Comparative study of two digital radiographic storage phosphor systems.

The objective of this study was to evaluate the image quality and dynamic range of two digital radiographic storage phosphor systems: Digora (Soredex, Finland) and DenOptix (Gendex, USA). Four objects were analyzed and eight exposure times employed, totaling 64 images that were analyzed by 5 examiners using a scale from 1 to 4 to classify the images. The scores were submitted to analysis of variance and the results showed statistical differences among the averages attributed to the systems, to the exposition times and to the objects (p 0.01 Pound). Digora presented a larger dynamic range and, in general, a better image quality. Although these 2 systems present the same photon detector, they present different results in relation to the evaluated items.

Cervical cancer screening programs in low-income communities. Experiences from Ecuador. Low cost detection of HPV infection in a developing country.

OBJECTIVES: With the support of the independent humanitarian organization "Amici Fundation Terra Nueva" in Quito, Ecuador, we evaluated the feasibility of a cytologic screening program sustained by volunteers on the field and in Italy. METHODS: 250 women underwent a cervical Pap-test. The women with a positive Pap-smear were re-called for visual inspection with acetic acid (VIA), whereas those with a negative smear were invited for a new Pap-test after 3 years. To obtain samples for molecular assays, cytologic material was removed from slides, submitted to DNA extraction and amplified by nested PCR of the L1 region of HPV DNA. PCR-positive samples were sequenced. RESULTS. Six (2.6%) samples showed squamous intra-epithelial lesions (SILs): 4 low grade and 2 high grade SILs were present in women more than 40 years old. The overall rate of successful DNA recovery on a per-slide basis was 96.5%. High grade SILs were characterized by HPV 16 and 18 co-infection. HPV 16 was detected in one low grade SIL. HPV-DNA was detected in 11 smears (4.95%): in all 6 SILS and in 5 of the 216 negative smears. CONCLUSION: Independent humanitarian organizations could play a role in supporting national screening programs offering skilled field professionals and technical support by scientists operating in their countries. Our molecular technique has the potential to provide important epidemiological information in many resource-poor areas of developing countries.

[Screening with latex IgM reagent on umbilical cord blood for demonstration of intrauterine infections]. / Screening con reattivo al latex IgM su sangue funicolare per evidenziare infezioni intrauterine.

The AA. have found IgM in cord sera of 903 newborns. In 13 (1.44%) there was an increase of IgM and the control made on neonatal serum within the first 5 days from birth has shown a positive result only in 1 case (7.69% of positives). The AA. present, in the conclusions, some considerations that justify the results of their work.

[Evaluation of the characteristics and performance of an automatic sphygmomanometer (Omega 1400)]. / Valutazione delle caratteristiche e delle prestazioni di uno sfigmomanometro automatico (Omega 1400).

24 hour pressure monitoring is a newly developing technique potentially yielding important informations in hypertensive patients. Numerous automated devices are available whose performance characteristics are poorly documented. To evaluate an automated sphygmomanometer commonly used in our Division (Omega 1400, Invivo Research Laboratories), we performed a series of measurements, simultaneously recording blood pressure in the opposite arm with a common sphygmomanometer. Each measure was then repeated reversing the position of the two devices (manual and automated), thus abolishing possible differences between the two arms. We observed a mean underestimation of 1.90 mmHg of systolic pressure and of 4.82 mmHg of diastolic blood pressure by the automated device. We conclude that the device by us evaluated is not advisable in the basal blood pressure evaluation, but useful in monitoring inpatients.

[Blood pressure monitoring during hospital convalescence]. / Il monitoraggio della pressione arteriosa durante il ricovero ospedaliero.

Blood pressure ambulatory monitoring has provided numerous and interesting informations on the clinical as well as investigational setting of arterial hypertension. The vast majority of data have been obtained registering blood pressure during the normal daily activities of the patients and surprisingly few studies have been undertaken to evaluate blood pressure behaviour in inpatients. We observed the 24 hours pattern of blood pressure in hypertensive and normotensive inpatients, using an automated sphygmomanometer (Omega 1400), whose performance was previously evaluated by us. The results demonstrate that blood pressure monitoring in inpatients could be a useful tool in managing hypertensive patients.

[A comparison of ventilation techniques in ARDS. Volume controlled vs pressure regulated volume control]. / Confronto tra tecniche di ventilazione nell' ARDS. Volume controllato vs volume garantito a regolazione di pressione.

