Pharmacokinetics of cefonicid in serum and its penetration into lung tissue, bronchial mucosa and pleura.

Cefonicid pharmacokinetics in serum and tissue penetration into the lung parenchyma, bronchial mucosa and pleura were studied in 39 patients undergoing lung excision for malignancy. Cefonicid concentrations in serum and tissues samples were assayed at different times after a single 1 g intramuscular administration. The concentrations observed were much higher than the reported minimal inhibitory concentrations for the microorganisms commonly responsible for bronchial and pulmonary infections and therapeutic concentrations were still detectable in the tissues 24 h after dosing. Kinetic findings demonstrated a similar half-life for cefonicid in tissues and in serum. These data provided a further kinetic explanation for the observed clinical efficacy of cefonicid with a single daily dose.

[Left ventricular aneurysmectomy: technical evolution and results]. / L'aneurismectomia del ventricolo sinistro: evoluzione tecnica e risultati.

A critical review of surgical techniques for left ventricular aneurysm treatment, with reference to literature data and author's personal experience, is reported. Aneurysm plicatio, performed in 35 patients, was always associated to coronary artery bypass graft and carried out mainly in small aneurysms of the posterior wall. In the last years this technique has been used very rarely, due to papillary muscle damage risk. Aneurysmectomy by usual technique only partially eliminates the a-dyskinetic area and moreover determines a severe ventricular deformation due to the linear suture. At Verona hospital it was carried out in 175 patients, with an 8% operative mortality and a survival rate of 82% at 3 years and of 80% at 5 years. Aneurysmectomy with converging walls left ventricular reconstruction, as proposed by Jatene and modified by the author, allows complete aneurysm removal and assures a ventricular reconstruction closer to normal morphology. In the Verona experience with this technique, referring to 51 patients operated up to 1989, operative mortality was 3.9% with a 89.9% survival rate at 3 years. These improved clinical results are associated with the improvement of left ventricular function indexes: average ejection fraction from 28.2% preoperatively to 42% postoperatively; average end diastolic left ventricular pressure from 23.6 mmHg to 18 mmHg.

[Bypass aorto-coronarico. Correlazione tra dati clinici, emodinamici ed angiografici e risultato operatorio in 100 casi (author's transl)]. / Aorto-coronary bypass: a correlation between the clinical, hemodynamic and angiographic data and the operative result in 100 cases

In 100 consecutive patients, subjected to myocardial revascularization by aorto-coronary saphenous vein bypass grafting with a standard technique, several clinical, hemodynamic and angiographic data were studied in correlation with the short-term prognosis. The operative mortality (6% on the whole) appeared to be strictly correlated with the degree of left ventricular impairment. Among the considered hemodynamic indices (LVEDP, CI, EDV, EF), EF was the most significant one: mortality was 0% if EF was normal, but raised to 15 and 40% respectively, when this was moderately or severely reduced. The operative risk was heavily aggravated if 4 or more indices of left ventricular impairment were present, mortality being 45% versus 1% in patients with abnormality of 3 or less parameters. The extension of coronary artery involvement proved to be a lesser prognostic factor than the degree of complements of the surgical revascularization. No correlation was found between the preoperative value of the hemodynamic parameters and the incidence of perioperative myocardial infarction (18% in the total series).

[Coronary aneurysm. Report of a case of inflammatory etiology and review of the literature (author's transl)]. / Aneurisma coronarico. Presentazione di un caso ad eziologia infiammatoria e revisione della letteratura.

The case is presented of a 31 year old man with anteroseptal myocardial infarction, whose chest X-ray showed an anomalous protrusion along the left cardiac border. After 6 months, the increase in size of such protrusion lead to left ventriculographic and coronariographic examination: the presence of a large nonfistulous bisaccular coronary aneurysm was documented along the anterior descending branch of the left coronary artery. Cardiac surgery consisted in resection of the coronary aneurysm and of the left ventricular post-infarction area, and was followed by good surgical and angiocardiographic result. Histological examination showed the wall of the coronary aneurysm to be composed of collagenous bands in the absence of elastic components, with hemosiderin and fibrino-hematic deposits and scattered granulocytic infiltrates. An infective etiology is hypothesized for the coronary parietal lesion, leading to a coronary pseudo-aneurysm an subsequent myocardial infarction.

[Prosthetic pathology of mechanical and biological valves in the mitral and aortic position. II. Hemodynamic-angiographic evaluation and anatomo-surgical aspects]. / Patologia protesica di valvole meccaniche e biologiche in posizione mitralica ed aortica. II. Valutazione emodinamico-angiografica ed aspetti anatomo-chirurgici.

