Promoting sport and physical activity in Italy: a cost-effectiveness analysis of seven innovative public health policies.

BACKGROUND: Inactive lifestyles are a key risk factor underpinning the development of many chronic diseases, yet more than half of the Italian population does not meet WHO thresholds for at least moderate physical activity. This study aims to make the economic case to upscale investments in policy actions to promote exercise and physical activity. STUDY DESIGN: Modelling-based cost-effectiveness analysis in Italy. METHODS: The study assesses the impact on health and healthcare expenditure of seven public health policies to promote exercise and physical activity against a business as usual scenario. Assessed policies include: promotion of active transport, workplace sedentarily interventions, investments in sports and recreation, mass media campaigns, prescription of physical activity in primary care, school-based interventions and mobile apps. RESULTS: Public policies to promote exercise have the potential to improve population health and produce savings in healthcare expenditure. Assessed policies can avoid hundreds of cases of cardiovascular diseases and diabetes per year and tens of cases of cancer resulting in gains in DALYs in the order of thousands per year. In the medium-term, the vast majority of policies show excellent cost-effectiveness ratio, below internationally recognized thresholds. CONCLUSIONS: Investing in policies to promote active lifestyles is a good investment for Italy.

[Clinical anatomy of the esophagogastric junction]. / Anatomia clinica a jonctiunii eso-gastrice.

UNLABELLED: The esophagogastric junction is a controversial anatomical area, due to its sphincteric mechanism which does not show an obvious anatomical basis. The aim of this study is to investigate the anatomical components that endoscopically indicate the mucosal esophagogastric junction in hiatal hernia patients. MATERIAL AND METHODS: The esophagogastric junction was investigated in 27 hiatal hernia patients undergoing surgery. Hiatal hernia is an extension of the stomach situated between the esophagogastric junction and the diaphragmatic indentation. The following types of hiatal hernia were found: sliding hiatal hernia (type I) in 4 patients (14.81%), rolling hiatal hernia (type II) in 2 (7.4%), mixed hiatal hernia (type III) in 12 (44.44%), type IV hiatal hernia in 4 (14.81%) and recurrent hiatal hernia in 5 (18.51%). Of the 27 hiatal hernia patients, 8 (29.6%) were operated using classical procedures: laparotomy--6 (75%) and laparoscopic surgery--2 (25%). RESULTS: The angle of His cannot be used for marking the mucosal esophagogastric junction due to the severe damage of the lower esophageal sphincter in hiatal hernia patients. The squamocolumnar junction is displaced in hiatal hernia patients and was not an option for the study group. The distal end of the esophageal longitudinal palisading vessels needs medication (proton pump inhibitors that reduce the gastric acid production), in order to enhance the visibility of these vessels. The proximal end of gastric longitudinal mucosal folds proved to be the most reliable site to identify endoscopically the mucosal esophagogastric junction. CONCLUSIONS: The anatomical structure of the esophagogastric junction differs in hiatal hernia patients and these peculiarities are very important in surgery.

Paediatric adverse drug reactions reported to the Spanish Pharmacovigilance System from 2004 to 2009.

