[Study of lung cancer risk in the electroplating industry in Lombardy based on the OCCAM method]. / Studio del rischio cancerogeno per il polmone nell'industria galvanica in Lombardia basato sul metodo OCCAM.

BACKGROUND: The OCCAM method consists of case-control studies aimed at estimating occupational risks by cancer site, by area and by economic sector, using available archives to identify cases and controls; for exposure definition each subject is assigned to the category code of the economic sector or company where he/she worked the longest, obtained by automatic link with the Social Security Institute (INPS) files. The reference category (unexposed) consists of service industry workers. The economic sector is given by the ATECO category that INPS assigns to each firm. OBJECTIVES: In the Lombardy Region, lung cancer risk evaluated for the "metal treatment" industry as a whole was 1.32 (90% CI 1.33-3.10, 67 cases) for males and 1.33 (90% CI 0.51-3.59, 10 cases) for females. The aim of the study was to estimate lung cancer risk among metal electroplating workers only. METHODS: The metal electroplating firms were identified according to the detailed description of production, data which was also contained in INPS files, instead of using the "metal treatment" ATECO code. Lung cancer risk was evaluated using 2001-2008 incident cases identified from hospital discharge records of residents in the Lombardy Region. Controls were a sample from National Health Service files. RESULTS: For the group of firms identified as metal electroplating industries the risk was 2.03 (90% CI 1.69-8.32, 18 cases) for males and 3.75 (90% CI 1.38-9.03, 4 cases) for females. CONCLUSIONS: Focusing on the true electroplating firms increased the risk estimates. Even though these risk were due to past exposures, case histories and recent acute effects indicate that, at least in some factories, a carcinogenic hazard still exists.

Cardiopatías Congénitas, Resultados del Manejo Perioperatorio en 18 Meses: Experiencia en el Departamento de Cardiocirugía Centro Materno Infantil. UNA / Results of Perioperative Care of Patients with Congenital Heart Defects during 18 Months: Experience of the Cardiac Surgery Department of the Centro Materno Infantil. National University of Asunción

Introducción: La sobrevida de los pacientes con cardiopatías congénitas ha mejorado en los últimos años gracias al perfeccionamiento en las técnicas diagnósticas, quirúrgicas, anestésicas y de perfusión, así como al advenimiento de nuevas y más selectivas drogas cardiológicas. Objetivos: Describir el manejo perioperatorio y la evolución postoperatoria de las cirugías realizadas en el Departamento de Cardiocirugía de la Cátedra y Servicio de Pediatría del Centro Materno Infantil (CMI), FCM-UNA en 18 meses de atención y su relación con el carácter de la cirugía (electiva o de urgencia), y el estado físico preoperatorio del paciente, definido por los criterios de la American Society of Anesthesiologists (ASA). Materiales y Métodos: Estudio observacional, retrospectivo, descriptivo, con componente analítico; se utilizaron fichas clínicas de pacientes operados en el Departamento de Cardiocirugía de enero de 2007 a junio de 2008. Resultados: Fueron operados 91 pacientes, 38 de sexo masculino (42%) y 53 de sexo femenino (58%), con edades comprendidas entre 2 días y 18 años. Las cardiopatías fueron 54/91 (59,3%) patologías simples y 37/91 (40,7%) patologías complejas. Todas con confirmación diagnóstica preoperatoria por ecocardiografía Doppler color. Precisaron cateterismo cardiaco preoperatorio 3/91 pacientes (3,3%). El 100% de las cirugías se realizaron con anestesia general balanceada. De los 91 pacientes operados, 42 (46,2%) fueron sometidos a circulación extracorpórea (CEC) y 49 (53,8%) sin CEC. De los 42 pacientes operados con CEC, todas fueron cirugías correctivas, 40 (95,2%) electivas, 2 (4,8%) de urgencia, 3 (7,1%) reintervenciones y 2 (4,8%) fallecieron. Presentaron complicaciones 16 pacientes (38,1%), 39 (92,9%) requirieron Asistencia Respiratoria Mecánica (ARM) menos de 24 horas y 3 (7,1%) más de 24 horas. Los tiempos de clampado aórtico variaron de 13 a 167 minutos (media 49,1) y los tiempos de CEC de 20 a 253 minutos (media 71,9). Se realizó ultrafiltrado plasmático (UFP) en el 100% de los pacientes operados con CEC, y todos ellos recibieron aprotinina para profilaxis del sangrado. De los 49 pacientes operados sin CEC, 30 (61,2%) fueron cirugías correctivas, 19 (38,8%) paliativas, 31 (63,3%) electivas, 18 (36,7%) urgencias, 1 (2,1%) reintervención y 10 (16,3%) fallecieron. Presentaron complicaciones 18 pacientes (36,7%), 39 (79,6%) precisaron ARM menos de 24 horas y 10 (20,4%) más de 24 horas. Del total de pacientes operados, 34 presentaron alguna complicación, el 50% fue de tipo hemodinámico, 35,3% respiratorio, 23,5% neurológico, 14,7% infeccioso, 14,7% metabólico, 11,8% hematológico y 11,8% renal. El 28% de las complicaciones se presentaron en las cirugías electivas y el 65% en las urgencias. Conclusiones: La morbimortalidad de los pacientes estuvo directamente relacionada con dos factores: el carácter urgente de la cirugía y el estado físico preoperatorio del paciente (evaluado según criterio de la American Society of Anesthesiologists ASA). No hubo mortalidad en las cirugías electivas y los pacientes fallecidos correspondieron a un estado físico preoperatorio ASA 4. La utilización intraoperatoria de UFP y aprotinina contribuyó para la buena evolución de las cirugías con CEC.

