Prospective comparison of laparoscopic left hemicolectomy for colon cancer with laparoscopic left hemicolectomy for benign colorectal disease

BACKGROUND

Short-term outcome and anorectal function results after laparoscopic hemicolectomy for colon cancer were compared with results after laparoscopic hemicolectomy for benign diseases.

METHODS

A total of 108 patients who underwent laparoscopic left colectomy (60 for colon cancer, 48 for diverticulitis or polyposis) were enrolled in the study. Left hemicolectomy in patients affected by cancer was performed by high ligation of the inferior mesenteric artery. A questionnaire concerning anorectal function was mailed to patients 6 months after surgery.

RESULTS

Complications were more frequent in the cancer group than in the benign disease group: overall morbidity rate (29.6% versus 8.7%; P = 0.009), diarrhea during the first 6 postoperative months (58.7% versus 34.1%; P = 0.022), and anorectal function problems (fecal incontinence and/or the inability to discriminate between gas and stool, and/or urgency, and/or tenesmus) (65.2% versus 31.7%; P = 0.002).

DISCUSSION

The level of ligation of the lower mesenteric artery and damage at the lower mesenteric ganglion could explain the poorer anorectal function outcome in the colon cancer group.

[Particulate matter (PM10) air pollution, daily mortality, and hospital admissions: recent findings]

The first studies conducted to evaluate a possible association between air pollution and mortality date back to the serious events that occurred in the Mosa Valley, Belgium (1930), in the small city of Donora ("killer fog" incident of 1948) and in London (1952). The latter episode led to the introduction of air pollution control policies. Following the introduction of air pollution control measures in economically advanced cities in the 60s and 70s, the concentration levels of pollutants reached were believed, for many years, to be risk free. However, despite improvements in air quality achieved by many industrialized countries the negative effects of air pollution remain today an important public health problem. Among all air pollutants, particulate matter is the type of air pollution that causes the most numerous and serious effects on human health, because of the broad range of diverse toxic substances it contains,. For this reason, when assessing human health risk, PM10 may be considered to be a reliable indicator of the impact of global air pollution. Various epidemiologic studies conducted in the last 10 years, such as the Air Pollution and Health-European Approach (APHEA) project, the National Morbidity, Mortality and Air Pollution (NMMAPS) Study and Italian Meta-analysis of Studies on the short-term effects of Air pollution (MISA), have shown that current ambient concentrations of PM10 may lead to increased mortality and morbidity. Various studies have reported mean increases in mortality below 1% for 10 ?g/mc increases of ambient PM10. Studies have also underscored the role of particulate matter in aggravating cardiorespiratory diseases and consequently increasing hospital admissions. Air quality standards have been recently revised by legislation. The EU has issued a directive that sets limiting values and, where appropriate, threshold values, for the different air pollutants.

Multicity Italian study of congenital cytomegalovirus infection

BACKGROUND

Cytomegalovirus (CMV) infection is the most frequent congenital infection in humans. Its prevalence and the frequency of disabling sequelae must be assessed in different populations to permit the formulation or assessment of preventive measures.

OBJECTIVES

To check the prevalence of congenital infection and seroprevalence in Italy; to verify the rate of sensorineural hearing loss (SNHL) in infected infants; and to assess the proportion of children with SNHL attributable to congenital CMV infection.

METHODS

Diagnosis of congenital CMV infection was sought in 9032 children born between March 2002 and February 2003 by testing for viral DNA [CMV dried blood spot (DBS) test] in each newborn's Guthrie card and confirmation by isolation of CMV from urine collected in the first 3 weeks of life; CMV IgG testing in 1200 women of childbearing age; clinical and audiologic tests in the first 24 months for infected children; CMV DBS tests on the Guthrie cards collected from screening centers for 77 children (3 months-5 years) presenting SNHL of 40 dB or more.

RESULTS

CMV infection was diagnosed in 14 asymptomatic and 2 symptomatic newborns (0.18%). CMV seroprevalence was 80%. In 2 infected infants, transient, unilateral SNHL was found. Nineteen of the 71 children with SNHL >70 dB were congenitally infected.

CONCLUSIONS

The prevalence of congenital CMV infection is low in Italy. Population characteristics limiting the circulation of CMV strains in adult women might explain this. The fact that CMV contributes to significant SNHL highlights the need for preventive measures.

