Serial measurements of blood haemoglobin, serum iron, serum transferrin, total iron-binding capacity, transferrin per cent saturation and serum ferritin were determined in 51 post-operative critically ill patients to investigate body iron status in severely stressed patients. The results showed decreased blood haemoglobin, serum iron, serum transferrin and transferrin saturation compared to an increase in serum ferritin levels. These results indicate that there is inadequate availability of iron to tissues (secondary to rearrangement of body iron to the advantage of the iron storage compartment), which is often present in severely critically ill patients. A positive correlation was found between the initial (ferritin) levels and SAPS (r = 0.41, p less than 0.01). In addition, the increase of ferritin concentration parallels a worsening of the clinical status in severely ill patients. This is due to enhanced release by the macrophage system. From this, we consider serum ferritin as an acute-phase protein and a useful marker of the severity of the clinical status. It appears to be useful in predicting the patient's outcome, but is not reliable in evaluating iron stores in stressed patients.

Adolescent↗

PubMed1989

Clinical uses of high frequency jet ventilation in anaesthesia.

Since 1981, high frequency jet ventilation (HFJV) has been used in 300 patients undergoing surgery, most commonly during i.v. general anaesthesia for endoscopy and surgery of the airways: laryngoscopy, bronchoscopy, laryngeal microsurgery and laser surgery (more than 230 patients); repair of tracheal stenosis, tracheal sleeve pneumonectomy and tracheal sleeve lobectomy. HFJV was administered through a narrow injection catheter inserted in the airway, with a second rigid catheter positioned distally to the injector in the airway for gas sampling and measurement of airway pressure. In all subjects gas exchange was satisfactory, even during tracheoplasty and bronchoplasty.

Adolescent↗

PubMed1989

Measurement of the flow-resistive properties of double-lumen bronchial tubes in vitro.

This study measures the resistance to gas flow of different double-lumen bronchial tubes used for separate ventilation of each lung in critically ill patients. Different-sized Robertshaw and Carlens' tubes were studied, as well as a new device that consisted of a cuffed bronchial catheter introduced through a standard tracheal tube. The pressure-flow relationship was curvilinear in all cases. Robertshaw and Carlens' tubes were generally found to have bronchial and tracheal channels with almost similar resistance and offered total resistances similar to those of 7.0-8.0 mm internal diameter tracheal tubes. The new device had a higher resistance than others of equal external diameter. This must be taken into account when its use is recommended for prolonged respiratory support.

Airway Resistance↗

PubMed1986

Early outcome prediction in severe head injury: comparison between children and adults.

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.

Adolescent↗

PubMed1984

Hemodynamic effects of continuous positive-pressure ventilation and high-frequency jet ventilation with positive end-expiratory pressure in normal dogs.

The hemodynamic effects of high-frequency jet ventilation (HFJV) at 60, 120, 240, and 480 breath/min, and conventional ventilation at 15 breath/min were compared in 6 anesthetized, paralyzed dogs, at 0, 10, and 20 cm H2O of positive end-expiratory pressure (PEEP). On HFJV at the same inspired oxygen, PaCO2, and PEEP levels, hemodynamic function improved significantly. Cardiac output was higher, whereas transmural CVP and pulmonary vascular resistances were lower. The improvement was primarily related to a decrease in mean airway pressure, particularly at higher PEEP levels. When PEEP was applied, hemodynamic function improved even when mean airway pressure was maintained constant. The findings suggest that lung volume was smaller during HFJV, and/or that lung volume changes during each respiratory cycle contributed to differences in venous return and ventricular function.

Animals↗

PubMed1983

Severe acute poisoning from the ingestion of a permanent wave solution of mercuric chloride.

1 A woman developed severe mercury intoxication from ingestion of about 2.5 g of mercuric chloride. 2 Antidotal treatment with a dithiol (BAL i.m.) and a monothiol (tiopronin i.v.) was started promptly. 3 Dialysis treatment thereafter markedly increased the elimination of mercury, thus hastening recovery. 4 It is suggested that chelating agents associated with dialysis are an effective treatment for mercury poisoning.

Dimercaprol↗

PubMed1983

New trends for pain relief in gynaecologic oncology.

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.

Autonomic Nerve Block↗

PubMed1982

Use of intramyometrial injection of prostaglandin F 2 alpha in the management of intractable hemorrhage due to uterine atony.

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.

Adolescent↗

PubMed1980

[Hemodynamic aspects of continuous-infusion ketamine anesthesia for visceral surgery in aged patients].

The results obtained in a haemodynamic study carried out in 9 elderly patients subjected to ketaminic anaesthesia in continuous perfusion for visceral surgery operations are reported and compared with those observed, under the same conditions, in 9 patients aged less than 65. Stress is laid on the stimulating cardiovascular action observed during induction and the lower myocardial reactivity of elderly patients by comparison with younger ones. Mention is also made of the stability of haemodynamic values throughout the period of the operation. There was, however, a tendency to bradycardia and the constant onset of systemic arterial hypotension during the initial period. These are interpreted as phenomena due to the cardiovascular lability of senile age. The effectiveness of ketamine's cardiocirculatory action is, however, a positive factor in the light of the haemodynamic findings obtained during anaesthesia with Althesin and Fentanyl. It is concluded that the anaesthesia technique employed has some positive aspects that make it particularly indicated in states of acute or chronic cardiocirculatory lability, for visceral surgery operations also.

Adult↗

PubMedDate not supplied