Introduction: Survival of patients with congenital heart defects has improved in recent years thanks to improved diagnostic, surgical, anesthetic, and extracorporeal circulation techniques, and the arrival of new and more selective cardioactive drugs. Objectives: To describe perioperative care and postoperative progress of patients following surgery performed in the department of cardiac surgery and pediatrics department of the Centro Materno Infantil (CMI) of the national university’s school of medical sciences over a period of 18 months, and its relationship to the type of surgery performed (elective or emergency) and the patient’s presurgical physical status classification of the American Society of Anesthesiologists (ASA-PS). Materials and Methods: A retrospective, descriptive, observational study with an analytical component using the medical records of patients operated on in the department of cardiac surgery between January 2007 and June 2008. Results: Of the 91 patients undergoing surgery, 38 (42%) were male, and 53 (58%) were female, with ages ranging from 2 days to 18 years. Uncomplicated heart disease was found in 54 patients (59.3%), and complications confirmed by color Doppler echocardiography were found in 37 (40.7%). Cardiac catheters were needed before surgery by 3 patients (3.3%). All surgeries (100%) were performed under balanced general anesthesia. Of the 91 patients operated on, 42 (46.2%) received extracorporeal circulation (ECC) and 49 (53.8%) did not. Of the 42 patients who received ECC, all involved corrective surgery, with 40 (96.2%) of those being elective, and 2 (4.8%) emergency surgery, while 3 (7.1%) were reoperated and 2 (4.8%) died. Complications appeared in 16 patients (38.1%), with 39 (92.9%) requiring mechanically assisted ventilation (MAV) for less than 24 hours, and 3 (7.1%) who received MAV for more than 24 hours. Aortic clamping time ranged from 13 to 167 minutes (mean 49.1 min.) and ECC times from 20 to 253 minutes (mean 71.9 min.). Plasma ultrafiltration (pUF) was done in all (100%) of patients operated on who received ECC, all of whom also received prophylactic aprotinin for bleeding. Of the 49 patients operated on without ECC, 30 (61.2%) were corrective surgeries, 19 (38.8%) were palliative, 31 (63.3%) were elective, 18 (36.7%) were emergency surgery, 1 (2.1%) was a reoperation, and 10 (16.3%) died. Complications appeared in 18 patients (36.7%), with 39 (79.6%) requiring MAV for less than 24 hours, and 10 (20.4%) receiving MAV for more than 24 hours. Of the patients operated on, 34 developed complications, 28% in elective surgeries and 65% in emergency surgeries; by type these were 50% were hemodynamic; 35.3% respiratory, 23.5% neurological, 14.7% infectious, 14.7% metabolic, 11.8% hematological, and 11.8% renal. Conclusions: Morbidity and mortality were directly related to two factors: being emergency surgery, and the pre--surgical physical status classification of the patient as per the ASA-PS. There were no deaths in the elective surgeries, and the patients who died had an ASA4 preoperative physical status classification. Intraoperative use of pUF and aprotinin contributed to the favorable progress of the patients operated on with use of ECC.

