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A 57-year-old man underwent myocardial revascularization for unstable angina. Cardiocirculatory arrest complicated the procedure and the patient was rapidly treated with advanced cardiac life support. After 26-min long resuscitation attempts, 5 DC-shock and cardioactive drug administration, an extracorporeal system was positioned and activated (extracorporeal membrane oxygenation, ECMO). After ECMO positioning, sinus rhythm was achieved after another DC-shock. Therapeutic hypothermia was started with a target temperature of 33°C. ECMO was removed after 12h, and therapeutic hypothermia was continued for 27h without any complications. The patient was discharged with good neurological outcome. This report shows the feasibility of treatment of a dramatic event such as refractory cardiac arrest, using modern and advanced techniques in the intensive cardiac care unit.

Vacuum-assisted breast biopsy (VABB) is now available for non-palpable lesions. The present study describes the results obtained from 226 consecutive VABBs performed at "L. Sacco" Hospital, Milan, from November 2005 to July 2007 (198 stereotactic and 28 ultrasonographic procedures). Adequate tissue samples for histopathological evaluation were obtained in 225 cases (99.6%). The diagnoses were as follows: 9 normal tissues (4%), 97 benign (43%), 25 "probably benign" (11%), 4 "suspicious for malignancy" (2%) and 90 malignant (40%, 53 in situ and 37 infiltrating carcinoma). Of the 90 malignant cases, 38 (42.2%) underwent subsequent surgical excision in our Unit; 84.2% (32/38) had concordant histopathological findings. In conclusion, VABB is an accurate and safe technique for diagnosis of non-palpable lesions, and in experienced hands avoids unnecessary surgical procedures.

Unlabelled: In Italy the prevalence of anemia in cancer patients has only been indirectly drawn from clinical studies, and a direct estimation has never been made., Methods: This is the first nation-wide survey on the prevalence of anemia in cancer patients in Italy. In 193 Centres, clinical data were collected on consecutive patients with non-myeloid malignancies entering a new cycle of chemotherapy during a reference week in 1997., Results: A total of 1763 patients has been recruited. At the time of enrollment grade I-II anemia was observed in 56% of patients, although only 1% showed severe anemia. Most of the patients (73%) experienced a decrease of haemoglobin level following treatment completion. Drop of haemoglobin correlated with a more advanced stage of the disease and with a lower performance status at baseline., Conclusion: Anemia is an increasingly common complication in cancer patients undergoing chemotherapy. Improving our knowledge on occurrence of anemia and the type of neoplasms and chemotherapies which are more likely to be associated with this complication may allow the adoption of specific measures to prevent the development of anemia and to avoid the need of blood transfusion in these patients.

Background: Infants undergoing cardiac surgery with prolonged cardio-pulmonary bypass are particularly exposed to the risk of acute renal failure for renal hypoxia due to low cardiac output., Methods: To limit fluid overload deriving from oligo-anuria and low cardiac output we have recently adopted an early peritoneal dialysis protocol, positioning the peritoneal catheter during the intervention and performing early exchanges at first signs of inadequate diuretic response and/or "leaky capillary syndrome" with diffuse edema. From 1-1 to 31-12-1997 12 patients (8 males), of median age of 65.5 days (range 1-350 days) and median weight of 3463 g (range 2380-6550 g) were treated with peritoneal dialysis (automated exchanges of 10 ml/kg body weight of 1.5% glucose, dwell time 20 minutes). Cardiac pathologies included complex hearth malformations. Cardiopulmonary bypass lasted a mean of 202 minutes (range 102-372 minutes). The children were treated for a minimum of 1 to 42 peritoneal dialysis sessions. The infusional therapy included human albumin and fresh frozen plasma to substitute losses and furosemide at the dose of 4 mg/kg/day to reduce the "leaky capillary syndrome"., Results: The results were very satisfactory: only 3 children died in the first 30 days after surgery. Renal function was normal at the end of the observation in 8/12 cases, and 2 cases presented chronic renal failure., Conclusions: Since similar series report a mortality rate of 33-79%, it is suggested that early peritoneal dialysis may have positively influenced the final survival rate.

Purpose: To review the early CT findings of invasive aspergillosis in AIDS patients who are at high risk for developing this infection. Early recognition of invasive fungal disease is imperative in these patients, and longer survival can be achieved with early CT detection and prompt institution of high-dose antifungal therapy., Material and Methods: February, 1992 to December, 1994, sixteen cases of invasive pulmonary aspergillosis in AIDS patients were retrospectively reviewed. All patients underwent a chest radiograph and high-resolution Computed Tomography (HRCT) and the results were confirmed by pathology., Results: 11/16 cases (68.8%) showed angioinvasive aspergillosis, characterized by nodules surrounded by the halo sign and cavitations; the remaining 5 patients (31.2%) showed invasive aspergillosis of the airways with centrilobular nodules and/or peribronchial consolidations. Five cases of extrapulmonary fungal dissemination were also observed., Conclusions: HRCT is a sensitive noninvasive method for evaluating early angioinvasive aspergillosis because the halo sign is characteristic enough to allow an early presumptive diagnosis. Invasive aspergillosis of the airways presents no characteristic radiologic pattern. However, the association of the clinical and radiologic pattern allows prompt institution of high-dose antifungal therapy.

