[3-year-survival and quality of life after out-of-hospital heart arrest]. / Sopravvivenza a tre anni e qualità di vita dopo arresto cardiocircolatorio extraospedaliero.

Although the long- and short-term aspects of the outcome of advanced cardiopulmonary resuscitation on patients have been studied to evaluate the percentage of survival up to the moment of discharge from hospital, little information has been published concerning the patients' long-term quality of life. In order to verify the efficiency of our group we retrospectively evaluated 468 subjects admitted to the Emergency Room of Rho Hospital (Milan, Italy) for out-of-hospital cardiac arrest that had occurred over a 90-month period. We studied the correlations between some variables: epidemiological (sex and age), objective (time required for advanced cardiopulmonary resuscitation and type of arrhythmias in the Emergency Room) and instrumental (left ventricular ejection fraction) and post-discharge survival. We also considered the state of health of the survivors by means of a questionnaire on their quality of life. Our data show that: a) 10.25% of the patients were discharged alive; b) younger men (< 65 years old) admitted with a ventricular fibrillation (p = 0.01) and those who had undergone advanced cardiopulmonary resuscitation for less than 25 min (p = 0.001) had a better survival rate at 3 years from discharge; c) 64% of the survivors have a satisfactory quality of life; d) younger age (p = 0.01) and cardiac left ventricular ejection fraction (> 40%) (p = 0.05) are positive predictors for future work capacity. In conclusion, we believe that the critical moment following advanced cardiopulmonary resuscitation is hospitalization because after discharge survival percentage abruptly increased from 10.25 to 65%.

[The epidemiology and management of an acute asthmatic attack]. / Epidemiologia e gestione dell'attacco asmatico acuto.

The mortality rate for acute asthma increased approximately 40% between 1982 and 1991 in the United States, while hospital admissions remained constant. In order to verify if inadequate therapy at home could increase hospitalization for this pathology, we evaluated retrospectively 94 subjects admitted to the Emergency Department of Rho Hospital, near Milan (Italy), for acute asthma in 1996. We studied the correlations between some epidemiological variables (sex and age) and the hospitalization of asthmatic patients and described the different therapeutic approaches at home and in the Emergency Department. Our data show that subjects > 40 years old, mostly females, were admitted more frequently than younger patients (38%) (p < 0.03). In comparison with the international guidelines we document the underuse of inhaled corticosteroids (69.7%) previous to the acute attack (p < 0.01). In conclusion, we believe that the correct early use of inhaled corticosteroids at home could prevent hospitalization for asthma, particularly in the elderly.

Erythrocyte antioxidant activity, serum ceruloplasmin, and trace element levels in subjects with alcoholic liver disease.

Erythrocyte antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase) and reduced glutathione, serum ceruloplasmin, and serum trace elements (copper, zinc, iron, and selenium) related to antioxidant enzymes were assayed in subjects with alcoholic liver disease of different degrees of severity. The erythrocytes of subjects with moderate and severe alcoholic liver cirrhosis had an unbalanced antioxidant system (normal superoxide dismutase, low catalase and glutathione peroxidase activities, and low glutathione content). Serum ceruloplasmin levels were in the normal range. Levels of the serum trace elements zinc and selenium were significantly low in subjects with moderate and severe cirrhosis, whose red cell half-life was also significantly short, as measured by radioactive chromium. These data suggest that the erythrocytes of subjects with moderate and severe alcoholic liver cirrhosis are less protected against oxidant stress. The particular erythrocyte antioxidant system and serum trace element pattern may play a role in the genesis of hemolytic disorders and of alcoholic hepatic damage.

Erythrocyte antioxidant system and serum ceruloplasmin levels in welders.

The erythrocyte antioxidant system (superoxide dismutase, catalase, glutathione peroxidase, reduced glutathione) and serum ceruloplasmin were studied in workers chronically exposed to welding fumes and gases, which are thought to be oxidant pollutants. Fifty-four healthy men using two electric arc welding processes (manual metal arc on stainless steel and mild steel, and metal inert gas on mild steel) were studied. The possible effects of cigarette smoking were also considered. The erythrocyte antioxidant system was in the normal range for all welders. Serum ceruloplasmin was significantly enhanced only in smoking welders and higher in manual metal arc than in metal inert gas welders, suggesting that the increase is related to the severity of the oxidant threat, which is more stressful for the workers using the manual metal arc technique because of the presence of stainless steel particles in the fumes. Although cigarette smoking alone did not increase serum ceruloplasmin levels, it affected the response to oxidant stress in welders.

Erythrocyte antioxidant system in Down syndrome.

It has been emphasized that an increased oxidative damage can exist in Down syndrome (DS), and that superoxide dismutase (SOD-1) seems to play a role in the pathogenesis of this disorder. We have studied the antioxidant system SOD-1, catalase, glutathione peroxidase (GSH-Px) and reduced glutathione (GSH) in erythrocytes of DS adults in order to evaluate if these cells are protected against oxidant stress. SOD-1 and GSH-Px were significantly increased while catalase and GSH activities were normal. These results suggest that the erythrocytes of these individuals have an unbalanced antioxidant system which may participate in the manifestations of DS.

[Mortality from malignant tumors of the digestive system in an area of the province of Milan from 1980 to 1987]. / Mortalità per tumori maligni dell'apparato digerente in un'area della provincia di Milano nel periodo 1980-1987.

