Effect of fentanyl on heart rate variability during spontaneous and paced breathing in healthy volunteers.

BACKGROUND: Many studies have been conducted to assess the effects of fentanyl on the autonomic nervous system (ANS) by heart rate variability (HRV) analysis, but disagreement on the results is still present due to confounding influences introduced by concomitant administration of other drugs or opioid-related transitory respiratory depression. We performed a single-drug controlled-breathing study on healthy volunteers to assess the impact of fentanyl on ANS. METHODS: HRV as a measure of sympathovagal balance was prospectively analyzed with an autoregressive model in 11 subjects during spontaneous and paced breathing (PB) at 20 breaths/min both before and after fentanyl 1 mcg/kg administration. HRV total power, sympathovagal balance (low-frequency/high-frequency ratio) and normalized spectral powers were considered (LFnu, HFnu). RESULTS: Fentanyl led to a reduction of LFnu (from 55.2+/-23.3 to 43.2+/-24.1, P<0.05) without HFnu increase during PB. A decrease in R-R interval variance (from 3345.6+/-3333.4 to 1806.9+/-1328.6 ms(2), P<0.05) was shown after fentanyl administration during spontaneous but not PB. PB alone decreased the HRV total power and R-R interval variance. CONCLUSIONS: Low-dose fentanyl administration in healthy volunteers leads to sympathetic and overall ANS modulation decrease, with a trend toward vagal activation.

Fungal infections: correlation with previous treatment and use of antimycogram.

From July 1987 to November 1988, 427 strains of mycetes (2.3% out of all microbiological samples) were isolated; 280 of these strains (146 from 84 in-patients, 134 from out-patients) were clinically relevant, and the cause of serious or systemic infections in 47 in-patients. Candida sp. (albicans and non-albicans) were the most frequently isolated (62% in-patients, 72% out-patients): Torulopsis sp., more frequent among in-patients (28% against 16%), were responsible for a limited hospital epidemic. 108 antimycograms were done; 7 patients had antimycotic treatment. In our hands antimycograms were useful in tracing hospital fungal infections. Before mycoses were detected, 78% of in-patients were on antibiotic treatment: 54 on 3rd generation cephalosporins, which seem to foster the outburst of fungi. The authors discuss the phenomenon and suggest some interpretation.

[Resistance to cephalosporin in hospital strains of the KES group]. / Resistenze alle cefalosporine in ceppi ospedalieri del gruppo KES.

In our laboratory KES group bacteria account for about 11% of all strains isolated from in-patients and are responsible for serious infections. Their well known increasing tendency to become resistant to beta-lactams prompted us to the KES strains isolated in medical or surgical patients in 1986.87. 30 Klebsiella retrospectively review the susceptibility to antibiotics of strains out of 59 had been isolated in that period from patients previously treated with beta-lactams: no significant variation in resistance to cephalosporins, compared to the 29 strains from non treated patients, was noted. However in the treated group one strain of Klebsiella pneumoniae out of 24 showed resistance to ceftazidime and one of Klebsiella oxytoca was resistant both to cefotaxime (1 out of 16) and ceftriaxone (1 out of 12). 19 strains of Enterobacter spp. out of 32 had bees isolated from treated patients; a significant increase in resistance to 3rd generation cephalosporins (p less than 0.01), compared to the 13 strains isolated from non treated patients, was noted. Our findings suggest that it is advisable to review the in-use antibiotic policy keeping in mind the severity of the infections caused by KES group bacteria.

Arteriographic findings in congenital malformations of the hand.

The authors show their routine technique for arteriographic examination in patients with congenital malformations. They demonstrate angiograms taken in the more common congenital deformities of the hand. Vascular anomalies are nearly always found. Most commonly the progressively more distal artery is seen with the development of a single arterial system in the more advanced deformities. The authors suggest that anomalies in the development of the vascular tree may in fact prove to be the determining factor in congenital anomalies, since the differentiation of the vascular tree appears very early in embryonic life.

Surgical treatment of Kirner's deformity.

In 1927 Kirner described a congenital deformity of the fifth finger. Since then only 68 cases have been reported and to date many different views in the pathogenesis and treatment exist. The authors report a case of a 13 years-old girl. By a dorso-lateral approach, the distal phalanx was exposed and bone resection performed; alignment was maintained by Kirschner longitudinal wires, parosteal for the left digit and intramedullary for the right. The cosmetic and functional results were good.

[About three cases of median nerve compression inside the carpal tunnel (author's transl)]. / Trois cas rares de compression du nerf médian dans le canal carpien.

The authors report about three cases of median nerve compression inside the carpal tunnel; they were caused by tendons or anomalous muscular bellies of the Palmaris Longus. The first two cases consider the anomalies of the distal insertion of the muscle, the third a volume anomaly; the first two findings allow to recall the hypothesis of a common philogenetic origin of the palmar aponeurosis and the Palmaris Longus.

[Mondor's disease. Considerations on 5 cases]. / La malattia di Mondor. Considerazioni su chinque casi.

The clinical, anatomical, topographical and pathological features of Mondor's disease are described, and five personal cases are presented. Their aetiopathogenetic characteristics reflect the doubts expressed in the literature. Stress is laid on the benign nature of the disease, the possibility of treating it at the out-patient level, and the complete remission of both subjective and objective symptoms obtainable in the space of a few weeks.

[Morgagni-Larrey hernia (2 personal cases)]. / L'ernia di Morgagni-Larrey. (Due osservazioni personali).

Morgagni-Larrey hernia is a rare diaphragmatic form whose time of onset is almost impossible to determine. Its symptoms, if any, are not easy to interpret. A standing X-ray of the chest is the only way in which its presence may be suspected and diagnosis must be confirmed by the use of contrast media. Abdominal or thoracic surgery is mandatory, even in symptom-free cases. The choice of route will be determined by the facts of the case and the patient's age. The clinical picture observed in two personal cases and their treatment are described.