Workload Balancing in Emergency Night Shifts for a Multicenter Diagnostic Imaging Department: a RIS-Integrated Solution

The purpose of this short report is to illustrate the implementation of a RIS function for balancing radiological activities and workloads between two different teams of radiologists from the same Diagnostic Department during emergency nights and holiday shifts. One group is from the main hospital, Arcispedale S.Maria Nuova di Reggio Emilia, and the other group belongs to the five minor hospitals in the district of Reggio Emilia.The implementation of a dedicated balancing function in the RIS system successfully allows the balancing of the radiological activity between two or more teams of different radiologists, while preserving the care continuity of care and the involved workers' experience and confidence in reporting.

[Urinary evaluations of drug consumption among workers having high risk of accident: technical difficulties, limits and possibilities of increasing efficacy of the law]

Urinary evaluations of drug consumption among workers having high risk of accident became compulsory in Italian legislation few years ago. We report results of 322.110 single urinary drug detections carried out between 2008 and 2011 on 35.789 subjects. We verified technical difficulties arisen during laboratory detections and organizational difficulties evidenced by Occupational Doctors during collections of samples. We screened 701 positive samples (1.96%), mostly to Cannabinoids and Cocaine, verified using first and second level screening according to national law. Many patients referred regular or irregular use of medicines active on Central Nervous System frequently ignoring their collateral effects. After the evidence of a positive result, during a second medical visit, many workers referred assumption of "natural diet supplements" acquired not in traditional commercial distributors. In two cases we have had the possibility of analyzing these supplements which have shown the presence of law concentrations of drugs in their compositions.

Prognostic value of motor evoked potentials in stroke motor outcome

Functional study technologies of the central nervous system (CNS) are fast developing, yielding further objective data for evidence based neurological rehabilitation. Transcranial magnetic stimulation is a safe and non invasive technique of functional investigation of several aspects of the CNS. During the past few years many studies have focused on motor evoked potentials (MEPs) in the investigation of central nervous system and particularly of central motor pathways. Among the various issues of rehabilitative concern in this context, the prognostic value of MEPs of motor outcome after stroke is the most interesting one. The aim of this review, conducted on Medline database, is to find out the current agreement in the literature about this topic and to outline clinical criteria of use of the test. Many of the retrieved papers suggest an added value of MEPs on motor prognosis after first ischemic sylvian stroke, highlighting higher specificity in clinical cases with paralysis or severe paresis in the acute stage. A clinical use of MEPs in specific stroke subgroups might help to plan a more individual rehabilitative project through realistic motor recovery goals and selected techniques of treatment; a more reliable motor prognosis may also be useful for rehabilitation effectiveness research and for a more aimed use of resources.

Effects of fasting on the growth plate: systemic and local mechanisms

Inadequate caloric intake inhibits longitudinal bone growth. This study was designed to investigate the mechanisms responsible for this suppression of growth plate function, focusing on the roles of systemic and local insulin-like growth factor 1 (IGF-1). Five week-old male rabbits were fasted for 48 h. Fasting significantly decreased proximal tibial growth velocity and growth plate width (both proliferative and hypertrophic zones). During the fast, systemic IGF-1 production was down-regulated. Serum IGF-1 levels and hepatic IGF-1 messenger RNA (mRNA) levels decreased despite increased GH levels. Serum levels of GH binding protein (a circulating fragment of the GH receptor) and hepatic GH receptor mRNA levels were not significantly changed. In contrast, the local, growth plate IGF-1 system appeared to be up-regulated. Growth plate GH receptor mRNA and IGF-1 mRNA levels were both increased during fasting. We conclude that, in the rabbit, fasting induces a rapid depletion of growth plate chondrocytes and inhibition of longitudinal bone growth. These effects appear to be mediated by systemic endocrine mechanisms; circulating IGF-1 levels are diminished because of hepatic resistance to GH. In contrast, the local, paracrine IGF-1 system in growth plate does not appear to contribute to the growth inhibition but instead appears to be up-regulated by fasting.

Gas chromatography of 4,4'-diphenylmethane diisocyanate in the workplace atmosphere

A sensitive gas chromatographic procedure for the determination of 4,4'-diphenylmethane diisocyanate concentration in air is described. Traps containing 20-40-mesh silica gel coated with phosphoric acid are used. After the aspiration of the air, the silica gel is eluted with sodium hydroxide in methanol. The amine formed is then separated with a gas chromatograph and measured with a nitrogen-phosphorus detector. This can be performed in 7 min. Virtually no breakthrough occurs if an air concentration of up to 128 nmol in 20 l is sampled. The detection limit based on a 20-1 air sample is 0.7 microgram/m3. Complete analysis requires about 30 min. The method was used to determine the concentration of 4,4'-diphenylmethane diisocyanate in working environments during spraying operations.

Hemispheric cavernous angiomas: presumptive preoperative diagnosis

Clinical history, CT scan and angiography may lead to a correct preoperative diagnosis of hemispheric cavernous angiomas. Surgical results and follow-up are favorable; considering the bleeding risk we think the operation to be mandatory.

Normal pressure hydrocephalus: relationship among clinical picture, CT scan and intracranial pressure monitoring

Fifty-five patients suffering from normal pressure hydrocephalus were considered. All patients underwent chronic intracranial pressure (ICP) monitoring for at least 24 h. The decision to perform surgery was made on the basis of the ICP monitoring data only. A retrospective analysis on clinical pictures, CT findings and ICP monitoring data was carried out in the attempt to find more selective criteria, in order to submit patients to chronic ICP monitoring. Clinical findings showed controversial data, whereas the enlargement of the III ventricle showed a strict, but not absolute, correlation to pathological pressure profiles. The follow-up of non-shunted patients is briefly discussed.

[Reference values of chromium urine in the population residing in Lombardy]

The accurate determination of Cr in normal human urine still presents a considerable challenge, connected to its very low content, supposedly about 1 ppb. The analytical data obtaining from many Authors varying between 0.3 microgram/day and 150 micrograms/day. The question now arises which data picture the true Cr content of normal human urine. To this purpose we have determined the content of total urinary chromium in 310 healthy individuals (170 male, 140 female) resident in Lombardy (Italy). A mean urinary Cr concentration of 0.59 +/- 0.26 ppb was obtained. The levels of urinary chromium tended to be higher in males than in females and to decrease with age.

[Plasma levels of Zn, Cu and Ni in healthy controls and in psoriatic patients. Possible correlations with vitamins (author's transl)]

Plasma levels of Zn, Cu and Ni were determined in psoriatic patients by atomic absorption spectrophotometry. In psoriatic patients, plasma Cu levels were significantly higher, whilst plasma Zn and Ni were significantly lower than in healthy controls.

[Determination of plasma chromium in pregnant women at term and in the umbilical cord blood]

Plasma chrome concentrations were determined in pregnant women, in the funiculus blood of their children and in a population of a children within the first year age. Plasma chrome concentrations tend to significantly decrease during pregnancy, pointing out the effect of pregnancy on chrome metabolism. No significant variations were found in plasma chrome values both of mother blood and foetus blood. In newborn babies, plasma chrome concentrations tend to significantly increase within the first year of age.