[Proposal for a written protocol: evaluation, treatment, and transfer of head injury patients].
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Biomedical subjects
Publications and source records attributed to C Ori.
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Computed tomography of 8 cases with West's syndrome before, during and after ACTH treatment are reported. The scans, performed at the third week of therapy, showed consistent widening of the sulci, cisterns and ventricles in all the patients. Of these, 2 patients underwent ICP monitoring which showed higher than normal values. A return to the normal ICP values in association with the disappearance of the CT findings was observed in both cases. It is concluded that widening of the sulci, cisterns and ventricles are not findings of atrophy, but a condition of initial communicating hydrocephalus, which is in accordance with the hypotheses of Riikonen and Lyen.
BACKGROUND: The 2% formulation of the intravenous anaesthetic agent, propofol (Diprivan), delivers half the amount of lipid compared with the original 1% formulation. This may provide an acceptable alternative for patients who have an impaired ability to metabolise lipids. METHODS: This study was a multicentre, randomised, open comparison of parallel groups. Seventy-three adult patients undergoing elective craniotomy in neurosurgery were randomised to receive either propofol 1% (10 mg/ml) or propofol 2% (20 mg/ml) for induction and maintenance of anaesthesia. RESULTS: Analysis of induction time (199 s, 1%; 202 s, 2%; p > 0.05) and induction dose (1.13 mg/kg, 1.12 mg/kg; p > 0.05) shows that propofol 1% and propofol 2% are pharmacodynamically equivalent. Both formulations were similar regarding overall administration rates, recovery times, haemodynamic variables and tolerability. Plasma triglyceride levels, were lower in the propofol 2% group compared with the propofol 1% group, and significantly lower (p < 0.05) from 1 to 4 hours after induction. CONCLUSIONS: We conclude that propofol 2% is as effective and as well-tolerated as propofol 1% for anaesthesia and is an acceptable alternative to propofol 1% in patients undergoing elective craniotomy in neurosurgery. The lower lipid load suggests it may be of particular benefit to patients with disorders of lipid metabolism.
AIM: Loco-regional antiblastic perfusion with circulatory block (stop-flow perfusion, SFP) is a procedure designed to treat solid tumors of the limb and pelvis in an advanced stage, like melanoma, sarcoma of the soft tissues and colon-rectal cancer. The aim of this study was to evaluate if subarachnoid anesthesia could represent a safe and suitable anesthetic technique for this procedure. METHODS: Thirty SFP procedures were performed in the angiographic room, 15 for the treatment of lower-limb neoplasias and 15 for pelvic neoplasias. The patients (ASA I-III) had a mean age of 59.1 years (range: 19-81 years). The patients were given different dosages of bupivacaine (range: 10-20 mg) in hyperbaric solution at the concentration of 0.5% and 1% by lumbar subarachnoid injection at different levels (from T12-L1 to L3-L4). Standard monitoring was set up (ECG, pulse-oximetry, and non-invasive artery pressure). The use of any anesthetic and analgesic drug, eventually used in the intra- or postoperative period, was recorded. RESULTS: The lumbar puncture was approached at L1-L2 and L2-L3 levels in 80% of the cases. Doses of bupivacaine between 12 mg and 14 mg were administered in 2/3 of the cases. Bupivacaine was formulated in hyperbaric solution and administered at a concentration of 0.5% (8 patients) or 1% (22 patients). Complica-tions related to the anesthetic technique were absent. Intraoperative pain control was almost complete with one exception, when the procedure lasted unusually long. Pain control was satisfying immediately after the procedure as well: only in 3 cases were non-opiod analgesics administered within the first 6 h. CONCLUSIONS: Spinal subarachnoid anesthesia has proven to be an effective, safe, and easy-to-manage technique for carrying out SFP procedure in a non-conventional environment such as an angiographic room. It was free of serious side effects and well tolerated even in patients in poor general conditions.
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Cerebral aneurysm following head trauma in pediatric age is a rare complication particularly in the absence of skull fractures or penetrating brain wounds as in the present case. In the presence of rapid worsening of neurological conditions after head trauma, one may take into consideration this complication among other possible vascular accidents.
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The clinical use of S.E.R. (Somesthesic Evoked Responses) from the lower limbs has peculiar prognostic value in cases of spinal pathology with clinical signs of transection, where other neuroradiological investigations are not helpful. However, in the present case of acute trasverse myelitis, persistence of an evoked response from the lower limbs was never followed by signs of recovery below the lesional level, while autopsy showed a complete degeneration of the descending spinal pathways with a good preservation of the posterior roots. The limits of this technique appear connected to the fact that the afferent volley of the S.E.R. travels exclusively along the posterior roots, not allowing a definite prognostic evaluation about function of the remainder descending pathways.
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The authors present the results of a survey of anesthesiologists members of the "SIAARTI (Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva) Committee for anesthesia and critical care in neurosurgery and neurology". Among the aims of the survey, was to evaluate when the interest in neuroscience of the members of this group started, and the clinical work dedicated to neuroanesthesia and critical care. At present, the group has grown to 143 members. In the questionnaire 105 members indicated the topic discussed for the medical degree thesis, and 87 indicated the thesis discussed for the board in anesthesia. As emerged from the topic of the thesis discussed for the medical degree, in 47% of the responders the interest in anesthesia began during the college. Of this, 6% chose a topic in neuroanesthesia and critical care. During the residency, the interest in neuroscience increased to 33%, that is 32 out of 97 responders discussed a thesis in neuroanesthesia and critical care. Forty-eight per cent of the members performs clinical work "exclusively" in neuroanesthesia, while 39% does it "mainly", and only 13% works in neurosurgery "fiftfully".