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Objectives: To investigate whether the use of economic evaluation (EE) in healthcare decision making is influenced by the social values and institutional context in a given country., Methods: We developed and tested a conceptual framework for the 36 Organisation for Economic Co-operation and Development (OECD) countries. The countries were divided into two groups based on the extent of their use of EE in drug reimbursement. The key social values were efficiency, equity, and personal responsibility, measured in an international survey. Countries were classified based on their institutional context in terms of their general welfare paradigm/type of healthcare system and the administrative tradition to which they belong. We performed correlation tests and ran path analysis regression models to test our hypotheses., Results: EE high users included significantly more Beveridge-type systems (50% vs 31%) and fewer Bismarck-type (15% vs 56%). Napoleonic tradition countries seemed to reject personal responsibility in health (r = -0.511, P = .009), whereas Germanic tradition countries embraced it (r = 0.572, P = .003); Anglo-American tradition countries exhibited a significant association with efficiency (r = 0.444, P = .026), whereas Scandinavian tradition countries appeared to reject it as a criterion for rationing in healthcare (r = -0.454, P = .023). No significant direct association was found between social values and use of EE., Conclusion: Our exploratory analysis suggests that institutional context and, indirectly, social values may play a role in shaping the use of EE in healthcare decision making. Because of the differences among countries in terms of institutional context, which may in part be influenced by social values, it is unlikely that there will ever be a single, harmonious approach to the use of EE., (Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Background: The ritonavir-boosted protease inhibitor (PI/r) use has been associated with several metabolic abnormalities, and the non-alcoholic fatty liver disease (NAFLD) is becoming a very frequent comorbidity among HIV-infected patients. Methods: We performed an observational, prospective study of HIV-infected patients with NAFLD, receiving one PI/r plus two nucleoside analogues, who switched from the PI/r to raltegravir or were treated only with lifestyle modification, maintaining antiretroviral therapy unchanged. Changes in liver steatosis after 12 months were evaluated by transient elastography and measurement of controlled attenuation parameter (CAP). Results: As a whole, 61 patients (46 males; median age, 55.4 years) were enrolled, and 32 of them have been switched from PI/r to raltegravir. At baseline, median CAP was 259 dB/m, 28 (45.9%) subjects had a moderate-to-severe hepatic steatosis (CAP ≥260 dB/m), and 19 patients (31.1%) had elevated aminotransferases. Type-2 diabetes mellitus was present in 5 persons, and chronic HCV coinfection in 4. At month 12, the median decrease in CAP values was -27 dB/m in patients switched to raltegravir and -11 dB/m in those with unchanged cART ( p  = .021). The number of patients with CAP ≥260 dB/m decreased from 16 to 6 (-62.5%) in patients switched to raltegravir and from 12 to 8 (-33.3%) in the other group ( p  = .037). Conclusion: After 12 months, HIV-infected patients with NAFLD switching from a PI/r to raltegravir showed a significantly greater decrease in the hepatic steatosis degreee in comparison with those with unchanged cART and treated only with lifestyle modification.

