Transvenous lead advancement in paediatric pacing to overcome growth stretching

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

One of the main complications of transvenous leads implanted in paediatric patients is the stretching of the lead caused by the somatic growth. It may cause pacing and sensing defects and lead dislodgement or even fracture. Absorbable lead ligature and atrial loop may reduce this risk. However, the loop may induce traction or may unroll too early and therefore impair lead function. Lead extraction and replacement is another solution, although it has some procedural risks in young patients. Lead advancement through pushing it from the pocket may solve growth-induced traction and spare the electrode throughout childhood until post-puberty.

Purpose of the study is the retrospective analysis of the outcome of the transvenous lead advancement in children with a pacemaker (PM) in a single tertiary paediatric center.

Methods

Consecutive patients with a VVIR PM implanted for isolated congenital complete atrioventricular block (no structural heart disease) in alternative right ventricular (RV) pacing sites, with lead stretching underwent a trial of lead advancement during general anaesthesia, cefuroxime antibiotic profilaxis, from 2014 to 2021. After venous angiography showed venous patency, the PM pocket was opened, the lead was released from subcutaneous adherences and with a stylet was gently advanced to create a semi-loop in the atrium without dislodging the tip. Lead data (threshold, sensing, impedance) were compared before and after the procedure. Data are expressed as median (25th-75th centiles) Results: 7 patients underwent PM implantation at 6.9 (5.5-8.0) years of age, 20 (18-21) kg, 116 (106-120) cm, with the lead positioned at parahisian(3)/mid-septum (4 pts) sites. During a follow-up of 3 (1-5) years, advancement procedures were 2 (1-4) per patient. Between procedures, delta age was 15 (12-19) months, height 7 (6-11) cm and weight 4 (2-6) kg. All leads were successfully advanced without any procedural complications. Procedure time (skin to skin) was 91 (69-105) minutes, fluoroscopy was 0.4 (0.2-1.2) mGy, 13 (9-35) microGy/m2. Electrical lead parameters did not showed significant differences between consecutive control times. In one parahisian pacing, chronic threshold increased after 3 years (2 advancement procedures) from 0.7V to 2.6 V/0.4 ms.

Conclusion

the advancement of transvenous leads in children is a safe and effective procedure, without significant procedural complications and during follow-up, and with low fluoroscopy exposure. This procedure may maintain a good function of transvenous leads until growth has completed.

Fractured epicardial lead in paediatric patients: can they be safely repaired?

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Before bipolar epicardial leads became widely available and used by heart surgeons, unipolar epicardial leads were frequently implanted in small children requiring permanent pacing. Main complications are lead fractures causing pacing/sensing defect. Therefore, patients should undergo new epicardial or endocardial lead implantation with relevant procedural risks, especially in complex congenital heart disease (CHD). Proximal fractures, close to the generator, may be repaired using a dedicated Unipolar Lead Adapter and Extension, with reduced operative risks. Purpose of the study is the retrospective analysis of the outcome of the repair of unipolar epicardial leads in young patients (pts) in a single tertiary paediatric center.

Methods

Consecutive patients with proximal fracture underwent a trial of lead repair using the lead adapter/extension, during general anaesthesia, cefuroxime antibiotic profilaxis, from 2004 to 2020. Lead data (threshold, sensing, impedance) were compared before and after the repair procedure.

Results

18 patients with CHD (12pts, 10 of whom complex, 6 post-Fontan) or normal structural heart (6pts), who underwent pacemaker implantation at 2.5 (0.7-5.8)years of age for congenital/postoperative atrioventricular block (11pts) and sinus node dysfunction (7pts), showed lead (7 atrial, 11 ventricular) fractures after chronic pacing. At 13 (8-17)years of age, all leads were successfully repaired without any complications. Follow-up was 4 (2-6)years. Four pts (22%) showed again fractures of the repaired lead, after 1 month, 1and 3 years (2pts). Electrical lead parameters are shown in table 1: there were not significant differences between consecutive time of controls, also in the atrial and ventricular lead subgroups.

Table 1.-------------------Pre-repair;--intraprocedural;---1 month;----------1 year;-------------4 years.

