[Postoperative evolution in 65 interventions for esophageal atresia].
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Biomedical subjects
Publications and source records attributed to E Vincenti.
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Plasma beta-endorphin levels were studied before induction of general anaesthesia for caesarean section and during some phases of surgery. A very high increase of beta-endorphin occurred following induction of anaesthesia. However fifteen minutes after fetal extraction a tendency of the beta-endorphin levels to decrease was noted. Some medical treatment, such as antiasthmatic medication with glucocorticoids and beta-mimetic treatment for controlling uterine hyperactivity, seemed to interfere with pituitary response.
In pre-terminal and terminal gynaecological patients with persistent cancer pain, now it is possible to carry out some anthalgic methods associated or not to parenteral administration of non-narcotic or narcotic analgesic, i.e. intrathecal neurolytic injections and epidural narcotic administration. Many favourable results have been obtained by means of single or repeated 7% phenol in glycerine injections to patients with advanced but not terminal cancer affected by somatic and segmental pain or by perineal pain. In order to control more extensive pains, epidural injections of morphine in saline have been employed in preterminal patients. This method appears to be the best answer to many problems complained by the patients: pain, depression, malaise. As a matter of fact, low doses of epidural morphine induce both complete pain relief and sedation or slight drowsiness.
Prostaglandin F2 alpha, in doses varying from 1 to 5 mg was injected transabdominally, transvaginally or intraabdominally (during caesarean section) into the myometrium in ten patients affected by metrorrhagias not responsive to conventional uterotonic drugs. In all cases but one the result was excellent. Important side effects were observed in only one patient, because of the inadvertent intravascular injection of 5 mg Prostaglandin into the endocervix. An adequate treatment of this patient brought her to complete recovery in a short time. According to our experience, the intramyometrial injection of PGF2 alpha, in doses varying from 1 to 2 mg, is a simple, safe and effective method in the control of severe hemorrhage due to uterine atony not responding to conventional treatment.
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The Authors report the results of study carried out on ten post-menopausal patients affected with endometrial carcinoma (FIGO stage I & II) who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH & BSO). Estradiol, Testosterone and Prolactin plasma levels were assayed before surgery and in the 2nd, 10th and 30th post-operative day. The evaluation of the data supports the opinion that in postmenopause Estradiol origin is mainly extraglandular and the ovaries produce Testosterone; the evaluation of Prolactin levels before and after surgery, at last, cannot rule out the hypothesis of an hypothalamo-pituitary disfunction in post-menopausal patients affected with endometrial cancer.
The authors studied the effects of acupuncture and pentazocine on post-operative respiratory function and pain management on patients hysterectomized by means of a subumbilical midline incision. The acupunctural technique consisted of GB-26, St-36, Sp-6 and auricular Shen-Men bilateral electrostimulation for 40 minutes. The analgesic effect of acupuncture was equivalent to that of 30 mg pentazocine, yet the most important effect of acupuncture consisted in a net increase of vital capacity during the period of acupuncture analgesia that lasted for 3-4 hr after stimulation; contrariwise, pentazocine did not cause any vital capacity increment and vital capacity remained at the levels observed prior to narcotic administration.
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Cardiotocographic variations certainly attributable to epidural anaesthesia were studied over the period 1972-1980 on 716 patients in labour. Transitory side-effects due to both direct and indirect action of local anaesthetics appeared in 1.4% of the cases, without, however, subsequently creating any particular foeto-newborn problem. On the basis of the experience acquired, it seems justifiable to affirm that the correct use of continuous epidural block, affected by very small doses of bupivacaine (10-20 mg per administration) is almost risk-free. The only inconvenience therefore that may sometimes arise would only be due to the relevation of a concealed cava occlusion when the maintenance of a left lateral position is not observed.
The levels of norepinephrine, dopamine and 5-hydroxytryptamine in brain homogenates of vitamin B12-deficient rats have been investigated. The norepinephrine levels were significantly decreased in the deficient animals compared to controls. The two major catabolic pathways of norepinephrine e.g. monoamine oxidase and catechol-O-methyl transferase did not show significant variations. Both acetyl cholinesterase and butiryl-cholinesterase markedly decreased in the plasma of the vitamin B12-deficient rats.
Enflurane and isoflurane appeared equally effective in decreasing the efficiency of oxidative phosphorylation in isolated mitochondria, while halothane was twice as effective as these two anesthetics. On the other hand enflurane and isoflurane exhibited different dose-response relationships when the uptake of calcium was measured (with a calcium-selective electrode) or the transmembrane electrical potential was monitored (with tetraphenylphosphonium-selective electrode) during ATP synthesis or calcium uptake in anesthetic treated mitochondria. The results indicate that the effects of isoflurane and enflurane on the mitochondrial energy converting processes are qualitatively, but not quantitatively, analogous to those previously described for halothane. Moreover the damaging action of isoflurane gradually increases as the anesthetic concentration increases, while that of enflurane suddenly increases above a threshold concentration. It appears that the effects of halothane, enflurane and isoflurane on isolated mitochondria involve both the ATP synthetase and the inner membrane permeability barrier, although the membrane-anesthetic interactions responsible for such effects are probably different for each anesthetic.
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