Stratification of patients admitted for SARS-CoV2 infection: prognostic scores in the first and second wave of the pandemic

To test the prognostic performance of different scores, both specifically designed for patients with COVID-19 and generic, in predicting in-hospital mortality and the need for mechanical ventilation (MV). We retrospectively collected clinical data of patients admitted to the Emergency Department of the University Hospital AOU Careggi, Florence, Italy, between February 2020 and January 2021, with a confirmed infection by SARS-CoV2. We calculated the following scores: Sequential Organ Failure Assessment (SOFA) score, CALL score, 4C Mortality score, QUICK score, CURB-65 and MuLBSTA score. The end-points were in-hospital mortality and the need for MV. We included 1208 patients, mean age 60 ± 17 years, 57% male sex. Compared to survivors, non-survivors showed significantly higher values of all the prognostic scores (4C: 13 [10-15] vs 8 [4-10]; CALL: 11 [10-12] vs 9 [7-11]; QUICK: 4 [1-6] vs 0 [0-3]; SOFA: 5 [4-6] vs 4 [4-5]; CURB: 2 [1-3] vs 1 [0-1]; MuLBSTA: 11 [9-13] vs 9 [7-11], all p < 0.001). Discriminative ability evaluated by the Receiver Operating Curve analysis showed the following values of the Area under the Curve: 0.83 for 4C, 0.74 for CALL, 0.70 for QUICK, 0.68 for SOFA, 0.76 for CURB and 0.64 for MuLBSTA. The mortality rate significantly increased in increasing quartiles of 4C and CALL score (respectively, 2, 8, 24 and 54% for the 4C score and 1, 17, 33 and 68% for the CALL score, both p < 0.001). 4C and CALL score allowed an early and good prognostic stratification of patients admitted for pneumonia induced by SARS-CoV2.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Measurement of the Cosmic Ray Helium Energy Spectrum from 70 GeV to 80 TeV with the DAMPE Space Mission

The measurement of the energy spectrum of cosmic ray helium nuclei from 70 GeV to 80 TeV using 4.5 years of data recorded by the Dark Matter Particle Explorer (DAMPE) is reported in this work. A hardening of the spectrum is observed at an energy of about 1.3 TeV, similar to previous observations. In addition, a spectral softening at about 34 TeV is revealed for the first time with large statistics and well controlled systematic uncertainties, with an overall significance of 4.3σ. The DAMPE spectral measurements of both cosmic protons and helium nuclei suggest a particle charge dependent softening energy, although with current uncertainties a dependence on the number of nucleons cannot be ruled out.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Measurement of the cosmic ray proton spectrum from 40 GeV to 100 TeV with the DAMPE satellite

The precise measurement of the spectrum of protons, the most abundant component of the cosmic radiation, is necessary to understand the source and acceleration of cosmic rays in the Milky Way. This work reports the measurement of the cosmic ray proton fluxes with kinetic energies from 40 GeV to 100 TeV, with 2 ¹/₂ years of data recorded by the DArk Matter Particle Explorer (DAMPE). This is the first time that an experiment directly measures the cosmic ray protons up to ~100 TeV with high statistics. The measured spectrum confirms the spectral hardening at ~300 GeV found by previous experiments and reveals a softening at ~13.6 TeV, with the spectral index changing from ~2.60 to ~2.85. Our result suggests the existence of a new spectral feature of cosmic rays at energies lower than the so-called knee and sheds new light on the origin of Galactic cosmic rays.

Observation of the suppression of the flux of cosmic rays above 4 x 10 (19) eV

The energy spectrum of cosmic rays above 2.5 x 10;{18} eV, derived from 20,000 events recorded at the Pierre Auger Observatory, is described. The spectral index gamma of the particle flux, J proportional, variantE;{-gamma}, at energies between 4 x 10;{18} eV and 4 x 10;{19} eV is 2.69+/-0.02(stat)+/-0.06(syst), steepening to 4.2+/-0.4(stat)+/-0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min.

Upper limit on the diffuse flux of ultrahigh energy tau neutrinos from the Pierre Auger Observatory

The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau neutrinos that interact in Earth's crust. Tau leptons from nu(tau) charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 are used to place an upper limit on the diffuse flux of nu(tau) at EeV energies. Assuming an E(nu)(-2) differential energy spectrum the limit set at 90% C.L. is E(nu)(2)dN(nu)(tau)/dE(nu)<1.3 x 10(-7) GeV cm(-2) s(-1) sr(-1) in the energy range 2 x 10(17) eV< E(nu)< 2 x 10(19) eV.