Threshold (V/0.4 ms):--1.1 (0.7-1.4);--1.0 (0.8-1.6);-------1.2 (0.9-1.5);-----1.2 (0.9-2.1);-------1.5 (1.1-1.8).

Sensing (mV):--------- 7 (2.4-12);------5.4 (1.3-15);-------4 (1.5-11);----------5 (1.6-12);---------3 (2-10).

Impedance (ohm): 343 (289-407);---350 (246-415);--346 (250-432);--374 (250-589);--362 (220-470).

Conclusion

The repair of fractured unipolar epicardial leads in young patients is a safe and effective procedure, with few complications during follow-up. Effective repair can delay more aggressive procedures.

The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs

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75 patients with ACS or CCS underwent S-ICD screening upon arrival and after PCI.

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Before PCI, STEMI patients had lower screening pass rates than NSTE-ACS ones

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STEMI was the only predictor of screening failure at multivariate regression analysis.

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Patient selection and dynamic device programming are fundamental in ischemic subjects

Background

The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain.

Objectives

We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization.

Methods

We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation.

Results

Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77–41.38, p = .001)

Conclusion

The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.

[Hydrating cleansing: efficacy and tolerability of new formulations with hyaluronic acid 0.2% for intimate hygiene in the woman in fertile age and menopause]

Dehydration of genital areas, known as vaginal dryness, frequently affects woman's life, from fertile to postmenopausal period, and must be treated with specific products, including proper intimate cleansing. Based on that, two new cleanser formulations, characterized by Hyaluronic Acid 0.2% as main ingredient, have been developed (Hyalo Gyn® Intimo Active and Hyalo Gyn® Intimo Advance), with the aim to provide an effective hydration of the vaginal, vulvar, perianal and anal areas beyond guaranteeing daily intimate hygiene. The two intimate cleansing mousses have been formulated in mousse and differentiated, in terms of ingredients, accordingly to the different physiological conditions and female needs of fertile age and menopause respectively. Clinical trials conducted on women of childbearing age and menopause showed that daily cleansing with these intimate washes promotes hydration of vaginal tissues thanks to the presence of hyaluronic acid. In particular, the cleansing mousse for fertile women gives also a soothing effect, offers antimicrobial protection and a long lasting feeling of freshness. The cleansing mousse for menopausal women provides a freshness sensation, improves elasticity and tonicity and exerts an anti-smell and anti-oxidative effect.

Hyaluronic Acid as a Protein Polymeric Carrier: An Overview and a Report on Human Growth Hormone

Hyaluronic acid (HA) is a natural polysaccharide primarily present in the vitreous humor and in cartilages where it plays a key structural role in organizing the cartilage extracellular matrix. HA is used in a wide range of applications including treatment of arthritis (as a viscosupplementation agent for joints) and in a variety of cosmetic injectable products. Its safety profile is thus well established. Thanks to its high biocompatibility and targeting properties, HA has also been investigated for use as a carrier of anticancer drugs and, recently, also of proteins. Its role in the last case is a particularly challenging one as dedicated coupling chemistries are required to preserve the protein's conformation and activity. This study focuses on the state of the art on protein HAylation. New data from our laboratory on the local delivery of specific biologics to joints will also be outlined.

Eigenstate thermalization hypothesis and quantum Jarzynski relation for pure initial states

Since the first suggestion of the Jarzynski equality many derivations of this equality have been presented in both the classical and the quantum context. While the approaches and settings differ greatly from one another, they all appear to rely on the condition that the initial state is a thermal Gibbs state. Here, we present an investigation of work distributions in driven isolated quantum systems, starting from pure states that are close to energy eigenstates of the initial Hamiltonian. We find that, for the nonintegrable quantum ladder studied, the Jarzynski equality is fulfilled to a good accuracy.

Drug conjugation to hyaluronan widens therapeutic indications for ovarian cancer

Management of ovarian cancer still requires improvements in therapeutic options. A drug delivery strategy was tested that allows specific targeting of tumor cells in combination with a controlled release of a cytotoxic molecule. To this aim, the efficacy of a loco-regional intraperitoneal treatment with a bioconjugate (ONCOFID-S) derived by chemical linking of SN-38, the active metabolite of irinotecan (CPT-11), to hyaluronan was assessed in a mouse model of ovarian carcinomatosis.

