Acute supralevator abscess: the little we know.

INTRODUCTION: Acute supralevator abscess (SLA) is an uncommon and complicated form of anorectal sepsis. Its correct management is crucial to avoid complex iatrogenic fistula formation. A comprehensive review of the literature was conducted to determine the incidence of SLA and the surgical outcome with particular reference to the direction of drainage. METHODS: A search of Medline, PubMed and the Cochrane Library was performed to identify all studies reporting surgical drainage of SLA. FINDINGS: A total of 19 studies were identified, including 563 patients. The only two prospective studies reported an incidence of SLA of 10% and 3% in 68 and 100 patients, respectively, with anorectal sepsis. In 17 retrospective studies, the incidence ranged from 0% to 28%. Magnetic resonance imaging (MRI) was performed routinely in only one study. The surgical anatomical classification of the abscess was described in six studies diagnosed at surgery. The direction of surgical drainage whether 'inwards' (into the lumen) or 'outwards' (into the ischioanal fossa) was stated in only six studies. In two of these, the direction of drainage was contradictory to the recommendation made by Parks et al. Recurrent sepsis was reported in eight studies and ranged from 0% to 53%. CONCLUSIONS: Detailed and prospective data on acute SLA are lacking. Its real incidence is unclear and it is not possible to analyse surgical outcomes conclusively according to different direction of drainage. The routine use of MRI in complicated anorectal sepsis would specify the surgical anatomy of SLA before any drainage is carried out.

Analysis of full-text publication and publishing predictors of abstracts presented at an Italian public health meeting (2005-2007).

BACKGROUND: In Public Health, a thorough review of abstract quality evaluations and the publication history of studies presented at scientific meetings has never been conducted. To analyse the long-term outcome of quality abstracts submitted to conferences of Italian Society of Hygiene and Public Health (SItI) from 2005 to 2007, we conducted a second analysis of previously published material aiming to estimate full-text publication rate of high quality abstract presented at Italian public health meetings, and to identify predictors of full-text publication. METHODS: The search was undertaken through scientific databases and search engines and through the web sites of the major Italian journals of Public Health. For each publication confirmed as a full text paper, the journal name, impact factor, year of publication, gender of the first author, type of study design, characteristics of the results and sample size were collected. RESULTS: The overall publication rate of the abstracts presented is 23.5%; most of the papers were published in Public Health journals (average impact factor: 3.007). Non universitary affiliation had resulted in a lower probability of publication, while some of the Conference topics had predisposed the studies to an increased likelihood of publication as well as poster form presentation. CONCLUSIONS: The method presented in this study provides a good framework for the evaluation of the scientific evidence. The findings achieved should be taken into consideration by the Scientific Societies during the contributions selection phase, with the aim of achieving a continuous improvement of work quality. In the future, it would be interesting to survey the abstract authors to identify reasons for unpublished data.

Microbiological contamination of radiological equipment.

BACKGROUND: Important changes have occurred in radiological departments (RDs) over the past 30 years. The procedures have become more complex and the number of patients has increased. This scenario could have important implications for public health and infection control but, to date, the scientific literature has dealt little with matters relating to microbiological monitoring in RDs. PURPOSE: To examine the level of microbiological contamination in the main RDs of Turin, a city in northern Italy, in order to analyze the presence of a possible biological risk. MATERIAL AND METHODS: We analyzed data from 12 RDs. Samples were taken from X-ray tubes, control panels, radiographic cassettes, and imaging plates. We used the French guidelines "Standards NF S 90--351" in order to obtain the threshold values of reference. Through a questionnaire we investigated the use of personal protective equipment by the chiefs of the RDs. RESULTS: We found values out of limits in 41.7% of the X-ray tubes sampled, in 91.7% of the control panels and imaging plates, while only 8% of the radiographic cassettes were contaminated. A total of 58.3% of RDs reported values above the threshold for three out of four samples. In 16.7% of the RDs only one surface presented acceptable values. CONCLUSION: Healthcare-associated infections are a cogent issue for the RDs, and knowledge of how to prevent them is increasingly required by health professionals. This study is meant to be a first analysis of the issue that highlights the need of further investigations, maybe with a more detailed monitoring through the characterization of the microbial species involved. Moreover, the development of shared and maybe official standards for the evaluation of microbiological contamination in RDs is strongly suggested.

[Public health accessible to all: use of smartphones in the context of healthcare in Italy]. / La sanità pubblica a portata di mano: l'uso degli smartphones nel contesto sanitario italiano.

