RESUMO
BACKGROUND: A sporicidal surface disinfection is recommended both for the outbreak and the endemic setting but a comparative evaluation on the efficacy of 'sporicidal' surface disinfectants using suspension tests and 4-field tests has not been performed. AIM: To determine the efficacy of five 'sporicidal' surface disinfectants (three ready-to-use wipes (A, B, E), two concentrates (C, D) based on peroxides or aldehydes against C. difficile spores. METHODS: The efficacy was determined under clean conditions using a suspension test and the 4-field test. Each test was performed in duplicate in two separate laboratories. Wipes were wrung to collect the solution for the suspension tests. RESULTS: Product A (peracetic acid; 5 min), product C (peracetic acid; 2% solution in 15 min or 1% solution in 30 min) and product D (peracetic acid; only 2% solution in 15 min) were effective with at least a 4 log10-reduction of C. difficile spores in suspension and on surfaces. Product B (hydrogen peroxide) was not effective in suspension (0.9 log10 after 15 min; 3.2 log10 after 1 h) and on surfaces (2.8 log10 after 15 and 60 min). Product E based on glutaraldehyde, (ethylendioxy)dimethanol and DDAC demonstrated 0.9 log10 after 4 h in suspension and 4.5 log10 after 4 h on surfaces. CONCLUSIONS: Not all surface disinfectants with a sporicidal claim were effective against C. difficile spores in standardized suspension tests and in the 4-field test. In clinical practice preference should be given to products that reliably pass the efficacy criteria of both types of tests.
Assuntos
Clostridioides difficile , Desinfetantes , Clostridioides , Desinfetantes/farmacologia , Humanos , Ácido Peracético/farmacologia , Esporos BacterianosRESUMO
If working tasks are carried out in inadequate conditions, workers with functional limitations may, over time, risk developing further disabilities. While several validated risk assessment methods exist for able-bodied workers, few studies have been carried out for workers with disabilities. This article, which reports the findings of a Study funded by the Italian Ministry of Labour, proposes a general methodology for the technical and organisational re-design of a worksite, based on risk assessment and irrespective of any worker disability. To this end, a sample of 16 disabled workers, composed of people with either mild or severe motor disabilities, was recruited. Their jobs include business administration (5), computer programmer (1), housewife (1), mechanical worker (2), textile worker (1), bus driver (1), nurse (2), electrical worker (1), teacher (1), warehouseman (1). By using a mix of risk assessment methods and the International Classification of Functioning (ICF) taxonomy, their worksites were re-designed in view of a reasonable accommodation, and prospective evaluation was carried out to check whether the new design would eliminate the risks. In one case - a man with congenital malformations who works as a help-desk operator for technical assistance in the Information and Communication Technology (ICT) department of a big organisation - the accommodation was actually carried out within the time span of the study, thus making it possible to confirm the hypotheses raised in the prospective assessment.
Assuntos
Acessibilidade Arquitetônica , Pessoas com Deficiência , Cultura Organizacional , Tecnologia Assistiva , Local de Trabalho , Atividades Cotidianas , Adulto , Pessoas com Deficiência/reabilitação , Eficiência , Eletromiografia , Planejamento Ambiental , Exercício Físico , Humanos , Itália , Masculino , Assistência Individualizada de Saúde , Postura , Estudos Prospectivos , Medição de Risco , Comportamento de Redução do Risco , Cadeiras de RodasRESUMO
AIM: Breast cancer in men is a very rare neoplasm accounting 1% of all breast cancer with an incidence ratio of 1:100 of men to women and about 1% of all malignancies in men. On the basis of the literature review the authors tried to determine the main characteristics of this rare neoplasm in terms of epidemiology, diagnosis, prognosis, treatment and survival. METHODS: The authors report the experience of the Breast Unit of the San Giovanni Addolorata Hospital in Rome, where 4 cases of male breast cancer were observed and treated over 784 breast cancers. RESULTS: All tumours were ductal carcinomas. The extent of disease was as follows: 3 cases with stage I and 1 case with Stage IIIB; in two cases estrogen and progesterone receptors expression was 100% and in the other two cases it was 20-80%. Median follow up was 57.5 months. At present, after 6-year follow up the three patients with stage I are in good conditions; the patient with stage III died after 27 months with metastatic disease. CONCLUSIONS: Surgical treatment remains the gold standard in male breast cancer. The prognosis for males with breast cancer is similar to female patients on equal terms of stage of disease. Adjuvant therapy is based on retrospective studies of male breast cancer conducted over the past 20 years using the guidelines for breast cancer in women.
