Hypertension and obesity in Italian school children: The role of diet, lifestyle and family history.

BACKGROUND AND AIMS: In Italy, the prevalence of hypertension, obesity and overweight in paediatric patients has increased in the past years. The purpose of this study was to analyse the relationship between obesity and hypertension and related factors in Italian students. METHODS AND RESULTS: We studied 2007 healthy individuals between the ages of 6 and 17 years of age (998 males and 1009 females) attending schools in the cities of Varese (northern Italy), Rome (central Italy) and Catanzaro (southern Italy). The blood pressure, weight and height of the students were measured. We also assessed their daily intake of foods and the amount of physical activity they performed. A questionnaire was administered to the parents of the subjects to obtain information on the child's medical history and family lifestyle. Of the students, 27.2% were overweight, and 6.6% were obese, with the highest percentages in southern Italy. A total of 6.2% of students had hypertension, and the region with the highest percentage was found to be northern Italy. Obese students had a risk of developing hypertension that was four times greater than those subjects who were of normal weight. CONCLUSION: Overweight and obese children/adolescents were more frequently found in southern Italy as opposed to northern and central Italy, and hypertensive children were more prevalent in the north. An unhealthy diet might explain the more widely spread obesity among children living in the south; an excess use of salt could explain the greater rate of hypertension found among children/adolescents living in the north.

[Discrimination at the workplace among immigrants in Italy]. / La discriminazione nell'ambiente di lavoro tra gli immigrati in Italia.

BACKGROUND: Discrimination at the workplace can be considered a risk factor for immigrants' health. OBJECTIVES: In this study we compared the occurrence of episodes of arrogance or discrimination perceived at the workplace between documented immigrants coming from countries with high migration pressure and Italians, and evaluated the role of selected risk factors among immigrants. METHODS: Using data from the 2007 Labour Force Survey conducted by the Italian National Institute of Statistics, adjusted odds ratios (ORs) for socio-demographic and occupational variables were estimated among a nationally representative sample of 61,214 employed persons aged 15 years or more. RESULTS: The occurrence of perceived arrogance or discrimination was higher among immigrant compared to Italian males for all geographical areas of origin considered. Adjusted ORs were 4.6 (95% CI: 3.6-5.8) for Africans, 3.4 (95% CI: 2.5-4.6) for Asians, 2.1 (95% CI :1.6-2.8) for Eastern Europeans, and 2.0 (95% CI: 1.0-3.7) for Latin Americans. Among male immigrants a higher occurrence of arrogance or discrimination was found for construction and other industrial workers and for those residing in central-southern regions of Italy. Among female workers only Latin Americans and Africans showed a higher occurrence of perceived arrogance or discrimination compared to Italians: adjusted ORs were respectively 3.9 (95% CI: 2.6-5.7) and 2.6 (95% CI:1.5-4.5). Female immigrants with a medium-to-high level of education or a highly skilled job, and those residing in the central-southern regions of ltaly perceived the highest occurrence of arrogance or discrimination. CONCLUSIONS: The study highlighted the need for policies to protect the wellbeing of immigrants that seem to be particularly exposed to patterns of discrimination at the workplace.

A systematic review of the literature concerning the relationship between obesity and mortality in the elderly.

INTRODUCTION: Obesity is a risk factor for chronic diseases and premature mortality, but the extent of these associations among the elderly is under debate. The aim of this systematic literature review (SR) is to collate and critically assess the available information of the impact of obesity on mortality in the elderly. METHODS: In PubMed, there are three-hundred twelve papers on the relationship between obesity and mortality among older adults. These papers were analysed on the basis of their abstracts, and sixteen studies were considered suitable for the purpose of the study. It was possible to perform a pooled estimate for aggregated data in three different studies. CONCLUSION: The results of this SR document that an increased mortality in obese older adults. The limitation of BMI to index obesity and the noted protective action of a moderate increase in BMI on mortality are highlighted. Waist circumference is an indicator of central adiposity and potentially as good a risk factor for mortality as BMI in obese elderly adults.

