Indices of muscular damage in the perioperative period of peripheral revascularization procedures.

AIM: We evaluated the perioperative levels of plasma myoglobin (Mb) and creatine kinase (CK) in patients submitted to peripheral revascularization surgery for a variety of conditions. METHODS, DESIGN AND SETTING: Observational study in a surgical ward of a community hospital. subjects: 50 consecutive patients were included in the study: 30 were admitted for elective peripheral revascularization (Group 1), 10 for urgent peripheral revascularization (Group 2), and 10 for major elective abdominal surgery with minimal risk of rhabdomyolysis. These latter patients served as Control Group. INTERVENTIONS: CK and Mb levels were measured immediately before intervention, 24 and 48 h postoperatively, and were compared in each group. Patients with CK >1,000 UI/l within this period were submitted to standard prophylaxis of acute renal failure (ARF), and further monitored. RESULTS: Preoperative values of CK and Mb were normal in Group 1 and Control Group, but not in Group 2. After the intervention, CK and Mb levels increased in all groups, although in a different degree. This increase was maximal in Group 2, where 9 patients showed CK >1,000 UI/l within the first 48 postoperative hours, and were submitted to ARF prophylaxis. In Group 1 CK and Mb values increased moderately, and maximal CK values were below 1,000 UI/l in all cases. The postoperative increase in CK and Mb values was minimal in Control Group, where these parameters were already in the normal range 48 hours after the intervention. CONCLUSIONS: Persistently increased CK and Mb at 48 h after a peripheral revascularization procedure are consistent with a significant ischemia-reperfusion injury.

[Continuous positive airway pressure in the treatment of postoperative hypoxia]. / La CPAP nel trattamento dell'ipossia postoperatoria.

The physiopathology of postoperative hypoxia has been analysed, the cause being identified in the worsening of the V/Q ratio consequent on the reduction in CFR. By increasing CFR, CPAP reduces the superimposition of Tidal Volume and Closing Volume, thus reducing dysventilated zones and thereby improving the V/Q ratio and oxyaemia. With these premises, 18 patients undergoing cholecystectomy were examined; 8 of them were treated in the postoperative period with CPAP at pre-established intervals. The results confirm its effectiveness in terms of PaO2 improvement and the need for constant administration, considering that the benefits are lost when the patient is disconnected from the mask.

[Critical course of a case of idiopathic pulmonary fibrosis]. / Evoluzione critica in un caso di fibrosi polmonare idiopatica.

The authors present a case of idiopathic pulmonary fibrosis with an unusual onset in the form of acute interstitial pneumonia. On being admitted to hospital the 53-year-old woman presented an altered breathing pattern which initially required oxygen therapy using Venturi's oxygen mask followed by sedation and mechanical ventilation with appropriate FiO2 to guarantee adequate pO2 and arterial saturation. For diagnostic purposes bronchiolar and alveolar lavage was immediately performed together with transbronchial biopsy during the course of fibrobronchoscopy. The results of these tests revealed a syndrome of interstitial pneumonia and widespread alveolar lesion with an enhanced lymphocyte population. Antibac-terial and immunosuppressive therapy (6-methylprednisolone and cyclophosphamide) commenced on the basis of these tests caused a temporary improvement in blood-gas parameters and parenchymal thickening. But in spite of treatment the patient's cardiocirculatory and respiratory conditions deteriorated, causing death. This case report raises a number of different questions regarding both diagnosis and treatment. With regard to diagnosis it is worth underlining the absence of hyaline membrane, pathognomonic of widespread alveolar lesions, in biopsies removed while the patient was still alive. With regard to treatment, in addition to specific antibiotic and immunosuppressive therapy, the authors consider that surfactants might be of some help given that widespread alveolar damage can be attributed to pulmonary fibrosis.