[Hyperbaric oxygen therapy in acute carbon monoxide poisoning. Illustration of a treatment protocol]. / L'ossigenoterapia iperbarica nell'avvelenamento acuto da monossido di carbonio. Illustrazione di un protocollo di trattamento.

After a brief digression on the etiopathogenesis of carbon monoxide poisoning, the paper underlines the importance of the timely use of hyperbaric oxygen treatment not only to impede the immediate effects of CO, but also to reduce the incidence of neurological complications. The paper illustrates the paroxysm protocol and hyperbaric oxygen treatment protocol used by the Authors.

[Long-term outcome of severe cranial injury]. / Esiti a distanza dei gravi traumi cranici.

Clinical data relating to the admission into hospital of patients who survived severe cranial traumas are reported and are compared with the long-term outcome in order to identify eventual significant prognostic parameters. No particular significant correlations were observed between the parameters in question, but, in accordance with other studies, a close correlation was observed between the duration of the state of coma and the incidence and severity of invalidating effects.

[Nimesulide in the treatment of postoperative pain in minor orthopedic surgery]. / La nimesulide nel trattamento del dolore postoperatorio in chirurgia ortopedica minore.

The study assesses the effect of Nimesulide in the treatment of post-operative pain in minor orthopedic surgery. Twenty-five patients who had received regional peridural or subarachnoid anesthesia were included in the study. After a variable interval of 60 to 90 minutes, the average level of pain, evaluated using a "pain score", was considerably reduced. This effect lasted for an average of 360 +/- 120 minutes. There were minimum side-effects.

[Intravenous anesthesia using propofol in surgical interventions in day hospital routines]. / Anestesia endovenosa con propofol negli interventi chirurgici in regime di day hospital.

Having illustrated the importance of extending surgical treatment into day hospital situations, the paper underlines the need for anesthetics with short-term effects. Two groups of 30 patients were included in the study and underwent anesthesia in day hospital using Propofol or Tiopentone-Enflurane. The results reveal comparable respiratory and hemodynamic effects for the two techniques, but Propofol is more reliable in terms of the lesser side-effects caused and above all the speed of the patient's psycho-physical recovery.

[Resuscitation in the treatment of severe tetanus: clinical experiences]. / La rianimazione nel trattamento del tetano grave; esperienze cliniche.

Following a brief review of the aetiopathogenesis, symptomatology and treatment of tetanus infection, a personal series of 31 patients (14 males and 17 females aged between 26 and 89) is considered. The patients were admitted between May 1970 and May 1978 to the Alessandria Civil Hospital Resuscitation workers, it is shown that mortality from tetanus increases steadily with the increasing age of patients. It is also observed that the introduction of Ossime therapy has reduced curarizing drugs. As a result of the cholinesterase-restoring effect of Ossime, a normalization in the transit of inhibitor stimuli on muscle tone and hence a reduction in hypertone is hypothesized.

[A case of death from a bee sting]. / Considerazioni su un caso di morte per puntura di api.

A case of severe shock due to bee poison with outcome in death is reported. The blood clotting picture was compromised owing to the presence in the circulation of heparin-like substances. A pharmacological study is proposed with a view to making a further contribution to the underlying cause of the disease.

[A comparison of ventilation techniques in ARDS. Volume controlled vs pressure regulated volume control]. / Confronto tra tecniche di ventilazione nell' ARDS. Volume controllato vs volume garantito a regolazione di pressione.

OBJECTIVE: Comparison between effects of a new method of mechanical ventilation (PRVC) and Volume Controlled ventilation in the ARDS treatment. DESIGN: Prospective study from March 1995 to March 1997. PLACE: Intensive Care Unit of Sanremo Hospital. PATIENTS: Nine patients, six males and three females, average age 49.2 years, average SAPS 35.5, with moderate to severe ARDS related to various etiologies. INTERVENTIONS: Patient were first ventilated with Siemens Servo Ventilators 300 in Volume controlled. They were then ventilated with Pressure-regulated Volume Control maintaining the same ventilation parameters (TV, RR, FiO2, PEEP and I:E ratio). MEASUREMENTS: After a 60 minute stabilisation period in each method, Peak inspiratory pressure, Static Compliance, PaO2, PaCO2, AaDO2 and cardiovascular parameters were measured. RESULTS: With the PRVC ventilation an important decrease of PIP and an improvement of PaO2 and SaO2 were observed. CONCLUSIONS: Although it is not possible to draw any conclusion on morbidity and mortality in patients treated with PRVC versus VC, for gas exchange and compliance improvement and for inspiratory pressure decrease with consequent reduction of barotrauma, it may be affirm that PCRV seems to be the best ventilation methods in the ARDS treatment.

[Blood levels of cortisol and prolactin. Are they indices of the degree of protection against surgical stress?]. / Livelli ematici di cortisolo e prolattina. Indici del grado di protezione dallo stress chirurgico?

The paper evaluates the level of analgesic protection by assaying cortisol and prolactin levels in two groups of 20 patients each undergoing general anesthesia using two different techniques: TIVA with propofol and fentanyl, and BPN-nitrous oxide. The results showed that TIVA caused a very slight increase in residue cortisol which was, however, within normal limits. With BPN-nitrous oxide anesthesia there was a greater increase in cortisol, reaching a statistically significant level in blood collected one hour after the end of surgery. With regard to prolactin, there was a marked increase in this hormone using both techniques although in percentage terms this increase was lower in TIVA. These results show that plasma prolactin is a more sensitive test than cortisol assay in evaluating antalgic protection and that, of the two anesthetic techniques used, the most protective appears to be TIVA with propofol and fentanyl.

[Clinical evaluation of pre-surgical anxiety: changes in plasma levels of the anxiety peptide (diazepam binding inhibitor)]. / Valutazione clinica dell'ansia pre-intervento chirurgico: modificazioni dei livelli plasmatici del peptide dell'ansia (DBI).

The score scale of anxiety (STAI, Y, 1-2) and haematic levels of DBI (diazepam binding inhibitor) were used in 48 surgical patients for clinical evaluation of preoperative anxiety, before and after drugs for preoperative medication. After randomization, were clinically and statistically compared 6 groups according to premedicant drugs (diazepam 0.3 mg/kg; flunitrazepam 0.03 mg/kg; saline; prometazine 0.7 mg/kg); before and after preoperative medication were evaluated the anxiety relief with the score scale, haematic levels of DBI and haemodynamics (systolic and diastolic AP and HR). The results show that DBI can objectively measure the anxiety relief, that not are correlate haematic levels of DBI and score scale, that the best benzodiazepines are diazepam (0.3) and flunitrazepam (0.015) and that the prometazine might give anxiety relief for 5-HT antagonist action. Even if there are limits to study (scanty cases, are missing the range and the brain values of DBI and blood test of DBI is slow method) may be useful the use of score scale and haematic levels of DBI in clinical evaluation of preoperative anxiety relief.