[The catamenial pneumothorax: a diagnosis often overlooked]. / Le pneumothorax cataménial : un diagnostic souvent méconnu.

The catamenial pneumothorax (CP) is defined as recurrent pneumothorax occurring from the day before menstruations until 72 hours after their beginning, but remains a diagnostic and therapeutic problem. We herein report the cases of two young women who presented several episodes of pneumothorax. The first patient (28 years old) underwent 18 recurrent pneumothorax before the diagnosis of CP. The video-assisted mini-thoracotomy found many diaphragmatic perforations, which were sutured after resection and biopsy. The latter patient underwent four pneumothorax before diagnosis of CP. A video-assisted mini-thoracotomy associated with pleurectomy and pleural freshening was then performed. CP is a rare entity of spontaneous pneumothorax often associated with thoracic endometriosis. The difficulty remains in diagnosis (diagnostic delay before the start of appropriate care), as well as in the treatment. Overall, CP requires a multidisciplinary approach combining pulmonology, thoracic surgery and gynecology.

On dithiothreitol (DTT) as a measure of oxidative potential for ambient particles: evidence for the importance of soluble transition metals.

The rate of consumption of dithiothreitol (DTT) is increasingly used to measure the oxidative potential of particulate matter (PM), which has been linked to the adverse health effects of PM. While several quinones are known to be very reactive in the DTT assay, it is unclear what other chemical species might contribute to the loss of DTT in PM extracts. To address this question, we quantify the rate of DTT loss from individual redox-active species that are common in ambient particulate matter. While most past research has indicated that the DTT assay is not sensitive to metals, our results show that seven out of the ten transition metals tested do oxidize DTT, as do three out of the five quinones tested. While metals are less efficient at oxidizing DTT compared to the most reactive quinones, concentrations of soluble transition metals in fine particulate matter are generally much higher than those of quinones. The net result is that metals appear to dominate the DTT response for typical ambient PM(2.5) samples. Based on particulate concentrations of quinones and soluble metals from the literature, and our measured DTT responses for these species, we estimate that for typical PM(2.5) samples approximately 80 % of DTT loss is from transition metals (especially copper and manganese), while quinones account for approximately 20 %. We find a similar result for DTT loss measured in a small set of PM(2.5) samples from the San Joaquin Valley of California. Because of the important contribution from metals, we also tested how the DTT assay is affected by EDTA, a chelator that is sometimes used in the assay. EDTA significantly suppresses the response from both metals and quinones; we therefore recommend that EDTA should not be included in the DTT assay.

Formation of hydroxyl radical from San Joaquin Valley particles extracted in a cell-free surrogate lung fluid.

Previous studies have suggested that the adverse health effects from ambient particulate matter (PM) are linked to the formation of reactive oxygen species (ROS) by PM in cardiopulmonary tissues. While hydroxyl radical ((•)OH) is the most reactive of the ROS species, there are few quantitative studies of (•)OH generation from PM. Here we report on (•)OH formation from PM collected at an urban (Fresno) and rural (Westside) site in the San Joaquin Valley (SJV) of California. We quantified (•)OH in PM extracts using a cell-free, phosphate-buffered saline (PBS) solution with or without 50µM ascorbate (Asc). The results show that generally the urban Fresno PM generates much more (•)OH than the rural Westside PM. The presence of Asc at a physiologically relevant concentration in the extraction solution greatly enhances (•)OH formation from all the samples. Fine PM (PM(2.5)) generally makes more (•)OH than the corresponding coarse PM (PM(cf), i.e. with diameters of 2.5 to 10 µm) normalized by air volume collected, while the coarse PM typically generates more (•)OH normalized by PM mass. (•)OH production by SJV PM is reduced on average by (97±6)% when the transition metal chelator desferoxamine (DSF) is added to the extraction solution, indicating a dominant role of transition metals. By measuring calibration curves of (•)OH generation from copper and iron, and quantifying copper and iron concentrations in our particle extracts, we find that PBS-soluble copper is primarily responsible for (•)OH production by the SJV PM, while iron often makes a significant contribution. Extrapolating our results to expected burdens of PM-derived (•)OH in human lung lining fluid suggests that typical daily PM exposures in the San Joaquin Valley are unlikely to result in a high amount of pulmonary (•)OH, although high PM events could produce much higher levels of (•)OH, which might lead to cytotoxicity.

