[Topical anesthesia for cataract surgery with phacoemulsification: lidocaine 2% vs ropivacaine 1%. Preliminary results]. / Anestesia topica nella chirurgia della cataratta con facoemulsione: lidocaina 2% vs ropivacaina 1%. Risultati preliminari.

BACKGROUND: The safety, tolerability and efficacy of ropivacaine 1% vs lidocaine 2% for phacoemulsification using topical anesthesia during cataract surgery, are compared. METHODS: A prospective, randomized, double-blind study comparing two agents for topical anesthesia is reported. ENVIRONMENT: Operative Unit of Ophthalmology, general Hospital. 1893 consecutively patients were studied (ASA 1-3, 738 males, 1155 females, age 71.8+/-9.7 years, range 35-90 years) undergoing routine phacoemulsification under topical 2% lidocaine (group I) and 1% ropivacaine (group II). The mains outcome measures of the study were: - the total dose of local anesthetic for obtaining a reduction of corneal sensation measured with the Cochet-Bonnet esthesiometer (value>3); - the pain recorded with visual analogic scale and verbal scale at: T1 = the first injection of local anesthetic; T2 = corneal incision; T3 = the end of surgery; T4 = 1h after surgery; T5 = the first postoperative day; - any requirement for additional intraoperative injection anesthesia and systemic sedation when needed; - surgeon assessments of operative conditions and patient cooperation; - patients' subjective level of comfort; - complications. RESULTS: Topical anesthesia using lidocaine 2% was significantly more painful than the ropivacaine 1%. The onset of anesthesia adequate for surgery was similar in all two groups. There were differences between the groups with respect to perioperative analgesia because the VAS was significantly higher in lidocaine group than in ropivacaine group. There were no statistically differences between the two groups at the follow-up. Inadequate anesthesia was seen in 8.05% (74/919 patients) cases of group I vs 0.9% (22/974 patients) of group II. Sedation was needed only in 10 patients and 6 patients of group I and II respectively. The surgeon assessment showed more patient cooperation in the ropivacaine group (83%). Satisfactory comfort (level 1) was reported by 60.4% in the lidocaine group and 86.8% in the ropivacaine group. In both groups there were cases of postoperative epithelial edema (29 patients in group I vs 36 patients in group II) although it decreased after the first postoperative day. No other significant side-effects were observed with the use of either formulations. CONCLUSIONS: Lidocaine 2% and ropivacaine 1% were safe and effective agents in patients having phacoemulsification with IOL implantation. However, ropivacaine provides more good operative conditions than lidocaine for the surgeon and comfortable surgical circumstances for the patient.

[Giant fibroadenoma of the breast in an adolescent: a case report]. / Fibroadenoma gigante della mammella in adolescente: contributo clinico.

The authors report a case of giant fibroadenoma of the breast in a girl of 11 years old. Juvenile or giant fibroadenoma is a rare pathology usually presenting in adolescence, characterized by massive and rapid enlargement of an encapsulated mass. Nowadays there are some preoperative difficulties distinguishing it from cystosarcoma phyllodes which has a benign and malignant form. It is important to differentiate the two pathologies before operation as they have a different therapeutic approach and different follow up. The etiology is believed to be an end-organ hypersensitivity to normal levels of gonadal hormones and the age of presentation is between 10 to 18 years old. Treatment is usually surgical and ranges from simple excision to subcutaneous mastectomy with reconstruction.

[Industrial noise and presbyacusia in the determination of hearing damage: studies in chemical industry workers]. / Rumore industriale e presbisociacusia nel determinismo del danno uditivo: indagine in lavoratori dell'industria chimica.

An audiometric investigation was carried out on 710 workers of a chemical plant in order to ascertain the role of industrial noise and presbysocio-acusia in causing hearing loss. The workers underwent an audiometric test both aerial and via bone, in a sound-proof chamber, after a 16-hour rest from noise. The subjects also answered a questionnaire on nonoccupational noise exposure and previous hearing and dysmetabolic disorders. Noise exposure was assessed on the basis of a cumulative exposure index obtained for each subject by multiplying the mean daily exposure level by seniority in the job. The results showed that in workers not exposed to high noise levels, industrial noise and presbysocio-acusia induce, via a direct mechanism, either separately or together, only slight damage to social hearing frequencies, i.e., those of normal conversation. At frequencies of 4 and 6 kHz, however, presbysocio-acusia seems to play a more important role than industrial noise in causing hearing loss. The practical implications arising from this study concern the frequencies that should be used for a medicolegal assessment of industrial noise induced hearing loss and the the threshold for these frequencies above which assessment of hearing loss should begin. As regards the first point, the results obtained in this study suggest the use of medicolegal methods based on normal conversation frequencies since presbysocio-acusia should not in any case be taken from these frequencies as it affects them only marginally. As regards the second point, the results show that assessment of hearing loss should begin when the hearing threshold at the above frequencies exceeds 25 dB. The study also showed that in epidemiological investigations on subjects exposed to industrial noise, the cumulative exposure index is better correlated with the rise in hearing threshold at the various frequencies than with seniority.

Activation of the alternative complement pathway and generation of stimulating factors for granulocytes by glass fibers.

Continuous-filament glass fibers coated with organic agents, candidate asbestos substitutes, were assessed for their ability to elicit from normal human serum complement-derived cleavage products which are able to stimulate the chemotaxis and the respiratory burst of polymorphonuclear leukocytes. Glass fibers generated chemoattracting and respiratory stimulating factors for polymorphonuclears from human serum. The effect was dose related for chemotaxis from the serum fiber concentration of 75 micrograms/ml to 1,250 micrograms/ml. The serum chemoattracting activity, as well the respiratory stimulation, were dramatically impaired when serum had been preliminarily absorbed with antiC5 antiserum. Since the impairment of chemotactic activity occurred also in the presence of EDTA, but not in the presence of EGTA, we assumed an activation of the alternative complement pathway. Glass fibers were studied in comparison to a UICC sample of Canadian chrysotile asbestos, which is able to activate in vitro the alternative complement pathway. Glass fibers exhibited less ability than asbestos fibers to generate complement cleavage products with chemotactic activity for polymorphonuclears; however, they produced an activity about equal to 80% of a chemotactic standard stimulus such as zymosan-activated plasma.

[Adsorption of proteins by artificial mineral fibers: in vitro experiments]. / Assorbimento di proteine da parte di fibre minerali artificiali (MMMF): esperimenti in vitro.

Since previous studies reported that in vitro some proteins and phospholipids were absorbed by asbestos fibres, namely chrysotile, in this study, man made filamentous glass fibers are been tested in vitro at the presence of proteins. The objective was to obtain evidence to evaluate whether continuous glass fibers have a behaviour similar to asbestos fibres. A sample of chrysotile fibres was used as control. Uptake of bovine serum albumin and horse spleen ferritin on these continuous glass fibres has been observed. However on glass fibres adsorbed less proteins per weight unit (22 mg/g and 12 mg/g respectively for albumin and ferritin) than asbestos chrysotile fibres (42 mg/g and 49 mg/g respectively for albumin and ferritin).