Preoperative changes of forced vital capacity due to body position do not correlate with postoperative respiratory function in obese subjects.

BACKGROUND: Obese patients are at risk of developing postoperative pulmonary complications. We hypothesized that preoperative changes in dynamic spirometry due to body posture would correlate with the drop of forced vital capacity (FVC) measured early after surgery. METHODS: Thirty consecutive morbidly obese patients undergoing gastric banding were investigated. All subjects were studied the day before surgery (T0) and on postoperative day one (T1). Forced Vital Capacity (FVC) was measured, together with heart rate, mean arterial pressure and respiratory rate. At T0 measurements were taken in a random fashion with subjects in upright and in supine position. Subjects were then investigated after surgery in the supine position (T1). Postoperative pain was assessed at T1 using visual analogue scale. Intraoperative variables were also collected. RESULTS: Body Mass Index (BMI) of the investigated subjects was 43.9 ± 5.7 Kg/m2 (range 33.8-60); their age was 40 ± 8 years. All dynamic spirometric data decreased significantly from upright to supine position (P<0.05) and after surgery from 3.07 L (2.77-3.71) to 1.50 (1.15-2.12) (FVC T0 supine vs. T1, P<0.05). Changes of FVC due to body position did not correlate with changes of FVC occurring after surgery (R2=0.105, P=0.081). When subjects were stratified by the median postoperative drop of FVC (45.74%), preoperative (anthropometric and spirometric data), intraoperative (ventilatory settings and hemodynamics) and postoperative (FVC and pain) parameters were similar between groups. The duration of pneumoperitoneum was correlated with the drop of FVC (R2=0.551, P<0.05). CONCLUSION: The derangement of FVC that occurs in obese subjects after gastric banding is not predictable before surgery from anthropometric or spirometric data. The duration of pneumoperitoneum significantly contributes to postoperative impairment of respiratory function.

[Evaluation of preoperative activity in a research and teaching hospital]. / Valutazione dell'attività di prericovero in un ospedale di ricerca e di insegnamento.

To shorten the length of stay before the surgical intervention and to increase the performance of the elective surgery, the Ospedale Maggiore di Milano decided to open a preadmission service working as a day hospital setting. This service has to evaluate patients eligible for surgery both from the surgical than for the anesthesiological point of view. The study wants to state the efficacy, the performance, the quality of this service with particular attention on the elaboration of diagnostic protocols. In this study were investigated more than 8.000 accesses registered in two years (2003-2004) from 9 units of surgery. The evaluation wants to improve the level of quality of this structure in order to better identify the anesthesiological patient risk, the diagnostic protocols and the coordination with all the ancillary services in the hospital.

[Vascular pathology. A study of some blood parameters indicative of leukocyte activation and platelet dysfunction]. / Patologia vascolare. Studio di alcuni parametri ematici indicativi di attivazione leucocitaria e disfunzione piastrinica.

BACKGROUND: In vascular pathology the endothelial lesions easily reflect on blood cells, inducing a reactive state. In the present study the eventual presence of activation signals in leukocytes and platelets was tested. METHODS: Fifty-eight subjects with major vascular pathology and 14 with lower limbs venous insufficiency were studied, together with a control group of 25 normal subjects. Elastase PMN, superoxide ion, leukocytes and subpopulation count, platelet factor 3, clot retraction, heparin in neutralizing activity (HNA plasmatic and intraplatelet), platelet count and volume were tested. RESULTS: As regards leukocytes, it was observed a significative increase of elastase PMN and monocytes number for both the studied pathologies, of superoxide ion and leukocyte number only for major vascular pathology; for platelets, an inhibition of functionality, revealed by clot retraction test for arterious and venous pathologies and by HNA test only for the venous one. CONCLUSIONS: As regards the leukocyte activation, elastase PMN is particularly responsive to the endothelial lesion both in arterious and in venous districts, while superoxide ion appears to increase in presence of a marked alteration. The level of monocytes is indicative of an inflammatory condition and of leukocytes of an atherosclerotic inflammatory process. As for platelets, the test clot retraction is specifically sensible to the endothelial abnormality in both the arterious and venous pathologies with addition of an abnormal HNA test only in venous insufficiency. This platelet dysfunction is probably due to endothelial release of vasoactive and heparin amplifying substances.