In vitro, the bioconjugate selectively interacted with ovarian cancer cells through the CD44 receptor, disclosed a dose-dependent tumor growth inhibition efficacy comparable to that of free SN-38 drug, and inhibited Topoisomerase I function leading to apoptosis by a mechanism involving caspase-3 and -7 activation and PARP cleavage. In vivo, the intraperitoneal administration of ONCOFID-S in tumor-bearing mice did not induce inflammation, and evidenced an improved therapeutic efficacy compared with CPT-11.

In conclusion, SN-38 conjugation to hyaluronan significantly improved the profile of in vivo tolerability and widened the field of application of irinotecan. Therefore, this approach can be envisaged as a promising therapeutic strategy for loco-regional treatment of ovarian cancer.

Peritoneal tumor carcinomatosis: pharmacological targeting with hyaluronan-based bioconjugates overcomes therapeutic indications of current drugs

Peritoneal carcinomatosis still lacks reliable therapeutic options. We aimed at testing a drug delivery strategy allowing a controlled release of cytotoxic molecules and selective targeting of tumor cells. We comparatively assessed the efficacy of a loco-regional intraperitoneal treatment in immunocompromised mice with bioconjugates formed by chemical linking of paclitaxel or SN-38 to hyaluronan, against three models of peritoneal carcinomatosis derived from human colorectal, gastric and esophageal tumor cell xenografts. In vitro, bioconjugates were selectively internalized through mechanisms largely dependent on interaction with the CD44 receptor and caveolin-mediated endocytosis, which led to accumulation of compounds into lysosomes of tumor cells. Moreover, they inhibited tumor growth comparably to free drugs. In vivo, efficacy of bioconjugates or free drugs against luciferase-transduced tumor cells was assessed by bioluminescence optical imaging, and by recording mice survival. The intraperitoneal administration of bioconjugates in tumor-bearing mice exerted overlapping or improved therapeutic efficacy compared with unconjugated drugs. Overall, drug conjugation to hyaluronan significantly improved the profiles of in vivo tolerability and widened the field of application of existing drugs, over their formal approval or current use. Therefore, this approach can be envisaged as a promising therapeutic strategy for loco-regional treatment of peritoneal carcinomatosis.

A hyaluronic acid-salmon calcitonin conjugate for the local treatment of osteoarthritis: chondro-protective effect in a rabbit model of early OA

Osteoarthritis (OA) is characterized by chronic degeneration of joints, involving mainly the articular cartilage and the underlying bone, and severely impairing the quality of life of the patient. Although with limited efficacy, currently available pharmacological treatments for OA aim to control pain and to retard disease progression. Salmon calcitonin (sCT) is a drug which has been shown to have therapeutic effects in experimental arthritis by inhibiting both bone turnover and cartilage degradation and reducing the activities of matrix metalloproteinases (MMP). High molecular weight hyaluronic acid (HA) is used as a lubricant in OA therapy, and, interestingly, HA polymers may normalize the levels of MMP-1, -3 and -13. We demonstrated that sCT rapidly clears from the knee joint of rat animal model, after intra-articular (i.a.) administration, and it induces systemic effects. Here, sCT was conjugated to HA (200kDa) with the aim of prolonging the residence time of the polypeptide in the joint space by reducing its clearance. An aldehyde derivative of HA was used for N-terminal site-selective coupling of sCT. The activity of sCT was preserved, both in vitro and in vivo, after its conjugation and the i.a. injection of HA-sCT did not trigger any systemic effects in rats. The efficacy of HA-sCT treatment was tested in a rabbit OA model and clear chondro-protective effect was proven by macro- and microscopic assessments and histological findings. Our results indicate that HAylation of sCT increases the size of the polypeptide in a stable covalent manner and delays its passage into the blood stream. We conclude that HA conjugation prolongs the anti-catabolic effects of sCT in joint tissues, including the synovial membrane and cartilage.

