[New trends in analgesic therapy: subarachnoid, peridural, and perineural perfusion of morphine using a micropump]. / Nuove prospettive in terapia antalgica. La pefusione subaracnoidea, peridurale e perinervosa di morfina mediante micropumpa.

Attention is drawn to the suitability of employing morphine in long and medium-term antalgic management. Exceptionally good results are observed when the drug is administered very near dolorific receptors located in the peripheral and central nervous systems. An account is also given of experience gained at the Antalgic Therapy Centre, University of Trieste, in the use of morphine via several routes: peridural, perinervous, subarachnoid, per os, i.m., and i.v. A new feature of major importance in this respect is the continuous perfusion of the peridural space, nerve trunks, and subarachnoid space by means of a micropump.

[Multidisciplinary approach in neurotic head and back ache. Clinical contribution]. / L'approccio multidisciplinare nelle cefalo-rachialgie nevrotiche. Contributo clinico.

Stress is laid on the need for a multidisciplinary approach to the treatment of pain. Reference is made to personal experience, during which the presence of a psychiatric specialist in the team permitted the discovery of 4% of patients with pain of a purely psychological origin in a series of 300 subjects, together with 10% with pain of mixed origin. Attention is drawn to the usefulness of centering treatment on recognition and evaluation of the psychological component, and on treatment with antidepressive drugs in association with classic antalgic procedures.

[A proposal for the amendment of Law No. 644 of 2 December 1975 on Regulation of the removal of parts of cadavers for the purpose of therapeutic transplantation, and rules concerning the removal of the hypophysis from cadavers for the production of extracts for therapeutic use: (Off. Gazz. No. 344, 19 December 1975)]. / Proposta di revisione della legge 2-XII-1975 n. 644 "disciplina dei prelievi di parti di cadavere a scopo di trapianto terapeutico e norme del prelievo dell'ipofisi da cadavere a scopo di produzione di estratti per uso terapeutico" G.U. n. 344, 19 dicembre 1975.

Law No. 644 on organ transplants is examined in the light of personal experience and the international literature. Reference is made to the non-correspondence of ECG, absence of plantar reflexes, and paralytic mydriasis for the early diagnosis of cerebral death. Stress is laid on the importance of cerebral arteriography, retinal fluorangiography, and evoked potentials in association with clinical criteria.

[Unusual cardiocirculatory response to naloxone administration. Clinical case]. / Inusuale risposta cardiocircolatoria alla somministrazione di naloxone. Caso clinico.

A patient in good general condition and a negative clinical history was anaesthetised for right lower extremity varices. Preanaesthesia with 10 mg diazepam and 0.3 mg atropine 45 min prior to surgery was followed by uneventful induction with thiopental sodium and succinylcholine orotracheally, and maintenance with N2O, O2 and Ethrane in standard percentages. Muscle relaxation was obtained with pancuronium bromide. Automatic ventilation was used to maintain a VT of 12 ml per kg body weight and a respiration rate of 10 breaths per minute. At the end of the operation, 2.5 mg neostigmine and 1.5 mg atropine were given. Since the patient failed to breather spontaneously, automatic ventilation was resumed and 0.4 mg naloxone were administered i.v. After about 2 min, the patient exhibited the classic signs of left ventricular insufficiency, with BP 260/150 mmHg, clinical evidence of acute pulmonary oedema, and an ECG showing atrial tachycardia and variable A-V block. Treatment with PEEP and i.v. furosemide led to spontaneous resolution of the clinical picture, and early normalisation of the ECG. The part played by naxolone in this picture is discusses with reference to similar cases in the literature. It is felt that massive release of catecholamines in response to pain after administration of naloxone is capable of triggering the typical clinical picture of left ventricular insufficiency. The possible role of naloxone vis-à-vis opium and endorphin receptors is also discussed.

[Parenteral or enteral feeding in intensive therapy?]. / Alimentazione parenterale o enterale in terapie intensiva?

Attention is first called to the reasons underlying resort to hyperalimentation. Difficulties and complications for both parenteral and enteral techniques are then indicated. Stress is laid on the importance of reassessing the enteral route and the commonest formulas are indicated on the basis of the literature and personal experience. Finally, a procedure for artificial enteral feeding providing for the use of the precooked foods used in infancy is described.

[Psychological problems in intensive care. I. The Resuscitation Center]. / Problemi psicologici in terapia intensiva. Parte prima. II Centro di Rianimazione.

Intensive therapy units are defined and their operation is explained for the benefit of the non-specialist, so as to clarify the background of the psychological situations in question. An investigation was made of the factors that may interfere with the smooth running of an intensive therapy department, where work is often done under emergency conditions. Interviews between psychologists, and physicians, paramedical staff and patients were chosen as a means of responding to this need. Open interviews were related to the length of hospital stay, patient age and sex, the clinical pictures of subjects admitted to the Resuscitation Centre, and another group admitted to the Coronary Unit. The results were examined with reference to: examinations during hospitalisation, things remembered about the period of admission, dominant thoughts during the acute stage, attitude towards the care received, and changes proposed by the patient. From an examination of these features, assessments are made with regard to the relations and interaction between each component, particularly between doctor and patient in coma, and patient and nursing staff and resuscitation centre and other departments. Particular stress is laid on the delicacy of the relationships with relatives and persons admitted to RC. Some technical advice is offered as the conclusion to the examination of the RC forming the first part of the research.

[Malignant hyperthermia. Review of literature and case reports]. / L'ipertermia maligna. Rassegna della letteratura e contributo clinico.

Malignant hyperthermia may appear during surgery. It has at least three features: 1) an anesthesiological trigger, usually the association of halothane and succinylcholine; 2) rapid increase in body temperature; 3) widespread muscle hypertonia. The literature is reviewed in an assessment of the physiopathological mechanism underlying the syndrome, with particular reference to the part played by calcium. Experimental data are cited and their similarity with the clinical, laboratory, anatomical, and histopathological picture in man is discussed. A detailed account is also given of two personal cases. Lastly, questions associated with the prevention and treatment of malignant hyperthermia are examined.