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Introduction: We describe two measures adopted in hemodialysis outpatient population in order to reduce Central Venous Catheter (CVC) related infections. The first is a nurse staff training in the field project and the second deals with the employment of chlorhexidine-impregnated dressing devices. These actions were performed after high infection rates were observed through a dedicated register., Materials and Methods: In the limited assistance dialysis center, direct observation (12/2012-02/2013) quantified the gap between the observed and expected health care behaviour. Training needs were defined and a 40 hours nurse staff training in the field was performed on two occasions. In the hospital dialysis center, we introduced alcoholic 2% chlorhexidine solution and chlorhexidine-impregnated dressing devices to the exit site (CHG-Tegaderm and BioPatch). Infections (cumulatively bacteremia/sepsis/skin exit/subcutaneous tunnel) were monitored continuously., Results: Infection rates at the two locations were progressively reduced, reaching a value of zero at the limited assistance center. Nurse staff training in the field produced: two patient reports and three CVC management protocols, Italian language translation of the "The 5 moments of dialysis" WHO poster, alcoholic 2% chlorhexidine adoption to exit-site medication and improvement of environment cleaning/sanitation actions., Conclusions: Our experience shows that continuously monitoring infection rates represents the first step for timely corrective action. The continuous updating of health personnel, codified prevention measures and an ongoing commitment to raise awareness in a routine practice, allows us to obtain the goal of "getting to zero infections". The staff training produced equal or superior results compared to the isolated use of new chlorhexidine-impregnated dressing devices.

Unlabelled: Randomized controlled trial on the effectiveness of Corpitolinol 60 in the prevention of pressure sores in surgical patients., Introduction: The risk of pressure sores in surgical patients is widely recognised. The Corpitolinol 60 (Sanyréne®) applied on compressed areas seems to reduce the risk of pressure sores., Aim: To assess the efficacy of Corpitolinol 60 in preventing pressure sores in the operatory theatre., Methods: The open label randomized clinical trial was conducted in 5 operating theatres of Northen Italy. Patients were randomized to receive Corpitolinol 60 in areas undergoing compression. Experimental group and controls were treated with usual measures for preventing pressure sores. The lesions were staged according to NPUAP up to 24 hours after surgery., Results: Three-hundred-one patients were randomized (155 in the Sanyréne® group and 143 controls). The main variables predictive of pressure sores risk (ASA class, sex, age, duration of the surgery, and BMI) were comparable across groups. At the end of the surgery 71 patients (23.8%) in the experimental group and 47 controls (30.8%) had a pressure sore (p 0.006; RR 1.81 IC95% 1.17-2.79). Twelve and 24 hours after surgery the differences between groups were not significant., Conclusions: The aim of reducing pressure sores was not reached for patients treated with Corpitolinol 60.

Unlabelled: Effectiveness of the transparent sterile dressing vs standard to fix the peripheral venous catheter (PVC), on the incidence of phlebitis. A randomized controlled trial., Introduction: The type of dressing could contribute to the incidence of phlebitis, infiltration and accidental removals but the results of the studies are contrasting and samples are limited., Aim: To compare the effectiveness of a transparent polyurethane sterile dressing on the rate of phlebitis associated to peripheral venous catheter (PVC) vs a non sterile sticking plaster in use in current practice (standard dressing)., Design: Randomized controlled trial. Participants. 1061 PVCs (703 patients, adults and children) at a research orthopedic hospital in the north of Italy; 540 PVCs allocated to receive the sterile and 521 the standard dressing., Results: 96 PVCs were excluded for phlebitis, 48 (9.6%) in the sterile and 48 (10.1%) in the standard dressing group, RR 0.96 (95%CI 0.697 - 1.335). Accidental removal of the PVCs was more frequent with the sterile dressing (9.6% vs 6.3%) but the number of catheters removed without complications was larger in the standard dressing group (48.9% vs 54.9% P=0.0503). Eighty-five PVCs were replaced for detachment of the dressing (50, 9.2% sterile and 35, 6.7% standard dressing). The cheapest transparent sterile dressing costs 32 cents while the standard 9 cents., Conclusions: A sticking non sterile plasters is not influential on the rate of phlebitis and ensures an good fix of the PVC compared the transparent sterile dressing to of polyurethane film.