Status of immunity against poliomyelitis: a study among European and extra-European young immigrants living in Parma

From January 2001 to December 2003 blood specimens obtained from 323 European and extra-European young immigrants were collected for the determination of anti-polio antibody levels. They were sent to the Section of Hygiene, Department of Public Health, by the Local Health Authorities. A neutralization assay was performed to detect the anti-polio antibodies against serotypes 1, 2 and 3, using rhesus monkey kidney cells. The results showed 98,1% prevalence of anti-polio 1 antibodies (titre > or =1:2), 99,1% of anti-polio 2, and 98,8% prevalence of anti-polio 3 antibodies. The seronegativity against only one or two serotypes (antibody titre <1:2) was found in 9 subjects (2,8%) while no subject was found totally seronegative against all 3 serotypes. According to the total amount of the analyzed samples, the estimated Geometric Mean Titre (GMT) resulted from moderate to low (GMT=29 of serotype 3; GMT=48,4 of serotype 2; GMT=56,5 of serotype 1) and it appeared to be similar to the results obtained in the previous years for all 3 serotypes; the GMT of serotype 3 was still the lowest. No difference was observed in the specimens with respect to the country of origin of the examined subjects and the data collected showed a good level of immunity.

[Sensorineural hearing loss in childhood: evaluation of economic impact in view of vaccine prevention of cases due to congenital cytomegalovirus infection]

Sensorineural hearing loss (SNHL) is a serious public health problem which affects 1-3% per hundred live born babies in developed countries. The congenital cytomegalovirus (CMV) infection is its most important non-genetic cause. The evaluation of the effectiveness of future programs of anti-CMV vaccination requires an assessment of the present costs of SNHL. Direct costs for the Italian public system were calculated per prosthesis child until his full age and turned out to add up to 260,000 euro. Private costs are difficult to be assessed and anyhow are highly dependent from the socio-economic level. This preliminary assessment suggests that the vaccination would be cost-saving if SNHL cases due to congenital CMV were more than 21 per year, corresponding to a congenital infection prevalence higher than 0.21%o.

Anti-Saccharomyces cerevisiae and perinuclear anti-neutrophil cytoplasmic antibodies in coeliac disease before and after gluten-free diet

BACKGROUND

Anti-Saccharomyces cerevisiae and perinuclear anti-neutrophil cytoplasmic autoantibodies are markers of Crohn's disease and ulcerative colitis respectively.

AIM

To determine the prevalence of anti-S. cerevisiae and perinuclear anti-neutrophil cytoplasmic autoantibodies in a large series of coeliac disease patients before and after gluten free diet, and to correlate anti-S. cerevisiae-positivity with intestinal mucosal damage.

METHODS

One hundred and five consecutive coeliac disease patients and 141 controls (22 ulcerative colitis, 24 Crohn's disease, 30 primary sclerosing cholangitis, 15 postenteritis syndrome, 50 blood donors) were tested for anti-S. cerevisiae by enzyme-linked immunosorbent assay and for perinuclear anti-neutrophil cytoplasmic autoantibodies by indirect immunofluorescence.

RESULTS

In coeliac disease anti-S. cerevisiae (immunoglobulin G and/or immunoglobulin A) were slightly less frequent (59%) than in Crohn's disease (75%, P = 0.16) and significantly more frequent than in ulcerative colitis (27%), primary sclerosing cholangitis (30%), postenteritis syndrome (26%) and blood donors (4%) (P = 0.009, P = 0.0002, P = 0.025, P < 0.0001). No correlation was found between anti-S. cerevisiae and degree of mucosal damage. Perinuclear anti-neutrophil cytoplasmic autoantibodies were detected only in one coeliac. After gluten free diet the disappearance of anti-S. cerevisiae-immunoglobulin A (93%) was more frequent than that of immunoglobulin G (17%, P = 0.0001); perinuclear anti-neutrophil cytoplasmic autoantibodies disappeared in the only coeliac positive at diagnosis.

CONCLUSION

More than half of untreated coeliacs are anti-S. cerevisiae-positive irrespective of the severity of mucosal damage. Differently from immunoglobulin A, anti-S. cerevisiae-immunoglobulin G persisted in more than 80% after gluten free diet. The high prevalence of anti-S. cerevisiae in coeliac disease suggests that they may be the effect of a non-specific immune response in course of chronic small bowel disease.

