Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies.

AIM: To evaluate the frequency of complications in bronchoscopy from data compiled between 1/2/2002 to 1/2/2003. MATERIALS AND METHODS: Nineteen Italian centres of thoracic endoscopy participated in the study, for a total of 20,986 bronchoscopies (FBS), including 10,658 explorative bronchoscopies (EB) (50.79%), 5,520 bronchial biopsies (BB) (26.30%), 1,660 transbronchial biopsies (TBB) (7.91%), 1,127 broncho-alveolar lavages (BAL) (5.37%), 930 transbronchial needle-aspirates (TBNA) (4.43%), 1.091 therapeutic bronchoscopies (TB), comprising ND-YAG Laser, argon-plasma, electrocautery knife, stent insertion (5.20%). 82.4% of the procedures involved the use of a flexible bronchoscope, 16.3% were carried out using a rigid bronchoscope and 1.3% using the mixed technique. RESULTS: The total number of complications recorded was 227 (1.08% of the cases examined), including 20 (0.09%) during local anesthesia and pre-medication, 195 (0.92%) during the endoscopic procedures and 12 (0.05%) in the two hours following FBS. The total number of deaths was 4 (0.02%), due to cardiac arrest, pulmonary edema, delayed respiratory failure and shock in pre-medication, respectively. 68.28% of the complications were treated medically, 25.99% by means of endoscopy and 5.72% with surgery. The healing percentage was 98.2%. CONCLUSIONS: This study has shown that bronchoscopy is a safe method with low incidence of mortality and complications. The preparation, experience and continuous training of the operators of the medical and nursing team seem to play a fundamental role in reducing the incidence of complications at least in certain procedures such as BB and TBB.

Effects of hemodialytic treatment on uremic polyneuropathy. A clinical and electrophysiological follow-up study.

The involvement of peripheral motor and sensory nerve, at least on a subclinical level, is nearly constant event with chronic renal failure. The study of the motor and sensory propagation velocity indicates that a widespread functional lesion of the axon with a peripheral point of attack and secondary demyelination, may be the basic pathogenetic event of uremic polyneuropathy. Prolonged hemodialytic treatment is substantially unable to influence the evolution of uremic polyneuropathy. The electrophysiological follow-up study of the peripheral nerve does not seem to be an index of adequate dialysis.

Plasma cholesterol and triglycerides in heroin addicts.

We examined total cholesterolemia, triglyceridemia, high density lipoproteins- (HDL) cholesterolemia, apolipoproteins A1 and B, body mass index, albuminemia and alanine aminotransferase in 60 heroin addicts. After comparing 23 control subjects with the heroin addicts the result was that the latter have significantly lower mean values of total cholesterolemia and of HDL-cholesterolemia and higher values of triglyceridemia. They also have significantly higher prevalences of cases of hypocholesterolemia and of hypo-HDL-cholesterolemia. Within the addict group there is no linear correlation between total cholesterolemia and body mass index; there is, however, an inverse linear correlation between total cholesterolemia and alanine aminotransferase. Therefore, the alterations found in the lipid pattern of heroin addicts are not due to malnutrition but hypothetically to liver diseases which are frequent in these patients.

Endemic non-filarial elephantiasis in Iringa District, Tanzania: a study of 30 patients.

Endemic non-filarial elephantiasis has not yet been described in the central tableland of Tanzania. We report the results of a clinical study in Tosamaganga Hospital, located in the middle of Tanzania (Iringa District). 30 patients with elephantiasis of the lower limbs were studied parasitologically (by blood smears) and clinically. Inguinal lymph nodes were removed from 10 patients and histologically examined. The mineral content of soil samples collected from 4 different areas of the region was assayed by X-ray fluorescence. The clinical, histological, parasitological and epidemiological data prompted us to conclude that in these patients elephantiasis was not of the filarial type, and that endemic non-filarial elephantiasis is present in the Central District of Tanzania.

[Value of some biological variables for the diagnosis of alcoholism in a hospital population]. / Valore di alcune variabili biologiche per la diagnosi di alcoolismo in una popolazione ospedaliera.

279 male patients consecutively admitted to a medical ward were interviewed about their drinking habits using a CAGE-like questionnaire and were subdivided into teetotallers, normal-, borderline-, heavy-drinkers. The mean values of the following laboratory tests resulted significantly different in heavy drinkers compared with the others: mean cell volume, gamma-glutamyl-transpeptidase, serum urea (BUN), SGOT, SGPT, total bilirubin. No significant difference was found for triglycerides, uric acid, albumin and gamma-globulins. Sensitivity, specificity, predictive values of positive test and negative test, "goodness" were calculated for each of the 6 above-mentioned tests. Each of them had a linear correlation (inverse for BUN, direct for the others) between amount of alcohol intake and level of the test.

Sympathetic skin response in patients with Duchenne muscular dystrophy.

To verify an eventual disfunction of the palmar sympathetic skin activity in Duchenne Muscular Dystrophy, we studied the sympathetic skin response (SSR) with endogenous, Deep Breathing (DB-SSR), exogenous Startle (SE-SSR) and Electric type stimuli (EE-SSR) in a group of patients and a control group. At the same time as the SSR, the heart rate (HR) and the basic R-R interval variation (RRIV) as well as the EMG diaphragmatic activity were checked. In this way, significant differences in the latency (p = 0.02) and amplitude (p = 0.009) values of the EE-SSR and in the amplitude values of the SE-SSR (p = 0.001) and of the DB-SSR (p = 0.02) were noted in the DMD group compared to the control group. In the group of patients the rise in latency of the EE-SSR correlates with the age (p = 0.0001) and with the reduction of its amplitude (p = 0.03). This last parameter correlates with the stage of the illness (p = 0.02). In the control group the mean amplitude of the EE-SSR is approximately 30% greater than that of startle and 50% of deep breathing. Although with amplitudes homogeneously reduced, these ratios are also conserved in the DMD group. Moreover the HR is greater (p = 0.0001) whilst the RRIV is reduced (p = 0.02) in the group of the patients. However these parameters do not correlated either to the cardiac involvement or to the stage of the illness. The presence of the SSR for all the modalities of stimulation indicates the substantial integrity of the afferent and the efferent paths of the ANS. The alterations in latency and amplitude of the SSR in the patients could be the consequence of a lack of dystrophin at the level of the sudoriparous myopithelium in analogy to what has been demonstrated in the mdx mouse.

