Adult cardiac surgery outcomes: role of the pump type

This study was carried out to evaluate whether the type of pump used for cardiopulmonary bypass (CPB; roller vs. centrifugal) can affect mortality or the neurological outcomes of adult cardiac surgery patients

OTTIMIZZAZIONE DI UNA PREPARAZIONE SEMISOLIDA CONTENENTE LIDOCAINA

Introduzione. Per alleviare il dolore associato alle procedure cutanee con minimo disagio e rischio per il paziente sono impiegati anestetici topici. Fra questi, il medicinale pi\uf9 ampiamente utilizzato a livello mondiale \ue8 Emla, una miscela eutettica di lidocaina e prilocaina. Tuttavia, resta crescente la richiesta da parte dei dermatologi di medicinali contenenti anestetici pi\uf9 efficaci e con una pi\uf9 rapida insorgenza d\u2019azione. Per ridurre il dolore associato ad alcune procedure laser, nel reparto di dermatologia dell\u2019IRCCS San Raffaele viene utilizzato un unguento al 30% p/p di lidocaina base preparato per dispersione a freddo presso la farmacia interna dell\u2019ospedale . Scopo del lavoro \ue8 stato l\u2019ottimizzazione di questa formulazione in termini di metodo di preparazione e di percentuale di principio attivo caricata. Materiali e Metodi. Sono stati allestiti unguenti idrofobi contenenti concentrazioni decrescenti di lidocaina base (30-5% p/p) con il metodo della fusione a caldo. Con tutti gli unguenti allestiti sono state effettuate prove di permeabilit\ue0 cutanea in vitro utilizzando celle di Franz e come membrana epidermide di origine umana per tempi di applicazione di 2 e 24 ore. Emla \ue8 stata utilizzata come formulazione commerciale di riferimento. La miglior formulazione \ue8 stata testata in vivo su 27 donne sane sottoposte a procedure laser Fraxel. Risultati. Il metodo di preparazione a caldo ha permesso di ottenere un unguento omogeneo ed elegante con un miglioramento del profilo di permeazione per l\u2019aumentata solubilizzazione del principio attivo nel veicolo. Le quantit\ue0 di lidocaina permeate dopo il tempo di applicazione di 24 ore sono risultate comparabili indipendentemente dalla percentuale di farmaco caricata nell\u2019unguento (p>0,05), tranne per quello contenente il 5% p/p per il quale si \ue8 misurata una quantit\ue0 permeata inferiore. Anche le quantit\ue0 di lidocaina accumulate nell\u2019epidermide non sono risultate significativamente diverse per tutti gli unguenti allestiti a caldo (p=0,04). Considerando invece il tempo di applicazione di 2 ore \ue8 stata osservata una diminuzione lineare della quantit\ue0 permeata al decrescere della quantit\ue0 di farmaco caricata nel veicolo (unguento al 20% p/p: 19,12\ub19,05 \u3bcg/cm2 vs unguento al 5% p/p: 8,94\ub16,01 \u3bcg /cm2). L\u2019unguento al 20% p/p ha prodotto in vivo lo stesso effetto anestetico di quello ospedaliero rispetto al quale ha manifestato una pi\uf9 rapida insorgenza d\u2019azione. Conclusioni. I risultati ottenuti dagli studi in vitro ed in vivo hanno evidenziato come ottimizzando il metodo di preparazione sia possibile ottenere un profilo di permeazione attraverso l\u2019epidermide ed un\u2019efficacia comparabili a quelli del prodotto a maggior concentrazione

TeleFOT, field operational tests of aftermarket nomadic devices in vehicles, early results

This paper presents the European Large Scale Collaborative Project TeleFOT, describing its status and its first results. The paper is structured into two main sections: The first paragraph briefly introduces the justification and core elements of TeleFOT, showing the scope and primary objectives of the project. Significant research and development in Europe in recent years have been focusing on Intelligent Transport Systems (ITS), since they are contributing to a change in mobility. The number of devices supporting transportation is increasing. In particular, the market penetration of aftermarket nomadic devices as personal navigation devices (PND) or smart phones is growing exponentially according to the market trends, but no scientific evidence of impacts directly related to the use of aftermarket and nomadic devices in vehicle exist yet. Therefore there is a need to test via Field Operational Tests (FOT) the impacts of driver support functions on the driving task, including future interactive traffic services that will become part of driving environment systems. The second paragraph of this paper illustrates the Field Operational Tests to be conducted in TeleFOT and progress reached so far in the project. These include (but are not limited to) large scale test sites in 8 member states, FOT framework creation, benchmarking, piloting and data analysis planning

A Comparison Between Lactose Breath Test and Quick Test on Duodenal Biopsies for Diagnosing Lactase Deficiency in Patients With Self-reported Lactose Intolerance.