Half of the patients hospitalized in intensive care units have a central venous catheter (CVC) inserted. Management of CVC is not simple and the wrong medication on the insertion site may cause many complications including sepsis. Among the various modes of dressing are transparent polyurethane patches and sterile gauze, and both have both advantages and drawbacks. The aim of this literature review is to compare these two methods in terms of effectiveness in reducing infections. Seven bio-medical databases of the primary and secondary literature were consulted. We considered all articles published in the last five years, in Italian or English, and research that studies purely human subjects. Moreover, the work was limited to all RCT, all systematic reviews and guidelines published on the databases consulted. Only five studies tackled the research question. The results show that CVC-related infections are a frequent problem in intensive care units. This research found two systematic reviews and two randomized controlled trials. None of the studies show any evidence of the type of dressing applied to the CVC. In conclusion, despite consulting several databases, we found no evidence recommending the type of medication to apply.

Pressure ulcers are evolutive tissue of the skin, derma and subcutaneous layer. If not treated properly, but sometimes despite that, they may even reach muscles and bones. Nutritional status of the patient is the most important and potentially reversible factor which can contribute to wound recovery. Several studies underline in particular the importance of the proteic and caloric intake in order to stimulate the formation of granulation tissue and collagen. We thought giving the nutrients for wound repair directly on the wound bed, topically, therefore using the wound bed as exchange surface and presuming the wounded tissues are able to absorb, metabolize and ultimately use the aminoacids to repair the damage. The goal of our work is to describe the clinical case patient treated with a new active wound dressing releasing aminoacids and hyaluronic acid.

Unlabelled: Abdominal blunt trauma is the main cause of death in people younger than 40 years old. The liver injury still represents a challenging problem. Isolated hepatic injury is rare and it occurs more frequentely in polytraumatizated patients and causes massive haemoperitoneum. The Authors report a case of a 83 years-old woman admitted to Emergency Department for syncope due to an active bleeding arising from a rupture of a right hepatic lobe unsuspected tumor. The computer tomography (CT) scans showed a clear pattern of liver laceration of the VI segment with contrast enhancement spreading in the surrounding tissues, and detected a multifocal hepatocarcinoma located in the VI, VII and VIII segments. Patient's haemodinamically unstable conditions suggested an urgent laparotomy. An accurate perihepatic packing with sterile-drape were successfully employed to control liver hemorrage. Temporary abdominal closure, followed by hepatic arteriography and the right hepatic artery embolization, completed the damage control. Re-exploration laparotomy after 72 hours confirmed the definitive haemostasis and the pack removal was performed without complications., Conclusions: CT plays a leading role in the diagnosis of liver damage. The patient's haemodynamic status is the principal criterion determining conservative or operative therapy in blunt liver injury. The early perihepatic packing followed by artheriographic embolization to stop liver hemorrhage showed efficacy and safety for the patient. The packing performed with sterile-drape is able to avoid removal complications and 72 hours timing for the pack removal is effective to avoid re-bleeding.

The study proposes a new method for measuring peripheral trophic lesions (leg ulcers) of the same patient medicated with different type of dressing, avoiding errors of evaluation due to comparing different patients who generally present different concomitant pathologies and aetiologies wigh are hard to compare. We studied the wound care of 11 patients with leg ulcers. Half of the ulceration was treated with a traditional dressing (group A) and the other half with a more advanced type of dressing (group B). We first photographed the ulceration at a predefined distance an then the ulcer was separated in two identical parts and measured with millimetre paper. The limits and sides of each part were marked with a indelible marker pencil. The dressings were changed at regular interval and the ulcers were re-measured and photographed every week from the same distance. We examined 19 ulcers of the 11 patients (7 men, 4 women; mean age: 71 years). Although wound healing appeared to be faster in group B, the difference was not statistically significant (p = 0,246), but the aim of the study was not to explore the difference or otherwise in healing rate between two dressings. The study confirms that this method enables the physician to compare two different wound care dressings on the same ulcer. Interpatient variability is thus avoided by applying the dressings to the same ulcer. Changes in ulcer size are easily monitored and the statistical analysis of the areas compared allows objective assessment of the wound treatments, avoiding the common bias due to comparing different ulcers on different patients with different underlying pathologies.

