Rheological and biochemical changes in open heart surgery with extracorporeal circulation and moderate hypothermia.

The plasma enzymes, glucose, urea nitrogen, total and conjugated bilirubin, osmolality, acid--base balance and rheological data have been studied in a group of patients who underwent open heart surgery to replace the stenotic or insufficient aortic valve. The aim of this study was to assess our operative conditions and to compare results with those obtained by other authors.

Biochemical changes in extracorporeal circulation in patients.

The effect of priming extracorporeal perfusion pumps with 50% and 80% diluted homologous blood on the serum electrolytes, acid-base status and plasma osmolality has been investigated in 103 patients undergoing open-heart surgery for congenital and acquired heart disease. The value in prognosis of plasma osmolality is discussed.

Plasma cortisol in open-heart surgery.

In view of disagreements about changes in plasma cortisol, during and after open-heart surgery, a group of patients was studied with both unconjugated plasma cortisol, and anaesthetic, surgical and pharmacological factors that could interfere with the response, being analysed.

[Afferent loop syndrome as an epiphenomenon of neoplasms of the gastric stump]. / La sindrome dell'ansa afferente come epifenomeno della neoplasia del moncone gastrico.

A clinical case is the basis for a report on the possibility that afferent loop syndrome might present as an epiphenomenon in gastric stump cancer. Stress is laid above all on the rarity of the syndrome and on the clinical and diagnostic difficulties of demonstrating it. The possibility that it might be a pointer to a pathology of greater clinical importance is pointed out.

[Anesthesiological problems in tracheal resection operations. Clinical contribution]. / Problemi anestesiologici negli interventi di resezione tracheale. Contributo clinico.

The anaesthesia technique adopted for tracheal resection in a woman patient with tracheal stenosis secondary to prolonged intubation is reported. The criteria underlying the choice of anaesthesia are outlined. Various anaesthesiological techniques are discussed and solutions illustrated in relation to the location of tracheal stenosis.

[Control of arterial pressure in aortic coarctation surgery]. / Il controllo della pressione arteriosa nella chirurgia della coartazione aortica.

After reporting personal experience in the pharmacological control of intraoperative hypertension in 14 patients with aortic coarctation, 7 of them treated with trimetaphan (TMF) and 2 with nitroprussiate of sodium (NPS), stress is laid on the advantages of NPS in comparison with TMF, namely as regards speed of induction, prompt reversibility of action and lesser interference with the haemodynamics of the renal and coronary circulations. Attention is also called to the collateral effects, such as reflex cardiostimulation, which may require the use of beta-blocking drugs, and cyanide-induced toxicity which demands dose limitation (0.5 mg/kg/h). NPS is considered the drug of choice in those situations which require emergency pressure control and in controlled hypotension, for which TMF was used in the past.