Rapid subthalamic nucleus deep brain stimulation lead placement utilising CT/MRI fusion, microelectrode recording and test stimulation.

Subthalamic nucleus (STN) deep brain stimulation (DBS) has become an established treatment strategy for patients with medically refractory Parkinson's disease (PD). There are however numerous strategies employed for STN lead placement. Variations include method of STN localisation, use of microelectrode recording, number of microelectrode recording passes and time taken for the procedure. We describe a relatively simple and rapid technique of STN lead placement utilising CT/ MRI image fusion, microelectrode recording and test stimulation. The first 58 consecutive patients undergoing STN DBS were assessed pre- and post-operatively. UPDRS scores, medication use and any surgical complication were assessed. Bilateral STN DBS was an efficacious treatment option for medically refractory PD. We have described a technique which can be performed with effect and low morbidity, and in a time which is well tolerated by patients.

[The Kern paradigm: professional independence and information demands of the scientific community]. / Il paradigma Kern: indipendenza professionale ed esigenza di informazione della comunità scientifica.

Legislative decrees 277/91 and 626/94 defined in detail role and duties of the occupational physician. There is no normative regulation about ethical principles for occupational professionals although some international organizations, such as the International Commission on Occupational Health (ICOH), are making proposals in this field. In the last decades, these principles have been assuming an increasing importance because of occupational medicine operators' major responsibility and the need of a multidisciplinary approach in work related risk prevention. The aim of this contribution is to present a case about professional independence and commercial secret that involved an occupational physician (David G. Kern), Brown University (that employees him) Memorial Hospital and a textile firm that consulted dr. Kern to investigate a pulmonary disease that affected some employees. The fact has been described by e-mail of OEM (Occupational Environmental Medicine) list. This event underlines the distance between the professional reality and ethical principles formulated in the ICOH code; these principles must be the base for a correct professional activity aiming only at promoting workers' health.

[Health surveillance program for the prevention of Mycobacterium tuberculosis infection risk among health personnel of the Polyclinic and the University of Modena]. / Protocollo di sorveglianza sanitaria per la prevenzione del rischio da Mycobacterium tuberculosis negli operatori dell'Azienda Policlinico e dell'Università di Modena.

Surveillance programme for the prevention of Mycobacterium tuberculosis risk infection among health care workers at Azienda Policlinico and Università di Modena. Increase in tuberculosis (TB) morbidity and mortality in the last decade even in highly industrialized countries represents a major public health problem. Health care workers (HCWs) are one of the high-risk group for TB infection in the population. Several international guidelines for the prevention and control of TB infection among HCWs have been proposed, also including expensive and not easily applicable interventions. A surveillance programme has been set up at the Servizio di Sorveglianza Sanitaria in the Azienda Policlinico di Modena aimed to the early identification of hospital workers with recently-acquired latent TB infection, B.C.G. vaccination of PPD skin negative subjects working in intermediate-high TB risk workplaces, periodic evaluation of PPD skin conversion rates among personnel of each working area. This programme, whose feasibility depends on the availability of adequate resources, is considered as a tool suitable for the individual risk assessment and should be performed together with technical and structural interventions to carry out an effective primary prevention of TB infection among HCWs.

[Organization of the activities of health services according to UNI EN ISO 9000 standards]. / Organizzazione dell'attività di sorveglianza sanitaria secondo la norma UNI EN ISO 9000.

Implementation of a Quality System in accordance with the ISO 9000 standard with an Occupational Health Service. Following the lead of the industrial sector, Quality Systems (QS), in accordance with the principles of the ISO 9000 standards, have been implemented in many health care organizations. The purpose is to improve the health care delivered to the patient in a systematic way improving the system efficacy and effectiveness. Our aim is to describe a practical approach for the implementation of a QS in accordance with the ISO 9000 standard within an Occupational Health Service (OHS) in a middle-sized hospital. The purpose of the system is to ensure that everyone at the OHS is aware of the common quality objectives and knows how to act in order to achieve them. The implementation of the QS has entailed 2 phases: (i) a conformity assessment to verify that the organization and services delivered measure up to ISO standards; (ii) the development of a deployment plan to support the activities and action implementation for achieving the QS requirement of ISO 9000. An early conformity assessment highlighted the need for management and control in order to assure quality. The Service did not have a documented QS, a documented management review and a documented procedure for corrective and preventive actions for ensuring QS implementation and its effectiveness. A strategic quality plan, focused upon the major areas for improvement, was developed. This practical approach shows encouraging results because it allows to build up the basic quality and to motivate the OHS personnel.

Evolution of a surgical technique for posteroventral pallidotomy using CT/MR fusion and intraoperative macrostimulation.

