Dataset for facilitating the calculation of aspect ratio of fibrillated cellulose suspensions based on gel point data

This article describes data related to the research paper "Simplification of gel point characterization of cellulose nano and microfiber suspensions" [1]. The characterization of fibrillated celluloses that include cellulose nano and microfibrils (CMNFs) is a challenge for their production on an industrial scale, requiring easy techniques that control their quality and reproducibility. Gel point is a convenient parameter commonly used to estimate the aspect ratio (AR) of CMNFs. However, this estimation requires many sedimentation experiments, which are tedious and time consuming. The dataset includes all information related to the traditional experiments and to the simplified experiments for estimating gel point and AR based on only one sedimentation experiment. The full data set is useful to select the initial concentration to carry out the experimentation. This dataset also includes the information for the validation of the proposed simplified methodology and shows that the errors are lower than 7% for the gel point calculation and of 3% for the AR estimation. A larger databased of nanocellulose suspensions can be built with the reuse of this data to allow the estimation of nanocellulose properties in a future.

Risk of unfavorable outcomes after penile prosthesis implantation - results from a national registry (INSIST-ED)

Like all surgeries, penile prosthesis implantation (PPI) has the potential for both postoperative complications and suboptimal patient satisfaction. In order to assess risk factors for poor satisfaction, we reviewed patients who had been prospectively recruited in a national multi-institutional registry of penile prostheses procedures (INSIST-ED) from 2014 to 20121. Patient baseline characteristics and postoperative complications were recorded. The primary endpoint of this study was unfavorable outcomes after inflatable PPI, defined as significant postoperative complications (Clavien-Dindo ≥2) and/or Sexuality with Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) scores below the 10th percentile. A total of 256 patients were included in the study. The median age was 60 years (IQR 56-67). The most common cause of erectile dysfunction (ED) was organic (42.2%), followed by pelvic surgery/radiotherapy (39.8%) and Peyronie's disease (18.0%). Postoperative complications were recorded in 9.6%. High-grade complications (Clavien ≥2) occurred in 4.7%. At 1-year follow-up, the median QoLSPP total score was 71 (IQR 65-76). In all, 14.8% of patients were classified as having experienced unfavorable outcomes because of significant postoperative complications and/or QoLSPP scores below the 10th percentile. Logistic regression analysis demonstrated patient age to be non-linearly associated with the risk of experiencing unfavorable outcomes. A U-shaped correlation showed a lower risk for younger and older patients and a higher risk for middle-aged men. ED etiology and surgical volume were not associated with PPI outcomes. Physicians should, therefore, be aware that middle-aged men may be at higher risk of being unsatisfied following PPI compared to both younger and older patients.

COVID-19 outbreaks in hospital workers during the first COVID-19 wave

Background

Health care workers (HCWs) are on the frontline, playing a crucial role in the prevention of infection and treatment of patients.

Aims

This study was aimed to evaluate the prevalence of hospital-acquired coronavirus disease 2019 (COVID-19) infection at work and related factors at the University Hospital of Trieste workers exposed to COVID-19 patients.

Methods

From March 1 to May 31, of 4216 employees, 963 were in contact with COVID-19 patients or colleagues and were followed up. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in nasopharyngeal swabs was determined every 3 days, by RT-PCR.

Results

During the follow-up period, 193 workers were positive for COVID-19 (5%), and 165 of these (86%) were symptomatic. We identified five major cluster outbreaks of COVID-19 infection in Trieste Hospitals, four of which occurred before the implementation of universal masking for HCWs and patients (1–14 March 2020). COVID-19 infection was significantly higher in high-risk ward workers (Infectious Diseases, and Geriatric and Emergency Medicine, odds ratio [OR] 13.4; 95% confidence interval [CI] 5.8–31), in subjects with symptoms (OR 5.4; 95% CI 2.9–10) and in those with contacts with COVID-19 patients and colleagues (OR 2.23; 95% CI 1.01–4.9).

Conclusions

Hospital workers were commonly infected due to contact with COVID-19 patients and colleagues, mainly in the first 15 days of the pandemic, before the implementation of universal mask wearing of HCWs and patients. Repetitive testing and follow-up permitted the identification of COVID-19 cases before symptom onset, obtaining better infection prevention and control.

INSIST-ED: Italian Society of Andrology registry on penile prosthesis surgery. First data analysis

OBJECTIVES

The Italian Society of Andrology, i.e. "Società Italiana di Andrologia" (S.I.A.), launched on December 2014 a prospective, multicenter, monitored and internal review board approved Registry for penile implants, the "INSIST-ED" (Italian Nationwide Systematic Inventarisation of Surgical Treatment for ED) Registry. Purpose of this first report is to present a baseline data analysis of the characteristics of penile implant surgery in Italy.

