Sexual behaviours and sexually transmitted infection outcomes in a cohort of HIV-negative men who have sex with men attending sexual health clinics in England.

Men who have sex with men (MSM) attending sexual health (SH) clinics are at high risk for HIV acquisition and are disproportionately affected by sexually transmitted infections (STIs). We collected standardised behavioural data from MSM attending clinics to characterise sexual behaviours and identify predictors for HIV and STIs. In 2012­2013, HIV-negative MSM attending five SH clinics in England reported sexual behaviours in the previous three months via a self-administered questionnaire. Behaviours were linked to the individual's clinical records using national surveillance. The prevalence and incidence of bacterial STIs (gonorrhoea, Chlamydia, lymphogranuloma venereum and syphilis) and incidence of HIV were calculated. Adjusted odds ratios and hazard ratios with 95% confidence interval (CI) were reported for significant predictors. Of 1278 HIV-negative MSM, 54% were of white ethnicity and UK-born and 43% were 25­34 years old. Almost all men reported at least one partner in the last three months. Half reported condomless anal sex and 36% condomless receptive anal intercourse (CRAI). Incidence of bacterial STIs was 46/100 (95%CI 39­54) person years (py) and of HIV was 3.1/100 (95%CI 1.7­5.6) py. A STI at baseline and CRAI with increasing numbers of partners were associated with both incident infections. In this cohort of MSM high-risk behaviours and STIs were prevalent. Engagement in CRAI increased the likelihood of subsequent infection, while men diagnosed with a bacterial STI were at increased risk of a future STI. Clinical and behavioural risk assessments to determine an individual's risk of infection could allow a more nuanced prevention approach that has greater success in reducing transmission.

Acute mercury intoxication and use of chelating agents.

There is a great hazard of mercury intoxication in the third world for artisanal miners using mercury as amalgam for extracting and refining gold. In developing countries, there is the possibility of risk regarding exposure to Hg from amalgam tooth fillings, ethyl-Hg (thimerosal) added as antiseptic to vaccines and methyl-Hg in fish. In one case, a 41-year-old man attempted suicide by ingesting 100 mg of HgCl2. After 8 hours, he developed hematemesis and entered the intensive care unit; his urinary Hg was 10.1 mg/l. Treatment with 2,3-dimercaptopropanol (BAL) was started by intramuscular route after 16 hours at the dosage of 5 mg/kg body weight every 4 hours on days 2-3 and 3 mg/kg every 6 hours on days 4-5 and then every 12 hours on days 6-14 without adverse side effects. Acute Hg intoxication can be managed with BAL as first choice chelator, whereas the less toxic 2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercaptopropane-1-sulfonic acid (DMPS) should be reserved for cases of less severe inorganic Hg or methyl-Hg acute intoxication. Such agents, recommended only for the treatment of acute Hg poisoning, should not be used for patients suffering from neurological diseases in which environmental Hg exposure is hypothesised.

Airway obstruction during arthroscopic shoulder surgery: anesthesia for the patient or for the surgeon?

Two cases of airway obstruction as a result of oedema of laryngeal structures which arose during protracted arthroscopic shoulder surgery, in which single-shot interscalene blocks had been performed, are reported. In these 2 cases, the complexity of the pathologies and the fact that the surgeons were at the beginning of their surgical experience are the most likely causes of the conditions which led to tracheal compression from extra-articular leakage of fluid. Therefore, we recommend a combined peripheral block and general anaesthesia with tracheal intubation for procedures performed by surgeons without an adequate experience and on obese patients, patients placed in a lateral decubitus, or procedures in which difficulties are expected. The advantages of regional anaesthesia with a constant control of the airways are underlined.

[Adiuvants in the axillary brachial plexus blockade. Comparison between clonidine, sufentanil and tramadol]. / Adiuvanti nel blocco del plesso brachiale per via ascellare: confronto tra clonidina, sufentanil e tramadolo.