Effective dose delivered by conventional radiology to Aosta Valley population between 2002 and 2009.

OBJECTIVE: Medical diagnostic procedures can be considered the main man-made source of ionising radiation exposure for the population. Conventional radiography still represents the largest contribution to examination frequency. The present work evaluates procedure frequency and effective dose from the majority of conventional radiology examinations performed at the Radiological Department of Aosta Hospital from 2002 to 2009. METHOD: Effective dose to the patient was evaluated by means of the software PCXMC. Data provided by the radiological information system allowed us to obtain collective effective and per caput dose. RESULTS: The biggest contributors to per caput effective dose from conventional radiology are vertebral column, abdomen, chest, pelvis and (limited to females) breast. Vertebral column, pelvis and breast procedures show a significant dose increment in the period of the study. The mean effective dose per inhabitant from conventional radiology increased from 0.131 mSv in 2002 to 0.156 mSv in 2009. Combining these figures with those from our study of effective dose from CT (0.55 mSv in 2002 to 1.03 mSv in 2009), the total mean effective dose per inhabitant increased from 0.68 mSv to 1.19 mSv. The contribution of CT increased from 81% to 87% of the total. In contrast, conventional radiology accounts for 85% of the total number of procedures, but only 13% of the effective dose. CONCLUSION: The study has demonstrated that conventional radiography still represents the biggest contributor to examination frequency in Aosta Valley in 2009. However, the frequency of the main procedures did not change significantly between 2002 and 2009.

Increased annual frequency of Hashimoto's thyroiditis between years 1988 and 2007 at a cytological unit of Sicily.

Like other auto-immune diseases, Hashimoto's thyroiditis (HT) results from the interaction of genetic with environmental factors. Only few studies have evaluated the year-to-year change in frequency of HT over a wide period of time. The endocrine division of our Hospital has reported a great increase in the annual frequency of HT between 1975 and 2005, and a progressive decrease in both age at presentation and female to male (F/M) ratio starting in the mid-1990s. Between years 1988 and 2007, we have collected 8397 adequate examinations by fine needle aspiration cytology (FNAC) on 8397 persons referred for the evaluation of a solitary or dominant thyroid nodule (total FNAC and persons=8520) with a 14-fold increase in 2007 over 1988. In this 20-year period, cases of HT, De Quervain's thyroiditis (DQT) and Riedel's thyroiditis (RT) were 490, 36 and two, respectively. HT cases were one in 1988 but 90 in 2007, with a significant upward temporal trend (r=0.919, P<0.001) and significant downward trend for age at FNAC (r=-0.466, P<0.05). In contrast, DQT cases were zero and one, respectively, with no significant temporal trend (r=0.29, P=0.21). The HT increase in frequency started in 1996 (+350% over 1995). Until 1995 there was only one man, but there were 22 men in 2005-2007. These FNAC data provide independent confirmation to the data from the endocrine division of the same hospital, further supporting the conclusion that only environmental modifications can explain these marked changes that have occurred in such a relatively short period of time.

[Fertility changes in women working in greenhouses]. / Alterazione della fertilità nelle lavoratrici in serra.