Introduction: On the 27th of October 2017 the National Center for Rare Diseases of the Italian National Health Institute (NHI), clinicians of the Italian National Referral and Support Centres for Cystic Fibrosis, Paediatric Hospital "Bambino Gesù", Italian Cystic Fibrosis Society, and the Italian League for Cystic Fibrosis renewed the agreement about FC data flow for a 3 years period. The possibility to access data by third parties is among the most important new introduced within the agreement., Objectives: Aim of the present report is to improve the know-how on cystic fibrosis (CF) through a better characterization of Italian patients. Furthermore, the present Report aims at improving the care of CF patient. In particular, the Report should contribute to the following objectives: * to analize medium- and long-term clinical and epidemiological trends of the disesase; * to identify the main health care needs at regional and national level in order to contribute to the healthcare programmes and to the distribution of resources; * to compare Italian data with international ones., Design: Analyses and results described in the present Report are referred to patients in charge to the Italian National Referral and Support Centers for Cystic Fibrosis in the period 2015-2016. Data were sent by Centres by means of a specific software (Camilla, Ibis Informatica). Data underwent to a double quality control (QC): the first by NHI and the second at a European level (before the inclusion of the italian data within the European Cystic Fibrosis Registry). These QCs assure the completeness and the accuracy of data as well as their consistency with European core data. Finally, in 2017, an additional CQ was performed to further reduce the number of missing data and consequently improve the precision and the consistency in the nomenclature adopted for genetic mutations., Setting and Participants: A total of 29 different CF Centres (referral, support, and Paediatric Hospital "Bambino Gesù") sent their data referred to 2015-2016 years to ICFR . Data regarding Sardinia (Southern Italy) are missing and those from Treviso (Veneto Region, Northern Italy) and Rovereto (Trentino-Alto Adige Region, Northern Italy) are sent through Verona CF Centre., Results: The present Report has been organized into 10 sections. 1. Demography: estimated CF patients is 5,204 in 2015 and 5,362 in 2016; median age is 20.6 and 21.0, respectively. Prevalence is 8.6/100,000 residents in Italy in 2015 and 8.8 in 2016. Male percentage is 51.6% on average for 2015 and 2016; CF distribution showed higher frequency in patients aged from 7 to 35 years. The mean of patients aged more than 18 years is 56.5% on average in 2015 and 2016. 2. Diagnoses: most of the CF patients were diagnosed before 2 years of age (median value: 68%); a significant percentage of patients (median value: 13%) was diagnosed in adult age. 3. New diagnoses: new diagnoses were 169 in 2015 and 153 in 2016. Estimated incidence in 2015 was 1/4,176 living births in 2015 and 1/5,510 in 2016. 4. Genetics: 99.5% of patients underwent genetic analyses and in 96% of patients a mutation in Cystic Fibrosis Transmembrane Regulator (CFTR) gene was identified. [delta]508F was the most frequent mutation (44,7% in 2016). Furthermore, 16.0% and 3.4% of patients was characterized by the presence of at least one "residual function" mutation and gating, respectively. Finally, 21% of patients was a stop codons (class 1 mutation) carrier. 5. Lung function: FEV1 (forced expiratory volume in the first second) scores progressively decreased before adult age, in accordance with the natural history of the disease. FEV1% values in patients between 6 and 17 years of age is ≥70%; patients with a FEV1% value of 40% are less than 2% in the period 2015-2016. 6. Nutrition: most critical periods are during the first 6 months of life and during adolescence. Prevalence of malnourished male aged 12-17 years is constant in 2015-2016 and is always more than the prevalence observed in female. An increasing percentage of female patient with a suboptimal BMI value (35.5%) is observed among patients aged more than 18 years 7., Complications: it was estimated that, in 2016, hepatopathies without cirrhosis (17.7%) is the principal complications in patients aged less than 18 years; in patients aged more than 18 years the principal complication was due to hepatopathies without cirrhosis (29.5%) and diabetes (23.3%). 8. Transplantation: in 2015-2016, 74 patients were bipulmunary transplanted; age was comprised between 8 and 52 years, median age at transplantation was 29,6 years. Median waiting times for transplantation is estimated in 17 months (24 months in 2015 and 14 months in 2016). 9. Microbiology: analyses were referred to test performed in 2016. Percentage of adult patients with chronic Pseudomonas aeruginosa infection is 52.1% compared to 15.2% of paediatric patients; Staphylococcus aureus infection is present in 53.2% of adult patients and 52.8% of paediatric ones; Burkholderia Cepacia complex is present almost exclusively in adult patients (4.3%); Nontuberculous mycobacteria is present in 1.2% and 0.4% of adult and paediatric patients, respectively; Stenotrophomonas maltophilia infection is present in the 6.1% of adult patients and 4.9 of paediatric patients. 10. Mortality: 102 patients (49 males and 53 females; median age 36.9 years in 2015 and 36.5 in 2016) died in 2015-2016 (transplanted patients are not included)., Conclusions: The present Report shows that Italian CF population is growing (median age) and paediatric mortality is decreasing. A very low percentage of paediatric population is characterized by complication of pulmonary function; adult patients are characterized by an increase of age at death (more than 36 years of age in 2016).