Pharmacokinetic profile of Oncofid-S after intraperitoneal and intravenous administration in the rat

Objectives

Oncofid-S is a bio-conjugate molecule obtained from the binding of campthotecin, SN-38, to hyaluronic acid. In view of a possible clinical development for loco-regional treatment of peritoneal carcinomatosis, this study aimed to establish the pharmacokinetic profile of Oncofid-S after single intraperitoneal or intravenous administration in the rat.

Methods

Single-dose intraperitoneal or intravenous administrations of Oncofid-S were performed. Groups of six rats were sacrificed at various times (up to 24 and 72 h in i.p. and i.v. study, respectively) after drug injection. Trunk blood, livers and spleens were collected for subsequent analysis. Total SN-38 was assayed by HPLC.

Key findings

We found that Oncofid-S was poorly absorbed after intraperitoneal injection, the estimated AUC0–72 being less than2%. The drug was distributed in liver, but not spleen, and was eliminated with a terminal half-life of 16 h. After intravenous dosing, Oncofid-S was found in liver as well as in spleen.

Conclusions

Here we have demonstrated that Oncofid-S administered intraperitoneally in the rat was poorly absorbed into the systemic circulation, even after the administration of an extremely high dose. This finding reinforces the rationale for developing Oncofid-S in the loco-regional intraperitoneal treatment of peritoneal carcinomatosis in man.

The response of intestinal mucous cells to the presence of enteric helminths: their distribution, histochemistry and fine structure

Histochemical and ultrastructural investigations were conducted on the mucous cells of the intestine of brown trout, Salmo trutta L., naturally infected with the cestode Cyathocephalus truncatus (Pallas, 1781) and the acanthocephalan Echinorhynchus truttae Shrank, 1788. A subpopulation of 45 S. trutta were examined of which 15 specimens harboured E. truttae, 15 of which were infected with C. truncatus and 15 fish, the control group, were uninfected. In histological sections, hyperplasia and hypertrophy of the mucous cells were evident at the site of parasite infection. Enhanced mucus secretion was also recorded in infected fish. The number of mucous cells close to the site of parasite attachment within the intestine was significantly higher than the number detected in uninfected individuals and in infected individuals at sites 1 cm or greater from the point of parasite attachment. There were no significant differences between the number of mucous cells found at the latter two sites. Alcian blue and periodic acid-Schiff's staining of representative histological sections revealed a significant increase in the number of mucous cells staining positively for acid glycoconjugates compared to the number of cells found in the intestines of uninfected S. trutta. In transmission electron microscopy sections, each mucous cell typically possessed an elongated, basally positioned nucleus. The cytoplasm was observed to possess numerous electron dense and lucent vesicles, in addition to well-developed rough endoplasmic reticulum, Golgi apparatus and a few round mitochondria.

High Sensitivity and Specificity of Digital Infrared Imaging for Breast Cancer Detection in Younger Women Undergoing Breast Biopsy

Background and aim: Recent published evidence suggests that digital infrared breast scanning may be a useful adjunctive tool for breast cancer detection. In this study we have assessed the effectiveness of digital infrared imaging captured using Sentinel BreastScan (Infrared Sciences Corp., Bohemia, NY, USA) and compared the computer-generated reports from this system with expert manual review of the images as well as a new software programme currently under development called NoTouch BreastScan.Methods: A total of 100 patients scheduled for breast biopsy (n=106), following detection of an abnormality via clinical examination or breast imaging were recruited to this research ethics committee-approved study. After obtaining informed consent all patients were imaged using Sentinel BreastScan, prior to their scheduled biopsy procedure in the Cambridge Breast Unit. The data for each patient was analysed in four different ways for comparison with final pathology findings as follows: 1. Sentinel screening report (score 0 = normal, 1-5 = abnormal); 2.Sentinel neural network (positive or negative); 3. Independent expert review (positive or negative); 4. NoTouch BreastScan artificial intelligence (score 0-3 = normal, 4-10 abnormal).Results: Sensitivity for the whole group using Sentinel screening (53%) and neural network (48%) was low compared to recently published data (97%), expert review (78%) and NoTouch (70%).Sensitivity and specificity results for NoTouch BreastScan by age group are shown in table1Sensitivity and specificity results for NoTouch BreastScan by age group &lt;50 years, n=2150-70 years, n=73&gt;70 years, n=12All patients, n=106Sensitivity78%72%42%70%Specificity75%37%N/A48% Conclusion: This study confirms acceptable sensitivity (72%) for breast cancer detection using NoTouch BreastScan in women under 70 years of age despite the data being captured with Sentinel. This sensitivity increases to 78% for women &lt;50 years old and is combined with a marked increase in specificity (75%) in this group. These encouraging figures may increase even further when data is captured by the NoTouch software and studies are ongoing with this novel imaging system.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5025.