Assuntos
Neoplasias da Mama Masculina/diagnóstico , Neoplasias da Mama Masculina/cirurgia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/cirurgia , Idoso , Biomarcadores Tumorais/análise , Neoplasias da Mama Masculina/química , Neoplasias da Mama Masculina/epidemiologia , Carcinoma Ductal de Mama/química , Carcinoma Ductal de Mama/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Mastectomia Simples , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Estudos Retrospectivos , Cidade de Roma/epidemiologia , Biópsia de Linfonodo Sentinela , Taxa de Sobrevida , Resultado do Tratamento , Ultrassonografia MamáriaRESUMO
BACKGROUND: Our aim was to study the value of sentinel lymph node (SLN) biopsy in patients with breast cancer seen at a community hospital. METHODS: Consecutive cases receiving primary treatment for unicentric breast cancer less than 3 cm in diameter were prospectively studied from January 1999 to July 2000. All patients signed a detailed informed consent. The majority of patients (89%) underwent a combined technique of intradermal injection of 0.3-1.2 mCi of (99)Tc and 1-3 cc of Patent Blue at the biopsy site. Intraoperative localization was performed with a hand-held gamma probe. The first 15 patients underwent routine back-up lymphadenectomy. Thereafter, only patients with positive SLN, suspicious findings, or personal preference underwent formal axillary dissection. RESULTS: One hundred eight cases were included in the study with a median age of 61 years and a median diameter of the breast tumor of 1.5 cm. Success rate for identification of SLN was 94% (101/108 cases). A total of 917 additional lymph nodes were removed after SLN biopsy (median 6.5 lymph nodes/patient). Correlation between SLN and the final axillary status was 98%. In 20/36 patients (61%) with positive axillary status the sentinel lymph node was the only positive one. Ten patients had only microscopic foci of cancer found in the SLN. Sixty-seven patients (62%) could have avoided axillary dissection becouse the SLN was found, it was negative, and there were no other intraoperative suspicious findings. CONCLUSIONS: SLN biopsy is accurate and easily reproduced. Our data confirms that the majority of breast cancer patients may no longer need routine axillary lymphadenectomy.
Assuntos
Neoplasias da Mama/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Biópsia de Linfonodo Sentinela/métodosRESUMO
The authors report the RCR results executed on 26 patients submitted to Hartmann operation for colo-rectal emergency at the Surgical Department of S. Giovanni Hospital during the period 1986-1995. The reconversion index (46.4%), the morbidity (42.3%) and the operation mortality (3.8%) agree with those reported in the writings. Therefore, the tactical, technical and prognostic aspect related to RCR are examined, a heavy operation fully justified by the patient quality of life expectations.
