[Cholecystectomy with laparoscopy and laparotomy. Analysis of the complications]. / Colecistectomia laparoscopica e laparotomica. Analisi delle complicanze.

Laparoscopic cholecystectomy (LC) has been adopted by many as the treatment of choice for uncomplicated biliary lithiasis; since an increasing number of surgeons use LC even in complicated cases, we examined our series in order to see if this is the correct procedure. We report on the results of our first 252 LC and compare them with our latest 66 open cholecystectomies, in order to evaluate number and importance of postoperative complications. Besides we compare complications in patients below and over 60 years of age to verify if age bears any significance. We found no difference in frequency of complications among patients younger or older than 60; highly significant is, on the contrary, the difference in complications between the two procedures, the incidence being much lower in the laparoscopic one. We state that LC is a safe and effective procedure and suggest it as the method of choice for the treatment of any symptomatic gallbladder stone disease.

[Schistosomiasis: possible cause of ectopic pregnancy. Four clinical cases]. / Schistosomiasi: possibile causa di gravidanza ectopica. Quattro casi clinici.

The Authors describe 4 cases of ectopic pregnancy associated with foci of schistosomiasis and point out the relevance of mass screening on urine, stool and vaginal secretions in those areas where schistosomiasis is endemic and frequent the involvement of female genital tract. Utilization of laparoscopy in all cases where as adnexal mass and/or a history of unexplained infertility is found is finally advocated.

Clinical outcome of fetal uropathy. I. Predictive value of prenatal echography positive for obstructive uropathy.

Clinical followup was performed in 73 neonates with a prenatal echographic suspicion of uropathy. Of 42 patients with a prenatal suspicion of unilateral hydronephrosis only 15 had pathological obstruction and 2 had multicystic dysplastic kidneys. Among 10 infants with a prenatal suspicion of bilateral hydronephrosis only 1 had true bilateral obstruction and 2 had unilateral obstruction. In 2 patients hydroureteronephrosis seen on prenatal echography was due to massive bilateral vesicoureteral reflux. In this group there was also a multicystic dysplastic kidney and 1 patient with bilateral cystic dysplasia. There was a prenatal suspicion of cystic disease in 8 infants. Postnatally, diagnosis was multicystic dysplastic kidney in 2 patients and a simple renal cyst in 4. The remaining 2 neonates had obstructive uropathy. Finally, of 13 neonates with a prenatal suspicion of anatomical-echo-structural abnormalities a definitive abnormality could be established in only 8. The predictive value of prenatal echography positive for obstructive uropathy was 34.6%.

Clinical outcome of fetal uropathy. II. Sensitivity of echography for prenatal detection of obstructive pathology.

Among 8,579 neonates born between February 1, 1981 and March 31, 1987, and cleared by prenatal sonography for significant urinary tract abnormality 158 subsequently were hospitalized because of signs or symptoms of urinary tract disease, predominantly urinary tract infection. Evaluation of these 158 patients revealed 24 with vesicoureteral reflux, 7 with duplicated systems (2 of which showed reflux), 1 with the syndrome of Fraley, 1 with pyelectasis and 5 with mild hydronephrosis (3 secondary to reflux and 2 with diethylenetriaminepentaacetic acid renal scans considered to be nonobstructed). There was no incidence of significant obstructive uropathy that had been missed by the previous prenatal sonography and that surfaced subsequently to cause morbidity in this series. The principal disorder of the urinary tract that may fail prenatal investigation is vesicoureteral reflux.

Improving patient flow in ambulatory care through computerized evaluation techniques.

The Authors describe the application of Patient Flow Analysis (P.F.A.), an efficiency evaluation technique in a Gynaecologic Clinic in a large Provincial Hospital. This technique evaluates both patient flow and staff utilization in ambulatory settings. Staff efficiency (percentage of work time spent with patients) was low, (43% for clinicians and 36% for aides, and patients waiting time was excessive (average 2 hours 44 minutes) for only 35 minutes of service time, and could have been substantially reduced by a more personalized appointment pattern and punctual starting of clinics by the clinicians. The usefulness of Patient Flow Analysis is clearly demonstrated.

Persistence of poliovirus-neutralizing antibodies 2-16 years after immunization with live attenuated vaccine. A seroepidemiologic survey in the mainland of Venice.

A seroepidemiological survey was conducted on subjects who had received a full vaccination course with live attenuated poliovirus 2-16 years before. For strains 1 and 2 prevalence of seropositives and median values dropped gradually during the first 10 years; strain 3 showed a much earlier decline. Environmental displacement of wild poliovirus by the attenuated, less immunogenic strain might eventually induce a 'gap', should complacency hamper needed vaccination efforts.

A simple system for auditing the quality of primary care screening in school-age children.

A system for auditing quality of care and increasing effectiveness was applied to a health screening program for school-age children and the results were analyzed during 2 subsequent years. A problem-oriented record to be filled in whenever the screening was positive represented the basic tool for the evaluation. The record was sent to the specialist who was requested to make a diagnostic assessment and a treatment plan. The same record returned back to the first-level staff thus providing feedback information about diagnostic accuracy and effectiveness of the screening. Periodic self-evaluation meetings and a tutorial system for diagnostic procedures were instituted leading to a general improvement in quality indexes.

The changing epidemiology of gynaecological cancer in Trieste: a fifteen-year case study.

