Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review.

Objectives: Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for acute severe respiratory failure. Patients on ECMO are frequently maintained sedated and immobilized until weaning from ECMO, first, and then from mechanical ventilation. Avoidance of sedation and invasive ventilation during ECMO may have potential advantages.

Intraoperative hypotension and postoperative outcomes: a meta-analysis of randomised trials.

Introduction: Intraoperative hypotension is associated with adverse postoperative outcomes; however these findings are supported only by observational studies. The aim of this meta-analysis of randomised trials was to compare the postoperative effects permissive management with targeted management of intraoperative blood pressure.

Methods: We searched PubMed, Cochrane, and Embase up to June 2023 for studies comparing permissive (mean arterial pressure ≤60 mm Hg) with targeted (mean arterial pressure >60 mm Hg) intraoperative blood pressure management.

Our operative technique for inguinal hernia.

The most commonly used methods of hernia repair are either Bassini repair or modifications of Bassini repair in fact each sutures, with different methods, the three anatomical coats (transversalis fascia, transversus abdominis and internal oblique muscles, external oblique muscle aponeuroses). Here we propose a different operative technique that sutures only two aponeurotic coats (transversalis fascia and over external oblique muscle aponeuroses). The second sutured coat supports the posterior wall of the inguinal canal.

["Incomplete closure" of the mitral valve: the relationships to valvular regurgitation and to the morphofunctional characteristics of the left ventricle].

Objectives: The present study was designed in order to evaluate the prevalence of mitral regurgitation in patients with the "incomplete mitral leaflet closure" echocardiographic pattern, to verify whether the amount of "incomplete mitral leaflet closure" is related to the severity of mitral regurgitation and, last, to verify the relation between the "incomplete mitral leaflet closure" and left ventricular morphology and function.

Methods: We studied 80 patients (14 patients with dilatative cardiomyopathy, 26 patients with coronary artery disease, and 40 patients with hypertensive heart disease or aortic valve disease) showing the "incomplete mitral leaflet closure" pattern, retrospectively selected from a population composed of 1700 consecutive patients routinely examined in our echocardiographic laboratory. In all patients we evaluated the presence and the severity of mitral regurgitation, the morphological and functional parameters of the left ventricle, the systolic diameter of the mitral annulus, the distance between the point of mitral leaflet coaptation and the annular plane, and the incomplete mitral closure area, assuming the last two parameters as indexes of the severity of incomplete closure of the mitral valve.

[Myocardial response to ischemia produced by repeated coronary occlusions: an experimental study].

Background: The fact that brief repeated episodes of ischemia may induce prolonged functional depression of the left ventricle is still a matter of debate. During an angioplasty several brief (20-90 sec) coronary occlusions are performed, with the potential risk of inducing myocardial jeopardy.

Methods: We performed 4 repeated LAD occlusions in 7 open chest pigs under general anesthesia and controlled ventilation.

Hemodynamic effects of nifedipine in patients with asymptomatic aortic regurgitation: evaluation by Doppler echocardiography.

Nineteen asymptomatic patients affected by isolated chronic aortic regurgitation received 20 mg of nifedipine sublingually: the acute hemodynamic effects of nifedipine were evaluated by combined cross-sectional and Doppler echocardiography. To assess variations in the regurgitant flow volume, the flow volume across the mitral and aortic valves was calculated as the product of velocity-time integral multiplied by the orifice valve area. Flow volume across these valves represented the total stroke volume, and forward stroke volume, respectively: the regurgitant volume was obtained by calculating the difference between total and forward stroke volume.

Effects of venous return reduction in hypertensive patients: is there a Doppler diastolic dysfunction index independent of preload reduction?

The aim of this study was to evaluate the effects of preload reduction on the Doppler transmitral flow pattern in the presence of diastolic dysfunction (hypertensive patients) and normal diastolic function (normal subjects) to identify, if present, one or more indexes of abnormal diastolic ventricular filling independent of variations in preload. For this purpose Doppler echocardiography was performed in 17 patients with hypertension and in 18 normal subjects under basal conditions and after 5 minutes of blood pressure cuff inflation at the root of the four limbs. The two groups showed a similar response to preload reduction: a significant reduction in peak velocity and the time-velocity integral of the E wave and in the ratio of peak velocities of E and A waves.