Conversion of mild cognitive impairment to dementia in elderly subjects: a preliminary study in a memory and cognitive disorder unit.

Prevalence and incidence of predementia syndromes vary as a result of different diagnostic criteria, as well as different sampling and assessment procedures. Mild cognitive impairment (MCI) is thought to be a prodromal phase of dementia and therefore highly predictive of subsequent conversion. The aim of our study was to investigate the risk of conversion to dementia for different MCI subtypes diagnosed according to standardized and recently revised criteria (amnestic; impairment of memory plus other cognitive domains; nonamnestic). Participants were recruited among the 2,866 patients referring to the Memory and Cognitive Disorders Unit of the Local Health Unit of Bologna, Maggiore Hospital, between October 2000 and February 2006. In this preliminary study we analyzed data from 52 elderly outpatients with a diagnosis of MCI and a mean follow-up of 1.21+/-0.61 years (range 0.23-3.10 years). Mean age was 72.8+/-6.6 years, males were 61.5%. Mean baseline mini mental state examination (MMSE) score was 27.1+/-1.5. There were 15 incident cases of dementia (28.8%), with Alzheimer's disease (AD) accounting for 53.3% of all cases, AD with cerebrovascular disease for 33.4% and fronto-temporal dementia for 13.3%. Overall rate of conversion was 23.8 per 100 person-years. During the same follow-up period, 53.8% of participants remained stable and 17.3% reverted to normal. Rates of conversion for the specific MCI subtypes were 38 per 100 person-years for amnestic MCI, 20 per 100 person- years for non-amnestic MCI, and 16 per 100 person-years for memory plus other cognitive domains MCI. With respect to non-converters, converters were generally older (76.1+/-4.2 vs. 71.5+/-7.0 years, p=0.021), had a lower MMSE score (26.4+/-1.66 vs. 27.4+/-1.4, p=0.035) and a higher prevalence of atrophy at neuroimaging (73.7% vs. 42.4%, p=0.047). Moreover, with respect to non-converters, converters tended to have higher serum high density lipoprotein (HDL) levels, and lower serum folate levels. No difference was observed for the other study variables, included MCI subtype. Our findings suggest that the current definitions for MCI subtypes, particularly those referring to individuals with multiple or non-amnestic cognitive impairment, include a substantial number of individuals who may not progress to dementia. The possible role of cortical atrophy and low folate in the conversion from MCI to dementia could have important implications, because both conditions are easily identifiable. Moreover, low folate status is potentially amenable to therapeutic options. Although discouraging with respect to the clinical usefulness of currently available MCI criteria, our results raise the possibility that defining a protocol of multiple clinical risk factors may be useful in identifying MCI individuals at increased risk of conversion.

Comprehensive complexity assessment as a key tool for the prediction of in-hospital mortality in heart failure of aged patients admitted to internal medicine wards.

Congestive heart failure (CHF) and cognitive impairment are both common problems in old age, associated with significant mortality, impaired quality of life and disability. This study evaluated patients with CHF, admitted to internal medicine and geriatric wards. We identified factors associated with a high risk of in-hospital mortality. Hospitalized CHF subjects with increased risk of in-hospital death present a clinical profile including: very old age, overt cognitive dysfunction, predisposition to falls, dependency, social-family problems, impairment in sphincter control and feeding ability, presence of bedsores, digoxin but not warfarin treatment, hypo-dysproteinemia and hypernatremia and mild renal impairment. We observed that patients admitted to our Internal Medicine Departments, in addition to CHF, present a high grade of complex therapeutic needs and that comorbidity, by itself, does not reflect complexity. Our data support the hypothesis that CHF has different patterns of severity and prognosis in young and in old or very old age groups.

Determination of halogenated mono-alcohols and diols in water by gas chromatography with electron-capture detection.

