Nitrous oxide occupational exposure in conscious sedation procedures in dental ambulatories: a pilot retrospective observational study in an Italian pediatric hospital.

BACKGROUND: Nitrous oxide has a proven clinical efficacy in conscious sedation. At certain environmental concentrations it may pose a health risk to chronically exposed healthcare workers. The present pilot study aims at evaluating the exposure to nitrous oxide of dental ambulatory personnel of a pediatric hospital. METHODS: A descriptive study design was conducted in two phases: a bibliographic analysis on the environmental safety policies and a gas concentration analysis in the dental ambulatories of a pediatric hospital, detected every 6 months from December 2013 to February 2017 according to law provisions. The surveys were carried out using for gas analysis a photoacoustic spectrometer Innova-B&K "Multi-gas monitor model 1312" and Innova-B&K "Multi-sampler model 1309". The biological analysis and monitoring have been carried out on staff urine. RESULTS: The analyses were performed during 11 dental outpatient sessions on pediatric patients. All the patients were submitted to the same dental procedures, conservative care and dental extractions. The pediatric patients were 47 (23 males, 24 females; age range 3-17 years; mean age 6,63, SD ± 2,69) for a mean of 4,27 (SD ± 1,49) per session., The mean environmental concentration of nitrous oxide during the sessions was 24.7 ppm (SD ±16,16). A correlation was found between urinary nitrous oxide concentration of dentists (Pearson's correlation 0.786; p = 0.007) and dental assistants urines (Pearson's correlation 0.918; p < 0.001) and environmental concentrations of nitrous oxide. Weak negative correlations were found between age and sex of patients and environmental concentrations of nitrous oxide. The mean values of the biological monitoring data referring to all the outpatient sessions are lower than the reference values foreseen in accordance to the regulations in force on nitrous oxide concentration. CONCLUSIONS: The mean environmental concentration values recorded in our study are below the limit of 50 ppm considered as a reference point, a value lower than those reported in other similar surveys. The results of the present study provide a contribution to the need to implement technical standards, criteria and system requirements for the dental ambulatories, to date not yet completely defined, and cannot be assimilated to the ones established for the surgical rooms.

[Artificial lighting and blue light in the operating room: what risks for the surgeon?]. / Illuminazione artificiale e luce blu in sala operatoria: quali rischi per il chirurgo?

BACKGROUND: Lighting in operating rooms must ensure conditions of visual comfort, wellbeing and safety when procedures are being carried out, so as to preserve  the health of both workers and patients. OBJECTIVES: In this study we attempted to develop a methodology for specifically assessing the risk for surgeons of exposure to blue light, simulating the surgeon's real working conditions. Visual comfort was also assessed by measuring maintained illuminance (Em) and the luminance levels in the visual task area within the operating field. METHODS: Blue light exposure was measured by an OCEAN OPTICS-QE65000 spectroradiometer and a LSI-Lastem model Z-Lux radiometer, while for lighting measurements, a videophotometer and luxmeter were used. RESULTS: Results show that the surgeons were exposed to blue light values lower than the limit of effective radiance LB= 100 W m-2 sr-1 foreseen by European Directive 2006/25/EC. For visual comfort, significant differences in illumination were observed between surrounding areas and the visual task areas, with very high luminance values measured in most of the observation points. CONCLUSIONS: In this case the measured values confirm that the workers were daily exposed to unsuitable luminance contrasts that can cause eyestrain. Given such results and considering the task analysis, we proposed to extend health surveillance to workers performing activities such as precision surgery for prolonged periods.

Transumbilical laparo-assisted appendectomy: a safe operation for the whole spectrum of appendicitis in children-a single-centre experience.

