"Side" effects of HAART: decreasing and changing occupational exposure to HIV-infected patients.

To investigate percutaneous exposures to HIV in the highly active antiretroviral therapy (HAART) era, we performed an analysis of all percutaneous exposures reported from January 1994 to December 1998 in 18 Italian acute-care hospitals. Frequency and rate per 100 prevalent AIDS cases of HIV exposures decreased by 40% (from 4.3% to 2.6%, and from 1.0% to 0.6%, respectively; p<0.001), which were mainly those related to the insertion/manipulation of peripheral vascular access devices (from 7.2% to 4.8%; p=0.05). We conclude that the benefits of HAART have changed the complexity of care required and therefore, the number and type of procedures performed on HIV patients that place the HCW at risk of injury.

[Pharmacological tests in the polycardiography of valve defects]. / Le prove farmacologiche nella policardiografia dei vizi valvolari.

Pharmacological tests are often indispensable in non-invasive polycardiographic diagnosis. Their advantages include easy execution, repeatability, and the absence of significant side-effects. Amyl nitrate, angiotensin and isoproterenol are most commonly employed for this purpose. Cases in which such tests enabled a correct evaluation of valve disease, congenital heart disease, and malfunction of a valve prosthesis to be made are presented.

Dilated (congestive) cardiomyopathy. Follow-up study of 137 patients.

The purpose of this study was to examine the clinical course of dilated (congestive) cardiomyopathy (DCM) and to identify the factors of prognostic significance. Between January 1969 and April 1982, 137 patients with a diagnosis of dilated cardiomyopathy were followed-up for a mean period of 48,7 +/- 40 months. Mean duration of illness before the first study was 15,5 months. A history of excessive alcohol intake was present in 22% of the patients and an influenza like syndrome in 9%. At diagnosis most of the patients were in NYHA functional class IV (43,5%) and III (35%). The 5-year survival rate was 45%, the mean annual mortality rate 10,2% and the highest mortality rate 14% in the second and third year. One hundred and seven patients (78%) progressed to major complications (worsening heart failure and death), while thirty patients (22%) showed stable or even improved conditions. Systemic or pulmonary emboli occurred in 18% of the patients, with a significant prevalence in patients with atrial fibrillation (p less than 0,05). Prognosis was unfavorably affected by the following factors: bi-ventricular heart failure as first clinical manifestation (p less than 0,01), intraventricular conduction delay (LBBB, LAHB) (p less than 0,05), significant cardiomegaly (cardiothoracic ratio greater than 0,53, p less than 0,001), left ventricular dysfunction (left ventricular fractional shortening less than 14%, p less than 0,005, left ventricular end-diastolic pressure greater than 17 mmHg, p less than 0,05, left ventricular end diastolic volume greater than 185 ml/m2, p less than 0,001, cardiac index less than 2,2/min/m2, p less than 0,001).