Recent statistics suggest that Italy is the first country in Europe for number of smartphone owners and it is foreseeable that these technological tools will play a key role in health care. In order to examine the main Italian applications for smartphones dealing with disease prevention, health education and health promotion, an extensive research was performed through the main search engines and the results were analyzed critically in order to select the best experiences available. The main applications developed covered the following macro-areas: lifestyles (nutrition, diet and physical activity), self-diagnosis and self-treatment, management of infectious and chronic degenerative diseases.

Skyscraper running: physiological and biomechanical profile of a novel sport activity.

Skyscraper running is here analyzed in terms of mechanical and metabolic requirements, both at the general and at the individual level. Skyscraper runners' metabolic profile has been inferred from the total mechanical power estimated in 36 world records (48-421 m tall buildings), ranked by gender and age range. Individual athlete's performance (n=13) has been experimentally investigated during the Pirelli Vertical Sprint, with data loggers for altitude and heart rate (HR). At a general level, a non-linear regression of Wilkie's model relating maximal mechanical power to event duration revealed the gender and age differences in terms of maximum aerobic power and anaerobic energy resources particularly needed at the beginning of the race. The total mechanical power was found to be partitioned among: the fraction devolved to raise the body center of mass , the need to accelerate the limbs with respect to the body , and running in turns between flights of stairs . At the individual level, experiments revealed that these athletes show a metabolic profile similar to middle-distance runners. Furthermore, best skyscraper runners maintain a constant vertical speed and HR throughout the race, while others suddenly decelerate, negatively affecting the race performance.

Indwelling ureteral stents and sexual health: a prospective, multivariate analysis.

PURPOSE: Ureteral stents are common devices in urological practice. However, a stent may provoke lower urinary tract symptoms that severely affect quality of life. We evaluated the relationship between ureteral stents and male erection/female sexuality. MATERIALS AND METHODS: A total of 30 men and 20 women undergoing ureteral stent positioning were considered. Patients affected by risk factors for erectile dysfunction or hormonal and metabolic alterations were excluded. Hystero-ovariectomy and menopause were considered exclusion criteria. Three questionnaires were administered before stenting and 45 to 60 days after stent positioning, including the International Prostate Symptom Score, the International Index of Erectile Function-5 for men and the Female Sexual Function Index for women. RESULTS: Mean age was 45 years in men and 39 years in women. The mean+/-SD International Index of Erectile Function-5 score was 23.2+/-1.27 and the mean Female Sexual Function Index score was 32.15+/-2.71 before stent positioning. No lower urinary tract symptoms were reported before the procedure. After the ureteral stent was indwelling the mean International Index of Erectile Function-5 score was 13.5+/-4.01 and the mean Female Sexual Function Index score was 23.6+/-14.66 (p=0.000 and 0.007, respectively). Of 30 men 25 reported a pathological International Index of Erectile Function-5 score and 6 of 20 women denied any sexual activity due to stent related anxiety, resulting in the minimum Female Sexual Function Index score. In the remaining 14 women sexual life was not significantly impaired by the ureteral stent (p=0.08). CONCLUSIONS: Ureteral stents impaired the quality of sexual life in male and female subjects. In men the most important distress was in regard to erectile function, probably related to lower urinary tract symptoms. Conversely female sexuality appeared to be severely impaired due to stent related psychological concerns.

Bacille Calmette-Guérin intravesical instillation and erectile function: is there a concern?

The aim of our study was to evaluate the effect of bacille Calmette-Guérin (BCG) therapy on erectile function in a cohort of male patients affected by non-muscle invasive bladder cancer. Thirty male patients undergoing BCG treatment for non-muscle invasive bladder cancer were enrolled in the study. Their mean age was 60.4 years. None of the patients had risk factors for erectile dysfunction (ED). All subjects underwent a BCG standard schedule therapy (once weekly instillation for 6 weeks). International Index of Erectile Function (IIEF-5) and International Prostate Symptom score (I-PSS) were addressed to the patients during the treatment schedule (at fourth or fifth instillation) and 1 month after the last instillation. The mean IIEF-5 score was 17.6 +/- 6.7 during therapy and 21.7 +/- 2.92 a month after the last instillation (P=0.008). Baseline ED and the association with lower urinary tract symptoms are variables significantly connected with post-treatment results (P=0.016 and 0.00 respectively) whereas the age seems not to be related to ED (P=0.256). No major side effects were recorded. It is concluded that BCG treatment is effective for prophylaxis of non-muscle invasive bladder cancer; however, it may induce a high incidence of ED. Although this effect is transient and reversible, erectile failure is another source of psychological distress that adversely affects the quality of life of men undergoing BCG treatment.

