Echocardiography-guided pericardiocentesis with probe-mounted needle: report of 53 cases.

Fifty-three pericardiocentesis procedures were performed on 48 patients from 1993 to 2000 at our coronary care unit. Percutaneous puncture (anterior thoracic in 43 cases, subxiphoid in 10 cases) was performed at the site closest to the exploring probe, where the largest amount of fluid was detected. A needle carrier supported by a bracket with two fixed angulations was mounted on the probe. The needle was advanced through the tissues and inside the pericardial space under continuous visualization. The procedure was successful in 52 of 53 cases. In 1 case of diagnostic pericardiocentesis, the pericardial space was impossible to reach because of the minimal amount of pericardial fluid. In 1 case of acute tamponade after transcatheter ablation of the atrioventricular node, the pericardial puncture caused a pleural-pericardial shunt with consequent drainage of pericardial fluid into the pleural space and symptom resolution. In 1 case, a transient atrioventricular type III block occurred. Emergency surgical drainage was not required in any of the cases. No puncture of cardiac walls ever occurred in this series of patients. No major complications occurred; the incidence of minor sequelae was lower than the incidence reported by other studies on pericardiocentesis without continuous visualization. Our technique appears to be safe and easy to perform even in the presence of minimal amounts of pericardial fluid.

Embryonic and neonatal mortality from salmonellosis in captive bred raptors.

In a captive breeding center near Rome (Italy), cases of embryonic and neonatal death were recorded during the breeding seasons in the European eagle owl (Bubo bubo), peregrine falcon (Falco peregrinus), buzzard (Buteo buteo), and lanner falcon. (Falco biarmicus). Salmonella havana and S. virchow were isolated. Three pulli, clinically infected with S. havana, were successfully treated with enrofloxacin. From two groups of healthy 3- to 4-wk-old eagle owls, Salmonella sp. group 61 (61:r:-) and S. havana were collected. A strain of S. paratyphi B was detected in a pharyngeal swab and a fecal sample from an adult female goshawk (Accipiter gentilis), affected with pharyngeal trichomoniasis. A S. hadar strain was collected from a healthy 1-yr-old female eagle owl and S. livingstone was isolated from a 1-mo-old female peregrine, dead of an acute respiratory syndrome. Lesions of fibrinous polyserositis and multivisceral congestion were observed. From frozen 1-day-old chicks, on which adult and young raptors were fed, S. havana and S. livingstone isolates with similar biochemical and drug susceptibility patterns to those isolated from raptors were identified. A surveillance program on infectious diseases reduced embryonic and neonatal death rates in the following breeding seasons.

Occurrence of Salmonella in swine in the Latium Region (central Italy) from 1980 to 1989: a retrospective study.

An extensive survey was carried out on 849 biological samples (dead animals, organs and viscera, faeces, and rectal swabs) from pigs in the Latium Region (Central Italy) throughout the years 1980-1989. In total, 46 of the samples (5.4%) were found to be bacteriologically positive for salmonellae. Among dead animals, typical gross lesions were observed in 6 clinically infected animals. As far as serotypes are concerned, 11 different ones were isolated, with a predominance of Salmonella typhimurium (26.1%), S. anatum (21.7%), S. bovis-morbificans (15.2%), and S. heidelberg (10.8%). According to Kauffmann-White's classification scheme, 39.1% of the isolated strains belonged to serogroup B, 13% to serogroup C1, 17.4% tot serogroup C2, 6.5% to serogroup D, and 23.9% to serogroup E1. In conclusion, the authors speculate that the relatively low Salmonella isolation frequency (5.4%) reported in this study was not dependent upon the cultural procedures used, since different enrichment and plating methods were used, but rather upon the great number of rural-type herds which were investigated over the decade compared to industrial-type herds. Other factors such as stress conditions, which are particularly pronounced in industrial-type herds, and overall climatic situations, which tend to be characterised by warm, dry and long summers in the Latium Region, are also considered in this respect.

[Heart arrest]. / L'arresto cardiaco.

