Hypoxic events during non-obstetric abdominal surgery in pregnant women.

OBJECTIVE: Every year 0.5-2% of women undergo non-obstetric surgery in pregnancy. Hypoxic events with short-term and long-term consequences are one of the most frequent complications in surgery. There is only limited data available regarding the impact of these events. This review aims to analyze the current literature on hypoxic events occurring in non-obstetric abdominal surgery in pregnant women, focused on maternal and fetal outcomes. MATERIALS AND METHODS: We performed a non-systematic review of the literature, through a PubMed search using the key words "hypoxemia", "non-obstetric surgery", "surgical procedures", "pregnancy", "pregnant women" and "outcome". RESULTS: There is little data available regarding maternal and fetal outcomes after hypoxic episodes during non-obstetric surgery in pregnancy. In these cases, conservative intrauterine resuscitation maneuvers or immediate delivery should be taken into account. Perimortem cesarean section can be lifesaving for both mother and fetus when maternal collapse is non responsive to resuscitation procedures. Inaccurate information regarding maternal and fetal outcomes is due to the lack of robust data and the heterogeneity of the causes underlying maternal respiratory complications during surgery. CONCLUSIONS: Non-obstetric surgery during pregnancy must be performed when indicated. An expert multidisciplinary team, composed of obstetricians, surgeons, and anesthesiologists need to be included, giving appropriate attention to the physiological changes of respiratory, cardiovascular, and gastrointestinal system that occur during pregnancy. The shortest operative time and peri-operative assistance should be ensured. Complications, such as hypoxic events in pregnant patients need adequate assistance. Multidisciplinary cooperation, continuous training and simulation for anesthesiology and resuscitative procedures can guarantee this.

Alkaline stability of quaternary ammonium cations for alkaline fuel cell membranes and ionic liquids.

The alkaline stability of 26 different quaternary ammonium groups (QA) is investigated for temperatures up to 160 °C and NaOH concentrations up to 10 mol L(-1) with the aim to provide a basis for the selection of functional groups for hydroxide exchange membranes in alkaline fuel cells and of ionic-liquid cations stable in basic conditions. Most QAs exhibit unexpectedly high alkaline stability with the exception of aromatic cations. ß-Protons are found to be far less susceptible to nucleophilic attack than previously suggested, whereas the presence of benzyl groups, nearby hetero-atoms, or other electron-withdrawing species promote degradation reactions significantly. Cyclic QAs proved to be exceptionally stable, with the piperidine-based 6-azonia-spiro[5.5]undecane featuring the highest half-life at the chosen conditions. Absolute and relative stabilities presented herein stand in contrast to literature data, the differences being ascribed to solvent effects on degradation.

Side-to-side cavocavostomy in adult piggyback liver transplantation.

OBJECTIVE: Our objective was to perform a retrospective study that described the anastomosis technique as well as the complications of side-to-side cavo-caval reconstruction. PATIENTS AND METHODS: From June 1998 to April 2011, we performed 284 liver transplantations including 10 adults with live donor organs. In all cases but 2 (272), cavo-caval reconstruction was performed using side-to-side cavo-caval (STSCC) anastomosis. In 19 cases (6.9%), we also carried out an end-to-side temporary porto-caval shunt (TPCS). In 17 cases (6.2%) the technique was performed for retransplantation. RESULTS: STSCC anastomosis was technically feasible in all but 2 cases, regardless of the recipient's vena cava, anatomic factors, or graft size. Mean operative time for the STSCC was 13 minutes (range, 6-25). Routine Doppler ultrasonography was performed intraoperatively at the end of the surgery. There was no case of cava stump thrombosis. Complications associated with this technique were limited to 2 patients. One complication was torsion due to donor graft/recipient mismatch, which was successfully treated surgically by falciform ligament fixation. The second complication was only evident by sinusoidal congestion and was managed nonoperatively. Seventeen cases were uneventful for retransplant recipients. CONCLUSIONS: STSCC during piggyback liver transplantation is safe and can be performed in the retransplantation setting, with a low incidence of venous outflow obstruction that can be associated with the traditional piggyback technique. Our data suggest that donor graft to recipient mismatch is not an absolute contraindication when proper body size match is considered. A wide anastomosis with typical recipient hepatic vein inclusion is warranted with routine postanastomotic Doppler ultrasonography.

Immunization coverage and timeliness of vaccination in Italian children with chronic diseases.

Since children with chronic diseases represent a primary target for immunization strategies, it is important that their immunization coverage and timeliness of vaccines is optimal. We performed a study to measure immunization coverage and timeliness of vaccines in children with type 1 diabetes, HIV infection, Down syndrome, cystic fibrosis, and neurological diseases. A total of 275 children aged 6 months-18 years were included in the study. Coverage for diphtheria-tetanus-pertussis (DTP), polio (Pol), and hepatitis B (HBV) vaccines approximated 85% at 24 months, while measles-mumps-rubella (MMR) coverage was 62%. Immunization coverage for seasonal influenza was 59%. The analysis of timeliness revealed that there was heterogeneity among children with different chronic diseases. A proportional hazard model showed that children with HIV infection had the longest time to complete three doses of DTP, Pol, and HBV, and those with neurological diseases received the first dose of MMR later than the other categories. Causes of missing or delayed vaccination mostly included a concurrent acute disease. Children with chronic diseases should be strictly monitored for routine and recommended vaccinations, and health care providers and families should be properly informed to avoid false contraindications.

Search for an annual modulation in a p-type Point Contact germanium dark matter detector.