The Authors describe the utility of comprehensive protocols for the treatment of major burns and the adoption of these for the initial and correct management of burns by prehospital and hospital emergency staff.

Central venous catheters (CVCs) are widely used in clinical practice; catheter related infection is the most important cause of sepsis in surgical patients . In the present study, we compared the effect of two different dressings in CVCs related infections and evaluated microorganisms involved. We studied 124 CVCs inserted patients. CVC was inserted under strict aseptic technique according to guidelines via percutaneous puncture of internal jugular or femoral vein. CVC dressing was made with gauze/tape in 60 patients (group A) and with polyurethane film in 64 patients (group B). Duration of catheterization was 5,27 SD 1,76 days in group A and 11,30 SD 5,84 days in group B. Statistical analysis showed a significant lower infection rate in tape/gauze dressings while polyurethane film dressings seemed to predispose to infections. For the statistic analysis we have used z statistic test and the contingency analysis charts.

Nowadays, the treatment of the difficult wounds represents an emergent socio-sanitary problem, due to the increase of the average duration of life, with consequent increasing costs by the National Sanitary System. The term 'difficult wounds' refers to all losses of cutaneous substances with multifactorial pathogenesis that do not spontaneously recover. Today it is possible to use advanced dressings, representing a valid tool to speed-up the healing process that--as a consequence--improves quality of life for the patient. These patients need to be followed by medical teams composed by different specialists sometimes working in different hospitals. As a consequence it is has been necessary to create an electronic document containing the clinical history of the patient and reporting the different treatments. The electronic sheet allows: a) to evaluate in detail the evolution of patient conditions, thanks to an always available iconographic documentation, even when the patient is not followed by the same physician; b) and to test the effectiveness of the new advanced dressings available on the market.

Intestinal ischemia in antiphospholipid antibody syndrome (PAPS) could be due to arterial thrombosis from hypercoagulability. A male patient, 45 years old, was admitted to the hospital with symptoms of acute abdomen and after laparotomy he developed sepsis, right kidney infarction, jejunal ischemia, aortic thrombosis, wide necrosis of both gluteus muscles, left subclavian vein thrombosis. Our therapeutic and diagnostic strategy was delineated after demonstration of antiphospholipid antibodies. The patient was treated with total parenteral nutrition in the presence of 5 enteric fistulas with very high outflow, arterial stent insertion and daily changes of medicated dressings. Outcome was excellent with small residual deficit in walking. Continuous nutritional status monitoring and very high nitrogen supply allowed excellent healing of huge wounds and closure of enteral fistulas.

Syncope is a transient, self-limited loss of consciousness, usually leading to falling. The underlying mechanism is a transient global cerebral hypoperfusion. Since there are many causes of syncope, a specific treatment cannot be administered without knowing the exact mechanism responsible for the loss of consciousness. The main therapeutic innovations of the most recent years are isometric counter-pressure maneuvres, lower limb compression bandage and therapy guided by implantable loop recorder in patients with recurrent suspected neurally-mediated syncope.

Total hip replacement surgery carries the risk of thromboembolic complications, which could be fatal. Over the last three decades however, the risk has decreased considerably thanks to progress made in the understanding of the physiopathogenetic mechanism of thromboembolic disease and perioperative prophylaxis. It is the purpose of this study to discuss the main medical and surgical preventive measures that must be carried out before, during and immediately after surgery. The old concept of deciding thromboembolic prophylaxis after surgery is now obsolete.

