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Unlabelled: Telemedicine is the transmission of medical notices and images among remote sites, that uses adequate audio-video systems., Objective: To increase the quality and the amount of medical informations, avoiding unnecessary carriages. Among main fields of interest in Telemedicine, monitoring of cardiovascular parameters and medical emergency represent situations that need to be promptly and appropriately approached. In such a similar conditions, a preliminary transmission to III level Health Institutions of informations as Electrocardiograms or even Echocardiograms may play an essential role in the diagnosis, prognosis and treatment of emergent cardiovascular disease., Methods: Since March 1998, an Audio-Video PC-based system that uses integrated services digital network (ISDN) at a bandwith of 384 Kbps, was installed at Pediatric Cardiac Surgery Department of Giovanni XXIII Hospital, Bari, Italy. On July 1999, thanks to Research Funds of the Health Ministry of Italy, similar audio-video systems that use ISDN were installed in the main pediatric institutions of provinces of Puglia and linked in a wide area network., Results: We report the experience of Telemedicine of a Department of Pediatric Cardiology and Cardiac Surgery, and we try to analyze its impact on improvement of quality of care, once employed in provincial field.

Three cases of congenital angiodysplasies of the extremities, classified as Klippel-Trenaunay syndrome, underwent to surgical treatment. These cases, clinically similar, have shown a quite different pathogenesis, according to which the surgical treatment has been modified. Once again we recommend a complete diagnostic study every time one find varicosities of the extremities which are atipical for time of appearance, territories involved or for aspect and thus be congenital varicosities with complex pathogenesis.

Two cases of mesenteric syndrome were observed in 41 patients undergoing correction of aortic coarctation at the School of Heart and Large Vessel Surgery of the 1st Medical Faculty of Naples University. In the light of the latest theories regarding the pathogenesis of the mesenteric syndrome, post-operative arterial hypertension is held to be a decisive factor in the genesis of the complication. Control of pressure is therefore believed to be of considerable importance in the prevention and treatment of the syndrome.

For a preoperative evaluation of the factors influencing low output syndrome significatively in open heart surgery where statistically studied 15 factors upon a pattern of 400 patients operated with extracorporeal circulation: age, sex, weight; functional class; cyanosis; pulmonary hypertension; cardiopathy; arterial blood hypertension; myocardiopathy; left ventricular end-diastolic pressure; cardiac index; cardiothoracic index; aortic clamp duration; reoperation; extracorporeal circulation technique. Significant risk factors are: myocardiopathy; aortic clamp duration; functional class; pulmonary hypertension; reoperation; cardiac index; cardiothoracic index and arterial blood hypertension. These factors increase the studied pattern mean risk respectively of a 17.6%; 27.8%; 17.5%; 14.5%; 13.7%; 10.7%; 8.8% and 8.7%. Also myocardial protection technique was considered to be a significant risk factor, since mean risk for low output syndrome is much higher for these patients operated with the coronary perfusion, normothermy and simple hypothermy than for those operated with hypothermia and pharmacologic cardioplegia.

A technique is described for providing myocardial protection with cold cardioplegia in a patient with cold autoagglutinins. The operation was done in normothermia and the coronary system was perfused with a normothermic (+37 degrees C) NaCl 0,9% solution to remove the blood before in it introducing the cold (+4 degrees C) cardioplegic solution. With this technique, the patient underwent an uneventful operation to relieve right ventricular-outflow stenosis operation.

The inhibition of demand pacemakers by muscular potentials is rarely described in the literature. The Authors have found an interference of the pectoralis muscle's electric activity with pacemakers in 4 patients suffering from occasional faints. Extending this study to a group of 10 asymptomatic electrostimulated patients, pacemaker's inhibition by sub-maximal contraction of pectoralis major muscle has been found in 9 of them. The 4 symptomatic patients have been operated displacing the battery near the sternum. The poor thickness of the pectoralis muscle's fibres suggested the treatment. The controls performed from 2 to 8 months respectively have shown disappearance of the symptoms.