Le lesioni di grossi collettori venosi nei traumi vascolari degli arti inferiori: attuali problematiche medico-legali

Nei traumi vascolari complessi degli arti le lesioni venose sono presenti in oltre il 50% dei casi. L’atteggiamento terapeutico nei loro confronti è evoluto nell’ultimo decennio essendosi passati da una posizione prevalentemente astensionistica (semplice legature) al convincimento dell’opportunità della riparazione della vena per ridurre le complicanze post-operatorie immediate e tardive. Sono stati individuati anche criteri di ordine clinico e strumentale per valutare la necessità alla riparazione del vaso, resa possibile anche in caso di estese distruzioni mediante sostituzioni con lunghi segmenti protesici. In tale prospettiva si è presa in considerazione la casistica della Divisione di Chirurgia d’Urgenza dell’Ospedale Cardarelli – USL n.40 di Napoli - relativa a lesioni venose operate e controllate in follow-up di breve-medio termine, per verificare i risultati oggi conseguibili con l’intervento e come supporto ad una disamina dei criteri per la loro valutazione medico-legale

[Postoperative hyperbaric oxygen therapy in the rat jejuno-ileal bypass. Preliminary note].

Experimental investigation of complications following jejunoileal by-pass in Wistar rats, treated with doxycycline, metronidazole, special diets and hyperbaric oxygen is reported. Hyperbaric management may even lead to worse liver function, contrary to what is observed in rats subjected to hyperbaric oxygen after a hyperlipidic diet

RABBIT DEEP SEDATION AND PLASMA CONCENTRATIONS AFTER TRANSNASAL ADMINISTRATION OF A DEXMEDETOMIDINE BUTORPHANOL AND MIDAZOLAM COMBINATION

Aim of this study was to correlate the clinical and sedative effects of a combination of Dexmedetomidine, Midazolam and Butorphanol (DBM) with their respective plasma concentrations after transnasal (TN) administration in healthy rabbits. This study was approved by the Ethics Committee of the University of Naples (CESA). A combination of 0.1 mg/kg of Dexmedetomidine (D- Dexdomitor® Pfizer Italia srl, 0.05%), 0.4 mg/kg of Butorphanol (B- Dolorex® Intervet, 1%) and 2 mg/kg of Midazolam (M- Midazolam IBI®, 0.5%) (DBM), was delivered by trans-nasal (TN) catheterization (Levin probe CH 6) onto the nasopharyngeal mucosa of 5 NZW Rabbits. Vital parameters were recorded (Mindary PM-9000 Exspress®) for 60 minutes along with sedation score (SS) and pain response by a numeric (0-12) rating scale (1). SS was classified (1) as insufficient (0-3), moderate (4-7) or deep (8-12). Blood samples (2 mL) were collected before (T-0) and at T-: 5, 10, 15, 30, 45, 60, 90, 120, 180 and 240 (minutes) after TN DBM administration. Plasma samples were then frozen and stored at -80°C. Single drug pharmacokinetics were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) using AB Sciex 3200 triple quadrupole with positive ion electrospray ionization. Chromatographic separation (LC Agilent 1200) was performed on column ZORBAX DB-C18 (4.6 x 50 mm, particle size 1,8 mm). Identification and quantification was based on selected reaction monitoring (SRM). Calibration curves were prepared using fortified plasma samples. All numerical data were processed by ANOVA for repeated measures. Significant differences were analyzed by a post hoc Tukey???s HSD test (P??? 0.05). Deep sedation ensued in all rabbits 1.5??? after TN DBM administration along with moderate respiratory and cardiovascular depression. Peak sedation and analgesia (T-5) coincided with mean plasma concentrations of about 23 ng/ml for D, of 34. ng/ml for B and of 560 ng/ml for M. Rabbits were still fairly sedated (T-60) at plasma levels of about 4 ng/ml for D, 12 ng/ml for B and 118 ng/ml for M. Insufficient sedation (T-90) was scored at plasma levels of about 2 ng/ml for D, 12 ng/ml for B and 85.40 ng/ml for M. No anesthetic complications were observed in any of the subjects. TN administration of our DBM combination in healthy rabbits produced a deep, long-lasting sedation and analgesia. Plasma concentrations of single molecules correlated well with sedation scores. 1)Raekallio M et al. (2002) J Vet Pharmacol Ther, 25(1):39-42