[SICI-GISE Position paper on the standards of cardiac catheterization laboratories in Italy: qualitative and quantitative standards of the Nurses and Allied Professionals Group]. / Documento di posizione SICI-GISE sugli standard dei laboratori di diagnostica e interventistica cardiovascolare: le professioni sanitarie del comparto standard qualitativi e quantitativi.

This document aims to be an integral part of the SICI-GISE position document on standards and guidelines for cardiovascular diagnostic intervention laboratories published in October 2015. It was created with the aim of defining quality and quantitative standards by providing practical support for the structuring of a training course to reach high levels of assistance for nursing and technical personnel working within the catheterization laboratories. The competences detected are the expression of a highly specialized organizational and operational reality that combines technicality with a well-defined clinical assistance need as an expression of a real patient care. The Nurses & Technicians Area of SICI-GISE aimed at issuing a flexible and dynamic document based on technical and operational progress which, in addition to defining qualitative and quantitative standards, describes the underlying knowledge of the professionals of the sector operating in our laboratories. This is the first experience that, through a survey carried out in 2015, has been able to decline qualitative and quantitative data so as to provide resources and skills for measuring and improving assistance outcomes.

Intrahepatic portal venous systems in children with noncirrhotic prehepatic portal hypertension: anatomy and clinical relevance.

BACKGROUND: Children with extrahepatic portal hypertension typically present with cavernomatous transformation of the portal vein and a poorly defined intrahepatic portal vein system on conventional imaging. With the Meso-Rex Bypass becoming the gold-standard intervention for a cure, a precise assessment of the intrahepatic portal vein system provides helpful data for deciding whether a Meso-Rex Bypass is feasible or not. METHODS: All children with extrahepatic portal hypertension were prospectively assessed by wedged hepatic venous portography. Venous anatomy was categorized into five subtypes (A to E), depending on the presence of thrombosis in the Rex recessus, or not, and its extension within the intrahepatic portal venous system. RESULTS: Eighty-nine children entered the study. Previous umbilical vein catheterization is usually associated with Rex thrombosis, while the Rex recessus and the intrahepatic portal venous system are patent in idiopathic cases, thus allowing for the performance of a Meso-Rex Bypass with a good outcome. CONCLUSIONS: Wedged hepatic venous portography is a very effective tool for detailed preoperative assessment and identification of children being considered for Meso-Rex Bypass surgery. An anatomic-radiological classification is useful in selecting patients for Meso-Rex Bypass with anticipation of a high rate of success.

Kinetics of catecholamines and potassium, and heart rate during exercise testing in obese subjects. Heart rate regulation in obesity during exercise.

BACKGROUND: Obesity is characterised by a marked insulin resistance which involves an abnormal regulation of K(+) uptake and metabolism. Less is known about the effect of physical exercise on K(+) kinetics. AIM OF THE STUDY: To assess plasma catecholamines and potassium levels and their relationship with cardiac activity during a physical effort up to exhaustion in young obese subjects. METHODS: Blood samples for epinephrine (E), norepinephrine (NE), potassium (K+) and heart rate (HR) were collected at the end of every step during a progressive cycloergometric test up to exhaustion in twelve obese subjects (6 males, aged 26+/-2, BMI 39.9+/-1) and twelve normal subjects (6 males, aged 28.2+/-2, BMI 22+/-1). In every subject anaerobic threshold (AT) was detected. RESULTS: In obese subjects plasma catecholamines rose faster but had a lower peak in correspondence of maximal work-loads, with respect to controls. Catecholamines had a linear correlation in the obese group and a quadratic one in the control group when plotted vs O(2) consumption. The increase of plasma potassium was less in obesity than in control. CONCLUSIONS: During physical exercise K(+) and catecholamines kinetics differ significantly in obese subjects vs normals and they may justify a less prompt cardiac response at the higher work-loads and a lower work capacity. The present data can be interpreted in the light of the insulin resistance syndrome of obesity, which causes an abnormal regulation of the Na-KATPase and of K(+) channels during physical exercise. The results of the present study may be relevant to nutritionists when suggesting physical exercise to obese subjects.