MATERIAL AND METHODS

The INSIST-ED Registry is open to all surgeons implanting penile prostheses (all brands, all models) in Italy, providing anonymous patient, device, surgical procedure, outcome, follow-up data, for both first and revision surgeries. A Registry project Board overviews all the steps of the project, and a Registry Monitor interacts with the Registry implanting surgeons.

RESULTS

As by April 8, 2016, 31 implanting surgeons actively joined the Registry, entering 367 surgical procedures in its database, that comprise: 310 first implants, 43 prosthesis substitutions, 14 device explants without substitution. Implanted devices account for: 288 three-component devices (81,3%), 20 two-component devices (5,4%), 45 non-hydraulic devices (12,3%). Leading primary ED etiologies in first implant surgeries resulted: former radical pelvic surgery in 111 cases (35,8%), Peyronie's disease in 66 cases (21,3%), diabetes in 39 cases (12,6%). Two intraoperative complications have been recorded. Main reasons for 57 revision surgeries were: device failure (52,6%), erosion (19,3%), infection (12,3%), patient dissatisfaction (10,5%). Surgical settings for patients undergoing a first penile implant were: public hospitals in 251 cases (81%), private environments in 59 cases (19%).

CONCLUSIONS

The INSIST-ED Registry represents the first European experience of penile prosthesis Registry. This baseline data analysis shows that: three-pieces inflatable prosthesis is the most implanted device, leading etiology of erectile dysfunction (ED) in patient receiving a prosthesis is former radical pelvic surgery, primary reason for revision surgery is device failure, primary settings for first penile implant surgery are public hospitals. Evaluation of penile implant impact on recipients quality of life is presently ongoing.

Measurement of the weighted peak level for occupational exposure to gradient magnetic fields for 1.5 and 3 Tesla MRI body scanners

The purpose of this work is to give a contribution to the construction of a comprehensive knowledge of the exposure levels to gradient magnetic fields (GMF) in terms of the weighed peak (WP), especially for 3 Tesla scanners for which there are still few works available in the literature. A new generation probe for the measurement of electromagnetic fields in the range of 1 Hz-400 kHz was used to assess the occupational exposure levels to the GMF for 1.5 and 3.0 Tesla MRI body scanners, using the method of the WP according to the International Commission on Non-Ionizing Radiation Protection (ICNIRP) approach. The probe was placed at a height of 1.1 m, close to the MRI scanners, where operators could stay during some medical procedures with particular issues. The measurements were performed for a set of typical acquisition sequences for body (liver) and head exams. The measured values of WP were in compliance with ICNIRP 2010 reference levels for occupational exposures.

[Musculoskeletal pain and perceived stress in civil servants]

«Muskuloskeletal pain and perceived stress in civil servants».

BACKGROUND

Musculoskeletal pain is the most important symptom reported in many occupations causing disability and long-term sick absence. Epidemiological research has linked this symptom to physical activities in the workplace but also to psychosocial factors, than can increase pain perception.

OBJECTIVES

To evaluate pain perception, psychosocial factors and stress in 413 workers in hospitals compared to 294 white collar workers at University of Trieste.

METHODS

The study population included workers who underwent periodical health surveillance from 20th of January, 2011 to 20th of June 2012. Psychosocial factors were evaluated using the Siegrist Effort Reward Imbalance Questionnaire, and depression and anxiety by means of the Goldberg General Health Questionnaire (GHQ). Pain perception in different body sites was reported on a visual numeric scale 0-10. The relation between pain perception in different body sites, individual characteristics, work tasks and psychosocial/psychological factors was assessed by means of multivariable logistic regression analysis.

RESULTS

The study population was characterized by low Effort and good Reward. In the multivariate linear regression pain perception was significantly related to age, to female sex in neck (OR=1.63; CI95% 1.13-2.34) and shoulder (OR=2.18; CI95% 1.49-3.2) pain and to Effort in all sites while occupational exposure as health care workers was significantly associated to higher pain in upper limbs (OR=1.76; CI95% 1.11-2.8) and low back (OR=1.73; CI95% 1.21-2.49).

CONCLUSIONS

Our study demonstrated that psychosocial factors can have an important role in pain perception in all body sites suggesting the need to consider these factors together with physical exposures in workplaces.