Visceral leishmaniasis has been recognized as an opportunistic infection affecting people with cellular-immunity impairment, including hematopoietic cell transplantation (HCT) recipients. We describe the case of a young Italian man with Hodgkin lymphoma, who developed visceral leishmaniasis after multiple lines of chemotherapy and allogenic HCT. Literature review of visceral leishmaniasis in HCT recipients was also performed. Eleven patients (median age 50 years, 9 male) developed visceral leishmaniasis after allogenic (n = 9) and autologous (n = 2) HCT. Most of them presented with fever and pancytopenia. Bone marrow examination was the main diagnostic technique; liposomal amphotericin B was the treatment of choice. Four out of eight patients (for whom data are available) experienced visceral leishmaniasis relapse. Visceral leishmaniasis in HCT recipients is a rare event that should be suspected in patients with persistent fever, pancytopenia and possible exposure to Leishmania spp., remembering that - as well as South-East Asia, East Africa and South America - it is endemic in several European regions., (Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Introduction: The Italian Cystic Fibrosis Registry (ICFR) is based on a new agreement about the data flow towards the Registry signed on October, 4th 2016 by the Centre for Rare Diseases of the Italian National Institute of Health (NIH), the clinicians of the Italian National Referral and Support Centres for Cystic Fibrosis, the Paediatric Hospital "Bambino Gesù" (Rome), the Italian Cystic Fibrosis Society, and the Italian League for Cystic Fibrosis., Objectives: The aim of the present Report is to improve the knowledge on cystic fibrosis (CF) through the epidemiological description of Italian patients. The members of the Scientific and Technical Committee have to write a report on data collected by ICFR, in order to contribute to achieve the aims of ICFR itself, i.e., to improve the care of CF patients. In particular, the Report should contribute to the following objectives: - to analyze the medium and long-term clinical and epidemiological trends of the disease; - to identify the main healthcare needs at regional and national level in order to contribute to the healthcare programmes and to the distribution of resources; - to compare Italian data with the international ones., Design: Analyses and results described in the present Report are referred to patients in charge to the Italian National Referral and Support Centres for Cystic Fibrosis in the period 2011-2014. Data were sent by Centres by means of a specific software (Camilla, Ibis Informatica) and has undergone a double quality control (QC): the first by NIH and the second at a European level (before the inclusion of the Italian data within the European Cystic Fibrosis Registry). These QCs assure the completeness and accuracy of data as well as their consistency with European core data., Setting and Participants: A total of 29 different CF centres (referral, support, and Paediatric Hospital "Bambino Gesù") sent their data to ICFR; data referred to the period 2011-2014. Data regarding Sardinia Region (Southern Italy) are missing; data from Molise (Southern Italy) CF centre refer only to 2014., Results: The present Report has been organized into 10 sections. 1. Demography - number of Italian patients with cystic fibrosis (CF) in 2014 was 4,981 and their median age was 20.4 years; estimated 2014 CF prevalence was 8.2/100,000 residents in Italy; on average, 52.1% of the patients were male and CF distribution showed higher frequency in patients aged from 7 to 35 years. On average, 53.7% of CF patients are aged more than 18 years. 2. Diagnoses - most of the CF patients were diagnosed before two years of age (around 66%); a significant proportion of patients (on average, 12%) was diagnosed in adult age. 3. New diagnoses - new diagnoses were 187 in 2011, 200 in 2012, 160 in 2013, and 135 in 2014. Estimated incidence was 1/4,052 live births in 2011; 1/4,313 in 2012; 1/5,189 in 2013 and 1/8,243 in 2014. 4. Genetics - 99.5% of patients was studied at the molecular level, with identification of 90.1% of Cystic Fibrosis Transmembrane Regulator CFTR mutations; [delta]508F was the most frequent mutation (44.8% in 2014). 5. Lung function - FEV₁ (Forced Expiratory Volume in the first second) scores progressively decreased shortly before the start of adult age, in accordance with the natural history of the disease. Most of the patients between 6 and 17 years of age reported a FEV₁ % ≥ 70% of the predicted value, while the proportion of patients with severe lung disease (FEV₁ % <40% of the predicted value) is <2% over the period 2011-2014. 