BACKGROUND: Greenhouse workers (GW) are exposed to environmental contaminants, including pesticides, that may not only cause known immediate effects such as acute poisoning, but also long-term effects related to chronic exposure to low dosages, a problem that has not been extensively studied This study investigated the relationship between fertility changes and exposure to pesticides in a group of women working in greenhouses. STUDY GROUP AND METHODS: The analysis is based on a retrospective cohort of 145 women working in greenhouses located in the province of Latina, Lazio Region, Italy, who were exposed to pesticides at the time of their first pregnancy. Information on health status, lifestyle, work activity, reproductive history and some confounding factors (age, smoking, alcohol abuse, drug consumption) were collected using a questionnaire. Exposure to pesticides was classified in two levels (high or low) according to the work task and the length of exposure. Changes in fertility were measured in terms of time to pregnancy (TTP), that is the number of non-contraceptive cycles that it takes a couple to conceive. A control group was selected among public administration employees in the same province. The difference in average TTP between exposed and non-exposed groups was analysed by using Student t-test. A Cox proportional hazard model was used to compare TTP between the two groups after correction for confounding factors. RESULTS: In the high-level exposure group average TTP was 10.8 months (+/- 2.0), among the non-exposed average TTP was 6.2 months (+/- 1.0). The difference between exposed and non-exposed was thus 4.6 months (p<0.05). Comparison of the distribution of TTP between the high-level exposure group and nonexposed resulted in a hazard ratio of 1.27 (I.C. 95%: 1.03-1.79); the same analysis using the low-level exposure group and non-exposed group yielded a hazard ratio of 1.12 (I.C. 95%: 0.67-1.87). DISCUSSION: The study showed reduced fertility, in terms of TTP, in the population exposed to pesticides. Among GW, TTP was as much as 50% higher than for the control group. Controlling for confounding factors, the study confirmed an increase in risk for the exposed group. The issue under investigation, however, is complex as health status is not the only factor that needs to be taken into account in studies of reproductive health; emotional status as well as congenital and acquired factors may also have a notable impact on women's fertility. Occupational exposure, therefore, can be said to be a condition requiring careful analysis while bearing in mind that other factors may influence the outcome.

Factors associated with health-related quality of life: the role of social relationships among the elderly in an Italian region.

OBJECTIVES: This study examines the association between social relationships and health-related quality of life (HRQL) in the elderly in Lazio Region, Italy, a Mediterranean country where the shape and role of social links has dramatically changed. METHODS: Data were extracted from a national cross-sectional survey in Italy, representative of the non-institutionalised population aged 60 years and over resident in Lazio Region during 1999--2000. HRQL was measured with the Short Health Survey Questionnaire (SF-12). Data analysis was performed using multiple linear regression models using adjustment for the main confounders. RESULTS: Among the sample, 40.4% of the elderly were not married and 27.1 % were living alone. While being married and not living alone were associated with higher scores in the physical and mental quality-of-life components (P-value<0.001), more frequent visiting/seeing friends was likely to be associated with higher scores in both the physical and the mental health components (P-value<0.05). Multiple logistic regression analysis demonstrated that low physical health scores were associated with a low frequency of meeting with relatives and with living far from relatives. CONCLUSIONS: In a region covering 9.2% of the whole Italian population, only a small proportion of the elderly lack frequent social ties, yet low frequency of relationships with friends is associated with a decline in quality of life measured through mental and physical scores. Our findings will be useful for drawing up welfare strategies both at the national and at the Mediterranean level, in countries, like Italy, where the primacy of family support of the elderly has been decreasing in recent years.

Systematic review of nutritional status evaluation and screening tools in the elderly.

One univocal definition for nutritional status (NS) does not exist. One set of generally accepted standards for assessing the nutritional status does not exist, either. The NS assessment is absolutely necessary because it drives to identify malnutrition which is a potential cause and or an aggravation of morbidity and mortality. Since malnutrition shows a high prevalence in the elderly, literature about the validation of tools exploring single or complex NS parameters in the elderly has been systematically review. 115 papers, published from January 1st 1990 to July 31st 2003, have been identified: among them, just 9 complied with the established quality criteria and were suitable to be systematically reviewed. Parameters and diagnosis protocols to assess NS used in the selected papers were not homogeneous. Two implications arise from this evidence: - as regards clinical practice: an assessment on NS in clinical practice is complex, but not impossible. Hopefully, despite the absence of a sure reference, nutritionists, during their own clinical practice, ought to choose a validated on their own population and complete tool (considering as NS indicators both dietetic, anthropometric and functional parameters) for NS assessment, among all the redundant set of tools proposed until now; - respecting a scientific point of view, there is the necessity for calling a consensus conference in order to establish an initial consensus to diagnose malnutrition in the elderly and to promote, therefore, a validation study.

