Safety-related properties of staphylococci isolated from food and food environments.

AIMS: To test some safety-related properties within 321 staphylococci strains isolated from food and food environments. METHODS AND RESULTS: The isolates were identified as Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Staphylococcus pasteuri, Staphylococcus sciuri, Staphylococcus warneri and Staphylococcus xylosus. Decarboxylase activity was quite common for the various Staphylococcus spp., and tyrosine was the most frequently decarboxylated amino acid. The frequency of antibiotic resistance was highest in Staph. pasteuri and Staph. xylosus. Several of the isolates were tolerant to QAC compounds, and in some cases, QAC tolerance was present in antibiotic-resistant strains. Most of the strains displayed moderate to high adhesion rates to stainless steel and Teflon(®). The strains that readily formed biofilms belonged to the species Staph. aureus, Staph. epidermidis and Staph. pasteuri. CONCLUSIONS: An high incidence of some safety hazards was found within the staphylococcal strains of food origin tested in this study. In particular, amino acid decarboxylase activity and biofilm-forming ability were common within strains, and antibiotic resistance and tolerance to QAC-based compounds occurred frequently as well. These characteristics are an important safety concern for food industry. SIGNIFICANCE AND IMPACT OF THE STUDY: This work gives a first picture of safety hazards within staphylococcal species isolated from food environments. The presence of disinfectant-resistant staphylococci is a concern because resistance can be genetically transferred between the various Staphylococcus species. This could lead an increase and spread of resistant enterotoxic staphylococci and/or pathogenic staphylococci.

Laparoscopic resection of colorectal cancer: matched comparison in elderly and younger patients.

BACKGROUND: Several studies have addressed the issue of the feasibility of laparoscopic colorectal surgery in elderly patients, usually by choosing an arbitrary cut-off age limit, and retrospectively evaluating patient outcomes. The aim of this study was to assess the effects of age on the outcome of laparoscopic colorectal surgery for cancer in a single department, by comparing younger and older patients, matched by ASA score and type of operation. METHODS: The perioperative outcome of patients ≥75 years old who underwent laparoscopic colorectal surgery for cancer between June 2005 and January 2009 were compared with findings in younger patients, matched by ASA score and type of operation. RESULTS: The study included 100 patients, fifty <75 years old (Group A) and fifty ≥75 (Group B) years old. There were 18 right hemicolectomies, 16 left hemicolectomies, 4 anterior resections, 9 low anterior resections, 2 Miles' operations and 1 segmental resection in each group. We observed a significantly higher overall morbidity rate among elderly patients than among younger patients (24 vs. 8%). CONCLUSIONS: Short-term results after laparoscopic colorectal surgery for cancer in patients ≥75 years old reveal that they have higher postoperative risk compared to their younger counterparts, even when matched by ASA score and type of operation. It suggests that although advanced age, per se, is not a contraindication, it is a risk for patients who undergo laparoscopic colorectal surgery for cancer. This surgery in elderly patients should be performed by experienced surgeons in specialized centers to keep postoperative risk to a minimum.

Laparoscopic colorectal surgery in the elderly.

BACKGROUND: The efficacy and safety of laparoscopic colorectal surgery have been demonstrated in several well designed trials in recent years. At the same time the experience in the field of laparoscopy in the elderly has increased. The aim of this study was to evaluate retrospectively the experience of laparoscopic colorectal surgery in patients over 75 years in our unit. DESIGN: Retrospective study. SETTING: Surgical Department, San Lorenzo Hospital, Valdagno (VI). SUBJECTS AND METHODS: All the patients over 75 years, out of a total number of 121 unselected patients, undergoing laparoscopic colectomy or laparoscopic abdomino-perineal resection between June 2002 and May 2005. MAIN OUTCOME MEASURES: Postoperative mortality, operating time, conversion rate, morbidity, time of discharge from hospital. RESULTS: Six patients were converted to open surgery. 87 patients over 75 years underwent laparoscopic colorectal surgery. There was no postoperative death, in three cases a reoperation was done, because of postoperative intestinal obstruction in one case (over 75) and for anastomotic fistula in two (one over 75, after low anterior resection). Mean operative time was was 180 minutes (range 150-300). CONCLUSIONS: Laparoscopic colorectal surgery in elderly patients is a safe group of procedures for benign and malignant lesions of large bowel, resulting in a low rate of complications even if the time of operation is increased compared with open procedures. Postoperative pain and hospital stay, with return to normal life, are decreased compared with open surgery.

