Study of the relationship between regional cerebral saturation and pCO2 changes during mechanical ventilation to evaluate modifications in cerebral perfusion in a newborn piglet model.

Near-infrared spectroscopy (NIRS) could be a useful continuous, non-invasive technique for monitoring the effect of partial pressure of carbon dioxide (PaCO2) fluctuations in the cerebral circulation during ventilation. The aim of this study was to examine the efficacy of NIRS to detect acute changes in cerebral blood flow following PaCO2 fluctuations after confirming the autoregulation physiology in piglets. Fourteen piglets (<72 h of life) were studied. Mean arterial blood pressure, oxygen saturation, pH, glycemia, hemoglobin, electrolytes, and temperature were monitored. Eight animals were used to evaluate brain autoregulation, assessing superior cava vein Doppler as a proxy of cerebral blood flow changing mean arterial blood pressure. Another 6 animals were used to assess hypercapnia generated by decreasing ventilatory settings and complementary CO2 through the ventilator circuit and hypocapnia due to increasing ventilatory settings. Cerebral blood flow was determined by jugular vein blood flow by Doppler and continuously monitored with NIRS. A decrease in PaCO2 was observed after hyperventilation (47.6±2.4 to 29.0±4.9 mmHg). An increase in PaCO2 was observed after hypoventilation (48.5±5.5 to 90.4±25.1 mmHg). A decrease in cerebral blood flow after hyperventilation (21.8±10.4 to 15.1±11.0 mL/min) and an increase after hypoventilation (23.4±8.4 to 38.3±10.5 mL/min) were detected by Doppler ultrasound. A significant correlation was found between cerebral oxygenation and Doppler-derived parameters of blood flow and PaCO2. Although cerebral NIRS monitoring is mainly used to detect changes in regional brain oxygenation, modifications in cerebral blood flow following experimental PaCO2 changes were detected in newborn piglets when no other important variables were modified.

Study of the relationship between regional cerebral saturation and pCO2 changes during mechanical ventilation to evaluate modifications in cerebral perfusion in a newborn piglet model

Near-infrared spectroscopy (NIRS) could be a useful continuous, non-invasive technique for monitoring the effect of partial pressure of carbon dioxide (PaCO2) fluctuations in the cerebral circulation during ventilation. The aim of this study was to examine the efficacy of NIRS to detect acute changes in cerebral blood flow following PaCO2 fluctuations after confirming the autoregulation physiology in piglets. Fourteen piglets (<72 h of life) were studied. Mean arterial blood pressure, oxygen saturation, pH, glycemia, hemoglobin, electrolytes, and temperature were monitored. Eight animals were used to evaluate brain autoregulation, assessing superior cava vein Doppler as a proxy of cerebral blood flow changing mean arterial blood pressure. Another 6 animals were used to assess hypercapnia generated by decreasing ventilatory settings and complementary CO2 through the ventilator circuit and hypocapnia due to increasing ventilatory settings. Cerebral blood flow was determined by jugular vein blood flow by Doppler and continuously monitored with NIRS. A decrease in PaCO2 was observed after hyperventilation (47.6±2.4 to 29.0±4.9 mmHg). An increase in PaCO2 was observed after hypoventilation (48.5±5.5 to 90.4±25.1 mmHg). A decrease in cerebral blood flow after hyperventilation (21.8±10.4 to 15.1±11.0 mL/min) and an increase after hypoventilation (23.4±8.4 to 38.3±10.5 mL/min) were detected by Doppler ultrasound. A significant correlation was found between cerebral oxygenation and Doppler-derived parameters of blood flow and PaCO2. Although cerebral NIRS monitoring is mainly used to detect changes in regional brain oxygenation, modifications in cerebral blood flow following experimental PaCO2 changes were detected in newborn piglets when no other important variables were modified.