The peculiarity of the geopolitical situation of the City of Trieste makes it a good observatory for surveillance of diseases. The Authors describe the changing patterns of gynaecological neoplasias in Trieste during a fifteen-year time span.

A simple local database for audit and epidemiologic studies.

The Authors, after having outlined the importance of clinical audit in order to improve the perinatal care provided and reduce management-dishomogeneity between obstetrical staff members, present a simple off-line system of computerized perinatal data collection that has proved to be the useful for audit applications and statistical epidemiological evaluations.

Objective diagnostic information and labour-delivery management homogeneity: our experience.

Since intrapartum cardiotocography was adopted as an objective diagnostic tool, we tried to evaluate if its routine use has induced more homogeneity in management between our staff members. The analysis of some simple parameters outlines how management variability between different staff members, still outweighs the supposed objectivity of the information coming from intrapartum cardiotocography.

Prevalence of poliovirus neutralizing antibodies. A seroepidemiologic survey of vaccinated and unvaccinated women of fertile age.

The Authors tested a group of 232 women of fertile age, living in the Venice mainland, for presence of detectable protective serum antibodies against poliovirus strains 1, 2 and 3, according to vaccination status with living, attenuated poliovirus. Overall, unvaccinated subjects had a slightly higher prevalence of seropositivity as well as higher geometric mean titres than the women who had undergone a full vaccination course fifteen to twenty years before. Particularly worrisome was lack of protection against poliovirus 3, found in 23% of vaccinated and 15% of unvaccinated study participants. Break in herd immunity might end up in localized outbreaks of poliomyelitis, a not too distant possibility in Italy, where a steady flow of immigrants from North Africa and the Near East provide a source of wild poliovirus strains.

Hepatitis B vaccine: immune response in student nurses. A fifteen-month follow-up.

The authors describe a 15-month follow-up of twenty-nine nurse students vaccinated against hepatitis B with Hevac B Pasteur. At three months all subjects were anti-HBs positive, with a geometric mean titre (GMT) of 1187 mIU/ml. At the time of booster dose (T14) GMT had fallen to 380 mIU/ml; after one month (T15) GMT had risen again to 9332 mIU/ml. Such a high antibody level suggests a long lasting protection.

The effect of legal abortion on teenage fertility in Trieste, Italy.

PIP: Abortion has been legal and publicly funded in Italy since 1978. However, unmarried women under 18 must obtain parental consent or written permission from their legal guardian or from a judge to undergo the operation. In this study an assessment is made on whether the recent law has had a particular impact upon the fertility of teenagers living in Trieste, a city of 250,000 inhabitants, located in northeast Italy. Data were obtained on 1st births among women aged 15-19 for the years 1977-81. 1st births were classified as: premaritally conceived, uncertain or postmaritally conceived. During the study period, the total number of births to Trieste residents fell from 1878 to 1326, a 29% decline. The number of out-of-wedlock births remained quite stable and the number of postmarital cenceptions fluctuated. Marital births resulting from premarital conception declined appreciable from 66% to 51%. It seem s likley that the most relevant factor accounting for the overall decline in teenage fertility is the availability of legal abortion. The very high legal abortion ratios for all women of reproductive age further confirms this hypothesis. The ratios are particularly high among younger teenagers, who had just over 2 abortions, an average, for every live birth in 1980 and 1981. The estimated age-specific abortion rates for woman aged 15-19 living in Trieste are very much higher than the 1981 rate for Italy as a whole. The historical and geographical nature of Trieste may, to some extent, help explain why Trieste women resort to abortion more frequently than other Italian women. When it was an important seaport, Trieste was an affluent city, but today most citizens view its decline as irreversible and consequently try to enjoy the present. Couples have only 1 child not expecting life to improve for the future generation. The trend also probably reflects the enhanced capability of young women to assume control over their reproductive lives. Voluntary interruption of pregnancy is sought by those who feel not yet ready to start a family or to marry the father.^ieng

[Availability, consumption of alcoholic beverages and alcohol-related mortality in Italy]. / Disponibilità, consumi di bevande alcoliche e mortalità alcool correlata in Italia.

On the basis of the W.H.O. guide lines the relevant parameters for the study of alcoholism in Italy have been identified. The production and utilization of alcoholic substances is very high, then appears to have reached a plateau about ten years ago. Likewise, consumption has not increased since a few years. Hospital admissions for symptoms related to alcoholism are no more available after the closure of all mental hospitals in 1978. Alcohol-related deaths seem to be stable, as well as cause specific death rates for cirrhosis .

[Improvement in the efficiency of an ambulatory service case load by applying a computerized method (patient flow analysis)]. / Miglioramento dell'efficienza di un servizio prelievi ambulatoriale mediante l'applicazione di un metodo computerizzato (patient flow analysis).

The authors describe the application of a technique called Patient Flow Analysis aimed at the improvement of Clinic Personnel efficiency and reduction of patient waiting time. Results were satisfactory and encourage further experiences.

Evaluation of a structured alcohol education course in a secondary school system in north Italy.

The authors describe the results of an alcohol education course given to 2166 high school students in the area of Padua, Italy. An evaluation was performed, utilizing a before and after technique: it was shown that baseline knowledge of relevant information on alcohology was similar among younger and older teenagers; also, baseline information and course gain varied according to question content.