[Health surveillance in health care workers]

In a complex reality as the hospital, occupational physician plays a key role in risk prevention through health surveillance. The medical examination is intended to highlight any possible deterioration of workers' health and to detect workers' hypersusceptibility to occupational hazards. We report biostatistic data resulted from health surveillance conducted on health care workers in 2005 and 2006 in a universitary hospital, with particular regard to the judgement of the fitness to work and the reasons that has determined it. Our report, in agreement with data available in literature, shows that manual patient lifting is one of the most common professional hazards within the hospital and occupational physician must pay a special attention to it, promoting an integrated answer.

[Myeloproliferative disorders due to the use of gasoline as a solvent: report of three cases]

BACKGROUND

Health effects of occupational exposure to benzene are currently a problem, despite the fact that preventive measures have been in existence in Italy for more than 40 years.

OBJECTIVES

To describe three recent cases of severe haematological disease presumably induced by an occupational exposure to benzene. Exposure occurred as a result of contact with ordinary automobile petrol used as a solvent-degreaser for metal parts.

METHODS

Clinical diagnosis was performed using standard immuno-phenotypic and morphological criteria; the hypothesis of an occupational origin was derived from analysis of the occupational histories.

RESULTS

The first case was a 59 year-old blacksmith suffering from acute myeloid leukaemia (AML) FAB M2, who had used petrol for 36 years to degrease the forged metal parts before painting them. The second was a 53 year-old mechanic with AML FAB M3 who had used petrol for 15 years to degrease mechanical parts of tanker motors. The third was an 82 year-old car mechanic suffering from idiopathic myelofibrosis since the age of 75, who had used petrol to degrease mechanical car motor parts for 42 years. In all three cases, the environmental hygiene measures necessary to limit inhalation or skin contact were not followed and, at times, in the case of the two mechanics, the petrol was siphoned by mouth; so there was substantial exposure to the 1-5% benzene present in the petrol. Latency of the disease was between 30-50 years from start of exposure, and between 3-17 years following cessation of exposure.

CONCLUSION

The cases described indicate that the myelotoxic effects of benzene are still a problem. They were the consequence of improper use of petrol, due to total misinformation of the risks involved in such use. It is not possible to ascertain whether the cases presented are a casual aggregation or if the use of petrol as a solvent is more common than is normally believed; in the latter case two questions must be asked: is a "normal" occupational history able to discover such an uncommon risky condition of exposure? If it cannot, how many cases of benzene-related diseases escape aetiological diagnosis? It is not possible to provide precise answers but efforts should be made to improve the quality of information about the risks of petrol. Furthermore, in all cases of haematological disease potentially related to benzene, any form of contact with petrol, even if uncommon, should be carefully researched.

Microfocal Prostate Cancer

To determine whether microfocal prostate cancer on needle biopsy predicts clinically insignificant prostate cancer.

Patients and Methods

We reviewed the records of 257 patients who underwent radical retropubic prostatectomy between January 1999 to September 2003. 18 patients had preoperative diagnosis of microfocal prostate cancer defined as 1 positive core/8 cores, cancer length < 3 mm and Gleason score less than/equal to 6.

Results

Of the 18 patients with preoperative microfocal cancer, only 1 case had clinically insignificant disease. 15 pts had organ confined disease (pT2) and 3 pts had capsular penetration (pT3). The lesion was bioptic undergraded in 33% of cases.

Conclusions

Microfocal prostate cancer as determined by needle biopsy does not predict clinically insignificant disease.

[Three cases of pleural mesothelioma and environmental pollution with tremolite outcrops in Lucania]

In a circumscribed rural area of Lucania (Italy) three cases of pleural mesothelioma have been identified: two men, 83 and 52 years old and a 78 year-old woman, who all had in common the fact of being shepards in that area. Possible asbestos pollution sources have been sought: we have immediately excluded an asbestos manufactured articles pollution, however we have highlighted the presence of "green stones", which had always been known to the local inhabitants and which, in three subsequent campains of collecting and chemical-mineralogical investigations, have resulted partly constituted by amphibole asbestos, classified as tremolite. Official institutions are organising a series of initiatives to verify the hypothesis of a causal relationship between the presence of tremolite and the cases of pleural mesothelioma, and preventive initiatives aimed at reducing exposure and to a sanitary surveillance. Similar problems had been identified in Turkey, Greece, Corsica, New Caledonia and recently in eastern Sicily.

