[Mortality among lead-zinc miners in Val Seriana]. / Studio di mortalità dei minatori di piombo-zinco della Val Seriana.

The mortality experience of 1392 lead-zinc-silver miners (Gorno, Northern Italy) employed in the period 1/1/1950-31/12/1980 and followed-up to 31/12/1986 was examined. Two separate estimates of the radon exposure level are available: 0.60 and 0.36 working levels respectively. The silica exposure level was not assessed. Vital status was ascertained for 95.6% of the cohort members and their mortality was compared with expected deaths based on national rates. Significant excess mortality from esophageal cancer, stomach cancer, lung cancer, respiratory tuberculosis, respiratory diseases and deaths from external causes was found among underground miners. Surface workers show significantly increased mortality from liver and bile ducts cancer, hepatic cirrhosis, respiratory tuberculosis and respiratory diseases. Based on the 16.4 excess lung cancer cases among underground miners and their cumulative radon exposure, an attributable risk estimate ranging from 9.78 and 16.31 cases per million person-years and WLM (Working Level Month) was calculated.

Fleroxacin: in-vitro activity worldwide against 20,807 clinical isolates and comparison to ciprofloxacin and norfloxacin.

By June 1987 worldwide investigators from 37 centres in 12 countries had completed epidemiological susceptibility testing studies comparing the in-vitro activity of fleroxacin with that of ciprofloxacin, norfloxacin and other antibacterials. In this paper the results of these studies, expressed primarily as MIC90S, are reviewed and analysed for centre to centre variability. Twenty thousand eight hundred and seven strains were evaluable for comparative analysis. All three quinolones exhibited high in-vitro activity against Enterobacteriaceae (MIC90 less than or equal to 0.125-2 mg/l), other common aerobic Gram-negative bacilli or coccobacilli (MIC90 less than or equal to 0.125-1 mg/l) and staphylococci, including selected resistant isolates (MIC90 less than or equal to 0.5-4 mg/l), and moderate to weak activity against streptococci and anaerobes (MIC90 = 1- greater than or equal to 8 mg/l). The activity of fleroxacin and norfloxacin was quite similar, but was usually inferior to that of ciprofloxacin. Comparison of data from the various investigating centres showed divergent results for many bacterial species, the MIC90S for the same quinolone varying by two to four dilution steps or more from centre to centre.

Effect of common airway manoeuvres on upper airway dimensions and clinical signs in anaesthetized, spontaneously breathing children.

Chin lift, jaw thrust and these manoeuvres combined with continuous positive airway pressure (CPAP) can be used to improve the patency of the upper airway during general anaesthesia. We used video endoscopy and measurement of stridor to compare the efficacy of these manoeuvres in 24 children (3-10 yr) with adenotonsillar hyperplasia. A bronchofibrescope was passed via the nose while the children were breathing spontaneously, to identify (i) the shortest transverse distance between the tonsils during inspiration and during expiration and (ii) the distance from the tip of the epiglottis to the posterior pharyngeal wall. Chin lift or jaw thrust lifted the epiglottis and, when combined with CPAP (10 cm H2O), there was a significant lateral displacement of the tonsils. Both chin lift plus CPAP and jaw thrust plus CPAP reduced stridor significantly compared with the unsupported condition. In conclusion, in spontaneously breathing children with large tonsils, chin lift plus CPAP is recommended, whereas jaw thrust plus CPAP is no better and may cause post-operative discomfort.

Dynamic imaging of the pediatric upper airway during general anesthesia.

Video endoscopy can be easily performed in young children during general anesthesia. Airway patency can be directly qualified and then the video material can be transferred to a PC-based image analysis system for subsequent interactive teaching.

Airway obstruction due to arytenoid prolapse in a child.

In paediatric patients, obstruction of the upper airway is still a common problem during general anaesthesia. This case report documents the susceptibility of arytenoids to prolapse in paediatric patients during halothane anaesthesia. The use of video endoscopy provides an excellent tool for visualizing this type of airway obstruction; and continuous positive airway pressure is an effective treatment for clearing the airway.

HAV epidemics in lower Valle Seriana (Bergamo): 1968-1984.

The observation of an HAV epidemic in Alzano Lombardo (Lower Valle Seriana, Bergamo) in 1984 induced to an epidemiological retrospective inquiry of previous epidemics happened in the above territory from 1968, to attain a comparative checking of epidemiological aspects. Organizative structural modifications on the overmunicipal water-cistern-management and the building of suitable sewers collector together with a better sanitary education become necessary against HAV, and they can be considered the only opportune prophylaxis.

Combined effect of patient variables on sensory level after spinal 0.5% plain bupivacaine.

BACKGROUND: The combined effect of age, weight, height, and vertebral column length (VCL) on the distribution of isobaric 0.5% bupivacaine within the subarachnoid space is unclear. The aim of the present study was to evaluate the combined influence of these patient variables on the upper sensory level and on its predictability. METHODS: In 100 patients who were above the age of 49 years, the age, weight, height, VCL, body surface (BS), and body mass index (BMI) were noted. Spinal puncture and subarachnoid drug administration were standardized. Cephalad spread of spinal anaesthesia (SA) was assessed by loss of temperature sensation and pinprick discrimination 15, 30, 60, 90, and 120 min following subarachnoid injection of 18 mg of plain 0.5% bupivacaine. Linear regression analysis was performed for each of the patient variables and the cephalad segmental spread of anaesthesia. Multiple regression analysis was used to test for combined correlation between patient variables and the sensory level of SA. RESULTS: No linear correlation was found between the patient variables and the sensory level of anaesthesia. In contrast, multiple regression analysis revealed that age (P<0.01), weight (P<0.05), and height (P<0.01) significantly contributed to the spread of anaesthesia. A squared multiple comparison coefficient between 0.10 and 0.21, however, is an indication that the predictive value of the combined variables remained rather low. CONCLUSION: Multiple regression analysis revealed that age, weight, and height significantly correlated with the sensory level after subarachnoid injection of plain bupivacaine. The low predictive value suggests that patient factors other than age, weight, or height add to cephalad spread of SA.

Prolonged decrease in heart rate variability after elective hip arthroplasty.

The pattern of postoperative heart rate variability may provide insight into the response of the autonomic nervous system to anaesthesia and surgery. We have obtained spectral (fast Fourier transform) and non-spectral indices of heart rate variability from electrocardiographic recordings, sampled during continuous perioperative Holter monitoring in 15 otherwise healthy patients with an uncomplicated postoperative course, undergoing elective hip arthroplasty with either spinal or general anaesthesia. In both groups, total spectral energy (0.01-1 Hz), low-frequency spectral energy (0.01-0.15 Hz) and high-frequency spectral energy (0.15-0.40 Hz) decreased after surgery to 32% (95% confidence interval (CI) 10.5; P < 0.01), 29% (95% CI 12.5; P < 0.01) and 33% (95% CI 12.5; P < 0.01) of their preoperative values, respectively, and these indices remained suppressed for up to 5 days. Non-spectral indices decreased to a similar extent. These findings indicate a substantial and prolonged postoperative decrease in both parasympathetic and sympathetic influence on the sinus node.