The use of an emergency ward by patients with depressive or anxiety disorders: a one year follow-up study.

OBJECTIVE: The present study examined patients during the year after the index hospitalization in an Emergency Ward (ED) to determine whether patients with depressive or anxiety disorders have a higher rate of readmission than patients without these conditions. METHOD: For this purpose, 165 subjects (85 diagnosed with DSM-IV depressive or anxiety disorders and 80 controls) were evaluated with the Hospital Anxiety and Depression Scale (HADS) and with the Duke Severity of Illness Scale both during the index hospitalization and one year later. Hospitalizations during the follow-up period were determined using the hospital database. RESULTS: During the follow-up period, depressed and anxious patients were more frequently rehospitalized in ED wards than controls (p = 0.006), after controlling for the effect of medical illnesses severity, marital status, living arrangement, and employment status. No difference was found regarding the admissions to wards different from ED. CONCLUSIONS: Patients with depressive or anxiety disorders use the ED ward more frequently than controls for the diagnosis and treatment of somatic symptoms.

The vertebral canal and the lateral recess of the lombar tract: an anatomo-radiologic study.

To address this work, we studied the vertebral canal and the lateral recess at the L1 to L5 level. The importance of this tract of vertebral column lies in the frequent pathologies involving this anatomical region. In fact, the diagnosis of any pathological condition requires the knowledge of the normal status of that anatomical district. In particular, in this study, we suggested the presence of a relation between the diameter of vertebral canal and lateral recess. In addition, the age of the subjects did not seem related to these diameters. In conclusion, we confirmed also that the living-obtained data have a practical utility for clinical and surgical applications.

[Spiral CT in maxillo-facial trauma]. / Spiral-TC in traumatologia maxillo-facciale.

Fractures of facial skeleton are common in a busy emergency department in often requires careful radiological study before surgical treatment. Radiographic evaluation of facial injuries is especially challenging because the complex facial structure results in a confusing overlapping of densities on the radiograph. Instead Spiral-CT enables obtaining images on different planes so that even subtle or complex fractures may be evaluated in the best way. Moreover, associated lesions of important organs can be diagnosed. Our purpose is to verify the value of Spiral-CT in traumatology of facial skeleton. We have evaluated retrospectively the images of 82 patients admitted for facial trauma. On the basis of our findings we think that conventional radiography should be reserved only for light traumas of superficial structures (nose, zygomatic arch, body of jaw); in the remaining cases Spiral-CT should be the first radiological examination.

[Cervical spine injuries: diagnostic imaging]. / Traumatologia del rachide cervicale: diagnostica per immagini.

In past few years, traumas of cervical spine have increased, chiefly owing to rise of road accidents. Nevertheless, only in a small percentage of cases lesions of cervical spine occur and, in order to reduce many negative radiographs, a careful clinical examination is required. Our purpose is to verify the value of radiology in evaluation of acute trauma of cervical spine and to propose an adequate radiological protocol. In the course of two years (1998-99), 376 patients were admitted in consequence of cervical trauma of different degree of gravity. In all patients, conventional radiographs were obtained, in 93 a computed tomography (CT) examination was executed and only in 18 patients with neurological symptoms a magnetic resonance (MR) was required. Fractures of cervical spine wee identified in 91 cases and in patients in which MR images were obtained, neurological lesions of various severity were diagnosed. On the basis of our results, we think that, in a clinical suspicion of cervical spine lesions, a conventional radiographic study has first to be performed even if often good radiographs aren't obtained for technical difficulties. If doubts persist on conventional radiographs or a fractures has already been diagnosed on radiographs but we want to verify its stability, a CT needs to be performed. MR is required if neurological symptoms are present in order to diagnose lesions of spinal marrow, nerve roots or ligaments.

Measurements of the diameter of the abdominal aorta using C.T.

The purpose of this study was to verify the difference between diameters of abdominal aorta obtained on corpses and on living bodies, using C.T. The Authors focused the attention on abdominal aorta, beneath kidney veins. Moreover, a linear relationship was found between height and diameter of abdominal aorta. A careful examination of the literature has shown discordance among the values of the abdominal aorta. The Authors conclude that improved techniques of radiological anatomy may offer an important support to obtain important data for clinical practice.