[Autopsy findings and pleural plaques in the Malignant Mesothelioma (MM) Regional Register of Friuli-Venezia-Giulia]

AIMS

To describe the cases of MM that occurred in the Friuli Venezia Giulia Region in the period 1995-2009 and evaluate the diagnostic contribution of autopsy findings.

METHODS

Via the Regional Register a search for MM cases was made following standardized criteria for diagnosis and past asbestos exposure assessment. Pleural plaques were identified by autopsy findings; the relationship between presence of pleural plaques and assessment of past asbestos exposure was analyzed.

RESULTS

834 cases of MM were recorded and 458 autopsy findings were available; for 142 cases (15% of males and 23% of women) the first diagnosis was made at autopsy. Data were available on previous asbestos exposure in 91% (416 subjects) of cases with autopsy findings: 255 had "certain occupational exposure" (group 1), 116 "other occupational and non- occupational exposure" (group 2), 45 "negative and unknown exposure" (group 3). Logistic regression showed that significant predictors for pleural plaques were age at diagnosis (OR=1.03 each year (95% CI=1.01-1.05), asbestos exposure in group 1 versus group 2 (OR=6.8 (95% CI=4-12), and exposure in group 1 versus group 3 (OR=6.4 (95% CI=3-13). Among subjects in groups 1 and 2, the presence of pleural plagues was significantly associated with latency (OR=l.03 for each year of latency; 95% CI=1.01-1.22) and asbestos exposure in group 1 versus group 2 (OR=7.8; 95% CI=4.4-13.0).

CONCLUSIONS

Autopsy findings improved the diagnostic level of MM in elderly subjects, for whom reliable data on past asbestos exposure is often lacking. In subjects suffering from MM direct interview is always the best tool to evaluate past asbestos exposure; autopsy findings of pleural plaques cannot replace the anamnestic history when this is lacking, although such findings can act as a support.

[Anti-smoking counseling in a group of workers with past exposure to asbestos]

BACKGROUND

Anti-smoking counseling is often part of healthcare protocols for workers with past asbestos exposure; nevertheless, data is lacking about the results.

OBJECTIVES

To evaluate smoking habits and the effects of anti-smoking counseling in a group of workers with past asbestos exposure.

METHODS

Smoking was assessed in 671 subjects who voluntarily attended a health surveillance protocol. Fagerstrom's and Richmond's tests were used in order to estimate smokers' addiction and their potential will to quit. Besides anti-smoking counseling, smokers were also offered a formal cessation programme.

RESULTS

The mean age of the 671 subjects was 66 (DS = 7,9) years. The population consisted of 87 (13%) current smokers, 372 (55%) ex-smokers and 212 (32%) non smokers. According to Fagerstrom's test results, only 10% of the smokers presented a strong/very strong addiction, while Richmond's test results showed that 50% of the smokers had a strong/very strong will to quit. Only one smoker decided to join a cessation programme.

CONCLUSIONS

The results of the study could present a bias, because volunteer-based protocols may promote the participation of self-motivated and health-sensitive subjects. This could be one of the reasons for the low prevalence of current smokers and high prevalence of ex-smokers. Anti-smoking counseling did not produce satisfactory effects because smokers were resistant to quitting smoking. Identification of anti-smoking counseling weak points may improve efficacy in health prevention controls made on subjects with past asbestos exposure.

Intraspecific variability of the essential oil of Calamintha nepeta subsp. nepeta from Southern Italy (Apulia)

The essential oil of 46 spontaneous plants of Calamintha nepeta (L.) Savi subsp. nepeta growing wild in Sud, Italy (Salento, Apulia), were investigated by GC/MS. Fifty-seven components were identified in the oil representing over the 98% of the total oil composition. Four chemotypes were identified: piperitone oxide, piperitenone oxide, piperitone-menthone and pulegone.

[Tuberculosis. Focus on risk assessment and health surveillance in health workers: results and perspectives of a multicenter working group]

INTRODUCTION

Tuberculosis (TB) is still a threat for healthcare workers (HCW), due to the non decreasing incidence, the spread of drug-resistance, the introduction of new tests for the screening, the relevant costs of surveillance of exposed subjects. These issues implicate a revision of activities to prevent TB in health-care settings.

METHODS

A multidisciplinary working group, led by occupational physicians, examined the activities to prevent TB performed in 9 Italian hospitals and reviewed the literature, with the aim to formulate evidence-based procedures.

RESULTS

In the considered hospitals, 23.000 HCW are classified as exposed to TB, out of 32.000 HCW exposed to biological risks; yearly, about 6000 subjects are screened for preventive, periodical or post-exposure surveillance and 110-130 chemoprophylaxis are prescribed. A high proportion of HCW (54-75%) refused or interrupt to assume the drugs. In the period 2004-2008, 14 occupational TB were diagnosed (9/100.000 HCW exposed to biological risks).

