Hemodynamic changes in Chevalier eversion versus conventional carotid endarterectomy.

OBJECTIVES: The eversion carotid endartectomy (E-CEA), mainly performed by means of Vanmaele technique, has been associated with loss of the baroreceptor reflex and postoperative hypertension. The purpose of this paper is to determine whether the eversion endarterectomy performed by means of Chevalier technique (C-CEA) modifies the function and the efficiency of baroreceptors, leading to lower postoperative hemodynamic change. METHODS: A retrospective review of 380 patients who underwent carotid endarterectomy (120 Chevalier-CEA; 260 Standard-CEA) from December 2002 to November 2012 has been performed. The changes of blood pressure baseline during the postoperative course in C-CEA and S-CEA group were analysed and compared. Postoperative hypertension was defined as an elevation of systolic pressure >180 mm Hg or >40% rise above baseline. RESULTS: The patients with Chevalier eversion technique did not develop a significantly higher blood pressure in the postoperative course compared to those operated with the standard technique. In the recovery room, the mean systolic blood pressure was 134 ± 21.9 mm Hg in C-CEA group versus 132 ± 24.6 mm Hg in S-CEA group. In the first postoperative day it was 132 ± 17.2 mm Hg in C-CEA versus 133 ± 17.4 mm Hg in S-CEA group. During the first six hours in the recovery room, the need for intravenous antihypertensive drugs was similar in the two groups. Fourteen patients in C-CEA group (11%) and thirty patients (11.5%) in the S-CEA group required vasodilators, without any significant difference (p = 1). The dosage of current preoperative antihypertensive therapy was increased in six patients (4.9%) of C-CEA group and in twelve patients (4.9%) of S-CEA group, without significant difference (p = 1). CONCLUSIONS: C-CEA has the same rate of postoperative hypertension of standard-CEA, which is probably related to the sparing of baroreceptor apparatus, compared to standard E-CEA. The Chevalier procedure could represent an E-CEA technique with its inherent advantages, without penalties related to postoperative hypertension, commonly observed after E-CEA.

[Anesthesia with high dosage fentanyl in coronary patients: effects of pretreatment with droperidol and diazepam]. / Anestesia con fentanyl ad alti dosaggi nel paziente coronarico: effetti di un pretrattamento con droperidolo e diazepam.

The Authors have considered the effects of droperidol or diazepam treatments in patients undergoing high-dose fentanyl anesthesia in cardiac surgery. Twenty patients have been examined and divided in two groups: group A received droperidol (0.2 mg.kg-1) and group B diazepam (0.1 mg.kg-1) five minutes after fentanyl anesthesia induction (500 micrograms.min-1) to reach the "sleep dose". The diazepam pretreatment, as regards droperidol, reduces a dose of fentanyl necessary to obtain the conscience loss (21.5 +/- 2.5 micrograms.kg-1 vs 28 +/- 2.9 micrograms.kg-1). Hemodynamically the droperidol group is very stable, whereas the diazepam group shows certain myocardial depression and less protection at the OTI time.

[THe surgical treatment of aneurysmatic lesions of the ascending aorta: the immediate and long-term results in 40 patients]. / Trattamento chirurgico delle lesioni aneurismatiche dell'aorta ascendente: risultati immediati e a distanza in 40 pazienti.

From January 1981 to January 1991, 40 patients underwent operation for acute ascending aorta dissection (AAD, 14 patients), chronic ascending aorta dissection (CAD, 9 patients) or aortic ectasia (AE, 17 patients), with simultaneous aortic valve replacement in 30 cases (75%). Average age was 54 years with a 3:1 M/F ratio. In 20 cases (50%) a composite graft bearing a mechanical bileaflet valve was inserted with coronary artery reattachment (Bentall operation). In 16 cases (40%) the ascending aorta was replaced by a woven dacron graft alone (7 cases) or associated with aortic valve substitution (7 cases) or resuspension (2 cases). In 1 case (2.5%) a sutureless ring graft replacement of ascending aorta was carried out and 3 patients (7.5%) underwent aortoplasty with aortic valve substitution. Postoperative mortality rate was 21% for AAD group, 11% for CAD group and 6% for AE group. Non-fatal postoperative complications developed in 36% of AAD patients and in 78% and 29% of CAD and AE patients respectively. These complications occurred in 45% of patients who underwent Bentall operation, in 44% of those who underwent ascending aorta replacement associated with aortic substitution or resuspension, and in 14% of those operated of simple ascending aorta replacement. Average follow-up was 41.6 months (range 1.7-107.4 months). During this period 5 deaths occurred for a long-term mortality rate of 14.2%. Out of 30 survivors 21 (70%) underwent CT-study to evaluate the natural course of the false channel and the risk of redissection or late aneurysm formation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anesthesia using high doses of fentanyl in coronary patients subjected to myocardial revascularization. Comparison of 2 administration methods]. / Anestesia con fentanyl ad alti dosaggi nei pazienti coronaropatici sottoposti ad intervento di rivascolarizzazione miocardica. Confronto tra due metodiche di somministrazione.

Eighteen patients to be submitted to heart surgery for myocardial revascularization have been considered. The patients were subdivided into two groups, A and B, and a high dose morphinic was administered for the induction and maintenance of the anaesthetic without further analgesic and/or narcotic supplement. The haemodynamic data obtained pointed to excellent stability in patient cardiocirculatory condition: preservation of IC within acceptable values was very interesting, owing to the fact that the high dose morphinic employed triggers very limited myocardiodepression. To conclude, the anaesthesiological techniques adopted seemed reliable and sufficiently protective with regard to exaggerated hyperdynamic responses to algogenic stimuli that trigger harmful haemodynamic conditions in coronary patients.

[Problems in reconstruction of digestive continuity in demolition surgery of the stomach]. / Problemi di ricostruzione della continuità digestiva nella chirurgia demolitiva dello stomaco.

The commonest stomach demolition techniques and the chances of re-establishing digestive continuity following gastric exersis are examined. The physiological consequences of gastric surgery - gastric, pancreatic and biliary consequences - are discussed. After analysing general and specific operating complications, early and late postoperative complications and general and metabolic complications, the paper closed with a presentation of the results of a reassessment of 1415 gastroduodenostomies carried out using the same technique over a period of eight years by three teams directed and controlled directly or indirectly by Prof. G. Brancadoro.

[Use of the duodenum in demolition surgery of the stomach. Reconversion gastroduodenostomy in post-resection syndromes following Billroth II operations]. / L'utilizzazione del duodeno nella chirurgia demolitiva dello stomaco. La gastro-duodenostomia di riconversione nelle sindromi post-resezione tipo Billroth II.

Stress is laid on the importance in digestive and absorptive physiology. The methods used for the re-insertion of the duodenum in the digestive circuit in the surgical correction of servious post-Billroth II syndromes are explained. Direct duodenal reconversion by means of the transformation of gastrojejunostomy into gastroduodenostomy is recommended in the light of results obtained in 25 cases of p.o.p.u., dumping syndrome, inflammation of the anastomosis, and ALS. It is suggested that jejunal interposition should be kept for cases in which the particular shortness of the gastric stump makes simple re-insertion of the duodenum into the stomach impracticable.