Adaptación y validación preliminar argentina del cuestionario de evaluación del apego (CaMir) / Adaptació i validació preliminar argentina del qüestionari d'avaluació de l’aferrament (CaMir) / Preliminary Argentinean adaptation and validation of the bonding assessment questionnaire (CaMir)

El propósitode este estudio fue adaptar lingüísticamente y evaluar validez y fiabilidad del instrumento de evaluación demodelos individuales de relación del estilo de apego, CaMir (Cartes: Modèles Individuels de Relation), en unamuestra argentina de adolescentes y adultos. Se trabajó con una muestra de 549 sujetos de ambos sexos deentre 14 y 80 años. El análisis factorial exploratorio develó una estructura de cuatro factores y el análisis fac-torial confirmatorio corroboró la misma, así como los índices de fiabilidad de los factores. Se confirma que esun instrumento válido y confiable para evaluar los modelos individuales de relación en adolescentes y adultosargentinos. Finalmente, se señalan limitaciones y contribuciones.(AU)

The pur-pose of this study was to linguistically adapt and evaluate the validity and reliability of the individual modelsof attachment style relationship assessment instrument, CaMir (Cartes: Modèles Individuels de Relation), in anArgentinean sample of adolescents and adults. A sample of 549 subjects of both sexes aged between 14 and80 years was used. The exploratory factor analysis revealed a four-factor structure and the confirmatory factoranalysis corroborated it, as well as the reliability indices of the factors. It is confirmed that it is a valid and reliableinstrument to assess individual relationship patterns in Argentinean adolescents and adults. Finally, limitations andcontributions are pointed out.(AU)

El propòsitd'aquest estudi va ser adaptar lingüísticament i avaluar la validesa i la fiabilitat de l'instrument d'avaluació demodels individuals de relació de l'estil d'aferrament, CaMir (Cartes: Modèles Individuels de Relation), en una mos-tra argentina d'adolescents i adults. Es va treballar amb una mostra de 549 subjectes d'ambdós sexes d'entre14 i 80 anys. L'anàlisi factorial exploratòria va desvetllar una estructura de quatre factors i l'anàlisi factorial con-firmatori la va corroborar, així com els índexs de fiabilitat dels factors. Es confirma que és un instrument vàlidi fiable per avaluar els models individuals de relació en adolescents i adults argentins. Finalment, s'assenyalenlimitacions i contribucions.(AU)

Use of the Oto lung donor score to analyze the 2010 donor pool of the Nord Italia Transplant program.

INTRODUCTION: The feasibility and utility of a lung donor score that has been recently proposed was tested among a pool of lung donors referred to the Nord Italia Transplant program (NITp) organ procurement organization. MATERIAL AND METHODS: Each lung donor was assigned an Oto score including, age, smoking history, chest X-ray, secretions and ratio of arterial oxygen tension to inspired oxygen fraction (PaO(2)/FiO(2)). Based on clinical compromise, each variable received a score between 0 and 3, except for PaO(2)/FiO(2), which was scored between 0 and 6 given its overall relevance. RESULTS: Throughout 2010, 201 multiorgan donors were initially considered to be potential lung donors. Among these, 59 (29.4%) eventually yielded 67 lung transplantations (named "Used group"). Among the 142 (70.6%) refused lungs, 28 were not used due to logistic or medical problems ("general exclusion" group, GE) and 114, because of poor lung function ("lung exclusion" group, LE). Median lung donor scores were 1 (range, 0 to 3), 4 (range, 2.5 to 6.5), and 7 (range, 5 to 9) in the Used, GE, and LE groups, respectively (one-way analysis of variance, P < .001). Some donors with Oto scores ≤7 worsened over time so that the score had significantly increased by the time of organ retrieval. Overall, subjects who died after lung transplantation were characterized by higher lung donor scores, (2 [1-4] versus 0.5 [0-3], P = .003). CONCLUSION: Our analysis suggested that the use of a donor score as a dynamic tool over the donation process was of great utility to describe and analyze a pool of lung donors.

Lung procurement for transplantation: new criteria for lung donor selection.

In Italy, like everywhere in the world, the organ shortage for transplantation is a real problem. It is well known that lung donors (LD) are particularly difficult to procure and that management of the organ do not care during the diagnosis of cerebral death represents a difficult challenge. In this context, the salvage of the so-called "marginal donors" may increase the pool of donors, favoring organ retrieval. To increase lung procurement, the intensivist must recognize "marginal donors," optimizing organ selection and function. The aim of our study was to review LD procured in 2008, as identified by the unrestricted criteria, of the Nord Italian Transplant program Center (NITp). Particularly, the age and habits of donors and the presence of a parenchyma contusion were not sufficient per se to exclude donation. We revisited lung ventilation and monitoring modalities during cerebral death before retrieval. In 2008, the application of enlarged criteria for LD enabled us to collect 21 LD, namely 33% of all cerebral deaths, versus 13% in 2007. Seeking to maintain good gas exchange and lung function, we implemented a safe ventilation program avoided high peak pressures, and fluid therapy properly guided by the cardiac index and extravascular lung water index monitoring. Specific actions to improve LD procurement may help cope with the organ-donor shortage. Although our series was small, our results were encouraging; they underline the necessity to continuously review donor criteria and care, allowing good donor/recipient matching.