Cardiac arrest is one of the leading causes of mortality in industrialized countries and is mainly due to ischemic heart disease. According to ISTAT estimates, approximately 45,000 sudden deaths occur annually in Italy whereas according to the World Health Organization, its incidence is 1 per 1000 persons. The most common cause of cardiac arrest is ventricular fibrillation due to an acute ischemic episode. During acute ischemia the onset of a ventricular tachyarrhythmia is sudden, unpredictable and often irreversible and lethal. Each minute that passes, the probability that the patient survives decreases by 10%. For this reason, the first 10 min are considered to be priceless for an efficacious first aid. The possibility of survival depends on the presence of witnesses, on the heart rhythm and on the resolution of the arrhythmia. In the majority of cases, the latter is possible by means of electrical defibrillation followed by the reestablishment of systolic function. An increase in equipment alone does not suffice for efficacious handling of cardiac arrest occurring outside the hospital premises. Above all, an adequate intervention strategy is required. Ambulance personnel must be well trained and capable of intervening rapidly, possibly within the first 5 min. The key to success lies in the diffusion and proper use of defibrillators. The availability of new generation instruments, the external automatic defibrillators, encourages their widespread use. On the territory, these emergencies are the responsibility of the 118 organization based, according to the characteristics specific to each country, on the regulated coordination between the operative command, the crews and the first-aid means. Strategies for the handling of these emergencies within hospitals have been proposed by the Conference of Bethesda and tend to guarantee an efficacious resuscitation with a maximum latency of 2 min between cardiac arrest and the first electric shock. The diffusion of external automatic defibrillators is a preventive measure. Such equipment has permitted early defibrillation by non-medical first-aid personnel. These instruments contain software capable of recognizing an arrhythmia which may be defibrillated and of instructing the operator whether and when to press the defibrillation button. The latest instruments deliver the shock by means of a biphasic wave necessitating a lesser amount of energy which can be provided by lighter condensers. Thus such equipment weighs just a couple of kilograms. As suggested by ILCOR, for reasons of priority, such instruments should not only be available within hospitals and in ambulances but also on the territory, in particular in more crowded places. The availability of external automatic defibrillators in such places should reduce the time latency before intervention and thus increase survival. The ILCOR guidelines have suggested the constitution of an itinerary team well equipped for defibrillation and composed of trained personnel of State Institutions such as the Municipal Police, Traffic Police and the Fire Brigades. With regard to the majority of arrhythmias amenable to defibrillation which occur at home or in less crowded places, other strategies, such as primary prevention and training programs for categories at increased risk, must be employed. Antiarrhythmic drugs have long been considered the best solution for the prevention and treatment of ventricular tachyarrhythmias. However, the approach to these pathologies has drastically changed during the last few years owing to accumulating evidence in favor of defibrillators which may be implanted for the primary and secondary prevention of malignant ventricular arrhythmias. For patients with previous cardiac arrest, randomized studies have proven the advantages of such an approach compared to medical therapy. On the basis of the above, the guidelines for the use of antiarrhythmic implants have been modified. In most western countries, the laws regarding this aspect of medicine have recently been renewed. In the United States, where there is the "Law of the Good Samaritan", in order to protect and acquit persons who give first-aid, many states have adopted new laws which promote the use of external automatic defibrillators. Following recent dispositions by the President of the United States that defibrillators should be present in all Federal properties and on civil aircraft, a new Federal Law is about to pass. Italy lacks legislation regarding the use of defibrillators: in order to rectify this position, which is still anchored to existing dispositions of the civil and penal codes including those regarding the omission of first-aid, a bill entitled "The definition and modalities of the use of the external cardiac defibrillator" has recently been presented.

Risk factors for treatment failure in patients with severe acute cardiogenic pulmonary oedema.

Intubation is necessary in 7 to 20% of patients with severe acute cardiogenic pulmonary oedema despite optimal treatment. This study evaluated the usefulness of parameters largely available in clinical practice to predict the need for intubation in a population of acute cardiogenic pulmonary oedema patients treated with medical therapy and continuous positive airway pressure. The present retrospective cohort study involved 142 patients with severe acute cardiogenic pulmonary oedema who were admitted to coronary care or the intensive care unit of a university hospital and were treated by an in-hospital protocol. Physiological measurements and blood gas samples were evaluated at 'baseline' (just after admission), 'early' (one to three hours after beginning treatment) and 'late' (eight to 10 hours after beginning treatment). Twenty-two patients (15.5%) required intubation. A systolic blood pressure at admission lower than 140 mmHg was significantly associated with a higher risk for intubation, while hypercapnic patients or those with a reduced left ventricular ejection fraction at admission did not show a worse prognosis. A simple score based on largely available parameters (1 point for each: age >78 years, systolic blood pressure <140 mmHg at admission, arterial blood gas acidosis and heart rate >95 bpm at early time) is proposed. The rate of intubation according to this score ranged from 0% (score of 0) to 90% (score of 3). Our study found that simple parameters available in clinical practice are significantly associated with the need for intubation in acute cardiogenic pulmonary oedema patients treated with continuous positive airway pressure and medical therapy. A simple score to evaluate the need for endotracheal intubation is proposed.