In a highly populated and industrialised zone of the province of Milan (Health Area 68, Rho) a study was made of mortality due to malignant neoplasms of the digestive organs in the years 1980-1987. The highest mortality percentage in both sexes is caused by stomach cancer, followed by neoplasms of the large bowel, particularly of the colon, malignant neoplasms of the pancreas, primary liver cancer and, in males, of the oesophagus. On the whole mortality from malignant neoplasms of the digestive organs is high in subjects over 75 years and in males a little earlier. Age standardised mortality rates of malignant neoplasms of the stomach and intestine are higher in the area being studied than in Italy. However in males mortality from cancer of the large bowel is lower than in Lombardy, especially in middle-aged subjects. The years 1980-87 have shown a statistically significant increasing trend in males of death from cancer of the colon, rectum and liver. There is an identical trend in females as regards cancer of the colon and liver with the addition of stomach cancer but mortality from cancer of the rectum is stationary. In both sexes mortality from malignant neoplasms of the digestive organs is on the increase but in females this coincides with a general increase in cancer mortality as a whole. Differences have emerged, however, between the sexes depending on age: in males the increasing trend refers mainly to the 35-64 year age group and in females to the over 65 age group. This is particularly true in the case of tumours of the large bowel. In the area being examined the middle-aged population was particularly affected by immigration caused by the rapid industrial development of the area in the 1960's and 70's. It is reasonable to assume that the increasing trend in tumours of the digestive organs, and in particular of the large bowel can also be explained by the fact that people coming on the whole from regions with a lower specific risk factor have had to adapt to different life styles and dietary habits that are typical of a highly industrialised metropolitan area. This assumption can be verified with case-control studies or with statistical techniques (e.g. the logistic regression model for the analysis of proportionate mortality data) that are more typical of occupational epidemiology. In this way it would be possible to understand better the effects of living in the area being studied, as well as of more specific risk factors.

[Mortality from malignant tumors in the industrial region of the province of Milan, 1980-1987]. / Mortalità per tumori maligni in area industriale della provincia di Milano periodo 1980-1987.

For the period 1980-87 mortality data relating to residents of a densely populated area in the province of Milan was collected and elaborated. The area is heavily industrialised and had a particularly high immigration level in the 1960's and 70's. Malignant neoplasms represented the cause of death in 35.59% of male cases and 26.59% of female, with greater incidence in the former of tumours in respiratory organs and in the latter in the digestive tract. High mortality rates were noted for cancer of the lung in males over 35 years and for neoplasms of the digestive tract in those over 75 years but in females high mortality from breast cancer prevailed between 25-74 years and cancer of the stomach and intestine in those over 75 years. S.P.M.R. were elaborated with proportional mortality analysis showing an overall tendency to an increased death rate from malignant tumours that was statically significant in females, particularly at an advanced age. Increasing trends in tumours of the stomach and of the lympho-hematopoietic tissues were evident in females, in urinary organs in males, notably in elderly men, and in intestinal cancer in both sexes. The trend in mortality from breast cancer was however on the decline. As a whole, mortality was stationary in cases of cancer of the lung (although it was on the increase in females over 65 years), in cancer of the prostate (showing a decrease however in older subjects) and in cancer of the uterus and ovaries (but increasing in the latter case in elderly women). By means of S.M.R. elaboration the data was compared with that in Lombardy. In the area being taken into consideration a picture emerged of cancer mortality in general which was virtually the same as that found in Lombardy. However, the result of the comparison differs when considering sex and age groups. In fact in the 35-64 age group an inferior mortality rate to the Lombardian one was noted in the total population and in women, whilst for the age group 65 and over, a higher mortality rate emerged in men and in the total population. In males mortality was lower stomach tumours and higher for lung cancer, especially in more elderly subjects. Cancer of the colon-rectum, uterus and breast did not show statistically significant differences. The comparison with Italian data effected with direct age-standardisation has shown higher mortality from stomach, intestinal and lung cancer in the area being studied.(ABSTRACT TRUNCATED AT 400 WORDS)

Antioxidant system and serum trace elements in alpha-thalassaemia and Hb Lepore trait.

Erythrocyte antioxidant enzymes, superoxide dismutase, catalase and glutathione peroxidase were found to be significantly high in subjects with alpha-thalassaemia and Hb Lepore trait, as a consequence of the increased oxidant stress which is known to exist in these conditions. Among the serum trace elements present in these enzymes, selenium was increased in subjects with Hb Lepore trait and significantly low in those with alpha-thalassaemia trait, while selenium erythrocyte content was significantly increased in alpha-thalassaemic subjects.

Erythrocyte glutathione peroxidase in subjects of Mediterranean origin. A family study.

Erythrocyte glutathione peroxidase (GSH-Px) was assayed in subjects of Mediterranean origin and the distribution of the data obtained seems to confirm the existence of two alleles coding for low and high enzyme activity. In order to define the limits of expected genotypes less arbitrarily we studied families where parents' genotypes could allow us to define that of the children. Gene frequencies were calculated from genotype frequencies of an unrelated population and from crossings distribution by the Hardy-Weinberg equation. We observed a good agreement between gene frequencies obtained by these two different methods.

[Fibroplastic parietal endocarditis with Löffler's hematic oesinophilia (author's transl)]. / Endocardite parietale fibroplastica con eosinofilia ematica di Löffler

The clinical data and autopsy findings in a case of Löffler endocarditis are reported. The differential diagnosis with endocardial fibrosis of East Africa is discussed. On the basis of their histological findings and recent literature the authors suggest that endocardial fibrosis follows the organization of successive fibrin layers.