DISCUSSION

Critical issues are the availability of a specific, written TB control plan, including risk assessment, protocols for identifying, evaluating, managing infectious TB patients, health surveillance, education programs, specifically addressed to increase Standard Precaution adoption and compliance to the screening and to adequate risk perception. Risk assessment identify HCW to be included in TB testing (characterized by low positive predictive value), unrecognized TB and environmental control needed; TB risk classification should include no more than 3 or 4 classes and performed by assessing the issues suggested in the Italian guideline. Tubercolin skin test should be used for HCW screening, adding in vitro test in specific circumstances (for example, skin test positivity in BCG vaccinated HCW); the frequency of the screening should not exceed 2 years. Periodical revision of preventive activities should follow up to date scientific literature and need appropriate data computing.

[Focus on risk assessment in health environments: results and perspectives of a multicenter working group]

The hospital risk assessment (VdR) is certainly a relevant issue concerning the activities of prevention for the health of healthcare workers in relation to biological risk. The aim of this paper is to provide an up-date of the issue, based on the suggestions of recent literature about the rules ratified by the new legislative decree and data supplied by the Group of 10 Hospitals participated in this multicenter study. From the analysis of data on healthcare settings (HCS) participating in the project the following considerations can be formulated: i) All HCS considered VdR from biological agents. The method recommended in the Guidelines SIMLII 2005 is the most followed ii) To grading the risk, the use of invasive procedures for carrying out the analysis results is a necessary element iii) the operators classified as exposed to biological risk, and therefore subject to health surveillance, represent almost all of workforce in 7 out of 10 HCS. The subgroup believes that VdR must be conducted in close collaboration with the occupational physician and should represent a worthwhile investment with spin-off character on prevention, decision making, empowering. The presence of environmental requirements and organizational procedures should be considered, so that HCS is enabled for an effective risk management, without which risk assessments cannot be performed. The method of VdR mentioned in the guidelines MLIS 2005, besides being the most widely used by the company participating in the study, still has practical reasons and opportunities to justify its use. The HCS group felt the need to propose an implementation of the definition of invasive procedures and EPP, together with individual assessment. Flexibility was suggested in identifying different levels of risk with the involvement of occupational physicians, especially in the presence of EPP, also in order to plan content and frequency of health surveillance.

[Exanthemic diseases (measles, chickenpox, rubella and parotitis). Focus on screening and health surveillance of health workers: results and perspectives of a multicenter working group]

BACKGROUND

Nosocomial transmission of varicella-zoster virus, certain paramixovirus and rubivirus might pose a risk of morbidity for varicella (V), rubella (R), mumps (Mu) and measles (Me) in health care workers (HCW), patients and coworkers. International literature and European legislation recommend preventive interventions to minimize the risk.

METHODS

A literature review and a seroprevalence study were carried out in 9 hospitals located in north and central Italy, in order to evaluate risk assessment, health surveillance and fitness for work of HCW exposed to V, R, Mu and Me. Antibodies (Ab) against V, R, Mu and Me were determined. For a subgroup of 4 hospitals; sociodemographic, occupational data and sera were collected and analyzed.

RESULTS

About 36000 tests on about 9000 HCW were analyzed. Differences in seroprevalence ratios (V 85.7-95.1%, R 47-96.8%, Me 71.4-97.8%, Mu 52.5-87.6%) were detected. In a subgroup, a relevant number of non immune HCW was also found among women infertile age and areas at higher risk. Statistically significant differences were detected only for selected variables and viruses.

DISCUSSION AND CONCLUSIONS

Data of multicenter study confirm literature evidences and allow to define good medical practices for manage and minimize the risk of nosocomial transmission of V, R, Me and Mu. Recommendation are issued about serologic screening on HCW exposed to all 4 viruses thorough the modern analytical techniques, in order to assess risk on individual a group basis and to select priorities for intervention. Vaccination should be prescribed for those HCW non immune, selecting areas and HCW according to priorities.

[Focus on coverage and promotion of anti influenza vaccine in health workers: results and perspectives of a multicenter working group]

INTRODUCTION

The influenza illness is a concern for health care workers (HCW) due to the potential nosocomial transmission and sickness absenteeism. Immunization and Isolation Precautions might be effective preventive measures.

AIMS

To formulate recommendations on vaccination in healthcare settings.

