Parasympathetic nervous system involvement in food allergy: description of a paediatric case.

The latest research data emphasize the interaction between the nervous and the immune systems. It has been demonstrated that the central nervous system (CNS) can be involved secondarily due to blood brain barrier (BBB) disruption via pro-inflammatory cytokines released in allergy. More recently it was demonstrated that the parasympathetic nervous system (PNS) could also be equally involved in models of peripheral inflammation such as food allergy; although this last clinical presentation has rarely been described. Herein, the authors report the case of a five-year-old Caucasian female who was admitted to our Pediatric Acute and Emergency Operative Unit for cyclic vomiting. Her vomiting, which was preceded by objective torque vertigo, headache and weakness, had been recurring with constant frequency every two months since she was 3 years old. After a complex diagnostic flow-chart, it was found that this spectrum of neurologic symptoms was due to a food allergy syndrome, which postulates some etiopathogenic hypotheses to explain the relationship between the two mentioned diseases.

[Leishmaniasis in a splenectomized thalassodrepanocytic young adult]. / Infezione da leishmania in un giovane adulto splenectomizzato affetto da talasso-drepanocitosi.

We report a 23-year-old thalassodrepanocytic man who contracted leishmaniasis. The diagnostic difficulties related to some overlapping features between the two conditions are discussed. To the best of our knowledge, this is the first reported occurrence of leishmaniasis in a thalassodrepanocytic patient.

[Neurogenic pulmonary edema during subarachnoid hemorrhage]. / L'edema polmonare neurogeno durante ESA.

Neurogenic pulmonary oedema occurs in about 10% of SAH-patients being mainly due to cardiocirculatory changes related to imbalance of the central neurovegetative control. In particular, ESA should induce a sympathetic descending stress causing left ventricle failure. Physiopathologic, diagnostic and therapeutic data are briefly presented.

One surgical experience in regime of day hospital: considerations on the first one-hundred patients treated.

The development of surgery in regime of day hospital proceeds swiftly, especially in Anglo-saxon countries, so that at the beginning of the second millennium it can be foreseen that in USA alone, 75% of all surgery will be carried out in this manner. From March 1st to September 1st 1994, 100 patients were submitted to operations in ODS (One Day Surgery). We had 3 reconversions into ordinary hospitalization (3%), 2 for social-economic reasons and one for headache and vomiting due to intolerance to local anesthetics. As has been seen we have encountered no important complications, all patients were satisfied. From the analysis of our experience we have deducted useful indications that oblige us to partially modify our attitude: we want to transform our service into a free standing center where the patient can undergo preoperative exams, anesthesiologic examinations and surgery on the same day; we are just about to verify the possibility, thanks to an accurate anamnesis, to not request preoperative routine exams in patients with ASA 1 and 2 physical status; to look for a possible asymptomatic crural hernia in patients that undergo inguinal hernioplasty; we do not submit patients to ODS if they do not have assistance at home; or if they live too far from our service.

[Advances in the treatment of gastroesophageal reflux. Intraoperative calibration of posterior fundoplication]. / Progressi nel trattamento della malattia da reflusso gastroesofageo. La calibrazione intraoperatoria della fundoplicatio posteriore.

Posterior partial fundoplication can be as effective as total fundoplication in the long-term control of gastroesophageal reflux if the gastric fundus valve is encircled around the distal esophagus for no less than 270 degrees to obtain effective pressures in the newly built sphincter. In order to minimize the adverse effects, to reach constant results and to guarantee the reproducibility of the technique we have modified the 270 degrees posterior fundoplicatio (formerly described by Lind) according to the following principles: 1) the length of the gastric valve must be limited to 3 cm for each side of the esophagus; 2) the gastric valve must be fixed to the right and left side of the hiatal orifice by a single stitch; 3) the gastric valve must be calibrated with an intraoperative manometry, this allowing the standardization of the valve pressure to an average value of 35 mmHg by varying its wrapping angle; 4) the hiatal orifice must not be closed unless it is large enough for thoracic migration of the gastroplasty. Since 1984 to 1991 43 patients with proven gastroesophageal reflux not controlled by medical treatment were submitted to surgery. Twelve Nissen procedures (NP) and 31 posterior calibrated fundoplications (PCF) were performed; PCF seemed to be superior to NP in terms of postoperative mobility. After two years 20 patients treated with PCF were evaluated clinically, manometrically and by 24-hour pH monitoring. No dysphagia was reported; in two patients a pH-metric, asymptomatic relapse was observed, while one patient complained mild and occasional heartburn.(ABSTRACT TRUNCATED AT 250 WORDS)