The paper reports the results of a retrospective review of the medical charts of 203 patients admitted to a pediatric surgical unit with a diagnosis of acute appendicitis between January 2006 and December 2010 when a transumbilical laparoscopic-assisted appendectomy (TULAA) was introduced as a new surgical technique. Among 203 admitted patients, 7 (3.5%) had a localized appendiceal abscess and were treated with antibiotics. All of them responded to antibiotics and underwent TULAA interval appendectomy 8 weeks later. 196 patients (96.5%) underwent immediate surgery. In 12/181 (6.6%) urgent cases, conversion to laparotomy was necessary, in 3 patients because of bowel distension and in 9 for retrocecal position of appendix. In all 181 TULAA completed procedures, one trocar was used in 151 cases (89.4%), two trocars in 16 (9.4%), and three trocars in 2 (1.2%). The mean operative time for single port TULAA was 52' Complications included 5 wound infections and 5 intra-abdominal abscesses, all managed conservatively. In conclusion, TULAA is a safe, minimally invasive approach with acute appendicitis, regardless of the perforation status, and can be recommended in the pediatric urgical settings.

[Risk of non-coherent optical radiation in the operating room]. / Rischio da radiazioni ottiche artificiali non coerenti in sala operatoria.

In this study, we evaluated the exposure of operating room personnel to non-coherent optical radiation by measuring the emission of blue light generated by operating lights. The values we obtained were largely below the exposure limit value of 100 W x m(-2) x sr(-1) provided by Legislative Decree no. 81/08 and European Directive 2006/25/EC, showing how workers can be exposed for longer than 8 hours without risk of acute health effects, confirming what was already said in literature. This work demonstrates, therefore, that the risk of acute nature of photochemical retinal damage, caused by exposure to blue light, is absent, if not exceeded the exposure limit values, on the basis of the current knowledge, however, respect for exposure level cannot protect against a possible retinal damage from chronic exposure, related to the total dose accumulated by the worker in the long-term.

[Conservative treatment of traumatic rupture of the biliary ducts: a case report]. / Traitement conservateur des ruptures traumatiques des voies biliaires: à propos d'un cas.

The diagnosis of a biliary duct transection after blunt trauma is difficult in children. Surgery is often performed late and therefore complicated. We present a case of mini-invasive approach for biliary duct transection in a 12-year-old child and review the literature. Transhepatic cholangiography is at the moment the most used technique to make the diagnosis but necessitates general anaesthesia. Stent placement is possible by the way. Endoscopic retrograde cholangiogram (ERCP) has been proposed even in children. Stent placement may be easier by this technique. For the diagnosis, Technetium 99m dimethylminodiacetic acid (HIDA) scanning seems interesting in terms of both sensitivity and specificity. Another promising diagnostic technique is MRI with 3D reconstruction.

Retroperitoneoscopic approach to the adrenal glands and retroperitoneal tumours in children: where do we stand?

Choosing the best way to approach adrenal gland and retroperitoneal tumours is still difficult. We reviewed our first 10 cases operated on by retroperitoneoscopy and compared this approach with other possible ways described in the literature. There were 2 intraoperative complications: 1 opening of the diaphragm and 1 bleeding. Tumour resection was always complete. There was no conversion. There were no postoperative complications. The retroperitoneoscopic approach for adrenalectomy and retroperitoneal tumour resection is increasingly being used. In children, operation is quite fast, without much blood loss and with spectacular postoperative recovery results. Even for the right side we advocate this approach, due to the particular anatomy (small tumour size, less fat, thinner muscle layers) in this age group. Trained surgeons are, of course, mandatory.

Long-term outcome of laparoscopic Nissen and Toupet fundoplication in normal and neurologically impaired children.

BACKGROUND: Laparoscopic fundoplication is a commonly performed procedure in children. This report describes the incidence of long-term recurrence and complications after laparoscopic Nissen or Toupet fundoplication in neurologically impaired and normal children. METHODS: Fifty-three children operated on before 1999 were reviewed. All children were evaluated clinically and with a barium meal study thereafter. Symptomatic children and those with abnormal barium meal underwent 24 h pH monitoring. RESULTS: A total of 45 patients were included in the study. The mean follow-up was 4.5 years. All, except one asymptomatic child that declined, had a barium meal. Four were abnormal (2 parahiatal hernias and 2 slight episodes of reflux). Four patients had symptoms related to the operation and 2 to clinical recurrence. Only 1 asymptomatic child with slight reflux at barium meal revealed abnormal 24 h pH monitoring. Finally, 6.6% patients were found to have late recurrence (2 clinical and 1 pHmetry). There was an obvious increase in children's weight, especially in neurologically impaired patients. CONCLUSION: Laparoscopic antireflux surgery is of value in children with gastroesophageal reflux disease. The long-term results are comparable with open surgery, and there was no difference in term of wrap failure between neurologically impaired and normal children.

