Sudden infant death following hexavalent vaccination: a neuropathologic study.

We examined a large number of sudden infant death syndrome victims in order to point out a possible causal relationship between a previous hexavalent vaccination and the sudden infant death. We selected 110 cases submitted to in-depth histological examination of the autonomic nervous system and provided with detailed clinical and environmental information. In 13 cases (11.8%) the death occurred in temporal association with administration of the hexavalent vaccine (from 1 to 7 days). In none of these victims congenital developmental alterations of the main nervous structures regulating the vital functions were observed. Only the hypoplasia of the arcuate nucleus was present in 5 cases. In one case in particular an acquired hyperacute encephalitis of the tractus solitarii nucleus was diagnosed in the brainstem. This study does not prove a causal relationship between the hexavalent vaccination and SIDS. However, we hypothesize that vaccine components could have a direct role in sparking off a lethal outcome in vulnerable babies. In conclusion, we sustain the need that deaths occurring in a short space of time after hexavalent vaccination are appropriately investigated and submitted to a post-mortem examination particularly of the autonomic nervous system by an expert pathologist to objectively evaluate the possible causative role of the vaccine in SIDS.

[Efficacy, safety and cost of sedation with sevoflurane in intensive care unit]. / Efficacité, tolérance et coût d'une sédation par sévoflurane en réanimation.

OBJECTIVES: To study efficacy, systemic and cerebral haemodynamic, and cost of sedation with sevoflurane after midazolam failure. STUDY DESIGN: Prospective observational study in a mixed intensive care unit. PATIENTS AND METHODS: Mechanically ventiled patients in whom deep sedation failed (Ramsay score<5 despite midazolam 10mg/h and fentanyl 400µg/h) were enrolled. Sedation with sevoflurane and fentanyl (200µg/h) was performed during 48 hours. Sevoflurane was administered with a dedicated filter (AnaConDa™) and sevoflurane infusion rate was adjusted in order to achieve a Ramsay score ≥5. Ramsay score, mean arterial blood pressure, norepinephrine dose/24h, intracranial pressure and cerebral perfusion pressure in patients with brain injury were measured. Directs costs for sedation were calculated. An analysis of variance for repeated measures compared values between D0 (intravenous sedation), D1 and D2 (inhaled sedation). RESULTS: Twenty-five patients (age=51 [38-63], SAPS II=43 [33-49]) were enrolled. Ramsay score was 4 [4,5] at D0 and 6 [6] at D1 and D2 (P<0.05 vs D0). Mean arterial pressure was significantly lower at D1 (80 [73-86] mmHg) as compared to D0 (84 [77-92] mmHg) and D2 (84 [78-91] mmHg) (P<0,05). Norepinephrine consumption was lower at D2 as compared to D1 (P<0,05). Intracranial pressure was lower at D1 (9 [5-13] mmHg) and D2 (11 [7-15] mmHg) as compared to D0 (12 [7-17] mmHg) (P<0.05). PPC was stable at D1 and increased at D2. Directs costs were significantly increased with sevoflurane. CONCLUSION: Sevoflurane is an effective and safe alternative to midazolam in ICU patients associated with a moderate increase in costs.

[Survey of the knowledge and behavior of Italian adolescents in the face of AIDS and sexually transmitted diseases]. / Inchiesta su conoscenza e comportamento negli adolescenti italiani nei confronti dell'AIDS e delle malattie sessualmente trasmesse.

The purpose of this study is to evaluate in youth people the knowledge, attitude and behaviours regarding HIV/STD infection, and to determine whether their extent varies by individual or lifestyle characteristics. A random sample of 558 male adolescents, selected from the list of people assisted by the regional health service and resident in an urban town in the northern of Italy, took part in a cross-sectional survey conducted by a questionnaire. Personal knowledge of HIV risk factors and level of concern about HIV infection are associated with years of education and drug use. This study indicates that more effective strategies on sexuality education that target adolescents, with special attention to the workplace health promotion, are needed to reduce risk of HIV/STD infection among youth.

Intrafamilial transmission of hepatitis B and C viruses in an Italian local health district.

The majority of investigations of HBV or HCV transmission were carried out on self-selected groups of people; the purpose of this study is to explore the routes of intrafamilial spread of HBV and HCV infection in a general population. Prevalence of hepatitis B and C virus markers was studied at various ages from 20 to 70 in a general population of 960 subjects of 422 households sampled from four towns. Serum specimens were collected for testing hepatitis B markers (HBsAg and anti-HBc) as well as hepatitis C antibodies (anti-HCV). The total prevalence of HBsAg was 5.8% and that of anti-HBc was 41.8%. The overall prevalence of anti-HCV was 4.7%. The odds on having HBsAg or anti-HBc infection for offspring with mother carrier are greater than for offspring with mother seronegative by a factor of about thirty and six respectively. Only anti-HCV positive mothers have a higher risk (OR = 12) of HCV infection in their offspring than in anti-HCV negative mothers. The risk on having a HBsAg or anti-HBc positive wife is significantly increased for exposure to a male partner respectively anti-HBc (OR = 5.6) or HBsAg positive (OR = 6.5), as compared with a male partner seronegative. A statistically significant risk of HBV infection (OR = 2.7) or carrier state (OR = 5.1) in husbands depends on the presence of anti-HBc positivity in their wives. There was no evidence (p >0.05) of a higher risk of HCV infection in spouses due to anti-HCV positivity in their partners. There is a higher risk in offspring exposed to mother seropositive for HBV or HCV infection in comparison with offspring not exposed. Evidence suggests that sexual contact does not play an independent role in the spread of HCV infection in the family setting as much as the HBV infection.

