Use of Remifentanil for sedo-analgesia in stapedotomy: personal experience.

Stapedotomy for otosclerosis presents particular anaesthesiology demands as the surgeon has to assess functional results during the operation, work with some bleeding, be ensured the collaboration of the patient, and limit the occurrence of intra- and post-operative symptoms (dizziness, nausea, vomiting and pain). Remifentanyl, a micro-opioid selective agonist characterised by short latency and duration, has been used for about 2 years at the Otolaryngological Unit of the "Federico II" University of Naples for patients with otosclerosis undergoing stapedotomy. Aim of the study was, therefore, to assess: efficacy and tolerability of Remifentanyl in combination with a local anaesthetic in surgical procedures for otosclerosis; intra- and post-operative reduction in patient symptoms of dizziness, nausea, vomiting and pain; reduction of intra-operative bleeding; degree of patient collaboration and optimisation of anaesthesiological and vital parameters monitored during surgery. The study was carried out on 92 patients with otosclerosis, (17 M, 75 F), median age 41 years (range 25-56), undergoing stapedotomy. Patients were randomly assigned to one of two groups, which were homogeneous as far as concerns age, sex and pre-operative hearing: i. Group A (50 patients), received Remifentanyl infusion in combination with canal injection for local anaesthesia with Mepivacaine 2% and Adrenalin 1/100,000; ii. Group B (42 patients), received only local anaesthetic by infiltration of the external canal ear. Remifentanyl led to an improvement over the local anaesthetic technique previously used, with a clear decrease in intra- and post-operative neurovegetative symptoms such as dizziness, nausea, vomiting and pain, as well as reduced bleeding.

Experiência inicial em cardiodesfibrilación empleando electrodos de superficie fractal / Early experience in desfibrilation with fractally coated leads

Se presentan los resultados del implante de una serie de cardiodesfibrilación en 27 pacientes, empleándose en todos los casos, electrodos de superfície fractal, con el objeto de obtener mayor biocompatibilidad, mejores umbrales de estimulación y sensado ventricular, y requerimientos de menor energia para la desfibrilación. El grupo estaba constituído por 8 mujeres y 21 hombres; en el 63 'por ciento' de los casos el generador fue implantado en el abdomem, y en el 37 'por cento' restante en la zona infraclavicular. El umbral de desfibrilación verdadero (true DFT), fue obtenido em 14 pacientes (promedio 12.85 Joules, SD(n-1) + 3.89, SEM + 1.04). En el resto del grupo (13 pacientes), el menor nivel de energia exitoso (lowest energy succesfully tested) fue establecido en 16.57 Joules, SD(N-1) + 2.53, SEM + 0.677). Pudo determinarse entonces que para todo el grupo estudiado, el umbral requerido fue menor, a 20 Joules en el 96.3 'por ciento' de los casos (26 pacientes), siendo necesaria una energia superior a 20 Joules en un único caso (3.7 por ciento). Conclusión: los electodos de superficie fractal constituyen un interesante aporte, para obtener la reversión de la fibrilación ventricular empleando bajos niveles de energia, en pacientes sometidos al implante de cardiodesfibriladores.

[Palliative endoscopic intubation of esophago-gastric neoplastic stenosis: analysis of factors that may influence immediate results]. / Intubazione palliativa endoscopica delle stenosi tumorali esofago-gastriche: analisi dei fattori che possono influenzare i risultati immediati.

The paper examines a series of 172 patients undergoing endoscopic intubation with plastic stent due to unoperable esophago-gastric tumoral stenoses during the period 1980-1991. An analysis of the data enabled the following conclusions to be drawn: (1) The majority of perforations occur during the treatment of distal stenoses (15%), anastomotic stenosis (20%) and extrinsic compression stenoses (23% vs 7% in the case of stenosing primary esophageal neoplasia). (2) Severe respiratory problems may occur during treatment of cervical stenoses. (3) Malfunctioning of prostheses is more frequent in the treatment of cardias stenosis (10%). Having a few technical comments on the subject of passing the guide thread through the most twisting and narrow stenoses, the authors express the wish that expandable metal prostheses will be more widely used in order to render the method less traumatic, increase the percentage of success (extending the indications regarding the site and type of stenosis) and reduce severe complications.

[Liver injury in abdominal trauma. Review of the literature and personal observations]. / Danno epatico nei traumi addominali. Revisione della letteratura e casistica personale.

In patients who suffered abdominal trauma, the liver is the most frequently involved organ, except the spleen. The % rises from 1520% to 30% if trauma is closed or open. Liver injury may spread from a simple parenchymal contusion to a break in vessels or biliary ducts. Life risk is related to hemorrhage. The mortality is due to: 1) extension of the injured liver surface, 2) possible damage to big vessels, 3) intra or extra abdominal associated injury in case of multiple trauma. It is important to known the kind of injury to choose the best therapy, not necessary surgical. The authors report on 15 patients with thoracoabdominal trauma and liver damage, comparing their cases with literature observations.