Electromagnetic field monitoring and control systems: state-of-the-art and work-in-progress.

The development of EMF monitoring and control systems unquestionably represents one of the major innovations in the range of methodologies for evaluating, through measurement, the so-called environmental electromagnetic pollution. The interest recently shown by ARPA and municipal and provincial councils for setting up electromagnetic field monitoring and control systems has created significant developments in the field under examination. This paper attempts to provide a complete overview of the technical possibilities provided by electromagnetic field monitoring and control systems in the environment and their possible applications. Equipment currently available and under development is described, as well as the most significant work-in-progress in this sector. In the near future, several monitoring systems will be proposed and set up by municipalities and provinces, or directly by telecommunications companies. For this reason, it is more than ever necessary that agreement be reached at a national level to define a unified methodological and operating approach to enable monitoring data from different sources to be compared.

[Our experience with the use of Absolok polydioxanone resorbable clips in laparoscopic surgery]. / Nostra esperienza sull'utilizzo delle clips riassorbibili in polidiossanone Absolok in chirurgia laparoscopica.

BACKGROUND: The study aims to evaluate the efficacy of resorbable clips in polydioxanone in laparoscopic surgery. METHODS: The authors report their personal experience regarding the use of Absolok (ABL) resorbable clips in laparoscopic surgery. Out of a total of 745 laparoscopic operations performed from September 1992 to February 1997, 438 included the use of resorbable clips in place of metal clips, both for cystic duct section during cholecystectomy and vascular structures, or to lock continuous sutures. ABL clips were also used for major vessels (e.g. mesenteric artery) during laparoscopic colic resections. RESULTS: In all cases when they were used, ABL never gave rise to complications, such as biliary outflow or hemorrhage caused by the dislocation of the clips themselves. CONCLUSIONS: The authors conclude by affirming the value and safety of this type of clip.

Conservative laparoscopy in the treatment of posttraumatic splenic laceration using microfiber hemostatic collagen: three case histories.

Three cases of posttraumatic splenic laceration in young patients are reported. In each case, hemostasis of the lesion was obtained by the use of microfiber collagen in emergency laparoscopy. In two cases, complete hemostasis was achieved and the entire organ was saved. In the third case, splenectomy proved necessary after renewed bleeding occurred.

Ileal volvulus on internal hernia following left laparoscopic-assisted hemicolectomy.

Described here is a case of constriction of the ileal loop caused by a volvulus forming on an internal hernia through the mesenteric opening in the anastomotic colonic stumps, following left laparoscopic-assisted hemicolectomy. This experience indicates the need for closure of mesenteric gaps with a continuous suture after laparoscopic-assisted left hemicolectomy.

[The Shouldice plastic surgery: our clinical experience]. / Plastica secondo Shouldice: nostra esperienza clinica.

The Authors present cases of groin hernioplasty using the Shouldice method; the method used for more than six years, such as elective technique to treat groin hernia, is evaluated on the basis of results of complications and recurrences. A careful clinical check of patients operated on over one year at least, allows confirmation of the efficiency of the method, because it results in a low percentage of recurrence and complications, plus a low social and economical cost. For these reasons it is proposed that the method is applied in day surgery.

[Pulmonary carcinoid tumors]. / I tumori carcinoidi polmonari.