6. Nutrition - most critical periods come out during the first 6 months of life and during adolescence. Prevalence of malnourished male aged 12-17 years decreases over the period 2011-2014; an increasing percentage of patient (both male and female) with a suboptimal body mass index value is observed among patients aged more than 18 years 7. Complications - the presence of missing data represents an obstacle in the correct evaluation of prevalence value of complications related to Italian patients within ICFR. Nevertheless, it was estimated that, in 2014, the principal complication in patients aged <18 years was hepatopathies (15%), while in patients aged more than 18 years the principal complications were due to hepatopathies (25%) and diabetes (22%). 8. Transplantation - during the period 2011-2014, 135 patients ageed between 7 and 53 years received a double lung transplant; median age at transplantation was 32.5 years. Median duration of waiting list for transplantation is estimated in 11 months. 9. Microbiology - analyses were referred to test performed in 2014. Prevalence of adult patients with Pseudomonas aeruginosa chronic infection is 49.4% compared to 14.5% of paediatric patients; Staphylococcus aureus chronic infection is present in 48% of adult patients and 45.6% of paediatric patients; Burkholderia Cepacia complex is present almost exclusively in adult patients (4.9%); Nontuberculous mycobacteria is present in 0.9% and 0.3% of adult and paediatric patients, respectively; Stenotrophomonas maltophilia infection is present in 4.6% of patients (both adults and paediatric). 10. Mortality - RIFC data show that 176 patients (median age 32 years; 81 males and 95 females) died in the period 2011-2014., Conclusions: The present Report shows that CF population is growing (median age), so paediatric mortality is decreasing. A very low percentage of paediatric population is characterized by complication of pulmonary functions; adult patients are characterized by an increase of age at death (more than 30 years of age). ICFR Report may represent an important tool to analyze clinical and epidemiological trends of the disease as well as to identify the main healthcare needs at regional and national level to contribute to the healthcare programmes and to the distribution of the resources.

In actively deforming regions, crustal deformation is accommodated by earthquakes and through a variety of transient aseismic phenomena. Here, we study the 2010-2014 Pollino (Southern Italy) swarm sequence (main shock M W 5.1) located within the Pollino seismic gap, by analysing the surface deformation derived from Global Positioning System and Synthetic Aperture Radar data. Inversions of geodetic time series show that a transient slip, with the same mechanism of the main shock, started about 3-4 months before the main shock and lasted almost one year, evolving through time with acceleration phases that correlate with the rate of seismicity. The moment released by the transient slip is equivalent to M W 5.5, significantly larger than the seismic moment release revealing therefore that a significant fraction of the overall deformation is released aseismically. Our findings suggest that crustal deformation in the Pollino gap is accommodated by infrequent "large" earthquakes (M W  ≥ 6.5) and by aseismic episodes releasing a significant fraction of the accrued strain. Lower strain rates, relative to the adjacent Southern Apennines, and a mixed seismic/aseismic strain release are in favour of a longer recurrence for large magnitude earthquakes in the Pollino gap.

The ISTIMES project, funded by the European Commission in the frame of a joint Call "ICT and Security" of the Seventh Framework Programme, is presented and preliminary research results are discussed. The main objective of the ISTIMES project is to design, assess and promote an Information and Communication Technologies (ICT)-based system, exploiting distributed and local sensors, for non-destructive electromagnetic monitoring of critical transport infrastructures. The integration of electromagnetic technologies with new ICT information and telecommunications systems enables remotely controlled monitoring and surveillance and real time data imaging of the critical transport infrastructures. The project exploits different non-invasive imaging technologies based on electromagnetic sensing (optic fiber sensors, Synthetic Aperture Radar satellite platform based, hyperspectral spectroscopy, Infrared thermography, Ground Penetrating Radar-, low-frequency geophysical techniques, Ground based systems for displacement monitoring). In this paper, we show the preliminary results arising from the GPR and infrared thermographic measurements carried out on the Musmeci bridge in Potenza, located in a highly seismic area of the Apennine chain (Southern Italy) and representing one of the test beds of the project.

