The direct influence of ship traffic on atmospheric PM2.5, PM10 and PAH in Venice.

The direct influence of ship traffic on atmospheric levels of coarse and fine particulate matter (PM(2.5), PM(10)) and fifteen polycyclic aromatic hydrocarbons (PAHs) has been estimated in the urban area of Venice. Data analysis has been performed on results collected at three sites over the summer, when ship traffic is at a maximum. Results indicate that monitoring of the PM daily concentrations is not sufficiently detailed for the evaluation of this contribution, even though it could be useful for specific markers such as PAHs. Therefore a new methodology, based on high temporal resolution measurements coupled with wind direction information and the database of ship passages of the Harbour Authority of Venice has been developed. The sampling sites were monitored with optical detectors (DustTrack(®) and Mie pDR-1200) operating at a high temporal resolution (20s and 1s respectively) for PM(2.5) and PM(10). PAH in the particulate and gas phases were recovered from quartz fibre filters and polyurethane foam plugs using pressurised solvent extraction, the extracts were then analysed by gas chromatography- high-resolution mass spectrometry. Our results shows that the direct contribution of ships traffic to PAHs in the gas phase is 10% while the contribution to PM(2.5) and to PM(10) is from 1% up to 8%.

Percutaneous management of complications of tuberculous spondylodiscitis: short- to medium-term results.

PURPOSE: Psoas abscesses are the most frequent complication of tuberculosis with skeletal involvement. The aim of this paper is to report our experience with the systematic application of percutaneous drainage to tuberculous psoas abscesses. MATERIALS AND METHODS: Between January 1997 and December 2005, 23 patients (14 men and nine women; age range 21-48 years), after a previous study with computed tomography (CT) and/or magnetic resonance (MR) imaging, underwent percutaneous drainage of a tuberculous fluid collection in the psoas muscles. Follow-up consisted of monthly clinical and laboratory assessment, and plain chest radiography and spinal CT every 6-12 months. RESULTS: Spondylodiscitis involved the thoracolumbar spine. Fluid collections were bilateral in 14 cases and communicating in ten of these. Maximum transverse diameter was 7 cm, whereas longitudinal diameter was 14 cm. Placement of the drainage catheter was successful in all cases, and the catheter was left in place for 5-36 (mean 18.4) days. Symptom regression occurred immediately after drainage of the fluid collection. The drainage procedure was curative in 100% of cases. Dislodgement of the drainage catheter occurred in two cases as a result of excessive traction during dressing removal. CONCLUSIONS: A serious complication of bone tuberculosis, psoas abscesses, can be effectively treated by percutaneous drainage, leading to immediate pain resolution. The drainage catheter requires daily monitoring to identify when it can be safely removed without risk of recurrence.

Hybrid treatment with angiographic catheter in massive pulmonary embolism: mechanical fragmentation and fibrinolysis.

PURPOSE: Massive pulmonary embolism is a severe clinical condition that requires prompt therapeutic intervention. We report our experience with a hybrid treatment involving systematic fragmentation of the embolus with an angiographic catheter associated with fibrinolytic therapy over the following days. MATERIALS AND METHODS: From 1999-2005 we treated 164 patients with massive pulmonary embolism. We used the same angiographic catheter for mechanical fragmentation and for administration of the fibrinolytic agent (24-72 h). Results were assessed on the basis of changes in mean pulmonary artery pressure. RESULTS: After fragmentation with the angiographic catheter, we observed four types of haemodynamic behaviour: in 61 patients (41.4%), mean pulmonary artery pressure fell rapidly below 30 mmHg; in 38 patients (23.1%), two passes were required to achieve the same result; in 32 patients (19.5%) three passes were required. In the remaining 26 patients (15.8%), at no time did the mean pulmonary artery pressure fall below 35 mmHg. The only two deaths occurred in this last group. CONCLUSIONS: Mechanical fragmentation with the angiographic catheter and administration of fibrinolytic agents effectively brought about a rapid improvement in patients' clinical status by moving the embolus towards the periphery.

Phlebographic classification of anatomic variants in the right internal spermatic vein confluence.