Sildenafil prevents the increase of extravascular lung water and pulmonary hypertension after meconium aspiration in newborn piglets

Meconium aspiration syndrome causes respiratory failure after birth and in vivo monitoring of pulmonary edema is difficult. The objective of the present study was to assess hemodynamic changes and edema measured by transcardiopulmonary thermodilution in low weight newborn piglets. Additionally, the effect of early administration of sildenafil (2 mg/kg vo, 30 min after meconium aspiration) on this critical parameter was determined in the meconium aspiration syndrome model. Thirty-eight mechanically ventilated anesthetized male piglets (Sus scrofa domestica) aged 12 to 72 h (1660 ± 192 g) received diluted fresh human meconium in the airway in order to evoke pulmonary hypertension (PHT). Extravascular lung water was measured in vivo with a PiCCO monitor and ex vivo by the gravimetric method, resulting in an overestimate of 3.5 ± 2.3 mL compared to the first measurement. A significant PHT of 15 Torr above basal pressure was observed, similar to that of severely affected humans, leading to an increase in ventilatory support. The vascular permeability index increased 57 percent, suggesting altered alveolocapillary membrane permeability. Histology revealed tissue vessel congestion and nonspecific chemical pneumonitis. A group of animals received sildenafil, which prevented the development of PHT and lung edema, as evaluated by in vivo monitoring. In summary, the transcardiopulmonary thermodilution method is a reliable tool for monitoring critical newborn changes, offering the opportunity to experimentally explore putative therapeutics in vivo. Sildenafil could be employed to prevent PHT and edema if used in the first stages of development of the disease.

Sildenafil prevents the increase of extravascular lung water and pulmonary hypertension after meconium aspiration in newborn piglets.

Meconium aspiration syndrome causes respiratory failure after birth and in vivo monitoring of pulmonary edema is difficult. The objective of the present study was to assess hemodynamic changes and edema measured by transcardiopulmonary thermodilution in low weight newborn piglets. Additionally, the effect of early administration of sildenafil (2 mg/kg vo, 30 min after meconium aspiration) on this critical parameter was determined in the meconium aspiration syndrome model. Thirty-eight mechanically ventilated anesthetized male piglets (Sus scrofa domestica) aged 12 to 72 h (1660 ± 192 g) received diluted fresh human meconium in the airway in order to evoke pulmonary hypertension (PHT). Extravascular lung water was measured in vivo with a PiCCO monitor and ex vivo by the gravimetric method, resulting in an overestimate of 3.5 ± 2.3 mL compared to the first measurement. A significant PHT of 15 Torr above basal pressure was observed, similar to that of severely affected humans, leading to an increase in ventilatory support. The vascular permeability index increased 57%, suggesting altered alveolocapillary membrane permeability. Histology revealed tissue vessel congestion and nonspecific chemical pneumonitis. A group of animals received sildenafil, which prevented the development of PHT and lung edema, as evaluated by in vivo monitoring. In summary, the transcardiopulmonary thermodilution method is a reliable tool for monitoring critical newborn changes, offering the opportunity to experimentally explore putative therapeutics in vivo. Sildenafil could be employed to prevent PHT and edema if used in the first stages of development of the disease.

[Determination of fibrinogen-fibrin degradation factors in neoplasms]. / Determinazione dei fattori di degradazione fibrinogeno-fibrina (FDP) in corso di neoplasie.

Disseminated intravascular coagulation (DIC) and Primary Fibrinolysis (PF) are frequently reported in the literature as occurring in a wide variety of tumours whether subjected to chemotherapy or not and triggering a thrombohemorrhagic mechanism that is often fatal. It was therefore decided to assess the extent of the Fibrinogen-Fibrin Degradation Products (FDP) in a group of cancer patients in order to identify the primary, asymptomatic clinical expressions of these syndromes with a view to ascertaining the possibility of preventing more severe forms. The data confirm the presence of circulating FDP in a small percentage of the patients (26.9%) especially those with solid tumours metastasising to the liver. The involvement of that organ is therefore considered decisive for the onset of DIC and PF.

[Primary extra-lymph node localization of non-Hodgkin's lymphoma. Considerations on a clinical case]. / Localizzazioni primitive extralinfonodali del linfoma non Hodgkin. Considerazioni su di un caso clinico.

The location on first diagnosis of a non-Hodgkin lymphoma (NH lymphoma) in the respiratory structures (bronchi, pleura, pulmonary parenchyma) is rather rare (2-4%) in the absence of mediastinic and/or hilar adenopathy. In any event diagnosis is extremely difficult, often impossible even with the aid of a properly conducted biopsy since the biopsy does not provide suitable material. The case is presented of a 72 year old woman with intermittent hyperpyrexia and multiple alveolar masses, the aetiology of which was only identified 8 months after the onset of the symptoms with the appearance of latero-cervical lymphadenopathy where biopsy revealed the presence of an N.H. lymphoma that was highly malignant but otherwise unspecificable.

