Evaluation of Intraoperative End-Tidal Carbon Dioxide Change Relates to Length Hospitalisation in Peridiaphragmatic Surgery: A Pilot Study.

Intraoperative evaluation is deeply changed using many new tools, both invasive and non-invasive. Peripheral oxygen saturation percentage (SpO2) is the more reliable method for a non-invasive monitoring of patient's blood oxygen concentration. Capnography (using end-tidal CO2 (EtCO2)) evaluation is an immediate and continuous non-invasive monitoring of carbon dioxide (CO2) in the breathing that provides important information on circulatory status and ventilation.Aim of this study is to perform a preliminary analysis of oxygen change during surgery exploring its possible influence on post-operative evolution. METHODS AND RESULTS: Intraoperative evaluation of SpO2 and EtCO2 was performed. Change in each parameter was categorised as 1 point for each five-point variation from baseline value (∆SpO2 as 1 point for each 5%, ∆EtCO2 as 1 point for each 5 mmHg). For each patient, the length of stay (LOS) in the intensive care unit (ICU), total hospitalisation, duration of intervention, surgical risk and complications were recorded. RESULTS: We analysed 93 consecutive patients (43 males and 40 females, aged 66.35 ± 9.79 years) that underwent peridiaphragmatic surgery. Forty patients (48.19%) presented complications after surgery. There was no statistically significant difference in age, duration of intervention and length of stay in ICU between complicated and non-complicated patients. As expected, patients with complications present an increased hospitalisation time compared to uncomplicated cases (14.69 ± 11.41 days vs 10.70 ± 6.28 days; p < 0.05). ∆EtCO2 was significantly increased (p < 0.05) in complicated compared to non-complicated. No differences were found in ∆SpO2 between the two groups. Considering the whole population, ∆EtCO2 presents a significant direct correlation to surgical risk, hospitalisation and duration of intervention. CONCLUSION: ∆EtCO2 may be related to possible complications after surgery and hospitalisation. An important comparison between SpO2 and EtCO2 and strict monitoring with an intraoperative arterial blood gas (ABG) sample during the main steps of surgery could bring some essential information to understand oxygen changes in intra- and post-operative evolution. However, a further validation analysis is needed before the approach can be used extensively in daily clinical settings.

Chlamydia pneumoniae in community-acquired pneumonia: seven years of experience.

OBJECTIVES: To determine the prevalence of Chlamydia pneumoniae in community-acquired pneumonia during a period of seven years. METHODS: Serum samples from 311 patients with pneumonia were evaluated using microimmunofluorescence assay to detect C. pneumoniae -specific IgG and IgM antibodies. RESULTS: Thirty nine patients (12.5%) complied with the diagnostic criteria of acute C. pneumoniae infection (a four-fold rise in the titer of IgG antibody, or a single IgG titer > or = 1:512, or a single IgM titer > or = 1:16). All patients were diagnosed as having pneumonia. Co-infection with other respiratory tract pathogens was found in four patients. CONCLUSIONS: C. pneumoniae is an important cause of pneumonia also in our area. Pneumonia due to this bacterium occurs in the cold months and in early spring; in addition we have observed periods of increased incidence of one years duration and periods of low incidence lasting one-two years. Therapy with macrolides and levofloxacin was effective in all patients with C. pneumoniae infection.

Community-acquired pneumonia in adults: a multicentric observational AIPO study.

The aim of this study was to obtain reliable data about the current aetiology (i.e. the frequency of the individual pathogens) of community-acquired pneumonia (CAP) while surveying the diagnostic and therapeutic behaviour of Italian chest physicians, compared with existing guidelines, and to test the usefulness of the current severity "criteria" or score as a predictor of disease outcome and guide for appropriate hospitalization. A prospective multicentre observational trial was carried out between October 1994 and February 1996 by the Italian Association of Hospital Pneumologists (AIPO) study group on respiratory infections. A total of 613 consecutive patients suffering from CAP were enrolled in 25 centres throughout Italy. Clinical, radiological and microbiological data were collected and patients were followed-up until complete resolution or death. Aetiological tests were not carried out in 204 patients. In the remaining 409 cases, the aetiology was defined by serological and quantitative microbiological tests in 184 (44.9%) patients. A total of 194 strains of pathogen were detected. The most frequently detected micro-organism was Streptococcus pneumoniae (18.5% of pathogen strains) but, unlike in other series of patients, high percentages of intracellular pathogens (32.5%, all with serological confirmation, mostly due to Chlamydia pneumoniae (13.4%) and of Gram-negative enterobacteria and Pseudomonas aeruginosa (12.5%) were also found. Antibiotic treatment differed from that recommended in American Thoracic Society guidelines, with a greater use of third-generation cephalosporins. Overall, a higher rate of hospitalization and a lower death rate than in other comparable studies was observed.

Relationship between environment spread and presence in hosts of Escherichia coli strains resistant to antibiotics and metals.

The antibiotic and metal resistance percentages of 315 E. coli strains, isolated from: a sample population not-exposed to antibiotics, hospitalized inpatients and from bred animals, were compared with the resistance percentages of 217 environmental isolates (sewage and river isolates). The highest levels of resistance and multiresistance were found for clinical and river isolates. A wider number of resistance markers, observed for environment isolates with respect to human and animal isolates, made it possible to hypothesis e that the resistant strains could possess some selective advantage that enhances their survival in the environment. Association of antibiotic resistance and metal-resistance has been demonstrated in all isolates but it is particularly evident in the environment and clinical isolates. Correlation analysis revealed that the patterns of antibiotic and metal resistance of environmental E. coli isolates are in good agreement with those of human origin and that sewage and river E. coli isolates are well correlated too.

Nutritional status of the elderly. II. Anthropometry, dietary and biochemical data of old pensioners in Perugia at the fifth year follow-up.

206 aged pensioners of the city of Perugia have been examined in a longitudinal study, with emphasis on body composition, diet, life habits and clinical-biochemical data. From the anthropometric data of the individuals examined in 1981 it is evident that both in men and women obesity is common especially among the women. The opposite is true for the arm muscle area. Comparing the same men examined in 1976 and 1981 body fatness decreased in the five years interval. Food and nutrient intakes are rather similar in the 1976 and 1981 surveys. Consumption of milk, eggs, fish and legumes is not high. The men, but not the women, tended to a high consumption of meat and alcoholic beverages. The intake in 1981 of thiamin, riboflavin and vitamin A seems in general to be inadequate according to our recommended values. The biochemical data show practically no difference in the two surveys. Serum cholesterol continued to be rather high for an Italian population.

[A little known source of lead poisoning: rasp and file manufacture (author's transl)]. / Una fonte poco conosciuta di saturnismo: la produzione artigianale di raspe e lime

Seventy-two subjects employed in rasp manufacturing and, especially, manual "engraving" were studied by the authors, mainly in order to find out whether lead poisoning could be induced by their particular working activity. Twelve subjects (16.7%) were found to have standard biological parameters for lead (blood lead, urinary delta-ALA and urinary coproporphyin levels) within normal limits. Twenty-five (34.7%) showed hematochemical and urinary signs of increased lead absorption, and 35 (48.6%) marks of lead poisoning, more or less severe. The manufacturing process was then studied and working places were inspected too. Finally, lead poisoning was found to be due to a small lead block, used by hand-engravers in order to avoid damages to the already engraved surfaces of the rasps. This survey leads therefore to the conclusion that rasp manual engraving has to be included among the working activities which can induce lead poisoning.