The Authors analize the interrelational evolution of a group of inmates during an outside working activity, with relation to the resocializing experiences which consider the insertion in the area of individuals subjected to detentive security measures. Such evolution, in relation with the influences of the social enviornment one was associated with, was associated with, was marked by an initial cohesion stage between members (of defensive significance), followed by a gradual research of a personal autonomy, in parallel with the acquisition of a reassuring and stabilized role. The utilization of a social space according to the conventional parameters used in the area (with particular concern towards syndical dynamics and rules), reached at the cost of self-exposure, has confirmed the reached maturity and the self balance in proposing themselves to the others as subjects active in their own resocialization, sharing the acquired social rights. Beside the situation concerning the side of the group in its insertion progress, the Authors take into examination the side of the free community in tis receptivity and availability towards the group members, analizing the interactions with the environment as therapeutical moment.

Humans↗

PubMedDate not supplied

[Recovery Room. Organization and clinical aspects].

Correct administration in the early postoperative phase is decisive in the final outcome of surgery and the presence of the Recovery Room (RR) contributes significantly to a reduction in the post-operative risk rate. The objectives of the RR are: removal of the pharmacological effect of general anaesthesia; stabilization of vital parameters (circulation and ventilation); stabilization of body temperature; control of the hydro-electrolytic balance; intensive intervention in the case of an acute complication; prescribing a suitable postoperative analgesia; recovering movement in the case of loco-regional anesthesia. Organization of RR must take into consideration: 1) aspect of environment and location; 2) transport of the patient from the operating room to the RR; 3) definition of the equipment necessary for the RR; 4) definition of the role and qualification of the medical and nursing staff; 5) definition of regulations of assistance and the clinical file; 6) definition of criteria for discharge and transfer; 7) definition of means of adjournment, improvement and comparison with other similar structures. RR is administered by an Anesthetist with clinical, therapeutic and decision-making responsibility for the discharge of patients, while the supervision and assistance patients is entrusted to specialised professional nurses. From a clinical point of view the following data are monitored and recorded: the vital signs (passage of air-ways, cardiac and respiratory frequency, arterial pressure, saturation of O2, EtCO2 (in patient with air-way support), body temperature and the state of consciousness, instrumental monitoring of the patient (at pre-established time intervals), control of the skin, the peripheral circulation, surgical wounds, drainage and catheters. The percentage of incidence of complications in RR varies from 6-7 to 30% depending on various studies, probably in relation to the diversity of criteria in defining the complication. The principal complications which can be found in RR, reported in several studies are: respiratory (obstruction of the air-way, hypoxemia, hypoventilation, inhalation), cardio-circulatory (hypotension, hypertension, arrhythmia, myocardial ischemia), postoperative nausea and vomiting, hypothermia and hyperthermia, delayed re-awakening, disorientation and hyper-excitability, postoperative shivering. As long as the patient can be discharged from the RR the following requisites must be satisfied: return of a state of consciousness, stable cardio-circulatory parameters, absence of respiratory depression, absence of bleeding, absence of nausea and vomiting, good analgesia and recovery of movement in the case of loco-regional anesthesia (on this last point not all authors agree). What has been said until now shows the function, usefulness and importance of RRs which must not replace the Intensive Therapy Units. In fact, they are places where the cure must be concluded, in which the Anesthetist is responsible for the whole process. This cure must begin in the preoperative period, continue in the intraoperative period and it is compulsory to proceed in the immediate postoperative period until such a time that, because of the anesthesia administered, the clinical situation of the patient ceases to be considered a potential medical-surgical urgency-emergency .

Anesthesiology↗

PubMedDate not supplied

[Recovery Room. One-year experience].

BACKGROUND: The objective of our study is to present the analysis of the organizational and clinical work carried out in the first year of activity of the Recovery Room (RR) at the Azienda Ospedaliera Santa Maria degli Angeli of Pordenone and to compare personal experience with what is stated in the literature. METHODS: The RR is located at the center of the operating block (composed of 10 operating rooms), the number of bed is 6, 3 of which are equipped with ventilators. There is a central nursing station where it is possible to concentrate all data deriving from the single monitors on one single screen. The RR operates from Monday to Friday from 8.00 to 20.00. An Anesthetist is on duty for the 12 hours and has the clinical, therapeutic and decision-making responsibility regarding the discharge of patients, while nursing assistance is provided by 2 qualified professional nurses for shift, assisted by an auxiliary. In the first year of activity of the RR, a total of 11,626 surgical operations were carried out; of these 1,047 patients, equal to 9%, were assisted in the RR. The age of 51% of the patients was between 61 and 80 years; 53.3% belonged to the ASA 2 group and only 0.48% to the ASA 4 group. The operations were sub-divided as follows: 56.8% general, thoracic and vascular surgery, 15.3% urological, 10% orthopedic, 7.7% obstetrical and gynecological, 6.1% ENS, 3% stomatological, 1% others. 56.8% off the patients underwent general anesthesia, 30.5% combined anesthesia and 12.6% local-regional anesthesia. The time spent by the patients in RR was between 1 hour 30 minutes and 10 hours 45 minutes, with an average time of 3 hours 49 minutes. RESULTS: Of the 1,047 patients studied no case of cardio-respiratory arrest or death was recorded, while the complications encountered were: 13.15% cardio-circulatory, 3.62% respiratory, 3.62% PONV, 2.1% oliguria, 1.24% hypothermia, 0.48% disoriented patients, 0.38% hyperthermia and 0.38% shivering. In the area of cardio-circulatory complications encountered, the most important was arterial hypertension (5.6%), followed by cardiac arrhythmia, such as bradycardia (2.5%) and tachycardia (2.6%). CONCLUSIONS: The conclusion is drawn that correct administration in the early postoperative period is decisive for the final outcome of surgery and that the presence of RR contributes significantly to a reduction in the postoperative morbidity rate. Our case-series leads us, however, to reflect on an excellent organization of the opening hours of RR.

