Entrapment and rupture of the guide wire during PTCA: case report and medico-legal considerations.

Background: In recent years, due to the increase of complaints for medical malpractice, the Sicilian Regional Health System has adopted proceedings for the direct management of claims by each healthcare facility with the aim of reducing costs of insurance premiums and their relative taxes. Thus this management has led to increased awareness and management of clinical risk through the introduction of mandatory sentinel event monitoring. Case report: A 55-year-old man with acute ischemic heart disease, due to three-vasal coronary diasease, underwent angioplasty perfomed on the second diagonal branch of the anterior descending artery. Simultaneously following the discovery of a major middle tract stenosis, he underwent further angioplasty surgery during which guidewire entrapment occurred, precisely in the proximal section of the vessel, resulting in the rupture and persistence of some fragments despite attempts to extract them. Subsequent antiplatelet therapy was prescribed and no further procedures were indicated for the removal of the guide wire, meanwhile a persistent reactive anxious-depressive state was established. Conclusion: The medico-legal analysis of the case excluded liabilty since it was a fortuitous, unpredictable and inevitable event. However, the patient had not been adequately informed about the possibility of the complication presented, which resulted in prolonged hospitalization and compensation for the psychological disorder suffered as a result of the adverse event. The attempted economic agreement was unsuccessful. A civil lawsuit was subsequently filed by the patient and the Judge's report confirmed the corporate CMC assessment and ruled out that the side effects related to the guideline fragment.

Association between genetic polymorphisms of glutathione S-transferase M1/T1 and psoriasis in a population from the area of the strict of messina (Southern Italy).

Glutathione S-transferases (GST) are antioxidant enzymes with frequent genetic polymorphisms. Homozygosis for gene deletion ("null" genotype) of GSTM1 and GSTT1, causing decrease of the antioxidant potential of the organism, is frequent, with variable frequency in different ethnic contexts. Although oxidative stress notoriously plays a role in the pathogenesis of psoriasis, few studies exist on the association between GSTM1/GSTT1 genotype and psoriasis, with different results. We aimed to assess the frequency of GSTM1/GSTT1 polymorphisms in Southern Italian psoriatic patients and controls and investigate the association of the GSTM1/GSTT1 genotype with individual and disease parameters. To this aim, the GSTM1/GSTT1 genotype of 148 psoriatic patients and 148 age- and sex-matched controls was defined by PCR on oral mucosa cells. GSTT1 null was associated with psoriasis (55.4% of patients vs. 25% of controls, p = 9.58 × 10-8, odds ratio 3.73), while GSTM1 null was not. The GSTM1/GSTT1 "double null" genotype conferred an even higher odds ratio for psoriasis (5.94). The association between psoriasis and GSTT1 null was stronger in women (54.1% of patients vs. 19.7% of controls, p = 8.13 × 10-5) than in men (56.3% of patients vs. 28.7% of controls, p = 0.0002). No association was found between GSTM1/GSTT1 genotype and psoriasis severity, age of onset or comorbidities (psoriatic arthritis, metabolic syndrome). The remarkable differences among the few available data on the association between GSTM1/GSTT1 polymorphisms and psoriasis suggest the need for further studies, on different and larger populations, to improve knowledge on the pathogenesis of psoriasis and possibly provide more precise and personalised prevention and treatment in the future.

[Genetic markers of individual susceptibility and oxidative stress in subjects exposed to low dose of benzene. Preliminary data]. / Indicatori genetici di suscettibilità individuale e stress ossidativo in soggetti esposti a basse dosi di benzene. Dati preliminari.

In the present study we used AOPPs and AGE as early markers of oxidative stress in refinery oil workers. In addition we evaluated whether a genetically determined reduction in the ability to detoxify electrophilic compounds, such as that expected among individuals with glutathione S-transferase (GST) null genotypes might influence the levels of AOPPs thus increasing toxicity. The study was performed on 25 oil refinery workers and in 18 age-matched control subjects. We found a statistically significant increase of AOPPs in exposed workers with respect to controls while AGE levels were not different. Finally serum level of AOPPs and AGE were not correlated with the different GTS genotypes.

Effect of nutrient composition of feeds on digestibility of organic matter by cattle: a review.

