Pre-operative leukocytosis: a potential poor prognosis risk factor in cardiac device implantation: a case report.

INTRODUCTION: Despite the benefits of the implantation of cardiac rhythm management devices cardiac implantable electronic device (CIED) infection is an emerging problem New debate emerged about the unclear role of the pre-operative alteration of pro-inflammatory parameters, such as leukocytosis, in the development CIED infection and/or heart failure, and its consequent impact on the timing of ICD implantation/reimplantation. CASE REPORT: A 65 years old patient with a history of Diabetes Mellitus (DM) type II, ventricular and supraventricular arrhythmias, chronic myocardial ischemia, heart failure was admitted to hospital. Healthcare workers opted for ICD implantation despite the presence of a persistent leukocytosis with normothermia. Five days later the implantation, patient showed fever and heart failure; blood culture resulted positive for Staphylococcus Aureus. Patient died for sepsis syndrome due to a cardiac device-related infection after a few days, despite the device extraction. DISCUSSION: Cardiac device implantation remains a necessary surgi-cal procedure in order to reduce sudden cardiac death's rate in patients with heart failure. Leukocytosis is a new potential poor prognosis risk factor. The relationship between pro-inflammatory markers', such as CRP and white blood cell count, and device implantation is still not entirely clear. Pro-inflammatory markers could facilitate an infection development; recent study hypothesized that these markers could promote the development of heart failure. CONCLUSION: Leukocytosis could represent a poor prognosis risk factor favoring the development of CIED infection and/or heart failure.

Environmental factors affecting the urinary excretion of inorganic arsenic in the general population.

OBJECTIVE: To assess the critical issues concerning the use of urinary inorganic arsenic (iAs), including As3, As5, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), as biomarker of internal dose in order to monitor environmental and occupational exposure to inorganic As, considering the influence of diet and drinking water on excretion of iAs. METHODS: The design protocol stipulated collection of weekly urine samples from 6 male subjects for 5 consecutive months. In all the urine samples, iAs was determined by Hydride Generation-Atomic Absorption Spectrophotometry (HG-AAS). In the subjects with iAs higher than 35 microg/L, Biological Exposure Index (BEI) proposed by the American Conference of Governmental Industrial Hygienists (ACGIH), urinary arsenic speciation was performed by HPLC-ICP-MS. Exposure to airborne As was evaluated monthly using personal environmental samplers worn for 8 hours. Throughout the study, the participants filled out a daily food diary, also detailing types of water drunk. RESULT: Exposure to airborne As was invariably below the limit of detection, equal to 1 ng/m3. A total of 77 urine samples were collected. iAs was always detectable and was higher in 7 urine samples, obtained from 5 of the 6 subjects examined, than the BEI. Among foods with a high As content, the intake of seafood and fish within 72 hours before providing the sample seems to be the principal source of the iAs concentrations, while the intake of rice or drinking water showed no influence on this biological marker. Instead, drinking wine within 24 hours before urine sample collection can cause a significant increase in the excretion of iAs. CONCLUSIONS: In populations that eat large amounts of fish and seafood, the use of iAs to monitor occupational and environmental exposure to inorganic As seems to present some problems, and urinary As speciation may be essential at least in cases with As measurements above the biological limit values. In any case, a diet sheet reporting all foods eaten within 3 days of urine collection seems to be an indispensable tool to ensure a correct interpretation of the results.

[Biological monitoring in workers exposed to inorganic arsenic in a disused industrial plant in the area of Manfredonia]. / Monitoraggio biologico dell'esposizione professionale ad As inorganico in lavoratori di un impianto industriale dismesso nell'area di Manfredonia.

Inorganic arsenic and its methylated metabolities were measured in 108 spot urine samples obtained from the medical surveillance programme of workers exposed to inorganic Arsenic in July 2006. 15% of the samples showed levels higher than limit value of 35 microg/L (mean value 23,9 microg/L). After the improvement of the working conditions, in August-October 2006, we collected a urinary sample from each of the 108 workers enrolled. A questionnaire was also administrated, in order to investigate the influence of occupational and non occupational factors on the urinary arsenic excretion. The median value of urinary arsenic was 15,12 microg/L; among the 108 samples, 5% showed levels higher than limit value. A significant difference was observed in relation with sea-food consumption and aging stratification. In conclusion, we have described a significant reduction of urinary arsenic excretion between the two phases of biological monitoring, likely due to a proper hygienic work-related intervention.