METHODS

A multidisciplinary working group, led by occupational physicians (OP), examined the information on seasonal influenza immunisation campaign in 9 Italian hospitals in the period 2005-2009 and reviewed scientific evidence.

RESULTS

Many health organizations recommend vaccination of HCW. The literature shows that seasonal influenza vaccination of healthy adult have a modest effect in reducing work day lost; there is no evidence that it affects transmission or it prevents the disease in elderly residents. These observations might be conditioned by methodological limitations. Further studies are required to avoid the risk of bias and in pediatric settings. The rate of flu vaccination among HCW is widely variable and it depends on individual risk perception and information about efficacy and side effects. In the considered hospitals, in the five-years period the vaccination rate ranged between 0 and 29%: the median value was 16-17% in 2005, 2008 and 2009 (only against H1N1 influence), 11% and 13% in 2007 and 2006 respectively. OP participation in the vaccination campaign seems to increase the immunization rate.

DISCUSSION

Seasonal influenza immunization of HCW might be effective. We recommend to formalize written procedures in health care settings, to perform data computing and to periodically revise immunization activities and promotion and scientific literature, with the aim to appropriately address resources.

[Focus on health surveillance of health workers exposed to blood-transmissible biological agents: results and perspectives of a multicenter working group]

The biological risk from exposure to bloodborne pathogens in health care environments represents a frequent and widespread risk, involving a large number of exposed workers. On the basis of the available scientific innovations, the recent legislation regarding health and safety of workers and the experiences of SIMLII guidelines on health surveillance (HS) workers exposed to biological risk, a multicenter study was carried out, involving nine relevant hospitals and about 32 000 healthcare workers (HCW). A review of the literature was performed, with particular reference to the last 10 years. For each hospital, protocols of HS have been examined according to tasks and biological risk from bloodborne viruses (HBV, HDV, HCV, HIV) as well as management of HCW infected with this pathogens. Differences of risk management in the hospitals, in relationship also with recommendations of the literature have been evaluated. The literature supplies important indications for HS management of HCW exposed to bloodborne pathogens, with relevant information also for patient safety. Preventive examinations are in line with the recommendations of literature and similar across the hospitals for HCV and HIV, while they are different for HBV. Periodic surveillance was different for the frequency, among the hospitals and also as compared to national SIMLII guidelines. As for management, no differentiation among the hospitals was detected as referred to different risk of exposure, while differences were observed around definitions of restrictions. Finally, good medical practices to support occupational physicians in the prevention and management of HCWs' exposed to biological risks are suggested.

[Retroperitoneoscopic nephropexy]

INTRODUCTION

Nephroptosis has been defined as renal descent of 5 or more cm on orthostasis. This disease is more frequent in young and slim women. The patient complains pain in upright position,that regress lying down. The therapy consists of surgical treatment. We report the case of a woman treated with retroperitoneoscopic nephropexy.

METHODS

We present the case of a 25-years old woman, affected by lumbar pain in upright position for about 1 year. Ultrasound scan of the abdomen and RX-KUB did not show hydronephrosis nor stones. Both an orthopedic examination and a spinal MRI excluded bone or muscular diseases. Intravenous pyelography and diuretic isotope renography in upright position revealed a renal descent of more than 5 cm, without obstruction of upper urinary tract. The patient underwent a renal color doppler imaging, that showed reduction of right kidney resistive index in upright position. The patient underwent a right retroperitoneoscopic nephropexy. After complete dissection of the perirenal fat from the kidney, three nonabsorbable sutures were placed between the posterior renal capsule and the psoas muscle.

RESULTS

No blood loss nor peri-operative complications have been observed. One month after the procedure, the patient did not complain any pain. Renal color doppler, performed one month after the nephropexy, showed a normalization of resistive index.

CONCLUSIONS

Symptomatic nephroptosis is a disease that has been questioned in the past. Nowadays, the modern imaging and functional examination available allow to identify the “true”cases of symptomatic nephroptosis. The treatment with retroperitoneoscopic nephropexy is an easy and effective procedure.

Nefropessi Retroperitoneoscopica

Introduction

Nephroptosis has been defined as renal descent of 5 or more cm on orthostasis. This disease is more frequent in young and slim women. The patient complains pain in upright position, that regress lying down. The therapy consists of surgical treatment. We report the case of a woman treated with retroperitoneoscopic nephropexy.