[Heparan sulfate in the therapy of postphlebitic syndrome. Evaluation of the efficacy and tolerability as compared to mesoglycan]. / Eparansolfato nella terapia a medio termine della sindrome postflebitica. Valutazione dell'efficacia e della tollerabilità nei confronti del mesoglicano.

BACKGROUND: Antithrombotics and profibrinolytics are indicated in several clinical thrombophilic conditions such as postphlebitic syndrome. Heparansulphate, a glycosaminoglycan, shows an antithrombotic activity with low anticoagulant effect. The aim of the study was to evaluate the efficacy and the safety of heparansulphate (100 mg b.i.d.) versus mesoglycan (50 mg b.i.d.), both administered for three months in patients with postphlebitic syndrome. METHODS: The trial was performed in an open-label, controlled, with parallel and randomized groups, design. Thirty patients, with chronic venous insufficiency and a history of venous thrombosis were enrolled. Coagulative and fibrinolytic parameters (PT, aPTT, euglobulin lysis time, fibrinogen, D-dimer, t-PA, PAI-1) and signs and symptoms (cramps, paresthesia, itch, edema, local pain, skin trophism) were assessed at enrollment, 15 days later after the pharmacological washout period and after 1, 2, 3 months of treatment. Safety was evaluated by monitoring any adverse event during the study and performing clinical laboratory tests at the beginning and at the end of treatment. RESULTS: The two drugs showed a superimposable efficacy and very good tolerability. Coagulative and fibrinolytic parameters were positively affected by both treatments and the clinical benefit was particularly evident in the heparansulphate group with a significant decrease "between times" of local pain, edema, paresthesia and itching. CONCLUSIONS: These data support the use of heparansulphate, and in general of glycosaminoglycans, in the postflebitic syndrome.

[Hemostatic factors of endothelial origin in major vascular pathology]. / Fattori emostatici di origine endoteliale in patologia vascolare maggiore.

There is an altered hemostatic balance in vascular-based diseases. The aim of this study was to compare a group (no. = 38) of vascular patients (aortic aneurysm, carotid obstructions arteriopathies of lower limbs) and a control group (no. = 40) and assess variations in the following endothelial factors: tPA, PAI1, vWf, fibronectin and dimer D, in differentiated degrees according to the type of pathology. These were the indicative signs of endothelial mobilization resulting in the renewed continuity of the stratum with the formation of a hemostatic plug. vWf was found to be particularly significant as a marker of an ongoing atheromasic process and its extension to various vascular districts.

[Major interventions in vascular surgery with and without autotransfusion. Comparison of coagulation and hemodynamic parameters]. / Interventi di chirurgia vascolare maggiore con e senza autotrasfusione. Confronto di parametri coagulativi ed emodinamici.

Twenty out of 32 patients undergoing major vascular surgery received autologous blood transfusion and hemostatic and hematological parameters were evaluated in both transfused and non-transfused groups. Blood and urine samples were also analysed. No acceleration of the hemostatic process was observed during either surgery or the postoperative period; free hemoglobin present in reinfusion sacks (?), even in high doses, was immediately restored to normal values in the patient's circulation. A slight effect was observed at the renal level alone. These findings confirm the good qualitative level of the procedures used to reinfuse blood lost during surgery.

[The rupture of an abdominal aortic aneurysm in a patient with a fused horseshoe kidney. A clinical case report]. / Rottura di aneurisma dell'aorta addominale in paziente portatore di rene fuso a "ferro di cavallo". Descrizione del caso clinico.

An emergency operation for a ruptured aortic aneurysm can be very difficult in the presence of horseshoe kidney. This concomitance is rare but represents an interesting challenge for vascular surgeons. The authors report a case of 80 year old male patient who reached the operating theatre for ruptured aortic aneurysm. Unexpectedly a preaortic horseshoe kidney was found. The authors describe the surgical technique adopted to get rapidly to the aneurysm collar preserving kidney integrity.

[Protection systems of erythrocytes during intraoperative autotransfusion. Experience with the use of S-adenosyl-L-methionine]. / Sistemi di protezione delle emazie in corso di autotrasfusione intraoperatoria. Esperienza sull'uso della S-adenosil-L-metionina (SAMe).

An experiment lasting 2 years in more than 200 patients in single blind conditions (S-Adenosyl-L-Methionine vs placebo) aimed to improve protection of red cells during intraoperative autotransfusion. The two groups are analysed and, on the basis of objective hematochemical data it is concluded that in patients treated with the pharmacological support erythrocyte membrane stability is good.