Outbreaks of infectious keratoconjunctivitis in alpine chamois and ibex in Switzerland between 2001 and 2003.

Five outbreaks of infectious keratoconjunctivitis (ikc) affecting alpine chamois and ibex in the western and central Swiss Alps were recorded in 2001 to 2003. Mycoplasma conjunctivae was identified from conjunctival swabs by means of a nested pcr in 27 of the 28 chamois tested. The outbreaks occurred in an area covering 1590 km(2). Deep valleys acted as a barrier to the spread of the disease. A total of 409 chamois and 33 ibex with clinical signs of ikc were reported. Most of the chamois were shot, primarily because they were blind or in poor general body condition. Almost a quarter were observed alive, and 16.9 per cent died as a result of ikc. Many of the affected animals were juveniles, and more females than males died of ikc. The disease was more common during the summer and autumn. The chamois affected by ikc were found at altitudes between 550 and 3200 m. The estimated overall mortality was less than 5 per cent, but more than 20 per cent may have died locally. Ibex affected by ikc were recorded in only two outbreaks. In six places, ibex with clinical signs of ikc were found before the first affected chamois appeared in the same area.

[Emergency surgery for complicated colorectal cancer. Retrospective study]. / Trattamento chirurgico del cancro colorettale complicato. Studio retrospettivo.

INTRODUCTION: Emergency surgery for the complications of colorectal cancer poses a significant surgical problem with published mortality rates as hight as 25% to 30%. We reviewed the results of the analysis and quantification of the influence of complications on the outcome of the patients who underwent emergency colectomy for colorectal cancer. MATERIALS AND METHODS: Retrospective study of the clinical features from, a series of 63 patients operated on from 1991 to 1997 (12% of all colorectal cancer operations in the same period). The correlations between complications and cancer stages were estimated by the KW (ANOVA method). RESULTS: Fifty-three patients underwent colorectal resection for intestinal occlusion (84%), 5 for perforation (8%) and 5 for lower gastrointestinal bleeding (8%). When the cancer complications were correlated to the different cancer stage at operation, the complications rate were 32%, 32%, and 36% in the stage II, stage III, and stage IV, respectively. This data was statistically significant: (KW = 58, p = 0.0001). The overall mortality rate was 8% (5 patients) and the total postoperative morbity rate was 32% (21 patients). The overall 5-year, 3-year, and 1-year survival was 47%, 48%, and 76% respectively. CONCLUSIONS: Emergency surgery for complicated colorectal cancer can be performed safely with low postoperative morbidity and mortality rate and can be advocated to realize both short and long-term survival rates comparable to elective surgery; the KW test supports the hypothesis that the a complication in the natural history of colorectal cancer doesn't correlate with the stage of disease.

[The ideal length of hospital stay in the surgical treatment of colorectal cancer]. / La lunghezza ideale del ricovero per il trattamento chirurgico del cancro colo-rettale.

In order to verify the safety of an ideal length of hospital stay (5-6 days) after open colectomy, we reviewed complications after 371 consecutive, elective colorectal resections for cancer at our institution between April 1991 and December 1998. Specifically, age of the patient, length of hospital stay and when the complication was diagnosed were registered. The median postoperative hospital stay was 9 days (range, 4-34 days). No difference in length of hospital stay was detected in patients < or = 65 years old versus > 65 years old (P = NS). All major complications (anastomotic leak, intestinal bleeding, intestinal occlusion, pneumonia, pulmonary embolism, pulmonary edema, stroke, angina pectoris, and fascial dehiscence) were diagnosed before the fifth postoperative day (P < 0.05). Among the minor complications (vomiting, packed red blood cells transfusion, diarrhea, wound infection, urinary tract infection, and pleural effusion), none requiring hospitalization was detected later then 5 days after the operation. We conclude that postoperative length of stay after colorectal resection for cancer can be reduced safely to five to six days after the operation.

Infectious keratoconjunctivitis of ibex, chamois and other Caprinae.