PURPOSE: Male varicocele is a clinical dysfunction caused by a pathological venous reflux. Knowledge of anatomic variants of the internal spermatic vein confluence is fundamental for the technical success of percutaneous treatment. While numerous studies have analysed the phlebographic anatomy of the left internal spermatic vein, no exhaustive description exists for the right internal spermatic vein. MATERIALS AND METHODS: From a retrospective review of 3229 patients treated percutaneously between 1988 and 2003, we extrapolated the phlebographic images of patients with incontinence of the right internal spermatic vein only. Mean patient age was 24.6 (range 14-46) years. Indication for treatment was presence of pain in the right inguinal region and absence of a history of trauma and/or seminal-fluid alterations. Phlebography had been performed with transbrachial access using a tilt table and a multipurpose angiographic catheter. Contrast medium was injected into both the inferior vena cava and the renal vein. Selective catheterisation of the internal spermatic vein was then performed to assess the radiological characteristics of the vessels prior to sclerosis. RESULTS: There were 93 cases of incontinence of the right internal spermatic vein only (2.8%). In the first group of patients (seven cases, 7.5%), the right internal spermatic vein drained exclusively into the renal vein; the injection of contrast medium during a Valsalva manoeuvre allowed visualisation of the vein almost as far as the iliac level. In most cases, the vein appeared uniformly dilatated and without valvular systems along its course. In the second group (21 cases, 22.5%), the vein drained into both the renal vein and the inferior vena cava, with one branch showing functional predominance over the other: selective catheterisation was easier to perform on the first branch. Selective catheterisation confirmed dilatation of the vein as well as the absence of valvular systems. In most patients, (65 cases, 69.8%), the internal spermatic vein drained into the inferior vena cava; the confluence was double in five patients and single in 60 patients. Visualisation of incontinence was limited to the initial 5-10 cm of the vein in 13 cases; however, vein dilatation and absence of valvular systems were confirmed beyond the semicontinent valve. CONCLUSIONS: Interventional treatment is one of the therapeutic options for male varicocele, but the method is limited by the presence of anatomic variants or aberrant supplying vessels, which make catheterisation and sclerosis of the internal spermatic vein difficult if not impossible. Interventional radiologists must have a thorough knowledge of anatomic variants of the right internal spermatic vein to be able to perform the procedure within a reasonable amount of time and reduce radiation exposure.

Use of the ALN permanent/removable vena cava filter. A multi-centre experience.

AIM: Vena cava filters are used for the prevention of pulmonary embolism in cases of contraindication, failure or complications of the anticoagulant therapy. There are no certain data in the literature concerning the effectiveness of vena cava filters and, above all, the possible long-term complications are not known. For this reason increasing attention is paid to permanent/removable filters that permit exploitation of the short-term advantages of vena cava interruption, eliminating the possible long-term complications. We have reported the results of a multicentre experience concerning ALN permanent/removable vena cava filters in a total of 276 patients. METHODS: Vena cava filters were placed in 276 patients via the jugular, femoral and brachial vein. The filter was removed in 43 patients after 3 months and in 28 patients after 6 months. RESULTS: In 1 case, due to incomplete opening of the filter, immediate percutaneous removal was performed and another filter was positioned. In 5 cases it was not possible to remove the filter, in 1 case due to inexperience and in the remaining cases due to adhesion of the head or claws of the filter to the wall of the vein. No problems occurred in the other cases. CONCLUSIONS: The ALN vena cava filter is safe, easy to position and remove even a long time after placement. Currently permanent filters should be used only for patients with poor survival expectancy whereas in all other cases the use of removable filters is preferable.

Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia.

PURPOSE: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance. MATERIALS AND METHODS: Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularisation. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities. RESULTS: Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the months immediately following the procedure. DISCUSSION: Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limbs. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of CT-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation.

Preliminary results of a soft novel lumbar intervertebral prothesis (DIAM) in the degenerative spinal pathology.

The authors report a series of 43 patients suffering from lower limb pain, almost constantly associated with chronic or acute backpain, treated by microsurgical nerve root decompression and by implantation of a soft intervertebral prothesis (DIAM). Satisfying results were obtained in 97% of cases, inducing the authors to consider the device a reliable tool for curing low-back pain and sciatica. Selection criteria are exposed and discussed.

Homocystinuria with transverse sinus thrombosis.

A case of cerebral venous thrombosis caused by undiagnosed homocystinuria is reported. The pitfalls regarding the diagnosis of a potentially medically treatable condition are discussed. Cerebral venous thrombosis in children has a variable type of onset and a multiplicity of causes. This type of pathology, although not frequent, is more common than previously thought. Among the different etiologies, undiagnosed homocystinuria is not routinely considered. We report a case of venous thrombosis of the left transverse cerebral sinus in a girl with drug-resistant partial epilepsy and homocystinuria. This diagnosis was considered and confirmed after the appearance of acute cerebral symptoms caused by venous thrombosis.