The Western immunoblotting pattern of anti-mitochondrial antibodies is independent of the clinical expression of primary biliary cirrhosis

Anti-mitochondrial antibodies are the serological markers of primary biliary cirrhosis. We analysed the detailed anti-mitochondrial antibodies patterns to see whether the immunological specificities detected at the time of the diagnosis correlate with the histological, clinical and immunological expression of the disease. One hundred and thirty primary biliary cirrhosis patients were studied at the time of presentation/diagnosis. Anti-mitochondrial antibodies reactivity was dissected and evaluated by Western immunoblotting with bovine heart submitochondrial particles as antigenic source. Six different Western immunoblotting patterns have been identified with the following hierarchy: pattern A (anti-PDC-E2+anti-E3BP, 38.5%), pattern B (anti-PDC-E2+anti-E3BP+anti-OGDC-E2, 20.8%), pattern C (anti-PDC-E2+anti-E3BP+anti-BCOADC-E2+anti-OGDC-E2, 13.1%), pattern D (anti-PDC-E2+anti-E3BP+anti-BCOADC-E2, 6.9%), pattern E (anti-BCOADC-E, 6.1%) and pattern F (anti-mitochondrial antibodies negative primary biliary cirrhosis, 14.6%). The different patterns were neither associated with peculiar clinical, biochemical, histological and immunological features nor with the Mayo Risk Score. The anti-mitochondrial antibodies pattern at presentation is independent of the stage of the liver disease; therefore, the Western immunoblotting characterisation of anti-mitochondrial antibodies does not seem to be helpful in identifying the clinical, biochemical or histological expression of primary biliary cirrhosis at the time of the diagnosis.

Anti-actin IgA antibodies in severe coeliac disease

Anti-actin IgA antibodies have been found in sera of coeliacs. Our aim was to define the prevalence and clinical significance of anti-actin IgA in coeliacs before and after gluten withdrawal. One hundred and two biopsy-proven coeliacs, 95 disease controls and 50 blood donors were studied. Anti-actin IgA were evaluated by different methods: (a) antimicrofilament positivity on HEp-2 cells and on cultured fibroblasts by immunofluorescence; (b) anti-actin positivity by enzyme-linked immuosorbent assay (ELISA); and (c) presence of the tubular/glomerular pattern of anti-smooth muscle antibodies on rat kidney sections by immunofluorescence. Antimicrofilament IgA were present in 27% of coeliacs and in none of the controls. Antimicrofilament antibodies were found in 25 of 54 (46%) coeliacs with severe villous atrophy and in three of 48 (6%) with mild damage (P < 0.0001). In the 20 patients tested, antimicrofilaments IgA disappeared after gluten withdrawal in accordance with histological recovery. Our study shows a significant correlation between antimicrofilament IgA and the severity of intestinal damage in untreated coeliacs. The disappearance of antimicrofilament IgA after gluten withdrawal predicts the normalization of intestinal mucosa and could be considered a useful tool in the follow-up of severe coeliac disease.

Modification of CMV DNA detection from dried blood spots for diagnosing congenital CMV infection

BACKGROUND

Detection of viral DNA in dried blood spots using the Guthrie card (DBS test) is a reliable and practical method of diagnosing congenital cytomegalovirus (CMV) infection. The test lends itself to epidemiological studies to establish the prevalence of the infection, but also to neonatal screening for secondary prevention of sequelae. These applications would be facilitated if it were possible to use smaller samples and do the test on pools of individual cases.

OBJECTIVE

To ascertain whether doing the test on smaller, pooled samples still accurately identifies neonates with congenital CMV infection.

STUDY DESIGN

We tested DBS from: (A) 39 laboratory reference cases; (B) 156 neonates suspected of having congenital CMV infection; (C) 119 children examined for the retrospective diagnosis of congenital CMV; (D) mock specimens prepared with known amounts of viral DNA.

RESULTS

The test using only one third of the usual amount of dried blood was 100% sensitive and specific compared to the standard DBS test (A) and to viral isolation (A and B). Pools of three single cases gave the same results as viral isolation (B) and the small-sample test (B and C). All the versions of the test gave a detection limit of 400 copies/ml.

CONCLUSIONS

The modified procedure can accurately diagnose congenital CMV infection. It achieves savings in both the patient material and the costs of testing.

Health hazard evaluation in private dental practices: a survey in a province of northen Italy

The purpose of this questionnaire survey was to evaluate the knowledge and attitudes of private dental health care workers about cross-infection hazards through examination of practising behaviour in respect of infection control. A questionnaire was sent by mail to the private dentists operating in Parma province. The survey concerned 7 groups of questions about demographic data, personal protective equipment, immunization, sterilization and disinfection, waste disposal and occupationally acquired injuries, behaviour. Four hundred questionnaires were sent to the members of the Medical and Dentist College of Parma: 122 were returned and analysed (30.5%). Among the infectious diseases 45% of the interviewed think that the most dangerous diseases are Hepatitis B and C, followed by HIV infection (21.5%). The most used personal protective equipments are gloves (98%), masks (95%) and protective eyewear (94%). Sixty eighth per cent of the dentists treat HBV, HCV, HIV, TB, HSV suffering patients at the end of the working day. Twenty nine point 7% of them claim to have written protocols to follow in case of accident. Altogether the results show a good knowledge of the most important risks related to dentistry activity and of the main procedures for the infection control and management.