Background: Experimental clinical observations suggest that fibrinolysis (FL) in acute myocardial infarction, even though reducing global mortality, is associated with an increasing incidence of death in the first 24-48 h. The responsible mechanism is not yet known, although available evidence supports heart rupture as the possible cause., Methods: We studied 154 patients at autopsy who died of cardiac causes from January 1, 1994 to December 31, 2005 among a cohort of 2260 patients who were admitted for ST-elevation myocardial infarction. They were divided into three therapeutic groups-- FL, coronary angioplasty (PTCA) and conventional therapy (CT)--in order to assess the incidence of cardiac rupture and compare it with the other causes of cardiac death., Results: Of the 896 patients (39.7%) who were treated with FL, 57 (6.4%) died; of the 804 (35.6%) treated with PTCA, 40 (5.05%) died, and of the 560 (24.7%) treated with CT, 57 (10.2%) died (p < 0.05 in the two first groups vs CT). We studied at autopsy 154 patients (mortality 6.7%). The mean admission delay was 5.05 h in the FL group, 7.04 h in the PTCA group, and 7.05 h in the CT group. Cardiac death occurred on average after 13 h in the FL group, after 15 h in the PTCA group, and after 19 h in the CT group. The cause of death was due to cardiac rupture in 56 patients (36.5%), to shock in 55 patients (35.7%), to electromechanical dissociation in 29 patients (18.8%), and to cardiac failure in 14 patients (9%). In the FL and PTCA groups, cardiac rupture was the major, and also the earliest (10 e 12 h, respectively), cause of death, whereas in the CT group cardiac shock (13 h) was the major cause of death. Anterior myocardial infarction (n = 104, 65%) was more prevalent in deceased patients, whereas inferior myocardial infarction was found in the other 50 cases (35%). Cardiac rupture was more prevalent in anterior myocardial infarction. In the FL and PTCA groups, histological examination showed unusual hemorrhagic infiltration in the necrotic areas with presence of leukocytes., Conclusions: Our study shows that cardiac rupture is the major cause of death in patients with ST-elevation myocardial infarction treated with FL and PTCA, suggesting that mechanical and lythic reperfusion injury, in coagulative necrosis, may represent a further cause of cardiac rupture that occurs early or within the first hours.

Bites of hymenopterans (bees, wasps and hornets) are very frequent phenomena that can stir up allergical reactions in venom-susceptible patients but that seldom provoke acute myocardial infarction. In the literature we can find case reports of myocardial infarction after bites of hymenopterans, and preceded by an allergic reaction (sometimes with angiographic evidence of undamaged coronary arteries). The pathophysiological determinant seems to be related to the chemical composition of hymenopterans venom, basically made up by vasoactive and thrombogenic substances able to create vasospasm and coronary thrombosis. Our report refers to a 65-year-old male patient without prior cardiological and allergic events who, bitten by a sharm of three bees, complains of an acute large anterior myocardial infarction with angiographic evidence of thrombotic lesion of the proximal left anterior descending artery treated with direct stenting with procedural success, without showing allergical symptoms. The pathophysiological determinant seems to be related to the release of vasoactive amines and thrombogenic substances contained into the hymenopterans venom, the former able to produce vasospasm, the latter able to create diffuse thrombosis. The use of adrenaline itself to counteract the possible systemic allergic reaction appears to advise against the treatment of patients with cardiological symptoms or coronary artery disease and because of its strong vasoactive activity (it leads, in fact, to vasoconstriction) and thrombogenic effects.

