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Antarctic expeditions are an important testing area for technology and procedures, such as telemedicine, with analogies for space and other extreme, isolated and remote environments. Telemedicine has also implications in reducing risks and costs related to accidents and health-care in general in Antarctica. During the last 14 years, since the very beginning of Italian Antarctic activities, we have tested many different technological solutions, and set up a link between one of the largest Italian hospitals, San Camillo in Rome, and the principal Italian Antarctic Base at Terra Nova Bay. In this paper, we discuss the road we have travelled in a field with many fast technological changes, and reflect on procedures and protocols. Once we had Health, today we have eHealth.(Int J Circumpolar Health 2004; 63(4):436-442)Keywords: Antarctic, maritime satellites, telemedicine

Objective: The aim of this double-masked, placebo-controlled trial was to confirm the anaesthetic effect of EMLA cream compared with placebo when used for sharp debridement of venous leg ulcers and to test its feasibility with respect to the usual procedure. Methods: One hundred and ten patients with venous ulcers were randomised to EMLA or placebo cream treatment for 30-45 min. Pain from debridement was evaluated by the patient on a 100 mm visual analogue scale (VAS) and by the physician on a verbal scale. Results: The median VAS scores were 16.5 and 52 in EMLA- and placebo-treated patients, respectively (pConclusion: Debridement of venous leg ulcers using topical anaesthesia is easy and safe, with adequate pain relief in both in- and outpatients.

Among 34 patients under observation, two young women, aged 23 and 24, developed Takayasu's disease (Takayasu's arteritis) associated with Crohn's disease. The typical vascular symptoms of Takayasu's arteritis developed late during a quiescent phase of Crohn's disease. We discuss the usefulness of diagnostic methods, particularly the contribution of duplex Doppler. Currently, this method appears to provide effective diagnosis of Takayasu's arteritis although clinical data, including hyposphygmy of the radial arteries and carotidynia (pain appearing along the carotid course) are still fundamental. The possible etiopathogenic relations between these two diseases and correlation of results with those in the literature are discussed (J Mal Vasc 1999; 24: 373-376).

The atherosclerotic disease is a very important problem for the health in the advanced countries. The Rose's questionnaire was utilised for diagnosing the intermittent claudication but the current diagnostic method is the ankle-arm blood pressure ratio (Winsor's index). The incidence of intermittent claudication is 0.4% to 14.4%, utilising the Rose's questionnaire and 4.2% to 35% using the Winsor's index. The main risk factor for the peripheral arteriopathies is the smoke followed by the hypertension and the diabetic disease. The dyslipidemic and coagulative diseases are important risk factors in some populations. The main cause of death is the myocardial infarction. The risk increases when it is present a cerebral or coronary arterial pathologies.

The authors report a clinical and ultrastructural study on a group of patients with angiomegaly, a vascular disorder characterized by elongated and distended blood vessels affecting the arterial (arteriomegaly) and/or venous system (venomegaly). The arterial group, drawn from a large arteriographic series, focuses on a comparison between atherosclerotic arteriopathy and arteriomegaly. The venous group, drawn from a large ultrasound series of vein disorders, is made up of patients with venomegaly. Venomegaly gives rise to few or no symptoms and it appears to be less frequent than arteriomegaly but as the latter proved to be associated in the majority of cases studied. Based on ultrastructural findings, the chief abnormality of angiomegaly seems to lie in a specific alteration of the elastic component of the vessel wall. We found slightly osmiophil amorphous elastic material neighbouring the basement membrane of the myocytes of the vessel walls. In the superficial parts of these myocytes occurred a great number of pinocytotic vesicles indicating for a rich creation of the new elastic material. Middle or highly osmiophil thick elastic fibers with irregular side protrusions were also found among myocytes remembering the moth-eaten picture. Results from a large ultrasonographic study on patients' relatives suggest an inheritability of this vascular disorder.

Deep venous thrombosis with pulmonary embolism is considered rare in pediatric population, but a literature review points out this disease more frequent than would be expected in children. The low incidence and the poor consideration of this occurrence in pediatric age group, cause the thromboembolic disease with pulmonary involvement an often missed diagnosis. The illness is usually related to intravenous catheters, surgery, trauma, sepsis, prolonged immobilization, neoplasia, drugs, some congenital or acquired diseases. The Authors report their experience with two pediatric cases of inferior vena cava thrombosis and pulmonary embolism treated with anticoagulant therapy, temporary vena cava filters and locoregional fibrinolysis.

The Doppler venous pressure measurement has been used by us since 1977 [1] with interesting results and usefulness not only in the diagnosis of venous diseases but also in the management of therapeutical treatment both in acute and chronic venous pathologies. There is difference between the tensive noninvasive Doppler values, repeatedly proposed by us [2,3,4,5,6] and those quoted by literature and obtained by invasive method [7,8].

Satisfactory function of vascular access is essential for adequate haemodialisys in patients with chronic renal failure. We propose a new non-invasive method to assess function of some vascular accesses. Thermal imaging is hightly developed with contemporary infrared imaging systems having thermal and spatial resolution far in excess of the earlier systems of 1960s. Real time imaging together with efficient processing has improved the ease of use and quality of information.