PURPOSE: This study was conducted to evaluate relevant new information about ADRs reported in the Spanish paediatric population over a 6-year period. METHODS: Adverse drug reactions (ADRs) for individuals aged 0-17 years reported to the Spanish Pharmacovigilance System from 2004 to 2009 were analysed with respect to time, age and sex, category of ADR [System Organ Class (SOC)], seriousness, suspected medicines [level 2 of the Anatomical Therapeutic Chemical (ATC) Classification System] and type of reporter. RESULTS: In total, 4,279 ADR reports corresponding to 8,196 ADRs were analysed, approximately two ADRs per report. The rate of paediatric ADR reports in 2009 was 165 per million, of which nearly half (46 %) were for children (age group 2-11 years). Similar total numbers of ADRs were reported for boys and girls. The most frequent ADRs reported were from the following SOCs: general disorders and administration site conditions (34 %); skin and subcutaneous tissue disorders (15 %); nervous system disorders (14 %). Reports encompassed medicines from various ATC groups: vaccines and anti-infectives for systemic use (67 %); nervous system (9 %); respiratory system (9 %). On average, 37 % of ADRs were classified as serious. There were 33 fatal ADRs, and 35 % of the paediatric population associated with the ADR notifications required hospitalization or extended hospital stay. CONCLUSIONS: In Spain, ADR reporting rate in the paediatric population has increased since 2004. The proportion of suspected ADR reports related to vaccines was predominant, which highlights the important role played by nurses. ADR notification of congenital malformations in newborn infants highlights the need for joint action between the Spanish System of Pharmacovigilance of Medicines for Human Use (SEFV-H) and paediatricians, obstetricians and gynaecologists. The publication of safety reports by regulatory agencies is determinant for the increased number of ADR notifications.

Tecnología de simulación tridimensional para la planificación de la implantación de endoprótesis traqueales / Three-dimensional simulation technology for planning tracheal stenting

Objetivo: Se ha realizado un estudio observacional sobre pacientes con estenosis de la vía aérea principal con el objetivo de demostrar la mejorar en los resultados del tratamiento mediante broncoscopia rígida al realizar una planificación preoperatoria (..) (AU)

Objective: An observational study was made of patients with stenosis of the main airway in order to demonstrate the improved results of treatment by rigid bronchoscopy to perform preoperative planning with computer simulation (..) (AU)

[Unique monoblock lung right-left, unique pleural cavity]. / Plamân monobloc dreapta-stânga. Cavitate pleurala unica. Plamîn hipoplazic stâng. Caz clinic.

A 34-year-old female with WPW syndrome has been under surgical treatment in our clinic with left basal chronic pleural empyema. During the surgical intervention multiple anatomical anomalies were detected, like unique pleural cavity, monoblock lung left-right, hypoplasic left lung, no scissures on the left side, no left pulmonary arteria with an aberrant arteria for the left lung derived from the right pulmonary arteria, the same for the bronchis. The pleural-pulmonary shelling proceeded without incidents and it has been finalized with the drainage of the whole pleural cavity.

[Surgical treatment of lung hydatid cysts]. / Tratamentul chirurgical al chistului hidatic pulmonar.

UNLABELLED: Lungs represent the econd most common localization of hydatidosis, after liver. The current treatment for pulmonary hydatid cyst (PHC) is complete excision with maximum preservation of lung tissue. The authors emphasize the particularities of diagnosis and surgical treatment of PHC. MATERIAL AND METHOD: A clinical retrospective study was carried out on a series of 247 cases with PHC, admitted in the Thoracic Surgery Department of Pneumology Hospital of Iasi between 1999 and 2007. Data regarding the clinical picture, imagistical findings and surgical treatment were collected from the medical files and reviewed. RESULTS: There were 162 men and 85 women, aged between 11 and 78 years. Of these, 134 patients had uncomplicated cysts and 113 had complicated forms. The cysts were located in the right lung in 115 cases (46.5%), the left lung in 98 cases (39.5%) and bilaterally in 34 cases (14%). Liver cysts were associated in 28 cases (11.3%) cases. The surgical procedures employed were: Dor in 118(47.5%) cases, Posadas in 64 (26%) cases, Geroulanos in 5 cases and ideal cystectomy in 14 cases. Pulmonary resection was used in 46 cases (18.5%), including 16 wedge resections, 27 lobectomies and 3 pneumonectomies. Medical parasiticide (Albendazole, 800 mg per day) was used postoperatively. The outcome was fatal in one patient (0.41%), mainly due to associated pathology. In our series, the overall incidence of complications was 7.7%, these consisting of: anaphyfilaxis (3 cases), hemothorax (2 cases), pneumothorax (2 cases), prolonged air leak in 5 cases (including a bronchial stump insufficiency) and atelectasis (5 cases). CONCLUSION: Surgery is the mainstay of the treatment of PHC and the operative technique must be adapted to each individual case.