Gastric volvulus associated with congenital diaphragmatic hernia, wandering spleen, and intrathoracic left kidney: CT findings.

We present an unusual case of gastric volvulus associated with wandering spleen, a delayed manifestation of congenital diaphragmatic hernia and left intrathoracic kidney. Gastric volvulus should be considered in any infant with unexplained vomiting and left diaphragmatic anomaly: in these patients, developmental disorders of the peritoneal visceral attachments of the left upper abdomen may coexist. The absence of ligamentous connections between the stomach, posterior abdominal wall, and spleen result in wandering spleen. We emphasize prompt surgical therapy to avoid gastric and splenic necrosis. Radiologic findings and the appearance of this complex congenital malformation are reported.

Prenatal management of inherited urogenital malformation: case report.

Documentation of unique kidney renal function early in pregnancy can be helpful in defining prenatal management and therefore in improving prognosis. Antenatal diagnosis of a solitary kidney was performed at 20 weeks' gestation in a foetus with a 1,7 chromosome translocation. Because of the decreasing renal function and the increasing pelvic dilatation, an early in utero stenting was placed at 23 weeks' gestation. Optimal outcome occurred and the baby was delivered at 32 weeks. Complete assessment of the malformation showed a left hydronephrosis due to a megaureter, right renal agenesis with ipsilateral cryprorchidism and agenesis of the right vas deferens. The chromosomic translocation was inherited from the mother who was affected by uterus didelphys, obstructed right hemivagina and right renal agenesis. Renal function of the unique kidney with hydronephrosis can be early diagnosed and promptly treated. This condition should also increase the index of suspicion of underlying genital and chromosomal anomalies.

The murine homolog of the HIN 200 family, Ifi 204, is constitutively expressed in myeloid cells and selectively induced in the monocyte/macrophage lineage.

To examine the expression of Ifi 200 genes in vivo and add new information about their function, polyclonal monospecific rabbit antibodies, designated N-term or C-term, were raised against both the N-terminus and C-terminus of the 204 protein (p204) respectively. Western blotting analysis demonstrated that p204 and D3, another member of the Ifi 200 gene family, are constitutively expressed, though at different degrees, in bone marrow, thymus and lymph nodes, and barely detectable in the spleen. Poly rI:rC treatment did not modulate their expression. Peritoneal resident macrophages (Mphi) from untreated mice were negative, but displayed high levels of both p204 and D3 on poly rI:rC treatment. A significant increase of these proteins is also observed when Mphi are cultured overnight in vitro with IFNs or LPS. Lung, kidney and brain were negative for p204 and D3 expression. These results, together with immunohistochemical analysis, demonstrate that the 204 gene has an expression pattern restricted to cells of the myelomonocytic lineage similar to that observed for the human homolog, the myeloid nuclear differentiation antigen (MNDA) suggesting its potential involvement in the differentiation and maturation of this cell lineage.

Inhibition of cell proliferation by the interferon-inducible 204 gene, a member of the Ifi 200 cluster.

The role of the IFN-inducible p204 as growth regulator was investigated by transfecting an expression vector constitutively expressing p204 into several cell lines. Like pRB and p107, p204 is a potent growth inhibitor in sensitive cells, as demonstrated by the cell focus assay. Since stable transfectants of sensitive lines constitutively overexpressing p204 could not be established in vitro, we inserted the 204 cDNA into a vector bearing an heavy-metal-inducible promoter. Here we show that proliferation of B6MEF fibroblasts lacking endogenous p204 is strongly inhibited by transient p204 expression in the nucleus. p204 delays G1 progression into the S-phase and cells accumulate with a DNA content equivalent to cells arrested in late G1. Moreover, the role of p204 in the control of cell growth in vivo was investigated by generating transgenic mice in which the Ifi 204 gene was constitutively expressed in all tissues. To this end, expression vectors bearing the 204 cDNA under the control of the SV40 viral promoter were constructed. The overexpression of the p204 transgene achieved by injecting fertilized mouse eggs with these vectors was compatible with embryo development up to the four-cell stage in an in vitro follow-up of 4.5 days. However, no viable animals with an intact copy of the transgene were obtained, suggesting that high and constitutive levels of p204 expression can impair normal embryo development. These findings indicate that p204 plays a negative role in growth regulation and provide new information about the molecular mechanisms exploited by IFNs to inhibit cell proliferation.