Infectious keratoconjunctivitis (IKC) caused by Mycoplasma conjunctivae is a highly contagious ocular infection which is common in domestic sheep and goats. In the European Alps, IKC is often observed in Alpine chamois (Rupicapra r. rupicapra) and in Alpine ibex (Capra i. ibex), but the disease has also been described in other wild Caprinae in the Pyrenees and in New Zealand. The infection is characterised by inflammation of the conjunctiva and cornea, and in the most advanced stages, the cornea is opaque or even perforated. In IKC outbreaks in chamois and ibex, spontaneous recovery is the most prevalent outcome of the disease. However, mortality can occasionally reach 30%. Recent studies in eastern Switzerland indicated that M. conjunctivae infection is not self-maintained in chamois. In contrast, the disease is endemic and self-maintained in the domestic sheep population. Spillover of the agent from sheep living in proximity during summer may be the origin of point-source epidemics in wild Caprinae. Flies are likely to play a central role in interspecific transmission of M. conjunctivae on alpine meadows. When outbreaks of IKC occur in wildlife, a special effort should be made to avoid unnecessary human disturbance in affected areas. However, animals presenting irreversible ocular lesions should be shot by professional gamekeepers to prevent suffering. Prevention of IKC in wild Caprinae should focus on preventing the spillover of M. conjunctivae from livestock. However, studies are required to evaluate the distribution of M. conjunctivae infection in domestic sheep in several countries and to assess the risk of IKC spillover from domestic animals to wildlife. In addition, immunological studies should be performed to develop tools which could lead to the control of M. conjunctivae infection in domestic sheep.

Mycoplasma conjunctivae infection is self-maintained in the Swiss domestic sheep population.

Bacteriological and serological investigations were performed to assess whether the domestic sheep population is a reservoir of Mycoplasma conjunctivae in Switzerland. Among a sample of 69 sheep showing clinical signs of infectious keratoconjunctivitis (IKC) in three Swiss cantons, M. conjunctivae was identified 53 times (76.8%). A commercially prepared indirect ELISA was used to detect M. conjunctivae antibodies in 674 sera of adult sheep. We analysed a stratified random sample of 123 sheep herds from 25 out of the 26 Swiss cantons. At least one positive animal was detected in 89.4% of the herds. In positive herds (n=110), 57.1% of the individual animals tested positive. To assess the importance of sheep's age in the spread of M. conjunctivae, 209 sera of adult sheep and 93 lamb sera among eight sheep herds were analysed using the indirect ELISA. Seroprevalence in 2-6-month-old lambs was 50.5%, indicating that the IKC agent is spread in sheep flocks during raising. Lambs experimentally infected with M. conjunctivae carried the agent for 8 and 23 weeks, respectively, depending on the strain used for challenge. We conclude that the M. conjunctivae-infection is endemic and self-maintained in the domestic sheep population in Switzerland.

Detection of specific Mycoplasma conjunctivae antibodies in the sera of sheep with infectious keratoconjunctivitis.

The serological cross reactions between Mycoplasma conjunctivae, the etiological agent of infectious keratoconjunctivitis (IKC), and the antigenetically and phylogenetically closely related Mycoplasma ovipneumoniae, which is often found in sheep, were analysed. Cross reacting antigens were identified using sera from sheep with IKC and from sheep of herds known to be free of IKC, as well as rabbit hyperimmune serum specific to the two Mycoplasma species. Cross reactions were predominantly due to the strongly antigenic proteins of 42 kDa and 83 kDa. Serospecific antigens of M. conjunctivae could be separated from cross-reacting antigens by the extraction of Tween 20-soluble membrane proteins. The Tween 20-extracted proteins of the M. conjunctivae strain HRC/581T were used for the development of an indirect ELISA test. This ELISA test was shown to be a useful serological method for the diagnosis of M. conjunctivae infections and to identify infected sheep herds.

Cosmology from MAXIMA-1, BOOMERANG, and COBE DMR cosmic microwave background observations.

Recent results from BOOMERANG-98 and MAXIMA-1, taken together with COBE DMR, provide consistent and high signal-to-noise measurements of the cosmic microwave background power spectrum at spherical harmonic multipole bands over 2

[Causes of death, zoonoses, and reproduction in the European brown hare in Switzerland]. / Todesursachen, Zoonosen und Reproduktion bei Feldhasen in der Schweiz.

To elucidate the importance of different causes of mortality which could explain the downward trend of the hare populations in Switzerland and for monitoring selected zoonoses, the health and reproductive status of 167 perished brown hares (Lepus europaeus) was assessed. Concerning causes of mortality, traumas were by far the most frequent diagnosis, 80% of the hares dying because of injuries. Animals killed by road traffic were highly represented. Predators (such as dogs, domestic cats, lynx, martens, buzzards, and golden eagles) killed 16% of the analysed animals. In juveniles, predation was significantly more frequent than in adults. Infectious diseases led to death in 15% of the animals, and cases of pasteurellosis, brucellosis, pseudotuberculosis, tularaemia, listeriosis, and toxoplasmosis were diagnosed. In 5% of the hares, the cause of death pertained to other categories or remained unclear. Reproductive performance was judged to be normal, since mean litter size was 2.5 per female and pregnancy rate in March-June was 74%. We conclude that neither a specific infectious disease, for which adult hares are particularly susceptible, nor an insufficient reproductive performance are responsible for the decline of brown hare populations in Switzerland. This phenomenon is rather a cause of a reduced survival rate in leverets.

