Minerva anestesiologica
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Minerva anestesiologica · Oct 1993
Review[Brain death: physiopathology and current diagnostic approach].
The concept of death has undergone many changes in the centuries depending on ages and social contexts. However death has always been identified by heart and respiratory irreversible arrest. In the last 30 years this concept has been suddenly and deeply modified by cardiocirculatory and respiratory support techniques. ⋯ In the large majority of cases the clinical and this strumental neurological findings are sufficient for the diagnosis of brain death. However in many other cases this diagnosis may be difficult because of problems in the ascertainment of the complete and irreversible lack of cerebral activities. In these cases many an strumental techniques (evoked potentials, Doppler and nuclear medicine studies) can help in the diagnosis.
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Minerva anestesiologica · Sep 1993
Review[Conventional radiology and computerized axial tomography in the diagnosis of pneumothorax in intensive therapy. Retrospective study of 2 years of activity].
The role played by chest radiograph and CT scan in diagnosis of pneumothorax is analyzed in a retrospective study based on two years of activity in Intensive Care Unit. The sensibility of traditional chest radiography was 75% while the sensibility of CT scan resulted higher (87.5%). In the authors opinion, when pneumothorax is suspected, particularly in patients with polytrauma, CT scan of the chest is mandatory unless patient's conditions or logistic difficulties related with transport of the patient contraindicate it.
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The safe conduct of anesthesia and intensive care for heart transplant recipient requires a sound understanding of the pathophysiology of advanced cardiac failure through knowledge of anesthetic and cardiovascular pharmacology and an appreciation of the altered physiologic and pharmacologic responses of acutely denervated and transplanted heart. The most serious dysfunction is acute distension and failure of the transplanted heart's right ventricle. Hemodynamic monitoring and TEE are useful in the management of inotropic support during heart transplantation.