[Use of the rendez-vous technique in endoscopic insertion of biliary prosthesis in malignant obstructive jaundice]. / Impiego del rendez-vous per l'inserimento endoscopico di protesi biliari nell'ittero ostruttivo maligno.

The paper describes the Authors' personal experience of the use of the rendez-vous technique (using a combined endoscopic-transhepatic route) for the endoscopic insertion of biliary prosthesis in cases of malignant obstructive jaundice. Having illustrated the series of cases, the paper proposes the use of this technique in the event of endoscopic failure due to the smaller incidence of complications compared the use of a wholly transhepatic route.

Penetrating wound of the right ventricle with intracardiac retention of the foreign body.

The rare case of a penetrating cardiac wound with fortuitous outcome caused by a disintegrating rotating electric saw at the patient's home is described. The patient was successfully treated in two stages: Emergency treatment in the nearest hospital, where no extracorporeal circulation facilities were available, to stop the bleeding, followed by transport to, an cardiac surgery in university hospital, where a foreign body in the right ventricle was removed. Pathophysiology of heart wounds and their surgical treatment are discussed.

Benzydamine for the prevention of pharyngo-laryngeal pathology following tracheal intubation.

A clinical study was carried out to assess the antiinflammatory effectiveness and related properties of this drug. It was performed double-blind in 40 adult patients (ASA I, and II) undergoing major otorhinolaryngological surgical procedures with tracheal intubation. The patients received benzydamine at random (n = 20), or a similar solution without the active substance (n = 20). The following parameters were considered: physical examination, sensations referred from patient, cytologic examination, glottographic examination, and spectrographic examination. The results suggest that benzydamine applied locally at a concentration of 0.3% has therapeutic efficacy without local or systemic side-effects.

[Various epidemiological data on breast cancer in the north-west Canavese area]. / Alcuni dati epidemiologici del carcinoma mammario nel Canavese nord-occidentale.

A retrospective epidemiological investigation has been conducted on nipple cancer cases observed over the past 10 years in the hospital of Castellamonte and Cuorgné. The high percentage of advanced cases of breast cancer encountered indicates the need for facilities (accurate, wide-ranging information, a tracer unit etc.) to provide early and therefore useful treatment of breast cancer in the area in question.

[Case of stenosing carcinoid tumor of the terminal ileum associated with gallbladder empyema with perforation]. / Su di un caso di tumore carcinoide stenosante dell'ileo terminale associato ad empiema della colecisti con perforazione.

The Authors report a case of stenosant carcinoid tumour of terminal ileum joined to biliary peritonitis due to perforation of gall-bladder empyema. After dealing the carcinoid and syndrome thereof, in the light of the study of literature, they show the case with some retrospective remarks, and frame it in the grolp of "little syndrome" carcinoid tumours.

[Experience with vascular access in hemodialysis treatment of acute and chronic renal insufficiency]. / La nostra esperienza sull'accesso vascolare nel trattamento emodialitico dell'insufficienza renale acuta e cronica.

The authors develop a retrospective investigation about 97 arterio-venous fistulae performed on acute and chronic uraemic patients for hemodialytic purposes. The method followed by the authors is to surgically insert a cannula in the femoral vein in case of urgency, and to prevailingly perform arterio-venous fistulae in the chronic uraemic patients' wrist. In the cases of difficult vascular access, the authors perform an autologous graft of large saphena vein to upper limb, between sublacertic umeral artery and cephalic or basilic median vein, and describe its technique.

[Evaluation of cellular DNA in the study of the relations between fibrocystic disease of the breast and breast cancer]. / Valutazione del DNA cellulare nello studio dei rapporti fra mastopatia fibrocistica e carcinoma mammario

Two cases of breast carcinoma observed four years after breast biopsy for fibrocystic mastopathy are presented. These two cases have been subjected to microspectrophotometric measurement of cell DNA as an objective test for the evaluation of risk in breast fibrocystic disease. Tissue specimens of the two carcinoma cases showed in some lesions aneuploid DNA, while control groups always showed a typical diploid situation. This technique is suggested when epithelial proliferative pictures in adenose-cystic mastopathy seem to reach serious histopathological levels.

[Primary sclerosing cholangitis]. / La colangite sclerosante primitiva

A case of intermittent cholostatic icterus has been observed at the Civil Hospital of Castellamonte. Clinical and laboratory examinations did not permit precise diagnosis, hence the decision to carry out exploratory surgery. The finding was hepato-choledochic fibrosis with severe stenosis of the lumen and patency of Vater's tubercle, with no calculosis or previous bile way operations. Transcholedochic and transpapillary biliary drainage was therefore performed with a T tube. The patient is in good condition about two years after the operation and cholangiocarcinoma can be excluded. It is therefore considered that the case can be classified as a "primary sclerosing cholangitis".