Effect of Alkaline Salts on Calcium Sulfoaluminate Cement Hydration.

This work analyzes the effect of the presence of 5 wt.% of solid sodium salts (Na2SO4, Na2CO3, and Na2SiO3) on calcium sulfoaluminate cement (CSA) hydration, addresses hydration kinetics; 2-, 28-, and 90-d mechanical strength, and reaction product microstructure (with X-ray diffraction (XRD), and Fourier transform infrared spectroscopy, (FTIR). The findings show that the anions affect primarily the reactions involved. Ettringite and AH3, are the majority hydration products, while monosulfates are absent in all of the samples. All three salts hasten CSA hydration and raise the amount of ettringite formed. Na2SO4 induces cracking in the ≥28-d pastes due to post-hardening gypsum and ettringite formation from the excess SO42- present. Anhydrite dissolves more rapidly in the presence of Na2CO3, prompting carbonation. Na2SiO3 raises compressive strength and exhibits strätlingite as one of its reaction products.

Intoxicación aguda por inhalación de acrilato de etilo, Lima 2002 / Acute intoxication caused by ethyl acrylate inhalation, Lima 2002

Objetivos: Describir las características clínico-epidemiológicas de los casos de intoxicación aguda por inhalación de acrilato de etilo, ocasionado por el manejo clandestino de un envase con restos de ésta sustancia, en una urbanización del distrito Comas, en Lima, Perú en noviembre del año 2002. Materiales y métodos: Estudio transversal analítico realizado en residentes y población del centro educativo aledaño a la zona del accidente. Se realizó una encuesta a todas las personas expuestas, se consideró como caso la presencia de cefalea, irritación ocular, nauseas, dolor abdominal y prurito intenso en el cuerpo. Se caracterizó el accidente en tiempo, espacio y persona.En el centro educativo se exploraron factores de exposición que favorecieron la presencia de intoxicados. Los datos fueron ingresados en Epi Info v 6.0 y analizados en STATA v.8.0 Resultados: Se encuestó 456 residentes y 326 personas en la escuela. La tasa de ataque general fue 21,9 por ciento, 46,9 por ciento en la escuela y 4,2 por ciento en viviendas. Los síntomas predominantes fueron cefalea 56 por ciento, irritación ocular 47 por ciento, dolor abdominal 42 por ciento. El 23 por ciento requirió hospitalización. El permanecer en pisos superiores de la escuela fue un factor de riesgo OR 4,54 (IC95 por ciento 2,66-7,84) y en el pabellón A OR 3,82 (IC95 por ciento 2,33-6,25). Conclusiones: Los síntomas predominantes fueron cefalea, irritación oculary dolor abdominal. La cercanía a la zona de exposición del cilindro y la dispersión de los vapores tóxicos influyeron para afectar mayormente a la escuela y a aquellos que ocupaban aulas en pisos superiores y el pabellón A. La legislación peruana debe contemplar el problema del manejo clandestino de residuos peligrosos.

Objectives: To describe clinical and epidemiological features of cases of acute intoxication caused by ethyl acrylate due to clandestine management of a container with this substance in an urban area in Comas District, Lima, Peru, in November 2002. Materials and methods: Analytical cross sectional study performed in residents and school population near the affected area. A survey was performed in every exposed person. Cases were defined as those people presenting with headache, eye irritation, nausea, abdominal pain, and intense pruritus. Accidents were characterized according to time of occurrence, space, and affected person(s). Exposure factors favoring the presence of affected persons were explored in a nearby school. Data was input in Epi Info v 6.0, and it was analyzed using STATA v 8.0 software. Results: 456 residents and 326 school students were interviewed. General attack rate was 21,9%, 46,6% at the nearby school, and 4,2% in surrounding households. Predominating symptoms were headache, 56%, eye irritation, 47%, abdominal pain, 42%. 23% of all affected persons required hospitalization. Staying in the upper floors in the nearby school was a risk factor for being affected, with an odds ratio (OR) reported as 4,54 (95% confidence interval [CI]: 2,66–7,84), and particularly in the «A¼ wing the OR was 3,82 (95% IC: 2,33 – 6,25). Conclusions: Predominant symptoms for acute intoxication caused by ethyl acrylate exposure were headache, eye irritation, and abdominal pain. Being near to the exposure area and dispersion of toxic fumes influenced the attack rate, mostly affecting the nearby school and those students in the upper floors and the «A¼ wing. Peruvian law should be stricter with respect to management of dangerous waste.

The risk of gallbladder perforation at laparoscopic cholecystectomy.

BACKGROUND: The best policy to prevent the potential hazard of bile and stones spilled at laparoscopic cholecystectomy (LC) is to avoid inadvertent gallbladder (GB) perforations. No study so far has investigated the mechanisms of GB rupture and its predictive risk factors. To address these issues and help define the best strategies to reduce undesirable long-term sequelae, we did a retrospective review of the first 350 consecutive LC performed by a single surgeon at our institution. METHODS: The clinical and surgical records of our first 350 consecutive LC were reviewed. The significant variables identified on univariate analysis were eventually validated through Spearman's correlation for ordered data and finally correlated to the risk of GB perforation by means of a casewise deletion multiple regression. The equation of the linear regression thus obtained was used to predict the probability of GB perforation by number of risk factors. RESULTS: Three risk factors predictive of GB perforation were identified: chronic cholecystitis with thickened walls >7 mm on preoperative ultrasound (US), GB hydrops (GB > 8 x 4 x 4 cm on US), and previous laparotomies. The incidence of GB perforation rose from a low of 3.5% in the absence of any risk factor to a high of 25% for patients with all three of the independent variables. GB hydrops yielded the highest diagnostic accuracy and probability of perforation (OR = 4.9). CONCLUSIONS: Inflammation and a positive history of previous laparotomies play a crucial role in GB perforation at LC. Hydropic GB was the most accurate predictor of rupture. A prospective trial is needed to confirm the data.