Tuberculin skin test conversion rates in New York City Emergency Medical Service health care workers.

OBJECTIVE: To determine annual tuberculin skin test conversion (infection) rates for prehospital health care workers (EMTs and paramedics) in an urban environment with a high prevalence of Mycobacterium tuberculosis. METHODS: We conducted a prospective study of prehospital health care workers for the New York City EMS, EMS Employee Health Service, and the Fire Department Bureau of Health Service to determine the tuberculin skin test conversion rates. In 1992, all current and new EMS prehospital health care workers without a known history of a positive tuberculin reaction received a baseline tuberculin purified protein derivative (PPD) skin test. Thereafter, (January 1, 1993-December 31, 1996) all EMS health care workers who had negative PPD skin test results received annual tuberculin PPD skin tests. Tuberculin skin test conversion was defined as induration of 10 mm or greater in a worker with a documented prior negative test result. The PPD skin test reaction was measured by trained professional readers. RESULTS: A total of 7,290 PPD test results were read during this study. Compliance with annual testing was 75%. Annual tuberculin skin test conversion rates were 1.3% in 1993, .7% in 1994, .1% in 1995, and .2% in 1996 (average .5%). In a static subgroup with at least 15 years' seniority, compliance with annual testing was 100% and annual tuberculin skin test conversion rates were .5% in 1993, 0 in 1994, .5% in 1995, and 1.5% in 1996 (average .6%). CONCLUSION: Despite the high prevalence of M tuberculosis infection in New York City and the potential for difficulty in the use of respiratory precautions during emergency response operations, EMS prehospital health care workers have an annual tuberculin conversion rate that is relatively low compared with hospital-based health care workers.

Triphasic waves associated with acute naproxen overdose: a case report.

Triphasic waves (TWs) can be recorded on EEG in the course of several metabolic disorders, mainly hepatic encephalopathy. A case of acute encephalopathy due to naproxen intoxication is reported, in the course of which diffuse, bilateral and symmetrical TWs were recorded. Biochemical mechanisms that might determine both a complex encephalopathy and TWs are discussed.

Nifedipine and methylprednisolone in facilitating ureteral stone passage: a randomized, double-blind, placebo-controlled study.

Expulsive medical therapy of ureteral stones is not well established. To test the efficacy of a calcium antagonist (nifedipine) associated with a corticosteroid (methylprednisolone) in facilitating ureteral stone passage, we studied 86 patients with a unilateral ureteral radiopaque stone not larger than 15 mm. in maximum diameter, confirmed in each case by drop excretory urography. Patients were randomly treated for a maximum of 45 days under double-blind conditions with 16 mg. methylprednisolone plus 40 mg. nifedipine daily (group 1-13 women and 30 men, mean age 45 +/- 14 years, standard deviation) and with 16 mg. methylprednisolone plus placebo daily (group 2-18 women and 25 men, mean age 43 +/- 14 years). All patients also received 2 l. of low mineral content water daily. The average maximum diameter of the stones was 6.7 +/- 3.0 mm. in group 1 and 6.8 +/- 2.9 mm. in group 2 (not significant). Partial ureteral obstruction was present in approximately half of the patients in both groups. Four patients in group 1 and 6 in group 2 dropped out of the study. In group 1, 34 patients had successful results (stone passage without surgical manipulation) and 5 failed (success rate 87%), compared to 24 and 13, respectively, in group 2 (success rate 65%). This difference was significant (p = 0.021, Fisher's exact test). No difference was present in the maximum stone diameter among the successful cases in groups 1 and 2 (6.4 +/- 2.8 and 5.3 +/- 2.2 mm., respectively, not significant). In both groups the maximum diameter of the stone was larger in the failed than in the successful cases (group 1-10.4 +/- 3.0 versus 6.4 +/- 2.8 mm., p = 0.005, and group 2-9.3 +/- 2.5 versus 5.3 +/- 2.2 mm., p = 0.0001). In group 1 the mean interval for stone passage in the successful cases was 11.2 +/- 7.5 days, compared to 16.4 +/- 11.0 days in group 2 (p = 0.036, Student's t test). We conclude that nifedipine associated with methylprednisolone is effective in facilitating ureteral stone passage.