[Giant diaphragmatic hemangiopericytoma. A case report]. / Hemangiopericitom diafragmatic gigant. Prezentare de caz.

A 47-year-old man presented with dyspnea and pain in the right lower thorax. The thoracic radiography and the MRI exam were suggestive for a giant tumor located in the right supradiaphragmatic region. Surgical exploration revealed a diaphragmatic pediculated tumor, hyper-vascularised, weighting 4.8 Kg and measuring about 27 / 18 cm, that was removed with difficulty due to adherences and bleeding. The histopathologic examination showed multiple capillary and arteriolar vessels, included in masses of round and fusiform cells (pericytes), having multiple nuclear abnormalities.

[Lymphangioleiomyomatosis (LAM)--an uncommon cause of bilateral spontaneous pneumothorax]. / Limfangioleiomiomatoza cauza rara de pneumotorax spontan bilateral.

LAM, a rare lung disease typically affecting women of reproductive age, is characterized by abnormal proliferation of smooth--muscle cells and progressive loss of pulmonary function due to destruction of lung parenchyma. Two cases of bilateral successive recurrent spontaneous pneumothorax and haemoptysis are presented. Repeated conventional and video-assisted surgery was required in both cases, for drainage of the recurrent pneumothorax and resection of subpleural bulla, with good immediate postoperative evolution. Immunohistochemical studies of resected specimens revealed LAM cells in the lung parenchyma with receptors for oestrogen and progesterone. HMB45 monoclonal antibodies in the LAM cells were identified in one case. The follow-up of the patients revealed no signs of recurrence at 84 and 18 months respectively, although pulmonary transplantation should be considered in case of further deterioration of respiratory function.

[Thoracoscopic pleurodesis in malignant pleural effusions]. / Pleurodeza toracoscopica in pleureziile maligne.

We performed retrospectively study on 136 thoracoscopies done in our clinic in the period January 2000 and December 2004. We reviewed 136 thoracoscopies, 71 patients were male and 65 were female (mean age 58.4 years). Straw colored effusions were present in 78 cases (57%) and hemorrhagic in 58 cases (43%). The surgical procedure consist in diagnostic of thoracoscopy with drainage of pleural effusion, multiply pleural biopsy, pleurodesis and continuous pleural drainage. In our study, the talc powder (5g) was successfully as sclerosing agent. The primary tumor was: lung-63 (46%), breast-26 (19%), mesothelioma-21 (15.5%), stomach-3, ovarian-3, prostate-3, colon-2, lymphoma-1, leukemia-2, plasmocytoma-1 and unknown primary tumor in 11 cases (8%). Adverse effects included-chest pain-35 cases (25%), fever-20 cases (15%), empyema-6 cases (4.5%), prolonged air leak-5 cases (4%), pulmonary infection-2 cases, acute respiratory failure-1 case, malignant invasion of scar-1 patient. For statistical analysis, the success of talc pleurodesis was defined as the absence of pleural fluid on the follow-up chest radiographs. Pleurodesis was successful in 125 cases (92%) of the patients after 1 month-follow-up. Thoracoscopic talc pleurodesis is a safe, economical and effective treatment for malignant pleural effusion.

[Up-to-date indications for surgery in pleural and pulmonary tuberculosis]. / Indicatii actuale in chirurgia tuberculozei pleuro-pulmonare.

Tuberculosis is an "old disease" but still remains a threat in modern days life. Despite human and material efforts, despite the improvements in drug therapy, the treatment of tuberculosis continue to consume a great amount of health care worldwide. A certain percentage among the patients with pleuro-pulmonary tuberculosis represents failures of DOTS therapy. Among them, paraclinical investigations will select candidates eligible for thoracic surgery. In our study we are reviewing the main surgical options and we present our experience regarding surgery in pleuro-pulmonary tuberculosis--what to operate and when is the best moment.