[Systemic reactions to hymenoptera stings: epidemiologic study of 100 forestry department agents]

An epidemiological study on the prevalence rate of systemic reactions among forestry workers exposed to hymenoptera stings was performed. A sample of 100 Forestry Department Agents was studied using a questionnaire with the purpose of evaluating the prevalence rate of systemic reactions due to hymenoptera stings. From the questionnaire it was found that 78 (78.0%) of the subjects had histories of Hymenoptera stings and 5.0% had experienced systemic reactions. In conclusion, we found that the percentage of systemic reactions was relatively higher than that in the general population previously reported (0.3-3.3%). Efforts should be made for the sake of these Hymenoptera hypersensitive workers to popularize venom immunotherapy.

Effect of acute load of grapefruit juice on urinary excretion of citrate and urinary risk factors for renal stone formation

The effect of citrus fruit juice ingestion on the risk of calcium oxalate stone formation is still debated. The present study was undertaken to investigate changes in urinary stone risk factors after administration of a soft drink containing grapefruit juice. Seven healthy subjects, with no history of kidney stones, were submitted to an acute oral load (20 ml/kg body weight over 60 min) of a soft drink containing grapefruit juice diluted (10%) in mineral water. After a 7-day wash-out period, each subject underwent an oral load with mineral water alone under the same conditions. Urine specimens were collected before (for 120 min) and after each oral fluid load (for 180 min). Urinary flow was significantly increased after both grapefruit juice (46+/-26 vs 186+/-109 ml/h, p = 0.01) and mineral water (42+/-16 vs 230+/-72 ml/h, p=0.001) compared to baseline. Compared to mineral water, grapefruit juice significantly (p=0.021) increased urinary excretion of citrate (25.8+/-9.3 vs 18.7+/-6.2 mg/h), calcium (6.7+/-4.3 vs 3.3+/-2.3 mg/h, p=0.015) and magnesium (2.9+/-1.5 vs 1.0+/-0.7 mg/h, p=0.003). Citrus fruit juices could represent a natural alternative to potassium citrate in the management of nephrolithiasis, because they could be better tolerated and cost-effective than pharmacological calcium treatment. However, in order to obtain a beneficial effect in the prevention of calcium renal stones a reduced sugar content is desirable to avoid the increase of urinary calcium due to the effect of sugar supplementation.

[Epidemiology and physiopathology of urinary incontinence after radical prostatectomy]

Beginning in the 1980s, a series of anatomical discoveries were introduced to modify the classic retropubic radical prostatectomy proposed by Millin in 1942 in an effort to reduce intra and postoperative complications such as intraoperative bleeding and postoperative erectile dysfunction and incontinence. Urinary incontinence post retropubic "anatomical" radical prostatectomy remains a distressing problem for the patient and the physician rating from 6 to 20% even in the hands of experienced surgeons from high volume Academic Centers. The reason for the discrepancy in results is unclear and should be searched in surgical experience of the surgeon, volume of surgical activity of the Center, and selection of the patients undergoing the radical retropubic procedure. In the Literature we identified methodological factors which can bias the data on post radical retropubic prostatectomy such as 1) Consensus is lacking on definition of continence and/or incontinence following radical retropubic prostatectomy 2) Different surgical techniques are compared: sphincter damaging, versus repairing, versus preserving; bladder neck sparing versus non sparing; nerve sparing versus non sparing 3) Patients with preoperative urinary incontinence are included in the series and the preoperative continence status is not known. 4) Different timing in registration of incontinence. 5) Different methods in data collection. This latter seems to be the most important reason for discrepancy in the collection of the data. Self administered questionnaires oriented to evaluate incontinence analyzed by a third party seem to be the most powerful and objective tool for post prostatectomy incontinence rating. Post prostatectomy incontinence may be attributed to sphincter dysfunction as a result of surgical injury during prostatic surgery and/or to bladder dysfunction including detrusor instability and decreased compliance resulting in stress or urge or mixed stress/urge postoperative incontinence. In the Literature bladder dysfunction is considered to be responsible or jointly responsible for post RRP incontinence in a rate as high as 93%. More recently, a major role is considered to be played in post RRP incontinence pathophysiology by intrinsic sphincter insufficiency. Rarely bladder dysfunction is an isolated cause of incontinence. Moreover the symptom of stress incontinence accurately predicts the finding of intrinsic sphincter deficiency. The apical dissection and the preservation of the intrinsic sphincter remain the most complex parts of RRP and the keys to the maintenance of postoperative urinary continence.

