[In search of the true dosage: statistics applied to the analysis of the cocaine]. / À la recherche du juste dosage : statistique appliquée à l'analyse de la cocaïne.

A method of separation by gas chromatography with a flame ionization detector was developed for quantifying cocaine in powders seized by the police. The method was validated by studying parameters of calibration, trueness, precision based on trueness error (or systematic bias) and random error. Total error, which is the combination of these errors, is used to confirm the method adequacy with the objectives fixed by the analyst. Accuracy profile is an efficient decision tool to do it. Results obtained with weighted regression model allow concluding that the method fits quantitation of heroin and cocaine in powders on 2 to 100% concentration (w/w) domain with 10% limits of acceptation and a risk of 5%.

[Injury rates and severity during the construction of High Speed Train Track Torino-Novara: which are the expected risks?]. / Frequenza e gravità infortunistiche nei cantieri dell'alta velocità Torino-Novara: qual e il rischio infortunistico atteso?

BACKGROUND: Construction of the Torino-Novara High Speed Train Track (TAV) provided a unique opportunity to describe the magnitude of accidents on a major construction project for which complete data were available for 123 companies with over 10,000 employees. OBJECTIVES: To describe the rate and severity of accidents during the construction of TAV and to compare this with national indexes. The limits and critical points of the national surveillance system are discussed and solutions for responding to public occupational safety and health service needs are proposed. METHODS: 1,691 injuries with more than 3 lost work days were recorded between 2003 and 2005 by the TAV Surveillance System (Orme-TAV). Accident rate and severity indexes (Orme indexes) by year and occupation, were compared with indexes for Piedmont and Italy for the period 2002-04 provided by INAIL (National Institute for Insurance against Occupational Accidents and Diseases) for the Construction sector and the Road and Railway Construction sub-sector. A comparison with the accident rate of the same 123 firms calculated for all construction yards in Italy in 2003-04 (national indexes) was also made. RESULTS: Accident rates decreased from 152 in 2003 to 72 in 2005 per 1,000 workers, but were higher than the national indexes (the Orme indexes/national indexes ratio was 1.75 in 2003 and 1.67 in 2004). Accident severity indexes were lower than the national figures. DISCUSSION: Complete reporting, facilitated by the existence of a Surveillance System, yielded accident rates that were more reliable than those previously reported. Data suggest that the discrepancy is due to both underreporting and exposed worker assessment difficulties. The burden of on-site work-related accidents in the construction sector appears to be higher and more costly than what has been desumed from national data.

[Occupational mortality in the population employed at 1991 Census]. / La mortalità per professioni nella popolazione occupata al Censimento 1991.

BACKGROUND: Despite limitations and problems connected to occupational surveillance systems based on mortality data, mortality from specific causes continues to be a crucial indicator for evaluating the differences in health among various occupations. OBJECTIVES: To evaluate the potential of a surveillance system of occupational mortality based on census and mortality data obtained from ISTAT (Italian Central Statistics Institute). METHODS: By means of record-linkage between Census data and death records from ISTAT, occupational mortality was assessed during the twelve month period following the 1991 census, limited to subjects aged 18-64 years for whom occupational information was available. The study population consisted of deceased subjects, 19,527 of whom were men and 3,547 were women. A cross-sectional model was used to evaluate odds ratios for cause-specific mortality. The risk estimates were then compared to the results obtained in a previous analysis on Census data gathered in the 1981 census. RESULTS: Among the significantly increased risks observed both in 1981 and 1991, of particular interest are the excesses of mortality from liver cirrhosis in caretakers, janitors, and cleaning staff; and the excess of breast cancer in teachers. Mortality from cirrhosis in masons, porters, and waiters, and from violent causes in transport workers and bar and restaurant workers, was instead significantly in excess only in 1991. CONCLUSIONS: The data on mortality by occupation does not permit inferences about occupational risks, though they can be useful to highlight socio-economic differences in premature death in the employed segment of the population and to draw attention to possible trends over time.

Mortality of a cohort of road construction and maintenance workers with work disability compensation.

BACKGROUND: Surveillance systems of occupational mortality are useful tools to identify cases of diseases suspected as occupational and to monitor their occurrence over time, in space and in population subgroups. Many surveillance systems make use of administrative data in which information about occupations and/or economic sectors of the subjects enrolled is reported, such as death certificates, hospital discharge data, census data, tax and pension records, and workers' compensation archives. OBJECTIVES: In the present study we analyzed the mortality of a cohort of road construction and maintenance workers enrolled through the Italian national archive of work disability compensations, also in order to evaluate the possible use of this administrative source to monitor occupational mortality. METHODS: 8,000 subjects (7,879 males) receiving a disability compensation while working in the "road construction and maintenance" sector were identified from INAIL (National Institute for Insurance of Accidents at Work) archives. Vital status of these subjects was ascertained using the information available in INAIL archives and in the national tax register. For those found to be deceased from INAIL or tax archives, or without any information on vital status, a mail follow-up was started. We considered as observation period the years from 1980 to 1993. A record linkage with the ISTAT (Italian Institute of Statistics) national mortality registry was performed and the cause of death was retrieved for 964 out of 1,259 subjects. The analysis was restricted to males, leaving altogether 863 observed deaths with ascertained cause (84.7% of 1,019 total male deaths). SMR for overall mortality and PMR for specific cause mortality were computed, using the general Italian male population as reference. RESULTS: Overall mortality was significantly reduced (SMR = 79.0; 95% CI = 74.2-84.0). Proportional mortality analysis revealed significant excess risks for all malignant tumours (332 deaths, PMR = 1.08) and for digestive diseases (87 deaths, PMR = 1.34), while mortality for cardiovascular diseases was significantly decreased (288 deaths, PMR = 0.90). Among specific causes of death, significant excess mortality was found for cancer of testicles (2 deaths, PMR = 5.98), liver and biliary ducts (32 deaths, PMR = 1.40), and for silicosis (10 deaths, PMR = 3.07) and cirrhosis (64 deaths, PMR = 1.40). CONCLUSIONS: The excess mortality observed for all cancers, digestive diseases and silicosis, and the decreased risk for cardiovascular diseases are in agreement with the results of other studies conducted on workers in road construction and maintenance. As expected, the low overall mortality and the reduced risk from cardiovascular diseases indicate that these workers present a strong "healthy worker effect".