To evaluate whether there exists a simple method to detect patients risking pulmonary oedema at high altitude (due to Acute Mountain Sickness) and better understand its physiopathology.

In 1942, Leriche described the first "dolichomégaartères" (or "arteriomegaly" according to the definition subsequently proposed by Anglo-Saxon researchers). We detected 199 cases of arteriomegaly (16.29% of cases examined) during a review of 1,221 translumbar arteriographies of the lower limbs performed from 1980 to 1985 in the vascular radiology department of our hospital. The percentage of associated aneurysms was 33.16%. The possible dysplastic pathogenesis of the affection and the differential diagnosis with atherosclerosis and other vascular affections found in connective tissue diseases is noted. Histopathology showed dystrophic lesions of the media and especially of the elastic fibers as well as occasional associated venous lesions and a familial basis. The peripheral symptomatology was acute, pseudoembolic and severe as revealed by ischemia and cyanosis. There was no collateral circulation. Medical treatment consisted especially in anti-coagulant and hypervolemic hemorrheologic therapy during ischemia. Ultrasonography enabled us to monitor the regular, systematic course of arteriomegaly, to make the diagnosis initially, to measure the exact size of the arteries, to observe the morphology of the wall and, moreover, to determine the presence or not of megaveins capable of reinforcing the dysplastic genesis of arteriomegaly.

Blood and plasma viscosity, erythrocyte filtrability and blood gas analysis were determined in 25 subjects with arteriosclerosis obliterans of the lower limbs before and after a muscle exercise test. Thirty-six shear rates between 0 and 230 s1 were studied to obtain viscosity curves, and regression analysis was performed for each curve. Mean viscosity curves for pathologic and control populations were plotted. The purpose of the study was to determine whether viscosity curves for blood and plasma before and after exercise, based on a high number of measurements, can provide information on rheological changes during intermittent claudication. Practically all viscosity curves in pathologic and control subjects could be described using a hyperbolic equation. Plasma as well as blood viscosity increased in pathologic subjects after exercise. However, erythrocyte filtrability and blood gas analysis in pathologic and control subjects, and blood and plasma viscosity in control subjects, showed no statistically significant changes after exercise. It is suggested that muscle exercise in reduced blood flow conditions can alter the aggregation of macromolecular complexes of plasma proteins, which could have an influence on cell components by modifying blood rheological behavior during claudication.

Specific seroagglutination tests were performed in 70 patients with Buerger's disease to detect possible antibodies to rickettsia, the test being repeated in 8 cases after activation by doxycycline administration over 10 days. In 21 patients a Weil-Felix test was also carried out. Tests were assessed as positive in 44 cases (62.8%): 18 times for Rickettsia Q. 18, 14 times for Rickettsia Mooseri, 13 times for Rickettsia Burnetii, 5 times for Rickettsia Conorii and 3 times for Rickettsia Prowazekii. After activation by doxycycline the antibody titre was increased 5 times, unchanged 3 times and reduced once. The Weil-Felix gave positive results in 3 of the 21 cases (14.28%), the reaction being positive to Rickettsia Prowazekii. These findings provide supplementary arguments for a possible pathogenic role of rickettsial infection in Buerger's disease.

Using the Doppler, we have studied the venous pressure, with the patients standing, of 6,172 legs. In a normal subject, the index of average pressure is 59 mmHg in the posterior tibial vein, and 58 mmHg in the long saphenous vein. Where there are varicose veins, the average pressure is 90 and 96 mmHg in the deep veins and in the superficial veins. In the case of post-phlebitic syndrome, the average index is 101 and 102 mmHg in the deep and superficial veins. In this work, the credibility of the method is discussed, and in particular, in comparison with the surgical methods, and its usefulness in current phlebological practice is defined.

A case of combined congenital discrete subaortic stenosis and infundibular pulmonic stenosis is described. Clinical, haemodynamic data and surgical results are reported. Only one similar case has been previously described.

A study was carried out in 127 patients (94 males and 33 females) presenting with arteriosclerosis (88 patients) or diabetic vasculopathy (39 patients) in different stages of severity (Fontaine) to assess the effectiveness and tolerance of treatment with high doses of pentoxifylline. Patients received a daily dosage of 2200 mg, given as 800 mg orally and 300 mg by intravenous infusion in saline twice daily, for a mean period of 15.8 days. Relevant clinical parameters were assessed and measurements made of biological and laboratory indices before and after treatment. The results showed that intermittent claudication was improved in 52.4% of the arteriosclerotic and 50% of the diabetic patients Stage II disease, pain at rest disappeared in 64% and 78% of patients in Stage III, respectively, and trophic lesions in Stage IV patients were reduced or became less clearly marked in 47% and 44%, respectively. Arterial blood pressure, recorded on the tibial arteries using Doppler ultrasound, showed a mean increase of 18%, but no significant changes in blood flow were evident from rheographic examination. Whole blood erythrocyte filtration time was reduced by a mean of 8%. The main changes in the biological indices after treatment were decreases in haematocrit, mean corpuscular volume and blood fibrinogen values, but these were not statistically significant. The other variables showed little if any change. Side-effects initially reported by the patients consisted of headache, nausea, sweating, pruritus and general malaise, and were mainly associated with the infusion time and regressed in most cases when this was extended.