Ten years experience in the treatment of pseudomyxoma peritonei by cytoreduction, peritonectomy and semi-closed hyperthermic antiblastic peritoneal perfusion.

BACKGROUND: In the literature good results have been reported for the treatment of Pseudomyxoma peritonei (PMP) by cytoreduction, peritonectomy and hyperthermic antiblastic peritoneal perfusion (H.A.P.P.). Forty-eight patients affected by PMP have been treated with this technique over the past ten years. PATIENTS AND METHODS: Peritoneal perfusion has been performed with the original semiclosed tecnique after complete surgical cytoreduction in 188 patients affected by peritoneal carcinomatosis. In 48 of the cases the patients were affected from PMP. Aggressive surgical cytoreduction was performed with multiple visceral resections and peritonectomies. RESULTS: Seventeen patients (38%) presented major perioperative complications, and in five cases the reoperation of the patient was required. In spite of this high complication rate, there was no perioperative mortality. The results of the Kaplan-Meier 5- and 10-year survival analysis, were 94% and 82%, respectively, with a disease-free survival of 80% at 5 years and 70% at 10 years. Thirty-nine patients (81.2%) had no evidence of disease at follow-up (range 1-120 months). DISCUSSION: Up to date, the most effective treatment for PMP has been aggressive cytoreduction plus H.A.P.P.

Erratum: "Eating and Nutrition Habits in Young Competitive Athletes: A Comparison Between Soccer Players and Cyclists".

[This corrects the article on p. 44 in vol. 11, PMID: 25674549.].

Medical simulation in anesthesiology training.

Simulators are more and more widely used in different scientific areas. Through very sophisticated and realistic simulations, they actually permit to teach and demonstrate theoretical or practical notions. Besides, they allow to evaluate a particular performance. In the latest years, the use of simulators has considerably developed in medicine. Anaesthetists have been the first to use and develop simulation. Having the possibility to deal with emergencies and getting accustomed to them without any real risk is an undeniable advantage. Even though the long-term effects due to a simulation session haven't been properly evaluated yet, it is important to bear in mind that simulators are being successfully used in an impressive number of centres in different parts of the world. The activities in the medical simulation centres deal to a certain extent with studying and teaching to manage critical events. This particular discipline, deriving from the aeronautic field, relies upon decision making and teamwork in order to manage the critical event most appropriately. Formative trainings, initially meant for anaesthetists and later on open to other medical categories as well, have been developed. Such courses aimed at establishing the proper interactions between different people with different tasks who are involved in the approach to an emergency rather than the management of the whole scenario. The main drawback of simulation is, however, the high costs required to set a simulation programme, especially as far as the human resources involved are concerned.

Bilateral concurrent massive hemoptysis successfully controlled with double endobronchial tamponade. A case report.

Massive hemoptysis is a potentially lethal situation for which emergency diagnosis and treatment are necessary. Endobronchial tamponade is widely used as a method for conservative management of massive hemoptysis by occluding the bleeding bronchus with a balloon catheter. Some balloon catheters can be introduced through the inner channel of a flexible bronchoscope. The main challenge in performing this procedure is how to remove the bronchoscope without displacing the catheter. Another technique is to place a catheter next to the fiberoptic bronchoscope and then advance the catheter to the hemorrhaging bronchial division. An advantage of this ''parallel technique'' is that the working channel is available for suction, lavage and for a biopsy forceps, that can be used to facilitate the positioning of the catheter. We used this technique to perform bilateral endobronchial tamponade with two 5 Fr Swan-Ganz catheters. This case shows that bilateral concurrent massive hemoptysis can be successfully controlled with the placement of more than one balloon catheter. This is a rare event and in the literature we found only one reference. The procedure was relatively easy to perform and well tolerated by the patient. In our opinion, this technique should be considered as a viable option in the treatment of massive hemoptysis especially in hospitals or patients where other treatments are impossible or contraindicated.

["Small volume resuscitation" in hypovolemic rats. Effects on microcirculation]. / "Small volume resuscitation" nel ratto ipovolemico. Effetti sulla microcircolazione.

BACKGROUND: Numerous publications have analysed the hemodynamic effects of "small volume resuscitation" during the initial phases of hemorrhagic shock. Nevertheless nowadays the information about microcirculatory effects are poor. The aim of this study was to estimate the change of tissue perfusion in hypovolemic rats, before and after infusion of Ringer's lactate (RL), hypertonic saline solution (HS) or blood. METHODS: Mesocecal microcirculation was visualized by intravital microscopy during 30 minutes of hemorrhagic hypovolemia (MAP, mean arterial pressure of 40 mmHg) and subsequent reinfusion period. Rats were resuscitated with RL (shed volume), HS (one-seventh of the shed volume), or blood (shed volume). The perfusion was estimated through speed of red blood cells. Moreover MAP, pH and B.E. was measured. RESULTS: Thirty minutes after hemorrhage a very important decrease of capillary flow was noticed and in lesser quantity, of the flow in arterioles and venules. The RL infusion did not cause measureable changes of microcirculatory blood flows. The HS infusion caused an improvement in the flow of arterioles and venules but not in capillaries. The blood infusion caused a progressive improvement in the flow of arterioles, venules and capillaries, however at slightly lower values than previous hemorrhage. CONCLUSIONS: Neither RL nor HS seem as efficient as blood to restore the microcirculatory blood flow in the mesocecum of the rats submitted to hemorrhagic hypovolemia.

[Apparent life threatening events (ALTE): prelude to SIDS? Description of 14 cases]. / ALTE: preludio alla SIDS? Descrizione di 14 casi.

The peak incidence of the Sudden Infant Death Syndrome (SIDS) is between 2 and 4 months of age. Its pathology is extremely heterogenous, infection, hypoxia and many others factors are all implicated. We examine here the possible relation between SIDS and Apparent Life Threatening Event (ALTE). We describe 14 cases that we have observed to establish a primary connection between these two situations and to identify a risk-group for an accurate follow-up.

[Atypical and incomplete Kawasaki disease]. / Le forme atipiche ed incomplete della malattia di Kawasaki.

Kawasaki Disease (KD) is an acute systemic vasculitic disorder of childhood of unknown etiology. Initially KD was thought to be a benign disease, but later on it became obvious that cardiac manifestations are present in about 25-30% of patients and lead to death in about 0.5-2% of them. An early diagnosis and treatment are important to avoid an unfavourable prognosis. In recent years, a number of publications described patients in which the diagnosis was delayed because they did not fulfil the required criteria of KD. These forms of KD are known as atypical or incomplete KD. The aim of this work is to describe two cases of atypical KD observed at the Department of Pediatrics, University of Pisa during the year 1992.