Cobalt powdersintering industry (stone cutting diamond wheels): a study of environmental-biological monitoring, workplace improvement and health surveillance.

This communication deals with an aspect of occupational hygiene in a factory producing granite cutting diamond wheels by sintering, in moulds, of fine cobalt powder. The factory has been studied between 1988 and 1991; the Department of Preventive and Occupational Medicine of the Local Sanitary Unit of Reggio Emilia has followed the evolution of the local exhaust ventilation equipment supplied by the employer in that period. At the same time, the following measurements and observations were carried out: (a) cobalt exposure by personal sampling, (b) airborne cobalt measurements by area sampling, (c) biological monitoring of cobalt in urine, (d) health surveillance.

[Lymphocyte subpopulations in workers exposed occupationally to styrene]. / Sottopopolazioni linfocitarie in lavoratori professionalmente esposti a stirene.

In a group of 32 workers occupationally exposed to styrene, the distribution of lymphocyte subsets was investigated by automated flow cytometry. The group under study consisted of 22 male and 10 female workers aged 39.7, D.S. = 10 years and employed for 6.8 years in factories manufacturing glass fibre-reinforced plastics. A control group (12 males and 7 females) recruited according to the same selection criteria was simultaneously examined. Environmental and biological monitoring was used to characterize styrene exposure. In styrene-exposed workers, phenotypic analysis of peripheral blood revealed a reduced proportion of T helper lymphocytes and a relative increase in the T suppressor subset, leading to a significant inversion of the helper/suppressor ratio (0.92) among heavily exposed workers (greater than 50 ppm, 8h-TWA) as compared to less exposed workers and controls (1.37 and 1.43 respectively). The proportion of natural killer (NK) T lymphocytes was significantly increased among styrene workers. The proportion of B lymphocytes was unchanged as compared to the control group. Dose-response relationships were clearly apparent for the observed increases in the prevalence of abnormalities: none of control subjects showed more than 2 (out of 8) abnormal values as compared to 20 and 40% of styrene workers belonging respectively to the low and high exposure group (p less than 0.007). Only a minority of controls exhibited abnormally high levels of both NK and suppressor T lymphocytes (0-5%), the corresponding figures for styrene workers being 7-10% (low exposure) and 45% (high exposure). As a whole, the findings support the hypothesis of the immunotoxicity of styrene, which could be due either to direct effects on lymphocytes or to indirect mechanisms possibly mediated by neuroendocrine changes.

[The determination of serum amino-terminal procollagen type-III propeptide (PIIINP) in occupational exposure to rock wool fiber]. / Il dosaggio del propeptide aminoterminale del procollagene III sierico (PIIINP) nell'esposizione professionale a fibre di lana di roccia.

Fifty-six males workers exposed to rock wool during production, and 20 referents were examined. Exposure, evaluated by personal sampling, ranged from 0.05 to 0.74 fibres/ml (median 0.15). The subjects underwent a medical examination, chest X-ray according to ILO recommendations and pulmonary function tests. In all subjects the serum levels of type III procollagen N-terminal propeptide (PIIINPs) were determined. No evidence of pulmonary fibrosis, nor work-related lung diseases were observed. PIIINPs mean values in the exposed (9.8 ng/ml; 2.8 S.D.) were slightly higher, but not significantly different when compared to referents (8.5 ng/ml; 2.5 S.D.). No significant correlation between PIIINPs and rock wool exposure (both airborne levels and exposure duration) was observed. Furthermore, peptide levels were not related to pulmonary function test results. Our results suggest that occupational exposure to rock wool fibres lower than 0.75 fibres/ml for less than 20 years does not induce definite cases of pulmonary fibrosis nor an increase of type III collagen synthesis in the lung.