Methods

We present the case of a 25–years old woman, affected by lumbar pain in upright position for about 1 year. Ultrasound scan of the abdomen and RX-KUB did not show hydronephrosis nor stones. Both an orthopedic examination and a spinal MRI excluded bone or muscular diseases. Intravenous pyelography and diuretic isotope renography in upright position revealed a renal descent of more than 5 cm, without obstruction of upper urinary tract. The patient underwent a renal color doppler imaging, that showed reduction of right kidney resistive index in upright position. The patient underwent a right retroperitoneoscopic nephropexy. After complete dissection of the perirenal fat from the kidney, three nonabsorbable sutures were placed between the posterior renal capsule and the psoas muscle.

Results

NO blood loss nor perioperative complications have been observed. One month after the procedure, the patient did not complain any pain. Renal color doppler, performed one month after the nephropexy, showed a normalization of resistive index.

Conclusions

Symptomatic nephroptosis is a disease that has been questioned in the past. Nowadays, the modern imaging and functional examination available allow to identify the “true” cases of symptomatic nephroptosis. The treatment with retroperitoneoscopic nephropexy is an easy and effective procedure.

Waste management from pulp and paper production in the European Union

Eleven million tonnes of waste are produced yearly by the European pulp and paper industry, of which 70% originates from the production of deinked recycled paper. Wastes are very diverse in composition and consist of rejects, different types of sludges and ashes in mills having on-site incineration treatment. The production of pulp and paper from virgin pulp generates less waste but the waste has similar properties to waste from the production of deinked pulp, although with less inorganics. Due to legislation and increased taxes, landfills are quickly being eliminated as a final destination for wastes in Europe, and incineration with energy recovery is becoming the main waste recovery method. Other options such as pyrolysis, gasification, land spreading, composting and reuse as building material are being applied, although research is still needed for optimization of the processes. Due to the large volumes of waste generated, the high moisture content of the waste and the changing waste composition as a result of process conditions, recovery methods are usually expensive and their environmental impact is still uncertain. For this reason, it is necessary to continue research on different applications of wastes, while taking into account the environmental and economic factors of these waste treatments.

Re-Biopsies of the Prostate after Endo-Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) in Patients with ASAP: Preliminary Results

Introduction e Objectives

There are some evidences that the combination of EndoMRI and MRS might be able to limit the number of iterative biopsies in patients with negative biopsies of the prostate and a still rising PSA. The aim of this study is to evaluate the possible role of EndoMRI/MRS in patients with ASAP.

Methods

From November 2005 to September 2008 we enrolled 28 consecutive patients diagnosed with ASAP at a TRUS-guided needle prostate biopsy. All patients underwent prostatic EndoMRI and MRS. A prostatic zone was classified as: suspicious for prostate cancer if low intensity signal was present on T2-weighted images and/or if the choline + creatine / citrate ratio was >0.86; equivocal or negative otherwise. A subsequent 12-core needle prostate biopsy was performed and supplementary biopsies were added in the suspicious zones. The results of MRI/MRS were then compared with histological findings.

Results

The combination of EndoMRI and MRS was suspicious for cancer in 70% of patients, equivocal in 23% and negative in 7%. Histological findings at re-biopsy included: prostate cancer in 35%, ASAP in 23%, BPH or prostatitis in 42%. In 78% of patients diagnosed with prostate cancer the combination MRI/MRS was suspicious and in 22% equivocal. In all patients the cancer was found in suspicious zones at MRI/MRS where targeted biopsies were performed.

Conclusions

The combination of EndoMRI and MRS proved to have a good sensitivity but a poor specificity in identifying a concurrent prostate cancer among patients with ASAP. The location of positive cores for prostate cancer was consistent with the suspicious zones at MRI/MRS.

[Freedom from smoking for health care workers. A project from Trieste]

A tree years interventional study to modify smoking habits in health workers in Trieste province was planed in the collaboration of occupational health unit and Tobacco's Dependence Study Center. The aim of this paper is refer about preliminary data of the project started in 2007 regarding smoking habits in health workers of the Azienda per i Servizi Sanitari n.1 "Triestina" (ASS1) and the Azienda Ospedaliera Universitaria Ospedali Riuniti di Trieste (AOUTS). The project consist of several actions. i) information about risks and opportunities of project; ii) pursuance of the law 51 L 3/2003; iii) Occupational Health Unit and Tobacco's Dependence Study Center collaboration; iv) follow-up of the subjects that choose the disaccustom program. During occupational medical surveillance we collected the data related to 492 workers, 37% of the cases were smokers (180). The results of test of dependence to smoke (test di Fagestrom) showed an high dependence in 19% and an high motivation to stop smoke (test di Richmond) in 39% of the smokers. More than fifty percent of this subjects gave their adhesion to the disaccustom program.