Synthesis, characterization and in vitro cytotoxicity studies of a macromolecular conjugate of paclitaxel bearing oxytocin as targeting moiety

The present study describes the experimental synthetic procedure and the characterization of a new polyaspartamide macromolecular prodrug of paclitaxel, bearing oxytocin residues as targeting moieties. In vitro stability studies of bioconjugate, performed in media mimicking biological fluids (buffer solutions at pH 7.4 and 5.5) and in human plasma, evidenced the high stability of the targeting portion (oxytocin)-polymer linkage and the ability of this conjugate to release linked paclitaxel in a prolonged way in plasma. Moreover, preliminary in vitro antiproliferative studies, carried out on MCF-7 cells, that are oxytocin receptor positive cells, showed that the polymeric conjugate has the same cell growing inhibition ability of free drug.

Reversibly stable thiopolyplexes for intracellular delivery of genes

Novel polyaspartamide non-viral carriers for gene therapy were synthesized by introducing, on the same polymer backbone, positively charged groups, for electrostatic interactions with DNA, and thiol groups for the formation of disulfide bridges between polymer chains. The introduction of thiols was aimed to have a vector with low redox potential sensitivity: disulfide crosslinking in fact, being stable in extracellular environment, allowed either to have stable complexes in plasma, that can protect DNA from metabolism, or to be reduced inside the cell, where the excess of glutathion in reduced form maintains a low redox potential. The consequent destabilization of the complex after disulfide cleavage can release DNA selectively inside the cells. Alpha,beta-poly(N-2-hydroxyethyl)-D,L-aspartamide (PHEA) was used as starting polymer being a highly water-soluble synthetic polymer, already proposed with success as therapeutic carrier by our group. In this study, PHEA was firstly functionalised with ethylendiamine, obtaining a well defined copolymer with pendant primary amine groups (PHEA-EDA), to which N-succinimidyl 3-(2-pyridyldithio) propionate (SPDP) and 3-(carboxypropyl)trimethyl-ammonium chloride (CPTA) were linked in two subsequent steps, allowing the introduction of thiol and cationic groups respectively. Finally DTT treatment lead to the final PHEA-EDA-SH-CPTA thiopolycation, named PESC. The present work describes the synthesis and characterization of the thiopolycation PESC. 1H NMR spectroscopy detected the derivatization molar degrees in SPDP and CPTA; the formation of DNA complexes (thiopolyplexes), their stability in the presence of polyanions and the ability to release DNA under reductive conditions were studied by agarose gel electrophoresis. DNase II degradation study was carried out to detect the ability of thiopolyplex to stabilize DNA towards enzymatic metabolism. Thiopolyplexes were then characterized by Dynamic Light Scattering (DLS) and Zeta Potential analysis. Finally, in vitro toxicity profile (MTT) and gene transfer efficiency (Luciferase assay) were carried out to evaluate thiopolyplex biocompatibility, safety and efficacy to be used as gene delivery system.