On-line quantitative coronary analysis in clinical practice: one step closer to reality?

Quantitative coronary analysis is widely used in studies of progression/regression and restenosis of coronary lesions. On-line digital systems are used in diagnostic coronary angiography, and as a guide in coronary interventions. The aim of this investigation was to test the reliability of measures obtained with one commercially available on-line equipment. Well-visualized coronary lesions from patient studies were analyzed for variability in single-frame measurement. Procedural factors affecting the consistency of measurements were identified by repeated visualization of the same coronary lesion with hand- and power-injection of contrast in various positions in the field of the image intensifier, and by imaging of steel phantoms in the same positions. Steel phantoms closely resembling coronary lesions as encountered in practice were visualized in the most favourable radiologic setting compatible with clinical situations. Accuracy and precision of measurements were found to be worse than reported in validation studies. This may be due to a host of variables which may need to be tested in each laboratory performing on-line quantitative coronary angiography, when data so obtained are to be used in clinical decision making or in research studies.

[Reciprocating tachycardias in pregnancy. A clinical case report]. / Tachicardie reciprocanti in gravidanza. Descrizione di un caso clinico.

The paper describes the case of a patients suffering from a pre-excitation syndrome who underwent numerous episodes of reciprocal tachycardia during pregnancy. The clinical implications and various methods of therapy used are discussed.

[Cardiac arrhythmias during dialysis. An unresolved problem]. / Aritmie cardiache in corso di dialisi. Un problema non risolto.

The incidence of the arrhythmias in 47 patients subjected to chronic hospital dialysis using different techniques has been assessed. Cardiopathies and non-cardiopathies were assessed separately. In the first group, no significant differences were observed with respect to the presence of heart rhythm disturbances. The second group showed increased ventricular arrhythmias during the intradialysis and postdialysis period. A statistical correlation was carried out between the presence of arrhythmias and various parameters (technique of dialysis, weight difference, ultrafiltrate/hour, age). The only statistically significant correlation in the non-cardiopathies was age.

[Persistent left superior vena cava in patients treated with a definitive pacemaker. Incidence in the population and follow-up of particular pacemakers]. / Vena cava superiore sinistra persistente in pazienti trattati con cardiostimolazione definitiva. Incidenza nella popolazione e follow-up di impianti particolari.

Four cases of persistent left superior vena cava encountered during the placing of a definitive pacemaker are reported. The incidence of the abnormality in the adult population is discussed together with the possible techniques for implanting an electrocatheter in the right ventricle.

Severe electrocardiographic abnormalities during arfonad administration.

Severe and reversible electrocardiographic abnormalities (first degree atrioventricular block, left bundle branch block, ventricular fibrillation), were induced by the administration of Arfonad in a patient with type III acute aortic dissection previously chronically treated with alpha-methyl-dopa. Any other possible cause of the electrocardiographic changes was excluded on the basis of clinical findings and laboratory studies. The explanation of the electrocardiographic abnormalities induced by Arfonad are not readily apparent, also on careful review of the literature. We suggest a strict electrocardiographic monitoring during Arfonad administration especially in patients with cardiac conduction defects and previous administration of cardiac cathecholamines depleting drugs.

[Left atrial myxoma and calcified aortic stenosis in a patient with syncope]. / Mixoma atriale sinistro e stenosi aortica calcifica in un paziente con sincopi.

A 59-year-old man who suffered several episodes of syncope had both calcific aortic stenosis and a left atrial myxoma. As syncope occurred during effort, rather than after postural changes, we believe that the symptom was caused by aortic stenosis. In fact the myxoma was only mildly obstructive both by haemodynamic measurements and at visual inspection at surgery.

[Small fistulas between circumflex coronary artery and left atrium associated with rheumatic valvular cardiomyopathy. A case report (author's transl)]. / Fistola tra la coronaria sinistra e l'atrio sinistro associata con cardiopatia valvolare reumatica. Descrizione di un caso.

Multiple small fistulas between the circumflex coronary artery and the left atrium were found in a patient with mitral stenosis, aortic and tricuspid regurgitation. Although their origin was proximal and they drained in a low pressure cavity, the anomalous channels were small and caused no clinically recognizable signs or symptoms. These findings support the view that hemodynamics (and hence clinical manifestations) of coronary artery fistulas are mainly determined by their developmental anatomy.