Prevalence and risk factors for latex allergy: a cross sectional study on health-care workers of an Italian hospital.

OBJECTIVES: The aim of this study was to determine prevalence and risk factors for latex hypersensitivity among health care workers (HCW) of an Italian general hospital. METHODS: 1747 HCW of the Ospedale Maggiore Policlinico of Milan were asked to fill in a questionnaire regarding latex-related manifestations (LRM) and personal medical history, and latex-specific IgE were measured by RAST-Cap system. RESULTS: 672 out of 1747 HCW (38.4%) answered to the questionnaire. LRM were reported by 168 out of 672 HCW (25%). The most common manifestation was hand dermatitis and itching (86.3%), followed by urticaria (3.5%) and respiratory symptoms (2.9%). Among the HCW with LRM, 75 (44.6%) reported a personal history of atopy and 24 (14.3%) reported oral allergy syndrome. most commonly related to kiwi, tomato, peach and melon/watermelon. Latex-specific IgE were found in 62 out of 1747 HCW (3.6%). Among the subjects answering the questionnaire, latex-specific IgE positivity was associated with occurrence of LRM (most commonly allergic contact dermatitis) and a longer professional exposure. The risk of latex IgE sensitisation was four times higher in HCW reporting atopic manifestations than in HCW without atopic disorders. Prevalence of LRM and latex-specific IgE was significantly higher among workers of auxiliary staff than among other job categories. The highest latex-specific IgE levels were found in subjects with severe latex-related symptoms and a personal history of atopy. CONCLUSIONS: A high prevalence of LRM was found among the HCW of an Italian general hospital, although a true latex sensitisation was detected only in a minority of cases. Members of the auxiliary staff, who wear latex gloves for several hours a day, had an increased prevalence of LRM and latex sensitisation. Atopy was a major risk factor for LRM and latex-specific IgE response.

The effect of extend bar containing uncooked cornstarch on night-time glycemic excursion in subjects with type 2 diabetes.

The objective of this study was to determine the effects of ingesting a snack bar containing uncooked cornstarch (Extend Bar, Clinical Products, Limited, Key Biscayne, FL) on nocturnal glycemic excursion in 28 adults (ages 22-78 years) with type 2 diabetes mellitus (mean HbAlc 8.21+/-1.28%). Thirteen subjects were treated with oral agents, eight with a combination of insulin and oral agents, and seven with insulin alone. Subjects ingested the study bar (Extend Bar, containing 30 g of total carbohydrate, including 5 g of uncooked cornstarch, 3 g protein, and 3 g fat) for three evenings followed by a placebo bar for 3 evenings (30 g of total carbohydrate, 3 g protein, and 3 g fat), or vice versa. Pre-snack before bedtime, midnight and before breakfast finger stick blood glucose levels were compared to determine the incidence of hypoglycemia (<60 mg/dl), hyperglycemia (>250 mg/dl), and to calculate any differences in the group's mean blood glucose levels when ingesting the study versus the placebo bar. There were no episodes of hypoglycemia or hyperglycemia. The mean blood glucose levels pre-snack at bedtime were nearly identical (Extend Bar value 117.5+/-45.6 mg/dl; placebo bar value 117.3+/-40.0 mg/dl; P=0.977), and lower at midnight and before breakfast on the Extend Bar nights compared to the placebo bar nights (Extend Bar, midnight value 127.9+/-31.0 mg/dl; placebo bar midnight value 148.2+/-32.1 mg/dl; P=0.0001; Extend Bar breakfast value 114.2+/-15.8 mg/dl; placebo bar breakfast value 158.49+/-30.3 mg/dl; P<0.0001). These data suggest that ingesting Extend Bar containing uncooked cornstarch as the nighttime snack may be an effective strategy to lesson the frequency of nocturnal and morning hyperglycemia in subjects with type 2 diabetes.