Presentación clínica de coartación de aorta, relato de casos: revisión de manejo actual / Clinical presentation of aortic coarctation: review of current management: a case series report

La coartación de Aorta es una cardiopatía congénita que se presenta con insuficiencia cardiaca congestiva precozmente sobre todo en la edad neonatal y que, de no ser diagnosticada oportunamente evoluciona con elevadísima morbi-mortalidad. Cuando sobrevive a la barrera de la primera infancia, cursa con hipertensión arterial sistémica, pudiendo debutar incluso con un accidente cerebrovascular, con resultado fatal para el paciente, ó dejarlo con incapacidades como secuela. Resaltamos la importancia del correcto y detallado examen clínico cardiovascular, que incluya la palpación adecuada de los pulsos periféricos así como la medición de la presión arterial sistémica, debido a que siempre cursa con hipertensión arterial en los miembros superiores y ausencia de pulsos en los miembros inferiores. Tratado correctamente presenta bajo riesgo de complicaciones y de mortalidad.

Aortic coarctation is a congenital heart defect that presents with early congestive heart failure, especially during the neonatal stage, and which if not opportunely diagnosed progresses with a high degree of morbidity and mortality. When patients survive the barrier of early childhood, they continue having such problems as systemic arterial hypertension, and run risks of outcomes such as fatal or incapacitating cerebrovascular accident. We emphasize the importance of a careful and detailed clinical cardiovascular examination, to include adequate taking of the peripheral pulses and measurement of systemic blood pressure, since this always presents with hypertension in the upper limbs and an absence of pulses in the legs. Treated adequately, it presents little risk of complications or mortality.

Cardiopatías congénitas,resultados del manejo perioperatorio en 18 meses: experiencia en el departamento de cardiocirugía: Centro Materno Infantil, Universidad Nacional de Asunción / Results of perioperative care of patients with congenital heart defects during 18 months experience of the cardiac surgery department of the Centro Materno Infantil: National University of Asunción

Objetivos: Describir el manejo perioperatorio y la evolución postoperatoria de las cirugías realizadas en el Dpto. de Cardiocirugía de la Cátedra y Servicio de Pediatría del CMI-FCM-UNA en 18 meses de atención y su relación con el carácter de la cirugía y el estado físico preoperatorio del paciente. Fueron operados 91 ptes, 53 de sexo femenino (58%), con edades comprendidas entre 2 días y 18 años. Las cardiopatías fueron 54(59,3%) patologías simples y 37(40,7%) patologías complejas, todas con confirmación diagnóstica preoperatoria por ecocardiografía Doppler color. Precisaron cateterismo cardiaco preoperatorio 3 ptes.(3,3%). El 100% de las cirugías se realizaron con anestesia general balanceada. De los 91 ptes operados, 42(46,2%) fueron sometidos a circulación extracorpórea (CEC) y 49 (53,8%) sin CEC. De los 42 ptes. operados con CEC, todas fueron cirugías correctivas, 40(95,2%) electivas, 2(4,8%) de urgencia, 3(7,1%) reintervenciones y 2(4,8%) fallecieron. Presentaron complicaciones 16 ptes.(38,1%), 39(92,9%) requirieron ARM menos de 24 horas y 3(7,1%) más de 24 horas. Los tiempos de clampado aórtico variaron de 13 a 167 minutos (media 49,1) y los tiempos de CEC de 20 a 253 minutos (media 71,9). Se realizó ultrafiltrado plasmático (UFP) en el 100% de los ptes. operados con CEC, y todos ellos recibieron aprotinina para profilaxis del sangrado. De los 49 pacientes operados sin CEC, 30 (61,2%) fueron cirugías correctivas, 19 (38,8%) paliativas, 31 (63,3%) electivas, 18 (36,7%) urgencias, 1 (2,1%) reintervención y 10 (16,3%) fallecieron. Presentaron complicaciones 18 pacientes (36,7%), 39 (79,6%) precisaron ARM menos de 24 horas y 10 (20,4%) más de 24 horas. Del total de pacientes operados, 34 presentaron alguna complicación, el 50% fue de tipo hemodinámico, 35,3% respiratorio, 23,5% neurológico, 14,7% infeccioso, 14,7% metabólico, 11,8% hematológico y 11,8% renal. El 28% de las complicaciones se presentaron en las cirugías electivas y el 65% en las urgencias...