The Legnano radiology picture archiving and communication system/radiology information system project implementation

The necessity to meet the ever-increasing diagnostic and interventional demands in the most cost-effective and efficient way led to the decision to turn the Department of Radiology at Legnano City Hospital nearly filmless. Crucial for the implementation of this challenging project was the development of a sophisticated and efficient digital architecture along with a nearly global renovation of the whole department, connecting it in the meantime to the hospital asynchronous transfer mode (ATM) backbone. The highlights and drawbacks faced in the implementation of the project are described and discussed.

[Interstitial cystitis: epidemiology]

The epidemiological assessment of intestitial cystitis (IC) is not definitive as no diagnostic criteria, such as endoscopy or biochemical and anatomopathological examination, exist. The diagnosis is solely based on symptoms like urgency, frequency and pelvic pain. The first studies on the population date back from 20 years ago and show a percentage of 10 cases every 100 thousand inhabitants. There is weak link between genetic factors, immunological diseases, previous cystitis or eating habits and intestitial cystitis. Epidemiological studies have highlight the frequency of this disease, and stressed the importance of stricted behavioural rules for the first stages of intestitial cystitis.

[Interstitial cystitis: surgical treatment]

Surgical therapy of interstitial cystitis must never be considered a first option but must be reserved for cases, less than 10%, in which conservative therapy has proven ineffectual. Surgical therapy includes a variety that started at the turn of the century. Neurosurgical denervation and perivesical denervation like cysto-cystoplasty and cystolysis, manipulate the innervation to reduce the bladder's hypersensitivity. This surgical approach may be considered in patients in whom bladder capacity is normal. The results are uncertain and the complications like neurogenic bladder relevant. Enterocystoplasty is much more widespread because interstitial cystitis is a benign disease that rarely required radical surgery. Augmentation cystoplasty and substitution cystoplasty are two variants but only the later has a rationale as it involves the resection of the detrusor which is the source of the pain. Detubularization drastically reduced urinary incontinence. The resection of the detrusor can be supratrigonal, subtrigonal or at the proximal urethra like in the orthotopic neobladder. If urinary diversion is chosen, the bladder must be removed. Before recommending surgical therapy each patient should undergo tests for the localization of the pain; moreover psychological and gynaecological evaluations should be made. If the bladder capacity exceeds 400 cc surgical operation is not advisable. If, on the other hand, the bladder capacity is lower than 400 cc substitution cystoplasty is first choice. If the patient suffers from trigonal cystitis or urethral hypersensitivity, urinary diversion is a better therapy. According to the questionnaires send to the Urologic Departments in Lombardy in 1998, the most widespread type of operation seems to be supratrigonal cystectomy + enterocystoplasty and augmentation cystoplasty. Subtrigonal cystectomy or urinary diversion are only occasionally chosen; continent pouch is the least frequent therapy at all.

Photoadaptation of two members of the Chlorophyta (Scenedesmus and Chlorella) in laboratory and outdoor cultures: changes in chlorophyll fluorescence quenching and the xanthophyll cycle

