[Various aspects of intensive therapy in myasthenia gravis].

Clinical experience acquired in the intensive treatment of 168 myasthenic patients after thymectomy, for respiratory insufficiency due to myasthenic or cholinergic crisis, after hormone treatment, or immediately after various forms of surgery is described. Particular attention is devoted to problems faced in respiratory care, anticholinesterasic and metabolic treatment, and in the prevention and treatment of infections.

[Cardiac contusion in closed injuries of the thorax].

Cardiac contusion is a fairly frequent clinical event in closed chest traumas. The diagnostic problems it involves influence prognosis in these patients and, in effect, prevention, speedy recognition and early treatment of the complications of cardiac contusion are essential for therapy. Here the incidence of cardiac contusion in a group of patients with closed chest trauma is analysed and the clinical, diagnostic and therapeutic aspects are examined.

Effect of respiratory acidosis on plasma and CSF free amino acids.

Acid-base data and levels of selected cerebrospinal fluid (CSF) free amino acids were analyzed in a series of 8 patients in acute respiratory failure. In these patients, there were increased CSF concentrations of methionine, phenylalanine, tyrosine, histidine, alpha-amino-N-butyric acid, glutamic acid, glutamine, glycine, alanine, and ammonia, while arginine decreased. Phenylalanine, tryosine, and alanine were correlated with CSF PCO2; and alpha-amino-N-butyric acid to the buffer capacity of CO2 and pH.

The significane of measurement of osmolality in critically ill patients.

The plasma and urine osmolality and their ratios were measured in 774 patients in critical care. We found that changes in osmolality were related to the alterations of ratios of sodium ion, glucose, blood urea nitrogen and unknown metabolites, and this knowledge may be of therapeutic and prognostic value.

Intravenous sodium lactate administration in respiratory alkalosis secondary to severe brain injuries.

In acute cerebrovascular accidents the uptake of lactate by the brain tissue is enhanced, possibly in an attempt to buffer the increased local lactic acidosis. In this paper the results obtained by the administration of the lactate in 78 cases of hyperventilatory syndromes secondary to acute brain injuries, and the biochemistry of the cerebrospinal fluid and blood, are reported.

Acute renal failure: biochemical evaluation of total parenteral nutrition with essential L-amino acids.

Plasma amino acid patterns were studied in three groups: one of 10 healthy subjects used as control, one of five patients in acute renal failure treated by haemodialysis plus a standard high-calorie non-protein diet, and one of five patients with the same clinical condition and treated in the same way except that the total parenteral nutrition consisted of a mixture of carbohydrate and essential L-amino acids. Our results indicate that haemodialysis seems to be responsible for some part of the depletion of amino acids and that their administration reduces this effect both for the essential and for the non-essential amino acids.

Plasma and intraerythrocyte amino-acid levels during and after haemodialysis in acute renal failure.

A study is carried out on the variations of plasma and blood red cells free amino acid concentrations secondary to haemodialysis in patients suffering from acute renal failure. A reduction in plasma free amino acid pool has been observed in patients undergoing to many periodic haemosialysis, but no significant differences occur in plasma aminogram between before and after a single dyalitic procedure. Significant alterations were also observed in blood red cells aminogram, and this may be interpreted as reflex of intracellular omeostatic mechanisms for the maintenance of normal plasma free aminoacid pattern.

Comparison of CSF-free amino acid concentrations among various neuropathological conditions.

The level of free amino acids in cerebrospinal fluid from eight patients in comatose states has been determined. The variations of cerebrospinal fluid-free amino acids observed in coma have been compared with those reported by other authors in patients affected by epilepsy, multiple sclerosis, infantile amaurotic idiocy (GM2-gangliosidosis) and phenylketonuria.

Changes in blood viscosity and plasma proteins in myocardial infarction.

A clinical study of some biological and biochemical factors was carried out on patients with acute myocardial infarction. It was shown that: (i) the plasma viscosity was highly correlated to the clinical evolution of myocardial infarction; (ii) the variations of plasma viscosity were related to changes in the connection of fibrinogen and globulin; (iii) the highest correlation was between the plasma viscosity and alpha2-globulin concentration. The monitoring of these may be useful in the clinical evaluation of myocardial infarction.

Plasma cortisol monitoring acute myocardial infarction.

A study of the concentration of unconjugated plasma cortisol in nine patients with acute myocardial infarction has been made. The effectiveness of monitoring this factor in assessment of the clinical course and establishing early treatment in this condition is also reported.

The action of phosphocreatine and fructose 1,6-diphosphate on blood in vitro.

Blood in vitro has been used to evaluate the effects of phosphocreatine and fructose 1,6-diphosphate on the adenylate cycle. These compounds, following different metabolic pathways, increased the ATP concentration, phosphocreatine through a direct action on the adenylic phosphate cycle and fructose 1,6-diphosphate mainly by it glycolytic effect.

A comparative study of free amino acids in coma of different aetiologies.

A comparative study of the concentrations of free amino acids in the plasma and cerebrospinal fluid in cases of coma of different origins has been made. Hypotheses are put forward to explain the biochemical steps involved in cerebral metabolism of protein.

Concentrations of free amino acids in plasma, erythrocytes and cerebrospinal fluid in coma.

The concentrations of free amino acids were measured in plasma and erythrocytes in 15 patients, and in cerebrospinal fluid in eight patients, who were in coma. Although there was a variety of causes of coma, there seemed to be a characteristic pattern of the concentrations of amino acids for coma, and the plasma/cerebrospinal fluid ratios also showed constant patterns.

Free amino acids in plasma and erythrocytes during and after cardiopulmonary by-pass in open-heart surgery.

The concentrations in plasma and erythrocytes of free amino acids before, during and after cardiopulmonary by-pass have been determined. During by-pass and the early postoperative period the total alpha-amino nitrogen decreased, mainly because of changes in glucogenic amino acids; ketogenic amino acids, on the other hand, increased. The phenylalanine/tyrosine ratio was markedly increased in all cases.

The acid--base status: a mathematical approach to its definition.

The respiratory and non-respiratory factors of acid--base status have been evaluated mathematically. New units of measurement for derangements of the acid--base balance are proposed.