[Role of echography in the differential diagnosis of accessory lobulations and small capsular traumatic fissures of the spleen]. / Ruolo dell'ecografia nella diagnosi differenziale tra lobature accessorie e piccole fissurazioni traumatiche capsulari della milza.

Emergency US in patients with abdominal trauma has become a routine diagnostic exam thanks to both its high reliability and its short acquisition time. US allows the overall evaluation of the patient, relative to both the localization of even very small fluid collections and the evaluation of traumatic changes in parenchymatous abdominal organs, especially the spleen which is often injured. Twelve patients were selected of all the cases submitted to emergency abdominal US between February 1989 and March 1992. All the cases with evident traumatic lesions of the spleen were excluded. In 10 cases US demonstrated interrupted splenic parenchyma, which was highlighted by intraperitoneal fluid collections; the interruption of splenic parenchyma is also evidenced by a thin hyperechoic capsular line with no changes in the echopattern of deep parenchyma. Surgery in 6 patients--4 of them as an emergency for hemoperitoneum and 2 operated subsequently--and US monitoring in the extant cases confirmed the diagnosis of simple accessory splenic lobulations. On the contrary, in 2 patients hospitalized in emergency, US showed no evident traumatic splenic alterations but only interruption of the hyperechoic capsular line with low hypoechogenicity in the splenic parenchyma below and a small fluid collection next to the lower splenic pole. Splenectomy confirmed a limited marginal tear of about 1.5 cm. The misdiagnosis of traumatic tears can be avoided if congenital splenic lobulation--evidenced by hemoperitoneum--is considered. US must also be employed to demonstrate minimal alterations in the hyperechoic capsular line of the spleen, in order to point out possible small tears and, if necessary, to suggest the need for clinical monitoring.

[The dynamic computed tomography of small hepatocarcinomas treated by US-guided percutaneous ethanol injections. The short- and long-term follow-up aspects]. / Tomografia computerizzata dinamica di piccoli epatocarcinomi trattati con iniezione percutanea ecoguidata di etanolo. Aspetti nel follow-up a breve e a lungo termine.

Dynamic CT studies with an automatic injector of iodinated contrast medium were performed in 22 patients affected with 29 hepatocellular carcinomas (HCCs) (phi: 0.8-4.5 cm) before and after treatment with percutaneous ethanol injection (PEI) and during the follow-up period, every 6-9 months. Before PEI, most of the HCCs showed contrast enhancement on CT scans. Treatment was suspended when US-guided fine-needle biopsy demonstrated the absence of malignant cells and when the lesions were unenhanced on dynamic CT scans. Dynamic CT detected 21 HCCs (72.4%) before PEI and 24 HCCs (82.8%) after PEI and during the follow-up period. After PEI, 14 HCCs exhibited a thin and hyperdense peripheral rim on dynamic CT scans. Nine of these lesions, with long-term follow-up (12-31 months), have a smaller diameter than the primary lesion; 6 patients have no HCC recurrence. The authors conclude that dynamic CT is useful for evaluating the effectiveness of PEI in the treatment of HCCs; moreover, their personal experience suggests that the finding of a thin and hyperdense peripheral rim cannot always be related to viable cancerous tissue.

[The efficacy of echography in the diagnosis of gallbladder carcinoma]. / Utilità dell'ecografia nella diagnosi del carcinoma della colecisti.

The preoperative diagnosis of carcinoma of the gallbladder is very difficult because the clinical manifestations of this disease are nonspecific and often indistinguishable from those of cholecystitis. Radiography, including oral cholecystograms and i.v. cholangiograms, give aspecific findings. Ultrasound scans were performed on 13 gallbladder carcinomas: only "massive" cancer was diagnosed correctly, because sonography does not offer specific patterns for "infiltrating" and "fungating" carcinomas.

Evaluation of systolic time intervals in patients with angina pectoris.