Early development of eye and retina in lanternfish larvae.

The morphological characteristics of the eyes and the retinae of lanternfish larvae of Lampanyctus crocodilus, Benthosema glaciale, and Myctophum punctatum were analyzed in pre-flexion, flexion, and post-flexion stages. Pre-flexion larvae of L. crocodilus, the species with the shallowest depth distribution, had spherical eyes located antero-laterally on a strongly laterally-compressed head, suggesting a forward binocular visual field. B. glaciale and M. punctatum larvae live deeper in the water column and had eyes elongated in the dorsal-ventral plane. The eyes of B. glaciale were prominent, projecting slightly outward from a laterally-compressed head, suggesting a strongly laterally-directed visual field. M. punctaum had stalked elongated eyes projecting from a dorso-ventrally flattened head. The eyes can be freely rotated allowing lateral, anterior and dorsally-directed vision. A prominent choroidal gland was situated beneath the ventral portion of the eye in M. punctatum and B. glaciale, while a smaller gland was present in the dorsal and ventral portions of the eye of L. crocodilus. In pre-flexion stage larvae, the retina of all three species was differentiated with numerous rod photoreceptors in the peripheral retinal areas and fewer cone photoreceptors mainly distributed in the central retina. This distribution suggests concomitant enhancement of scotopic sensitivity in the vertical visual plane and improved photopic acuity in the lateral and forward visual directions. The concurrent development of cones and rods, as observed in the pre-flexion stage of myctophid larvae, is consistent with meeting the special demands of visual planktivory in sub-surface waters. During larval development a gradual increase of ROS length was also accompanied by a progressive loss of cones that were almost totally absent in post-flexion larvae. This can be interpreted as an adaptive response to an impending deep mesopelagic adult life.

Retinal ganglion cell topography in elasmobranchs.

Retinal wholemounts are used to examine the topographic distribution of retinal cells within the ganglion cell layer in a range of elasmobranchs from different depths. The retina is examined for regional specializations for acute vision in six species of selachians, Galeocerdo cuvieri, Hemiscyllium ocellatum, Scyliorhinus canicula, Galeus melastomus, Etmopterus spinax, Isistius brasiliensis, one species of batoid, Raja bigelowi and one species of chimaera, Hydrolagus mirabilis. These species represent a range of lifestyles including pelagic, mesopelagic and benthic habitats, living from shallow water to the sea bottom at a depth of more than 3000 m. The topography of cells within the ganglion cell layer is non-uniform and changes markedly across the retina. Most species possess an increased density of cells across the horizontal (dorsal) meridian or visual streak, with a density range of 500 to 2,500 cells per mm(2) with one or more regional increases in density lying within this specialized horizontal area. It is proposed that the higher spatial resolving power provided by the horizontal streak in these species mediates panoramic vision in the lower frontal visual field. Only I. brasiliensis possesses a concentric arrangement of retinal iso-density contours in temporal retina or an area centralis, thereby increasing spatial resolving power in a more specialized part of the visual field, an adaptation for its unusual feeding behavior. In Nissl-stained material, amacrine and ganglion cell populations could be distinguished on the criteria of soma size, soma shape and nuclear staining. Quantitative analyses show that the proportion of amacrine cells lying within the ganglion cell layer is non-uniform and ranges between 0.4 and 12.3% in specialized retinal areas and between 8.2 and 48.1% in the peripheral non-specialized regions. Analyses of soma area of the total population of cells in the ganglion cell layer also show that the pelagic species possess significantly smaller soma (9-186 micrometer(2)) than benthic and/or deep-sea species (16-338 micrometer(2)), and that a number of different morphological classes of cells are present including a small population of giant ganglion cells.

Cardiac involvement by non-Hodgkin's lymphoma: an unusual presentation of heart conduction disturbances.

A 57-year-old man with non-Hodgkin's lymphoma presented with solitary sinus node dysfunction. Superior vena cava syndrome and progressive disturbance of the conduction system requiring dual chamber pacemaker implantation later appeared. Combination chemotherapy and radiation reversed abnormal sinus node function and the AV conduction disturbance, as demonstrated during electrophysiological evaluation.