[Elevated blood pressure in adolescents from Rome, Italy. Nutritional risk factors and physical activity]. / Valori elevati di pressione arteriosa: ruolo di fattori nutrizionali e stili di vita.

Aim of the study was to detect the prevalence of hypertension among 11-14 years old schoolchildren (n. 487, mean age 12.7 +/- 0.9). The influence on blood pressure (BP) of body mass index (BMI), dietary habits (frequency of breakfast and food items consumption) and life-style was also investigated. Hypertension was defined according to blood pressure tables for children and adolescents of the NIH-Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force Dietary habits and life-style were investigated by specific questionnaires. The prevalence of overweight and obesity was respectively 31.8% and 10.3% of the subjects studied. Moreover 10.3% of them showed BP values between 90th and 95th percentile and 10.1% was hypertensive. In general the prevalence of overweight (p < 0.05), obesity (p < 0.001) and sedentary activity (p < 0.05) was higher in hypertensive adolescents. The multivariate logistic regression analysis showed a direct association between obesity (OR = 4.35; IC 95% = 2.24-8.44), sedentary life-style (OR = 2.38; IC 95% = 1.17-4.63) and hypertension. Food habits were not associated with BP levels. The results confirmed that an increase of cardiovascular risk in early age was correlated with the increase of the prevalence of obesity and sedentary life-style. Regular measurement of BP together with healthy dietary and life-style indications are recommended to overweight/obese children and adolescents.

Prevalence of prelingual deafness in Italy.

Neonatal hearing loss is the most frequent sensorial congenital defect in newborns. No data are available on worldwide prevalence of congenital deafness. World Health Organization (WHO) data indicate 1-4 cases per 1000 individuals, with a considerable increase in developing countries. A prevalence exceeding 1 per 1000 however, indicates a serious public health problem calling for urgent attention. Aim of the study was the evaluate the prevalence of prelingual deafness in the Italian population and determine the socio-demographic characteristics of the condition. Data were provided by the National Institute of Social Insurance (INPS) and the Italian Central Statistics Institute (ISTAT) and were collected in 18 out of the 20 Italian regions (98.2% of total population). All subjects recognized as deaf-mute by a special medical committee were included. According to law No. 509/1988, they had to present a mean bilateral sensorineural-hearing impairment, detected in neonatal age, which caused the damage in speech development and equal to 60 dB or more for 500-, 1000- and 2000-Hz frequency tones in the better ear. Prevalence rates were calculated according to region and age bracket using updated population data from census 2001. Statistical analyses were performed using the SPSS statistical software package. A total of 40,887 cases of prelingual profound sensorineural hearing loss > or =60 dB were detected in Italy in 2003, for a total prevalence rate of 0.72 per 1000. The hearing impairment prevalence differs according to sex. The overall prevalence is 0.78 per 1000 for males and 0.69 per 1000 for females (p < 0.001). The hearing impairment prevalence differs according to region of residence (p < 0.001). The geographic distribution of prelingual deafness was found to be: North 15,644 cases (0.63 per 1000), Central Italy 7111 cases (0.64 per 1000), South and Islands 18,132 (0.87 per 1000). The prelingual hearing loss is highly prevalent in South Italy (Basilicata, Calabria and Sicily). For the southern regions of Italy, the rate observed in the 50-64 and >64 age groups reached 1.27 and 1.15, respectively. This phenomenon may have been due, in part, to the epidemic incidence of maternal rubella which occurred in the 40's and 50's (in Italy, the rubella vaccination was only recommended starting from 1972), and, in part, to the habit of contracting consanguineous marriages. Data from the Vatican Archives on 520,492 consanguineous marriages, for which dispensation was requested in the period 1911-1964, indicate that in the years 1935-1939, in small villages in South Italy (Basilicata, Calabria, Sicily) consanguineous marriages accounted for over 40% of marriages.

[Increase of hypertension among adolescents in Rome]. / Notevole aumento di soggetti ipertesi tra gli adolescenti romani.