Aim: The purpose of this prospective, randomized, controlled study was the comparison of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, large drape) vs control precautions (mask, cap, sterile gloves, small drape) and of transparent polyurethan film vs gauze dressing for use on central venous (CVC) nontunneled catheters, inserted via the jugular vein. Skin colonization at the insertion site (defined by quantitative skin cultures performed at the time of insertion and in days 2 and 5) was used as a primary endpoint. Catheter tip colonization was also assessed through qualitative culture and CVC related sepsis was defined by the isolation of the same organism from the catheter tip and the blood, with clinical sepsis of no other apparent source., Methods: Eighty-two consecutive patients were enrolled, admitted to a mixed medical-surgical ICU, aged 72+/-12 years, 58% male, SAPS II 42+/-13. One-hundred and seven CVCs were studied (presenting 750 catheter in situ days); CVCs were in place for a mean period of 6.9+/-4.7 days and 5 episodes of central catheter-related bloodstream infection were detected (6.6 per 1000 catheter days)., Results: A multiple logistic regression detected an increased risk of skin colonization in male gender (OR=2.5) and control precautions (OR=3.4) and no difference with regard to age, dressing and diagnostic group., Conclusions: Maximal sterile barrier proved to be an effective and recommended practice. However surveillance skin cultures revealed the common and changing nature of colonization of skin at the insertion site.

We estimate the effectiveness of the manual lymphodrainage in the patients with post-mastectomy lymphedema of the upper limb associated to axillary lymphnodes dissection of the ipsilateral arm. The best results were found in the patients with soft and recent lymphedema (which means that was seen within one year); the worst were found in the chronic hard lymphedema. An important psychological assistance and physiotherapy were required to complete the rehabilitation. However, the physiotherapy was very effective when associated to pressed bandage of the arm, at the end of the LDM therapy. Furthermore, the muscle contraction in the bandage had reinforced the lymphoematic pump effect.

External compression, both intermittent by pneumatic pumps and continuous by anelastic or elastic bandages and by graduate compression stockings, play a pivotal role in prophylaxis of Deep Venous Thrombosis (DVT). The use of external compression in DVT therapy and in prophylaxis of pulmonary embolism (PE) and of post-thrombotic syndrome has not been validated as well as in DVT prophylaxis. The pathophysiologic properties of the external compression and the most recent evidences about the early mobilization of the patients with DVT and about Low Molecular Weight Heparin (LMWH) therapy suggest the advantages of the external compression. The authors review the most important clinical investigations about early use of external compression in DVT joined with pharmacological therapy: the results have been the reduction of the growth of the thrombus, the reduction of PE ratio, the prevention of the post-thrombotic syndrome, the indirect improvement of the quality of life. Finally the authors confirm the recommendations about the use of physical therapy with early mobilization and external compression joined with LMWH anticoagulation in DVT.

Objective: To assess the antalgic activity of thermomagnetic bandages and belts in cervical and lumbar pain syndrome (respectively CPS and LPS), compared with non-magnetic devices (placebo)., Patients and Methods: It was a double-blind study on two groups of 30 patients suffering from chronic back pain (15 cervical and 15 lumbar in each group). Patients had to stop any previous analgesic or antiinflammatory drug treatment at least 8 days prior to entering the study. Each subject included in the study had to wear the bandage/belt for 8 hours a day for 14 consecutive days. Before the start, every subject underwent an initial assessment of his/her current pain level and functional status through the use of two visual analogue scales (pain and functional status) and one verbal scale (pain). After the end of the study, a final assessment was made using the same tools., Results: 93 and 97% (respectively in the CPS and LPS group) were the percentages of patients in the actively-treated arm who showed an improvement both in pain level and in functional status. This improvement was statistically significant vs. the correspondent placebo-treated groups (respectively, 20 and 23% in the CPS and in the LPS). No adverse events associated to treatment were signalled., Conclusions: The use of thermomagnetic bandages and belts (which are, virtually in all cases, free of contraindications) allows us a more rational and easy management of the patient suffering from chronic back pain.

The authors report their experience in the sclerotherapy of varicose veins. They have used the technique of French school: with the patient half sitting, direct puncture not far from the gulf of saphena without tourniquet, on a weekly basis.

The Authors report their experience in the treatment of the post phlebitic syndrome at ulceration stage. The therapy is based on three important points: a first medical treatment and later saphenous striping with a specific tying of the insufficient perforant veins to consolidate the results of scarification in the future; finally ther removal of plugs of fascia for the therapy of hypodermitis with a personal technique.

