[Urinary hexafluoroisopropanol in the assessment of occupational exposure to sevoflurane: methodologic features and critical points]

The increasing use of sevoflurane as anaesthetic leads to the need for finding a biological index to evaluate the occupational exposure in surgical activity. Several studies indicate that Hexafluoroisopropanol (HFIP) is a specific sevoflurane metabolite quickly glucuronidated and excreted as HFIP-glucuronide in the urine (HFIPu). Therefore the HFIP removal kinetics in occupational exposure and the correlation between sevoflurane exposure and HFIPu are poorly understood. We studied no. 86 operating room workers of Novara Hospital to evaluate the correlation between the sevoflurane individual exposure (SE) and the HFIPu at the end of the shift expressed in microgram/L (A-HFIPu) and in microgram/g creat. (C-HFIPu). Therefore, in the same group of subjects we evaluated the HFIPu in the urine sampled at 8.00 a.m. before the work. The correlation coefficient was R2 = 0.782 (p < 0.0001) for SE/A-HFIPu and R2 = 0.862 (p < 0.0001) for SE/C-HFIPu; HFIPu normalized for urinary creatinine (C-HFIPu) is an index more suitable than the A-HFIPu. Furthermore we concluded for the usefulness of pre-shift HFIPu.

[24 Hour arterial pressure in insulin-dependent diabetics and non-insulin-dependent diabetics with preserved renal function]

BACKGROUND

The aim of the study was to value the behaviour of systolic (S) and diastolic (D) arterial pressure (AP)/24 hrs in a group of diabetic patients insulin-dependent (IDDM) and non insulin-dependent (NIDDM) with preserved renal function.

METHODS

We examined 65 diabetic patients (aged 39.1 +/- 23.3), 33 IDDM (aged 18.2 +/- 7.5; years of diabetes: 5.8 +/- 4.9) and 32 NIDDM (aged 60.7 +/- 11.4; years of diabetes: 7.2 +/- 7.5). In all of them we computed BMI and determined creatinine clearance, glycosylated haemoglobin A, total and HDL-associated cholesterol, triglyceridemia, middle glycemia and microalbuminuria. AP measurement was performed by 24 hrs monitoring (periodicity 15') using a Takeda 2420 measurer. Chronobiological characteristics of AP were analysed by statistical method of cosinor according to Halberg, examining if there was or not a blood pressure circadian rhythm (PCR) (p < 0.05) and its characteristics represented by the mesor, the amplitude and the acrophase. Moreover the patients were subjected to a diet with fixed contents of sodium (130 mEq/day) and afterwards we drew (every 4 hours) renin (R), aldosterone (A1) and atrial natriuretic factor (ANF) which were analysed with cosinor's method. The purpose was not to compare the two populations, not homogeneous between them and not different only for the years of diabetes, but to study their blood pressure behaviour, the rhythm, the order of the indicated hormones for possible pathogenetic connections.

RESULTS

NIDDM presented higher blood pressure values (PAS 134.2 +/- 3.5 and PAD 80.9 +/- 2 mmHg) than IDDM (PAS 116.6 +/- 1 and PAD 66.4 +/- 1.7 mmHg), still in limits of substantial normality. The acrophase was in the midday for NIDDM (PAS 11:25', PAD 12:06') and in the early afternoon for IDDM (PAS 14:15', PAD 14:06'). Analysing the trend of the AP in the single cases, PCR was present in 70% and absent in 30% of IDDM while it was persistent in 56% and disappeared in 44% of NIDDM. IDDM without PCR differed from those with it in years of diabetes (p < 0.001), body weight (p < 0.02), BMI (p < 0.01), triglyceridemia (p < 0.05), all more elevated, as well as in higher PAS and PAD (p < 0.001) and in higher concentration of ANF (p < 0.05). The same comparison was done in NIDDM. Patients without PCR were older (p < 0.025), had higher PAS (p < 0.025) and PAD (p < 0.001) and also a more activated ANF (p < 0.001).

CONCLUSIONS

This hormonal anomaly may be ascribed to a lower excretion of sodium with consequent expansion of extracellular volume due to antinatriuretic action of insulin often found at high plasmatic levels particularly in NIDDM.

Reconstruction of calcaneal skeletal defects caused by trauma

Since 1976, we have treated displaced intra-articular fractures of the calcaneus by open reduction through a lateral approach, temporary percutaneous fixation, and bone grafting. We assessed the results after a mean follow-up time of 98.9 (SD = 53) months in 30 patients with 35 fractures. In this report we review, clinically and radiologically, 35 fractures in 30 patients (five bilateral). Autografts was used in five cases (five patients) with an average follow-up of 145 months (SD = 43.7). Allografts were used in 19 cases (16 patients) with an average follow-up of 124 months (SD = 31.2), and hydroxyapatite was used in 11 cases (nine patients) with an average follow-up of 34 months (SD = 12.9). Clinical assessment was based on the Creighton-Nebraska Health Foundation scoring system and radiological measurements made from a lateral view. Seventy-seven percent of the patients had excellent or good clinical results and none had a poor result. Open reduction restored the "crucial angle" and the height of the calcaneus. The tuber joint angle described by Böhler was above 20 degrees in all the cases. There were no significant differences among the three groups of patients with regard to degree of residual pain, walking activities, range of subtalar movement, ability to return to their original jobs, hindfoot swelling, or change in footwear.

[Variability of the response to recombinant human erythropoietin in patients undergoing hemodialysis treatment]

The paper assesses the existence of possible interference between dialysis and the response to human recombinant erythropoietin administered i.v. in a group of patients undergoing regular dialysis. The results obtained show that the time taken to reach the set hemoglobin target (Hb 10 g%) was shorter in hemodiafiltered (HDF) patients compared to those receiving bicarbonate dialysis (BD). A plausible explantation may be the different depurative characteristics and the greater degree of biocompatibility of alternative dialysis which is able to achieve a more rapid cellular response to pharmacological stimulation.