The catheterization parameters of 42 patients with surgically confirmed prosthetic valve malfunction were retrospectively analyzed in order to evaluate the role of hemodynamic and angiocardiographic examination in the diagnosis of prosthetic complications. The invasive investigation provided in all cases more precise informations regarding the type and grade of prosthetic malfunction as compared to noninvasive techniques. Transvalvular gradients could be quantified, the amount of regurgitation could be defined and associated lesions (paraprosthetic aneurysms, aortic root dissection, fistulas secondary to bacterial endocarditis) could be recognized. The surgical exploration confirmed prosthetic malfunction in all cases except two, with fibrous tissue ingrowth: at the moment this complication is not distinguishable from thrombosis and no specific diagnostic signs have been described either with invasive or noninvasive techniques. In our experience the patients who can benefit from hemodynamic examination are: patients with echocardiographic examination of poor technical quality, patients in whom noninvasive investigations can not completely explain the clinical status ("false negative" echocardiograms, multiple prosthetic valves), all cases in whom cardiac surgery requires a precisely detailed evaluation of the prosthetic malfunction. The opportunity or necessity to perform an invasive study in patients with clinically suspected or proven prosthetic malfunction should be discussed individually.

[Surgical complications of pacemaker implantation (author's transl)]. / Complicanze chirurgiche dell'impianto di pacemaker.

During the period 1966-1977, 705 pacemaker implantations with transvenous endocardial electrode and 369 substitutions of generators were carried out, besides 275 operations treating some complications after implantation were required. The most frequent complications were: endocardial electrode dislocation (9.4%), lesion caused by decubitus (7.5%) and infection of subcutaneous pocket (5%), decubitus lesion and infection of the skin caused by the electrode (1.7%), electrode and generator breaking (1.3%), right ventricle perforation caused by the electrode (0.37%). Surgical mortality-rate was 0.18%.

[Role and limits of diagnostic imaging in the staging of lung cancer]. / Ruolo e limiti dell'imaging diagnostico nella stadiazione del cancro del polmone.

A total of 474 histologically proved Lung Cancers (LC) were evaluated by Conventional Radiology (CR) and Computed Tomography (CT) in order to assess the role of these two diagnostic modalities in the staging of LC. In 196/474 LC it was possible also to refer, for the evaluation of the diagnostic reliability, to the surgical control. The CR features of LC both at stage III (13% of the global series) and at stage I-peripheral T1 (16% of the global series) presented very high positive and negative predictive values (90% and 95%, retrospectively); in these cases it was considered useless to perform CT. The CT grading showed a high negative predictive value in excluding stage III caused respectively by grade T3 (91.5%) and grade N2 (93.5%). As to the staging, the CT assessment of the stage I and II showed a high predictive value (91.5%). On the other hand, the CT assessment of stage III presented an unsatisfactory predictive value (71%), due to the low predictive value in grade T3 (71.5%), poor in grade N2 (57.5%). The increase of the value threshold mediastinal adenopathies from 1 to 2 cm, leads to a great improvement of this predictive value (92%). The CT reliability was matched with the two different surgical "philosophies" (non aggressive or aggressive); surgery was excluded or performed according to the presence of omo-lateral mediastinal adenopathy. A correct advice to perform surgery was achieved in 33.5% (non aggressive "philosophy") and 43.8% (aggressive "philosophy") of cases; surgery was correctly excluded respectively in 49.6% and 45.9%. The resort to mediastinoscopy was advised in 7.8% and 1.3% of the cases respectively. In both "philosophies" the error of under-staging was lower (2.5%), than that of over-staging (6.6%).

[Surgical treatment of postinfarctual left ventricular aneurysm (author's transl)]. / Trattamento chirurgico dell'aneurisma ventricolare sinistro postinfartuale.

Ventricular aneurysm is a frequent complication of myocardial infarction, but its diagnostic and prognostic implications are not fully defined. A surgical series of 66 ventricular resections for symptomatic left ventricular aneurysm is analyzed. Pts. age varied between 26-29 years; the interval between the episode of infarction and operation from 2 mos. to 12 years. Indication for surgery was angina in 53% of the cases, heart failure in 23%, arrhythmias in 15%, angina and failure in 9%. In 55 cases surgical findings were consistent with true aneurysm in the anatomical sense, in 11 cases with a wide area of wall akinesia. In 24 cases endocavitary thrombosis was present. In 23 cases aneurysmectomy was the only surgical procedure, with closure of acquired VSD in 1 case and mitral valve prosthesis in 2 cases. In 43 cases aorto-coronary bypass grafting was associated (single bypass in 18, double in 23, triple in 2). Operative technique underwent modifications in time, in relation to the use of local and general hypothermia, of cardioplegia, of early aortic cross-clamping. Surgical mortality was of 7.5% (5 cases); the actuarial courve, including operative mortality, showed survival of 88% at 1 year and of 78% at 5 years interval. Correlation between mortality and clinical symptomatology, hemodynamic data and surgical findings was not statistically significant; a statistically highly significant correlation was found between mortality and operative technique. The results are interpreted and discussed in relation to the diagnostic definition of the problem, to the criteria of indication to surgery and to the operative technique.