[Trichomonas tenax in pulmonary and pleural diseases]. / Pleuro-pneumopathie à Trichomonas tenax.

INTRODUCTION: Trichomonas is a protozoan rarely incriminated in pulmonary or pleural disorders. CASE: An 84-year-old man, under treatment for chronic lymphoid leukemia with hypogammaglobulinemia, was hospitalized for respiratory distress and fever due to bilateral pulmonary and pleural disorders. Direct examination of the bronchoalveolar lavage fluid revealed a flagella protozoan identified as Trichomonas tenax. DISCUSSION: Although Trichomonas is rare in pulmonary disorders, when it occurs, T. tenax appears to be the most common species. Treatment with metronidazole was effective.

[Creation of an ongoing database on food inspections to improve the Food Service effectiveness]. / Implementazione di un database elettronico per la raccolta e l'elaborazione dei dati relativi ai sopralluoghi ispettivi del Servizio di Igiene degli Alimenti e della Nutrizione.

The purpose of the present study is to create a database for the collection and analysis of data related to the inspection program carried out by a Food and Nutrition Unit, Department of Health Services Milan 1. 1202 reports, stored in the archives of the Unit, were examined. On the basis of the results a computerised reporting form by Microsoft Access was created. The study confirms the necessity of a computerised recording system to point out the most common infractions and to standardise the work of operators. Moreover, on the basis of available data, food inspection activity can be more easily planned focusing on the actual local problems. The described system is a valid tool to store and analyse the information gathered from the inspections. Further implementations could make the database more informative.

[Postoperative nausea and vomiting in adult patients]. / Nausées et vomissements postopératoires de l'adulte.

OBJECTIVE: Identifying risk factors and predictive models for Postoperative Nausea and Vomiting (PONV) and developing antiemetic guidelines for its prevention and treatment. DATA SOURCES: Medline (1997-2002) searches, using "postoperative nausea and vomiting" [MESH], complemented by handsearch. STUDY SELECTION AND DATA EXTRACTION: Published randomised controlled trials, systematic reviews and multivariable analysis of large cohort studies were evaluated. DATA SYNTHESIS: Avoiding PONV seems to be one of the highest priority for most patients. Its most important risk factors are volatile anaesthetics and opioids. If these are given to susceptible patients such as female, those with previous history of PONV or motion sickness and non-smoker, this is likely to result in PONV. For patients receiving volatile anaesthesia, simplified risk scores are available to estimate the individual risk of PONV. Patients at high risk for PONV may benefit from a multimodal approach which involves a) lowering the baseline risk (e.g. by total intravenous anaesthesia with propofol) with b) prophylactically given antiemetics such as droperidol, dexamethasone and serotonin antagonists, alone or in combination. In these selected patients, antiemetics are cost effective. CONCLUSIONS: A strategy to prevent and treat PONV should depend on the individuals risk. However, its clinical usefulness and economic implications needs to be validated.

Alcohol and pregnancy: an international comparison.

A study was set up to compare the drinking habits of women of childbearing age in two cities (Milan and Southampton) in two countries, Italy and the United Kingdom, and to look at the effects of alcohol consumption on the weight of the babies born to these women. The sample consisted of 1516 women in Milan and 996 in Southampton, who were interviewed after delivery; data on their drinking history, before and during pregnancy, were gathered, together with social, demographic and health data. The clinical records of the women and their babies were examined. On average, both groups drank less than one unit/day before pregnancy, but there were differences in drinking habits between the two countries, as well as in the modifications induced by pregnancy. The possible effects of alcohol on birthweight were then considered. After controlling for confounding factors, there was no general association between birthweight and alcohol consumption. The impact on health education policy is discussed.

[Diagnostic and therapeutic of human hydatidosis. Study of a hospital case series]. / Aspetti diagnostici e terapeutici dell'idatidosi umana. Studio di una casistica ospedaliera.