[Microbial air monitoring in operating theatre: active and passive samplings]

Microbial air contamination was evaluated in 11 operating theatres using active and passive samplings. SAS (Surface Air System) air sampling was used to evaluate cfu/m3 and settle plates were used to measure the index of microbial air contamination (IMA). Samplings were performed at the same time on three different days, at three different times (before, during and after the surgical activity). Two points were monitored (patient area and perimeter of the operating theatre). Moreover, the cfu/m3 were evaluated at the air inlet of the conditioner system. 74.7% of samplings performed at the air inlet and 66.7% of the samplings performed at the patient area before the beginning of the surgical activity (at rest) exceeded the 35 cfu/m3 used as threshold value. 100% of IMA values exceeded the threshold value of 5. Using both active and passive sampling, the microbial contamination was shown to increase significantly during activity. The cfu values were higher at the patient area than at the perimeter of the operating theatre. Mean values of the cfu/m3 during activity at the patient area ranged from a minimum of 61+/-41 cfu/m3 to a maximum of 242+/-136 cfu/m3; IMA values ranged from a minimum of 19+/-10 to a maximum of 129+/-60. 15.2% of samplings performed at the patient area using SAS and 75.8% of samplings performed using settle plates exceeded the threshold values of 180 cfu/m3 and 25 respectively, with a significant difference of the percentages. The highest values were found in the operating theatre with inadequate structural and managerial conditions. These findings confirm that the microbiological quality of air may be considered a mirror of the hygienic conditions of the operating theatre. Settle plates proved to be more sensitive in detecting the increase of microbial air contamination related to conditions that could compromise the quality of the air in operating theatres.

[Air pollution and mortality and hospital admission for respiratory disease in Parma on 1992-2001 period]

A study into the effects of atmospheric pollution on the health of people living in the city of Parma (population 170,000) shows motor vehicle traffic of average density and light industrial activities that have little impact on air pollution. General mortality and hospitalisation for all causes and for DRG specific were considered as sanitary events. The day values of the total PT, PM10, SO2 and NO2, CO and benzene were analysed. In addition, atmospheric conditions and outbreaks of flu were considered. The study results for the period 1992-2001 show quite moderate pollution levels with the sole exception of PM10 that shows average values often higher than 40 microg/l. An analysis of the associations between mortality and climatic parameters shows the role of temperature with RR equal to 1.0064 (CI95% 1.0046-1.0082) and epidemics of influenza with RR 1.042 (CI95% 1.0219-1.0671). As regards the pollution parameters, the total PT and SO2 turned out to be related to increases in mortality of respectively 0.6% for 100 microg/m3 of PT and 1.72% for 50 microg/m3 of SO2 while the NO2 turned out to be related to an increase in hospitalisations of 1.9% for 10 microg/m3 of NO2.

[Presence of disinfection by-products (DBPs) and other halogenated compounds in drinking water samples collected in the areas of Modena and Parma]

The Authors report data about the presence of Disinfection By-Products (DBPs) and other halogenated compounds in drinking water samples collected in the areas of Modena and Parma (20 water supplies). Trihalomethanes, chlorite and chlorate (only in water samples treated with chlorine dioxide), and halogenated compounds were investigated. On the whole, trihalomethanes were evidenced in the 85% of the samples (n. 285) at low levels, while chlorite and chlorate were present in the 67% and 63% of the treated samples with chlorine dioxide (257 samples). Chlorite mean and median values were 225.70 microg/l and 136.75 microg/l respectively, ranging from 20 to 2000 microg/l. Chlorate concentrations were lower than chlorite: the mean value was 102.93 mg/l, while median level was 50 microg/l (range: 20-1500 microg/l). The high concentrations of chlorite and the wide range of values within each municipality plant in Modena and Parma suggest to investigate further in order to evaluate the human exposure in drinking water thoroughly.

[Evaluation of the immune status against poliomyelitis in a group of young immigrants]

The immunity state towards poliomyelitis has been evaluated in 506 young immigrants coming from European and extraeuropean countries without immunization history. Polioviruses 1, 2 and 3 antibodies were detected in 97% of the serum samples. 15 subjects did not have detectable antibodies at 1:2 dilution for one or two polioviruses. Out of these subjects, 6 (coming mostly from East European Region) were negative in the undiluted serum too. On the whole, GMTs for type 1 (43,29) and 2 (41,9) appeared higher than those for type 3 (33,6). Moreover there are differences among the origin countries; in fact, GMTs more elevated for type 1 and 3 (74,6 and 49,6 respectively) have been observed in the subjects coming from the African region, as well in those coming from the American region.