Adolescent↗

PubMedDate not supplied

[Analysis and comparison of the guidelines regarding recovery-room management].

The purpose of this study was to analyse and compare the guidelines regarding Recovery-Room (RR) management at international level, pointing out the main differences and common aspects. The guidelines on the RR management in various countries have been compared in particular the Italian, French, German, Australian, Canadian and American guidelines. In addition, the management of postoperative patients in some of these countries where guidelines on the subject have not yet been published have been analysed. In some countries, France for instance, the guidelines have been published as a ministerial decree (Décret n degrees 94-1050 du Décembre 1994) and are therefore a law with proper articles, in others (Italy for instance), they are mere recommendations, which do not have immediate effect and are regarded as a target to be achieved. SIAARTI considers that this is due to the dishomogeneity of the Italian hospital situation as far as medical and nursing staff as well as buildings and applied technology are concerned. The comparison between guidelines of different countries has shown that RR is a reality which has now existed for many years at international level and it has demonstrated that all guidelines agree on the fact that postoperative patients must be observed in a protected and safe environment. The following rules are common to all guidelines: the anaesthetist is responsible for the RR and for discharging the patient; there must be a clinical record and a written report which are considered to be essential (not in Italy); RR must be next to the surgical rooms; the patient must be escorted to RR by the anesthetist; monitoring must be guaranteed during transfer; monitoring continuity in RR (at regular and a appropriate intervals) is essential. The following rules are not common to all guidelines: numbers of beds in RR; the proportion between the number of nurses and the number of patients; regulation for day-surgery; specific regulations for obstetrical patients. Guidelines are subject, as any regulation, to continuous revision, and this is a very important requirement which helps keeping them always update and in line with scientific research.

Guidelines as Topic↗

PubMedDate not supplied

Mouthrinses: a comparative microbiological study.

This study was performed in order to evaluate the efficacy of different mouthrinses whose use is extended in Spain. Six different antiseptic mouthrinses were studied by means of determination of Minimal Inhibitory Concentration (MIC) values against Klebsiella pneumoniae, Serratia marcescens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella typhimurium, Bacillus subtilis, Streptococcus mutans, Prevotella intermedia, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans. Also in vivo experiments were carried out in volunteers by the use of mouthrinses and evaluation of bacterial populations before and after the treatment. Finally, the kinetics of bacterial death was determined. Results suggested that the determination of MIC values is not a reliable method to evaluate the antibacterial effect of such products. On the other hand those rinsing solutions based on the effect of oxygen, such as those containing carbamide peroxide have a greater efficacy against anaerobic bacteria compared with rinses whose active molecule is a disinfectant. Finally, the kinetics of bacterial death demonstrates that the essential oil rinse kills bacteria much faster. All tested mouthrinses were active as antibacterial although those based on oxygen production or essential oils were more active than solutions based on chlorhexidine and Triclosan.

Aggregatibacter actinomycetemcomitans↗

PubMedDate not supplied

[Primary neoplasm of unknown origin].

Cancers of unknown primary site constitute a heterogeneous group having in common their biological behaviour. We have analysed patients with cancer of unknown primary site admitted to University Hospital of Coimbra/Internal Medicine Service III from 1st January of 1992 to 30th June of 1998. The study included 26 patients corresponding to a prevalence of 2.5% malignant neoplasias; the median age of affected patients was 64 years old with a male-to-female ratio of 4.2:1. The most frequent histological type was well differentiated and moderately well differentiated adenocarcinoma, 46.1% of all cases. Three years global survival rate was 3.9%. The herein-reported prevalence is comparable to that found in recent literature, showing a good diagnostic skill. As expected, the prognosis was poor, revealing the disease's aggressiveness and the lack of efficient therapy in the majority of case.

Adult↗

PubMedDate not supplied

[Treatment of postoperative entero-cutaneous fistula: personal experience].

The authors present their experience on surgical treatment of intestinal fistulas based on personal cases treated from 1981 to 1990. The cases are divided into two groups: the first: the first group of patients was treated only surgically (1981-1984); the second group was treated with surgery and artificial nutrition (1984-1990). The mortality rates are much lower in the second group. The conclusion is that is always necessary to associate a form of artificial nutrition to surgery because the percentage of healing is statistically higher.

Adult↗

PubMedDate not supplied

[Piringer-Kuschinka's lymphadenitis. Clinical and morphologic study. Apropos of a case].

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

[Saliceta S. Giuliano prison (Modena). Criminological unit for observation and treatment of prisoners (Case F/2)].

Explore the source record for details and available documents.

Adult↗