Bronchioloalveolar carcinoma (BAC) is a relatively uncommon tumor of the lung accounting for 1 to 9% of all pulmonary neoplasms. Its radiologic appearance is characterized by solitary nodular opacity or diffuse air-space consolidation. The aim of this work is to report the different patterns of this neoplasm, particularly in the diffuse form, and to demonstrate the sensitivity and specificity of HRCT in its early identification. We examined 11 patients affected with multifocal bronchioloalveolar carcinoma to identify HRCT signs which could lead to improved diagnostic criteria. These signs are represented by ground-glass opacity (8/11) and alveolar consolidation (6/11), with a plurilobular, segmentary or lobar distribution. The lesions were bilateral in 8/11 cases and abnormal mediastinal lymph nodes were found in 5/11 cases. Air bronchogram was seen in all cases of ground-glass opacity and in 5/11 cases of air-space consolidation. In conclusion, in our experience, HRCT is a useful tool in the study of BAC, which has a long and slow evolution and is underestimated at chest radiograph in its early stage. Moreover, HRCT can help distinguish this condition from other lung diseases characterized by diffuse air-space consolidations, whose clinical history is useless to make an unquestionable diagnosis.

In 1993, a hundred and fifty AIDS patients were submitted to high-resolution CT (HRCT). In 102 patients, bronchoalveolar lavage and/or transbronchial biopsy findings suggested the diagnosis of Pneumocystis carinii pneumonia--a pure Pneumocystis carinii infection in 75 patients and associated with other pathogenic agents in 27. We report the most common HRCT patterns, such as ground-glass opacities, cysts, interstitial changes and nodules. Ground-glass opacities were demonstrated in 57.8% of cases, cysts in 44.1%, interstitial involvement in 52.9% and nodules in 28.4%. HRCT permitted lung disease to be demonstrated in 55% of our patients, suffering from impaired breathing, with negative chest films. Respiratory function tests and gallium scintigraphy show their low specificity in the diagnosis of Pneumocystis carinii infection because, although depicting diffuse interstitial involvement, they fail to detect the pathogenic agent. As for hemogasanalysis, in the presence of hypoxia, this technique can suggest the diagnosis of Pneumocystis carinii infection, while the pathogenic agent can be isolated with bronchoalveolar lavage, which demonstrates the simultaneous decrease in CD4 and increase in CD8 lymphocytes, respectively. To conclude, HRCT does detect the basic changes occurring in Pneumocystis carinii pneumonia, thus contributing to the diagnosis of this condition.

The paper reports the results of a research project on hospital work in which the analysis of organized work situations in different contexts was made using a method based on a valid organizational theory, with the objective of an ergonomic study on the relationships between organized work and well-being. From the analysis of these different situations, via the application of the Method of Organizational Congruencies, the greatest individual level of danger for well-being was constantly observed in nurses, not only as regards the traditional risks of exposure to physical or biological agents, but also the psychophysical aspecific discomfort related, particularly, both to imposition and to uncertainty in the coordination and control of technical actions and in the coordination and control of individuals. The use of an instrument of organizational analysis and the contribution of specific disciplinary approaches (the theory on stress by H. Selye and the theory on communication by G. Bateson), satisfied the needs of suggesting and understanding the relationships between organization choices and well-being of nurses, with the aim of reducing the conditions of danger for well-being related to organization choices.

To assess the prevalence of atypical PCP patterns in AIDS patients, the chest films of 300 patients with clinical and laboratory diagnosis of PCP were reviewed. We considered as atypical patterns the finding of an asymmetric lesion, the involvement of apical regions, pleural effusion, hilar and/or mediastinal lymphadenopathy, parenchymal nodules and pneumatoceles. In some patients more than one of these patterns was found. Atypical patterns were observed in 32% of cases and consisted of: unilateral involvement in 11% of cases, apical involvement in 6%, pleural effusion in 9%, hilar and/or mediastinal lymph nodes in 4%, parenchymal nodules in 6% and finally pneumatocele in 12% of cases.

The Authors describe two monochorionic twins affected by Niemann-Pick disease type C with a clinical picture beginning in the neonatal age and with a progressive mental deterioration, loss of speech and spasticity started at 30 months. The importance of cultured skin fibroblasts is emphasized. The evidence of a defective intracellular cholesterol esterification is established as an intrinsic feature of Niemann-Pick disease type C.