[Percutaneous treatment of varicocele. 13-year experience with the transbrachial approach]. / Trattamento percutaneo del varicocele. 13 anni di esperienza transbrachiale.

PURPOSE: To report our experience using the transbrachial approach, which is easily accepted by the patient, in the treatment of varicocele. MATERIAL AND METHODS: Between January 1986 and December 1998, 1490 patients with clinical or subclinical varicocele, but with seminal fluid alterations, underwent spermatic phlebography using the transbrachial approach. Since 1991 the procedure has also been adopted at the Unit of Pediatric Surgery of our hospital, which proposes it as a first choice treatment in adolescents with varicocele. The procedure consists in accessing the basilic vein at the elbow level percutaneously and using a hydrophile guidewire and multipurpose angiographic catheter to reach and catheterise the spermatic vein responsible for the varicocele. During the first years, we used sclerotherapy alone; subsequently, if the varicocele recurred or if the reflux was refractory to sclerotherapy or if the veins were large we adopted vein embolisation. Follow-up was one year and consisted of testicular ultrasound, Doppler flowmetry and/or color Doppler ultrasound at one, six and twelve months after the procedure. Patients were considered restored if they were free of symptoms, showed no venous reflux and/or had normal seminal fluid parameters and improved if they were free of symptoms but still presented venous reflux. Varicocele was considered persistent if the procedure failed to produce any beneficial effects, and recurrent if, although absent at the first follow up, it reappeared after the fifth month. RESULTS: We found 1296 (86.9%) cases of left varicocele, 25 of right varicocele and 169 (11.3%) of bilateral varicocele. In all cases, the symptoms disappeared after the percutaneous procedure. Duration of radioscopy was reduced to 3.5'; the procedure lasted 90' for the monolateral varicoceles and 120' for the bilateral forms. 313 diagnostic procedures were performed (20.7%). The procedure could not be completed in 104 patients (6.8%) due to basilic vein spasms, difficulties encountered in catheterizing the spermatic vein and, particularly in pediatric patients, anatomic variations. A total of 1195 (79.2%) procedures were completed: sclerotherapy alone in 642 patients and sclerotherapy followed by scleroembolisation in 527. Sclerotherapy alone was sufficient to restore 524 patients (86.6%), while 384 (78.5%) required scleroembolization. A small number of patients underwent scleroembolization alone, which brings the success rate for the two procedures to 82% and 84%, respectively. No serious side-effects were noted. DISCUSSION: The transbrachial approach in spermatic phlebography has proved to be a safe and effective technique for the treatment of both monolateral and bilateral varicocele. Furthermore, the procedure is well accepted by patients and can be performed in a day-care setting. In some cases, we only obtained partial results because of the large caliber of the spermatic vein; in other cases, we were unable to complete the procedure due to anatomic variations or to the spasm of the basilic vein. CONCLUSION: The safety and effectiveness of this procedure make it a valid alternative to traditional surgery, that should be considered as a possible first-choice treatment for varicocele in adolescents.

Clinical predictors of obstructive sleep apnea.

OBJECTIVE: To identify physical findings that can be standardized to predict the presence and the severity of obstructive sleep apnea (OSA). STUDY DESIGN: One hundred seventy-two patients who answered questionnaires with responses that suggested they might have OSA were included in this prospective study. METHODS: All patients underwent a physical examination and polysomnography. The physical examination included the measurement of four parameters used by anesthesiologists to identify patients likely to have difficult intubation to determine if these same parameters predict OSA. We recorded modified Mallampati grade (MMP), tonsil size, and body mass index (BMI) and measured thyroid-mental distance (TMD) and hyoid-mental distance (HMD) in the study population. RESULTS: When the physical findings were correlated singly with the respiratory disturbance index (RDI), we found that MMP (P < .001), tonsil size grading (P = .008), and BMI (P = .003) were reliable predictors of OSA. A greater correlation with OSA emerged when an "OSA score" was formulated by factoring the MMP, tonsil grade, and BMI grade (RDI = 7.816 x MMP + 3.988 x Tonsil Size + 4.675 x BMI - 7.544). A high score was not only predictive of OSA but also correlated well with OSA severity. Neither HMD nor TMD correlated with the severity of RDI. CONCLUSIONS: An OSA score may help identify those patients who should have a full sleep evaluation.

