[Long term central venous catheterization revisited]. / Rivisitazione degli incannulamenti cavali a lunga permanenza.

The authors describe their experience about long-term VAD (Venous Access Devices) placement and in particular of placement techniques types of catheters, complications, and risk and benefit. 243 placements of VAD in 112 males and 131 females mainly affected by leukemia or breast cancer have been analyzed. 145 Leonard, 54 Groshong and 44 Hickman type silicon catheters have been implanted. The preferred access vein was the right internal jugular vein in 75% of patients and the right subclavian vein in the remained. The results show implant success in 98.7% of the patients. Complications have been rare and not serious and they have been divided into: 1) complications due to venipuncture, 2) complications during implant, 3) complications during the staying of catheter, 4) complications during the removal. The authors underline the advantages of puncture access through the right internal jugular vein in comparison with access through the right subclavian vein. Groshong type catheter is better than Leonard and Hickman. Very few infections have been noticed and patients seem to accept more willingly percutaneous placement than surgical one.

[Changes in immune status due to anesthesia and surgical intervention. The role of thymopentin and interleukins]. / Modificazioni dello stato immunitario indotte dall'anestesia e dall'intervento chirurgico. Il ruolo della timopentina e delle interleuchine.

OBJECTIVE: Purpose of the study was clinical evaluation of thymopentin and interleukins in the changes of immunity due to anesthesia and surgical operation. DESIGN: After randomization the patients were divided into four groups according to starter type (thiopental or propofol) and immunological pre-treatment (tymopentin or saline of control group) administered for three days before and two days after operation. SETTING AND PATIENTS: The study was effected on 40 patients undergoing venous vascular surgery in operating rooms of Medical School of University of Genoa. MEASUREMENT: At pre-established times (basal, before and after induction, recovery and 72 postoperative hours) were measured some immunological data (plasmatic concentrations of red blood cells, white blood cells, lymphocyte cells, antibodies, complement analysis, interleukins 1 and 2). RESULTS: The results show a depression of immunity with hypoleucocistosis and hyperlymphocytosis due to surgical trauma or to anesthesia drugs. CONCLUSIONS: Pre-treatment with thymopentin no change perioperative immunity and the role of interleukins isn't clear; the immunological depression is the same in thiopental of propofol groups.

[Clinical and neuropsychologic evaluation of different anesthesia techniques (propofol vs isoflurane) in general surgery]. / Valutazione clinica e neuropsicologica di differenti tecniche d'anestesia (propofol vs isoflurano) in chirurgia generale.

Different anaesthetic techniques in the perioperative period (induction and maintenance of anesthesia, recovery and 48 postoperative hours) were evaluated in 200 patients undergoing general surgery. After randomization, results from 4 groups, were clinically and statistically compared according to the anesthetic techniques performed (propofol + fentanyl in air/O2; isoflurane + fentanyl in air/O2; propofol + fentanyl in N2O/O2; isoflurane in N2O/O2). The results show that anesthesia without N2O is difficult and fentanyl isn't the ideal analgesic; but no difference was found between the anesthetic techniques in quality of induction and maintenance, speed of recovery and quality of postoperative period.

[Respiratory function tests and operative risk in thoracic surgery]. / Prove di funzionalità respiratoria e rischio operatorio in chirurgia toracica.

In a retrospective study on 145 patients who underwent anesthesia for thoracic surgery, perioperative variables and preoperative pulmonary function tests influencing mortality and morbidity were evaluated. 3 patients (2.07%) died and 6 (4.14%) had cardiac, respiratory and other complications in postoperative 48 hours. Clinical-statistic analysis has shown the perioperative variables predictive on mortality and morbidity and operative risk: the operation type, FEV1, MVV (% theoretical), postexclusion gas analysis, Motley index (TLC/RV), intraoperative PaCO2, muscle-relaxant dose, preoperative myocardial infarction, weight, ASA, abnormal ECG, hypercreatininemia and loss of blood. MVV, FEV1, Motley index and residual FEV1 are the useful preoperative pulmonary function tests for evaluation of operative risk and surgical resection. Evaluation of operative risk in thoracic surgery shows the necessity of preoperative pulmonary function tests.

[Clinical evaluation of propofol-ketamine anesthesia in general surgery]. / Valutazione clinica dell'anestesia con propofol-ketamina in chirurgia generale.

The combinations propofol-ketamine vs propofol-fentanyl in absence of N2O was compared in 60 patients undergoing abdominal surgery. The results show that ketamine and fentanyl provide a good analgesia in the absence of N2O and that ketamine offers better haemodynamic control.