The role of hypoxic stop-flow perfusion and high dose chemotherapy in the treatment of regionally advanced colorectal cancer.

The primary or secondary forms of colorectal cancers involving local structures or spreading in the abdomen or pelvic area without extra-regional metastases are identified as regionally advanced colorectal cancers (RACRC). They are unresectable and thus radiotherapy and chemotherapy are the fundamental treatment methods. However, these regimens have failed to check the diffusion of tumor satisfactorily in most forms of RACRC. The abdominal and pelvic regions can be isolated from corporal circulation by temporary occlusion of the aorta and cava and perfused with high doses of chemotherapeutic drugs. The hypoxic abdominal or pelvic stop-flow method for delivering high-dose antiblastic agents to these body districts to avoid toxicity by chemofiltration has been suggested. This study examines the possibility of using this method to treat various forms of RACRC.

Spinal cord stimulation in vibration white finger.

The authors report a case of vibration white finger syndrome in a 51-year old male, pneumatic drill worker. The patient complained of severe pain in the I, II, III and IV right fingers related to acral ischemic lesions. Dried skin with desquamation, tingling, paraesthesia and loss of sensation were present in both hands. Several arterial obstructions on forearm, hand and fingers were evident bilaterally at the angiography. Medical treatment, including administration of calcium-channel blockers, pentoxifylline and intravenous prostaglandin therapy, was unsuccessful. Under local anaesthesia an epidural spinal cord cervical electrode was implanted to control pain and ameliorate local microcirculatory conditions. The clinical result was excellent with the disappearance of symptoms and healing of acral lesions in a few weeks. Epidural spinal cord electrical stimulation represents an excellent technique for treatment in secondary Raynaud phenomenon related to vibration white finger syndrome.

[Use of ketorolac in patient controlled analgesia (PCA) in postoperative pain]. / Impiego del ketorolac in patient controlled analgesia (PCA) nel dolore postoperatorio.

The investigators analyzed postoperative analgesia quality by randomizing 28 patients (ASA I-II) in two group. I group (14) received ketorolac 120 mg throughout a 24 hs observation period via a pump (20 mg initial bolus, 2 mg demand bolus, 5 min lock-out time 4 mg/h continuous infusion, 48 mg maximum dose not including initial bolus. II group (14 patients) were treated with ketorolac 30 mg im every 6 hs. During the study several parameters were recorded: MR, SAP, RR, SatO2 and pain level by noting' pts' filuing VAS. In the I group pain level dramatically dropped from 6.37 +/- 1.44 to 3.5 +/- 1.11 (p < 0.01) during the first 3 hrs. Pain level continued to decrease in a significant way up to 6 hs after the end of the surgical procedure (p < 0.01). Even in the II group patients the pain level drop in the first 3 hrs was significant (p < 0.01), never the less it did not show any further change throughout the following observation period. RR decreased from 19.7 +/- 3.7 to 15.9 +/- 3.2 (p < 0.01) in the first group, in the first 3 hrs, while in the II group patients lowered from 26.4 +/- 2.2 to 23.6 +/- 2.4 (p < 0.01) in the same time fraction. Results show a significant analgesic effect in both groups of patients in the first 3 hs. However pain control is more dramatic and stable up to the 6 hs in the patients of I group.(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of a transillumination method for locating the subclavian vein for its catheterization. A preliminary study]. / L'uso della metodica di transilluminazione per il reperimento della vena succlavia ai fini di un cateterismo mirato della stessa. Studio preliminare.

After commenting brief on the complications related to the cannulation of the subclavian vein, the paper outlines a simple and original method for finding the latter. An illuminator optical fibre is inserted in the fore region of the elbow and this enables the subclavian vein to be located by transillumination.

[Monitoring of antithrombin III in general surgery]. / Monitoraggio dell'antitrombina III in chirurgia generale.

The authors studied the effects of surgery on hemocoagulation parameters (PT, PTT, PLT, Fibrinogen, AT III). 30 patients, undergoing extrahepatic surgery were observed. Measurements were performed before, during and immediately after procedure, and 24 hs and 48 hs later. Results showed a significant drop of AT III activity (p < 0.05) throughout the surgical procedure with a prompt reversal to normal values right after the end of it. Fibrinogen values continuously increased from the end of surgery (compared to intra-op values) (p < 0.05) up to 48 hs (p < 0.01). PTT values decreased at the end of surgery (p < 0.05) and returned to normal during the following 24 hs. No thromboembolic and hemorrhagic complications were observed during the postoperative phase, with all patients being discharged after surgical resolution of pathologies. In conclusion accurate monitoring of hemocoagulation parameters (especially AT III) seems to be useful in order to prevent thromboembolic and/or hemorrhagic complications during and after surgery.

[Use of new elastomeric pumps and PCA in postoperative pain control in thoraco-abdominal surgery]. / Impiego di nuove pompe elastometriche e della PCA nel controllo del dolore post-operatorio in chirurgia toraco-addominale.

36 patients submitted to interventions for thoraco-abdominal surgery has been submitted to antalgic post-operatory therapy with elastomeric pump at a continuous intravenous infusion and patient controlled analgesia (PCA). The patients have been randomized in three groups. The patients of the 1 degree group received 30 minutes before of the end of the surgical intervention 30 mg of Ketorolac. At the end of the anesthesia came started an infusion of 150 mg of Ketorolac (5 vials) in 60 ml of isotonic chlorinated solution at the rate of 0.5 ml/h. The pump had besides the capability of disperse a maximum of 4 bolus/ h, everyone of 0.5 ml, on demand of the patient. The 2 degrees group received a solution containing 60 ml of Morphine in 60 ml of isotonic chlorinated solution with the same formality of administration. The 3 degrees group (placebo) received 60 ml of isotonic chlorinated solution in pumps from infusion and Ketorolac intramuscular on demand. To the times T0 (awakening), T1 (3 h), T2 (6h), T3 (12 h), T4 (24 h), T5 (30 h, was collected algometrical consequences according to VAS (Visual Analogous Scale of Sc modification of the PA increase, FC, FR, SatO2.. The obtained results have highlighted like in the 1 degree group, to the 1 degree algometric consequence (T0), there is a good sedative effect on the pain (intensity of the middle low pain 3.70 +/- 1.64); this antalgic effect has also continued in the other consequences effected in the post-operatory. In the 2 degree group to the awakening (T0), the pain was middle-tall (5.50 +/- 2.32) and an expressive reduction appeared at the time T2 (3.60 +/- 1.35 P < 0.005). In the 3 degrees group have not recorded a diminution of the pain if not after 24 hours from the end of the intervention deposit the intramuscular antalgic therapy. In conclusion, the system infusion + PCA represents an indubitable advantage in comparison with the traditional antalgic therapy as for concern the entity of the reduction of the pain as because it permits the use of a smaller quality of drugs.