Abstract Introduction: Iatrogenic acute aortic dissection (IAAD) type A is a rare but potentially fatal complication of cardiac surgery. Methods: The purpose of this article is to review the literature since the first reports of IAAD in 1978, examining its clinical characteristics and describing operative details and surgical outcomes. Moreover, we reviewed the recent literature to identify current trends and risk factors for IAAD in minimally invasive cardiac surgery procedures, often related to femoral artery cannulation for retrograde perfusion. Results: We found that IAAD ranges from 0.04 to 0.29% of cardiac patients in overall trials and ranged from 0.12 to 0.16% between 1978-1990, before the minimally invasive surgical era. And we concluded that since the first cases to the recent reports, the incidence of IAAD has not significantly changed. As minimally invasive procedures are on the rise, some authors think that the incidence of IAAD could increase in the future; we think that using all the precaution - such a strict monitoring of perfusion pressure throughout the intervention, avoiding extremely high jet pressures using vasodilators, repositioning of arterial cannula, or splitting perfusion in both femoral arteries -, this complication can be extremely reduced. Finally, we describe a very singular case occurring during mitral valve replacement followed by spontaneous dissection of left anterior descending artery one month later. Conclusion: The present article adds to the literature a more detailed clinical picture of this entity, including patients' characteristics, the mechanism, timing, and localization of the tear, and mortality details.

INTRODUCTION: The Regulation (EC) No. 1272/2008 on classification, labelling and packaging of substances and mixtures (CLP) sets further obligations for manufacturers, importers, distributors, downstream users of substances either on their own or in mixtures. According to the European mandate, each Member State has constituted its National Helpdesk to provide advice to the interested parties on their duties under this Regulation. In Italy, the contact point for questions has been established at the National Centre for Chemical Substances of the Istituto Superiore di Sanità. FUNCTIONS: The responders of the Italian CLP Helpdesk process the requests that have been submitted by the dedicated website. Applicants are asked to complete the form with all the required information. The Helpdesk staff also take part in the European network of CLP, REACH and ECHA Helpdesks together with the European Commission and other parties, that is the HelpNet. RESULTS: The present paper describes the results of the three-year activity of the Italian CLP Helpdesk (2009-2011).

INTRODUZIONE: Il Regolamento (CE) No. 1272/2008 (CLP) relativo alla classificazione, all'etichettatura e all'imballaggio delle sostanze e delle miscele fissa ulteriori obblighi per i fabbricanti, gli importatori e gli utilizzatori a valle di sostanze in quanto tali o in componenti di miscele. Su mandato dell'Europa, ogni Stato Membro ha stabilito l'Helpdesk Nazionale con lo scopo di fornire assistenza alle imprese nell'adempimento dei vincoli imposti da tale regolamento. In Italia, il punto di contatto per i quesiti e stato istituito presso il Centro Nazionale Sostanze Chimiche dell'Istituto Superiore di Sanità. FUNZIONI: Il personale dell'Helpdesk CLP italiano risponde ai quesiti posti dalle aziende inviate tramite il sito web appositamente dedicato. Su questo sito è presente una scheda da compilare, a cura delle imprese, nella quale sono richieste alcune informazioni. Inoltre, lo staff dell'Helpdesk partecipa attivamente al circuito degli Helpdesk degli Stati Membri CLP, REACH e dell'ECHA insieme alla Commissione Europea ed altre parti interessate denominato HelpNet. RISULTATI: La presente pubblicazione descrive i risultati dell'attivita svolta dall'Helpdesk CLP italiano nel periodo di tempo che va dal 2009 al 2011.

National CLP heldpesk is a service established in every Member State providing advice to companies and other stakeholders on the obligations they may have under CLP. In Italy the national helpdesk is located into the Center of Chemical Substances (CSC) in the National Institute of Health. Helpdesks will provide with wide ranging information on the provisions of CLP. They will also advice on the responsibilities the suppliers of chemical substances have to fulfill under these Regulations. Too specific questions cannot be answered as the aim of the helpdesk is to give a general interpretation of CLP principles and requirements instead of solving tailor made problems.

L'helpdesk nazionale è un servizio stabilito presso ogni Stato Membro per fornire supporto alle ditte e agli altri soggetti interessati sugli obblighi del CLP. In Italia l'helpdesk nazionale è stabilito presso il Centro Nazionale Sostanze Chimiche (CSC) dell'Istituto Superiore di Sanità. L'helpdesk fornisce un ampio ventaglio di informazioni sui requisiti del Regolamento CLP e consiglia in merito alle responsabilità dei fornitori di prodotti chimici nel soddisfare i requisiti del CLP. Le risposte ai quesiti non risolvono le esigenze troppo specifiche dei singoli richiedenti. Lo scopo dell'helpdesk è quello di fornire interpretazioni di applicabilità generale pur riferite a casi specifici.