BACKGROUND: Evaluated effects of tramadol used as adiuvant in brachial plexus block and compared with clonidine and sufentanil. METHODS: Randomized, prospectic study with 80 patients, ASA status I-II, undergoing carpal tunnel release performed under axillary plexus block with ropivacaine 0.75% 20 ml divided in 4 study groups: tramadolo 100 mg (Group T), clonidina 1.5 g/kg (Group C), sufentanil 20 g (Group S) in 5 ml. of NaCl. Control (Group F) NaCl 5 ml. Adeguacy of the block was evaluated using pinprick test ( three points scale) and a temperature test. Onset time, duration of analgesia and anesthesia were recorded. Also during the surgery the sedation score on a five-point scale was evaluated and were recorded episodes of hypotension, bradycardia, Sp02<90% and other side effects. Results are reported as median+/-SD. For statistical analysis ANOVA test, Bonferroni test and c2 test were used. RESULTS: Onset time of anesthesia showed significant difference between three study groups than control group, while no significant differences was recordered between groups S, C and T (S: 11+/-7 min; C: 12+/-4 min; T: 14+/-8 min; F: 20+/-11 min.). Same results were obtained among duration of anesthesia and analgesia, that were lower in F group. An adeguate quality of block for surgery was obtained in 79 patients. Only one patients of F group needed surgical infiltration. A significant difference was recordered among quality of anesthesia between group F and other three study groups. Highest sedation score was noted in C and S groups. Significantly highest incidence of bradycardia and hypotension episodes were observed in group C. CONCLUSIONS: The use of tramadol as adiuvant provides a significative redution of onset time. Also provides a prolongation of anesthesia and analgesia with a quality of block similar that obtained with clonidine and sufentanil and a lower incidence of side effects of clonidine (sedation, bradycardia and hypotension) and sufentanil(itch and sedation). We conclude that tramadol may be a useful alternative, as adiuvant in periferic block, with same effects of other drugs commonly used and a lower incidence of side effects.

Selectivity in citric acid production by Yarrowia lipolytica.

This experimental study reports about production selectivity in the fermentation of glucose to citric acid by Yarrowia lipolytica as a function of substrate concentration. Batch runs featuring biomass growth and one or two citric acid production phases were carried out in a 15-l stirred tank fermentor. The presented results demonstrate that working at high initial substrate concentration in the production phase is beneficial both in terms of a higher production rate of citric acid, the desired metabolite (reaching 0.077 h(-1)) and of a higher utilization degree of the employed carbon source (yield up to 0.384 g(c.a.)/g(glucose)). The production rate of isocitric acid, the major undesired metabolite, was found to be practically constant over the tested initial substrate concentration range.

[Use of remifentanil in ambulatory obstetric-gynecologic surgery. A dose-effect study]. / Uso del remifentanil in chirurgia ambulatoriale ostetrico-ginecologica. Studio dose-effetto.

BACKGROUND: Remifentanil, a recently commercialised opioid, is characterised by a predictable and non cumulative effect which vanishes rapidly without determining side effects in the long term. These characteristics make remifentanil an ideal opioid in continuous infusion for the ambulatory surgery setting. Aim of this study was to assess the ideal dose of remifentanil, administered in bolus before propofol, in patients undergoing uterine curettage and assisted by mask ventilation in 100% oxygen. METHODS: Sixty patients, ASA status I-II, scheduled for uterine curettage, were divided into three study groups according to the bolus dose of remifentanil received before the induction agent: group A (n = 20) 1 microgram/kg; group B (n = 20) 2 micrograms/kg; group C (n = 20) 2 micrograms/kg. All patients were assisted by 100% oxygen ventilation with facial mask. During surgery the following were recorded: time to spontaneous ventilation (in case of post induction apnea); incidence of somatic and autonomic responses to surgical stress (treated with remifentanil in bolus). At the end of surgery the times to response to simple verbal commands, to discharge from the recovery room (by Aldrete score every 5') and to discharge from hospital (by PADSS score every 30') were registered. RESULTS: All patients presented post-induction apnea with a significantly more rapid return to spontaneous ventilation in group A. Six patients of group A responded to surgical stress while in groups B and C there was no need for supplementary boluses (p < 0.05). Five patients of group C were treated with atropine for bradycardia, in four of group C it was necessary to administer succinylcholine for thoracic rigidity. No significant differences regarding the anesthesia recovery times were observed. All patients were discharged from the recovery room after 10' from the end of surgery. Overall, the qualification for discharge from hospital was obtained at the second PADSS score control, except for one group A patient who incurred in metrorrhagia. CONCLUSIONS: The administration in bolus of remifentanil, before the inducing agent, permits short-term surgery in ambulatory surgery settings thanks to the rapid recovery of vital functions. Compared to the other doses, the 1.5 micrograms/kg dose guaranteed a good control over surgical stress without influencing the speed of awakening and without determining uncomfortable side effects.

[The current status of obstetric analgesia and anesthesia in Italy]. / Indagine conoscitiva sulla situazione italiana dell'analgesia ed anestesia in ostetricia.