This article reports a case of infective endocarditis in a patient with a permanent pacemaker 15 months after the generator had been replaced. The patient had Staphylococcus epidermidis isolated in several blood cultures. No interventional or clinical procedure with any risk of bacteremia was performed, nor was any infective complication of the pocket observed. Thus, the portal of entry of the etiologic agent is unclear. The role of transesophageal echocardiography in detecting pacemaker-induced endocarditis is very important and therapy of choice involves removal of the pacemaker system as soon as possible.

A personal experience concerning vertebral excision and resection in a single stage for neoplasm is discussed. The surgery requires anaesthesia of long duration, hemodynamic stability, compensation of significant blood loss, monitoring of heat loss, maintenance without injury of prolonged prone position. Experience, with 24 cases lasting an average of 14.5 hours proves that inhalation or intravenous anaesthesia with a strong analgesic component is satisfactory. Normal heat saving systems reduce intraoperative hypothermia. Transfusion is always abundant, autologous contribution is moderate. Hemodilution is well-tolerated up to Hb 7%; below this amount there may be problems of a hemodynamic and coagulative nature. The quantity and quality of filling is guided by monitoring of pre-loading pressures and availability of oxygen. There were no critical complications; all of the patients left the hospital in good condition.

Background: Despite improvements in coronary care, cardiogenic shock (CS) remains the leading cause of death in patients with dramatic cardiac diseases of which acute myocardial infarction (AMI) is the most frequent event. Conventional therapy for CS with coronary care unit (CCU) monitoring and vasopressor agents to support blood pressure has historically been associated with an 80% to 90% mortality rate in large series. Intra-aortic balloon pump (IABP) therapy for shock results in initial favourable clinical and haemodynamic responses, but ultimately, in most patients, death is merely delayed and hospital mortality still exceeds 80%. In several recent non-randomised series, coronary revascularisation performed early in the course of CS with the use of coronary artery by-pass grafting (CABG) or coronary angioplasty (PTCA) resulted in an apparent reduction in the hospital mortality rate to less than 50% in selected patients with shock., Objectives: This study reviews our experience of cardiogenic shock treatment at a time when standard care included aggressive use of the intra-aortic balloon pump counterpulsation, cardiac catheterisation, coronary angioplasty and/or coronary artery by-pass grafting, ventricular septal defect and mitral incompetence repair., Methods: We retrospectively analysed 20 patients (13 M and 7 F, with an average age of 62 years and a half) affected by cardiogenic shock consecutively admitted to our CCU between October 1, 1992 and April 1, 1995. Fifteen patients (pts) were hospitalised for AMI, shock and pump failure (2 of them with pulmonary oedema), all with admittance delay less than 24 hours. Five patients were hospitalised for AMI with shock and mechanical defects, of which 3 pts with AMI and ventricular septal rupture and 2 pts with AMI and mitral regurgitation. All patients underwent IABP, coronary angiography (CA) and then were treated with PTCA, CABG and cardiac surgery or medical treatment., Results: On the whole, 7 pts died (35%): 4 of shock, 1 of haemorrhagic complications, 1 of septic shock in the CCU, and 1 of heart failure after CABG in cardiosurgery. One more patient died of heart failure two months after discharge (late mortality 5%). Out of the 15 patients hospitalised with AMI, shock and pump failure, 13 patients with AMI and CS less than 24 hrs were treated as follows: 1 patient was successfully submitted to emergency CABG and 12 patients to PTCA of the infarct related artery (IRA). Eight patients enjoyed a good outcome, but 1 patient died of haemorrhagic complications and 4 with a persistently occluded IRA also died (3 in the CCU and 1 after CABG). Of the 2 remaining pts with AMI, shock and pulmonary oedema, 1 patient underwent CABG with success and 1 patient with the 3-vessel disease was submitted to PTCA with reperfusion of the IRA, but he died from reocclusion three days later. Out of the 5 patients with AMI, shock and mechanical defects, 3 patients with AMI and septal ventricular rupture underwent cardiac surgery and CABG with early and late success. One of the 2 patients with AMI, shock and mitral regurgitation underwent cardiac surgery with valve repair and CABG and had a good outcome, the other died from septic complications in the CCU., Conclusions: IABP is an useful device for stabilising patients in cardiogenic shock and safely performing angiography as well as PTCA, CABG or surgical correction of all mechanical complications with a more stable haemodynamic balance. Therefore, IABP is an useful tool to improve successful coronary revascularisation after direct PTCA or direct CABG. These data also suggest that the combination of successful coronary revascularisation and intra-aortic balloon pumping can improve survival in pts with cardiogenic shock complicating AMI with early pump failure.

