Surgical results and survival of older patients with unsuspected N2 (stage IIIA) non-small cell lung cancer.

PURPOSES: The optimal treatment of N2 non-small cell lung cancer (NSCLC) in older patients is still debate and represent an important treatment and ethical problem. PATIENTS AND METHODS: Between January 2000 to December 2010, 273 older patients underwent lung resection for (NSCLC). RESULTS: The overall-operative mortality was 9.5%. Risk factors for in-hospital mortality were pneumonectomy and poli-vasculopathy. One, 3 and 5-year survival were 73%, 23% and 16% respectively. CONCLUSIONS: In potentially operable older patients with NSCLC we need to make every effort to exclude N2 involvement because very poor long-term survival. Pneumonectomy in older patients gains prohibitive in-hospital mortality.

Effects of oral glucose administration on plasma growth hormone levels in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the sensitivity of GH secretion to the suppressive effect of oral glucose administration in women with polycystic ovary syndrome (PCOS). DESIGN: Comparison of the GH response to an oral glucose load in women with PCOS and in weight-matched normally menstruating women (controls). SETTING: Reproductive endocrinology unit. PATIENT(S): Eighteen obese and 11 nonobese patients and 10 obese and 10 nonobese controls. INTERVENTION(S): After an overnight fast, each woman underwent a 75-g, 3-hour oral glucose tolerance test (OGTT). MEAN OUTCOME MEASURE(S): Growth hormone, glucose, and insulin responses to OGTT. RESULT(S): No significant differences in the glycemic and insulinemic responses were found between the patients and the weight-matched controls. No decrease in plasma GH was observed in both obese and nonobese patients and in obese controls during the OGTT, whereas a significant GH decrease occurred in nonobese controls 60 and 120 minutes after glucose intake. CONCLUSION(S): Oral glucose administration was unable to suppress GH levels in nonobese as well as in obese women with PCOS and in obese control women. These data suggest that both PCOS and obesity are associated with a reduced sensitivity of GH secretion to glucose suppression.

Prevention of deep vein thrombosis in orthopaedic surgery. Comparison of two different treatment protocols with low molecular weight heparin ('Fluxum').

The efficacy of two treatment protocols with a low molecular weight heparin used for the prevention of post-operative deep vein thrombosis was compared in 40 patients undergoing hip replacement surgery. The aim was to assess whether the different timing--2 hours before (Group A, 19 patients) or 2 hours after (Group B, 21 patients) the surgical operation--of the first dose administered (15,000 aXaU) of a therapeutic cycle of 7 days could affect the results, both with respect to the preventive efficacy and to the risk of haemorrhage often connected with antithrombotic therapy. The results showed that the incidence of deep vein thrombosis was very similar and extremely low in the two groups, only 1 patient in each group having a positive diagnosis on phlebography. The effectiveness of a single daily dose of 15,000 aXaU in orthopaedic surgery was also confirmed. This dose guaranteed effective prophylaxis against the onset of deep vein thrombosis and did not appear to have any local side-effects (such as burning or pain at the site of injection) which could diminish patient compliance.

Bacterial species detected in some bottled mineral waters sold in Italy.

A total of 51 samples from 32 different kinds of mineral water were examined to investigate their microbial facies in view of a possible relationship with ionic composition. No difference was found between mineral and oligomineral waters. The genera most represented were Pseudomonas, Flavobacterium and Alcaligenes; only rarely could members of these genera be assigned precisely to a defined species, because many strains showed intermediate patterns. The authors suggest widening the microbiological examination of mineral waters and improving ecological and taxonomic knowledge of the autochthonous species in all processing phases in order to evaluate not only their compliance with the law, but also the variations imposed on microflora by different conditions related to container materials, time and temperature of storage.

Associated lesions in multiple trauma of the pelvis. Diagnostic and therapeutic considerations.

On the basis of 80 cases of traumatic lesion of the pelvis with associated vascular and visceral lesions, observed between 1985 and 1994 at the Department of Surgery in Modena and at the Rizzoli Orthopaedic Institute in Bologna, the options for diagnosis as related to the specificity of lesions are examined, and the choices of indications and surgical technique are illustrated.