AIM: The aim of this study was to investigate the prevalence of overweight/obese and hypertensive roman adolescents belonging to a medium-low social environment. The purpose of this research was also to find out the correlations between high blood pressure and obesity, dietary habits and physical activity. METHODS: Nutritional status of 474 subjects (age 12.7+/-0.9 years) of a low-medium social class public school was assessed by measuring height, weight and waist circumference according to international indications. Over-weight and obesity were defined by body mass index (BMI) according to International Obesity Task Force (IOTF). Blood pressure (BP) was measured in duplicate and hypertension was defined by international percentiles. Food habits and lifestyle were investigated by a questionnaire. Multivariate logistic regression was used to relate variables. RESULTS: The prevalence of overweight and obese adolescents was respectively 31.7% and 10.3% with a slight higher presence of males in both cases. The whole sample showed a prevalence of hypertension of 10.1%. Systolic and diastolic BP showed a direct association with BMI and waist circumference (P<0.01). BMI and systolic and diastolic BP were lower in active students (>7 h a week of physical activity). Food habits were not associated with hypertension. CONCLUSIONS: The high prevalence of hypertensive adolescents could be explained with the consistent number of overweight/obese subjects, their social medium-low context and their being sedentary. As reported in literature, all these factors may contribute to the ''metabolic syndrome'' aetiology.

Effect of tidal volume and respiratory rate on the power of breathing calculation.

BACKGROUND: The power of breathing (PoB) is used to estimate the mechanical workload of the respiratory system. Aim of this study was to investigate the effect of different tidal volume-respiratory rate combinations on the PoB when the elastic load is constant. In order to assure strict control of the experimental conditions, the PoB was calculated on an airway pressure-volume curve in mechanically ventilated patients. METHODS: Ten patients received three different tidal volume-respiratory rate combinations while minute ventilation was constant. Respiratory mechanics, PoB and its elastic and resistive components were calculated. Alternative methods to estimate the elastic workload were assessed: elastic work of breathing per litre per minute, elastic workload index (the square root of elastic work of breathing multiplied by respiratory rate) and elastic double product of the respiratory system (the elastic pressure multiplied by respiratory rate). RESULTS: Despite constant elastance and minute ventilation, the elastic PoB showed an increment greater than 200% from the lower to the greater tidal volume, accounting for approximately 80% of the whole PoB increment. On the contrary, elastic work of breathing per litre per minute, elastic workload index and elastic double product did not change. CONCLUSION: Changes in breathing pattern markedly affect the PoB despite constant mechanical load. Other indexes could assess the elastic workload without tidal volume dependence. Power of breathing use should be avoided to compare different mechanical loads or efficiencies of the respiratory muscles when tidal volume is variable.

[Musculoskeletal disorders and housework in Italy]. / Disturbi muscolo-scheletrici e lavoro domestico in Italia.

The housework exposes to the risk of musculoskeletal disorders, which may appear as disabling diseases, both temporary and permanent ones. To evaluate the epidemiology of the phenomenon a retrospective survey was conducted by administering a mail questionnaire to a sample of 1,000 families residing in the whole national territory. The participation rate was 31.7%. Among respondents 20.5% reported spinal pain, 65.6% of them with continuous pains (41.4% assumed pain-killer drugs). 37.0% of the interviewed persons reported to disorders in upper limbs. It was analysed the association between the presence of disorders and the frequency in making some housework duties. Washing clothes (OR=1.8; C.I. 95%: 0.6-4.5), making beds (OR=1.5; C.I. 95%: 0.2-13.1), and taking care of pets (OR=1.4; C.I. 95%: 0.6-3.4) were associated, even if not in a statistically significant way, with the presence of spinal pain. Upper limbs disorders were associated with duties naturally related to such a disorder, like washing dishes (OR=4.6; C.I. 95%: 1.3-16.5), cleaning clothes (OR=3.1; C.I. 95%: 1.3-7.0), cleaning up carpets (OR=2.3; C.I. 95%: 1.3-3.9). To assist the relatives in state of need was identified as risk factor for both the body areas (OR=2.9; C.I. 95%: 1.2-6.7 for the spine, OR=2.6; C.I. 95%: 1.3-5.2 for upper limbs), putting in evidence the physical stress attributable to the duty. The exact identification of the typology of housework which can induce musculoskeletal disorders, and the level of related risks, are essential information to devise campaigns and protocols of health education aimed at the prevention of chronic pathologies caused by the housework.

