Total intravenous anesthesia (TIVA) with propofool and remifentanil during operative endoscopy tracheobronchial laser therapy.

Background: The aim of our study was to assess how total intra-venous anaesthesia (TIVA) achieved by propofol and remifentanil continuous infusion could ensure proper success of the endobronchial laser therapy, in optimal conditions for the endoscopist, determining at the same time an adequate hypnosis and a good analgesia. Methods: We studied 50 patients (28M - 22F), ASA class I-IV, mean age 42 ± 32.5 years , subjected to laser endoscopy to repair tracheal stenosis. TIVA was performed in all patients, and spontaneous breathing was maintained. Results: 10.2% of patients experienced episodes of coughing during induction. The depth of the anaesthesia plan, monitored by BIS, was 55 ± 5. The awakening was fast in all patients, with an Aldrete score of 7.71 ± 1.14 at 1 minute and 9.31 ± 1.12 at 10 minutes. Conclusion: The results of this study allow us to state that the continuous infusion of propofol and remifentanil proved to be the gold standard in patients ASA I-II-III undergoing endobronchial laser therapy. The use of TIVA has also allowed to perform endoscopic intervention on patients who suffered from a significant decrease of both cardiac and respiratory functions.

Fracture and migration in right atrium of a permanent venous central access system in a elderly patient: case report and literature review.

Abstract: Catheter dislocation and fracture with migration of central venous lines have been reported in the International literature. Catheter fracture with consequent migration has been observed in 0.5-3.0% and may either be consequent to catheter removal or it can occur spontane-ously. Our case report concerns the migration of a Hickman catheter connected to a venous port to the right atrium in a 61-year old patient. A literature up-to-date has been performed to assess the risk of port-a-cath positioning. The position of catheter tip is considered critical for the risk of migration, that is greater as higher the tip localization respect to the carina. The aim of our study is to underline the critical role of X-ray to visualize the exact location of the catheter tip, regard-less of the approach used for catheter positioning.

Sevoflurane inhalation for severe bronchial obstruction in infants with bronchiolitis.

Bronchiolitis is a lower respiratory tract viral infection which may result in severe bronchial obstruction and respiratory failure despite treatment with beta-adrenergic agonists and glucocorticoids. Here we describe two otherwise healthy infants with severe bronchiolitis whose clinical course was complicated by marked bronchial obstruction and respiratory acidosis refractory to conventional medications (ß-stimulants, anticholinergics and corticosteroids) and non-invasive positive pressure ventilation. Sevoflurane inhalation allowed both infants to attain a sustained, clinical improvement in ventilation and one patient to avoid mechanical ventilation. We suggest that sevoflurane inhalation may be a therapeutic option in the treatment of young infants with severe bronchiolitis who respond poorly to conventional therapy.

[Liposarcoma of the leg]. / Liposarcoma dell'arto inferiore.

The Authors report an interesting case of liposarcoma of the leg and review the international Literature. Moreover, a particular analysis of different aspects such as anatomy, clinic, diagnosis and treatment has been carried out.

[Spontaneous rupture of duodenum: case report and review]. / Rottura spontanea del duodeno: presentazione di un caso clinico e revisione della letteratura.

Although rare, injuries of the duodenum increased in frequency during the past ten years. Careful attention must be paid to them, especially in blunt trauma of the abdomen and lower thoracic regions. Often they occur along with lesions of other related structures in polytraumatized patients. X-rays are the most important mean used in diagnosis. Early diagnosis and surgical treatment are conditio sine qua non for successful results. Complete intraoperative inspection of the duodenum, careful suture of the perforation and a correct placement of drainage are essential for the prevention of postoperative complications. If the duodenal wall had lost its vitality, a gastrojejunal or duodenojejunal anastomosis or gastrostomy are performed; the duodenum is decompressed and drainage of the peritoneal cavity is established. In cases of associated injury of the pancreas or choledochus, the drainage of the extrahepatic bile duct is recommended. The Authors report a case of spontaneous rupture of duodenum in which all of the above mentioned procedures were used; they stress that only suspicion of a duodenum's rupture indicates an immediate laparotomy.

[Monitoring of consciousness with BIS during induction of anesthesia. Which muscle relaxant?]. / Monitoraggio con BIS dello stato di coscienza durante induzione dell'anestesia generale. Quale miorilassante?

The BIS-index data show that an opiate as Fentanyl is advisable with associations Cisatracurium/Propofol or Vecuronium/Propofol. It is possible to use in these cases a drip infusion to avoid the risk of awareness during intubation.

[The colecistectomy in primary sclerosing cholangitis: case report and review of literature]. / Indicazione alla colecistectomia nella colangite sclerosante primitiva: presentazione di un caso clinico e revisione della letteratura.