New perspectives in the assessment of cardiac chamber dimensions during development and adulthood.

The use of body surface area to assess the normalcy of cardiac dimensions has several limitations. To determine whether cardiac dimensions can be assessed by other indexes of body size and growth, this study evaluated the relations between cardiac dimensions assessed by two-dimensional echocardiography and age, height, weight and body surface area. The study group included 268 normal persons aged 6 days to 76 years of age.

[Effects of low-dose diltiazem on isovolumetric relaxation and contraction].

Calcium entry blockers are commonly believed to have a direct negative inotropic effect, but systolic function of the left ventricle (LV) can be improved when the peripheral vasodilator activity of the drug is present. The aim of our study was to evaluate the effect of diltiazem (D) on isovolumic contraction (IC) and relaxation (IR) at a dosage which is not effective on the peripheral vascular bed. We infused 10 micrograms/Kg/min i.

Left atrial dimensions in growth and development: normal limits for two-dimensional echocardiography.

Reference values for normal left atrial dimensions have been based primarily on blind M-mode measurements, with no reports based on two-dimensional echocardiography to provide a comprehensive analysis of the two-dimensional measurements from infancy to old age. This report analyzes the left atrial dimensions from two-dimensional echocardiographic studies in 268 normal healthy subjects to determine normal limits and relations among linear, area and volume measurements of the left atrium. The group mean values change with body size, fitting well to the exponential growth model (r = 0.

Effects of preload reduction on mitral flow velocity pattern in normal subjects.

In the last few years, alterations in transmitral diastolic flow pattern have been used to assess changes in left ventricular diastolic properties. However, since diastolic flow primarily reflects the atrioventricular pressure gradient, loading conditions, as well as intrinsic left ventricular properties, should be able to affect this pattern. This study was selectively designed to decrease preload (a major determinant of the atrioventricular pressure gradient) in normal subjects to observe the effects on the Doppler transmitral flow pattern without pharmacologic interventions that may also affect left ventricular diastolic properties.

[A comparison between mitral and aortic outputs evaluated by Doppler echocardiography in a group of healthy subjects: false regurgitation].

Doppler echocardiography is a potentially useful tool for the non invasive evaluation of cardiac output and, therefore, for the quantitative assessment of valvular regurgitation. The aim of our study was to establish the presence of possible pitfalls in the evaluation of mitral and aortic regurgitant fraction obtained by Doppler echocardiography comparing the cardiac output measured at the level of the mitral and aortic valve. For this purpose 19 healthy volunteers, aged between 14-68 years, were studied.

[Model for an epidemiological study of the health status of a population of health workers].

The authors describe a model of retrospective research on the state of health in a sample of the staff in a big hospital. The sample was composed of selected sub-groups taken from professional categories notoriously exposed to risk at work. The aim was to help define a model in simple ad versatile epidemiologic research and by applying it to a sample population of health operators, to verify the extent, the prevalence and incidence, the evolution in pathologies in order to make comparisons with the normal population, thus making it easier, for future research, to study casual phenomena and correlate between them.

Calculation of transmitral flow by Doppler echocardiography: a comparison of methods in a canine model.

Although several Doppler echocardiographic methods for measuring transmitral flow have been described, the optimal method for calculation of flow remains unclear. Seven time/shape combinations were tested in an experimental preparation in which mitral flow could be precisely controlled and measured. Annular shape was considered to be either circular or elliptical, and the mitral orifice area was calculated from the anteroposterior and/or the mediolateral dimension(s) recorded at early and middiastole.

[The "diagnostic day hospital." A proposal for functional support by hospital services and primary care].