[Angioimmunoblastic lymphoadenopathy with dysproteinemia. A doubtful clinical case]. / Linfoadenopatia angioimmunoblastica con disproteinemia. Un caso clinico dubbio.

After a brief description of the clinical and laboratory picture of angioimmunoblastic lymphadenopathy with Dysproteinaemia (AILD), the case of a 49 year old woman is described. The woman died of haematemesis and with a clinical picture that originated 14 years earlier with Sjogren's syndrome that developed with modest systemic lymphadenopathy, splenohepatomegaly, autoimmune anaemia (Coombs direct positive). Histological examination of the parotid, certain lymph glands, the liver and the spleen suggested a diagnosis of proliferative lymphopathy that might have been either AIDL or low malignity NH lymphoma. The rarity of the syndrome and the clinical difficulties of accurate diagnosis are discussed.

[Occupational exposure to hepatitis B virus in personnel of the S.S. Trinità Hospital in Borgomanero]. / Esposizione professionale al virus dell'epatite B (H.B.V.) del personale ospedaliero "S.S. Trinità" di Borgomanero.

369 workers at the S.S. Trinità Hospital, Borgomanero - Health Unit 54 were screened for H.B.V. H.B.V. markers were found in 49.9% of whom 28% presented a profile of immunization, 1.9% were found to be chronic carriers of HBsAg, 18.1% were only positive for anti-HBc and 1.9% presented a doubtful serum profile that will require further study. Women and senior staff (in terms of both age and seniority of service) were most often affected. In view of the high rate of H.B.V. infection, preventive vaccination is though necessary to protect the workers' health.

[Essential thrombocythemia. Clinical case report]. / La trombocitemia essenziale. Contributo clinico-pratico.

Essential thrombocythemia is a rare form of proliferative myelopathy and should not be confused with secondary thrombocythemia. In view of the frequency with which an increased platelet count is recorded with the automatic hemochromogen recorder, the fundamental parameters necessary for an accurate diagnosis are summarised on the basis of a typical clinical case observed for two years.

[Proposal for a program in the early diagnosis of breast cancer]. / Proposta per un programma di diagnosi precoce del carcinoma della mammella.

Systematic examination of the breasts of women admitted to a medical ward for apparently non-breast-related pathologies revealed 22 cases of isolated nodules (2.06%) of which 9 (40.9%) were carcinomatous. It is pointed out that while mass screenings are impossibly expensive careful periodic clinical examination by the G.P. is sufficient to identify a good percentage of potentially curable neoplasias.

[Para-albuminemia and alloalbuminemia: 1st case report of a VR/VR B genetic variant in the Novara area]. / Paraalbuminemia e alloalbuminemia. Prima osservazione nel novarese della variante genetica VR/VR B.

The 12th case of alloalbuminaemia in Piedmont, and the 1st in the Novara area, coded NO/PN, are reported. Although alloalbuminaemia is at present purely a clinically asymptomatic scientific curiosity, future investigations could link it to other genetic marks with consequent practical advantages. It is also important to distinguish this form from acquired para-albuminaemia, often the only sign of pancreatic fistulisation.

[Behavior of blood composition in chronic liver diseases]. / Comportamento della crasi ematica in epatopazienti cronici.

On the basis of data from hospitalised patients with chronic liver pathology, the relationship between the type and severity of the disease and the nature and extent of changes in blood composition was studied. It is concluded that a direct relationship exists between liver pathology and haemopathy which can be attributed to various aetiopathogenetic factors. The severity of the liver pathology is the main factor, independently of its aetiology.

[Syndrome of clinical pseudohypoglycemia]. / Sindrome della pseudoipoglicemia clinica.

Four cases of coma, clinically typed as hypoglycaemic but without low blood sugar levels are presented. The clinical picture was rapidly normalised by immediate infusion with hypertonic glucosate. A tentative pathogenetic hypothesis is proposed and the Yager and Young "non-hypoglycaemia" syndrome is once more discussed.