27 patients suffering from carcinoid of the lung (18 females and 9 males, middle age 52 years, range 26-68) underwent surgery in our department. The neoplasms were located at the pulmonary hilum in 21 cases. The diagnosis was occasional in 6 cases, cough (51.8%) and recurrent bronchitis (37%) were the most frequent symptoms. No instances of carcinoid syndrome were detected. Preoperative staging ruled out pathologic mediastinal lymph nodes or hematogenous metastases. 26 patients underwent complete excision of the neoplasm (11 lobectomies, 9 pneumonectomies, 4 bilobectomies, 1 segmental resection, 1 bronchial wedge resection). Histologically, 4 cases were categorized as atypical carcinoids. Two patients died within 1 year, one suffering from atypical carcinoid because of disease progression, and an other one (suffering from atypical carcinoid) who underwent only at exploratory thoracotomy followed by chemotherapy. A patient suffering from typical carcinoid died within 1.5 years because of gallbladder carcinoma. From our experience and from the literature review it appears that carcinoids has to be considered as malignant neoplasms and treated according to.

Palliative treatment of carcinoma of the rectum by endoscopic injection of polidocanol.

Between January 1987 and December 1988, at the Surgical Department of Chiarenzi Hospital, five patients underwent endoscopic intratumoral injection of polidocanol for palliative treatment of inoperable carcinoma of the rectum. Histological evaluation was performed in all cases. The patients comprised two males and three females aged 78 to 88 years (mean 83.4). One of them refused surgery for recurrent rectal cancer, four consulted us with impending intestinal obstruction; three were inoperable due to local spread of the tumor and poor general condition, the other was in a poor general condition due to massive metastatic hepatic disease. In all the patients, we observed remission of the obstructive symptoms with no major complications; none of them has required a colostomy. The follow-up period has covered a period of two months to two years. The technique of injection is simple, inexpensive and, properly performed, safe. All these advantages make this type of palliative treatment for rectal cancer interesting, even when compared with laser treatment, urological resectoscope or electric snare resection, and electrocoagulation.

Thoracic complications of pancreatitis.

Pancreatitis may be associated with thoracic complications, notably chronic massive pleural effusion (CMPE) and, rarely, pseudocysts with mediastinal extension (PME) and enzymatic mediastinitis (EM). Our personal experience with 14 cases of thoracic complications (nine CMPE, two PME associated with pleural effusion, and three EM of 670 patients who underwent surgery; of these, 191 had acute and 479 had chronic pancreatitis) during 16 years (1970-1986) is reported. In the patients with CMPE, the initial symptoms were progressive dyspnea eventually associated with cough and chest pain. In the PME cases, there was dysphagia associated with left subscapular pain and left chest pain. The initial signs in the patients with EM were sudden dyspnea, cyanosis, retrosternal pain, tachycardia, and acute heart failure. A fistula between the pancreatic ductal system and the pleural cavity in seven of the nine patients with CMPE was demonstrated by intraoperative pancreatography and/or cystography. On the contrary, preoperative endoscopic pancreatography demonstrated the sinus tract in only three of the seven. In both cases of PME, computed tomography (CT) provided a correct diagnosis that was confirmed at surgery. In the patients with EM, the diagnosis was suggested by the clinical appearance and was confirmed by the chest roentgenogram and by CT. All patients had operations after varying periods of unsuccessful 2-4-week-long conservative treatment. One patient with infected ascites died postoperatively. There were no thoracic recurrences of pancreatic disease among the other patients at a 10-month-10-year follow-up observation after surgery.

Bronchopulmonary carcinoids: report of nine surgically treated cases.

Nine cases of bronchial carcinoids treated by surgery are reported. Six of them were females and three males. Their ages ranged from 37 to 68 years (median 52.8 years). Lobectomy was carried out in four instances (bilobectomy in one) and pneumonectomy in three. Based on preoperative histology two conservative operations were performed: one patient underwent segmental resection of the right upper lobe for a peripheral carcinoid and the other sleeve resection of the bronchus. The operations were complicated only in one case in which a broncho-pleural fistula appeared postoperatively and was successfully treated by thorachoplasty. There was no postoperative death. The only patient with an atypical carcinoid died one year after pneumonectomy. The other eight patients, with typical carcinoids are alive and without recurrent disease at 6 months to 8 years from surgery. Lymph node and parenchymal infiltration, observed in 3 patients, were not fatal. It is concluded that carcinoids should now be considered malignancies; typical carcinoids carry a more favorable prognosis than atypical ones and can be managed by conservative operations without affecting the survival rate. The spreading of the tumor to lymph nodes and surrounding tissues was not associated with an increased mortality in the reported cases.

