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BACKGROUND: A prospective randomized trial to compare normothermic CPB with hypothermic CPB has been performed. METHODS: 132 patients undergoing CPB were randomized into two groups: group 1 underwent normothermic CPB and group 2 hypothermic CPB (between 26 and 30 degrees C). RESULTS: Any significant difference was observed between the groups with regard to hospital mortality, blood transfusions, incidence of neurologic deficits and hematocrit, blood hemoglobin levels, platelet counts, plasma concentrations of glutamic-pyruvic transminase, glutamic-oxaloacetic transaminase, creatine kinase, valued at the 12th and 24th postoperative hour and at the 2nd, 3rd, and 4th postoperative day. A significant difference was observed between the groups with regard to tracheal extubation time, discharge time from the intensive care unit and inotropic drug infusion. The normothermic CPB patients group needed shorter time for tracheal extubation and discharge from the intensive care unit: this difference may be ascribed to a shorter inotropic drug infusion. Any increased surgical risks have been observed. CONCLUSIONS: In conclusion, we think that normothermic CPB is favourable because it can reduce costs, it can improve the management of a cardiac surgery unit and it is more comfortable for patients.

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Dissection of the aneurysm is the most dangerous step during graft replacement of the descending thoracic aorta. Sudden hemorrhage may follow wall rupture or disruption of major collaterals before the aorta can be clamped. A simple modification of the classic Gott is illustrated, which makes the shunt work also as a partial bypass if needed, with rapid reinfusion of blood losses. Nineteen of 25 patients requiring resection of descending aortic aneurysms from 1982 to 1990 were treated with this method with no mortality.

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Hyperthermic antiblastic isolated perfusion is a method largely used for the treatment of locally advanced limb melanoma. The method requires vascular isolation and hyperthermic perfusion of the limb using an extracorporeal circuit and administering the melphalan as antiblastic drug. Twenty-six patients with primary or recurrent melanoma of the limbs have undergone this treatment at our Institute. There were no cases of operative mortality and systemic toxicity was negligible. The local complications were transitory and no patient showed symptoms of nervous toxicity or permanent functional damage. Two cases of deep thrombophlebitis and two of lymphocele were documented a few months after treatment. Four clinically complete responses, 3 partial and 2 cases of stable disease were observed in the 9 patients treated with unexcised lesions. Our data like the totality of the present experience points to the safety of this method in the therapy of locally advanced limb melanoma. Nevertheless further controlled studies are required to define its role in order to improve survival.

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A detailed review and analysis of world literature on the techniques employed for the retrieval of polythene catheter fragments, metal spindles or Pudenz catheters from the heart or large vessels is presented. Non-surgical retrieval techniques are discussed on the basis of 174 cases reported in the literature. 2 personal cases of the retrieval of foreign bodies from the heart using a Deyhle-Seubert catheter are presented.

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Cardioplegia gave excellent results in a preliminary series of 33 cases in which it was used during surgery. The fact that a sinus rhythm was re-established at the end of extracorporeal circulation in patients in atrial fibrillation suggests that it exerts an antiarrhythmic action at the atrial a level.

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The Authors report on their own experience of 77 lithium pacemaker implanted between 1974 and September 1977 in the Centre of Cardiac Surgery of the University of Genova (Italy). Only one generator has been replaced till now because of liquid infiltration. Rate variations in pacemaker marketed by Sorin were studied, considering the test-stand rate the first control and the following rate controls; the reliability of this parameter was confirmed.

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After a brief examination of the technical problems of current pacemakers, with special reference to the battery state control, the authors present a new technique for such control. A power stabilizer able to generate a standard pulse of 4.3 in every condition of battery charge has been fitted on the power supply of a fixed rate pacemaker of normal production. By activating (through an external magnet) such apparatus, it is possible with an easy oscilloscopic measurement to obtain the real value of the battery voltage. Thus the comparison with previously taken measurements and the errors connected with the repetition of such measurements can be avoided. The stimulation rate and the pulse duration corresponding to the discharged state of the batteries can also be known in advance. The data obtained from the first two controls are reported.

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Reference is made to three cases in proposing an explanation for the shifting of endocavitary catheters, namely traction of the lead attached to the lower side of the stimulator owing to movement of the apparatus, resulting in displacement of the tip. It is pointed out that the intravasal length of the displaced catheter is markedly decreased in 3 out of 4 cases. Attention is therefore drawn to the importance of the relation between catheter and stimulator in causing a high percentage of the case of displacement observed.

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