Vascular anomalies of the large bowel.

Vascular anomalies of the large bowel, commonly known as vascular malformations of the colon (VMC), constitute a rare but important condition, potentially causing significant morbidity and mortality. Our aim is to provide an up-to-date, practical summary evaluating this disease entity, focussing on pathogenesis, as well as diagnostic and therapeutic modalities. We reviewed available data in the literature, and discussed it in the form of a narrative, readily applicable review. Most VMC (over 70%) are detected in the caecum and ascending colon, and affect people aged over 50 years. VMC are almost always symptomatic, presenting with lower bleeding. Endoscopy is crucial to identify and locate VMC, and to treat the lesions. In patients who fail or do not fit endoscopic treatment, aggressive approaches (interventional angiology or surgery) are mandatory. Up to 40% of patients may have relapse in the long term. VMC are rare but potentially life-threatening. Advances in endoscopic imaging and therapy have improved the results of treatment. Long-term follow-up after treatment is recommended.

Predictors of Venous Thromboembolism after Colorectal Surgery in a Single Unit.

BACKGROUND: Patients undergoing colorectal surgery are at risk of developing venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). Knowing predictors of VTE could help preventing this life-threatening complication. METHODS: We collected data of patients undergoing colorectal surgery at our Unit between 2009 and 2014. Baseline characteristics, type of surgery, and postoperative complications were gathered. A univariate regression analysis was performed with symptomatic VTE as outcome. Pre-, intra- and postoperative clinical factors were separately tested. All variables significantly associated with VTE occurring within three months from the discharge were entered in the final multivariate regression model. RESULTS: A total of 476 patients were included. Symptomatic VTE occurred in 13 patients (2.7%). Six (46.1%) occurred after hospital discharge. Preoperative variables associated with VTE were: advanced age at surgery (OR 2.3, 95%CI 1.8-5.6), smoking (OR 1.7, 95%CI 1.2-2.5), inflammatory bowel diseases (OR 2.1, 95%CI 1.5-4.3), advanced pelvic malignancies (OR 2.4, 95%CI 2.0-4.2), and obesity (OR 1.5, 95%CI 1.1-2.1). Prolonged pelvic manipulation (OR 1.8, 95%CI 1.1-4.3) and steep Trendelenburg position (OR 2.4, 95%CI 1.9-5.0) were intraoperative predictors of VTE, while stockings significantly reduced the risk (OR 0.8, 95%CI 0.4-0.9). Late mobilization (OR 2.5, 95%CI 2.0-4.6) and septic complications (OR 1.4, 95%CI 1.2-3.7) were postoperative predictors of VTE, whereas anticoagulants administered for at least 3 weeks after discharge were associated with lower VTE risk (OR 0.5, 95%CI 0.2-0.8). CONCLUSIONS: We observed several modifiable predictors of VTE. Patients with ≥2 risk factors undergoing colorectal surgery could benefit from a more intensive VTE preventive pathway.

Vascular anomalies of the large bowel.

INTRODUCTION: Vascular anomalies of the large bowel, commonly referred to as vascular malformations of the colon (VMC) constitute a rare but important condition, potentially causing significant morbidity and mortality. Our aim is to provide an up-to-date, practical summary evaluating this disease entity, focussing on pathogenesis, as well as diagnostic and therapeutic modalities. MATERIALS AND METHODS: We reviewed available data in the literature, and discussed it in the form of a narrative, readily applicable review. RESULTS: Most VMC (over 70%) are detected in the caecum and ascending colon, and affect people aged over 50 years. VMC are almost always symptomatic, presenting with lower bleeding. Endoscopy is crucial to identify and locate VMC, and to treat the lesions. In patients who fail or do not fit endoscopic treatment, aggressive approaches (interventional angiology or surgery) are mandatory. Up to 40% of patients may have relapse in the long term. CONCLUSIONS: VMC are rare but potentially life-threatening. Advances in endoscopic imaging and therapy have improved the results of treatment. Long-term follow-up after treatment is recommended.

[Surgical treatment of secondary hyperparathyroidism. Results from 47 consecutive patients]. / Trattamento chirurgico dell'iperparatiroidismo secondario. Esperienza clinica in 47 pazienti.