Background: There are many causes of ulcer of the lower limb. In the elderly, venous ulcers and arteriosclerosis often coexist; for this reason pressure bandages might be contraindicated for the risk of precipitating a potentially critical arterial flow. In this work, the conditions which allow a safely treatment with pressure bandage in the elderly are evaluated., Material and Method: Eleven self-sufficient elderly, with venous ulcerations to one leg only, and ankle pressure/omeral pressure between 0.92 and 0.86 were treated with elastic bandaging of the leg., Results: All patients completed the treatment, with healing of the ulcer obtained in 3-8 months time. So far none of them relapsed., Conclusions: In the elderly, in selected cases, when Pc/Po > 0.86, pressure bandages can be safely applied to heal the ulcer, without running the risk of endangering arterial circulation.

Background: Deep venous thrombosis (DVT) of distal veins of the legs is important for its frequency and its potential proximal extension. The incidence of embolization in distal DVT is limited and treatment still undefined., Methods: After diagnosing with duplex scanning a distal DVT patients were included in a 24-week follow-up. All subjects used elastic compression (stockings TED = thromboembolic deterrent) for 24 weeks after DVT. In the 4 groups the following prophylaxis for 8 weeks were used: A: oral anticoagulant (INR 2.5). B: subcutaneous calcium heparin 0.2 ml bid (8.00 and 20.00). C: subcutaneous calcium heparin (0.5 ml at 20.00). D was the control group (only elastic TED stockings). heparin 0.2 ml bid (5000 IU) and 0.5 ml once daily (12.500 IU) were used for individuals with weight range between 65 and 90 kg. No patient was admitted into hospitals. Initially 106 patients were included. There were 17 (9.6%) drop outs and after 8 weeks 177 patients completed the study. No pulmonary embolisation or side effects were observed. In one patient (control group) an important extension of the thrombus to the femoral and iliac veins was observed., Results: The percentage of thrombus reduction was higher in the treatment groups than in controls (p < 0.05). No significant differences were found among the 3 treatment groups. At 8 weeks 88.6% of patients treated with oral anticoagulant showed improvement (stability/reduction in size of the thrombus; the percentage was 88.4% in subjects treated with subcutaneous heparin bid and 93.2% in those treated with a single dosage). In the control group thrombus increase was observed in 78.3% of patients (this difference was significant in comparison with the treatment groups; p < 0.05). At the 24-week control in 97.6% of patients in group A thrombosis was reduced/stable. This percentage was 97.7% in the ca-heparin double-dose group (B) and 100% in the single dose group (C), significantly lower than in group D (75%; p < 0.05)., Conclusions: Results indicate that untreated subjects with distal DVT are at risk of thrombus extension. In this study treatments were clinically equivalent. However one single dose of subcutaneous heparin is as effective as the double dose, is better tolerated, does not require haematological monitoring and has a lower cost.

Use of definite molecular weight heparan sulphate in a protocol for the prevention of deep venous thrombosis in the total joint replacement surgery. The authors propose a working protocol for the prevention of deep venous thrombosis in prosthetic orthopaedic surgery. It requires that integration of pharmacological, anaesthesiological, rheological and physiokinesitherapic measures, it has permitted a very good prevention of thromboembolic disease and it is well-tolerated and safe. The protocol requires: peripheral anaesthesia (sub-arachnoidal block), pre and post-operative pharmacological treatment with heparan-sulphate of a fixed molecular weight, haemodilution with maintenance of the haematocrit at no more than 30%, early physiokinesitherapy associated with the use of elastic stockings graduated tension. The fifty patients treated with this protocol were controlled during the pre-operative and post-operative stage and one month later and no thrombo-embolic complications resulted.