European brown hare syndrome in free-ranging European brown and mountain hares from Switzerland.

From 1997 to 2000, complete necropsy and histopathologic investigations were performed on 157 free-ranging European brown hares (Lepus europaeus) found dead throughout Switzerland. Organ samples of all these individuals (157 livers and 107 spleens available) were tested for European brown hare syndrome virus (EBHSV)-antigen by enzyme-linked immunosorbent assay (ELISA) test kit. Furthermore, 60 additional blood samples were tested for antibodies against EBHSV by ELISA. In addition, liver samples of 87 free-ranging mountain hares (Lepus timidus) hunted in 1996 were tested for EBHSV-antigen. In two European brown hares from southern Switzerland lesions suggestive of changes induced by EBHSV were present, and high titers of EBHSV-antigen were detected in both liver and spleen samples of these animals. Based on negative staining electron microscopy investigations of liver and spleen homogenates, we observed calicivirus in one antigen-positive hare. Low EBHSV-antigen titers were found in three additional European brown hares from central and western Switzerland, but EBHS-lesions were absent. Antibodies against EBHSV were not detected in any of the sera of European brown hares, and EBHSV-antigen was not found in the samples of mountain hares. This is the first report of EBHS in European brown hares from Switzerland.

A Zoletil-Rompun mixture as an alternative to the use of opioids for immobilization of feral red deer.

Sixty chemical immobilizations of red deer (Cervus elaphus hippelaphus) have been carried out during an etho-ecological study from August 1994 to December 1996 in a 35 ha pen in the district of Nitra (Slovac Republic). Our objective was to determine the efficacy and standard dosages of Zoletil and Rompun for the immobilization of adult red deer in feral conditions as an alternative to the use of the highly toxic opioids. We therefore compared an Immobilon-Rompun combination (ImRo) with a 1:1 mixture of Zoletil and Rompun (ZoRo) as an injectable solution. Use of both combinations led to the immobilization of >92% of deer with an injection volume <3 ml. Mean (SD) dose to achieve immobilization was 35 (14) microg/kg ethorphine + 0.14 (0.056) mg/kg acepromazine + 0.36 (0.14) mg/kg xylazine compared to 1.2 (0.8) mg/kg tiletamine + 1.2 (0.8) mg/kg zolazepam + 2.3 (1.6) mg/kg xylazine. This corresponds to a volume of 1.8 (0.7) ml/100 kg body mass (BM) for ImRo (range = 1.0 to 4.6) and to 2.3 (1.6) ml/100 kg BM for ZoRo (range = 0.7 to 4.0), respectively. Heart rate, respiratory rate and oxyhaemoglobin saturation values did not differ significantly between the two groups during immobilization. Three deer (5%) died during immobilization, but fatalities could not be directly associated with the drug effect. Mean (SD) time from darting to complete immobilization was 5.5 (4.2) min for ImRo and 7.5 (6.1) min for ZoRo, respectively. Differences were not statistically significant. Anesthesia with both combinations of immobilizing agents could be reversed within 2 min using sarmazenile-yohimbine for ZoRo and diprenorphine-yohimbine for ImXy immobilizations, respectively. We conclude that the 1:1 combination of Zoletil and xylazine is a valuable alternative to the use of opioids for the immobilization of adult red deer including feral adult animals.

Measurement of a Peak in the Cosmic Microwave Background Power Spectrum from the North American Test Flight of Boomerang.

We describe a measurement of the angular power spectrum of anisotropies in the cosmic microwave background (CMB) at scales of 0&fdg;3 to 5 degrees from the North American test flight of the Boomerang experiment. Boomerang is a balloon-borne telescope with a bolometric receiver designed to map CMB anisotropies on a long-duration balloon flight. During a 6 hr test flight of a prototype system in 1997, we mapped more than 200 deg(2) at high Galactic latitudes in two bands centered at 90 and 150 GHz with a resolution of 26&arcmin; and 16&farcm;5 FWHM, respectively. Analysis of the maps gives a power spectrum with a peak at angular scales of 1 degrees with an amplitude 70 µK(CMB).

A Measurement of Omega from the North American Test Flight of Boomerang.

We use the angular power spectrum of the cosmic microwave background, measured during the North American test flight of the Boomerang experiment, to constrain the geometry of the universe. Within the class of cold dark matter models, we find that the overall fractional energy density of the universe Omega is constrained to be 0.85