High levels of donor CCL2/MCP-1 predict graft-related complications and poor graft survival after kidney-pancreas transplantation.

In this study we analyzed the role of CCL2, a member of the chemokine family, in early graft damage. Using simultaneous kidney-pancreas transplantation (SPK) as a model, we showed that brain death significantly increases circulating CCL2 levels in humans. We found that in such situations, high donor CCL2 levels (measured before organ recovery and at the onset of cold preservation) correlate with increased postreperfusion release of CCL2 by both the graft and recipient throughout the week following transplantation (n = 28). In a retrospective study of 77 SPK recipients, we found a significant negative association between high donor levels of CCL2 and graft survival. Decreased survival in these patients is related to early posttransplant complications, including a higher incidence of pancreas thrombosis and delayed kidney function. Taken together our data indicate that high CCL2 levels in the donor serum predict both an increase in graft/recipient CCL2 production and poor graft survival. This suggests that the severity of the inflammatory response induced by brain death influences the posttransplant inflammatory response, independent of subsequent ischemia and reperfusion.

Risk of transmission of hepatitis B virus from anti-HBC positive cadaveric organ donors: a collaborative study.

Organ donors with a serologic profile of recovered (HBsAg negative and/or anti-HBc IgG positive) hepatitis B virus infection (HBV) have been reported to transmit HBV to recipients. In Italy, up until 2002, anti-HBc determination was not mandatory. We retrospectively evaluated the incidence of HBV transmission among recipients transplanted with organs from anti-HBc positive donors from 1997 to 1999. Anti-HBc was screened in 886 available sera among 964 HBsAg and anti-HCV negative donors. HBV transmission was evaluated in 325 kidney, liver, and heart recipients according to their pretransplant HBV serum profile. Of 210 anti-HBc positive donors, 185 were anti-HBc positive/anti-HBs positive and 25 anti-HBc positive/anti-HBs negative with a prevalence of 20.8% and 2.8%, respectively. One hundred seven sera (51%) were collected from donors after transfusion of blood components, the remainder were either before transfusion or from nontransfused donors. The 210 anti-HBc positive subjects donated 356 kidneys, 117 livers and 117 hearts, among whom follow-up is presently available for 251 kidney, 61 liver, and 25 heart recipients. No HBV transmission was observed independent of the recipient immunological profile among the kidney or heart recipients. In liver recipients, no transmission was reported in recovered or vaccinated patients, while a high incidence (43%) of de novo hepatitis was observed among naive patients. In conclusion, there does not seem to be a risk of transmitting HBV through anti-HBc positive transplants in heart and kidney recipients; only naive liver recipients are at high risk of HBV infection.

[Adequacy of admission in neurosurgical intensive care]. / Appropriatezza dei ricoveri in terapia intensiva neurochirurgica.

OBJECTIVE: The Intensive Care Units of Milano metropolitan area are characterized by difficulties of hospitalization for acutely injured patients due to the low bed availability. We evaluated the problem trying to find out possible solutions. DESIGN: On the day of achieved neurological and neurosurgical stability-defined as the day when the intracranial pressure and jugular venous oxygen saturation monitoring, hyperventilation, osmotic therapy were considered no longer needed--the monitoring procedures and instrumental and/or pharmacological treatments that the patients received were recorded and classified as follows: 1) intensive, 2) intermediate, 3) non-intensive. PATIENTS: All the acutely injured patients admitted at five Neurosurgical ICUs during June-July and October-November 1994 have been studied. Only one of these ICUs had a "sub-intensive unit". MEASUREMENTS AND MAIN RESULTS: 391 patients (29.9%) aneurysms and arteriovenous malformations, 25.1% tumours, 2.8% head injuries, 8.7% spontaneous intracranial haematomas, 13.5% various pathologies) were studied. Out of them 358 had an acute brain failure. 16.5% died during brain failure and 83.5% reached neurological stability within 3 days. When neurological stability was reached 32.1% of patients could be classified as "intensive", 63.6% as "intermediate" and 4.3% as "unintensive". In the four ICUs, without sub-intensive ward facilities, 361 patients were admitted with a total amount of 2292 days of hospitalization. Among them 61.9% were spent for a) patients with no brain injury (32 pts/113 days), b) postoperative patients (113 pts/167 days), c) patients in stable neurological conditions (159 pts/1139 days). Therefore, only 38% of the days recorded were given to patients that needed neurointensive care. CONCLUSION: Out data suggest that the receptivity for acute injured patients could be increased creating recovery room units and intermediate post-intensive units together with a better interchange between general and neurosurgical ICUs.

