Bone mineral density, osteopenia, and osteoporosis in the rhesus macaques of Cayo Santiago.

This cross-sectional study investigates metabolic bone disease and the relationship between age and bone mineral density (BMD) in males and females of a large, well-documented skeletal population of free-ranging rhesus monkeys (Macaca mulatta), from the Caribbean Primate Research Center Museum collection from Cayo Santiago, Puerto Rico. The sample consists of 254 individuals aged 1.0-20+ years. The data consist of measurements of bone mineral content and bone mineral density, obtained from dual-energy X-ray absorptiometry (DEXA), of the last lumbar vertebra from each monkey. The pattern of BMD differs between male and female rhesus macaques. Females exhibit an initial increase in BMD with age, with peak bone density occurring around age 9.5 years, and remaining constant until 17.2 years, after which there is a steady decline in BMD. Males acquire bone mass at a faster rate, and attain a higher peak BMD at an earlier age than do females, at around 7 years of age, and BMD remains relatively constant between ages 7-18.5 years. After age 7 there is no apparent effect of age on BMD in the males of this sample; males older than 18.5 years were excluded due to the presence of vertebral osteophytosis, which interferes with DEXA. The combined frequency of osteopenia and osteoporosis in this population is 12.4%. BMD values of monkeys with vertebral wedge fractures are generally higher than those of virtually all of the nonfractured osteopenic/osteoporotic individuals, thus supporting the view that BMD as measured by DEXA is a useful but imperfect predictor of fracture risk, and that low BMD may not always precede fractures in vertebral bones. Other factors such as bone quality (i.e., trabecular connectivity) should also be considered. The skeletal integrity of a vertebra may be compromised by the loss of key trabeculae, resulting in structural failure, but the spine may still show a BMD value within normal limits, or within the range of osteopenia.

[Medium- and long-term use of central venous catheters in pediatrics. Personal experience]. / L'uso dei cateteri venosi centrali a medio e lungo termine in pediatria. Esperienza personale.

From January 1992 to October 1994, 74 central venous catheters were inserted, in the University Hospital of Rome: Polyclinic Umberto I - "La Sapienza", in 62 paediatric patients (15.17 +/- 1.64 years old), admitted to the paediatric surgery division. The authors used a large amount of CVC: totally implanted devices (34 Groshong, 7 Broviac, 2 Hickman, 3 Port) and percutaneous catheters (28 Arrow). The choice of the infusional devices has been influenced by the length of the treatment, the primitive disease, the age and the size of the patient. The authors used totally implanted devices in paediatric patients undergoing chemotherapeutic and nutritional therapies. External central venous access devices were used in patients undergoing central catheterization lasting less than two months. The subclavian vein has been used as venous access in patients weighing > 5 kg, the internal jugular vein in < 5, kg patients. This work reports the early (PNX, hematomas, arterial access) and the long term complications (infections, accidental unthreading, occlusions and dislocations). We can say that the medium and long last term CVC is well tolerated and accepted in paediatric patients too, for antineoplastic, nutritional and infusion therapies.

[Complex extravascular dislocation of a guidewire during catheterization of the subclavian vein]. / Dislocazione complessa extravascolare della guida metallica in corso di cateterizzazione della vena succlavia.

A case is presented in which a guidewire, during subclavian catheterization in a 63 years old patient, became knotted outside the vein, behind the clavear head of the sternocleidomastoid muscle. The wire was easily removed by surgical approach and the post operative course was uneventful. The causes of this complication are discussed and a few main points are emphasized when the Seldinger technique is employed for subclavian vein catheterization.

[Report of a case of spontaneous thrombolysis]. / Segnalazione di un caso di trombolisi spontanea.

Spontaneous thrombolysis is a quite rare event. It's not predictable through a clinical examination of the patient, but there are some markers that are supposed to be diagnostic because of the high percentage of their occurrence in coincidence with spontaneous thrombolysis. The goal of the authors is to describe a case of spontaneous thrombolysis in a middle age men (62 years). The diagnosis was done by the use of the most typical markers.

[Clinical evaluation of a method of total intravenous anesthesia in various types of surgical patients]. / Valutazione clinica di una metodica di anestesia endovenosa totale in talune categorie di pazienti chirurgici.

Inhaled anaesthetic agents (gases and vapours) may be detrimental to the health of patients and cause a chronic operating room air pollution. Therefore, the authors expound the results obtained using a total intravenous anesthesia technique including propofol to induce and maintain hypnosis integrated with pancuronium bromide, droperidol and fentanyl. Patients have been ventilated with mixture of air and oxygen 30%. This technique has been tried in 60 cases of various kind of elective surgical patients obtaining very good results: in 40% of cases the anaesthetic level was excellent, while in some patients it was not adequate on account of intraoperative pressure increases. This technique of total intravenous anesthesia deserves wider use on account of the good tolerance to propofol, the excellent awakening without postoperative troubles (nausea and vomiting).