[Heart surgery with cardiopulmonary bypass in patients on chronic dialysis treatment: our experience]. / Interventi cardiochirurgici in circolazione extracorporea in pazienti in trattamento dialitico cronico: nostra esperienza.

METHODS: To determine the mortality and the morbidity of cardiac surgery in patients on chronic hemodialysis, we retrospectively reviewed eighteen adult patients (13 males and 5 females) with a mean age of 54.7 years (range: 30-67 years) who underwent cardiopulmonary bypass procedures between 1987 and 1995. The operations included: isolated coronary artery bypass grafting in 12 patients, coronary artery bypass grafting plus mitral ring annuloplasty in 1 patient, mitro aortic valve replacement in 2 patients, isolated aortic valve replacement in 1 patient, aortic valved conduit implantation in 1 patients and mitral valve replacement plus tricuspid annuloplasty in 1 patient. There were 10 and 3 patients in CCS functional classification III and IV respectively; 1 and 4 patients were in NYHA classification II and III respectively. All of them were hemodialyzed the day before surgery: the average time they had been on hemodialysis was 6.5 years. Anesthesia and the cardiopulmonary bypass (CPB) in these patients required attention in order to provide the optimal fluids and electrolytes balance: particularly intravenously administered fluids were kept to a minimum and drug dosages were reduced to recommended levels for anephric patients. An hemoconcentrator was used in all patients during the CPB and, in the last 4 cases, we used a dialysis filter and a sterilized perfusional solution to reduce the level of potassium and to put off postoperative dialysis. RESULTS: In three patients there were major bleeding problems resulting in reoperation; 5 perioperative deaths occurred: two of them due to myocardial infarction and three due to irreversible low cardiac output state. In our experience there were four late deaths: one patient died four months after surgery for chronic heart failure, another one died twelve months after surgery for dilated cardiomyopathy and two patients died respectively seventeen and seventy two months after discharge for myocardial infarction. Two of the remaining patients reported recurrence of angina while the others achieved symptomatic improvement. CONCLUSIONS: In conclusion, cardiac surgery is performed on chronic renal dialysis patients with high mortality and morbidity and it's indicated only if medical treatment is ineffective. The successful surgical results, obtained with an adequate management between surgeons, anesthesiologists and nephrologists, don't assure the long-term survival of the patients.

[Quality of reawakening and dismissal after anesthesia with various techniques for minor surgical intervention. Clinical and medico-legal aspects]. / Qualità del risveglio e dimissibilità dopo anestesia con tecniche diverse per interventi di chirurgia minore. Aspetti clinici e medico-legali.

Different drug combinations were compared in order to assess the quality of anesthesiological control, tolerability and the speed of reawakening and recovery of self-sufficiency in 60 patients undergoing minor surgery. Propofol, combined with fentanyl and N2O due to its inadequate analgesic cover, showed a quickness of action with scarse side-effects, prompt reawakening and rapid recovery of deambulatory self-sufficiency in comparison to the associations of thiopentonefentanyl and thiopentone-isoflurane, thus indicating its preferential use in short surgical operations which can be carried out under a day hospital regimen. In addition, some medico-legal aspects of dimissional of recent developments regarding professional responsibility.

[Evaluation of the efficacy of cefoperazone sodium in the treatment of infections in intensive therapy]. / Valutazione dell'efficacia del Cefoperazone sodico nel trattamento delle infezioni in terapia intensiva.

The efficacy and tolerability of Cefoperazone sodium in the treatment of infections primarily of the lower respiratory and/or urinary tract were assessed. The drug was given to 16 intensive care patients encountered over a period of a few months. The results appear to be satisfactory and suggest that the drug is suitable for use in the treatment of intensive care infections.

[Pathology of infections in the resuscitation and intensive care center of the Biella Hospital]. / Studio sulla patologia da infezioni nel centro di rianimazione e terapia intensiva dell'Ospedale di Biella.

A survey was conducted into the problems of infections in intensive care units. After a short report on the survey methodology, the equipment most frequently involved in infection and the germs implicated are described. Results and conclusions agree with data from the literature reported in the introduction.

[Altitude-induced retinal hemorrhages. A new aspect of mountain sickness]. / Emorragie retiniche da alta quota. Un nuovo aspetto del mal di montagna.

The authors discuss modern views on altitude acclimatization and acute mountain sickness (A.M.S.). They particularly consider recent observations of high altitude retinal hemorrhages (H.A.R.H.). They report some subjects they personally examined and suggest the probable factors involved in the pathogenesis of the disorder.

[Posttraumatic fat embolism. Clinical case contribution]. / L'embolia adiposa post-traumatica. Contributo clinico-casistico.

Various aspects of post-traumatic fat embolism are discussed in relation to aetiopathogenesis, therapy and clinical development. Four significant cases are described. This research shows the importance of prevention and early diagnosis in limiting serious consequences, and makes clear the advantages of a right therapeutic technique.