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Background: During general anesthesia, mechanical ventilation can cause pulmonary damage through mechanism of ventilator-induced lung injury, which is a major cause of post-operative pulmonary complications, which varies between 5 and 33% and increases the 30-day mortality of the surgical patient significantly. Objective: The aim of this review is to analyze different variables which played a key role in the safe application of mechanical ventilation in the operating room and emergency setting. Method: Also, we wanted to analyze different types of the population that underwent intraoperative mechanical ventilation like obese patients, pediatric and adult population and different strategies such as one lung ventilation and ventilation in trendelemburg position. The peer-reviewed articles analyzed were selected according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) from Pubmed/Medline, Ovid/Wiley and Cochrane Library, combining key terms such as: “pulmonary post-operative complications”, “protective ventilation”, “alveolar recruitment maneuvers”, “respiratory compliance”, “intraoperative paediatric ventilation”, “best peep”, “types of ventilation”. Among the 230 papers identified, 150 articles were selected, after title - abstract examination and removing the duplicates, resulting in 94 articles related to mechanical ventilation in operating room and emergency setting that were analyzed. Results: Careful preoperative patient’s evaluation and protective ventilation (i.e., use of low tidal volumes, adequate PEEP and alveolar recruitment maneuvers) has been shown to be effective not only in limiting alveolar de-recruitment, alveolar overdistension and lung damage, but also in reducing the onset of Pulmonary Post-operative Complications (PPCs). Conclusion: Mechanical ventilation is like “Janus Bi-front” because it is essential for surgical procedures, for the care of critical care patients and in life-threatening conditions, but it can be harmful to the patient if continued for a long time and where an excessive dose of oxygen is administered into the lungs. Low tidal volume is associated with a minor rate of PPCs and other complications and every complication can increase the length of Stay, adding cost to NHS between 1580 € and 1650 € per day in Europe and currently the prevention of PPCS is the only weapon that we possess.

The purposes of this study were to evaluate the tolerance, efficacy and safety of isovolemic erythrocytapheresis (EA) in nonanemic patients with hereditary hemochromatosis (HH), and to assess the usefulness of recombinant human erythropoietin (rHuEPO) associated with EA to reduce treatment duration.In 10 asymptomatic patients with serum ferritin400 microg/l, transferrin saturation50%, and GPT elevation, EA with rHuEPO and folic acid was performed.Red cell indices, serum ferritin, and other iron metabolism parameters (serum iron, transferrin, and transferrin saturation); GPT and other laboratory data were considerably improved.This method offers better results in less time than traditional phlebotomy. EA with rHuEPO is an effective therapeutic alternative for patients with HH.

There is convincing evidence that cell adhesion plays an important role in cardiovascular pathology and is frequently associated to “in vivo” cellular activation. This study involves patients with mechanical heart valve replacement (MHVR patients) who have increased platelet polymorphonuclear leukocyte (PMN) reactivity. Dual-color cytometry was used to determine the expression of adhesive molecules on cellular surfaces, platelet, and PMN-bound fibrinogen as well as the presence of circulating platelet/PMN mixed-cell aggregates (MCA) in 55 MHVR patients, 49 control patients under oral anticoagulant therapy, and 22 healthy volunteers. The results demonstrated that (a) PMN from MHVR patients showed an increased PMN-bound fibrinogen (mean ± SEM: 1,420 ± 169 anti-fibrinogen fluorescence intensity, P= 0.0012), when compared to controls (mean ± SEM: 747 ± 32 anti-fibrinogen fluorescence intensity) and healthy volunteers (mean ± SEM: 692 ± 25 anti-fibrinogen fluorescence intensity; (b) platelet activation in MHVR patients was evidenced by the higher expression of CD62P (mean ± SEM: 128 ± 19 anti-CD62P fluorescence intensity, P = 0.003) compared to controls (mean ± SEM: 65 ± 15 and 50 ± 10 anti CD62P fluorescence intensity) and by increased levels of platelet-bound fibrinogen (mean ± SEM: 625 ± 20 anti-fibrinogen fluorescence intensity, P = 0.0043 versus 496 ± 45 and 480 ± 30 for control patients and for healthy volunteers, respectively); and (c) the proportion of MCA in MHVR patients (15 ± 2%) was significantly higher (P = 0.009) compared to controls (7 + 1%) and healthy volunteers (6 ± 2%). The results indicate that the presence of stable circulating MCA represents another marker of “in vivo” PMN activation in MHVR patients. Am. J. Hematol. 65:93–98, 2000. © 2000 Wiley-Liss, Inc.

