[Guidelines for return to work of patients with infarction and coronary disease treated by angioplasty and/or by-pass].
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Biomedical subjects
Publications and source records attributed to F Gobbato.
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The authors report on pollution measures in some operating theatres and consider biological data for the hepatic and hemopoietic functions in operating room personnel and in control groups. Waste gas concentrations range from 17.3 to 22.6 ppm for enfluorane and from 500 to 1275 for N2O in theatres not equipped with antipollution systems. Pollution is 3-8 times lower when a scavenging system is present, while with horizontal laminar air flow exhaust in function, the gas concentration in the air is insignificant. Tests for the hepatic and hematological functions, done on 61 operating room personnel, 87 ward nurses, and 69 technicians and physicians of radiology services, do not show any significant difference between those exposed to anesthetic gases and controls.
In 1,405 patients who died at the General Hospital of Trieste in 1974 and 1978, malignant neoplasm was revealed at autopsy. Clinical diagnosis was accurate in 54 per cent of these patients. The tumor was clinically suspected in 19 per cent and was undiagnosed in 27 per cent. The accuracy of the clinical diagnoses varied significantly according to the primary site and type of tumor; accuracy was inversely related to the age of the patient and varied also according to the department of the hospital to which the patient had been admitted. This latter variation is age-dependent, too. In the past decades clinical diagnosis of malignancy has not greatly improved, although the autopsy rate has almost everywhere strongly decreased, representing a heavy handicap in the epidemiologic research on cancer as a cause of death.
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The authors analysed the behaviour of the mechanical systole (electromechanical systole; tension time, left ventricular ejection time), as well as of the diastole (both cardiac and hemodynamic diastole) during exercise tests performed on a bycicle ergometer, with 40, 80, 120 watt workloads. The mechanical systole--as well as its components--duration is influenced, during exercise test, by both heart rate and stroke volume--pulse pressure being assumed as an indirect index of the latter. The study of the correlation between the two above mentioned parameters has a great importance in evaluating the cardiac pump efficiency both in health and disease. The study of the behaviour of diastole is likewise very important, as it provides useful information concerning: a) the length of the cardiac muscle post-exercise recovery phase; b) the coronary available perfusion time; c) the Windkessel (arterial bellows) emptying time. Moreover, the blood pressure fall rate in diastole is an useful indirect measure of the peripheral resistance changes during muscular work. A statistical analysis is made and the correlation coefficients and the regression equations between the various parameters are defined.
The kinetics of carbon monoxide absorption was studied by the authors. An equation is proposed which enables to define the percentage of blood HbCO on the basis of the CO concentration in the air, the length of exposure, and the lung ventilation. The results proved to be satisfactory and were found to be comparable to the experimental data reported in the literature. A set of nomograms is reported which enables to define the blood HbCO saturation on the basis of the parameters which it depends on, therefore appearing to be very profitable to the physician in order to foresee and then prevent the hazard of acute carbon monoxide poisoning.
Several surveys of ethrane pollution were made by the authors in operating rooms, either equipped or not with general ventilation systems, during operations where non-rebreathing anaesthesia devices were used. In operating rooms without general ventilation systems, but with simple air conditioning systems, ethrane pollution was found to be rather high and to attain 30-40 ppm at the fourth hour of operation. No statistically significant differences were elicited among levels found at the anaesthetist, surgeon and assistance personnel sites. The authors analyze the kinetics of ethrane pollution as a function of its consumption and of time and discuss the most suitable means for decreasig and preventing such pollution.
The authors examined the electrocardiographic features of ventricular fibrillation and other ventricular paroxysms induced by electric shock in the guinea pig. The analysis of the electrocardiographic patterns, as well as the vectorial study of the cardiac potentials during repeated episodes of ventricular "anarchy" induced in more than forty animals, showed the following data: 1. following electric shock, ventricular paroxysms appear, featuring paroxysmal tachycardia, typical or impure flutter, tachycardia--either "torsade de pointe" or "spindle" type, and typical ventricular fibrillation. Such different electrocardiographic patterns represent evolutive stages of electric activity disorganization, leading to a complete ventricular "anarchy". Such steps may reverse when reorganization of the electric activity and spontaneous defibrillation occur; 2. an attempt can be made at present to classify ventricualr paroxysms, thus eleminating semeiotic and semantic errors, still present in the literature, and providing a standardization of both nomenclature and electrocardiographic interpretation; 3. during fibrillation, the mean ventricular rate decays, featuring an exponential curve. This phenomenon accounts for a metabolic depletion of the myocardium: the higher the number of fibrillation episodes previously induced and subsided (either spontaneously or not) in the same animal, the faster the course of the phenomenon; 4. the vectorial analysis of the fibrillation potentials and, particularly, the graphic construction of "depolarization" and "repolarization" vectorcardiograms, in the differenttypes or variants of ventricular paroxysms, show that the basic mechanisms leading to ventricular electric activity disgregation are the multiple re-entry and the irregular spreading of the activation front; 5. on the basis of the acquired data, the authors believe that the "circus movement" theory (Wiggers) is still the most suitable for explaining the onset and the evolution of ventricualr fibrillation.
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