This is a prospective review of 60 posteroventral pallidotomies performed in 48 patients. Twelve patients had bilateral pallidotomies; five of these were staged and seven were performed simultaneously at the one surgical procedure. The report focuses on evolution of a surgical technique originally using the computed tomographic (CT) scan for target acquisition, culminating in a technique of fusing the magnetic resonance (MR) and CT scans. The technique involves macrostimulation with threshold identification of the optic tract and internal capsule. Utilizing the current procedure reproducible accurate lesions were made in the ansa lenticularis and internal pallidum as confirmed on postoperative MR scans. Initial results would indicate a very good effect on motor functions such as rigidity and dyskinesia and moderate to good effect on tremor. Secondary effects were seen on hypokinetic features such as on/off fluctuations, postural stability, gait dysfunction and limb bradykinesia. There was no injury to the internal capsule or optic tract throughout the series. Gait and postural stability were adversely affected in two patients early on in the series before the utilization of the MR/CT fusion technique and before the introduction of the current lesioning technique. There was no other adverse morbidity for the procedure.

[Occupational asthma caused by cefmetazole and 7-aminocephalosporanic acid: description of a clinical case]. / Asma professionale da cefmetazolo ed acido 7-amino-cefalosporinico: descrizione di un caso clinico.

A case of professional asthma, following exposure to cefmetazole and 7-ACA, occurring in a non atopic subject with remarkable bronchial hyperreactivity, is described. From the diagnostic point of view the execution of specific bronchial stimulation tests was conclusive. It is probable that the occurrence of the illness is due, in this case, to the ability of the inhaled substances to cause inflammation in a subject with bronchial hyperreactivity, without inducing an immunologic mechanism.

Omeprazole enhances efficacy of triple therapy in eradicating Helicobacter pylori.

Triple therapy has been recommended as the most effective treatment for Helicobacter pylori eradication. Despite achieving a comparatively high eradication result, however, around 10% of patients still fail to be cured. Omeprazole can enhance efficacy of single and double antibiotic protocols and is particularly effective when combined with clarithromycin and a nitroimidazole. This study examined the effect of combining triple therapy with omeprazole. A prospective, randomised, unblinded, single centre trial was carried out on consecutive patients with symptoms of dyspepsia and H pylori infection confirmed by rapid urease test, microbiological culture, and histological assessment. Patients were given a five times/day, 12 day course of colloidal bismuth subcitrate chewable tablets (108 mg), tetracycline HCl (250 mg), and metronidazole (200 mg) with either 20 mg omeprazole twice daily (triple therapy+omeprazole) or 40 mg famotidine (triple therapy+famotidine) at night. Compliance and side effects were determined using a standard questionnaire form. One hundred and twenty five of 165 triple therapy+omeprazole patients and 124 of 171 triple therapy+famotidine patients returned for rebiopsy four weeks after completion of treatment. Significantly more triple therapy+omeprazole patients achieved eradication 122 of 125 (97.6%) as assessed by negative urease test, culture, and histological assessment, when compared with 110 of 124 (89%) triple therapy+famotidine patients (p = 0.006; chi 2). There were 30 triple therapy+omeprazole (24%) and 26 triple therapy+famotidine (21%) patients with de novo metronidazole resistant H pylori included in the study. Side effects were mild and infrequent and were comparable in both groups, although pain in duodenal ulcer, gastric ulcer, and oesophagitis patients seemed to subside earlier in those taking omeprazole. Compliance (>95% of drugs taken) was achieved by 98% of patients of both groups. A 12 days regimen of triple therapy with omeprazole is more effective in achieving H pylori eradication than is triple therapy plus famotidine. Use of 20 mg omeprazole twice daily rather than 40 mg famotidine with a 12 day, low dose triple therapy enhances eradication to over 97% whether the H pylori is metronidazole sensitive or resistant.

The European Community's research projects in the field of health services.

Collaboration within the European Community (EC) over health problems and their possible solutions has progressed significantly during the past decade. The pursuit of appropriate choices among a variety of issues has resulted in a growing demand for comparable health data. EC efforts to coordinate the health services research of the member states in the fourth Medical and Health Research Program (1987-91) are discussed. Its contribution to the development of information relevant to the EC's health needs as well as financing, policies, and practices is outlined.

Performance of venturi oxygen delivery devices.

The oxygen blenders used in disposable oxygen masks from five manufacturers (Hudson, Inspiron, McGaw, Medishield and Vickers) were tested for delivered oxygen concentration and flow. In all concentration ranges the Medishield and McGaw were more accurate than the others. With some exceptions the flow output of these two devices was also adequate. The Medishield blenders which were tested over a wide range of oxygen inflows proved very stable in their delivered oxygen concentration.

The two prolongations of spinal ganglia neuroblasts: an ultrastructural study during chick embryo development.

Peripheral and central prolongations of chick embryo spinal ganglia neuroblasts were studied and compared at an ultrastructural level during development. Important differences in the terminal tracts of the prolongations and their endings were demonstrated. The possibility of environmental influences being responsible for structural differences in the two prolongations is suggested. It was not possible, at any stage of development, to demonstrate significant polarization of any cytoplasmatic structure in the emerging cones.