BACKGROUND: A lactose breath test (LBT) is usually used to diagnose lactase deficiency, and a lactose quick test (LQT) has been proposed as a new test on duodenal biopsies to detect this disorder. GOALS: We aimed to assess the diagnostic accuracy of LBT and LQT and their ability to predict the clinical response to a lactose-free diet in patients with self-reported lactose intolerance. STUDY: Fifty-five patients (age 47\ub114 y; M/F 15/36) underwent upper gastrointestinal endoscopy and 25g-LBT. Two duodenal biopsies were taken to determine lactase deficiency (normal, mild, or severe) by LQT and to rule out other causes of secondary lactose malabsorption. Patients with a positive LBT and normal LQT also underwent a glucose breath test to exclude small intestinal bacterial overgrowth as a cause of the former result. The severity of gastrointestinal symptoms was measured with a GSS questionnaire, under basal condition and 1 month after a lactose-free diet. RESULTS: Lactose malabsorption was detected in 31/51 patients with LBT and in 37/51 patients with LQT (P=NS). Celiac disease was found in 2 patients. Two LBT+ patients showed a positive glucose breath test for small intestinal bacterial overgrowth. Eight patients had a mild hypolactasia by LQT and a negative LBT, but they had a significant improvement of symptoms after diet. LQT and LBT were concordant in 83% of cases and predicted the response to a lactose-free diet in 98% and 81% of the cases, respectively (P=0.03). CONCLUSIONS: LQT is as sensitive as LBT in detecting lactase deficiency; however, it seems to be more accurate than LBT in predicting the clinical response to a lactose-free diet

Screening for GJB2 and GJB6 gene mutations in patients from Campania region with sensorineural hearing loss

The aim of this study was to screen 349 patients affected by sensorineural hearing loss (SNHL), mostly from the Campania region (southern Italy), for GJB2 gene mutations and for two deletions of the GJB6 gene (del GJB6 -D13S1830 and del GJB6 -D13S1854). We identified pathogenetic GJB2 mutations in 51 cases (15% of patients). No GJB6 mutation was found. We also examined the audiologic features of the patients for whom we had an etiologic diagnosis, in order to identify correlations between the severity of hearing loss and the type of mutation

Platelet function and anesthetics in cardiac surgery: an in vitro and ex vivo study

We studied the effects of the anesthetics commonly used in cardiac surgery on platelet function. Fentanyl, droperidol, succinylcholine, pancuronium, thiopental, and diazepam at therapeutic concentrations were tested for their in vitro effects on the expression of platelet membrane glycoproteins Ib and IIbIIIa (GpIb, GpIIb-IIIa) and of P-selectin in anticoagulated whole blood by flow cytometry. The expression of P-selectin was determined under basal conditions, after the incubation of blood with adenosine diphosphate (ADP) 10 micromol/L, and the stable prostaglandin endoperoxide analog U46619 1 micromol/L. No drug affected the expression of P-selectin in unstimulated and ADP- or U46619-stimulated platelets, with the exception of thiopental, which markedly decreased the U46619-induced expression of P-selectin. Thiopental concentration-dependently inhibited U46619-induced and ADP-induced platelet aggregation, with effects on U46619-induced aggregation at therapeutic concentrations. To assess ex vivo effects, the same platelet markers were also assessed in blood obtained from 10 patients undergoing elective coronary surgery. Compared with basal values, platelet response to U46619 was significantly reduced just after the administration of anesthetic drugs, and the effect persisted for 48 h after surgery. Our study suggests that, at therapeutic concentrations, thiopental inhibits U46619-induced platelet activation both in vitro and ex vivo. The mechanisms responsible of this effect, together with its clinical significance, require further investigation. IMPLICATIONS: Thiopental inhibited prostaglandin-induced platelet activation at therapeutic concentrations both in vitro and ex vivo in cardiac surgical patients whereas adenosine diphosphate-induced activation was affected only at supratherapeutic drug concentrations. Thus, administration of sodium thiopental may contribute to the in vivo impairment of platelet function in patients undergoing elective cardiac surgery

