Spontaneous ventilation and epidural anesthesia in a patient with a large tracheoesophageal fistula and esophageal cancer undergoing colon interposition.
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Biomedical subjects
Publications and source records attributed to G Pittoni.
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This study evaluated renal function and histological and oxidative injury in transplanted kidneys harvested after prolonged warm ischemia in pigs. In 8 donor pigs, kidneys were perfused in situ 120 min after cardiac arrest. One of each pair of kidneys was used for histological and biochemical studies while the other was transplanted into a recipient undergoing bilateral nephrectomy. In 6 cases, renal function was satisfactory 14 days after transplantation. Histologically, a reversible acute tubular necrosis was observed with partial recovery at the 14th postoperative day. A moderate oxidation was revealed by decreased glutathione and increased malondialdehyde levels. In spite of this ischemic injury, these findings suggest that kidneys harvested after prolonged warm ischemia can still recover after transplantation, and that non-heart-beating donors may be considered as an alternative organ source for kidney transplantation.
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In order to evaluate the possibility of using a selective subarachnoid anesthesia in ambulatory surgery we studied its feasibility with a Sprotte needle 24 G in 103 patients (range 15-67 years) undergoing a knee joint arthroscopy. The subarachnoid anesthesia was achieved with Sprotte needle 24 G with introducer with patient on lateral decubitus. Hyperbaric bupivacaine 1% (0.05 mg/cm height) was used in order to obtain a selective homolateral metameric anesthesia between L1 and S3. The numbers of attempts were 1.29 (range 1-4). We involved the homolateral determatomeres in 94% of our attempts, adding a weak anesthetic action on contralateral ones. In the remaining 6% of the patients the anesthesia was bilateral and extending in an overlying manner. Anesthesia was adequate for the time needed to perform all the surgical procedures. Nevertheless in 3 patients the tourniquet was painful. We registered systemic hypotension only in 2% of the patients (a reduced systolic pressure value > 30%). No cases of postdural puncture headache were registered. Non postural atypical headache was seem in 3.9% of the patients. Urinary retention necessitating catheterization was noted only in 3 cases. A weak backache was revealed in 8.8%. When interviewed after surgery, 98% of our patients fulfilled the technique. In spite of technical difficulties that the use of the Sprotte needle may present, the selective subarachnoid anesthesia may be a safe alternative to the other anesthetic procedures for ambulatory surgery of the legs.
The availability of a long-term central venous access for the management of neoplastic and chronic patients is extremely important in order to achieve an easy and safe infusion of chemotherapeutic drugs, blood components, and parenteral nutrition. The authors evaluated 26 adult patients (25 with malignant tumors and 1 with severe asthma) in whom implantable catheter systems were placed subcutaneously between February 1989 and March 1992. Catheters were inserted through the cephalic vein in 13 cases, the subclavia vein in 8 cases and jugular vein in 5 cases. The mean function time was 262 days in deceased patients and 155 in alive ones. There were no infective or thromboembolic complications. The authors, in agreement with the literature, confirm that TIS represent a safe and easy access for a long term i.v. therapy, with a very low complication rate. Furthermore, comfort of the patients is substantially improved and nursing care is greatly facilitated.
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The nutritional and immunological status have been evaluated in 28 consecutive patients with esophageal cancer. Patients (21 male and 7 female), had a mean age of 61 years, ranging from 34 to 84 years. The tumor histological type was squamous in 25 patients. A melanoma, an oat cell carcinoma and a adenocarcinoma were observed in the remaining cases. The nutritional status was assessed by means of weight loss, triceps skinfold, midarm muscle circumference and serum levels of albumin and transferrin. On the basis of this data the patients were divided into two groups: A, 19 patients (68%), normal nourished group (or with a mild malnutrition) and B, 9 patients (32%) with a severe malnutrition. The immunological status was assessed by determining the lymphocyte absolute number (H-6000-Technicon), the T-Lymphocyte sub-populations (flow-cytometry with monoclonal antibodies--Ortho Diagnostic System) and the patient's response to intradermally placed recall antigens (Multitest Merieux). Significative immunological abnormalities were found only in malnourished patients, group B (p less than 0.05). Moreover a reduction of OKT4 helper (less than 30%) and the inversion of OKT4/OKT8 ratio (less than 0.9%) were also observed only in the malnourished group (p less than 0.01). Therefore, we conclude that acquired immunodeficiency, when present in patients with esophageal cancer, is due to the severe malnutrition rather than to the cancer itself.
The clinical course and the treatment of two patients with chronic idiopathic pseudo-obstruction are reported. Venting enterostomy to reduce the frequency of the occlusive symptoms and home parenteral nutrition to correct malnutrition have been employed, after the failure of aggressive medical treatment with prokinetic drugs. These measures improved symptoms of obstructions and allowed the reestablishment of oral alimentation. Therefore, according to medical literature, we suggest that patients with chronic idiopathic pseudo-obstruction can be safety managed for prolonged period with this treatment.
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The Authors investigated the usefulness of some biochemical markers of visceral protein synthesis (TSF, TBPA and RBP) in 24 patients affected with gynecological cancer and treated with Total Parenteral Nutrition in the perioperative period. The absence of an improving TSF and TBPA is related to increased morbidity and mortality.
The prognostic value in 49 children and 56 adults of the following parameters recorded on admission was analyzed: oculocephalic and light reflexes, posturing, Glasgow Coma Scale (GCS), the need for ventilatory support, and the presence of associated injuries. All patients had been in coma for at least 6 h. The presence of intracranial hematoma and the duration of coma were recorded and the relative risk of poor outcome calculated. There was poor outcome in 51% of the children and 61% of the adults. Oculocephalic and light reflexes, posturing, GCS, need for ventilatory support, and duration of coma were significantly related to the outcome in children. Only oculocephalic and light reflexes, and posturing were significantly related to the outcome in adults. Some parameters appeared to have different prognostic value in children and in adults: the simultaneous evaluation of oculocephalic reflex and need for ventilation was the best prognostic guide in children, the light reflex was the best prognostic indicator in adults.
We report 298 patients admitted to the Neurosurgical unit of the University of Padua during one calendar year. We divided the patients into two groups. "in coma" and "not in coma", and analyze their data records. The time between injury and admission to a neurosurgical centre is important for therapy as well as for transport. The necessity of an "Admission Chart" is emphasized.
In order to gather fundamental information about the reanimative, diagnostic, and therapeutic measures concerning head-injured patients, we propose the introduction of an "Admission Chart". This Chart ought to accompany patients from the first contact with Accident-Emergency Medical Staff to arrival at a specialized Centre.
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