In the last 20 years within the clinical research on venous thromboembolism a major objective was to identify and develop increasingly effective and safe methods of prevention. This trend is justified by the high incidence of thromboembolism as well as by the relevant mortality for acute pulmonary embolism and postphlebitic sequels of difficult treatment. A significant contribution to the rational application of methods of prevention was given by the knowledge of risk factors. Together with acquired risks, as surgery, age, malignant tumors, in the last 30 years some conditions of thrombophilia were identified. They are caused by deficiencies in coagulation inhibitors (antithrombin III, protein C, protein S) or other alteration of the anticoagulation system as resistance to activated protein C or antiphospholipid antibodies. The primary prophylaxis of venous thromboembolism is aimed at the prevention of thrombosis by pharmacologic methods able to oppose the procoagulant alterations while avoiding hemorrhagic complications. The physical methods tend to reduce the stasis in the veins of the lower extremities. Subcutaneous calcium heparin at the dose of 5000 U twice or three times a day is the most common pharmacologic method used. It was shown to be safe and effective especially in postoperative prophylaxis of venous thromboembolism in general surgery. More recently, low molecular weight heparin fractions have been introduced. As compared to standard heparin they have the advantage of a single daily dose and a better efficacy in some groups of patients, as those undergoing hip replacement. Among the substances under clinical experimentation, dermatan sulfate seems promising. Most common physical prevention methods consist in the use of elastic graduated compression stockings and systems of intermittent pneumatic calf compression. The former can be used also in presence of a hemorrhagic risk as in neurosurgery. The latter have shown a good efficacy in increasing flow velocity and probably also in enhancing the fibrinolytic activity. The combination of physical and pharmacologic methods seems to be able of enhancing the efficacy of prophylaxis.

The author analyses a series of 41 heterogeneous skin lesions treated with Katogel for a period ranging between 3 and 6 months. The wounds were divided into two broad groups: acute and chronic, and the latter were then analysed according to pathological category. This dressing showed excellent local performance, although it did not detract from the importance of general treatment, together with good tolerance, ease of use and comfort.

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.

The authors present a plan for pharmacological treatment of pressure sores in patients affected by neurological pathologies: cerebrovascular accidents, head injuries, spinal cord injuries. This plan is easily applicable to all pressure sores included between first and third degree of the Reuler and Cooney classification. Authors identified some drugs specifically usefull in different cutaneous lesion degrees. Skin lesions and employed medicines are described as follows: Erythema: semi occlusive bandage with porous adsorbing membrane. This dressing must be left in for five days at least. Excoriation: bactericidal or bacteriostatic medicines if it's situated in a non pressed area while the same dressing utilized for erythema if it's localized in a pressed area. Pressure sores: if there is local infection cleanse the wound from bacterial defilement using topic antibiotics apply compresses with vitamin C if the cutaneous lesion is larger than deeper, Cadexomero lodico if it's deeper than larger. Fistulas: wadding with tablets of collagen. Necrobiosis: complete or partial surgical removal of eschar preceded by the use of enzymatic drugs when eschar is firmly adherent to subcutaneous tissues. The first group collects 9 patients with stroke and head injury: 8 with sacral and 1 with heel pressure sores. First degree pressure sores heal within 45 days and third degree lesions within 160 days. The second group collects 10 spinal cord injury patients mostly with complete lesion among which: 7 sacral, 1 heel, 1 ischiatic and 1 malleolar lesions. First degree pressure sores heal within 30 days, third degree pressure sores heal within 200 days. Healing time are considered acceptable. Pressure sores recovery swiftness can be related to different factors such as pressure sores sterness, neurological pathology and arising of clinical complication (hyperthermia, infections, low serum albumin values, etc).

Hydrogels are a new revolutionary method used to dress wounds without using gauzes and cotton wool. Our hydrogels were produced by irradiation and are perfectly sterile and biocompatible. The innovation of this topical treatment permits direct contact of hydrogels on wounds and results in complete repair of wounds and ulcers that do not heal easily. The fundamental advantage are: disappearance of local pain, very good protection of wounds, easy removal of necrotic tissue, total adhesion on wounds and simple removal without pain, faster tissue repair.