Neuropatía femoral como presentación de un hematoma del psoas ilíaco / Femoral neuropathy as presentation of psoas iliacus hematoma

No disponible

The role of interleukin-10 promoter polymorphisms in the clinical expression of primary Sjögren's syndrome.

OBJECTIVE: To analyse the role of polymorphisms of the interleukin-10 promoter region in the epidemiologic, clinical and immunologic characteristics of patients with primary Sjögren's syndrome (SS). METHODS: Sixty-three consecutive patients (59 women and four men; mean age 57 yr; range 20-83 yr) were studied in our Unit. All patients fulfilled four or more of the modified diagnostic criteria for SS proposed by the European Community Study Group in 1996. As controls, 150 healthy volunteers were recruited from the medical and laboratory staff working in our hospital. All the samples from patients and controls were analysed by PCR amplification and direct sequencing. RESULTS: The frequency of the interleukin-10 (IL-10) GCC haplotype was higher (0.48 vs 0.34, P=0.006) and the frequency of the IL-10 ACC haplotype lower (0.25 vs 0.39, P=0.005) in patients with primary SS compared with healthy controls. In the genotype analysis, the frequency of the GCC/ATA genotype was higher (29 vs 11%, P=0.001) and that of the ACC/ACC genotype lower (3 vs 12%, P=0.044) in patients with primary SS compared with healthy controls. GCC-carriers showed an earlier onset of the disease (48.06+/-14.98 yr vs 57.53+/-14.20 yr, P=0.034). The existence of systemic involvement (defined by cutaneous vasculitis, peripheral neuropathy, renal and/or pulmonary involvement) was more frequent in carriers of the GCC haplotype, although the difference did not reach statistical significance (40 vs 27%, P=0.278). No significant differences in the haematologic (hypergammaglobulinaemia, elevated ESR) and immunologic (ANA, RF, anti-Ro/SS-A and anti-La/SS-B antibodies) parameters were observed in carriers of the GCC haplotype. CONCLUSION: We describe an abnormal distribution of IL-10 promoter haplotypes in patients with primary SS compared with healthy controls. This consists of a predominance of the GCC haplotype, mainly related to a higher frequency of the heterozygote haplotype GCC/ATA. The presence of the GCC haplotype does not originate a different immunologic pattern but leads to an earlier onset of primary SS.

Síndromes hereditarios de fiebre periódica / Hereditary periodic fever syndromes

Los síndromes de fiebre periódica hereditarios (HPF) son un grupo poco frecuente de síndromes autoinflamatorios con base genética. Se caracterizan por la recurrencia de episodios de fiebre e inflamación de serosas sin causa infecciosa aparente. Clínicamente son similares y se clasifican según el modo de herencia. Así, la Fiebre Mediterránea Familiar (FMF) y el síndrome de Hiperinmunoglobulinemia D (HIDS) son autosómicos recesivos mientras que el Síndrome Periódico Asociado al Receptor del TNF (TRAPS) y el Síndrome Autoinflamatorio Frío Familiar (FCAS) son autosómicos dominantes. El depósito de la proteína sérica de fase aguda amiloide A (SAA), como resultado de su síntesis en cada episodio inflamatorio, puede causar en algunos pacientes una amiloidosis secundaria de tipo AA, lo cual es determinante para el pronóstico de dichos síndromes. El diagnóstico de cualquier síndrome de FPH está basado en la descripción detallada de los episodios, incluyendo la edad de inicio, duración y periodicidad de los brotes, síntomas principales, síntomas menos frecuentes y origen étnico. El análisis genético es de gran utilidad en el diagnóstico molecular de la mayoría de los casos. La colchicina es el tratamiento específico de la FMF, el síndrome de FPH más frecuente. El reciente desarrollo de nuevas estrategias terapéuticas aplicadas a enfermedades autoinflamatorias más comunes, como la basada en el TNF para el tratamiento de la Artritis Reumatoide, ha indicado su administración a pacientes de FPH, en concreto a pacientes con TRAPS siendo los resultados preliminares bastante prometedores. Aunque en los últimos cinco años se ha avanzado notablemente en este campo, los mecanismos etiopatogénicos de cada enfermedad siguen sin comprenderse. En el presente artículo se revisan los avances clínicos, epidemiológicos, genéticos y los aspectos moleculares de los síndromes FPH. (AU)