Primary sclerosing cholangitis (PSC) is an idiopathic chronic inflammatory condition affecting intra- and extra-hepatic biliary system. The aim of this study is to stress the importance of cholecystectomy in patients with PSC. Consideration should be given to performing a cholecystectomy in PSC patients with gallbladder adenomyomas or calculi, even asymptomatic; this happens in approximately 15% of cases.

[Collateral effects of intraoperative hyperthermic chemotherapy in peritoneal carcinomatosis]. / Effetti collaterali della ipertermochemioterapia intraoperatoria nel trattamento della carcinosi peritoneale.

The association between chemotherapy and hypertermia produces a synergic effect. In this study the Authors present their experience, by the analysis of the results. From 1993 to 2000, 17 patients have been treated with surgery associated with hypertermic chemotherapy for peritoneal carcinomatosis. For the management of these patients a constant cooperation among surgeon, cardiologist and anaesthetist is very important.

[A case of total spinal block during epidural anaesthesia]. / Un caso di blocco spinale totale durante anestesia peridurale lombare.

Most cases of total spinal block have been reported in the literature. The displacement of the catheter and the consequent dural perforation are the causes in large percentage of the patients (75%). The Authors describe this case for the importance of the causes and outcome of the patient. A 48 years old woman presented for hysterectomy for uterine fibromas. After having individualized the L3-L4 interspace, a test dose of 3 ml carbocaine 2% was injected. After that, the spinal block was obtained using ropivacaine 0.75% (total dose = 10 ml) injecting slowly, in following times, 5+5 ml of anaesthetic solution. The patient, perfectly conscious at first, presented a gradual increase of the difficulty in talking and breathing. Subsequently she showed a complete paralysis with loss of the consciousness, respiratory arrest, bilateral and symmetrical midriasis, as well as total areflexia. Endotracheal tube was placed. After eighty minutes from the end of the administration of the local anesthetic, spontaneous thoracic excursions appeared, even though of moderate ampleness, midriasis reduced. The patient recovered consciousness and sufficiently ventilated; therefore the endotracheal tube was removed.

[Anaesthesiologic problems about hyperthermic intraoperative intraperitoneal chemotherapy]. / Chemioipertermia intraperitoneale intraoperatoria: problematiche anestesiologiche.

The literature considers hyperthermic intraoperative intraperitoneal chemotherapy a safe and effective procedure for peritoneal carcinomatosis, but a technical improvement is necessary. Regional chemotherapy anticipates the "downfall" of tumoral cells in the peritoneum. The Authors considered 5 patients--female, age 27-45 years, ASA 2--operated of peritonectomy in ovaric neoplasia with peritoneal metastasis. The hyperthermic intraoperative intraperitoneal chemotherapy has been made at the end of the surgery with a hot solution (43 degrees C): 3000 ml of dextrose 1.5% with mytomicina C 25 mg e cysplatino 75 mg/m2. We considered variation of emodinamic parametres (blood pressure, central venous pressure, stroke volume, etc.) and biochemical parametres (Na, K, CI-, CO2, etc.). These parametres have been correlated with some complications: fistula, anastomotic leakage, pancreatitis and postoperative bleeding.

[Non-Hodgkin's lymphoma of the testis. Report of a clinical case and review of the literature]. / Il linfoma non Hodgkin del testicolo. Presentazione di un caso clinico e revisione della letteratura.

The Authors report a case of primary non-Hodgkin's lymphoma of the testis. Although lymphoma is a rare neoplasm, it is commonest tumor in the elderly age. Surgical therapy is essential but some times it can be associated to radio-chemotherapy.

[Emergency treatment of bleeding esophageal varices]. / Il trattamento d'urgenza nelle varici esofagee sanguinanti. Revisione della letteratura ed esperienza personale.

BACKGROUND: The hemorrhage from breakup of the varix esophageal is a dramatic complication of the hypertension of the circle portal, numerous attempts have stayed performed for identify the patients that present taller risk of hemorrhage, to the purpose of to establish the preventive more proper measures to arrive before the first episode of hemorrhage. The treatment of the patient with high pressure portal stays still today extremely controversial, to concern the choice of the more opportune strategies, that for it as concerns the choice of the better moment for effect the single therapies. METHODS: We have taken 63 patients treatises in urgency for esophageal variceal bleeding in consideration, we of the initial group of the 63 patients have subjected endoscopic 34 patients, subjected elastic binding of the varix 20 patients, and to derivative interventions in urgency 9 patients. RESULTS: The results to distance after surgical treatment for it as concern the rise of encephalopatia it show a percentage of the 60% of patient and the actuarial survival to 5 ages is of the 33.3%. CONCLUSIONS: In conclusion seem us of power affirm that the role of the endoscopic of the esophageal varix is prominent in the management of massive acute esophageal bleeding.

[The subrenal abdominal aortic aneurysm. An examination of case histories and comments]. / L'aneurisma dell'aorta addominale sottorenale. Esame di una casistica e considerazioni.