Interleukin-2 (IL-2) and interferon-beta (IFN-beta) have demonstrated activity against lymphoid malignancies, presumably mediated by the augmentation of lymphokine-activated killer (LAK) cell and natural killer (NK) cell activity. There is in vitro and in vivo evidence to suggest that the combination of IL-2 and IFN-beta is synergistic. The Cancer and Leukemia Group B (CALGB) conducted a randomized phase II trial of IL-2 with or without IFN-beta in 49 patients with relapsed or refractory non-Hodgkin's lymphoma (NHL). Overall toxicity was severe, with 17 patients experiencing life-threatening toxicity. Three patients had treatment-related deaths. Responses were noted in seven patients (17%). There were no meaningful differences between treatment arms in toxicity profile, response rate, or modulation of in vivo NK and LAK activity. We conclude that IL-2 with or without IFN-beta is not effective therapy for NHL in the doses and schedule used in this study.

Ifosfamide (2.0 g/m2 intravenously/day x 3) with mesna (400 mg/m2 intravenously q 4 h daily x 3) was combined with mitoxantrone (14 mg/m2 intravenously x 1) and given on a 3 week schedule to patients with previously treated non-Hodgkin's lymphoma. In 45 eligible/evaluable patients, a 47% response rate (95% confidence interval: 32%, 62%) was achieved of which 25% were complete responses and 22% were partial responses. Median duration of remission was 10 months with 42% of patients in remission at 18 months. Hematologic toxicity (granulocytopenia) was the dose-limiting toxicity with severe or life-threatening granulocytopenia in 98% of patients at full protocol doses. Nausea/vomiting was seen in 73% of patients but was usually mild/moderate. Three patients had significant hematuria secondary to ifosfamide. Two patients had severe changes in the left ventricular ejection fraction (LVEF) secondary to mitoxantrone; and one patient had acute neurologic dysfunction secondary to ifosfamide. Ifosfamide/mesna can be safely combined with mitoxantrone at full doses in previously treated patients with non-Hodgkin's lymphoma. This combination should be considered for other trials in lymphoma.

A total of 277 patients with untreated Hodgkin's disease, clinical stages I-II, were randomized to cyclophosphamide, vinblastine, procarbazine, and prednisone (CVPP) alone for 6 monthly cycles or to CVPP plus radiation therapy (RT), 3,000 rad, to involved areas (CVPP plus RT). One or more of the following factors were considered as unfavorable prognosis: age greater than 45 years, more than two lymph node areas involved, or bulky disease. In the favorable group, disease-free survival (77% vs. 70%) or overall survival (92% vs. 91%) at 84 months for CVPP versus RT plus CVPP was similar. Patients with unfavorable prognosis treated with RT plus CVPP had longer disease-free survival (75% vs. 34%) (P = .001) and overall survival (84% vs. 66%) than patients treated with CVPP alone.

In Argentina, no studies had been organized to evaluate the results of therapy on Hodgkin’s disease in childhood before the Argentine Group for Treatment of Acute Leukemia (GATLA) was created. As an historical comparison, we have an early evaluation of two series diagnosed and followed at the Children’s Hospital of Buenos Aires. The first one, from 1940 to 1966, included 43 children. Minimal investigations were performed during this period, consisting primarily of physical examination, chest x-ray, and hemogram. Low-dose (