[Myorelaxants and intracranial pressure (ICP) in neurosurgery. Preliminary clinical results of pipecurium bromide (Arduan) on ICP and on cerebral perfusion pressure (CPP)]. / Miorilassanti e pressione intracranica (PIC) in neurochirurgia. Risultati clinici preliminari del bromuro di pipecurium (Arduan) sulla PIC e sulla pressione di perfusione cerebrale (PPC).

Pipecurium bromide, a new non-depolarizing myorelaxant, was administered intravenously, at a dose of 0.06 mg/kg, to 10 patients suffering from expansive endocranial lesions, who had been anesthetised to undergo neurosurgery. The following parameters were recorded simultaneously, before and after drug administration: intracranial pressure, mean arterial blood pressure, central venous pressure, heart rate and end tidal CO2. No statistically significant changes in the above parameters were observed following the administration of the myorelaxant; these observations, which were considered together with the long duration of action, confirm that pipecurium bromide is a valuable tool in anesthesia for neurosurgery.

Effects of low-dose propofol administration on central respiratory drive, gas exchanges and respiratory pattern.

The effects of sedative-hypnotic doses of propofol on respiratory drive and pattern have not yet been extensively described. Repeated small boluses of propofol (0.6-0.3 mg.kg-1) were administered to ten ASA I patients undergoing carpal tunnel release using regional anaesthesia. Airway pressure, capnography and pneumotachography were continuously recorded. With respect to basal values, no significant variations of respiratory rate, minute volume, tidal volume, inspiratory and expiratory time, total expiratory cycle, Ti/Ttot, TV/Ti, P0.1, EtCO2 and blood gas analysis were observed. Low doses of propofol, to maintain conscious sedation of light sleep, have not been shown to cause respiratory depression.

Brain oedema and intracranial hypertension treatment by GLIAS.

The authors present their results regarding the use of a buffered solution of glycerol 30%-sodium ascorbate 20% (GLIAS) for the treatment of brain oedema and intracranial hypertension. GLIAS was perfused intravenously in 80 patients with several types of brain oedema. In every patients serum and urinary osmolarity, diuresis, main blood and urine parameters, and ICP were monitored. Following GLIAS infusion an increase in plasma osmolarity was observed, changing the average basal value plus 13.4% after 15 min., 10.5% after 30'. At the same time there was a reduction of ICP and improvement in cerebral compliance. In each case there was a decrease in intracranial hypertension and brain oedema without significant collateral effects.

The effects of pipecuronium bromide on intracranial pressure and cerebral perfusion pressure.

Twenty patients with expansive pathologic intracranial lesions, who were anesthetized with thiopental, nitrous oxide in oxygen, and fentanyl and mechanically ventilated to ensure normocarbia, received pipecuronium bromide 70 microg/kg i.v. Intracranial pressure (ICP), heart rate, arterial pressure, central venous pressure (CVP), EKG, and end-tidal CO2 were simultaneously recorded for 5 min before and for 15 min after administration of the muscle relaxant. No statistically significant changes in ICP and cerebral perfusion pressure were observed after administration of pipecuronium bromide. Cardiovascular stability was maintained during the study period except for a small, although significant, decrease of the CVP from 5.7 +/- 2.5 (SEM) to 5.0 +/- 2.5 mm Hg. These results, together with the long-lasting muscular effect of pipecuronium bromide, suggest that this new neuromuscular blocking agent may be used for muscle relaxation during neurosurgical operations in patients who have normal intracranial pressure at the time of administration of the drug.