Evaluation of prognostic significance of circulating interleukin-6 in patients with accident spine injuries.

Our study aimed to verify whether patients with spine accident injury present altered plasma levels of IL-6 and whether the levels of this cytokine are related with the production of acute phase proteins which are elevated after trauma and infection. 34 subjects admitted to an Intensive Care Unit for spine injuries were examined: 26 presented fever over 38.5 degrees C and in 13 of them blood or local cultures were positive for pathogenic bacteria. IL-6, C-reactive protein (CRP), haptoglobin (HPT), alpha 2-macroglobulin (alpha 2Mg), C3c and C4 Complement factors were determined on admission and in the course of their hospital stay. No changes in IL-6 systemic levels were present in the subjects examined and only CRP was constantly high. Although within the normal range IL-6 levels inversely correlated with fever. Our results show the difficulty to utilize the IL-6 circulating levels as prognosis parameter in patients subjected to spine accident injuries.

[The evaluation of day hospital activities: an analysis of intervention protocols and a comparison between the indicators of the activities of the day hospital and of the regular admission]. / Indagine per la valutazione delle attività di Day Hospital: analisi dei protocolli di intervento e confronto tra indicatori di attività del Day Hospital e del ricovero ordinario.

Day hospital (DH) activity may avoid in-staying of patients resulting in an increase of efficiency and in a more satisfying diagnostical-therapeutical process for the patient. All the same, it is quite difficult to identify parametres and indicators to be used in the evaluation and quantification of DH, so that both scientific literature reporting experiences and law are lacking. One of the reasons is probably due to the lack of nosological characterization of patients and protocols of DH activity, so that the definition relies only on organizational and technical parameters. Characterization of protocols of intervention is the basic approach to the present DH investigation. Parameters such as: multiplicity of services, weekly planning of the activity and surveillance needed by the patient are considered the fundamental criteria to identify and quantify DH in the present research carried out at the University Regional Hospital of Pisa. The aim of this article is, on one side, to give a methodology of investigation based, as far as possible, on "explicit" indicators and parameters, so that the experience may be exported into other contexts and on the other, to give an example of resource analysis and efficiency evaluation which were internally used for "audit" review.

[Hygiene and health importance of histamine as an unhealthy factor in several food products]. / Interesse igienico-sanitario per l'istamina come fattore di insalubrita' di alcuni alimenti.

Epidemiologic reports on food-borne diseases from different countries show not infrequently outbreaks due to histamine toxicity. The Authors were interested in assessing the relative importance of this nosological entity in Italy and made a global review of old and recent literature on the subject referring also their earliest data on a recently performed laboratory work. Several foods can show histamine contents potentially toxic for man; amongst the most frequently incriminated products fish, especially the scombroid species (tuna, mackerel), plays a pre-eminent role in the etiology of the so called scombrotoxic fish poisoning. This syndrome begins from a few minutes to two hours from incriminated meals and presents itself with the characteristic signs and symptoms of histamine activity on various organs and is very rarely, if ever, life threatening. Histamine formation in food is due to the decarboxylase activity of some microorganisms, mainly enterobacteria; they can be part of its normal flora or represent a secondary contamination and find a favourable environment for outgrowth if food is not stored or processed in proper conditions. An international outlook on the epidemiology of this syndrome is then given, including some considerations on the real dimension of the problem in Italy, at present widely underestimated. Though a pioneer work was accomplished by Pergola, who started his researches in 1910 after receiving several reports of food poisoning related to consumption of tuna and finally established the causative role of histamine, we are lacking at present an up to date picture of this problem in our country, notwithstanding a few sporadic notifications. Two of the most relevant ones concern a survey in Rome on a collection of 110 cases observed in the seventies and an outbreak occurred in Palermo in 1979 affecting nearly 250 people. The relationship between the intake of histamine and the clinical effects on man of a given dose are then evaluated together with histamine catabolic pathways in the gut, where possible interference by enhancing substances may occur. Finally a brief review of the analytical methods currently employed gives the Authors the possibility to refer about their first data of a survey on the hygienic quality of scombroid species commercialized in their metropolitan area.