[Levels of tumor necrosis factor and interleukin 1 in uremia and in hemodialysis]

The present study aimed to assess the serum levels of tumor necrosis factor (TNFalpha) and Interleukin-1 (IL-1) in uremic patients and those patients undergoing extracorporeal replacement therapy in relation to the duration of dialysis and the type of membrane. Serum cytokine values were assayed using an immunoradiometric technique (monoclonal antibodies) in 28 uremic patients and 7 healthy controls. TNFalpha levels were normal in control subjects but increased in uremic patients. Patients undergoing hemodialytic treatment showed increases which were statistically significant in comparison to basal levels, with a trend which was directly correlated to the duration of dialysis. No significant variations were induced by the different types of dialysis membranes used. In virtually all patients IL-1 values could not be assayed using this method.

[Netilmicin in a single daily dose for treatment of systemic infections]

The Authors report the results obtained in 35 patients of either sex suffering from various systemic infections and treated with netilmicin. Netilmicin has been intramuscularly administered in once daily dose of 4.5 mg/kg (mean daily dose 294.3 mg) for a mean duration of 17.8 days. The clinical resolution of the infections has been achieved in 97.1% (34 patients) of the study population; only one patient showed failure. Thirty-three of the 35 baseline causative pathogens have been eradicated. The local and systemic tolerability was good. The serum pharmacokinetics showed bactericidal levels of netilmicin and no serum accumulation.

[The intradialytic kinetics of uremic toxins in the diffusion-convection hemodialysis method]

A kinetic evaluation of dialytic methods using a diffusive-convective mechanism in comparison to the standard bicarbonate dialysis was performed in order to verify the possible therapeutic uses. The "kinetic" comparison of PFD and HDF to HBD, using equal quantities of dialysate, showed no significant change in the mention of uremic toxins of small molecular weight and a more efficient capacity to extract beta 2M by the diffusive-convective methods. The biophysical evaluation of dialysis still appears to represent the best means of defining the clearance possibilities and of identifying the most suitable technique for achieving a dialytic adequacy.

Serum osteocalcin (bone Gla-protein) following corticosteroid therapy in postmenopausal women with rheumatoid arthritis. Comparison of the effect of prednisone and deflazacort

In 28 postmenopausal women with rheumatoid arthritis, serum osteocalcin (OC) concentration decreased from 5.2 +/- 1.9 ng/ml to 3.0 +/- 1.6 ng/ml after 6 months therapy with corticosteroids (p less than 0.005). No differences, however, were found in a control group of 13 patients treated for 6 months with nonsteroidal anti-inflammatory drugs. In those patients with serial OC measurements, changes in serum OC were already evident within the first month of therapy. This suggests that a suppressed osteoblast function may be detectable early during corticosteroid therapy in rheumatoid arthritis. Fifteen patients treated with prednisone (5-25 mg once daily, mean 12.33 mg/day) showed a more marked decrease in serum OC than 13 patients treated with equivalent doses of deflazacort (p less than 0.005). Prednisone therapy at doses higher than 10 mg/day resulted in a severe suppression of OC values in most cases. The effect of deflazacort was, however, mild in the majority of patients treated with doses of up to 30 mg/day.

[Pharmacological and clinical research on the interaction of digitalis and amiodarone in heart disease patients with varying degrees of cardiac insufficiency]

The increasing use of amiodarone as antiarrhythmic drug has raised the possibilities of dangerous effects from amiodarone-digitalis interaction. We have studied twelve patients who were taking digitalis and to whom amiodarone was administered because of arrhythmias. We found a 75,42% increase of digitalis plasma levels (p less than 0,001) in the early days of amiodarone therapy, and a 52,1% increase (p less than 0,001) in the medium term. An inverse correlation was found (r = -0,65; p less than 0,05) between the plasma levels of digitalis during the steady-state control period and during the following 2-to-6 months evaluation. Acute episodes of cardiac failure caused in our patients an abrupt increase of digitalis plasma levels: in three patients digitalis toxicity occurred. Based on our experience, we recommend that the dose of digitalis be halved when the two drugs are given together in patients with various degree of cardiac failure; moreover digitalis plasma levels should be frequently monitored in these patients. On the other hand digitalis administered according to age, sex, weight, kidney function, together with amiodarone, can be given at full dosage in patients without cardiac failure.

[Automatic method for the evaluation of the extent of myocardial infarct from the serum of CPK curve]

An off-line system for calculating the extent of infarct from serial serum CPK determinations based on Sobel et al.'s compartmental model is presented. Results in 40 patients with acute infarct in a coronary unit showed that the index of infarct extent had an appreciable prognostic significance. Employment of the MB isoenzyme in the calculation could, it is felt improve the sensitivity of the method.

[Blood and liver fat values in rats kept on a hyperlipid, hypoprotein, steatogenous diet, with or without choline]

Serum and liver tissue fatty acid and lipid fraction values were studied in rats kept for various periods on a hyperlipid, hypoprotein, steatogenous diet, with or witout choline. There was a general increase in liver fats due to an absolute increase in triglycerides, accompanied by changes in the fatty acid methyl ester composition, indicating the storage of lipids of lesser metabolic activity and more similar to those of peripheral fat (palmitic and oleic acid increments; decreases in myristic, stearic, linoleic and arachidonic acid values). These changes were partly reflected in the blood picture: little difference in lipid fraction ratios, coupled with fatty acid gas chromatograms similar to those observed for the liver. The omission of choline aggravated the alterations caused by the experimental diet.