Synthesis and characterization of polyaminoacidic polycations for gene delivery

The properties as non viral gene vector of a protein-like polymer, the alpha,beta-poly(N-2-hydroxyethyl)-d,l-aspartamide (PHEA) were exploited after its derivatization with 3-(carboxypropyl)trimethyl-ammonium chloride (CPTA) as molecule bearing a cationic group, in order to obtain stable polycations able to condense DNA. PHEA was firstly functionalized with aminic pendant groups by reaction with ethylenediamine (EDA) obtaining the alpha,beta-poly(N-2-hydroxyethyl)(2-aminoethylcarbamate)-d,l-aspartamide (PHEA-EDA) copolymer. We demonstrated that polymer functionalization degree is easily modulable by varying reaction conditions, so allowing to produce two PHEA-EDA derivatives at different molar percentage of amine groups. Subsequently, the condensation reaction of PHEA-EDA copolymers with CPTA yielded alpha,beta-poly(N-2-hydroxyethyl)(2-[3-(trimethylammonium chloride)propylamide]-amidoethylcarbamate)-d,l-aspartamide (PHEA-EDA-CPTA) polycation derivatives. In vitro studies were carried out to evaluate polycations ability to complex DNA and to protect it from nuclease degradation. Obtained results demonstrated the good ability of our new PHEA polycationic derivatives, PHEA-EDA-CPTA, to complex and condense genomic material, neutralizing its anionic charge even at very low polycation/DNA weight ratio. Finally, PHEA-EDA-CPTA polycations were characterized by in vitro cytotoxicity studies to evaluate their effects on the viability of HuH-6 human hepatocellular carcinoma cells by MTS assay. No cytotoxicity was evidenced by both polycationic derivatives after 48h of incubation at all tested concentrations.

Effects of naltrexone on the intake of ethanol and flavored solutions in rats

It has been suggested that the endogenous opioid system may mediate the intake of preferred fluids, perhaps through an attenuation of reinforcement properties causing a subsequent shift in palatability. The purpose of the present study was to investigate the effects of the nonspecific opiate antagonist naltrexone on the intake of 10% ethanol, 0.1% saccharin, 0.0006% quinine, 0.4% saccharin + 10% ethanol, and 0.4% saccharin + 0.04% quinine solutions. Fluid intake was measured in male Long-Evans and Wistar rats under 24-h continuous and 30-min limited-fluid-access drinking paradigms. All rats received injections of naltrexone hydrochloride (10 mg/kg, i.p.) for 5 days after baseline intake measures and were monitored for a further 5 days (after-treatment phase). Results indicated that naltrexone did not affect intake of any solution when fluids were available over 24 h. However, under limited-access conditions, naltrexone caused a decrease in the intake of all fluids except quinine in both rat strains. On the basis of these findings, it is possible that the effects of this dose of naltrexone were not due to any true conditioning effect on the reinforcement properties of ethanol, but perhaps to some nonspecific effect of the drug, such as an alteration in palatability or an attenuation of locomotor activity. As well, due to the inconsistent results in fluid intake across drinking paradigms, the present findings do not provide evidence for an effective role for opiate mediation in ethanol intake as well as any ethanol-sweet fluid intake interactions.

A diary model for monitoring blood pressure in the elderly

Activity can significantly change blood pressure. Twenty four hour ambulatory blood pressure monitoring (Holter method) was introduced to optimize diagnosis and the changes in blood pressure. It was flanked by the purpose to use diaries to correlate symptoms and pressure changes, pressure changes and psychophysical activity, life style and drugs. The diary model adopted by us for 380 elderly subjects between 65 and 85 years old is divided into four main sections: 1. general activities (8 items); 2. situational variations (7 items); 3. correlation between symptoms and pressure changes; 4. drug treatment and pressure changes. The aim of our study was to assess the compliance of the elderly to keeping a diary. Our results showed that compliance was satisfactory in 352/380 subjects (93%).

[Cranial injury in children]

The Authors report personal experience in management of 23 children after severe head injury. All patients were submitted to TC scanning and their performance status was evaluated according to Glasgow Coma Scale (G.C.S.). All children were treated with hyperventilation, steroids, mannitol and, when necessary, Penthobarbital (TPS). Authors present the outcome at a distance of 6 months from trauma's beginning.

[Monitoring of intracranial pressure]

A very small fiberoptic catheter initially developed as an intravascular pressure sensor was incorporated into a system to be used as an intracranial pressure (ICP) monitor. 13 patients with intracranial hypertension have been studied with this probe. The clinical experience confirmed the safety, accuracy and reliability of the device. The monitor has functioned very well, and there have been no complications except for two breakages of optic fiber as a result of nursing manoeuvres. This new device can be placed into the ventricular, subdural and epidural space. Camino System appears to offer advantages over other monitors presently in use.