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The consensus conference on blood saving has allowed us to formulate some interesting guidelines. The autologous and homologous transfusion require the patient's consent. For volemic replacement crystalloid solutions are used for phlebotomies below 10-15%, and colloid solutions for those greater than 10-15% of the blood mass. Severe isovolemic hemodilution (Ht < 20%) necessitates the reduction of the dosage of some drugs. A limit of Hb around 9 g/dl after phlebotomy may be acceptable in the absence of cerebral and coronary vascular disease. Phlebotomies are therefore possible also when the Hb values are 10 g/dl (Ht 30%). Hb values around 7 g/dl in the late postoperative period (from day 3 to 6) may be accepted only if well tolerated. The blood salvaged during surgery and at the beginning of the postoperative phase must always be centrifugated, washed and microfiltered. Subsequently, in the first 8 hours it is possible to reinfuse red cells after sedimentation and microfiltration. The techniques of predeposit, hemodilution and recovery are valid especially if associated with careful control of postoperative bleeding by means of aspiration under controlled pressure (at minimum negative values and sometimes positive ones), monitoring of blood loss from drainage and application of elastic compression bandages.

Serum beta 2-microglobulin levels (beta-2-M) were studied in 150 drug addicts, 50 of them asymptomatic carriers of anti HIV-1 antibodies, 50 symptomatic carriers with persistent generalized lymphadenopathy (P.G.L.) and 50 serum negative patients who had been living in a closed community for at least 2 years. The results showed increased beta-2-M in 24 P.G.L. patients (48%), in 6 of the asymptomatic serum positive cases (12%) and in 3 of the serum negative subjects (6%). No such increase was found in the selected control group. Statistical analysis using the chi-square test and one-way variance analysis gave a significant result. The data suggest that increased serum beta-2-M is essentially linked to the presence of P.G.L.

The histopathological background to the healing process in lesions of the superficial tissues is described briefly and the effect of oxygen at various stages in this process is examined. The propriety of using hyperbaric oxygen therapy in certain types of lesion is discussed and the most effective therapeutic approaches are suggested.

The devastating nature of gas gangrene has in the past necessitated radical surgery to prevent the destructive spread of the disease. The advent of antibiotics only partly reduced the need for radical amputations and distressing multilations. Immediate, extensive surgery has now been reduced to a minimum thanks to Hyperbaric Oxygen which rapidly dominates the toxicity of Clostridium. Experience shows that it is still, unfortunately, necessary to emphasize the futility of certain ill-timed and often exaggeratedly multilating surgical approaches, which have at times utterly nullified the clearly positive results obtained by HOT in three cases of post-traumatic gas gangrene.

The main physiopathological changes occurring in heat loss and therapeutic warming stages are examined. Excessive heat loss in water is much more frequent than is imagined and effects: Swimmers through cutaneous transpiration and respiration. Sailors and surfers through heat dispersion in water and exposure to air and wind. Deep and Scuba divers due to respiratory mixes as well as heat dispersion. The first aid treatment of heat loss whether mild or severe is then analysed. As far as possible first aid should concentrate on maintaining the cardiorespiratory functions. Heat treatment should be reserved for specially equipped treatment centres.

A controlled double blind clinical trial has been conducted in 16 patients with "angina pectoris" in order to investigate the effect of Perexiline maleate as compared with prenilamine. Perexiline at the dose of 400 mg/die and prenilamine at the dose of 120 mg/die have been administered over a period of 4 weeks each. Between these periods placebo has been administered for two weeks. The number of attacks of angina and the number of tablets of nitroglycerine used per week by the patient during each period has been used for the evaluation. Furthermore ECG at rest and after exercise has been performed every two weeks. Our results statistically evaluated show a definite antianginal effect of Perexiline. According to our experience Perexiline should be considered the drug of choise in the treatment of angina complicated by bradicardia, left ventricular failure, bronchospasm, and in angina unresponsive to other drugs.

The Anaesthesia and Recovery Service at the Galeazzi Orthopaedic Centre in Milan has an HOT unit where various cases of necrosis following radiotherapy for neoplasias have been and are still being treated. Some cases of radiodermitis and osteoradionecrosis only cured after HOT treatment are presented. The recovery of the scarring and granulation processes in these cases is attributable to the increased perfusion and above all diffusion of oxygen which activates the heating processes in the hypoxic tissues. An additional advantage of HOT is that patients can be treated in outpatients department (for periods ranging from 25 to 70 days according to the seriousness of the case), thus avoiding long-term hospitalisation and withdrawal from normal working life.

The Authors examine one thousand lone bone X-rays of professional divers and non-diving controls. The goal is to look for a correlation between hyperbaric exposure and bone alteration images type "dense bony islet" and "translucent cystic area" according to McCallum, Walder and Davidson. The results show a statistically non significant difference between divers and controls: Hip: Divers 31%, Controls 30%; Knee: Divers 17%, Controls 23%; Shoulder: Divers 22%, Controls 22.5%. The types of bone structural alterations studied never seemed to originate forms of aseptic bone necrosis but had a tendency to evolve favourably and independently from diving activity. These structural alterations are therefore deemed as non significant with regard to the bone risk of professional diving. The Authors suggest that until the real significance of these bone X-ray images is cleared by further research only the bone structural alteration which are within one centimeter from the articular surface should be considered for possible negative evolution.

A Hyperbaric oxygen therapy (HOT) unit was set up some months ago in the Anaesthesia Service of the Galeazzi Orthopaedic Institute in Milan. HOT can be used in a number cases which are not relevant to the present report. In the field of Orthopaedics and Traumatology HOT in isolation or in association has proved useful in the following field: acute and chronic osteomyelitis; infected and non-infected pseudoarthroses; slow bone-knitting following limb lengthening or high risk fractures; local oedemas and disturbed scarring. Cases of patients sent to hospitals and Centres specialising in the treatment of all the above pathologies are presented. The results are highly encouraging given the high percentage of cures and the rapidity with which they were obtained. HOT has the added advantage of not requiring long-term hospitalization, since patients can be treated in outpatient departments.