[Severe and prolonged post-dural puncture headache: from pathological basis to therapeutic role and correct timing for epidural blood patch]. / Cefalea da deliquorazione grave e protratta: dal riconoscimento del substrato organico al ruolo terapeutico e alla corretta temporizzazione del blood patch peridurale.

Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss through the spinal dural puncture hole, post-dural puncture headache (PDPH) is often considered as a physiological syndrome, usually reversible without pathological sequelae after dural hole's closure. The clinical case here presented (incapacitating headache associated with diagnostic dural puncture in a leukaemic young female patient who underwent bone marrow transplantation) shows potentially fatal pathological sequelae following prolonged headache (untreated, due to the severe postransplant immunodeficiency and coagulopathy). The observed RMI lesions suggest interesting conclusions about the clinical indications and correct timing of autologous epidural blood patch (EBP). We also suggest the ways to preventing rebound intracranial hypertension following autologous epidural blood patch in patients suffering from incapacitating and prolonged headache.

[Effectiveness and modality of continuous infusion administration of atracurium dibesylate]. / Attuabilità e modalità di somministrazione di atracurium dibesilato in infusione continua.

One-hundred and five patients with ASA I-II were scheduled for general surgery. Atracurium was the muscle-relaxant of choice. A bolus dose of atracurium (0.5 mg/kg-1) was administered immediately before thiopentone. After 15 minutes began the infusion of atracurium diluited in saline solution and administered through a simple infusion set. The neuromuscolar function was investigated evaluating the amplitude of response to TOF and DBS. This procedure proved to be safe, reliable and easily performed in every operating room.