Varicocele: a multidisciplinary approach in children and adolescents.

PURPOSE: To minimize varicocele treatment in children and adolescents a multidisciplinary approach that includes surgery and operative radiology has been used at our institution since 1991. We present our results during this 7-year period. MATERIALS AND METHODS: From January 1991 to December 1997 we examined 477 patients 4 years 5 months to 25 years 4 months old (mean age 13 years 3 months) with varicocele, of whom 367 (396 varicoceles) required treatment. Percutaneous sclero-embolization was suggested as the primary treatment of choice in all cases, while surgery was reserved for select cases. A total of 366 cases followed at least 6 months (mean 1 year) were entered into this study. RESULTS: Only 7.1% of the patients or families preferred surgery. In 47 patients sclero-embolization was not possible due to technical problems or vascular anomalies. Sclero-embolization was successful in 79.4% of 277 patients, and retroperitoneal ligation was successful in 88.7% of 124. Since 1995 ligation of the whole spermatic bundle above the vas deferens has been preferred, and only 1 recurrence has been observed in 60 cases. CONCLUSIONS: Percutaneous sclero-embolization is a minimally invasive treatment of varicocele that is feasible in children and adolescents. Most patients prefer this therapy, although it is not as safe as surgery. When open surgery is required, complete ligation of the whole vascular pedicle above the vas deferens offers excellent success.

ESS, eye stimulator system for VVIS facility (Visual and Vestibular Investigation System).

The ESS (Eye Stimulation System) is one of four main Subsystems of the Visual and Vestibular Investigation System ( VVIS ), Facility developed in the field of EDEN program and aimed to the research in the area of neurosensors physiology under microgravity conditions. In particular, the ESS is an Optokinetic Stimulator that stimulates the Subject's eyes with moving black and yellow patterns, in order to allow, by another main Subsystem, video recording of the pupil movement and, successively, to elaborate the relevant data of the neurovestibular experiment. This Stimulator was designed by the Officine Galileo as Subcontractor of Aerospatiale, leader of the VVIS facility, developed under ESA contract and successfully flown in April 1998 aboard the Neurolab mission. The Eye Stimulation System, on the frame of the VVIS Facility, is used in conjunction with the Body Rotating Device and the Eye Movement and Recording System, in order to fulfill all operations that lead to carry-out the experiments proposed. The Subject, seated on the Rotating Chair, observes the stimuli on a display monitor through a set of lenses, mounted on a proper box, fixed to a main structure of the unit. The stimuli patterns are showed on a display, placed on a movable support in order to fix it in a proper position, depending on the optical characteristics of the Subject. The experiments are repeated with different kind of patterns. All the main components of the visual system are mounted on a structural base plate, that gives also the mechanical I/F with the other system, supporting the ESS.

Attenuation of levodopa-induced toxicity in mesencephalic cultures by pramipexole.

The direct-acting dopamine (DA) agonist pramipexole (2 amino-4,5,6,7-tetrahydro-6-propyl-amino-benzthiazole-dihydrochlori de) was evaluated for its ability to attenuate levodopa-induced loss of tyrosine hydroxylase immunoreactive (THir, a marker for dopamine neurons) cells in mesencephalic cultures. Pramipexole reduced levodopa-induced THir cell loss in a dose-dependent and saturable fashion (ED50 = 500 pM), its inactive stereoisomer was significantly less potent in this regard and pergolide and bromocriptine had negligible cytoprotective effects. Culture media from mesencephalic cultures incubated with pramipexole for 6 days increased THir cell counts in freshly harvested recipient cultures. The magnitude of this effect was directly proportional to the amount of pramipexole in the donor cultures and heat-inactivation of the media abolished the growth promoting effect. The results from this exploratory set of experiments suggest that pramipexole may be cytoprotective to dopamine neurons in tissue culture. Pramipexole's affinity for DA receptors, its antioxidant action or its ability to enhance mesencephalic trophic activity could be responsible for this effect.

Gastrointestinal tubercular arteritis during HIV infection.

Although digestive tract is often involved in HIV disease, severe gastrointestinal bleeding rarely occurs. We describe a case of severe gastrointestinal bleeding associated with a mycobacterium tuberculosis arteritis of colonic tract. It is reported a morphology change of mesenteric arteries by mycobacterium tuberculosis revealed by angiography. The superselective embolization of branches mesenteric inferior artery resolved the important bleeding without surgical intervention. In AIDS patients, during intestinal tuberculosis, massive enteric-hemorrhage suggests for involvement of mesenteric arteries by mycobacterium tuberculosis. An angiography is basic to discover bleeding and if necessary for the therapeutic treatment.