The purpose of the search has stayed that of verify the evolution of the approach to the patient carrier of MA and of the treatment pre-intra-post-operatorio. The study has stayed effected on sheltered patients in our Institute from the January 1988 to the January 1997. They are about to be examined the data regarding 282 patients of which 215 cases in election and 67 in urgency. The analysis of the data has shown that the sex masculine are stricken more than female one with a relationship of 8.4: 1; the range more stricken the inclusive one in 65-79 years, the mortality in election has stayed almost unchanged while that in urgency has suffered a clean decrement. The amelioration of the diagnostics techniques of the preparation preoperative of the technical anesthesiologic and surgical has allowed to get good person results in election and above all in urgency. From the comparison with the world literature result that the incidence of the MA is in increase in the population, but we have not given univocal for define the entity of this pathology, common datum is the small badger of mortality. In conclusion the MA stays a serious pathology, diagnosed for case burdened from the mortality still elevated (40%).

Renal cell carcinoma in adolescents. A case report and review of the literature.

Renal cell carcinoma is rare in adolescents. Observation of a 16-year-old girl with a clear-cell carcinoma prompted us to review 372 published cases in adolescents. The tumor affects the sexes indifferently and has no side predominance. The incidence is higher in white races. The most frequent presenting sign is a palpable mass (52.7%). X-ray films typically show renal calcifications (25%). The most common histotype is the clear cell carcinoma (76.8%) and at diagnosis 59.5% of these tumors already extended beyond the kidney. The overall 5-year actuarial survival rate is 60.4%.

[Update on deep thrombophlebitis and pulmonary thromboembolism]. / Attualità in tema di flebotrombosi profonde e tromboembolia polmonare.

Pulmonary thromboembolism, a frequent complication in deep vein thrombosis, is still a pathology with a high rate of mortality and morbidity. The authors underline that this pathology is particularly frequent after some types of surgery and in subjects with primary or secondary risk factors. The paper analysis the pathogenesis of deep-vein thrombosis and the physiopathology of pulmonary embolism. The authors then outline the current management in terms of the diagnosis, prophylaxis, and medical and surgical therapy of this pathology.

[Renal cell carcinoma. Significance of prognostic factors & current treatment]. / Il carcinoma del parenchima renale. Significato dei fattori prognostici ed attuali orientamenti di terapia.

The Authors carried out a literature review on prognostic factors and current management of renal cell carcinoma. A significant factor influencing survival appears to be the extension of the primary tumor (T). The finding of no nodal involvement is not always a favourable prognostic factor if the tumor is no more confined. A perfect knowledge of the prognostic factors may be useful to identify those patients who need post-operative chemotherapy. Surgery is still the treatment of choice for renal cell carcinoma. Extensive lymphadenectomy does not influence long-term survival, nevertheless since there is no additional mortality or morbidity, it is considered useful for a correct staging and a better evaluation of long-term prognosis.

The usefulness of biliary drainage for restoring liver function in obstructive jaundice.

In eighty patients with obstructive jaundice treated with percutaneous or endoscopic drainage, the results of biochemical liver-function tests (serum bilirubin, transaminase, gamma-glutamyl transferase, alkaline phosphatase, and albumin) were analyzed to evaluate the return of liver function after biliary decompression. Before decompression all the patients had increased serum concentrations of all the liver-function indicators measured. Conjugated bilirubin normalized within 7 days in 67.5% of the patients and within 14 days in 94.5%. The other serum responses normalized as follows: glutamic oxaloacetic transaminase (7 days in 45%, 14 days in 100%); glutamic pyruvic transaminase (7 days in 46.2%, 14 days in 100%); gamma-glutamyl transferase (7 days in 56.2%, 14 days in 89.1%); alkaline phosphatase (7 days in 52.5%, 14 days in 90.4%); and albumin (7 days in 100%, 14 days in 90.4%). The low mortality and morbidity rates in this series of patients with obstructive jaundice: 0% and 7% after endoscopic and 2.1% and 10.4% after percutaneous drainage suggest that biliary drainage has a valuable place in the preparation of jaundiced patients for surgery and in some cases provides a definitive intervention.

[Current trends in the treatment of giant nonparasitic cysts of the liver]. / Attuali orientamenti sul trattamento delle cisti non parassitarie giganti del fegato.

The authors report 10 cases of giant non-parasitic congenital cysts of the liver (7.7-25 cm in size). All the patients were symptomatic; preoperative ultrasonography was diagnostic in all cases allowing to discover the cyst. Six patients underwent partial resection of the cyst (in one of these a cystojejunostomy was performed), while atypical hepatic resection was performed in two cases, enucleation in one and left lobectomy in another case. No evidence of malignant degeneration was found in the histologic study of the specimens. No mortality nor morbidity were registered. All patients were followed up for 1-20 years and no recurrences were found. The authors point out that partial resection of the cyst is a safe operation with good immediate and long-term results.