Introduction: Survival of patients with congenital heart defects has improved in recent years thanks to improved diagnostic, surgical, anesthetic, and extracorporeal circulation techniques, and the arrival of new and more selective cardioactive drugs. Objectives: To describe perioperative care and postoperative progress of patients following surgery performed in the department of cardiac surgery and pediatrics department of the Centro Materno Infantil (CMI) of the national university's school of medical sciences over a period of 18 months, and its relationship to the type of surgery performed (elective or emergency) and the patient's pre-surgical physical status classification of the American Society of Anesthesiologists (ASA-PS). Materials and Methods: A retrospective, descriptive, observational study with an analytical component using the medical records of patients operated on in the department of cardiac surgery between January 2007 and June 2008. Results:Of the 91 patients undergoing surgery, 38 (42%) were male, and 53 (58%) were female, with ages ranging from 2 days to 18 years. Uncomplicated heart disease was found in 54 patients (59.3%), and complications confirmed by color Doppler echocardiography were found in 37 (40.7%). Cardiac catheters were needed before surgery by 3 patients (3.3%). All surgeries (100%) were performed under balanced general anesthesia. Of the 91 patients operated on, 42 (46.2%) received extracorporeal circulation (ECC) and 49 (53.8%) did not. Of the 42 patients who received ECC, all involved corrective surgery, with 40 (96.2%) of those being elective, and 2 (4.8%) emergency surgery, while 3 (7.1%) were reoperated and 2 (4.8%) died. Complications appeared in 16 patients (38.1%), with 39 (92.9%) requiring mechanically assisted ventilation (MAV) for less than 24 hours, and 3 (7.1%) who received MAV for more than 24 hours...

[Occupational safety and health in hospitals of Regione Lombardia. Are there differences among public, private nonprofit and private profit hospitals?]. / Sicurezza occupazionale e salute negli ospedali della Regione Lombardia. Ci sono differenze tra ospedali pubblici e privati, profit e no profit?

In 2006 an extensive survey took place in all hospitals of Lombardia, to assess, through inspections, the safety conditions and the efficiency of the organisations invested to assure that. During these inspections were evaluated 6 safety sections and hospital organization and efficiency, by means of a questionnaire. The aim was to assess the internal consistency of questionnaire sections, the presence of differences of such scores among public, private non-profit and profit hospitals and the correlations among safety scores and among these latter and efficiency indexes. Significant differences for size factors and efficiency indexes have been pointed out among different types of hospitals. Instead, safety scores showed good internal consistency and have been resulted statistically significant correlated in most cases. For all types of hospital have been observed high values for safety scores, with exception of occupational health service, better organized in public hospitals, and of safety conditions of worker from external agencies, which have been displayed low. This last consideration stick out the need to pay more attention to safety conditions of these workers.

[Ethical problems in health surveillance]. / I problemi etici della sorveglianza sanitaria.

Surveillance of workers' health in the field of occupational medicine poses substantial ethical problems in view of occupational medicine's complex responsibilities towards workers and employers, preventive and protection services, workers' representatives, public healthcare and preventive medicine facilities, controlling agencies and judicial authorities. Potentially conflicting rights and duties often come into play in this sector. In the last few years various international and national bodies have drawn up codes of ethics or guidelines for the conduct of physicians in occupational medicine, three of which are of particular importance: 1) The International Ethical Code of the International Commission on Occupational Health (ICOH, 1992); 2) The Code of Conduct of the National Association of Company Doctors (ANMA, 1997); 3) The Technical and Ethical Guidelines for workers' health (ILO, 1998). The chief purpose of all these documents is to safeguard the health of workers and to guarantee the safety of the workplace by defining programmes of health supervision to match specific risks. The methods should be non-invasive and should allow for a check or efficiency. The physician is expected to have a high degree of professionalism and up-to-date skills; to be independent and impartial; to be reserved and capable of inter-disciplinary co-operation. On the basis of the above documents, a number of problematic aspects may be appraised concerning the relationship between the occupational health physician responsible for the surveillance activities of the local health authority and the relative company physician. The documents stress the importance of keeping up to date and of quality, fields in which the dominant role played by Scientific Societies is underlined. Finally it is recommended that health supervision be arranged in such a manner as to foster the professionalism and responsibility of the physician in charge rather than the formal implementation of health-care procedures that are inadequate and not in line with up-to-date scientific knowledge.