Suppression of high mobility group protein T160 expression impairs mouse cytomegalovirus replication.

The high mobility group (HMG-1) box proteins bind both non-B-DNA conformations and specific nucleotide sequences. They have been implicated in a wide variety of cellular functions involving DNA, such as transcription, replication and recombination. To determine whether HMG-1 box protein T160 plays a role in virus replication, we employed an antisense strategy to inhibit its expression in NIH 3T3 cells. The two T160 clones that expressed levels of T160 50% lower than those expressed by clones transfected with the empty vector (Neo+ clones) were investigated with respect to their permissiveness to the growth of viruses representing three families: Rhabdoviridae, vesicular stomatitis virus (VSV); Picornaviridae, encephalomyocarditis virus (EMCV), and Alpha- and Betaherpesviridae, herpes simplex virus 1 (HSV-1) and mouse cytomegalovirus (MCMV), respectively. They displayed a high degree of resistance to MCMV replication, but were fully permissive to the other viruses. Competitive PCR and probing IE-1 products by Western blot analysis showed that this resistance was not due to depressed levels of virus adsorption during the early phases of infection. We therefore conclude that T160 is involved in replication of the betaherpesvirus MCMV.

Evaluation of immunization coverage at local level.

Two simple methods were employed for evaluating immunization activities in three rural health districts of Zaire, with a view to improving service delivery. One method involves the use of cumulative frequency graphs for monitoring progress at the health centre level towards the achievement of coverage targets. The other requires a clinic-based audit and a population-based survey of children aged 12-23 months to ascertain whether they have been immunized against measles at the appropriate time. These approaches can help to identify operational problems and to motivate the people in charge of immunization at local level.

PIP: In Zaire, immunization activities in 3 rural health districts were evaluated using 2 simple methods designed to measure the quality of immunization coverage at the local level. The quality of an immunization program is linked to the administration of the proper doses of vaccine at the proper times; missed opportunities and dropouts reduce the effectiveness of a program. One assessment method, therefore, used the cumulative frequency graph recommended by WHO which shows, in monthly intervals, the number of percentage of children who have to be vaccinated to obtain targeted yearly coverage. By adding the figures for all preceding monthly intervals, the cumulative number is reached. The final graphs shows expected and actual numbers. Multiplication of a targeted population by its estimated birth rate gives the number of children to be immunized monthly to achieve complete coverage of a birth cohort. Graphs for 1989 revealed problems such as a lack of vaccine in March and April and a widening gap between the number of children who received their first and third doses of polio and DPT vaccines. In 1990, the staff took measures to correct problems revealed by the 1989 graph. For the second assessment method, records of all children 12-23 months old were checked to determine if the child received measles vaccine--which is likely to be omitted in an incomplete vaccination program. This clinic-based audit gives a quick estimate of the proportion of vaccinated children among clinic clients and the proportion immunized at the proper time and allows local health managers to determine the ability of auxiliary nurses to schedule the administration of vaccines. To gather data on children who do not attend health centers, a population-based survey is useful. In January 1990, therefore, the whole 1988 birth cohort in 3 health areas was enrolled in a retrospective health survey. Of the 1771 children 1523 were registered at a clinic, 1251 were vaccinated, and 272 were not. The proportions differed among he 3 health areas and allowed useful comparisons which showed that the proportions were associated with paternal education level, maternal educational level, and distance from the clinic. This study identified the need for a network of outreach sites and indicated when health workers needed additional training and supervision. By focusing on the vaccination process, these assessment methods identify operational problems and motivate the people in charge of local level immunization to achieve better results.

Evaluation of pefloxacin activity against recent clinical isolates.