We have developed an analytical method for the detection of halogenated alcohols in water with particular focus on 3-chloro-1,2-propanediol and 3-bromo-1,2-propanediol. In this method the target analytes are extracted from water, derivatized with heptafluorobutyric anhydride, and then analyzed with gas chromatography with electron-capture detection. The effects of water, pH and seawater constituents on the method were investigated. Method detection limits for a 5 ml aqueous sample ranged from 0.14 microg l(-1) for 2-bromo-1,3-propanediol to 1.7 microg l(-1) for 1,3-dichloro-2-propanol (1,3DCP).

Cost effective prophylaxys of postoperative nausea and vomiting by anesthetic premedication.

Postoperative emesis is a common daily problem in anesthetic practice. Authors report their experience about prevention of PONV (postoperative nausea and vomiting) with the association of different drugs in premedication, and suggest Promethazine as an effective and inexpensive medication to prevent PONV in orthopedic surgery.

Self-care burden in women with human immunodeficiency virus.

The authors of this descriptive study used Orem's Theory of Self-Care to assess perceived demand for or change in universal and health-deviation self-care activity and the degree of difficulty ascribed to meeting that demand. Perceived demand or change in self-care and difficulty in self-care were measured using the Self-Care Burden Scale (Oberst, Hughes, Chang & McCubbin, 1991) and a structured interview. A convenience sample of 10 English or Spanish-speaking women with HIV infection utilizing a city hospital's outpatient immunodeficiency clinic were recruited. Of the health deviation self-care items, home medical/nursing treatments, special diet, and obtaining resources were the most burdensome categories. Universal self-care tasks with the highest burden scores were caring for children, physical activity, and work.

HIV and tuberculosis: noncompliance revisited.

Revisiting the stereotype of the noncompliant patient can transcend the frustrating or resentful feelings nurses may experience when caring for patients with HIV and tuberculosis. This reevaluation also can lend itself to developing mutually participative nurse-patient relationships. The author suggests relationship goals, assessment parameters, and intervention strategies--including a directly observed therapy (DOT) contract. These actions support a commitment to empowering both the nurse and the patient in their relationship in the TB treatment process.

Aqueous-phase photochemical formation of peroxides in authentic cloud and fog waters.

Gas-to-drop partitioning of hydrogen peroxide and its precursor, the hydroperoxyl radical (HO2.), has been considered the predominant or sole source of hydrogen peroxide in atmospheric water drops. However, atmospheric water can absorb solar ultraviolet radiation, which initiates the photoformation of peroxides (primarily hydrogen peroxide). Measurements of peroxide photoformation rates in authentic atmospheric water samples demonstrate that aqueous-phase photochemical reactions are a significant, and in some cases dominant, source of hydrogen peroxide to cloud and fog drops. This additional source could significantly change the current understanding, and hence, the models, of sulfuric acid deposition because hydrogen peroxide is the limiting reagent in the dominant pathway for the oxidation of sulfur dioxide to sulfuric acid in the troposphere over eastern North America.

Plasma lactoferrin as a marker of infection in elderly individuals.

To assess lactoferrin as a marker of infection, plasma lactoferrin (LF) levels were determined in elderly in patients with infection and compared with age- and sex-matched healthy and hospital controls and young healthy blood donors. The median LF level in infection (800 ng/mL) was significantly higher than in healthy elderly living in old people's home (300 ng/mL) or elderly hospital controls (298 ng/mL) (p less than 0.01 in each case). Plasma LF correlated significantly with elastase alpha-1-proteinase inhibitor complex (EPIC) (Rs = 0.8, p less than 0.01) and C-reactive protein (CRP) (Rs = 0.45, p less than 0.02), but not with erythrocyte sedimentation rate (ESR) or white blood cell counts. We conclude that plasma LF, like CRP and EPIC, is a marker of infection in elderly individuals.

Incidence of pulmonary embolism in elderly patients newly admitted to an acute geriatric unit: a prospective study.