Different perception of cognitive impairment, behavioral disturbances, and functional disabilities between persons with mild cognitive impairment and mild Alzheimer's disease and their caregivers

Insight in dementia is a multifaceted concept and ability, which includes the persons' perception of their behavioral and cognitive symptoms and functional disability. This ability seems to deteriorate as dementia progresses. The aim of this study was to evaluate the level of insight in the cognitive, behavioral, and functional disorders in a group of persons with mild cognitive impairment (MCI) or mild AD (Alzheimer's disease) and to compare their perception of their illness with that of their caregivers. The study involved a group of 121 persons with MCI and mild AD and their caregivers. The persons with MCI and mild AD were administered the tests Mini-Mental State Examination, Instrumental Activities of Daily Living, Activities of Daily Living, Neuropsychiatric Inventory, Schedule for the Assessment of Insight, Clinical Insight Rating Scale, and a short interview. Major differences were identified between how the persons with MCI or mild AD and their caregivers perceived the persons' cognitive and behavioral disorders. The group with MCI or mild AD underestimated their deficits, which were considered serious and disabling by their caregivers.

[The role of the occupational health physician in the implementation of the European and Italian regulations on mechanical vibration at work]

The European Directive 2002/44/EC and the Italian Decree 187/2005 establish the minimum health and safety requirements regarding the exposure of workers to the risks arising from mechanical vibration. Excessive exposure to hand-arm vibration from powered processes or tools can cause disorders in the vascular, neurological and musculoskeletal systems of the upper limbs. Long-term occupational exposure to intense whole-body vibration is associated with an increased risk for disorders of the lumbar spine and the connected nervous system. The prevention of injuries or disorders caused by mechanical vibration at the workplace requires the implementation of administrative, technical and medical procedures. The role of the occupational health physician in the implementation of the health surveillance of vibration-exposed workers is discussed in the light of the requirements established by the European and Italian regulations. The health surveillance of vibration-exposed workers consists of pre-employment medical screening and subsequent clinical examinations at regular intervals. The aims of health surveillance are to make the worker aware of the hazards connected with exposure to mechanical vibration, to obtain baseline health data for comparison with the findings of subsequent periodical health examinations, to verify the presence of pathological conditions which may increase the risk of adverse health effects due to vibration exposure, to make a diagnosis of occupational or work-related disease, and to check the long-term effectiveness of preventive measures.

Stiff person syndrome and motor mononeuropathy with conduction block: a singular association

The "Stiff person syndrome"(SPS) is a rare dysimmune chronic neurological disorder, sometimes paraneoplastic, characterized by progressive stiffness, painful persistent or spasmodic muscle contractions, mostly involving spine and lower extremities. In 60 to 90 percent of cases, non-paraneoplastic forms are associated to the presence of anti-glutamic acid decarboxylase (anti-GAD) antibodies in the cerebrospinal fluid and in the serum, while anti-amphiphysin antibodies are frequently associated to paraneoplastic types. The relevant treatment consists of three basic approaches: increase in the inhibitory processes in charge of muscle activity control, re-modulation of the immune response, removal of any associated neoplasia. Indications regarding the efficacy of high-dose intravenous immunoglobulin (IVIG) also in this dysimmune pathology are on the increase. We described an unusual case of autoimmune SPS associated with an exclusively motor left peroneal nerve neuropathy, with conduction block, treated with high-dose intravenous immunoglobulin (IVIG), oral cyclosporine, sodium valproate, baclofen and diazepam.

Testis Sparing Microsurgery

The unexpected detection of non palpable hypoechoic testicular lesions has become more frequent thanks to the increased use of trans-scrotal ultrasound (US): patients are often asymptomatic and the objective examination reveals no palpable masses. The different diagnostic, therapeutic approaches vary from radical orchifunicolectomy to simple US follow-up, although the guidelines on the management of these lesions are not defined, yet. The article shows our series of patients with hypoechoic testicular lesions who underwent surgical exploration, with the aid of the operating microscope and histologic test.

Materials and Methods

6 patients in total underwent microsurgical exploration of non palpable hypoechoic testicular lesions, from April 2003 to December 2004.

Results

4 out of the 6 cases were a left-sided testicular lesion, whereas the 2 remaining cases revealed a right-sided lesion [hypoechoic areas mean size = 3.9 mm (range 2.5 – 16)]. The lesions in all patients could be easily identified and successfully excised thanks to the microsurgical technique. The intraoperative frozen section examination (FSE) showed a benign lesion in 5 cases and an intratubular germ cell neoplasia (ITGCN) in one. Patient with ITGCN underwent radical orchiectomy. The final histological analysis confirmed the frozen section examination report for all the 6 cases. Patients were clinically and ultrasonographically evaluated with a mean follow-up of 15 months. No complication occurred.