[Ultrasonography in the preoperative assessment of candidates for laparoscopic cholecystectomy: examination technique and results]. / L'ecografia nella valutazione preoperatoria dei pazienti candidati a colecistectomia laparoscopica: tecnica d'esame e risultati.

Laparoscopic cholecystectomy needs a more specific preoperative diagnostic approach than open cholecytsectomy. We investigated the role of US in the preoperative assessment of patients candidate to laparoscopic cholecystectomy. Two hundred patients were examined and then submitted to laparoscopic cholecystectomy regardless of US results: the surgical approach had to be changed from laparoscopy to laparotomy only in 10 of them. We focused our study on two major parameters to reduce the surgical risk: the anatomical study of the so-called "Calot's triangle" (the hepatic artery, common duct and cystic duct) and the study of the gallbladder bed and of pericystic structures. In the study of gallbladder walls and bed, US had high sensitivity (100%) and diagnosed no false negatives and 11 false positives of pericholecystitis (94.5% specificity), with a trend toward overstaging; in these 11 cases, gallbladder wall thickening was seen but the organ was not particularly difficult to remove at surgery. In cystic duct studies, we correctly diagnosed 6 abnormalities (3 cystic duct stones, 2 anatomical variants and 1 anatomical variant plus stone), with no false-positive and 2 false-negative diagnoses of abnormal insertion (75% sensitivity and 100% specificity). The common duct was shown along its whole course in 80% of cases; both sensitivity and specificity were 100% in dilatation detection, while the presence of stones was diagnosed with 70% sensitivity and 100% specificity.

The role of preoperative investigations in predicting difficult laparoscopic cholecystectomies. Results in 200 consecutive cases.

BACKGROUND: When we began laparoscopic cholecystectomy (LC) we set up a strict preoperative workup in order to assess whether currently available investigations could help predict difficult laparoscopic procedures. METHODS: Reported here are the results of a prospective trial carried out in our first 200 consecutive patients, who underwent routine intravenous cholangiography (IVC), abdominal ultrasound scan (US), blood tests-namely, markers of biliary stasis (MBS)-and preoperative endoscopic retrograde cholangiopancreatography (ERCP) in case of clinically suspected common bile duct stones (CBDS). RESULTS: On the basis of our experience we think that the US findings relate to the difficulty of the laparoscopic procedure more closely than the other preoperative investigations, and the association of US and liver chemistry provides an accurate evaluation of biliary stones. CONCLUSIONS: In agreement with data emerging from the literature, the preoperative investigations do not seem to be useful in predicting biliary and vascular complications, whose prevention lies in the adoption of correct surgical technique and a low threshold for conversion.

Glucocorticoid receptors immunoreactivity in tissue of human embryos.

The exact period when glucocorticoid receptors (GR) appear in human embryos is unknown, however their presence is acknowledged in target tissues before the fetal adrenal cortex secretes cortisol. Determining when GR develop could serve as an index of the importance of glucocorticoids in the morphological and functional development of tissues. The aim of this study was to determine time of onset of GR in human tissues using an immunohistochemical method. Results indicate GR are present in tissues of 8-10-week-old human embryos: in most tissues, the immune reaction was only or predominantly nuclear.

Alternative laparoscopic management of perforated peptic ulcers.

Surgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.

[Renal damage in rheumatoid arthritis]. / Il danno renale in corso di artrite reumatoide.

Renal damage is not uncommon in rheumatoid arthritis, but the causative role of the disease per se is not well defined yet. In this paper the updated literature data are reported and our own experience as well. In particular, we describe renal syndromes associated with non-steroidal antiinflammatory drugs, remission-inducing agents (gold and penicillamine) and cytotoxic drugs, secondary amyloidosis, systemic rheumatoid vasculitis, glomerular and tubulo-interstitial nephritis not related to drug therapy.

[Ileo-ileo-colic invagination due to pure fibroma of the small intestine. Personal observation (author's transl)]. / Invaginazione ileo-ileo-colica da fibroma puro del tenue. Osservazione personale.

Starting from a case of pure fibroma of the small intestine, which led to ileo-ileo-colic invagination, the Authors review the literature on the subject. The great rarity both of the type of neoplastic pathology found and the type of induced intestinal invagination is stressed. It is concluded by asserting that correct diagnosis, adequate selection of the type of surgery and its efficient performance allow a favourable prognosis in the overwhelming majority of cases.

[Preliminary study of ultrastructural changes of the gastric mucosa due to cholecysto-gastrostomy. Experimental research]. / Studio preliminare delle alterazioni ultrastrutturali della mucosa gastrica in seguito a colecisto-gastrostomia. Ricerche sperimentali.

After reviewing the literature on anatomo-histological lesions of the gastric mucosa in so-called "biliary reflux gastritis", the Authors undertook an experimental study of ultrastructural alterations of the gastric mucosa after cholecysto-gastrostomy operation conducted in the dog. In this preliminary note they report the alterations observed 60 days after the operation and consider it necessary to continue observations for a longer space of time after the operation.

[Anastomosis of the thoracic duct and the esophagus in surgical treatment of cholestasis. Experimental research]. / Anastomosi fra dotto toracico ed esofago nella terapie chirurgica della colestasi. Ricerche sperimentali.

After brief recall of the pathophysiology of cholestasis, the authors describe a technic of internal drainage of lymph from the thoracic duct by an indirect anastomosis created surgically between the latter and the esophaghus. They conclude that the procedure definitely solves certain symptomatologic aspects of cholestasis, but has no effects on the underlying anatomopathological lesion, which does not regress once established.