The in-vitro antibacterial activity of pefloxacin, a new quinolone carboxylic acid, was tested against 1140 bacterial strains, recently clinically isolated, by measuring the minimum inhibitory concentrations. Comparisons were made with other quinolones (enoxacin, norfloxacin, flumekin, oxolinic acid, pipemidic acid) and other drugs (piperacillin, cefotaxime, ceftazidime, gentamicin, tobramycin, amikacin) widely used for the treatment of bacterial infections. Pefloxacin was very active against the tested species and was the most active drug against all the bacterial strains, with a geometric mean of MICs, a MIC 50 and MIC 90 of 0.27, 0.12 and 4 microg/ml respectively.

Evaluation of ciprofloxacin's activity against recent clinical isolates.

The in vitro antibacterial activity of ciprofloxacin, a new quinoline carboxylic acid, was tested against 1671 recently clinically isolated bacterial strains, by measuring the minimum inhibitory concentrations (MIC). Comparisons were made with other quinolones: nalidixic acid, norfloxacin, and other drugs: piperacillin, cefoxitin, cefotetan, ceftazidime, tobramycin, rifampin, tetracycline, chloramphenicol. Ciprofloxacin was very active against the tested species and was the most active drug against all the bacterial strains, with a geometric mean, a MIC50 and MIC90 of 0.27, 0.12 and 2 micrograms/ml, respectively.

Monitores de resíduos de fungicidas ditiocarbamatos em hortifrutigranjeitos no Estado do Rio de Janeiro / Monitoring of dithiocarbamates residues greengroceries markated at the State of Rio de Janeiro, Brazil

Foram analisadas 239 amostras de hortifrutigranjeiros (alface, batata-inglesa, batata-doce, beterraba, couve-flor, cenoura, pimentäo, repolho, salsa, tomate, abacaxi, laranja e mamäo), provenientes de duas maiores fontes distribuidoras do Estado, envolvendo 14 diferentes culturas. Para as determinaçöes analíticas de resíduos, foi utilizado método baseado na reaçäo colorimetrica do dissulfeto de carbono liberado na hidrólise dos fungicidas (KEPPEL-1971). Do total de amostras analisadas, 129 apresentaram resíduos de fungicidas ditiocarbamato; sendo estas correspondentes a 13 espécies de hortifrutigranjeiros, com exceçäo da batata-doce. As amostras, apresentram incidência de resíduos de 50-75% e 22% continham resíduos acima dos limites de tolerância de legislaçäo vigente. A importância do monitoramento de resíduos de diticarbamatos, deve-se ao fato produtos, por características de baixo custo, fácil manuseio, amplo espectro e compatibilidade com a maioria dos inseticidas e adjuvantes, ocuparem ampla faixa na preferência do mercado nacional. Aliado a isto, mecanismos de degradaçäo dos fungicidas ditiocarbamatos, podem originar Etilenotiuréia (E.T.U.), substância de açäo cancerigena, mutagênica e terapêutica

Evaluation of in vitro activity of teicoplanin against recent clinical isolates.

The in vitro antibacterial activity of teicoplanin, a new glycopeptide antibiotic, previously named teichomycin A2, has been compared to that of five other chemoantibiotics: netilmicin, clindamycin, rifampicin, enoxacin and vancomycin. The minimum inhibitory concentration (MIC) values against 588 gram-positive strains, 561 facultative aerobes and 27 anaerobes, recently isolated from clinical specimens, were evaluated. Teicoplanin showed the highest activity against all the tested strains, with a geometrical mean of the MICs (GMM), a MIC50 and MIC90 of 0.123, 0.12 and 0.5 micrograms/ml respectively.

[Evaluation of the in vitro activity of enoxacin on bacterial strains recently isolated in a hospital milieu]. / Valutazione dell'attività in vitro dell'enoxacin su ceppi batterici di recente isolamento ospedaliero.

The in vitro activity of enoxacin, a new quinolone derivative, was tested against 2180 bacterial strains, recently clinically isolated, by measuring the minimum inhibitory concentrations. Comparisons were made with other drugs (flumequine, oxolinic acid, pipemidic acid) widely utilized for the treatment of urinary tract infections. Enoxacin showed the highest activity against all the tested strains, with a geometrical mean of MICs (MG) of 0.39 micrograms/ml and a MIC 50 and MIC 90 of 0.25 and 4 micrograms/ml, respectively.