To study the incidence of pulmonary embolism (PE) in elderly patients newly admitted to an acute geriatric unit, the authors carried out ventilation perfusion scans on 33 patients, 25 women and 8 men, mean age 79 years, consecutively admitted to the geriatric wards. The first scan was done within 5 days of admission and repeated between days 10 and 20. Where possible, patients with a positive second scan had a repeat scan at 2-3 months. Six (18%) patients were found to have a high probability of PE, 4 (12%) at the time of admission and two (6%) after admission. Three patients (9%) were considered to suffer from chronic pulmonary artery disease. Mortality was 5 for the whole group (15%) and 1 of 6 (17%) with a high probability of PE; this patient was suffering from carcinomatosis. The only patient who was anticoagulated suffered serious side effects. In no patient was PE clinically suspected. The authors conclude that PE is common in sick elderly patients newly admitted to acute geriatric wards, that rehabilitation with mobilization may precipitate new PE, and that nonanticoagulated PE does not seem to appreciably shorten the prognosis for life. Treatment with anticoagulants may be more dangerous than not treating PE in this older age group.

Circulating neutrophil elastase in infectious diseases in geriatric patients.

Enzyme-linked immunosorbent assay has been used to measure elastase proteinase inhibitor complex (EPIC) and C-reactive protein (CRP) in the elderly, with and without infection. Median EPIC levels in the elderly with infection, hospital controls, healthy elderly residents in old people's homes and healthy blood donors were 300, 104, 96 and 74 ng/ml respectively. Ninety-five per cent of the patients with infection had EPIC levels well above the normal range. The median EPIC level in the elderly with infection showed a statistically significant difference from that in the control groups (p less than 0.0001, Mann U test). CRP showed similar results. Elevation of EPIC or CRP did not depend on the type of infection or bacteria isolated. We would conclude that neutrophil inhibitor-bound elastase could be used as a marker of inflammation in old people.

Antibodies against monocytes and endothelial cells in the sera of patients with atherosclerotic peripheral arterial disease.

We looked for antibodies against endothelial cells, monocytes, fibroblasts, lymphocytes and Epstein-Barr virus transformed lymphocytes in the sera of 28 elderly and 18 middle-aged patients with atherosclerotic peripheral arterial disease and 13 controls. Inclusion criteria were symptomatic peripheral arterial disease with intermittent claudication and ankle/radial Doppler pressure ratio less than 0.7 in the patient group and greater than 1 in the controls. The sera were tested using a standard cytotoxic technique against a cell panel of monocytes, T and B lymphocytes from 5 donors, and against endothelial cells, fibroblasts and Epstein-Barr virus transformed lymphocytes from one umbilical cord vein and blood. The sera of 30 of 46 (65.2%) patients showed toxicity against monocytes from at least one member of the cell panel and 12 of 19 sera tested (63%) reacted with endothelial cells. Only one of the control sera was positive against monocytes and none reacted with endothelial cells. None of the sera of either patients or controls contained cytotoxic antibodies against T and B lymphocytes, Epstein-Barr virus transformed lymphocytes or fibroblasts. The selective cytotoxicity suggests that the antibodies detected are not against HLA-antigens (which are expressed by normal lymphocytes and Epstein-Barr virus lymphocytes). Our results suggest that immune phenomena occur in atherosclerosis.

Campylobacter pylori in abattoir workers: is it a zoonosis?

Sera from 98 abattoir workers were tested for IgG to Campylobacter pylori, C jejuni, and klebsiella. Clerical workers had significantly lower C pylori and C jejuni IgG titres than any of the groups in direct contact with freshly cut animal parts. No difference was found for antibodies to klebsiella. 28 non-clerical workers with high-titre C pylori IgG consented to upper gastrointestinal endoscopy. C pylori associated gastritis was found in all 28, and four weeks of colloidal bismuth subcitrate (240 mg twice daily) was prescribed. On repeat testing at three months all showed a decrease in IgG titres to C pylori but not to C jejuni, whereas 18 untreated non-endoscoped workers showed no change. These findings raise the possibility that C pylori infection is a zoonosis.

[What is in the future for geriatrics? I]. / Quale futuro per la geriatria? Prima parte.

The authors, after an evaluation of the historical course of the geriatrics in England and its contents, point out the importance of this specialty from a demografic, economical, social, epidemiological and cultural point of view.

[What is in the future for geriatrics? II]. / Quale futuro per la geriatria? Seconda parte.

The authors point out the importance of geriatric medicine in the hospital in its traditional goals and in some new proposals: geriatric case finding, general practitioner's education, teaching in nursing schools, family education, pre-retirement courses etc.