Assuntos
Colo/cirurgia , Colostomia , Reto/cirurgia , Idoso , Anastomose Cirúrgica , Estudos de Avaliação como Assunto , Seguimentos , Humanos , Qualidade de Vida , Reoperação , Fatores de TempoRESUMO
During the CERTAIN study (research carried out in 1994-96 within the Technology Initiative for Disabled and Elderly (TIDE) programme of the European Union), a number of real life case studies of provision of assistive technology to disabled persons were investigated in order to assess the applicability of socio-economic principles, methods and techniques already available from Health Care Technology Assessment studies. A retrospective study on cost, effectiveness and utility resulting from the implementation of assistive technology was carried out over a sample of disabled persons who had adopted technical aids before the start of the project. The sample was selected in such a way to include different pathologies (steady or progressive), impairments, ages, technology and social environment. Each case was described by considering all clinical, technical and social aspects; a common structure for case reporting was developed and tested; attempts were carried out to apply and refine concept and tools derived from health technology assessment studies; on the grounds of such experience a decision support model was elaborated for the choice between different alternatives in order to maximize the client's quality of life while making efficient use of scarce resources. A computer implementation of such a model was also developed, along with a mathematical structure of cost analysis. Within a national research programme such findings were further exploited, leading to the development of a prototype cost-outcome instrument designed for use in clinical practice in the provision of assistive technology to individual cases.
Assuntos
Pessoas com Deficiência/reabilitação , Avaliação de Resultados em Cuidados de Saúde , Reabilitação/economia , Tecnologia Assistiva/economia , Avaliação da Tecnologia Biomédica/métodos , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Qualidade de Vida , Reabilitação/instrumentação , Estudos RetrospectivosRESUMO
The Hartmann procedure has, in emergency colo-rectal surgery, many implications. The decision is based on clinical, radiological, instrumental and pathological findings. The authors report the results of 76 Hartmann's procedures performed between 1986 and 1995 and compare their results with those found in the current medical literature on the topic. In particular, they draw attention to an increased use of this procedures in colo-rectal emergencies; the morbility and mortality rates confirm the severity of the clinical cases that can be treated with this operation. To improve results the authors propose a therapeutic plan that uses a score for stratification of the risk (MPI, APA-CHE II, SSI, Hinchey); so the surgeon can choose the best surgical operation. Finally, the authors underline the importance of the principles of oncology surgery in colo-rectal cancer.
Assuntos
Doenças do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Doenças Retais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
An experimental teleworking arrangement was established between Milan and Rome in order to evaluate the use of multimedia technology and remote working for improving the service provided by an information and advice centre for the disabled. This activity requires a highly interdisciplinary approach and both clinical and technical expertise. The hypothesis was that offering the lone expert in Rome the possibility of teleconsulting with colleagues in Milan (where the whole range of expertise was available) would provide a comprehensive service for disabled clients asking for advice on technical aids in Rome. The results of an experiment demonstrated the feasibility of such teleworking and allowed a teleconsulting method to be defined that fits the specific needs of the technical-aid information service and improves quality.
Assuntos
Pessoas com Deficiência/reabilitação , Consulta Remota/métodos , Tecnologia Assistiva , Adulto , Aconselhamento , Humanos , Itália , Multimídia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Consulta Remota/instrumentação , SoftwareRESUMO
In major hepatic surgery the temporary exclusion of the vena cava may be achieved using a variety of more or less complex procedures. Alternatively, for use above all in emergency surgery, the paper illustrates a method of clamping the suprahepatic inferior vena cava using a left lateral route, which is quick to carry out and undoubtedly efficient.
Assuntos
Fígado/cirurgia , Veia Cava Inferior , Constrição , Emergências , Humanos , Fígado/lesões , Procedimentos Cirúrgicos Operatórios/métodosAssuntos
Artérias/cirurgia , Veias/transplante , Adulto , Idoso , Animais , Artérias/anatomia & histologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ratos , Técnicas de SuturaRESUMO
Following a number of general remarks regarding the metabolic physiopathology of the surgical patient, the indications and biochemical premises for total parenteral nutrition are examined. Stress is also labor, on problems of administration routes and modalities and on the chemico-clinical controls needed to weigh up the technique. Finally, the results of personal experience in the treatment of 16 patients whose prevalent pathology consist of necrotico-haemorrhagic A.P. and its sequelae are reported. The usefulness of the technique is confirmed because it offers interesting results in difficult and often dramatic surgical situations.