studied by means of an echo-doppler (duplex) system, which combines a B-mode images with a pulsed doppler. A high prevalence (17.02%) of patients with a severe (greater than 50% diameter reduction) carotid involvement was detected (Tab. II). However, no correlations between the coronary and the carotid disease were found in terms of extension and severity (Tab. V). In conclusion, a systematic evaluation of the carotid arteries is recommendable in the coronary patients, candidates to CABG, even in the absence of cerebrovascular symptoms.

[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.

[Clinical experience with althesin]. / Esperienza clinica con althesin.

On the basis of the clinical records of experiments on 110 patients treated with Althesin as induction and maintenance anaesthetic in association or otherwise with other anaesthetics, it is concluded that Althesin possesses good hypnotic power and is compatible with other anaesthetics. It also offers fair stability of cardiocirculatory and respiratory values with slight incidence of unwanted side-effects. Althesin is therefore classed among the safest anaesthetics.

[Althesin in cesarean section]. / L'althesin nel taglio cesareo.

The effects of Althesin (group A) and thiopentone (group B) in mother and newborn were compared after their use in the induction of narcosis in 80 patients undergoing Caesarean section. The mean doses of Althesin (0.072 ml/kg i.v.) and thiopentone (4.1 mg/kg i.v.) proved sufficient to guarantee rapid onset of sleep (about 20 seconds) in both groups. As of cardiovascular effects on the mother in the induction-extraction period, greater stability of cardiac frequency (c.f.) was noted with thiopentone, while Althesin produced rapid, frequent variations in c.f. The reverse phenomenon was observed with respect to arterial pressure variations. The clinical condition of the newborns at 1st, 3rd and 5th minutes after extraction, assessed by means of the Apgar index, was excellent in both groups of patients. Results obtained were assessed by analysing variance with the Fisher test.

[Precurarization using pancuronium in male subjects. Evaluation of certain clinical effects]. / La précurarisation par pancuronium chez le sujet de sexe masculin. Evaluation de certains effets cliniques.

The authors studied certain effects in the male subject of precurarisation using different doses of pancuronium. The results obtained show that the maximum doses used, corresponding to 0.01 Omg/kg of pancuronium, were associated with subjective symptoms which were well tolerated by the conscious patient, a decreases in the incidence of fasciculations, antagonistic effects against succinylcholine and a decreases in postoperative myalgia. In their conclusion, the authors confirm that the maximum doses of pancuronium used require an increase in doses of succinylcholine in order to avoid the antagonism phenomenon, and that doses ranging from 0.010 to 0.020 mg/kg of pancuronium could be used in order to completely eliminate postoperative myalgia related to succinylcholine.

Fatal air embolism after subclavian vein catheterization. Case report.

The authors describe a case of fatal air embolism in a patient with an endovenous catheter introduced into the subclavian vein through a supraclavicular way. The opening of pleura caused by the needle during the thrusting of the needle caused a subcutaneous supraclavicular and laterocervical emphysema during ventilation with intermittent positive pressure (IPPV). The authors suggest that IPPV, in the postoperative period following kidney removal, was the main ancillary reason of the air embolism since opening of pleura, in a patient who breathes spontaneously, only induces pneumothorax according to the majority of the authors.