To date surgical treatment of secondary hyperparathyroidism (HPTs) is still controversial. Subtotal parathyroidectomy with sparing of a part of not-nodular gland and total parathyroidectomy with autotransplantation (subcutaneous or muscular) represent the most common procedures with the aim to warrant a condition of euparathyroidism. Total parathyroidectomy (or so presumed) represent an unusual therapeutic option as the risks arising from aparathyroidism and from the need of a substitutive therapy are largely known. The authors evaluate the surgical results collected from 47 consecutive patients affected by HPTs and Chronic Renal Failure (CRF) and operated on between January 1999 and January 2006. Probably, a proper indication to the type of surgical procedure could be based on the severity of the disease, on the age of the patient and on the expectation of transplant. The significant incidence of recurrence and persistent disease is due to autoimplantation or residual gland hypertrophy after subtotal parathyroidectomy, to the presence of supernumerary or ectopic glands, to cervico-mediastinic hypertrophy of cellular foci. The identification and removal of supernumerary glands, which may cause persisting hyperparathyroidism, is mandatory.

Videolaparo-assisted subtotal colectomy with cecorectal anastomosis in the treatment of chronic slow transit constipation.

Mechanical cecorectal anastomosis after subtotal colectomy, in the treatment of slow transit constipation, probably represents the most attractive surgical alternative to total colectomy and ileorectal anastomosis. In fact the operation allows better results in terms of postoperative diarrhoea, fecal incontinence and postoperative adherential syndrome. Literature data have demonstrated the feasibility of the laparoscopic approach with tipically advantages of less invasive surgery respect of parietal integrity,less postoperative pain and ileus, fewer postoperative adhesions, a reduced hospitalitation and finally, a better cosmesis. The Authors report a case of mechanical end to end cecorectal anastomosis after laparo-assisted subtotal colectomy (by four trocars) preserving superior rectal and ilecolic vessels, for the treatment of slow transit constipation in a 20 years old male patient .The reported operative approach which links tipical laparoscopic advantages to a more "safety" and "accurate" extracorporeal mechanical anastomosis.

Minimal immunological effects on workers with prolonged low exposure to inorganic mercury.

OBJECTIVES: This study was carried out to investigate possible immunological changes in workers with prolonged low exposure to inorganic mercury in a fluorescent light bulb factory. METHODS: 29 immunological variables were examined in 34 workers with prolonged low level exposure to inorganic mercury (exposed workers) and 35 unexposed workers as the controls. The selected indicator of mercury exposure was concentration of mercury in the urine (U-Hg), which declined progressively from 36.0 micrograms/l in 1978 to 6.0 micrograms/l in the study year 1994. RESULTS: None of the exposed workers had ever shown signs of either acute or chronic inorganic mercury toxicity or had shown any form of hypersensitivity. The only changes found in the exposed workers, compared with the controls, were a reduction of the cells that express cluster differentiation (CD25,(T activation antigen (Tac antigen))) and concentrations of tumour necrosis factor-alpha (TNF-alpha) in serum. However, the decrease of cells that express CD25 was unrelated to occupational exposure and was, in all likelihood a chance finding. Conversely, the decline in serum TNF-alpha was closely associated with occupational exposure. However, no dose-response relation was found between U-Hg and TNF-alpha concentrations; nor were TNF-alpha concentrations affected by cumulative occupational exposure to inorganic mercury in over 20 years. CONCLUSIONS: Tentatively, we suggest that reduced serum TNF-alpha concentrations might be indicative of an in vivo functional defect of the monocyte macrophage system in this particular group of workers even though they were clinically asymptomatic.

[Clinico-statistical investigation about cement dermatitis in Italy]. / Indagine clinico-statistica sulla dermatite da cemento in Italia.