The role of the xanthophyll cycle in the adaptation of two chlorococcal algae Scenedesmus quadricauda and Chlorella sorokiniana to high irradiance was studied under laboratory and outdoor conditions. We wished to elucidate whether the xanthophyll cycle plays a key role in dissipating the excesses of absorbed light, as in higher plants, and to characterise the relationship between chlorophyll fluorescence parameters and the content of xanthophyll-cycle pigments. The xanthophyll cycle was found to be operative in both species; however, its contribution to overall non-photochemical quenching (NPQ) could only be distinguished in Scenedesmus (15-20% of total NPQ). The Scenedesmus cultures showed a larger pool of xanthophyll-cycle pigments than Chlorella, and lower sensitivity to photoinhibition as judged from the reduction of maximum quantum yield of photosystem II. In general, both algae had a larger xanthophyll-cycle pool when grown outdoors than in laboratory cultures. Comparing the two species, Scenedesmus exhibited a higher capacity to adapt to high irradiance, due to an effective quenching mechanism and high photosynthetic capacity; in contrast, Chlorella represents a species with a larger antennae system, less-efficient quenching and lower photosynthetic performance. Non-photochemical quenching (NPQ) induced through the xanthophyll cycle can, to a limited extent, represent a regulatory factor in diluted algal cultures grown in outdoor solar photobioreactors, as well as in natural algal phytoplankton populations exposed transiently to high irradiance. However, it does not play an appreciable role in dense, well-mixed microalgal suspensions.

Shock Wave Treatment of Peyronie'S Disease: Our Experience

From September 1997 to April 1998, 40 patients with induratio penis plastica were treated with extracorporeal shock waves (ESWT). This work compares our results with those of the main Italian centres that first used this method. The aim of this study is to assess the efficiency of the treatment in the period before the main guidelines were laid down: guidelines which from now on should standardise indications and methods of application whilst optimising results.

[Stents in the treatment of stenosis of the entero-urethral junction in continent diversion: case reports]

Strictures of entero-urethral anastomosis in orthotopic neobladder and of the catheterizable conduit in continent diversion after cystectomy are seldom encountered; they are usually treated with dilation, TUR or cold incision. 3 cases that came to our observation are presented. The first was treated with TUR after neo-bladder neck stricture in orthotopic neobladder; total incontinence occurred after this procedure. The patient at present is waiting for AS800 artificial sphincter implant. The second patient had similar features. After repeat TUR a prostacoil removable stent was placed through the stricture and removed after 5 months. At 12 months from removal the patient is continent and doesn't present clinical evidence of restriction. The third patient underwent cystectomy with Indiana continent pouch. After 4 months increasing problems in self catheterization occurred due to stricture of the catheterization conduit (appendix). He was treated twice with cold incision with early recurrence of the stricture. A permanent Memotherm stent (indicated for urethral strictures) was placed inside the appendix. After one month self catheterization was started again. At a 2 months follow up there is no evidence of stricture. In our experience, even if anecdotal, we have verified that treatment of this kind of strictures with TUR can cause incontinence or expose to further recurrences. 2 of the cases presented were treated with different kind of stents; the outcome is good even if the follow up is still short. We believe that this kind of treatment can be considered in selected cases.

[pT1G3 bladder carcinoma: our experience]

Approximately 6 to 23% of the patients with transitional cell carcinoma confined to the superficial mucosa of the bladder suffer for a pT1G3 tumor. Between 1984 and 1994, 12 patients were treated for high grade stage T1 tumores. Trans-urethral resection of the bladder cancer was performed in 8 patients, supported in two cases by immunotherapy with B.C.G. and in one case by endovesical chemotherapy. Radical cystectomy was carried out in 4 patients. Our results are similar to what reported by other Authors, but we didn't have any progression in all 8 patients treated with conservative therapy.

[Echo-guided retropneumoperitoneum in laparoscopic renal surgery]

Laparoscopic surgery admits the retroperitoneal approach: the main restriction is the tight manoeuvring space that can be obtained with insufflation. The use of a dilatator balloon in the retroperitoneal cavity offers a solution to this problem. A cutaneous access and a dull parietal path is created, with blind positioning of the apex of the dihedron between the inferior renal pole and the ureter. Peroperative ultrasound control makes it possible to identify the inferior renal pole, to control the position of the apex of the catheter with the balloon and the movements of the retroperitoneal organs in real time. The possibility of following the procedure by ultrasonography have proven usefull in our experience.

