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Background Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available. Methods Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks. Results The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks. Conclusion The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs.

Riassunto Obiettivi Scopo del lavoro e descrivere un caso clinico di rimozione chirurgica di un osteoma centrale localizzato distalmente al 47. Materiali e metodi Il caso clinico presentato illustra la metodica di rimozione di un osteoma localizzato a livello mandibolare, situato distalmente rispetto al secondo molare di destra. Avvalendosi della chirurgia piezoelettrica, l’approccio a questa lesione e avvenuto nel modo meno invasivo possibile, attraverso il quale sono state eseguite l’asportazione della lesione e la toilette chirurgica del sito operatorio. Risultati Il controllo radiografico sei mesi dopo l’intervento evidenziava segni di guarigione con ossificazione della lacuna ossea residua. Conclusioni L’approccio chirurgico minimamente invasivo e l’utilizzo della chirurgia piezoelettrica rappresentano una metodica che lo specialista in chirurgia deve considerare per la risoluzione dei casi clinici che manifestano un elevato rischio di lesione per le strutture neurovascolari circostanti.

Background Extracorporeal (EC) carbon dioxide (CO 2 ) removal (ECCO 2 R) may be a powerful alternative to ventilation, possibly avoiding the need for mechanical ventilation and endotracheal intubation. We previously reported how an infusion of lactic acid before a membrane lung (ML) effectively enhances ECCO 2 R. We evaluated an innovative ECCO 2 R technique based on ventilation of acidified dialysate. Methods Four swine were sedated, mechanically ventilated, and connected to a venovenous dialysis circuit (blood flow, 250 ml/min). The dialysate was recirculated in a closed loop circuit including a ML (gas flow, 10 liters/min) and then returned to the dialyzer. In each animal, 4 different dialysis flows (DF) of 200, 400, 600, and 800 ml/min were evaluated with and without lactic acid infusion (2.5 mEq/min); the sequence was completed 3 times. At the end of each step, we measured the volume of CO 2 R by the ML (Vco 2 ML) and collected blood and dialysate samples for gas analyses. Results Acid infusion substantially increased Vco 2 ML, from 33 ± 6 ml/min to 86 ± 7 ml/min. Different DFs had little effect on Vco 2 ML, which was only slightly reduced at DF 200 ml/min. The partial pressure of CO 2 of blood passing through the dialysis filter changed from 60.9 ± 3.6 to 37.1 ± 4.8 mm Hg without acidification and to 32.5 ± 5.3 mm Hg with acidification, corresponding to a pH increase of 0.18 ± 0.03 and 0.03 ± 0.04 units, respectively. Conclusions Ventilation of acidified dialysate efficiently increased ECCO 2 R of an amount corresponding to 35% to 45% of the total CO 2 production of an adult man from a blood flow as low as 250 ml/min.

PURPOSE: Extracorporeal CO2 removal is an effective procedure to allow a protective ventilatory strategy in ARDS patients, but it is technically challenging due to the high blood flow required. Increasing the CO2 transfer through the membrane lung (ML) may lower the demand of extracorporeal blood flow and consequently allow for a wider clinical application of this technique. Since only the dissolved CO2 (5% of the total CO2 content) is easily removed by the ML, we tested whether acidifying the blood entering the ML to convert bicarbonate ions towards dissolved CO2 could enhance the CO2 transfer though the ML. METHODS: Six pigs were connected to an extracorporeal circuit comprising a ML. The extracorporeal blood flow was 500 ml/min, while the gas flow was 10 l/min. A 15-min continuous infusion of 0.5 N lactic acid was added to the extracorporeal blood flow before the ML at a rate of 1, 2 and 5 mEq/min. Between steps we waited for a reequilibration time of at least 30 min. RESULTS: Acid infusion at 0, 1, 2 and 5 mEq/min increased pCO2 (56.19 +/- 7.92, 68.24 +/- 11.73, 84.28 +/- 11.17 and 136.66 +/- 18.46 mmHg, respectively) and decreased pH (7.39 +/- 0.05, 7.30 +/- 0.05, 7.20 +/- 0.05 and 6.91 +/- 0.05, respectively). ML CO2 removal increased 11, 23 and 70% during acid infusion at 1, 2 and 5 mEq/min, respectively. CONCLUSIONS: Blood acidification at the inlet of a ML with infusion of 1, 2 and 5 mEq/min of lactic acid can increase the CO2 removal capacity of the ML up to 70%.