OBJECTIVE: Comparison between effects of a new method of mechanical ventilation (PRVC) and Volume Controlled ventilation in the ARDS treatment. DESIGN: Prospective study from March 1995 to March 1997. PLACE: Intensive Care Unit of Sanremo Hospital. PATIENTS: Nine patients, six males and three females, average age 49.2 years, average SAPS 35.5, with moderate to severe ARDS related to various etiologies. INTERVENTIONS: Patient were first ventilated with Siemens Servo Ventilators 300 in Volume controlled. They were then ventilated with Pressure-regulated Volume Control maintaining the same ventilation parameters (TV, RR, FiO2, PEEP and I:E ratio). MEASUREMENTS: After a 60 minute stabilisation period in each method, Peak inspiratory pressure, Static Compliance, PaO2, PaCO2, AaDO2 and cardiovascular parameters were measured. RESULTS: With the PRVC ventilation an important decrease of PIP and an improvement of PaO2 and SaO2 were observed. CONCLUSIONS: Although it is not possible to draw any conclusion on morbidity and mortality in patients treated with PRVC versus VC, for gas exchange and compliance improvement and for inspiratory pressure decrease with consequent reduction of barotrauma, it may be affirm that PCRV seems to be the best ventilation methods in the ARDS treatment.

Efficacy of recombinant alpha-interferon 2a and 13-cis-retinoic acid in the treatment of squamous cell carcinoma.

BACKGROUND: Recent in vitro and in vivo studies hypothesize a synergistic effect of 13-cis-Retinoic Acid (13cRA) and recombinant alpha-IFN 2a (alpha-IFN) in the treatment of squamous cell carcinoma (SqCC). PATIENTS AND METHODS: 35 patients with SqCC in several sites were treated with 13cRA (0.6-1 mg/kg/day) combined with alpha-IFN (6 x 10(6) I.U./day), continuously for 3 months. RESULTS: We observed an objective response in 41% of cases (13/32 evaluable patients) with 5 complete and 8 partial responses. Toxicity was mild and always rapidly reversible, with no haematological side effects. CONCLUSIONS: These preliminary data confirm the feasibility and effectiveness of the combination of 13cRA and alpha-IFN in the therapy of SqCC, also in pre-treated patients, with acceptable toxicity and good compliance.

Apheresis for severe malaria complicated by cerebral malaria, acute respiratory distress syndrome, acute renal failure, and disseminated intravascular coagulation.

Malaria has become a very uncommon disease in Italy. Recently a variety of circumstances, such as travel to tropical countries as well as immigration from Asia and Africa, have combined to increase the number of malaria cases recorded annually. In this report we describe the use of red cell exchange transfusion and plasma exchange in the treatment of a patient with hyperparasitemic malaria (51% erythrocytes or more parasitized). When first observed the patient was in shock and had signs of cerebral malaria, disseminated intravascular coagulation, and acute respiratory distress syndrome, which in the following 2 days were complicated by acute renal failure. After mefloquine therapy combined with 3 red blood cell exchanges, 2 plasma exchanges, and 10 dialysis sessions over 14 days, the patient recovered completely. This case of severe malaria with multiple complications, treated with mefloquine in conjunction with both exchange transfusion and plasmapheresis, had a successful outcome and lends further support to the possible beneficial role of exchange transfusion in complicated malaria.

Renovascular hypertension with low-to-normal plasma renin: clinical and angiographic features.

1. Low-to-normal renin renovascular hypertension (RVH) and the accuracy of renal vein renin ratios were investigated in 129 consecutive patients referred for suspected RVH. Forty-nine had essential hypertension, 24 unilateral renoparenchymal hypertension and 56 renal artery obstruction. Of the latter, 86% were diagnosed retrospectively as RVH, based on fall in blood pressure with correction of renal ischaemia. We measured baseline, captopril-stimulated and renal vein plasma renin activity (PRA) levels, as well as several other parameters. 2. PRA was low-to-normal in 37% of the RVH patients [low-to-normal renin (LNR-) RVH group] and elevated in the remaining 63% [high-renin (HR-) RVH group]. In the LNR-RVH group, low-to-normal renin levels, by immunoreactive active renin and plasma renin concentration measurements, and a blunted response of PRA to captopril, were seen. As compared with HR-RVH, LNR-RVH patients had a longer duration of hypertension (P < 0.05), higher serum K+ (P = 0.04) and lower diastolic blood pressure (P = 0.02). However, they did not differ for the other variables, including the fall in blood pressure after correction of renal ischaemia. Although the number of bilateral stenoses was similar in the two groups, no patient in the LNR-RVH group had total renal artery occlusion compared with 53% in the HR-RVH group (P = 0.00015). The accuracy of renal vein renin indices were high enough to justify their use only in the patients with total occlusion of a renal artery. 3. Thus LNR-RVH is common in patients with longstanding hypertension without a totally occluded renal artery. Since the sensitivity of renin measurements is low, cure of hypertension would be precluded for more than one third of RVH patients, if these tests were a prerequisite for identifying RVH.