[Pulmonary silicosis associated with MacLeod syndrome: a case report]

The paper reports a case of silicosis associated with idiopathic unilateral hyperlucent lung--MacLeod's disease (ML)--in a 65-year old miner. ML had not been diagnosed before this clinical observation and the patient had been exposed to silica dust for about 15 years as a truck operator in water supply tunnelling work in central Italy. Impaired ventilatory function due to left pulmonary dystrophy was the favouring or even the causal factor of dust accumulation in the functionally active right lung and of the tissue reaction to the dust, leading to interstitial fibrosis. A radiological diagnosis of p 1/0 pneumoconiosis was made according to the 1980 International Labour Office classification. Clinical, radiological and functional findings indicated the presence of respiratory failure as a result of the sum of silicotic and dystrophic lesions. Two combined pulmonary scintigraphic examinations with Tc99 perfusional and mTc-DPTA inhalatory methods revealed peculiar alterations: absence of ventilation associated with severe vascular impairment in the left lung, inequality of the ventilation/perfusion rate, due to pneumoconiosis, in the right lung. MacLeod's disease is rare, but must be considered as a mandatory contra-indication for work involving dust exposure risk since it is one of the predisposing factors which can cause an occupational disease even if environmental exposure standards are observed.

[Complications of hepatic hydatidosis]

Fifty cases of complicated hydatid cyst of the liver on a total of 250 cases of hydatid cyst observed were analyzed. The Authors describe the several complications observed (compression, infection, rupture into biliary tract or into the thorax or into the peritoneal cavity, the diagnostic and therapeutic procedures. Total mortality was about 7.6% (3 cases) 2 patient died for intraperitoneal rupture and one for rupture in the biliary tract. Surgical treatment should be as radical as possible performing total or subtotal pericystectomy, hepatic resection is reserved to selected cases. Drainage by Kehr tube of biliary tract is necessary of rupture of the cyst in the biliary tract, while we limit the indication for a papillostomy to the sphincter duct stenosis.

[Exposure to solvents and tardy epilepsy: 2 clinical cases]

Organic solvents (OS) are widely used in industry and craft work. The neurotoxic effects of OS are well known in occupational exposure occurring in poor industrial hygiene conditions. There has been interest recently in a possible epileptogenic effect of OS exposure. Two cases are reported of late onset epilepsy observed in workers heavily exposed to OS. Case 1 was a 27-year-old male painter employed in a car body repair workshop. Solvent exposure was high for a few months because after his regular work, the man continued working as a car body painter in his own private concern. After a period of weakness and headache, probably indicating an excessive solvent absorption, he suffered two generalized paroxysmal seizures during sleep which necessitated hospitalization and continuous treatment with barbiturates. Case 2 was a 44-year-old male painter in a road advertising billboard factory who was continuously exposed to OS. Ten years previously he had been exposed to accidental massive inhalation of solvent vapours while opening a drum of solvents for coloured paint. Acute solvent poisoning followed and seven weeks later he suffered several epileptic episodes associated with typical EEG alterations; for many years, however, treatment was ineffective. In both cases there was neither a history of neurologic disease nor any other neurologic dysfunctions and the results of comprehensive neuroradiological studies were normal. Evidence exists of a chronological connection between high exposure to paint solvents and clinical evidence of late onset epilepsy, but it is not possible to identify a definite causal relationship.(ABSTRACT TRUNCATED AT 250 WORDS)

[Perforation of the colon]

The paper reports personal observations relating to 111 cases of colonic perforation. Etiopathogenesis and different surgical approaches are discussed and results are compared. Hartmann's operation is identified as the best solution in cases of colonic perforation with diffuse peritonitis. In cases of localized peritonitis, excellent results may be obtained by operating immediately.

[Emergency surgery in icterus]

Obstructive jaundice may be, still today, a surgical emergency. After the analysis of the serious syndrome following a persistent cholestasis, the authors discuss new technological diagnostic procedures and indications, pros and cons of the use of P.T.D. (Percutaneous Transhepatic Drainage). Finally, they underline emergency cases and proper surgical management, on the basis of their personal experience, as well.

[Experience in the use of the tumor markers CEA, GICA and TPA in the postoperative monitoring of colorectal neoplasms]

Current use of tumour markers in the followup to malignant digestive tract neoplasias is restricted mainly by the non optimal sensitivity levels and specificity of these markers. These aspects of CEA, GICA and TPA markers used in follow-ups for 23 patients surgically treated for Duke's stage B2 neoplasias of the colon and rectum were examined over the period 1980-1983. Each marker examined displays its own individual characteristics of sensitivity and specificity. An X-ray endoscopic confirmation is required in all cases as no single marker is sufficiently reliable to be used as a diagnostic tool on its own. It is concluded that biological markers should be used as part of a follow-up programme embracing more than one diagnostic procedure.