Minerva medica
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The Authors analyse and discuss some particular problems related to anaesthesia in neurosurgery according to the patient's clinical and neurological status and to the surgical treatment. The evaluation of systemic and neurological physiopathology during pre-, per- and post-operative periods are important for this analysis. Therefore anaesthesia and intensive care methods are attentively discussed. Intracranial pressure, cerebral blood flow, metabolism, intracranial space-occupying lesions and surgical techniques are the main factors interfering with anaesthesia in neurological surgery.
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After a survey of conventional and modern therapeutic strategies in pulmonary edema, a simple clinical approach to the management of this cardiac emergency is suggested. The central role of chlorpromazine, as a vasodilator drug, is also stressed.
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The clinical behaviour of three patients with primary antibody deficiencies was studied. Two of three were affected by X-linked agammaglobulinemia and one by common variable hypogammaglobulinemia that, besides clinical features common to most of the immunodeficiencies, showed pre-existent physiopathologic conditions completely different from the features traditionally found in primary antibody deficiencies. Moreover, the development of some immunologic parameters (monoclonal antibody analysis, surface markers and electrophoretic mobility of lymphocytes) has been carefully checked in these patients after immunotherapy by intravenous infusion of immunoglobulins. The lymphocyte electrophoretic mobility underlines how peripheral blood lymphocytes, faster than those normally controlled before therapy, normalized their velocity after immunotherapy.