[Care of skin infections in patients in peritoneal dialysis]. / Indagine descrittiva sulla cura dell'emergenza cutanea nel paziente in dialisi peritoneale.

The incidence of exit-site infections among peritoneal home-dialysis patients was quantified following for 1 year all home dialysis patients of 23 dialysis centres. The exit site conditions were observed and classified according to Twardowsky. When an infection occurred data on its treatment were collected. 393 patients were observed. The infection occurred in 40 patients (10.1%). 82.2% of patients wear a Tenckoff catheter, 3% do not protect the exit site with any kind of dressing. The strategies adopted by different centres vary for the choice of antiseptics, the suggested frequency of changes dressing and the routine use of nasal swabs. Due to the limited number of patients with infection no association was found between tunnel direction or frequency of dressing changes and infections occurrence. Discussion on controversial aspects and the definition of common guidelines for instance for frequency of dressing changes, use of antiseptics is warranted.

[Acute effects of propionyl-L-carnitine on anomalies of parietal kinetics of the left ventricle induced by atrial pacing in patients with ischemic heart disease. A bidimensional echocardiographic study]. / Effetti acuti della propionil-L-carnitina sulle anomalie della cinetica parietale del ventricolo sinistro indotte dal pacing atriale in pazienti con cardiopatia ischemica. Studio ecocardiografico bidimensionale.

This double-blind randomized placebo (PL) controlled study was undertaken to evaluate, by 2D echo transesophageal atrial pacing (TAP), the effects of acute iv administration of a new compound propionyl-L-carnitine (PLC) on atrial pacing (AP) induced left ventricular wall motion abnormalities. Twelve male patients with coronary artery disease and normal regional motion at rest, after a preliminary 2D echo-TAP, on the eight and thirteenth day of trial were subjected to 2D echo-TAP 30 min after iv administration of 15 mg/Kg PLC or PL. For analysis, the left ventricle was divided into 11 segments. A wall motion score (WMS), evaluated at 130 b/min and at 150 b/min, was derived by adding together the scores assigned to each segment. Wall motion was graded +2 (normokinetic), +1 (hypokinetic), 0 (akinetic), -1 (dyskinetic). Left ventricular ejection fraction (EF) was evaluated at rest and at 150 b/min. Statistical analysis of the results was performed using a 2-way analysis of variance. The WMS at 130 b/min improved significantly after PLC vs PL from 18.66 +/- 2.46 to 19.50 +/- 2.77 (p less than 0.02). The WMS at 150 b/min improved significantly after PLC vs PL from 16.00 +/- 2.95 to 16.91 +/- 3.47 (p less than 0.01). The EF at rest was not significantly unchanged after PLC. The EF at 150 b/min was significantly different after PLC vs PL, from 53.6 +/- 7.36 to 55.6 +/- 6.45 (p less than 0.05). The blood pressure and the double product at rest and at 150 b/min were not unchanged after PLC.(ABSTRACT TRUNCATED AT 250 WORDS)

Approach to the abdominal aorta: impairment of respiratory function after supraumbilical transverse and midline laparotomy.

Midline and transverse incision are commonly used in upper abdominal surgery. A comparison of the two procedures with respect to the respiratory function, assessed by spirometry, blood gas analysis, inspiratory and expiratory pressures, and thoraco-abdominal respiratory synchronism, was made in two groups of patients after surgery on the abdominal aorta. 32 patients affected by abdominal aortic obstructive or aneurysmatic disease, candidates for aortoiliac revascularization, were randomized into two groups of 17 (group A) and 15 (group B) patients respectively. Group A underwent midline laparotomy and group B supraumbilical transverse laparotomy. Ventilatory function and blood gas analysis were determined on the day before operation and on the second and eight postoperative day. All patients showed a depressed ventilatory function postoperatively, but the impairment was significantly minor after transverse laparotomy.