Going green by reducing red. New alternative medical waste treatment technologies.

The field of medical waste disposal is changing rapidly. Over the past decade, there has been increasing public health concern over health care's red bag waste. The health care industry must routinely contend with a complex set of regulations covering occupational safety, transportation and packaging, medical waste disposal management, and now environmental regulations for medical waste incinerators.

Lactobacilli isolated from sugary kefir grains capable of polysaccharide production and minicell formation.

Homo- and heterofermentative species of Lactobacillus have been isolated from sugary kefir grains. Most of the homofermentative strains fermented tagatose and aldonitol and presented 48-54% of homology with Lactobacillus paracasei ssp. paracasei NCDO 151 (ex Lactobacillus casei). The two variants of a hetero-fermentative species, although fermenting arabinose, were related to Lactobacillus hilgardii NCDO 264 (type strain) with 88% of homology. One of them produced polysaccharide from sucrose at pH 4.8 and 30 degrees C; the best glucose conversion into polysaccharide was obtained from 3% of sucrose (81.8%), and the maximum production occurred about 35 hours after the end of the log phase of growth, in MRS sucrose broth. Polysaccharide formation did not occur above 40 degrees C, a temperature at which no growth was observed. The two variants were forming minicells by abnormal divisions.

Epidemiological survey of multiple sclerosis in the provinces of Reggio Emilia and Modena, Italy.

We present the results of an epidemiological survey on MS conducted in the provinces of Reggio Emilia and Modena (4,980 km2) from 1970 to 1990. The population increased from 943,182 residents in 1970 to 1,024,223 in 1990, with an average population during the period of the survey of 993,056. The mean annual incidence was 1.59 cases/100,000 inhabitants (c.i. 95% 1.42-1.78). The prevalence as of December 31, 1990, was 39.44/100,000 inhabitants. Our study is a further demonstration that Italy is a high-risk zone for this disease, and also demonstrates the possibility of carrying out reliable epidemiological surveys even over extensive territories.

Cost/benefit relationship in 46 cases of myelodysplastic syndrome (RAEB and RAEB-T): a quality assurance analysis in clinical haematology.

BACKGROUND: Myelodysplastic Syndromes (MDS) are common and severe haematologic diseases. Clinicians still have no standard therapies surely able to obtain a better result in the different MDS (RAEB and RAEB-t in particular). Moreover, the costs due to the specific drug, to its clinical complications and to the days spent in hospital can be influenced by the chosen therapeutic regime. There are no published studies regarding a cost-benefit relationship of the different drugs commonly used today for MDS patients. PATIENTS AND METHODS: This retrospective study refers to 46 patients with RAEB or RAEB-t, followed in our Division from 1986 up to December 1992. The authors reviewed specific therapies (ARA-C vs other drugs, in particular), the costs supported by the National Health Service and the effects of the same therapies in terms of survival. The results have been worked out by statistical analysis. RESULTS: Some interesting data are presented in this study: chemotherapy does not improve survival and causes higher costs; the length of stay in hospital is not influenced by using chemotherapy or not; RAEB patients cause as high costs as RAEB-t ones. CONCLUSIONS: Although the study regards only a limited number of cases, it shows that the therapeutic efforts made so far in order to improve MDS patients' prognosis cannot be considered satisfying and their social cost is very high. Our report can be a useful starting-point for a QA analysis concerning the rational use of new drugs such as growth factors and interleukins.

Visual "disappearing phenomenon" can reliably predict the nonadenomatous nature of rectal and rectosigmoid diminutive polyps at endoscopy.

Previous studies have failed to differentiate adenomatous from nonadenomatous diminutive polyps according to their gross macroscopic features at endoscopy. We prospectively evaluated the prevalence, distribution, and predictive value of a recently described morphologic feature-the "disappearing phenomenon"-in diminutive polyps of the distal 20 cm of the large bowel by studying 218 polyps in 90 consecutive patients. Disappearance was graded as complete, incomplete, or absent. Overall, complete disappearance was noted in 93 (43.1%) polyps, with a significantly higher prevalence in the middle and lower rectum (p < .05) and among smaller, paler, and smooth-surface polyps (p < .001). Incomplete disappearance was detected in both nonadenomas (23.1%) and adenomas (15.8%), but, more importantly, complete disappearance occurred in none of the 19 observed adenomas compared with 93 of 199 nonadenomas. Multiple logistic regression analysis revealed that disappearance was the strongest predictor (p < .001) of nonadenomatous histology among considered morphologic criteria. When complete disappearance was used to predict histologic type of diminutive polyps, its sensitivity was 100% and its specificity was 46.7%. In conclusion, the disappearing phenomenon represents a reliable visual marker for identifying nonadenomatous rectal and rectosigmoidal diminutive polyps at endoscopy. Diminutive polyps that disappear completely upon insufflation are invariably nonadenomatous and should not require endoscopic biopsy or removal.