Water safety in healthcare facilities. The Vieste Charter.

The Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) and the Local Health Authority of Foggia, Apulia, Italy, after the National Convention "Safe water in healthcare facilities" held in Vieste-Pugnochiuso on 27-28 May 2016, present the "Vieste Charter", drawn up in collaboration with experts from the National Institute of Health and the Ministry of Health. This paper considers the risk factors that may affect the water safety in healthcare facilities and reports the current regulatory frameworks governing the management of installations and the quality of the water. The Authors promote a careful analysis of the risks that characterize the health facilities, for the control of which specific actions are recommended in various areas, including water safety plans; approval of treatments; healthcare facilities responsibility, installation and maintenance of facilities; multidisciplinary approach; education and research; regional and national coordination; communication.

Pleural effusion in sarcoidosis: a case report.

Pleural effusion is a well-recognized clinical entity that can be associated with sarcoidosis. Nevertheless, the real prevalence of this phenomenon remains to be established. This study describes the case of a 57-year-old male sarcoid patient who presented with right exudative pleural effusion, dyspnea on exertion, and bilateral pulmonary interstitial infiltrates. Sarcoidosis was diagnosed more than 2 years prior to the onset of pleural involvement. Pleural biopsy revealed the presence of typical sarcoid non caseating granulomas. Sarcoid involvement of the pleura resolved following a 1-month course of high doses of steroids and did not recur during a 18-month follow up. When we retrospectively analyzed clinical data obtained from 624 consecutive sarcoid patients who were referred to our hospital between January 1980 and June 1993 and examined for the presence of pleural involvement, the only patient who showed pleural effusion and histologically proven sarcoidosis of the pleura was the case here described. The frequency of the phenomenon in our series is 0.16%. We conclude that pleural effusion represents a rare event in sarcoidosis.

Bronchial carcinoids: a review of 60 patients.

Sixty patients with a bronchial carcinoid underwent surgical treatment. Preoperative fiberoptic bronchoscopy revealed a characteristic pink, smooth, bleeding tumor in 71.4% of the patients with a typical carcinoid and 16.7% of those with an atypical carcinoid (p less than 0.05). Eight pneumonectomies, seven bilobectomies, 34 lobectomies, three lobectomies with bronchoplasty, six bronchotomies with bronchoplasty, and two segmental resections were performed. All patients entered follow-up, and 47 were followed for more than 5 years. Ten-year survival was 89.6% for patients with a typical carcinoid and 60% for those with an atypical carcinoid. Ten-year survival was 88.1% for patients with carcinoids without lymph node involvement. All patients with lymph node involvement died within 5 years. Overall, 5 of the 8 patients having pneumonectomy died of acute cardiorespiratory failure. We conclude that a limited surgical resection with or without bronchoplasty and systematic lymphadenectomy is the procedure of choice in patients with typical carcinoids. On the other hand, atypical carcinoids are comparable to well-differentiated malignancies of the lung. Whenever possible, pneumonectomy should be avoided in favor of bronchial sleeve resection.

Longitudinal study of alveolitis in hypersensitivity pneumonitis patients: an immunologic evaluation.

Cells recovered from bronchoalveolar lavage were studied, both from a phenotypic and functional point of view, in 18 patients with hypersensitivity pneumonitis (HP) during a prolonged follow-up. A series of monoclonal antibodies against different lymphocyte subpopulations, including T cells, T cell subsets, and natural killer (NK) cells have been used. In some cases, an immunohistologic analysis of lung tissue sections has also been performed. The NK activity has been evaluated with regard to the in vitro function. At the time of the first evaluation, a high number of CD8+ cells with an imbalance of CD4/CD8 ratio had been demonstrated in patients with HP. Consecutive bronchoalveolar lavage evaluations demonstrated a persistent increase of CD8+ cells and a reversal of CD4/CD8 ratio in patients who continued to be regularly exposed to etiologic antigens at work (W+). In the same cases, a persistent increase of NK cells was demonstrated. Cytotoxic cells demonstrated a persistently enhanced in vitro lytic function during the follow-up, even though there appeared to be a trend toward the normal range. Patients who continued to live in agricultural environments but were not further exposed to specific antigens at work (W-) exhibited a recovery of CD4+ cells, a decrease in CD8+ cells, and an increase of CD4/CD8 ratio to the normal range 6 months after the first observation. Immunohistologic analysis, performed at the time of the first evaluation, demonstrated a diffuse infiltration of lung parenchyma by CD8+ cells, both in W+ and W- patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Sleeve lobectomy in the treatment of bronchogenic carcinoma.

From 1980 to 1985, 44 sleeve lobectomies were carried out in patients with bronchial cancer. Sixteen patients received preoperative radiotherapy. Perioperative mortality was 6.8%. There were seven anastomotic complications (three fistulae and four stenoses) and two recurrences at the anastomosis. Overall actuarial survival was 45% at four years. These results seem to suggest that sleeve lobectomy should be considered an elective rather than a compromise procedure and a viable alternative to pneumonectomy. Preoperative radiotherapy neither increases complications nor has a negative effect on outcome. It contributes towards reducing local recurrences and maximizes tissue salvage. Long-term survival is related to stage or histology, factors generally governing the survival of lung cancer operated patients, although the TNM classification is ill-suited to identifying tumors which can be resected by a sleeve lobectomy.

[Typical, atypical and malignant bronchial carcinoid]. / Il carcinoid bronchiale tipico, atipico e maligno.

A series of 54 bronchial carcinoids operated in the course of 12 yr is presented. There were three histological types: typical, atypical and malignant. A parallel was also apparent between histological appearance and clinical pattern. Correct prognosis, however, demands the examination of other parameters, such the tendency of the neoplasia to infiltrate, and the presence of metastatic lymph nodes.