Use of natural surfactant in an infant with aspiration syndrome

The remarkable effectiveness of surfactant in neonatology suggested its use also in adults as well as in children on the basis of the pulmonary pathophysiology. We describe a case of an 18 month-old child affected by acute respiratory distress syndrome (ARDS) due to asphyxy by gastric juice inhalation, successfully treated with porcine surfactant (Curosurf) associated with ventilatory therapy.

Use of activated protein C in a case of paediatric septic shock

We describe a clinical case of a 7 year old girl, affected by peritonitis, septic shock and multiorgan failure, treated successfully with drotrecogin alpha associated with conventional therapy.

Influence of gastric pH changes on pharmacokinetic of a sustained-release formulation of theophylline

The effect of magnesium-aluminum-hydroxide antacid (Maalox) on the oral absorption of theophylline anhydrous time-release capsules Somophyllin CRT was studied in eight healthy volunteers. The subjects were given 500 mg of theophylline alone or with 30 ml of antacid in a complete crossover design. Drug serum concentrations were determined by an immunoenzymatic method within 24 hours at frequent intervals. Antacid induced a significant reduction of theophylline serum levels and of the fraction absorbed at 1 and 1.5 hours of the monitoring period (less than 0.05), but no significant differences were found at later sampling time. Maalox did not influence the area under the curve from 0 to 24 hours and the peak concentrations; the time to peak was slightly but significantly longer with antacid (p less than 0.05). Our results indicate that physicochemical factors such as gastrointestinal fluid pH do not influence substantially absorption of the slow-release formulation Somophyllin.

[Preoperative evaluation of the patient candidate for surgical intervention on the chest: methods of study and risk factors]

The authors review the main methods designed to evaluate operability and surgical risk in candidates for chest surgery. They also report on their own experience with 135 cases operated on for thoraco-pulmonary diseases requiring surgery; in these cases, postoperative complications were studied in relation to various respiratory parameters evaluated differentially and as a whole prior to surgery. This study enabled the investigators to establish that patients with CV, FEV1, FEF25-75 and Tiffffeneau Index values below 60% of the respective theoretical reference values run a very substantial risk of postoperative complications, with a post-surgical morbidity rate of more than 60% in such patients. Similar risks are run by patients with VR values below 60% or above 120% of predicted values or with Emphysema Index values above 120% of predicted values. The author's experience with fractional bronchospirometry revealed that, in the high-risk patient sample, a predicted postoperative FEV1 value of only 800 ml/sec is a poorly selective limit.

[Esophagogastroplasty in the treatment of squamous carcinoma of the esophagus (our experience)]

The authors report on their experience with 42 cases of squamous carcinoma of the oesophagus subjected to oesophagectomy and oesophagogastroplasty. The patients' mean age was 55.2 years (range: 41-70) with a 13:1 male/female ratio. A positive history of cigarette smoking and of alcohol consumption was found in 87% and 80% of patients respectively. The sites of the neoplasms were as follows: 24 in the mid 3rd of the oesophagus, 9 in the lower 3rd, 6 in the upper 3rd of the thoracic oesophagus and 3 in the cervical oesophagus. In 39 patients the operation was performed in two stages according to Lewis and in 2 cases it was performed in 3 stages according to McKeown, while one patient was treated with a pull-through operation according to Akiyima. Six patients died during the first 30 days postoperatively as a result of circulatory complications or ARDS. Fistulization of the anastomosis as observed in 5 cases, though this was clinically manifest only in two. Mean survival was 5.9 months, 18.6 months and 10.5 months according to the period considered.

[Respiratory function after traumatic rupture of the diaphragm]

In eight patients who underwent surgical treatment for diaphragmatic rupture, pulmonary function and differential ventilation of the lungs were evaluated four months-one year after surgery. The results of the study show that diaphragmatic rupture produces only a small reduction in total ventilatory function. Moreover our data indicate that the ventilation estimated to be contributed by the side injured, is decreased in a larger extent in abdominal than in thoracic trauma.