Venous ulceration is a troublesome and disabling complication, representing one of the most difficult problems to be treated by the vascular surgeon. Venous insufficiency is a widespread condition, the prevalence of venous ulceration being 0.5 - 1 per cent in European populations. Although all venous ulcers will heal if the limb is elevated above heart level for an extended period of time, patients need a safe, effective, not disabling and quick therapy. Hence, the competent vascular surgeon must be familiar with venous pathophysiology and possess a thorough understanding of the treatment options available for a discouraged patient in need of an acceptable and effective approach. The aim of the present study was to assess the efficacy and the speed of healing of venous ulcer using an outpatient ambulatory treatment protocol. This protocol consisted of elastic compression bandage allowing deambulation, local dressing using lyophilized heterologous collagen (Condress, Gentili) and systemic profibrinolytic drugs. Exclusion criteria were coexisting arterial insufficiency, ulcer area greater than 25 cm2, coexisting disabling diseases (congestive cardiac failure, hepatic insufficiency, malignancy). From December 1990 to June 1993, 37 patients affected by venous ulcer were treated, according to the aforementioned protocol, at the Surgical Department of Montecchio Maggiore Hospital (VI). There were 16 male and 21 female patients, mean age was 66 years (range 59-91). Results show the complete healing of the venous ulcer in 94.5% of patients; mean time for ulcer healing was 128 days (range 45-91). The Authors conclude that the outpatient ambulatory treatment protocol is safe, quick, and effective for the therapy of chronic venous ulcer; once obtained the healing of the ulcer, elastic compressive bandage with elastic stockings is mandatory to prevent recurrences.

The authors report on the pharmacological employment of defibrotide in the treatment of a case of deep vein thrombosis (DVT) of the left iliac-femoral veins in a patient with a high-risk of hemorrhage (haematuria from kidney neoplasm, rupture of basilar artery aneurysm, urethral bleeding from catheter trauma). Alternatively to the traditional thrombolytic and anticoagulants, not indicated here for their haemorrhagic risk potential, defibrotide promptly resolved the DVT without any major effect on blood coagulation parameters. Initially, 1 gr of defibrotide in 250 ml of glucose-1-phosphate solution was administered twice-daily for the first two days when improvement had been observed. An additional 5 days of therapy was continued under the same regimen, then 400 mg intravenously every 2 hours for 14 days, and 400 mg intramuscularly every 24 hours until the 30th day. The patient was dismissed from the hospital on therapy with indobufen 200 mg orally, and elastic support stocking. After 6 months the patient is well. An echo color Doppler evaluation showed a normal venous blood flow through the femoral, iliac and caval veins, and venous blood reflux in the iliac-femoral and femoral saphenous veins due to valvular insufficiency. Caval filters, although recognized by many institutions as a preferred method of protection against pulmonary thromboembolism especially in patients with a contraindication to anticoagulation therapy or recurrent pulmonary embolism, was not used in this case, since the patient was critically ill. From this case report and the review of the literature it seems that defibrotide may represent a valid alternative therapy in the treatment of DVT, especially in high risk haemorrhagic patients.

The Authors examine the endocrinological, mechanical and constitutional factors which are involved in the pathogenesis of varicose veins in pregnancy. Discussing the results of their experience (328 pregnant patients observed, 158 of which affected with various degrees of varicose veins) they suggest a protocol of treatment in the different situations in order to obtain an improvement of the clinical conditions and, if necessary, postpone a surgical operation after delivery, so avoiding useless risks during the pregnancy.

A questionnaire concerning the prophylaxis of venous thromboembolism was filled in by 326 surgical departments in Italy. In 58% the prophylaxis was routinely used and in 29% more than one method was used. The most used method of prevention was subcutaneous heparin followed by elastic compression. In 51% of the centers the prophylaxis was used only in high risk patients and in 22% it was not used at all. The most relevant risk factors in the development of thrombosis were considered age, tumors and obesity. Finally in a questionnaire sent to 350 vascular laboratories it was found that--according to the operators--76% of all documented thromboses were possibly consequent to surgical procedures (in 86% no prophylaxis had been used).