BACKGROUND: There is a more and more vivid interest regarding methods of obstetric analgesia and anesthesia while there is a lack of epidemiological data about the Italian reality. Aim of the study was to evaluate the current state of obstetric analgesia and anesthesia and create an interest for anesthesiologists in a professionally and scientifically interesting field. DESIGN: transversal study of clinical observation of the Italian situation based on questionnaires composed of 20 multiple choice and closed questions, addressed to chief anesthesiologists of 220 randomized Italian hospitals. SETTING: 220 Italian hospitals having a capacity of more than 100 beds. RESULTS: Out of the 220 questionnaires, 91 were returned. Merely 17 hospitals guaranteed a permanent peridural analgesic service. To improve this situation, anesthesiologists call for introducing chargeable services and increasing the medical staff. In spite of the widely documented advantages that regional anesthesia offers for maternal and fetal well-being, this technique is practised in only 26% of cesarean sections. This percentage is greatly higher than that obtained from a similar experience in 1991, where the use of regional anesthesia technique was of 3-4%. In 11 hospitals postoperative analgesia is not carried out on a regular basis. CONCLUSIONS: Even though the general opinion is showing a growing interest for obstetric analgesia and anesthesia, it has not yet reached the same dignity as in other countries.

[Analgesia and anesthesia in obstetrics. Territorial investigation]. / Analgesia e anestesia in ostetricia. Indagine conoscitiva sul territorio.

BACKGROUND: There is a more and more interest regarding methods of obstetric analgesia and anesthesia while there is a lack of epidemiological data about local experiences. METHODS: This survey on obstetric anesthesia and analgesia in Abruzzo and Molise is based on data obtained from questionnaires of 28 questions sent to all the departments of anesthesiology in the two regions. DISCUSSION: Out of 24 questionnaires sent, 18 were returned. By analysing the replies obtained in this investigation it is clearly pointed out how the possibility of having peridural analgesia during labor is often not available. In fact, only one center is able to guarantee an operative service 24 hours a day. Many colleagues have reported this deficit and in order to improve the situation they have proposed to activate chargeable services for labor analgesia and to increase the staff of anesthetists. Also the data concerning treatment of post vaginal delivery pain are not satisfactory. With regard to the Caesarean sections, locoregional anesthesia is performed in 24% of all cases, while the highest scores are registered in the hospitals of Castel di Sangro and L'Aquila, where general anesthesia is practically never employed. Merely in 67% of all patients postoperative analgesia is carried out on a regular basis. CONCLUSIONS: The data obtained only confirm the extent of a well-known problem. In spite of the growing interest by the medical community, the attention shown for obstetric anesthesia and analgesia is, nevertheless, insufficient, especially due to financial and organizational problems which prevent from establishing a permanent pain therapy center.

[Retroperitoneal tumors: personal experience]. / I tumori retroperitoneali: esperienza personale.

The Authors experience in five retroperitoneal tumors with symptoms and histopathological characteristics not different from those described in the Literature, is here reported. Topographic findings, classification, and incidence of retroperitoneal tumors as referred by various Authors are discussed. Two aspects are particularly pointed out: the histological type and the surgical strategy for their removal. Concerning the first aspect, the Authors underline that benign lesion may have an optimal outcome and a long survival, unlike the malignant ones, which have always unfavourable prognosis, despite adjuvant and complementary therapy (radiotherapy, chemotherapy). As for the second aspect, surgery is the treatment of choice even when other organs different from those exclusively retroperitoneal, may be involved in the demolition.

[Synchronous carcinomas of the large intestine]. / I carcinomi sincroni del grosso intestino.

The incidence of synchronous carcinoma of the colon and rectum is rising and ranges from 0.6 to 11% in the international literature. We present a study on 410 patients with colorectal cancer; 10 patients (2.4%) had synchronous carcinoma. The group of patients with synchronous carcinomas were older than the group with nonsynchronous carcinomas (70.5 versus 67.4 years). The choice of surgery depended on the involved portions of the colon and the distance between the lesions. For tumoral sites in 2 different segments was performed subtotal colectomy, in the other cases (cancers located on one segment) was performed segmental colectomy. The incidence of synchronous tumors is sufficiently high to suggest that the preoperative identification of lesions by either colonoscopy is important for the proper treatment of patients with carcinoma of the colon and rectum and moreover an so high incidence, more the risk of not recognising the disease, especially in the case of small lesions, emphasizes the importance of postoperative endoscopic and clinical controls.