To define the prevalence of cement dermatitis (allergic contact dermatitis-ACD-and irritant contact dermatitis-ICD), two retrospective studies have been carried out in Italy: the first one based on the analysis of dermatitis cases ascribable to cement as defined by INAIL (Italian Institute for Industrial Accidents Insurance) from 1984 to 1992; the second one by surveying cement dermatitis cases in workers in the building industry aged between 16 and 70 carried out by Istituto di Clinica Dermatologica dell'Università di Bari from 1988 to 1994. The survey on INAIL data showed that in the years take into account 5,290 dermatitis cases included in item 41 of the occupational diseases table have been defined. About 80% of these cases have been observed in workers working as bricklayers and floor-layers. Therefore, given the remarkable exposure to cement in these professions, the prevalence of cement dermatitis in Italy has been estimated to 6 cases/province/year, even though it has not been possible recognize the clinical form of cement dermatitis. Moreover, the study showed that disabling cutaneous after-effects eligible for compensation have been observed in 30% of the cases defined by INAIL. The allergologic study carried out by Clinica Dermatologica has not only defined the incidence of contact dermatitis (ACD and ICD), in building workers, but it has also extrapoled dermatitis cases due to cement. As a whole, in the years taken into account, 166 occupational or mixed ACD cases and 77 occupational or mixed ICD have been diagnosed. The incidence of contact dermatitis ascribable to cement has equalled 79% among ACD and 88% among ICD, with a ratio of about 2 to 1 in favour of allergic forms. Among the chemicals tested, potassium bichromate showed the highest frequency of cases positive to patch tests. The skin site the most affected by cement dermatitis is hand, followed by upper limbs, lower limbs and feet. In the province of Bari, in the years taken into account, an average incidence of 28.4 cases per year of the two forms of cement dermatitis has been observed.

[Evaluation of noise-induced injury: consideration of a group of exposed cement workers]. / La valutazione del danno da rumore: considerazioni su una casistica di esposti addetti alla produzione del cemento.

The study covered 1334 workers employed in 12 cement factories located in southern Italy. They were submitted to audiometric screening consisting of a questionnaire containing questions on past otologic complaints, metabolic diseases, use of ototoxic drugs and past occupational or non-occupational exposure to noise, plus otoscopic examination and full audiometric examination. The results revealed a statistically significant relationship between duration of exposure to noise and elevation in the hearing threshold. The highest noise levels were found in the "crude/baked mills" department; however, the highest frequency of occupational hearing loss was observed in the "mine and crushing installations", maintenance and "hodmen" departments. On the question of assessment of the audiometric tracings for preventive and insurance purposes, attention is drawn to the fact that there is a need for a method that will enable an evaluation for prevention to be transformed into an evaluation for insurance. This method should in any case allow for deduction of the portion of hearing loss regarding presbycusis and socioacusis and take due account of the 3 KHz frequency. The attention of industry and public administration is drawn to the urgent need for prevention programs to protect against noise-induced hearing loss in both occupational and non-occupational settings.

[Health survey on morbility and accidents in various productive agricultural sectors]. / Indagine sanitaria sulla morbilità e sugli infortuni in diversi settori produttivi in agricoltura.

A health survey on morbidity and accidents was carried out on a population of 970 farmers in the district of Bari working in 6 different agricultural sectors. Data were gathered through a CNR-based (National Research Council) questionnaire administered by two occupation specialists. Results showed, first of all, that fertilizers are used in all agricultural sectors, while antiparasitic agents and herbicides are used in different ways according to the kind of culture. Horticulture is the sector where pesticides are more widely used as it is an intensive culture and has many cultivation cycles during the agricultural year. Interviewed subjects referred different pathologies, in particular arthrosis of spinal cord and limbs paresthesia. No significant direct association was observed between these pathologies and the sectors considered. Arthrosis of spinal cord seems to be related to exposure duration as it is well known that agricultural work implies unfavourable postures and exposure to adverse climatic conditions which favour the degeneration processes causing arthrosis. 19.5% of cases showed eczema. As far as accidents are concerned the situation is worrisome both for the frequency of accidents and the seriousness of lesions. This survey showed the need to investigate thoroughly the etiology of limbs paresthesia, eczema and accidents of farmers.

The computer-based medical record: analysis of problems in its implementation in a hospital.

The literature gives evidence of a growing interest in the application of computer systems to medicine. It outline the performances, advantages, and benefits of these systems, but often does not present the problems that arise in the design, realization, and introduction of such systems in health care organizations. This paper presents and analyzes some project-oriented and organizational problems, giving some possible solutions.