[Measurement of anti-HBs antibodies in a population of 18-year-olds 6 years after the primary vaccination series]

We have analized the persistence of vaccine-induced antibodies to hepatitis B surface antigen, in a cohort of 445 eighteen-year-old males, who had been immunized against hepatitis B six years earlier (when they were 12 years old, according to the Italian law). These young men were about to begin their military service and were going through the routine check-up. They came from two different towns Reggio Emilia and Mantova, in the north of Italy, and were divided into two groups (group A no 258 men, group B no 187 men) depending on where they had been vaccinated. The serologic results showed that 97% of subjects had anti-HBs and 94% anti-HBs protective levels (> or = 10 mIU/ml). Moreover 81% of responder subjects showed titles > or = 100 mIU/ml, and 25% showed titles even > or = 1000 mIU/ml. Anti-HBs GMT of the total responders was 367.1. Differences have been found in the anti-HBs levels of men vaccinated in the two different towns.

[Neuroleptic malignant syndrome. Case reports]

Neuroleptic malignant syndrome is a serious adverse reaction of neuroleptic drug therapy, composed of mental status changes, muscular rigidity, hyperthermia, signs of autonomic instability and typical laboratory findings. The syndrome has received increased attention in the scientific literature since 1980; nevertheless some weighty issues regarding clinical symptoms, etiopathogenesis and treatment require additional studies. This paper presents 9 cases of neuroleptic malignant syndrome prospectively observed in 8 inpatients and 1 outpatient with different psychiatric diagnosis. Levenson's diagnostic criteria were fulfilled in 7 cases; the remaining two had slighter symptoms. So neuroleptic malignant syndrome is to be considered a rare but not unusual side effect of neuroleptics. The risk of syndrome doesn't seem to be correlated with chemical class, D2 receptor affinity and total dosage of neuroleptics; a key factor seems instead to be a quick loading rate of neuroleptics. Seven of 9 cases displayed severe changes in mental status (clouding of consciousness that varies from stupor to coma), violent psychomotor excitement and aggressiveness before the onset of the syndrome. Such clinical features seem themselves, in our experience, to be potential risk factors besides reason for an increase of neuroleptic dosage. Neuroleptic malignant syndrome usually is preceded by prodromal signs, the most important appearing the worsening of alterations in consciousness. Symptoms of neuroleptic malignant syndrome usually appear abruptly and in some cases with a dramatic course; they last, in cases with favourable outcome, a few days to two weeks from neuroleptic withdrawal; by far the worst outcome, instead, occurs if diagnosis and drug discontinuation are not carried out early. The first measure in the treatment of neuroleptic malignant syndrome consists of prompt discontinuation of all neuroleptic medications and other psychopharmacological cures, except for benzodiazepines, and institution of supportive therapy; such interventions can resolve the most of cases. Three patients treated with bromocriptine and/or dantrolene didn't display a different duration of clinical symptoms and rate of complications if compared to patients treated with supportive therapy only. Use of bromocriptine or dantrolene, or both, therefore should be considered as a second line of action. In four cases, neuroleptics were reintroduced within few days of recovery; low potency neuroleptics were employed, given low doses which gradually increased: in none of the 4 cases did the patients experience partial or complete recurrence of neuroleptic malignant syndrome.

[The role of HBV and HCV viruses in the pathogenesis of hepatic lesions in alcoholics]

Due to the high prevalence in the population of both viral hepatitis and alcoholism it is not uncommon to find patients with chronic hepatitis in whom both these stigmata are simultaneously present. In such cases, the risk of evolution to cirrhosis is thought to be greater. In this study was evaluated 104 alcoholic patients (50 of whom had hepatic biopsy), with or without antibodies (ab) to hepatitis C virus (HCV). In addition, we retrospectively examined 183 hepatic biopsies of alcoholic patients with or without hepatitis B virus (HBV markers). At the end of the study the following conclusions were drawn: (i) Contact with HBV is unlikely to effect either the histologic picture or the course of alcoholic liver disease. (ii) The incidence of ab to HCV is higher in more advanced stages of the disease. (iii) As regards biopsies of alcoholic patients, sometimes it was impossible to establish a relationship between piece-meal necrosis or portitis and viral markers of hepatitis; therefore, other factors may be synergic with alcohol (ie nutritional, immunologic, genetic factors, concomitant diseases, etc.). For each of these factors, the relative risk of cirrhotic evolution could be assessed by a multicenter survey with case-control design.