Maternal and neonatal outcome after cesarean section: the impact of anesthesia.

BACKGROUND: Among the anesthetic technologies used, regional anesthesia is becoming the most common in cesarean section (CS) deliveries. Aim. This retrospective survey examined the variables taken into account when selecting the anesthetic technique to be used, and how this choice affects the outcome for the mother and the newborn. METHODS: One thousand eight hundred and seventy elective and emergency CS were evaluated for anesthetic technique used, indications, and maternal and neonatal outcome. RESULTS: Of the 611 elective CS (32.6%), 206 (33.8%) were performed under general anesthesia and 405 (66.2%) under regional anesthesia. Of the 1259 emergency CS performed (67.4%), 525 (41.9%) were under general anesthesia and 734 (58.1%) under regional anesthesia. Conditions associated with a newborn 1-minute Apgar score of <7 were general anesthesia and multiple pregnancy (p<0.01); a 5-minute Apgar score of <7 was only associated with multiple pregnancy. The most important factor for very low Apgar scores was the presence of fetal malformations. Whatever the chosen technique, neither maternal deaths directly or indirectly due to the anesthesia nor major maternal and perinatal complications were found. CONCLUSIONS: This survey confirms the preference for regional anesthesia during elective cesarean sections and for general anesthesia in emergency situations. Moreover, newborn outcome was found not to be influenced either by the technique used or by the character of the procedure.

Prognostic role of B-type natriuretic peptide in patients with diabetes and acute decompensated heart failure.

BACKGROUND: Several studies have reported the prognostic value of natriuretic peptides, but their predictive value in patients with diabetes mellitus is unknown. The aim of the study was to test the hypothesis that measurement of brain natriuretic peptide (BNP) levels in ambulatory patients with congestive heart failure (CHF) and diabetes can predict the occurrence of cardiovascular events at 6-month follow-up. METHODS: We enrolled 145 consecutive patient with diabetes [age 72 +/- 9 years, hypertension (21%), ischaemic heart disease (52%), atrial fibrillation (22%), preserved left ventricular function (29%)] seen in the outpatient heart failure clinic after an acute episode of cardiac failure. RESULTS: The median (25th/75th interquartile range) BNP concentrations at discharge were 186 (75-348) pg/ml. At 6-month clinical follow-up 10/145 (7%) subjects had died and 31/145 (21%) had been readmitted because of cardiac decompensation. BNP values of 200 and 500 pg/ml were found to have the best compromise between sensitivity (88 and 46%, respectively) and specificity (71 and 89%, respectively) for predicting events at 6 months. Multivariate Cox regression analysis identified only two parameters as predictors of events: serum creatinine [hazard ratio (HR) = 3.3; P = 0.02], and BNP plasma level BNP cut-off values (HR = 3.8; P = 0.03 for 201-499 pg/ml and HR = 7.7; P = 0.001 for > or = 500 pg/ml). CONCLUSION: These results suggest that BNP and serum creatinine are strong predictors of clinical events in patients with diabetes and CHF. In these patients, clinical outcome might be stratified by plasma BNP levels.

[Pulmonary embolism. A case report of right atrial thromboembolism treated by thrombolysis]. / Embolia polmonare. Descrizione di un caso di tromboembolia atriale destra trattata con trombolisi.

This case report describes a 40-years-old man affected by fracture of leg and pulmonary embolism. Two-dimensional echocardiography showed a large right atrial migrant thromboembolus prolapsing into tricuspid valve during diastole. The patient was treated with rt-PA through right atrial venous catheter and underwent to serial echocardiographic examinations. The rt-PA determined the dissolution of the thrombo-embolus at the 2nd hour of infusion. It is concluded that early two-dimensional echocardiography might be a very helpful technique to diagnose and follow-up therapy of pulmonary embolism.

[Myocardial ischemia induced by exercise. Analysis of the recovery phase. Behavior of the rate-pressure normalization product in patients with fixed ischemic threshold and patients with variable ischemic threshold]. / Studio dell'ischemia miocardia indotta dallo sforzo. Analisi della fase di recupero. Comportamento del doppio prodotto di normalizzazione nei pazienti con soglia ischemica variabile e nei pazienti con soglia ischemica fissa.

Traditionally, in patients with exercise-induced myocardial ischemia we analyze the stress-test by studying the behaviour of double product at ischemia. We recognize the presence of a functional component in the reduction of coronary-flow reserve if the double product at ischemia (DPI) varies in 3 stress-tests i.e. more than 20% or more than 3200 mmHg b m'-1. Any analysis that relies exclusively on double product at ischemia is, of necessity, limited to the beginning of the ischemic phenomenon. To better understand the development of the whole event, we also considered the double product calculated when the ischemic electrocardiographic signal regressed (double product of normalization: DPN). More specifically, we set out to determine whether or not double product at ischemia behaviour in patients with variable ischemic threshold (i.e. double product at ischemia variation greater than 3200 mmHg b m'-1) differs from that of patients with fixed ischemic threshold (i.e. double product at ischemia variation less than b m'-1). We performed four multistage bicycle ergometer tests, without drugs, on 19 patients with chronic exertional anginal and exercise-induced ST depression. Patients were tested at the same time of day, within a 10 day period. In the second, third and fourth stress test double product at ischemia was calculated. On the basis of double product at ischemia values in three stress-tests, we distinguished two groups.(ABSTRACT TRUNCATED AT 250 WORDS)