The general lack of nurses and the attention due to the purposes of efficiency, effectiveness and economy of hospital services oblige to better the cooperation between attending and family physicians, to improve the resources, the productiveness of clinicopathology, the use of daily hospital services (such as ambulatories, daily hospitalization and treatments) and emergencies. For this end the authors propose the realization of a day hospital which mainly aim is the diagnostic (D.H.

Limits of normal left ventricular dimensions in growth and development: analysis of dimensions and variance in the two-dimensional echocardiograms of 268 normal healthy subjects.

The majority of studies generating normal echocardiographic reference values for left ventricular dimensions have been based on blindly performed M-mode measurements, and there are no previous reports based on two-dimensional echocardiography that provide a comprehensive analysis of the two-dimensional measurements from infancy to old age. This report presents the results of analyzing the left ventricular internal dimensions from cross-sectional echocardiographic studies on 268 normal healthy subjects (none were hospitalized for any reason) whose ages ranged from 6 days to 76 years. The mean data are reported as functions of body surface area and, in addition, the variance is modeled as a function of body surface area to provide an accurate and clinically useful determination of normal limits and to model changes in the cardiac dimensions and in their variance representing normal growth and development.

[First seconds after acute experimental ischemic: changes in isovolumic contraction and relaxation].

The purpose of this study was to answer the following questions: 1) are isovolumic contraction and relaxation affected in a different way by LAD occlusion? 2) Does proximal and distal LAD coronary occlusion induce different changes in isovolumic contraction and relaxation? In 22 pigs, LAD coronary artery was dissected free right after the first or third diagonal branch and occluded by ligation. The following variables were evaluated: left ventricular systolic and end-diastolic pressure; peak - and + dP/dt, mean arterial and pulmonary pressure. All our data were obtained in the first minute following the occlusion.

The relationship of mitral annular shape to the diagnosis of mitral valve prolapse.

The geometric or anatomic diagnosis of mitral valve prolapse, as opposed to the pathologic diagnosis of myxomatous valve disease, is based on the relationship of the mitral leaflets to the surrounding anulus. Current echocardiographic criteria for this diagnosis include leaflet displacement above the annular hinge points in any two-dimensional view; implicit in this equivalent use of intersecting views is the assumption that the mitral anulus is a euclidean plane. Prolapse by these criteria is found in a surprisingly large proportion of the general population.

[Anti-hepatitis B vaccination in health personnel at the Ospedale Maggiore of Milan].

The paper deals with the screening of the staff at the Ospedale Magiore of Milan within the Region-wide program of recommended B Hepatitis vaccination. The HBsAg positive subjects are 3.1% and antiHBs are 32.

[Functional evaluation of the autonomic regulation in mitral valve prolapse].

We examined fifty patients aged from 15 to 35 years, mean 23 +/- 5, with mitral valve prolapse (MVP) documented by two-dimensional echocardiography in the apical 4-chamber view as well as in the parasternal-long axis. The patients have been submitted to 4 tests: Valsalva maneuver, standing and exercise test and 24 hours ambulatory ECG monitoring. Fourty-five healthy subjects of similar age and sex served as controls.

[Study of the regional contraction of the left ventricle in normal subjects using a two-dimensional echocardiographic technic].

The purpose of this study is to evaluate normal left ventricular regional wall motion pattern in order to answer the two following questions: does wall motion change at different levels of the left ventricle from the base to the apex? does wall motion change among different segments at the same level? Seventy-two normal subjects were submitted to a cross sectional echocardiographic examination and the tape recordings were analyzed by a computerized system. Parasternal short axis views at mitral valve and papillary muscles level were chosen and divided by the computer in 16 areas which were fitted to a more anatomical division, i.e.

Prostacyclin effect on heart rate in the pig.

The purpose of this study was to assess the hemodynamic response after prostacyclin infusion into the venous system and into the carotid artery in the pig. During the study the following circulatory variables were studied: mean systemic arterial pressure, mean pulmonary arterial pressure, wedge pressure, heart rate, cardiac output, systolic and diastolic left ventricular pressure, stroke volume, total systemic resistance, total pulmonary resistance, left ventricular stroke work. Our results confirm that prostacyclin is a powerful hypotensive agent.