Improving the management of patients with chronic cardiac and respiratory diseases by extending pulse-oximeter uses: the dynamic pulse-oximetry.

Respiratory and cardio-vascular chronic diseases are among the most common noncommunicable diseases (NCDs) worldwide, accounting for a large portion of health-care costs in terms of mortality and disability. Their prevalence is expected to rise further in the coming years as the population ages. The current model of care for diagnosing and monitoring NCDs is out of date because it results in late medical interventions and/or an unfavourable cost-effectiveness balance based on reported symptoms and subsequent inpatient tests and treatments.

Awake intubation with the Bonfils fibrescope in patients with difficult airway.

Background: In the majority of patients with difficult airways intubated using the Bonfils fibrescope, intubations have been performed under general anaesthesia. Our aim is to report a consecutive series of intubations on awake patients with anticipated difficult airways, performed using the Bonfils fibrescope.

Methods: A prospective case series of intubations performed with the Bonfils fibrescope by a single anaesthesiologist is described in this article.

Massive venous air embolism in the semi-sitting position during surgery for a cervical spinal cord tumor: anatomic and surgical pitfalls.

Although venous air embolism (VAE) in neurological surgery is mainly associated with posterior fossa procedures, this complication may also occur, with comparable severity, in the posterior cervical spine approach in patients who are semi-sitting. We report a patient with a massive VAE that occurred in the semi-sitting position during a posterior approach to an extended cervical-thoracic level (C3-T2) intramedullary tumor, which interrupted the surgical procedure. We discuss the possible causes of air embolism, the anatomic and pathogenetic mechanisms, treatment and preventive measures.

Orbital head pain elicited by neuroendoscopy of the third ventricle performed under local anesthesia.

Endoscopic third ventriculostomy (ETVS) is considered a minimally invasive procedure for blocked hydrocephalus. In 24 cases, this procedure was carried out in awake patients under local anesthesia. All patients reported abrupt orbital pain when the third ventricle floor was manipulated.

A simplified endoscopic third ventriculostomy under local anesthesia.

The aim of this study is the analysis of our experience with awake endoscopic third ventriculostomy (ETVS) in hydrocephalic patients. From September 1994 to December 2001, 24 neuroendoscopic procedures were performed under local anesthesia. Local infiltration was administered using a bupivacaine and lidocaine mixture.

Posterior capsule opacification after phacoemulsification: silicone CeeOn Edge versus acrylate AcrySof intraocular lens.

Purpose: To compare the rates and morphologic features of posterior capsule opacification (PCO) after small-incision phacoemulsification and in-the-bag implantation of 2 foldable intraocular lenses (IOLs) over an 18-month follow-up.

Setting: Departments of Ophthalmology, Hospital of Conegliano, Conegliano, and Maggiore Hospital of Bologna, Bologna, Italy.

Methods: In an open clinical study, 78 cataract patients were randomly selected to have implantation of a silicone CeeOn Edge (Pharmacia) or acrylate AcrySof (Alcon) IOL after phacoemulsification cataract surgery.

Slow-resolving pneumonia secondary to bronchiolitis obliterans organizing pneumonia.

We report a case of slow-resolving pneumonia secondary to bronchiolitis obliterans organizing pneumonia (BOOP) in a 73-year-old woman. Owing to a delayed diagnosis of BOOP, the clinical course was quite long. This syndrome is caused by a nonspecific inflammatory pneumonitis, either idiopathic or associated with infectious or irritant agents (or drugs).

Guillain-Barré syndrome with associated thrombocytopenia: prompt response to combined corticosteroid and immunoglobulin treatment.

We report a case of Guillain-Barré syndrome (GBS), requiring prolonged mechanical ventilation, associated at its presentation with thrombocytopenia, in a 50-year-old woman. She was treated with immunoglobulin, and short-term corticosteroids for thrombocytopenia. In spite of the severe presentation we observed a very good and rapid recovery, which could have been determined by the therapeutic association.

Multiple organ failure due to Clostridium difficile sepsis. A case report.

A case of severe sepsis caused by Clostridium difficile infection in a 66-year-old cirrhotic female is described. Severe systemic symptoms evolved rapidly to septic shock and ARDS, with signs and symptoms suggesting an acute abdomen requiring exploration for exclusion of surgical treatable diseases. The delayed diagnosis of Clostridium difficile infection probably contributed to the severity of the clinical course.

Evaluation of trauma care: validation of the TRISS method in an Italian ICU.

Objective: To validate the TRISS method as an audit system on a group of patients with severe trauma admitted to an Italian general intensive care unit (ICU).

Design: Prospective, cohort study of consecutive admissions to the ICU.

Setting: A 6-bed general ICU in a 500-bed general hospital.

[Respiratory obstruction caused by retropharyngeal hematoma secondary to cervical spinal injury. Report of a case].

A case of severe airway obstruction secondary to retropharyngeal hematoma in a young multiple trauma patient with a stable occipitoatloid capsular-ligamentous injury is reported. The onset of mechanical obstruction occurred eight hours after the trauma requiring emergent oral intubation, and lasted seventeen days. The initial lateral cervical spine radiograph was negative, whereas the second one performed 7 hours after and initially underestimated, showed a large prevertebral soft tissue swelling.

[Comparison of 2 modified Fick methods and thermodilution for determining the cardiac output in patients with mechanical ventilation].

Objective: To evaluate the effectiveness of two cardiac output measurement methods based on a modified Fick equation, that calculate the O2 consumption (VO2) dividing the CO2 production (VCO2) by a fixed respiratory quotient (RQ).

Design: Comparative study.

Setting: One 5 beds general intensive care unit in a 500 beds general hospital.