Spontaneous minute ventilation is a predictor of extubation failure in extremely-low-birth-weight infants.

OBJECTIVE: To validate the percentage of time spent below a target value of spontaneous expiratory minute ventilation (< 125 ml/min per kg) during a 2-h period of continuous positive airway pressure (CPAP) via an endotracheal tube (ETT) as a predictor of failed extubation in preterm infants. METHODS: Forty-one infants intubated for at least 24 h, with birth weight between 500 and 1000 g, who were clinically stable and at ventilator setting compatible with an extubation attempt, were studied during a 2-h period of ETT CPAP. Dynamic lung compliance and total lung resistance were measured during a period of quiet breathing, while tidal volume (Vt), respiratory rate and the corresponding spontaneous expiratory minute ventilation values were calculated for the complete recording period of 2 h using a customized computer program. The time each patient spent below the target spontaneous expiratory minute ventilation value was reported as a percentage of the total recorded time (% spontaneous expiratory minute ventilation < 125 ml/min per kg). Extubation failure was defined as the need for reintubation within 72 h. RESULTS: Eleven out of 41 babies (26.8%) experienced failure of extubation (failure group) while 30 infants (73.2%) were successfully extubated (success group). There were no significant differences in dynamic lung compliance and lung resistance between the two groups, but the mean values of respiratory rate and spontaneous expiratory minute ventilation were significantly lower in the failure group than in the success group: 43 (37-56) breaths/min and 240 (160-353) ml/min per kg vs. 53 (28-67) breaths/min and 309 (223-434) ml/min per kg, respectively (p = 0.0129 and p = 0.0039). Moreover, the babies in whom extubation failed spent a longer time below the target value of spontaneous expiratory minute ventilation when compared with successfully extubated babies (p < 0.0001). Percentage of time spent with spontaneous expiratory minute ventilation < 125 ml/min per kg had a larger area than transcutaneous (Tc)PCO2, TcPO2 and pulse oxymetry saturation (SpO2) under the receiver operator characteristic curves. CONCLUSION: The measurement of spontaneous expiratory minute ventilation prior to extubation could be useful in identifying those babies who are not ready for spontaneous ventilation.

Effect of breathing pattern on the pressure-time product calculation.

BACKGROUND: The pressure-time product (PTP) is often used to compare conditions with different breathing patterns. Being the pressure-time product calculated with pressures changes over a minute, mechanical load and inspiration time per minute should be its main determinants. The aim of this study was to investigate if the method of PTP computation is affected by the breathing pattern when mechanical load and inspiratory time per minute are constant. METHODS: Respiratory mechanics and the PTP developed by the ventilator were calculated in 10 mechanically ventilated patients at three different respiratory rate/tidal volume combinations, provided that minute ventilation and inspiratory time per minute were constant. RESULTS: The static elastance did not change at different tidal volumes. Despite the constant elastic load over a minute, the elastic PTP showed an increment greater than 200% from the higher to the lower respiratory rate, responsible for approximately 80% of the whole PTP increment. On the contrary a 'corrected' elastic PTP (calculated using the square root of the elastic pressure-time area), the elastic double product of the respiratory system and the mean elastic pressure per minute, did not significantly change. CONCLUSIONS: Changes in breathing pattern markedly affected the PTP independently by the mechanical load and the inspiratory time per minute. In these conditions it could not correctly estimate the metabolic cost of breathing. The use of a 'corrected' PTP, the mean inspiratory pressure per minute or the double product of the respiratory system, could overcome this limitation.

MNA predictive value in the follow-up of geriatric patients.