[Preoperative evaluation of the patient candidate for surgical intervention on the chest: methods of study and risk factors]. / Valutazione preoperatoria del paziente candidato ad intervento di chirurgia toracica: metodi di studio e fattori di rischio.

The authors review the main methods designed to evaluate operability and surgical risk in candidates for chest surgery. They also report on their own experience with 135 cases operated on for thoraco-pulmonary diseases requiring surgery; in these cases, postoperative complications were studied in relation to various respiratory parameters evaluated differentially and as a whole prior to surgery. This study enabled the investigators to establish that patients with CV, FEV1, FEF25-75 and Tiffffeneau Index values below 60% of the respective theoretical reference values run a very substantial risk of postoperative complications, with a post-surgical morbidity rate of more than 60% in such patients. Similar risks are run by patients with VR values below 60% or above 120% of predicted values or with Emphysema Index values above 120% of predicted values. The author's experience with fractional bronchospirometry revealed that, in the high-risk patient sample, a predicted postoperative FEV1 value of only 800 ml/sec is a poorly selective limit.

Leiomyomata of the oesophagus: report of four surgically-treated cases.

Four patients with leiomyoma of the upper or middle third of the oesophagus treated by surgical excision are reported. All operations were performed through a right thoracotomy with simple enucleation of the lesion. Two patients were asymptomatic. In one the tumour had a spiral configuration almost completely surrounding the lumen. No complications occurred. Early surgical treatment is advised although the tumour grows slowly.

[Respiratory function after traumatic rupture of the diaphragm]. / La funzionalità respiratoria dopo rottura traumatica del diaframma.

In eight patients who underwent surgical treatment for diaphragmatic rupture, pulmonary function and differential ventilation of the lungs were evaluated four months-one year after surgery. The results of the study show that diaphragmatic rupture produces only a small reduction in total ventilatory function. Moreover our data indicate that the ventilation estimated to be contributed by the side injured, is decreased in a larger extent in abdominal than in thoracic trauma.

[Our experience in the use of "traction" endoprosthesis as a palliative treatment of cardial carcinoma]. / La nostra esperienza nell'uso delle endoprotesi "a trazione" quale trattamento palliativo del carcinoma cardiale.

The Authors review the methods of palliative treatment of cardial carcinoma, and particularly report some results obtained through the application of oesophageal endoprostheses (by Celestin and by Haring), following the traction method, in 38 patients. The global mortality amounted to 8 cases (21%). In 12 patients (31%), complications such as stoppage or dislocation of the prosthesis were observed. In two cases the perforation of oesophageal wall occurred, with spontaneous resolution in one of the two patients and serious mediastinitis and exitus in the other. The Authors' present trend is toward the use of push type endoprosthesis, because of the lower mortality reported in literature.

[Surgical therapy of gastric carcinoma in an advanced stage (clinical cases)]. / Terapia chirurgica del carcinoma gastrico in fase avanzata (contributo clinico).

The Authors study the casuistry of the Verona Surgical Clinic concerning the interventions for gastric cancer; they particularly study 35 cases of plurivisceral demolition for neoplasm in advanced phase. After a discussion of the data supplied by the literature; the Authors, as a conclusion, suggest not to consider the overcoming of the gastric barrier in multivisceral sense as a rigid element for the exclusion of these patients from surgery, although they exclude widely demolitive interventions in seriously weakened patients, or in bearers of such spreadings as to involve tremendous operative risks, not rewarded with a satisfactory advantage.

[Traumatic rupture of the diaphragm. Diagnostic problems and surgical therapy]. / La rottura traumatica del diaframma. Problemi diagnostici e di terapia chirurgica.

The Authors show 10 cases of traumatic disruption of diaphragm, subsequent to close or open trauma, all subjected to urgency operation. They discuss the problems concerning diagnosis and surgical tactics, and point out the frequency of visceral and osseous associated lesions and their importance in conditioning prognosis.