[The Mallampati's scale: a study of reliability in clinical practice]. / Scala di mallampati: studio di validità nella pratica clinica.

The need to predict the rank of difficulty of tracheal intubation is of paramount importance in anaesthesia as has been well documented in numerous studies. We assessed the use of the Mallampati scale as possible predictive indicator of difficult tracheal intubation in a study conducted on 700 patients. The rank of difficulty determined during the pre-anaesthesiological examination by the Mallampati scale, was compared to the Cormack scale as assessed by the laryngeal direct examination at the beginning of anaesthesia. The correlation between the two first ranks of both scales was highly significant. The evaluation by the scale of Mallampati showed a good sensibility and a low specificity with incorrect overestimation only for the difficult intubation. In our study orotracheal intubation was rated difficult in 10.4% of the patients by the Mallampati scale and in 11% of the patients score by the Cormack scale. The chin to jugulum distance, also studied as a possible predictive parameter, did not correlate with the Cormack scale.

Algodystrophy and related psychological features.

This work wants to emphatize the role of the personality in the development of the algodystrophic syndrome. For this purpose 13 patients affected by algodystrophy of the hand and 23 with brachial plexus lesions were invited to fill in the M.M.P.I.; the patients suffering from algodystrophy reached higher scores on the Depression, Hysteria and Hypocondria scales.

Acute respiratory failure following pharmacologically induced hyperventilation: an experimental animal study.

The pulmonary effects of hyperventilation following infusion of sodium salicylate into the cisterna magna was studied in 16 spontaneously breathing adult sheep. We found a fall in PaO2, a decrease in the static compliance of the respiratory system, abnormal chest roentgenographic films, and grossly abnormal lungs following 3.5 to 13 h of hyperventilation. A control group of 15 sheep (10 sheep similarly injected with sodium salicylate, but then sedated and paralyzed and ventilated at normal tidal volume and respiratory rate on a mechanical ventilator, and 5 sheep infused with saline alone and breathing spontaneously) showed no pulmonary or arterial blood gas abnormalities. We conclude that prolonged hyperventilation under the conditions of this experiment precipitated events that resulted in acute lung injury.

Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study.

We explored the pulmonary effects of continuous mechanical ventilation (MV) at a peak inspiratory pressure of 50 cm H2O in healthy, paralyzed, and anesthetized adult sheep during a period of 48 h. The 9 control sheep (Group A) were ventilated with 40% oxygen at a tidal volume of about 10 ml/kg and a peak inspiratory pressure of 15 to 20 cm H2O. All these animals remained stable throughout the 48 h of MV with no change in lung function. The 7 sheep in Group B were ventilated with 40% oxygen using a pressure-controlled ventilator at 50 cm H2O peak inspiratory pressure, at a VT of 50 to 70 ml/kg. All sheep in Group B developed severe respiratory failure and died or were killed within 2 to 35 h, and showed parenchymal consolidation at autopsy. The 9 sheep in Group C were ventilated as in Group B, except that 3.8% CO2 was added to the inspired gases: the Group C animals deteriorated more slowly, with little change in PaO2 but with a severely reduced FRC, VT, total static lung compliance, and grossly abnormal lungs at autopsy. We conclude that in this model, mechanical ventilation at peak airway pressure of 50 cm H2O will lead to progressive impairment in pulmonary mechanics, lung function, acute respiratory failure, and alveolar cellular dysfunction, as demonstrated by highly abnormal minimal surface tension values of saline lung lavage fluid in both study groups.

Successful treatment of biliary colic with intravenous ketoprofen or lysine acetylsalicylate.

In a double-blind trial, 60 patients with biliary colic were allocated at random to receive 200 mg ketoprofen, 1.8 g lysine acetylsalicylate or placebo by intravenous bolus. The patients were asked to rate their pain at intervals within 3 hours of injection and to indicate their overall pain experience on a visual analogue scale. Both ketoprofen and lysine acetylsalicylate proved significantly more effective than placebo in relieving pain, with no significant difference between them. A good analgesic response, reflected by complete or almost complete relief of pain within 30 minutes of injection, was recorded in 4, 17, and 16 patients, respectively, in the placebo, ketoprofen, and lysine acetylsalicylate treatment groups. All drugs were well tolerated. It is concluded that the results provide further evidence for a useful therapeutic role of prostaglandin inhibitors in the treatment of biliary colic.