OBJECTIVE: The aim of this study is to verify, in a sample of elderly subjects admitted to long-term care, the impact of malnutrition, according to the Mini Nutritional Assessment (MNA), on mortality and on the occurrence of Adverse Clinical Events in a 3-12 months follow-up study. SUBJECTS: The survey included all patients admitted to a geriatric hospital--"Villa delle Querce", Nemi (Rome, Italy)--between January 1997 and April 2000, whose nutritional status we were able to monitor for over 3 months. The study comprised 167 elderly subjects, of which 125 women (74.9%) aged 83.3 8 years (60-95 years), and 42 men (25.1%) aged 79.6 9 years with an average follow-up period of 7.5 months. METHODS: Upon admission and at every check we evaluated each subject's cognitive functions, functional status, co-morbidity, frailty, nutritional status (anthropometric and biochemical indices; MNA). During the follow-up we recorded Adverse Clinical Events. We calculated the predictive value of MNA, we correlated variations in MNA scores with variations of nutritional parameters. RESULTS: MNA's predictive ability both upon admission and upon discharge was found to be excellent. The MNA score was found to be correlated-although not to a very high degree-with variations nutritional parameters. Even more than malnutrition, a low MNA score was found to be predictive of a greater incidence of Adverse Clinical Events during hospitalisation and of higher mortality.

Resistive load of laryngeal mask airway and ProSeal laryngeal mask airway in mechanically ventilated patients.

BACKGROUND: The ProSeal Laryngeal Mask Airway (PLMA) ventilation tube is narrower and shorter than the standard Laryngeal Mask Airway (LMA) and is without the vertical bars at the end of the tube. In this randomized, crossover study, PLMA and LMA resistances were compared. METHODS: Respiratory mechanics was calculated in 26 anesthetized, mechanically ventilated patients with both LMA and PLMA. The laryngeal mask positioning was fiberoptically evaluated. Differences in the respiratory mechanics of the LMA and the PLMA were attributed to the differences between the laryngeal masks. RESULTS: In the total study population the airway resistance was 1.5 +/- 2.6 hPa.l-1.s-1 (P = 0.005) higher with the PLMA than with the LMA. During the PLMA use, the peak expiratory flow reduced by 0.02 +/- 0.05 l min-1 (P = 0.046), the expiratory resistance increased by 0.6 +/- 1.3 hPa.l-1.s-1 (P = 0.022), and the time constant of respiratory system lengthened by 0.09 +/- 0.18 s (P = 0.023). These differences doubled when the LMA was better positioned than the PLMA, whereas they disappeared when the PLMA was positioned better than the LMA. CONCLUSIONS: The standard LMA offers a lower resistive load than the PLMA. Moreover, the fitting between the laryngeal masks and the larynx, as fiberoptically evaluated, plays a major role in determining the resistive properties of these devices.

Comparison of the standard laryngeal mask airway and the ProSeal laryngeal mask airway in obese patients.

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) may have advantages over the laryngeal mask airway (LMA) in obese patients. We tested this hypothesis in a clinical setting. METHODS: Sixty obese patients (BMI >30) were randomized to receive mechanical ventilation (tidal volume 7 ml kg(-1), PEEP 10 cm H(2)O), through either the PLMA or the LMA. A gastric tube was used in all patients. Cuff pressure was set at 60 cm H(2)O and increased progressively until excessive leak occurred. The incidence of sore throat was assessed at recovery and after 1 week. RESULTS: The mean leak fraction was 6.1 (SD 2.9)% with the LMA and 6.4 (3.5)% with the PLMA (P=0.721). With the PLMA, with no sign of ventilation problems, the drainage tube was not patent in three patients. The cuff pressure was >100 cm H(2)O in 38% of the LMA group and 7% of the PLMA group (P=0.05). The incidence of sore throat was similar in both groups and it was similarly scored in the recovery room and 1 week after surgery. CONCLUSIONS: Both the PLMA and the LMA can be used for mechanical ventilation of obese patients. The patency of the PLMA drainage tube needs to be checked constantly even when an optimal airtight seal is present. In obese patients the LMA requires a greater cuff pressure than the PLMA, but sore throat is not related to the cuff pressure. Sore throat assessment in the recovery room appears as reliable as assessment later.