Estimates of nutrient availability, calculated as TDN for 106 different feedstuffs generated from various published equations, were compared with TDN for similar feeds listed in the 1961 text by F. B. Morrison titled Feeds and Feeding. Incomplete analysis of carbohydrate fractions limited accuracy of evaluations. Although published equations may satisfactorily rank feeds in energy value, the absolute values, correlations, and SE of the estimates revealed that most equations were inaccurate. Across all feeds and forages, TDN was related most closely to crude fiber (R(2) = 0.68) within data sets from Morrison's text and from the NRC publications concerning Nutrient Requirements for Dairy and for Beef Cattle in 1989 and 2000, respectively. Within the latter data set, of the total variation, ADF accounted for 65% of the variation in TDN across all feeds, 62% of the variation in TDN for concentrate feeds, but only 41% of the variation in TDN of forages. Within the 2001 publication for dairy cattle from the NRC, ADF content was related most closely to TDN for all feeds, but nonfiber carbohydrate was most closely related to TDN of forages (R(2) = 0.81 and 0.69, respectively). To separate true from apparent digestibility of nutrients, fecal excretions of components (i.e., CP, fat, crude fiber, nitrogen free extract) were regressed against concentrations of these nutrients in feedstuffs and summed to estimate fecal loss. Metabolic fecal loss of OM (MFOM), the difference between true and apparent OM digestibility, was correlated closely with crude fiber content of feedstuffs (R(2) = 0.86) and increased from 7 to 25 g/100 g of diet as dietary crude fiber concentration increased. This may explain why most TDN equations are based on crude fiber or ADF. Whether dietary NDF similarly increases metabolic OM excretion is not certain, but when humans were fed NDF-enriched diets, fecal excretion of nonfiber carbohydrate increased markedly. The impact of crude fiber on nutrient availability of feeds appears to be related more closely to its adverse effect on apparent digestibility of other nutrients than to the amount of energy that fiber itself contributes. Refinements to laboratory methods for measuring fiber digestibility that match apparent in vivo digestibility coefficients for fiber by ruminants is needed, and the origin, composition, and cost of replacing MFOM need additional research.

Polymorphism of glutathione S-transferases M1 and T1: susceptibility to solar keratoses in an Italian population.

BACKGROUND: Polymorphisms of glutathione S-transferases (GSTs) are linked to skin cancer, but data on their association with solar keratosis (SK) are few and conflicting. AIM: To verify the possible association between the development of SK and the 'null' GSTM1 and/or T1 genotype. METHODS: Analysis of the GSTM1 and T1 genotype of 33 subjects with ≥3 solar keratoses and of 150 controls, before and after stratification based on smoking habits, sun exposure and immunosuppression. RESULTS: The GST T1 null allele is significantly (P < 0.03) associated with increased prevalence of SK in our population. CONCLUSIONS: Our study, the first on a Mediterranean population, shows the existence of a correlation between SK and the GST T1 null genotype. This result points out significant differences between subjects of different ethnic and geographical origin and warrants further investigation on a larger population, and ethnically different populations.

[Genetic polymorphisms (GSTT1 e GSTM1) and urinary excretion of t,t-muconic acid among refinery workers]. / Polimorfismi genetici (GSTT1 e GSTM1) ed escrezione urinaria di acido t,t-muconico in lavoratori di una raffineria.

Many xenobiotics agents are metabolized by enzymes mechanisms through Phase I, activating substances procancerogene through oxidative reactions, and / or through mechanisms Phase II, acting on metabolic intermediate products of oxidative processes with conjugation reactions with endogenous mediators, in order to generate hydrophilic products that can be easily excreted by the body. Among the enzymes Phase II is a heterogeneous group represented by glutathione S-transferase. Genetic polymorphisms encoding for these enzymes (GSTs) are responsible phenotypic expression of enzymes specifically involved in the detoxification and elimination of different genotoxic agents (IPA, toluene, benzene). Accordingly, the authors have investigated a population of subjects professionally exposed to benzene (used in active refining and storage of crude oil) in order to assess the genetic profile in relation to possible null genotype (responsible for the failure phenotypic expression of protein) of polymorphism GSTT1 and GSTM1 and correlate the impact that the genotype effect of normal metabolic pathway t, t-muconico.

[Screen dermatitis and visual display units]. / Screen dermatitis e videoterminali.

Over the last fifteen years, the increasing prevalence of screens and electromagnetic devices used in a number of activities has determined the occurrence of new emerging clinical problems. Hence the need to evaluate the ergonomic aspects of the professions using such equipment to study the effects of electromagnetic fields on human health. The objective difficulties to standardize the studies on this field makes controversial the debate on the evidences in support of these nosographical entities and on the possible causative factors. One interesting area is that of dermatological diseases. The authors present the results of a study on the incidence of dermatological diseases of the face and of the neck in a population of screen workers. To achieve this goal subjects underwent dermatological counselling during the periodic of monitoring visits. Subjects were then identified in two groups: screen workers and as a control group, subjects not exposed to electronic equipments. Members of the first group when compared with those of the second, suffered more frequently from skin diseases, although there was just a statistical trend. However skin diseases were distributed with different frequency in the two groups and seborrheic dermatitis was much more represented among screen workers.

