[Nephrectomy in pulmonary tuberculosis patients: an anesthesiological approach]. / Nefrectomia in tubercolosi polmonare: un approccio anestesiologico.

Authors report a case of renal cell carcinoma in a patient suffering from cavitary tuberculosis. Nephrectomy was carried out in epidural anaesthesia together with Propofol continuous infusion and maintaining the patient in spontaneous breathing. The epidural anaesthesia avoided the possible pulmonary complications due to Nitrous Oxide and artificial ventilation. The combination of epidural anaesthesia with Propofol infusion gave both a better operability and a higher therapeutic compliance. The indications to this anaesthesiological method are analysed and discussed herein.

[Kinetic study during amino acid infusion in catabolic patients. Comparison between two solutions]. / Studio cinetico durante infusione aminoacidica in pazienti catabolici. Confronto tra due soluzioni.

The equilibrium kinetic of two different amino acid solutions was investigated in ten catabolic patients (Parentamin, Pierrel; HBC, Baxter). Plasma amino acid pattern was determined on arterial samples before TPN and several times over 48 hours of TPN. Nitrogen balance was measured from 24 hours urine collection. Three different cinetic trends were found: a fast modification (diminution or increase), a slow adaptation, or no modification of plasmatic levels, however each amino acid reached a steady state plateau. The adequacy of the infusion of each amino acid was evaluated comparing its steady-state plasma level to the after lunch level in healthy man. This made possible to approximate metabolic needs of each of the infused amino acids and to identify the inadequacy of some metabolic pathways to synthetized non essential amino acids lacking in solutions. This made possible to identify amino acids infused in excess or in defect, and those infused in dose adapt to the metabolic needs of such patients.

[Effects of various caloric intakes on nitrogen metabolism of the body, the muscles and the viscera during total parenteral nutrition with aminoacidic solution enriched with branched-chain amino acids]. / Effetto del diverso apporto calorico sul metabolismo azotato corporeo, muscolare e viscerale durante NPT con soluzione aminoacidica arricchita in BCAA.

Nitrogen metabolism was studied in ten injured/septic patients by means of a two compartment model, differentiating muscle from non muscle (central) tissue. During fasting muscle tissue loses a consistent amount of aminoacids which is retained in part by central tissue, giving rise to a positive nitrogen balance, whilst three methyl histidine and body nitrogen output are elevated. Total parenteral nutrition (glucose 15 kcal kg-1 day-1, nitrogen 0.30 g kg-1 die-1) improved body nitrogen balance and three methyl histidine excretion, but did not affect significantly either muscle or central nitrogen balance. Increasing caloric support to 30 kcal kg-1 day-1 did not showed any further effect on body nitrogen balance and three methyl histidine, while it improved significantly vs basal muscle nitrogen balance, but did not affect central nitrogen balance.