[Analysis of telomeric length in epithelial carcinoma of the ovary]. / Análisis de la longitud telomérica en el carcinoma epitelial de ovario.

BACKGROUND: As a consequence of the high cell division rate, telomeric repeat reduction in human tumor cells, giving rise to genetic instability, has recently been described. The aim of this study was to analyze by Southern blot telomeric length alterations in a retrospective group of patients with ovarian epithelial carcinoma. PATIENTS AND METHODS: Tumor and corresponding normal DNA were isolated from paraffin-embedded tissue of 16 patients with ovarian epithelial carcinoma. Telomeric Restriction Fragments (TRF) were studied by Southern blot and densitometric analysis. RESULTS: No telomere alterations were detected in 37.5% of patients (6/16). Of the remaining ten, 5 were found to have telomere reduction and five telomere elongation. No significant correlation was found between clinicopathological variables, response to chemotherapy, survival rate or time to progression, and telomere length alterations. CONCLUSIONS: In ovarian epithelial carcinoma telomere elongation may be a marker of the presence of immortal cells within the tumor, but telomere or the absence of telomeric alterations do not rule out the presence of these cells. Although TRF analysis can be performed in paraffin-embedded tissues, it is not the best indicator of telomerase activity and thus of tumor aggressiveness in early stages of this carcinoma.

[A rare nosological association: a villous gastric polyp and asymptomatic choledocholithiasis]. / Concomitenta nosologica rara: polip gastric vilos împietruire coledociana asimptomatica.

The authors present the case of a male patient, aged 68, admitted in our department for a upper gastrointestinal hemorrhage. The upper gastrointestinal series showed a large gastric villous adenoma located in the body of the stomach. Intraoperative, we found a gastric villous adenoma and multiple choledocholithiasis and gallbladder stones which evolved completely asymptomatic. We performed a mediogastric resection, Fredet pyloroplasty and laterolateral choledochoduodenostomy with a good postoperative result. This case is peculiar due to the concomitant occurrence of two rare diseases the gastric villous adenoma and the asymptomatic multiple choledocholithiasis.

[Proposal of a new standard for the nutritional assessment of pregnant women]. / Propuesta de un nuevo estándar de evaluación nutricional en embarazadas.

BACKGROUND: There is evidence to suggest that the criteria for nutritional assessment of pregnant women, used by the Chilean Ministry of Health, overestimates nutritional disturbances. AIM: To propose a new reference table to assess the nutritional status of pregnant women, based on body mass index. MATERIAL AND METHODS: The table was theoretically defined using criteria for normality proposed by FAO and the weight increase during pregnancy that is associated with a lower maternal and fetal morbidity and mortality. In 665 pregnant women, weight, height, mid arm circumference and skinfolds were measured using standard techniques. Body mass index, arm fat and muscle area and percentage of body fat were calculated. Body composition for each nutritional category, derived from the body mass index or "Rosso-Mardones classification", was analyzed. RESULTS: According to the new table, under weight women had lower percentage of body fat and mid arm circumference and overweight women had higher weight, skinfold thickness and percentage of body fat than the homologous groups defined according to Rosso-Mardones tables. CONCLUSIONS: The proposed reference table may be useful to correct distortions generated by the current norms for nutritional assessment of pregnant women, proposed by the Chilean Ministry of Health. It has to be validated, analyzing its sensitivity, specificity and predictive value to predict fetal and maternal variables.