Physiological effects of a lung-recruiting strategy applied during one-lung ventilation.

BACKGROUND: One-lung ventilation (OLV) affects respiratory mechanics and ventilation/perfusion matching, reducing functional residual capacity of the ventilated lung. While the application of a lung-recruiting manoeuvre (RM) on the ventilated lung has been shown to improve oxygenation, data regarding the impact of RM on respiratory mechanics are not available. METHODS: Thirteen patients undergoing lung resection in lateral decubitus were studied. During OLV, a lung-recruiting strategy consisting in a RM lasting 1 min followed by the application of positive end-expiratory pressure 5 cmH(2)O was applied to the ventilated lung. Haemodynamics, gas exchange and respiratory mechanics parameters were recorded on two-lung ventilation (TLV(baseline)), OLV before and 20 min after the RM (OLV(pre-RM), OLV(post-RM), respectively) and TLV(end). Haemodynamics parameters were also recorded during the RM. RESULTS: The PaO(2)/FiO(2) ratio was 358+/-126 on TLV(baseline); it decreased to 235+/-113 on OLV(pre-RM) (P<0.01) increased to 351+/-120 on OLV(post-RM) (P<0.01 vs. OLV(pre-RM)), and remain stable thereafter. During the RM, CI decreased from 3.04+/-0.7 l/m(2) OLV(pre-RM) to 2.4+/-0.6 l/m(2) (P<0.05), and returned to baseline on OLV(post-RM) (3.1+/-0.7 l/m(2), NS vs. OLV(pre-RM)). The RM resulted in alveolar recruitment and caused a significant decrease in static elastance of the dependent lung (16.6+/-8.9 cmH(2)O/ml OLV(post-RM) vs. 22.3+/-8.1 cmH(2)O/ml OLV(pre-RM)) (P<0.01). CONCLUSIONS: During OLV in lateral decubitus for thoracic surgery, application to the dependent lung a recruiting strategy significantly recruits the dependent lung, improving arterial oxygenation and respiratory mechanics until the end of surgery. However, the transient haemodynamic derangement occurring during the RM should be taken into account.

[CA 125, CA 19.9, MCA, CEA, 17 beta-estradiol and progesterone in functional and benign cysts and carcinoma of the ovary]. / CA 125, CA 19.9, MCA, CEA, 17 beta-estradiolo e progesterone nelle cisti funzionali e benigne e nel carcinoma dell'ovaio.

CA 125, CA 19.9, CEA, MCA, E2 and P levels have been assessed in the serum and in the ovarian mass fluid of 216 patients through echo-guided puncture to distinguish between functional, benign and malignant cystic neoplasm. Statistically evaluated data have been assessed through histological diagnosis in 122 cases: cyst fluid markers do not always differentiate ovarian carcinoma from benign cysts, while they have a significant concentration in persistent functional cysts (follicular and luteal) if compared with benign and malignant neoplasms. The following management is suggested: 1) Echo-guided puncture in case of simple, persistent ovarian cyst with low levels of CA 125 and CA 19.9 in serum; 2) Operation in case of fatty, chocolate or mucinous fluid. Wait and see if the fluid is either clear or hematic/chocolate with high P levels (luteal cyst); 3) Operation on simple cyst with high CA 125 ald low E2 and P levels (serous c.), in case of relapse or persistence after aspiration; 4) Wait and see if CA 125 is low and E2 and P levels are high (follicular c.).

[Endometriosis of the abdominal wall after cesarean section]. / Endometriosi della parete addominale dopo taglio cesareo.

The finding of endometriosis of the abdominal wall is a rare event; we describe three cases observed after cesarean section. The first case is an endometriosis of the rectus abdominis, first occurrence in literature. The second case describes a localization limited to the subcutaneous tissue. The third case describes the involvement of the entire abdominal wall. Only two patients complained about excruciating abdominal pain during menstrual bleeding. In one case pain was only an occasional event.

Laparoscopically-assisted vaginal hysterectomy.

We report on our initial experience with laparoscopically-assisted vaginal hysterectomy. Seven patients aged 41 to 67 years were successfully treated with this new technique without significant morbidity and with the advantage of early discharge and return to full activity. We discuss the indications, technical details including preparation and positioning, and the shortcomings and problems encountered. It is concluded that laparoscopically-assisted vaginal hysterectomy may in the near future become a valid alternative to the conventional procedures in selected cases.

Antenatal prevention of respiratory distress syndrome; a multicentre survey.

Obstetric and neonatal data were collected on 934 preterm deliveries in 11 Italian centres in 1980, 1985 and 1986. Therapeutic regimens for prevention of respiratory distress syndrome (RDS) were applied in 42% of the cases in 1980, 32% in 1985 and 42% in 1986. Prevention was made in most cases with corticosteroids, although their use fell progressively from 94% in 1980 to 74% in 1986. A combination of two substances was used in a percentage of cases varying from 5 to 10% in all three years. In 903 non-malformed infants, the overall incidence of RDS was not significantly different in cases in which pharmacological prevention was attempted compared with cases without prevention. The only factors significantly affecting the incidence of RDS were gestational age, birth weight and Apgar score.