[Benefit from bio-enteric Intra-gastric balloon (BIB) to modify lifestyle and eating habits in severely obese patients eligible for bariatric surgery]. / Utilità del palloncino intragastrico nel modificare le abitudini di vita del paziente affetto da obesità severa, candidabile alla chirurgia bariatrica.

AIM: The therapeutic model for severe obesity includes bariatric surgery, representing the safest way to keep weight down and to prevent relapses. The selection of patients for the most suitable type of surgery implies multidisciplinary approach (nutritionist, dietist, clinical psychologist and surgeon). The intragastric balloon may represent a relatively invasive method to help the medical team to select and prepare severely obese patients for restrictive bariatric surgery. METHODS: In our study we considered 48 severely obese patients: initial weight 111+/-14.8 kg, BMI 43+/-5.02, excess weight 77.47+/-16.14%. These patients have been treated with intragastric balloon (BIB) filled to a volume of 500 cc for 6 months. We considered variations induced by BIB treatment on a number of parameters--clinical, anthropometric, food intake, partition of nourishing elements and psychological and psychometric data. RESULTS: At the end of the treatment the patients showed significant reductions of excess weight (67.35+/-20.19%), of weight (103.4+/-16.72 kg) and food intake, without modification of the items in the EDI2 test, but with important motivational support for a change in life style between the beginning and the end of the treatment, clearly resulting from the medical, dietist and clinical-psychological follow-up. CONCLUSIONS: BIB is a relatively invasive means capable of modifying eating habits in the short term; it induces weight loss, may help to reduce the anaesthesiological risk and to foster a change in the patient's behaviour. In our experience treatment with BIB is useful from the educational point of view and can be used to select patients for bariatric surgery only within a multidisciplinary team. Further clinical studies are necessary.

Original insight into continuous cardiac output monitoring: "TruCCOMS". Correlation with other methods.

AIM: Of all technical devices used for continuous or intermittent monitoring of cardiac output, in our clinical practice during the last year, we tested a new system, the true continuoas cardiac output monitoring system (TruCCOMS), for the continuous real time measurement of cardiac output. The purpose of this study was to compare the accuracy, reliability and promptness of TruCCOMS with other systems and methods of cardiac output (CO) measurement such as pulsion continuous cardiac output (PiCCO) and end diastolic Area (EDA) determination by trans-esophageal-echocar-diography (TEE), keeping as gold standard for CO measurement the thermodilution method by Swan-Ganz. METHODS: Sixteen male patients, aged 50 to 60 years, with ejection fraction (FE) >50%, EUROSCORE=1, who underwent CABG surgery with circulation extra corporeal (CEC), were analysed with all methods mentioned above. The measurements were obtained at different phases: pre-CEC; post-CEC; and Intensive Care Unit (ICU). In the ICU setting, 5 patients classified as under-filled with a pulmonary capillary wedge pressure (PCWP) =/<8 mmHg were filled until a PCWP gs;13 mmHg in order to evaluate the promptness of the various systems to detect the new condition. RESULTS: The statistical analysis of data obtained in our survey, clearly demonstrates that TruCCOMS is at least equivalent to average thermo-dilution cardiac output (AvTDCO), with the advantage of being continuous, real time and, furthermore, with no need for physician intervention/interference. CONCLUSION: In our experience the TruCCOMS seems to be an ideal method for continuous cardiac output (CCO) monitoring compared with the other bedside systems challenged.

Virulence genes in halophilic Vibrio spp. isolated in common mussels.

Twenty-five Vibrio strains belonging to nine different species, isolated in common mussels, were examined for the presence of different virulence genes: ctxA, tcpA, toxR, toxS, ace, zot and vpi previously found in pathogenic Vibrio cholerae strains. Our results suggest that there is a wide dissemination of Vibrio cholerae virulence genes among the various Vibrio species tested. This finding raises the question of whether a different approach should be taken to study "environmental" Vibrio strains.