We have explored the systolic time intervals of 52 patients with angina pectoris at the time of their hospitalization in our wards. Our results are in close agreement with published data, essentially indicating prolongation of the preejection time and shortening of the ejection time. These alterations of systolic times can be interpreted pathophysiologically as as expressing reduced myocardial contractility. The long PEP-short LVET polygraph picture, occurring in the course of chronic ischemic heart disease, reveals the deficit of myocardial contractility at a stage of the disease at which clinical evidence of left ventricular failure is usually not yet detectable.

A polygraph study of ischemic heart disease: short-term prognosis of acute myocardial infarction based on early modifications of isometric contraction time.

The authors have explored the early modifications of systolic time intervals in 90 patients hospitalized as emergency cases for acute myocardial infarction. From analysis and interpretation of the collected data they conclude that such modifications have considerable prognostic value. All patients fitting the specifications of NYHA classes I and II, but at the same time showing a shortening of the isometric contraction time to less than 39 +/- 1.4 ms turned out to constitute a high-risk group for the development of major mechanical and electrical complications in the next 2 weeks.

[Plasma and intra-erythrocyte variations in acid-base equilibrium in acute acidosis due to acetazolamide loading]. / Le variazioni plasmatiche ed intraeritrocitarie dell'quilibrio acido-base in corso di acidosi acuta da carico di acetazolamide.

Plasma and red cell acid-base equilibrium was studied in 14 healthy subjects following the induction of acidosis by means of i.v. acetazolamide. It was found that changes in red cell values were significantly less marked than those in plasma.

[Metabolic alkalosis. III. Spontaneous and experimental compensation mechanisms in plasma and erythrocytes]. / In tema di alcalosi metabolica. Nota III.--Studio, nel plasma e nell'eritrocito, dei meccanismi di compenso spontanei e sperimentali.

Plasma and red cell acid-base balance were studied in 13 patients with metabolic alkalosis and 14 healthy subjects following the infusion of bicarbonate. Differences between the plasma and red cell patterns suggested that application of the results of plasma determinations to the body as a whole could be the cause of serious inaccuracies. Since the changes noted occurred in different combinations according to whether alkalinisation was acute or not, it is felt that cell response to a fall in (H+) varies in relation to the time available for compensation.

[Metabolic alkalosis. Relation between bicarbonate load and the behavior of blood lactic acid in the light of the intra-erythrocyte indices of the acid-base balance]. / In tema di alcalosi metabolica. I rapporti fra carico di bicarbonato ed andamento della lattacidemia alla luce degli indici intraeritrocitari dell'equilibrio acido-base

The plasma an intra-erythrocyte acid-base balance in man was studied, along with blood pyruvate and lactate levels, in acute metabolic alkalosis induced by i.v. infusion of bicarbonate. It was found that the red cell offers a satisfactory expression of the phenomena that occur in the intracellular space. The bicarbonate ion has difficulty in crossing the red cell membrane, while the production of lactate is seen as a fundamental compensation mechanism for rapid buffering of the extra base.

[Metabolic alkalosis. Compensation mechanisms in the light of new experimental data]. / In tema di alcalosi metabolica. Il problema dei meccanismi di compenso alla luce di muovi dati sperimentali

Changes in arterial blood and erythrocyte acid-base and electrolyte balance in the course of acute alkalinisation caused by bicarbonate loading showed that extracellular alkalosis has no significant effect on the concentration of intraerythrocyte bicarbonate concentration, though a marked increase in pH and electrolyte balance within the red cell is apparent. Erythrocyte alkalinisation may thus be seen as essentially due to the escape of H+ ions, while the entry of Na+ ions is the main device by which the law of electroneutrality is respected. The literature suggests that lactic acid offers a source of H+ ions for destruction of bicarbonate, whereas the diffusion of the ion lactate within the cell is compensated by the release of Cl-. In addition, the data now reported indicate that the red cell is a sufficiently valid model for the study of phenomena occurring within the intracellular compartment when a state of extracellular alkalinisation in created.