Cardiological assessment of cardiac patients undergoing non-cardiac surgery (usefulness of surveys).

AIM OF THE STUDY: The aim of the study was to considerate the effective usefulness of preoperative stress test and echocardiography in adult patients with coronary artery disease, undergoing non-cardiac surgery. MATERIALS AND METHODS: In the last three years, 200 patients aged 58-85, affected by stable ischemic pathology, undergoing non cardiac surgery, and treated with oral drugs, were enrolled for an assessment orotocol including anamnesis, objective examination, blood pressure, RCG, blood chemistry analysis, and was performed a cardiac risk evaluation. A second 50 patients control cohort of the same class was subjected to the same tests, and preoperative and exercise stress test. RESULTS: All patients showed a good hemodynamic compensation and a quick recovery, and the group of 200 patients for whom the risk was closed without further investigation has concluded the process on average three days before the group underwent echocardiography and exercise stress test. DISCUSSION: The clinical evaluation of cardiac patients waiting for non-cardiac surgery, performed through anamnesis, examinations and the ECGs, is the cornerstone of cardiac risk stratification. It also important the type of surgery, as well as some priority conditions like certain neoplastic: diseases, where it seems appropriate to speed up the diagnostic program. CONCLUSIONS: When patients are hemodynamically stable and their conditions controlled by appropriate therapy, it is sufficient to perform first-level tests for the preoperative stratification of cardiovascular risk. It's recommended to perform echocardiogram and stress test when the first level tests are abnormal, when there is a worsening of the conditions prior to admission, or when the patient is not hemodynamically stable.

[Management of maxillofacial injuries in an emergency unit: our experience]. / I traumi maxillo-facciali in Pronto Soccorso: casistica di un dipartimento d'emergenza e d'accettazione del Sud Italia.

Maxillofacial injuries are relatively frequent. These may be complicated by cranioencephalic injuries or large facial wounds. We report our experience with the initial management of these lesions in an emergency unit setting. In 2007, we observed 105 patients with maxillofacial injuries. Maxillofacial injuries were associated with cranio-encephalic injuries in 69 patients (65.7%) and with polytrauma in 31(29.5%), while in 5 cases (4.8%) they were isolated. The main causes of trauma were motorcycle accidents (60%). All patients were treated in accordance with the Advanced Trauma Life Support guidelines and assessed by computed tomography. No mortality was observed after diagnosis in the emergency unit or in the month following the trauma. Seventy-seven patients (73.3%) were admitted and 28 (26.7%) were treated and discharged. Accurate diagnosis and appropriate initial management yield good clinical outcomes with functional restoration and fewer aesthetic complications.

[Management of polytrauma: our experience]. / La gestione del politrauma: nostra esperienza.

In the advanced nations trauma represents the third cause of death after cardiovascular diseases and tumours. Recently, great importance has been given to the need to treat traumas as quickly as possible in order to reduce mortality and morbidity. Prompt management of is the gold standard in the emergency setting and the phrase "golden hour" is now commonly used. The authors report on their experience with the management of multiple trauma, through the study of 617 clinical cases. Patients were evaluated with the Revised Trauma Score (RTS), Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS). Of 420 (68%) cases of major trauma only one patient had ISS > 60. Patients were admitted on average after 47 +/- 18 min. Only two deaths occurred in the emergency unit. The task of the emergency unit is to stabilise the patients, anticipate the complications, including mainly shock and multiple organ failure, optimizing time, interventions and resources to reduce morbidity and mortality.