We report a case of a 61-year-old woman admitted to our Coronary Care Unit for pulmonary embolism following cholecystectomy. After thrombolytic therapy, and during treatment with heparin (administered as a continuous intravenous infusion in the standard dose), the patient had a recurrence of pulmonary embolism and a subsequent implant of a Gianturco-Rohem vena cava filter. The patient presented an initial reduction in the number of platelets from 477 x 10(3)/microliters to 360 x 10(3)/microliters that was ascribed to a heparin side effect or to a blocking of the platelets in a massive pulmonary thrombosis. A predischarge platelet count, however, showed an elevated number of thrombocytes (944 x 10(3)/microliters) and hyperfibrinogenemia (fibrinogen = 750 mg/dl). Essential thrombocythemia was demonstrated and treated with interferon alpha-2b-recombinant 3,000,000 U.I. on alternate days with a reduction in platelets to 450 x 10(3)/microliters. This case demonstrates the necessity of exploring, during pulmonary embolism, all possible causes of hypercoagulability in the course of thrombolytic therapy.

To evaluate the feasibility and the utility of an integrated service for the pre-hospital diagnosis and care of cardiovascular emergencies a new pre-hospital intensive care system has been developed. Such an emergency medical service relies on the telephone transmission of ECG and the conversation between the first aid service and the cardiologist of the hospital coronary care unit. It also implies early therapeutic intervention performed at home under the responsibility of the chief physician of the referring centre. From March '86 to December '88, 311 telephone ECG transmissions were obtained; the home diagnosis and the consequent proper therapeutic regimen were considered sufficient to avoid the transportation of the patient to the hospital emergency room in 43% of the cases. The symptoms were: precordial chest pain (54%); palpitations (10%); dyspnea (8.4%); hypertensive crisis (1.3%), dizziness or syncope (12.3%). Pre-surgical or organ transplantation controls totaled 13.5%. One-hundred-forty-eight patients were admitted to the coronary unit because of an acute myocardial infarction between June and December 1988. Forty-seven patients were sent by the family doctor (group I) and 30 patients by the first aid service (group II) without any electrocardiographic diagnosis or home therapy; 14 patients were sent by the first aid service after a telephone transmission of ECG and early therapeutic intervention (group III); 57 patients reached the hospital independently (group IV). The following differences among the groups were observed: only the patients of group III received proper early therapeutic regimen at home, and 85% were admitted within 4 hours of the onset of symptoms (vs 46% of the patients of the other groups).(ABSTRACT TRUNCATED AT 250 WORDS)

The hemodynamic monitoring of acute myocardial infarctions has been carried out in patients less than 75 y.o. who showed: a) extensive anterior myocardial infarction; b) inferior myocardial infarction and ST segment depression of the anterior chest leads; c) acute myocardial infarction and cardiac failure. The hemodynamic measurement were carried out at the 12 hours (mean) from the beginning of chest pain on 65 patients who suffered the first myocardial infarction and were protracted to 60 hours (mean). The hemodynamic findings were classified according to the relationship between the stroke work index of the left ventricle (LVSWI) and the mean pulmonary artery pressure (MPAP) as following: normals: 6 pts; hypovolemia: 15 pts; reduced compliance: 2 pts; mild LV failure: 19 pts; severe LV failure or shock: 23 pts. 35 pts have carried out a complete rehabilitation programme has shown an inverse linear relationship to the MPAP of the first recording in CCU. The incidence of death was 29% one year after the myocardial infarction and showed a significant relationship to the hemodynamic findings. The LVSWI resulted more sensitive than MPAP; 90% of patients who showed a LVSWI less than 20 gmb/m2 died.