Fifteen months of cumulative CoGeNT data are examined for indications of an annual modulation, a predicted signature of weakly interacting massive particle (WIMP) interactions. Presently available data support the presence of a modulated component of unknown origin, with parameters prima facie compatible with a galactic halo composed of light-mass WIMPs. Unoptimized estimators yield a statistical significance for a modulation of ∼2.8σ, limited by the short exposure.

Results from a search for light-mass dark matter with a p-type point contact germanium detector.

We report on several features in the energy spectrum from an ultralow-noise germanium detector operated deep underground. By implementing a new technique able to reject surface events, a number of cosmogenic peaks can be observed for the first time. We discuss an irreducible excess of bulklike events below 3 keV in ionization energy. These could be caused by unknown backgrounds, but also dark matter interactions consistent with DAMA/LIBRA. It is not yet possible to determine their origin. Improved constraints are placed on a cosmological origin for the DAMA/LIBRA effect.

[Rad-Esito: new informational debt as integration of hospital discharge cards for acute patients]. / Rad-Esito: nuovo debito informativo ad integrazione del contenuto delle schede di dimissione ospedaliera (SDO) per pazienti acuti.

Since the January 2008 the tracking of additional information about hospital discharge card's content has been activated in Latium. The new data, noticed by RAD-Esito card, regard the hospitalizations for acute myocardial infarction, femoral neck fracture and coronary artery bypass surgery. This study's objective has been to evaluate the quality of the data collected with the new card, at the end of the 1st semester of experimentation, concerning two institutes of care of Latium (Region of Central Italy), the Casilino Polyclinic (ASL Rome B) and the Anzio-Nettuno hospital (Assembled Hospitals, ASL Rome H). Furthermore, any significant correlation's existence between variables for acute myocardial infarction and femoral fracture with the mortality rate and an increased average hospitalization period has been statistically verified. In acute myocardial infarction mortality is significantly related to a low systolic blood pressure (<130 mmHg) at admission (p < 0.02) and to having no surgical intervention instead of transcutaneous transluminal coronary angioplastic surgery (p < 0.0001); in this case there is also an increased average hospitalization period (p < 0.03). In femoral neck fracture mortality is significantly related to having a conservative surgery instead of fracture reduction or prosthesis implantation (p < 0.0002).This study's preliminary results show how the integration of the hospital informative flow with the new clinical variables will be able to allow the promotion of the quality in the coding of the diagnosis and procedures, according to the current international innovations. This additional information will also be able to support the regional appropriateness and outcome of the treatments evaluation programs.

Experimental constraints on a dark matter origin for the DAMA annual modulation effect.

A claim for evidence of dark matter interactions in the DAMA experiment has been recently reinforced. We employ a new type of germanium detector to conclusively rule out a standard isothermal galactic halo of weakly interacting massive particles as the explanation for the annual modulation effect leading to the claim. Bounds are similarly imposed on a suggestion that dark pseudoscalars might lead to the effect. We describe the sensitivity to light dark matter particles achievable with our device, in particular, to next-to-minimal supersymmetric model candidates.

Risk factors for psoriasis: a retrospective study on 501 outpatients clinical records.

Possible risk factors for psoriasis were studied by means of a retrospective evaluation of epidemiological and clinical features in 472 clinical records of outpatients affected by plaques psoriasis. We calculated the relation between the categorical variables with chi-squares contingency table analysis (with Yates correction) and odds ratio (O.R.) from the two variables with their respective confidence intervals at 95%. Among patients 267 were men (57%) and 205 women (43%); the mean age was 46.5+/-16.7 years, with no differences in sex. A significant relationship was found between age at onset < or =40 years and familiarity for psoriasis (p<0.0001-O.R.=2.71, C.I..95%: 2.12-3.48). The percentage of men with extensive lesions (extension >30%) was significantly higher than of women (p<0.05-O.R.=1.60, C.I..95%:1.35-1.90). Moreover, a significant association between extension of lesions and BMI was detected (p<0.0107-O.R.=2.10, C.I.95%:1.33-3.30) and the strength of this relation was assessed using the linear regression test. Mean age at onset was significantly lower in patients systemically treated (p<0.0003-O.R.=2.61, C.I.95%: 1.69-4.04). The results obtained can provide the basis for a standard clinical record, including data for a prospective study that may confirm the relation between psoriasis and some risk factors.

[Intracystic papillary carcinoma of the breast. Personal experience]. / Carcinoma papillare intracistico della mammella. Esperienza personale.

The Authors, on the base of three cases of intracystic papillary carcinoma of the breast, discuss about the diagnostic means and the modalities of treatment of such rare cancer. They stress the value of cytology by fine needle aspiration, which gives more detailed informations than mammography or ultrasonography. As far as the treatment concerns, the Authors, according to the data of the literature, suggest for this tumor, still at an "in situ" stage, a conservative surgical treatment such as a quadrantectomy or tumorectomy plus lymphadenectomy followed both by radiotherapy. Finally, they remark that the intracystic papillary carcinoma of the breast, mainly arising in old women (7th, 8th decade), was found within their series (two out of three) in young women in the 5th decade of life.

Application of United States advance directives on Italian soil.

United States medical facilities located overseas must comply with American laws and the laws that govern the host nation. The Patient Self-Determination Act of 1990 is in direct conflict with Italian law. Honoring the advance directives of American patients on Italian soil constitutes a criminal offense for the physician, who is subject to 15 years of imprisonment. In response to issues identified in this case report, hospital staff have taken proactive steps to improve the management of dying patients overseas by establishing clearer hospital instructions education, and training and by better managing the psychosocial concerns of family and staff.