Conclusion

Microsurgical exploration of the testis combined with FSE represents a safe, effective and reliable technique in case of non palpable hypoechoic testicular lesions. This approach leads to significant advantages and should be considered especially in patients with a solitary testis or presenting bilateral lesions, and wishing to father a child.

Modified Nesbit Procedure: An Easy and Effective Technique

This paper reports the results of a modified Nesbit procedure, designed to increase precision and to simplify the correction of penile congenital or acquired curvatures.

Materials and Methods

58 patients in total were considered candidates for surgical treatment of penile curvature, and underwent a modified corporoplasty procedure involving plication suture on the convex aspect of the penis before tunica albuginea resection. Hospital records and follow-up data were retrospectively reviewed.

Results

37 patients were affected by congenital penile curvature (mean angle: 48 degrees - range 40 to 90); they reported difficult vaginal penetration. Another 21 patients suffered from Peyronie's disease, with mean angle penile deformity of 48 degrees (range 40 to 60), but no hourglass deformity or hinge effects. All patients had spontaneous and full erections. Mean operative time ±SD was 62±15 minutes. No intra-operative complications were reported. Penile curvature was completely corrected in all cases. Neither residual curvatures nor hypercorrections were recorded. Regarding erectile function, which was evaluated in the Peyronie's disease group, pre-operative average International Index of Erectile Function-5 score was 17.83±4.17, whereas post-operatively it was 19±4.63 (p >0.036). With regard to overall satisfaction, 3 patients (5%) with Peyronie's disease were unsatisfied.

Conclusions

This modified corporoplasty procedure has resulted in an improved straightening outcome thanks to the possibility of performing tunica albuginea excision only after the surgeon has made and verified the exact correction in real time. A slight but statistically significant improvement in erectile function was observed in patients with Peyronie's disease.

A follow up study of vibration induced white finger in compensation claimants

AIMS

To follow up vibration induced white finger (VWF) in a selected group of 73 vibration exposed workers who claimed unsuccessfully for VWF compensation at a first examination.

METHODS

The VWF claimants were sent to our unit by the National Insurance Institute. The basic compensatory criteria included a positive history of VWF and abnormal cold response of the digital arteries. Following the first unsuccessful examination, over a mean time period of 4.1 (range 1-11) years the National Insurance Institute requested a second examination for all 73 claimants and a third examination for 29. During the follow up period, all subjects continued to work with vibratory tools.

RESULTS

There were 14 new cases who reported white finger during the follow up period. In the new VWF cases, finger blanching attacks became visible after about 3.5 years since the first examination. All incident cases of anamnestic VWF showed an abnormal cold response in the digital arteries and obtained compensation according to the basic compensatory criteria. In the entire sample of VWF claimants, there was a discrepancy between positive history of VWF symptoms at medical interview (55%) and abnormal cold provocation outcomes (19%). Digital arterial hyperresponsiveness to cold was associated with both VWF symptoms and the duration of vibration exposure since the first examination. Over the follow up period, a significant increase in the vasoconstrictor response to cold was observed in the vibration exposed workers with no symptoms of finger whiteness. Abnormal cold response was not associated with either age or smoking habit.

CONCLUSIONS

Cold test measuring finger systolic blood pressure may be considered a useful laboratory method to confirm objectively VWF symptoms and to disclose abnormal cold induced vasoconstrictor response in vibration exposed workers with a negative history of VWF. Medical interview outcomes should be interpreted with caution in medicolegal situations involving VWF claimants.

Cerebellar subacute syndrome due to corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis (also called "Hashimoto's encephalopathy")

The corticosteroid-responsive encephalopathy associated with autoimmune thyroiditis (the so-called "Hashimoto's Encephalopathy") is a rare disorder with multiple symptomatology, breaking out with an acute or subacute onset and having a relapsing course, not correlated to thyroid hormone levels, with autoimmune pathogenesis, and usually associated with Hashimoto's thyroiditis. In this paper, we report on a case study regarding a 46 year-old woman showing a subacute course cerebellar syndrome, associated with Hashimoto's thyroiditis, diagnosed as "Hashimoto's encephalopathy". The possible pathogenesis and the major aspects of the differential diagnostic sector are discussed with particular reference to an ataxic syndrome caused by a progressive non-familial adult onset cerebellar degeneration (PNACD), associated with the thyroid disease itself.