[Anatomo-radiologic study of the mesenteric small intestine using double-contrast enema. II. The surface of the mucous membrane]. / Studio anatomo-radiologico dell'intestino tenue mesenteriale mediante enteroclisi a doppio contrasto. Parte II: I rilievi della tonaca mucosa.

X-ray analysis were used to study the jejunum and ileum, in vivo. 2019 patients were examined by double contrast small bowel enema. We considered some parameters concerning the folds of its mucous membrane and its thickness and depth. Furthermore, we considered the radiological appearance of the Peyer's patches and solitary lymphatic follicles. The results are according to the literature.

[Anatomo-radiological study of the mesenteric small intestine using double-contrast enteroclysis. I. Position, length and diameter of the loops, thickness of their walls]. / Studio anatomo-radiologico dell'intestino tenue mesenteriale mediante enteroclisi a doppio contrasto. Parte I: Posizione, lunghezza e diametro delle anse; spessore della parete.

The Authors examined some anatomical parameters concerning the jejunum and ileum as the relationship between the loops, their extension, length, diameter and the wall thickness. 2019 patients have been studied by "double contrast small bowel enema". The results are in general according with the literature. Only the measure of the length changed, in fact it is shorter than that indicated in the literature.

[Comparison of HbA1c, fructosamine and the main metabolic parameters in a non-insulin-dependent diabetic population]. / Confronto tra HbA1c, fruttosamina e principali parametri metabolici in una popolazione di diabetici N.I.D.

Our objective was the checking of clinical data obtainable from the assay of some parameters in NID diabetic individuals. To this end, we studied 133 patients--57 males and 76 females, average age 74.36 +/- 1.01 years, 72.6% of which were above 65 years of age. The control population was subdivided as follows: 50 subjects, 26 F and 24 M; average age 71.25 +/- 1.32 years, with normal glucidic tolerance as assessed by OGTT. Current glycemia, average glycemia, fructosamine, glycosylated hemoglobin, triglycerides, LDL-cholesterol and apolipoprotein B were obviously much higher than normal in the individuals admitted to the study. A statistically significant correlation was found between average glycemia, glycosylated hemoglobin, LDL-cholesterol and blood triglycerides (p less than 0.05). No correlation was found between current glycemia, fructosamine and glycosylated hemoglobin. Similarly, serum fructosamine was unrelated to the parameters studied. In our study, fructosamine, glycosylated hemoglobin and current glycemia offered unrelatable data. Hence, in our opinion it is necessary to assay these three parameters contemporaneously for a reliable assessment of metabolic compensation.

[Homeostasis of blood glucose and abuse of exogenous opiates: evaluation of fructosamine and glycosylated hemoglobin]. / Omeostasi glicemica ed abuso di oppioidi esogeni: valutazione della fruttosamina e dell'emoglobina glicosilata.

The study was designed to assess glycaemic homeostasis in different situations of chronic stimulation of the opiate receptors by exogenous opiates. After an OGTT, levels of glycosylated haemoglobin (HbA1c) and serum fructosamine were measured in 3 groups of male drug addicts of comparable age. Group A consisted of 10 subjects undergoing substitution treatment with oral methadone. Group B consisted of 10 subjects addicted to intravenous injection of the syrup based methadone intended for oral administration. Group C consisted of 10 heroin addicts. Ten healthy subjects of the same age and sex were used as controls. Analysis of the results showed normal glucose tolerance in all groups with tendentially higher basal glycaemia levels in group B. HbA1c levels were significantly higher, though within normal limits, in group B than in either those receiving oral methadone (p less than 0.01) or the heroin addicts (p less than 0.01). The group B subjects also showed the highest fructosamine levels that were both well above normal limits and higher than those in the other groups in whom fructosamine levels were normal. The data therefore confirm normal glycaemia compensation in those taking oral methadone and in heroin addicts during the period considered. A new type of drug addiction involving the intravenous injection of methadone was also encountered. This produces an outstanding short-term change in glycaemic homeostasis and may well lead to future alterations in glucose tolerance.