Comparison of the neurotoxicity of dihydroxyphenylalanine stereoisomers in cultured dopamine neurons.

Oxidant stress resulting from excess dopamine (DA) may contribute to the development and progression of Parkinson's disease (PD). Free radicals resulting from the enzymatic metabolism of DA are most often discussed in this regard. However, levodopa (L-DOPA) and DA can also undergo autooxidation, producing free radicals as well as cytotoxic metabolites. We evaluated the neurotoxic effects of the two stereoisomers of L-DOPA to differentiate between enzyme-mediated and autooxidation mechanisms. Various concentrations of D- or L-DOPA (1 mM through 10 nM) were added to freshly harvested rostral mesencephalic tegmentum cultures. After 72 h, the cultures were fixed and stained for tyrosine hydroxylase (TH). The number of TH-immunoreactive (THir) neurons was then assessed and used as an index of DA neuron survival. Both D- and L-DOPA induced a dose-dependent loss of THir neurons (F10,21 = 135.75, p < 0.0001 and F10,21 = 142.53, p < 0.0001, respectively) with ED50 values of 10(-5.3) and 10(-5.2) M, respectively. The dose-response curves for each drug were not significantly different from one another (F1,43 = 0.09, p > 0.05). Moreover, both drugs killed THir as well as non-THir cells at high concentrations, suggesting a nonspecific toxic effect. These data are most consistent with an enzyme-independent, autooxidation-mediated mechanism for DA neuron loss.

Massive haemobilia after percutaneous liver biopsy in a patient with POEMS syndrome successfully treated by arterial embolization.

A 65-year-old woman with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) developed severe upper right quadrant colic with jaundice, massive haematemesis and melaena following an apparently uncomplicated percutaneous liver biopsy performed for suspected liver involvement. Symptom onset occurred about 18 hours after the procedure. Haemobilia was diagnosed on endoscopic retrograde cholangiopancreatography. An arteriovenous fistula in the third hepatic segment was demonstrated by transfemoral arteriography and successfully embolized using Gelfoam pledgets mixed with Ivalon fragments. A review of percutaneous liver biopsy related haemobilia is presented.

Drinking behaviors of women in four occupational groups.

Questions about alcohol consumption, social and work contexts, and negative consequences related to alcohol use were asked of forty-nine academics, 27 physicians, 15 attorneys, and 169 business women. The majority of the women were light drinkers and their drinking does not appear to be accompanied by negative consequences. The exception to this is driving while intoxicated or riding with an intoxicated driver, behaviors which may be increasing as a result of business-related or after work drinking. The women reported being in drinking settings relatively often. Frequency in drinking settings was correlated with both level of alcohol consumption and number of negative consequences of alcohol use. Presence in such settings may be related to women's employment status, and thus could be considered both a work-related risk factor and a location for abuse prevention activities.

Renal involvement in canine leishmaniasis. A light-microscopic, immunohistochemical and electron-microscopic study.

In a prospective survey in the Isle of Elba, 413 dogs affected by naturally acquired Leishmania infantum infection were identified out of a controlled population of 1,500 resident mongrel dogs. In all the 34 randomly selected dogs of different breed, age, and duration of disease, the presence of glomerular lesions which defined mainly two categories of glomerulonephritis (GN) was observed. The first group was characterized by mesangial-cell proliferation either with focal features (11 dogs), or with a diffuse pattern (10 dogs). The second group (12 dogs) showed the typical findings of segmental membrano-proliferative GN; amyloid deposits were seen in the glomerular tuft and interstitium in 1 dog. Immunohistochemical investigation revealed granular deposits of IgG, IgM, and C3 both in mesangial areas as well as on glomerular capillary walls. Granular immune deposits om the tubular basement membrane were also found in 31 out of 34 dogs examined. With ultrastructural investigation, subendothelial and mesangial electron-dense deposits were revealed. Age, sex, serum creatinine, BUN, duration of disease, anti-Leishmania antibody titers, and immune complexes did not discriminate between the types of observed GN, while proteinuria did. The study shows that the renal involvement is the natural sequela in dogs infected with L. infantum, and that the kidney lesions are characterized by immunologically mediated glomerular and tubular damage.