A prospective multicentre survey on the treatment of acute pancreatitis in Italy

Background: The Italian Association for the Study of the Pancreas released a diagnostic and therapeutic algorithm for acute pancreatitis in 1999. Aim: This study focused on the analysis of the therapeutic approach for the treatment of acute pancreatitis in Italy. Patients: One thousand, one hundred and seventy-three patients were recruited: 1006 patients (85.8%) had mild acute pancreatitis (MAP) and 167 (14.2%) had the severe acute pancreatitis (SAP); 161 patients showed pancreatic necrosis at computed tomography; 121 patients (10.3%) had sequelae and 36 (3.1%) died. Results: Non-steroidal anti-inflammatory drugs and tramadol were used more frequently in patients with the MAP whereas opioids and the association schedules were used more frequently in patients with the SAP (P < 0.001). Gabexate mesilate was utilised in 831 out of 1173 patients (70.8%); in particular, gabexate mesilate was used in 70.6% patients with MAP and in 73.1% of those with SAP (P = 0.521). The duration of the drug administration was significantly shorter in those having MAP than in those having the SAP (P < 0.001). The antibiotics most frequently used for the prophylaxis against infection from pancreatic necrosis (43.1%) were carbapenems. Only a small number of patients received enteral nutrition (4.7%). Endoscopic retrograde cholangiopancreatography was carried out in 344 of the 1173 patients (29.3%). Surgery was performed in 48 with SAP (19 had elective biliary surgery and 29 had pancreatic surgery). Conclusions: The results of this survey indicate a lack of compliance with the guidelines which regard the indications mainly for interventional endoscopy and surgery. \ua9 2007 Editrice Gastroenterologica Italiana S.r.l

Diagnostic assessment and outcome of acute pancreatitis in Italy: Results of a prospective multicentre study. ProInf-AISP: Progetto informatizzato pancreatite acuta, Associazione Italiana Studio Pancreas, phase II

Background and aim: Up till now, only one study providing practically complete information on acute pancreatitis in Italy has been published. The aim of this prospective study was to evaluate the clinical characteristics, in terms of diagnostic assessment and outcome, of a large series of patients affected by acute pancreatitis in Italy. Materials and methods: The study involved 56 Italian centres, homogeneously distributed throughout the entire national territory. Each participating centre was furnished with an ad hoc software including 530 items along with subsequent collection, tabulation and quality control of the data. Results: One thousand five hundred and forty case report forms of patients affected by acute pancreatitis were collected but 367 of them (24%) were subsequently eliminated from the final analysis. Therefore, 1173 patients (581 females and 592 males) were recruited. Mean age of patients was 62.0 \ub1 18.2 years (95% confidence interval, 60.9-63.0). On the basis of Atlanta classification, 1006 patients (85.8%) were defined as mild and 167 (14.2%) as severe pancreatitis. Biliary forms represented the most frequent aetiological category (813 cases, 69.3%) while alcoholic forms only 6.6% (77 cases); the remaining aetiologies accounted for 7.1% (83 cases) while 200 cases (17.1%) remained without a definite aetiological factor. Complete recovery was achieved in 1016 patients (86.6%) whereas morphological sequelae were found in 121 patients (10.3%) and mortality in 36 patients (3.1%; 0.4% in mild and 19.2% in severe acute pancreatitis). Ultrasonography was largely utilised as a first line diagnostic tool in all patients, with valuable visualisation of the pancreas in 85% of patients. Computer tomography scan was also widely used, with 66.7% of exams in mild and 33.3% in severe pancreatitis. Patients affected by biliary pancreatitis presented more severe (p = 0.004) and necrotizing forms (p = 0.021). Mortality was significantly related (p < 0.001) with the extension of pancreatic necrosis and with an age of over 70 years. Body mass index presented significantly greater values in severe than in mild forms (p < 0.001). Conclusions: Association of creatinine serum level over 2 mg/dl with an abnormal chest X-ray showed a high significant correlation with a more severe outcome in terms of morphological sequalae and mortality (p = 0.0001). Acute pancreatitis in Italy more commonly presents biliary aetiology and favourable outcome with low rate of complications and mortality. From a cost-effectiveness standpoint, diagnostic approach to this disease needs to be better standardised. \ua9 2007

Long term outcome of acute pancreatitis in Italy: Results of a multicentre study

Background: In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. Aim: To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. Methods: Data of 631 patients admitted to 35 Italian hospitals were retrospectively evaluated 51.7 \ub1 8.4 months after discharge. Results: The average recovery time after mild or severe pancreatitis was 28.2 and 53.4 days respectively. Fourteen sequelae were not resolved and 9 cases required late surgical intervention. Eighty patients (12.7%) had a second hospital admission. Of the patients with mild biliary pancreatitis, 67.9% underwent a cholecystectomy. The overall incidence of relapse was 12.7%. Mortality was 9.8% and no death was related to pancreatitis. Three patients died from carcinoma of the pancreas. Conclusion: Reported recovery time after an attack of pancreatitis was longer than expected in the mild forms. The treatment of sequelae was delayed beyond one year after discharge. The incidence of relapse of biliary pancreatitis in patients not undergoing a cholecystectomy was low, due to endoscopic treatment. Mortality from pancreatic-related causes is low, but there is an association with malignant pancreatic or ampullary tumours not diagnosed during the acute phase of the illness. \ua9 2013 Editrice Gastroenterologica Italiana S.r.l