[Test of pharmacologic bronchial stimulation in the assessment of work suitability]. / Il test di broncostimolazione farmacologica nella valutazione dell'idoneità al lavoro.

The suitability to the work is one of the main items of occupational medical doctor's activity, often developed with very few informations about the effective features a worker is about to carry out. Consequently, every appraisal of work suitability is based almost exclusively on clinical analysis. A peculiarity of the problem is the one strictly connected with the Allergic Pathology, since it brings a condition in which the subject under medical exams don't present any operative-limiting pathological condition; he could, anyway, presents a slight limitation connected to a subjective response toward a eventually workplace-based specific allergenic agent. It's important, therefore, the need to show, in case of workers exposed to potentially allergenic substances, that subjective conditions who could cause an abnormal reactivity in presence of a potentially efficient stimulation. The main intention of this piece of work is to develop a study about the utility of bronchial challenge with methacoline in a context of evaluation of work suitability for those allergenic substances exposed jobs.

Nutritive value of corn silage as affected by maturity and mechanical processing: a contemporary review.

Stage of maturity at harvest and mechanical processing affect the nutritive value of corn silage. The change in nutritive value of corn silage as maturity advances can be measured by animal digestion and macro in situ degradation studies among other methods. Predictive equations using climatic data, vitreousness of corn grain in corn silage, starch reactivity, gelatinization enthalpy, dry matter (DM) of corn grain in corn silage, and DM of corn silage can be used to estimate starch digestibility of corn silage. Whole plant corn silage can be mechanically processed either pre- or postensiling with a kernel processor mounted on a forage harvester, a recutter screen on a forage harvester, or a stationary roller mill. Mechanical processing of corn silage can improve ensiling characteristics, reduce DM losses during ensiling, and improve starch and fiber digestion as a result of fracturing the corn kernels and crushing and shearing the stover and cobs. Improvements in milk production have ranged from 0.2 to 2.0 kg/d when cows were fed mechanically processed corn silage. A consistent improvement in milk protein yield has also been observed when mechanically processed corn silage has been fed. With the advent of mechanical processors, alternative strategies are evident for corn silage management, such as a longer harvest window.

Observations on in situ degradation of forage cell components in alfalfa and Italian ryegrass.

The rate and extent of degradation of forage feed fractions contained in alfalfa and Italian ryegrass hays were determined. Nylon bags filled with 4 g of each forage were suspended in the rumen of two cannulated cows immediately before feeding and incubated for 10 different times (0, 2, 4, 8, 12, 24, 48, 72, 120, and 168 h). The alfalfa hay, which had lower NDF, showed a lower extent, but a higher rate, of NDF degradation than the Italian ryegrass (41.1 vs. 59.8% and 4.64 vs. 2.91%/h, respectively). Alfalfa cell walls were degraded more rapidly than Italian ryegrass even though their lignin content was higher. The hemicellulose fermentation of alfalfa showed a longer lag time (13 h) and an undegradable fraction nearly twice that for Italian ryegrass (63.3 vs. 37.1%). Cellulose from alfalfa was degraded at a higher rate than NDF or ADF, indicating that cellulose may be the primary site of hydrolysis of the cell wall in the rumen. Calculations based on in situ degradability indicate that alfalfa can have a higher inclusion than Italian ryegrass in diets for dairy cows because of lower NDF and greater availability of cell contents.

Characterization of endotoxin from the rumen bacterium Megasphaera elsdenii.

Phenol-water extraction of Megasphaera elsdenii, a predominant gram-negative coccus in rumens of cattle fed high-grain diets, yielded material that exhibited typical characteristics of endotoxin. The extract was lethal to mice and to chicken embryos, caused biphasic fever in rabbits, leukopenia in mice, and local and generalized Shwartzman reactions; and induced tolerance to the lethal effect of the endotoxin in mice. The material contained carbohydrate, protein, lipid, phosphorus, and 2-keto-3-deoxyoctonate, but no nucleic acid. The beta-hydroxymyristic acid was absent. Results imply that M elsdenii endotoxin has many biological and chemical characteristics common to enterobacterial endotoxin. However, the median lethal doses in mice and in chicken embryos, and minimal dose required to elicit a local Shwartzman reaction, indicate that M elsdenii endotoxin's potency is low, which may explain why the large gram-negative bacterial population in the rumen of cattle is generally innocuous.