Sorbsan is a new dressing composed of alginate fibers extracted from seaweed. It is claimed to have important hydrophilic, haemostatic and biocompatible qualities. Sorbsan was used in the treatment of the donor site of split skin grafts in 52 patients operated in this department from 1988 to 1990. The patients of this series required a skin graft for various reasons as detailed below: a) skin burns in 24 cases; 2) covering of a muscle flap used in the treatment of sacral pressure sores in 15 cases; c) 13 cases of loss of substance from other various causes. Healing time averaged 16.8-13.4 and 9.3 days respectively in the three groups reported above. In 85% of cases, healing was achieved in a period variable between one and two weeks and a half, varying in accordance with patient age and general conditions. The speed of healing, particularly where thin grafts were taken, allowed multiple split skin grafts to be taken from the same donor site, facilitating the treatment of extensive skin burns. The dressing can be removed with ease with only minimal discomfort to the patient. The incidence of side effects such as itching and scar hypertrophy or pigmentation is low. We haven't noticed any allergic reaction in this series. We found the use of this dressing satisfying in the treatment of donor sites of split skin grafts, particularly in terms of patient comfort and speed or healing.

In the patient with homogeneously or inhomogeneously distributed atelectasis, localized primarily in the apices, overdistension of the non-dependent portion of the lung bases, only partially surrounded by the rib cage, is generally observed during mechanical ventilation. This phenomenon is even more pronounced in the neonate and in the infant because their rib cage compliance is almost infinite. In order to protect the lung bases in the event of their overdistension and/or to reexpand the atelectasis of the upper lobes we apply an external resistance, in form of thoracoabdominal binding, to limit the movement of the diaphragm. The degree of the binding's tension is regulated according to the degree of the distension of the lung bases detected on chest x-ray. This restriction was so far applied in 12 children using elastic bandages. We have used the thoraco-abdominal binding with good result in the treatment of atelectasis of the upper lobes, in extensive atelectasis as well as in the treatment of primitive lung bases overdistension, as described in 3 cases reports. We suggest this technique in order to obtain an homogeneous ventilation along the longitudinal axis of the lung. This method does not interfere with prone-supine postural changes, systematically applied in our department, and therefore, the homogeneous ventilation along the vertical axis is also provided.

Post-partum superficial and deep venous thrombosis are still an important obstetric problem. Varicose veins of the lower limbs are closely associated epidemiologically and pathogenically with venous thrombosis. A controlled group of 1,588 parturients was studied to single out other risk factors and to ascertain the prevalence of thrombosis. A group of 1,464 parturients was treated with graduated compression stockings, in low risk patients, adding preventive treatment with low dose heparin in high risk patients. The prevalence of post-partum venous thrombosis was reduced from 4.3%, in the control group, to 0.9% in the study group: in women who received preventive treatment, the prevalence of thrombosis diseases was decreased over 90%.

Antiquated first-aid procedures, such as the incision and sucking of the wound and the application of a tourniquet, are still used in Italy consequent to the bite of vipers. The A. hope that such procedures will be finally abandoned, since they are ineffective, impractical, painful and can furthermore produce invalidating or disfiguring permanent outcomes. In this report they extensively describe Australian first-aid measures consequent to snakebites, constituted by a compressive bandage and by immobilization of the bitten limb by splinting. They hope therefore that the divulgation of this procedure in Italian will bring about, within a short period of time, its extensive use in Italy consequent to viper bites, as it is very effective, practical and easy to carry out.

Eighteen male patients, mean aged of 55.7 years, affected by psoriasis were treated for an average of 19 days with fluocinolone acetonide (FA) using an occlusive traditional dressing with a 0.025% cream or with a medicated plastic porous tape (8 micrograms/cm2), according to a controlled hemipart design. The average total quantity of FA administrated for each patient was 3.431 mg on the side treated with tape and 19.827 mg on the side treated with cream. Both the treatments showed excellent efficacy (ANOVA between times p less than 0.01), better with the tape than with the occlusive conventional dressing. The patients preferred the use of the tape to the cream. The tolerability was very good. Treatment with the medicated tape was shown to be more effective than the occlusive traditional dressing, and yielded a reduction of the quantity of corticosteroid administrated to the patients.