Pressure controlled versus volume controlled ventilation with laryngeal mask airway.

STUDY OBJECTIVE: To quantify the impact on peak airway pressure of pressure-controlled and volume-controlled ventilation during Laryngeal Mask Airway (LMA) use. DESIGN: Prospective, crossover clinical study. SETTING: University-affiliated hospital. PATIENTS: 32 ASA physical status I and II patients undergoing general anesthesia with the LMA. INTERVENTIONS: Patients were ventilated for three minutes both with pressure-controlled and volume-controlled ventilation, provided that tidal volume (V(T) ) and inspiratory time (It) were constant. MEASUREMENTS AND MAIN RESULTS: The monitored parameters were electrocardiography, arterial blood pressure, pulse oximetry, capnography, neuromuscular transmission, airway pressure and flow, and concentration of ventilated vapors and gases. The actually delivered V(T) was similar with both types of ventilation (volume-controlled = 0.67 +/- 0.13 lt, pressure-controlled = 0.67 +/- 0.14 lt; p = 0.688). Peak airway pressure was lower during pressure-controlled ventilation (14.6 +/- 3.5 cmH(2)O) than during volume-controlled ventilation (16 +/- 4 cmH(2)O) (p < 0.001). Furthermore, we noted that the higher the airway pressure with volume-controlled ventilation, the greater was the reduction in airway pressure during pressure-controlled ventilation. CONCLUSIONS: Pressure-controlled rather than volume-controlled ventilation can improve the effectiveness of mechanical ventilation in patients with high airway pressure.

On the symmetry of limb deficiencies among children with multiple congenital anomalies.

In humans, unpaired organs are placed in a highly ordered pattern along the left-right axis. As indicated by animal studies, a cascade of signaling molecules establish left-right asymmetry in the developing embryo. Some of the same genes are involved also in limb patterning. To provide a better insight into the connection between these processes in humans, we analysed the symmetry of limb deficiencies among infants with multiple congenital anomalies. The study was based on data collected by the International Clearinghouse for Birth Defects Monitoring Systems (ICBDMS). Registries of the ICBDMS provided information on infants who, in addition to a limb deficiency, also had at least one major congenital anomaly in other organ systems. We reviewed 815 such cases of which 149 cases (18.3 %) were syndromic and 666 (81.7 %) were nonsyndromic. The comparisons were made within the associated limb deficiencies, considering the information on symmetry, using a comparison group with malformations associated not involved in the index association. Among the non-syndromic cases, the left-right distribution of limb deficiencies did not differ appreciably between limb deficiency subtypes (e.g., preaxial, transverse, longitudinal). The left-right distribution of limb anomalies did not differ among most types of non-limb anomalies, though a predominance of left-sided limb deficiencies was observed in the presence of severe genital defects - odds ratio [OR], 2.6; 95 % CI, 1.1-6.4). Limb deficiencies (LDs) were more often unilateral than bilateral when accompanied by gastroschisis (OR, 0.1) or axial skeletal defects (OR, 0.5). On the contrary, LDs were more often bilateral than unilateral when associated with cleft lip with or without cleft palate (OR, 3.9) or micrognathia (OR, 2.6). Specifically, we found an association between bilateral preaxial deficiencies and cleft lip, bilateral amelia with gastroschisis and urinary tract anomalies, and bilateral transverse deficiencies and gastroschisis and axial skeleton defects. Of 149 syndromic cases, 62 (41.6 %) were diagnosed as trisomy 18. Out of the 30 cases of trisomy 18 with known laterality, 20 cases were bilateral. In the remainder the right and left sides were equally affected. Also, in most cases (74.4 %) only the upper limbs were involved. In conclusion the left-right distribution of limb deficiencies among some non-limb anomalies may suggest a relationship between the development of the limb and the left-right axis of the embryo.