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.

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.

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.

Studies on canine leishmaniasis control. 1. Evolution of infection of different clinical forms of canine leishmaniasis following antimonial treatment.

81 dogs naturally infected with Leishmania infantum in the Isle of Elba, Italy, were treated with meglumine antimoniate (Glucantime). 36 of them (45.5%) were asymptomatic cases. 4-24 months after treatment the dogs were clinically and serologically examined; the recovery rates were 47.2% for asymptomatic cases, 33.3% for oligosymptomatic cases, and 11.1% for symptomatic cases. Furthermore, treatment had prevented the development of patent disease in 90% of non-recovered asymptomatic cases, whereas it had produced only slight improvement of clinical condition in patent dogs which were still infected after drug administration. Treatment with antimonial drugs is therefore recommended in canine leishmaniasis control if non-patent or sub-clinical forms of the disease are detected by seroepidemiological surveys.

Studies on canine leishmaniasis control. 2. Effectiveness of control measures against canine leishmaniasis in the Isle of Elba, Italy.

A serological and parasitological survey carried out in 1985 in the Isle of Elba, Italy, revealed a high prevalence of canine leishmaniasis. This focus was considered ideal for the evaluation of effectiveness of treating infected dogs with meglumine antimoniate, applied as a control measure during 1985 and 1986. New data on prevalence were obtained for the years 1986 and 1987. Incidence of new canine leishmaniasis cases after the transmission seasons 1984, 1985 and 1986 were determined by examining 2 cohorts: cohort I, dogs born within 2 transmission seasons, and cohort II, adult dogs examined and found to be negative before each transmission season. Over 2000 tests were carried out on 1500 dogs. Prevalence analysis showed a reduction of infective dogs (symptomatic and oligosymptomatic) from 14.4% in 1985 to 5.2% in 1987. Incidence analysis showed a decrease of new cases from 12.4% after transmission season 1984 to 4.6% after transmission season 1987. The results indicate a two-thirds reduction of the disease frequency in dogs of the Isle of Elba after a 2-year period of control measures.

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.

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.

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.

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.

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.

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.

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.

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.

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.