A case-study on 95 inpatients with hydatid disease admitted to a community hospital in Milan is presented. Clinical records from January 1975 through December 1985 were reviewed. Data were analyzed according to: individual characteristics of the subject; previous history of hydatid disease and present signs and symptoms; tests and instrumental examinations performed to ascertain the disease; type of treatment and outcome. Liver (56%) and lung (18%) were the most commonly involved organs, but lung location was, relatively to age, more frequent in children and teenagers than in adults. Intradermal (Casoni) or serological (Ghedini) tests and scintigraphy for the hepatic localization, and lung stratigraphy or histologic section for the pulmonary one, were the most frequent examinations performed. Seventy-three patients (77%) underwent surgical treatment.

Gynaecomastia and premature thelarche in a schoolchildren population of northern Italy.

The prevalence and incidence of gynaecomastia and thelarche have been studied in pre-school children and school children belonging to different socio-economical classes in two Northern Italian Cities: Milano and Mantova. The children selected underwent three clinical examinations in their own school by the same examinator. The highest prevalence (36.6%) of breast enlargement was observed in nursery children until 2 years of age in Milano. Age and sex specific incidence rates were higher in Milano than in Mantova except in boys 11-14 years old. Assumption of drugs which might induce gynaecomastia thelarche was excluded. Relative risks calculated for veal and chicken must suggest that these are not relevant in the etiology of breast enlargement.

Problems in the assessment of human exposure to tetrachlorodibenzodioxin (TCDD): the marker chloracne.

An epidemiological study, aiming to assess the extent of the exposure to tetrachlorodibenzodioxin (TCDD) of the population involved in the Seveso accident, needs an effective information system, able to answer the questions usually asked--such as: why? what? who? where? when? how long?--and therefore concerning the wide range of the expected events, from the early cases till the ones expected in the long term. The paper is concerned with evaluation of possible use of chloracne as indicator of human exposure to TCDD, taking into account from one hand chloracne itself (i.e. its latency period, sensitivity, specificity, predictive value of diagnosis, etc) and, from the other, the development of the observational process. Moreover, the paper points out the role of the dermatological findings as representative--more than and before the other clinical findings--of the exposure conditions in the polluted area. The group of subjects classified as "chloracne" by the end of the second screening (May, 1977) included 187 cases, 164 of which were children 0-14 yrs old by the 10th of July 1976; 34 out of 164 were diagnosed in September-December 1976, the other 130 were diagnosed within the screening program. The results of a survey concerning their exposure data, clinical and laboratory findings are detailed. Finally, some remarks are made related to the quality of data. The authors emphasize that the reliability of assessment of health status of the exposed population depends not only upon a comprehensive a posteriori analysis of the different sets of clinical findings, but also upon the degree of integration of the professional staffs involved at operational levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Chloracne following environmental contamination by TCDD in Seveso, Italy.

Data are presented on the occurrence of chloracne, clinical symptoms and biochemical changes in 164 children following environmental contamination by TCDD from an industrial accident in Seveso, Italy. An overall positive association was found between the territorial distribution of chloracne cases and the different levels of soil contamination in the affected area. Individual risk factors such as condition and length of exposure, intake via contaminated foods, etc. were evaluated; no single factor appeared to be associated with chloracne. Disturbances of the gastrointestinal tract were more frequently observed in children affected with chloracne in those from the same areas having no skin lesions. However, no clinically definable systemic disease has been diagnosed.

[Duration of tetanus immunity in relation to the number of doses of vaccine]. / Durate dell'immunita' antitetanica in relazione al numero di dosi di vaccino.

A study of the duration of the immunity to tetanus, by means of the passive haemagglutination test, was undertaken in three groups of subjects immunized with two (primary immunization), three (basic immunization) and four (basic immunization with booster) does of DT. All the subjects of the first group, who had gone 9 months since their last dose, possessed antitoxin titers greater than or equal to 0.01 I.U./ml. Among the subjects of the second group within 12 months of the basic immunization course none had less than 0.01 I.U./ml, within 13-48 months 3% had less than 0.01 I.U./ml, within 49-72 months 9.7% had less than 0.01 I.U./ml and after 73 months 26.5% had less than 0.01 I.U./ml. No dependence on age at time of vaccination could be demonstrated. In the third group of subjects within 48 months of the immunization course with four doses none had less than 0.01 I.U./ml, after 48 months 11.1% had less than 0.01 I.U./ml. Interpolation of the data with the use of linear regression (y = a + bx), which better-fits in comparison with polynomial model (y = a + b1x + b2x2...+ bnxn) until the quartic term, pointed out the possibility that titer falls below the "alert level" (0.1 I.U./ml) and the protective threshold (0.01 I.U./ml): after 22 and 34 months for subjects of the first group; after 110 and 180 months for subjects of the second group and after 164 and 269 months for subjects of the third group. However, the presence of "poor" or "not responders" in the second group is not negligible and justifies the necessity that the first booster dose be given at five-year intervals.

Experiences from the accident of Seveso.

Provisional data on selected sanitary events which took place at Seveso after July 10 1976 are reported. 187 cases of chloracne, mostly in children, were detected, 50 just after the accident, the others within a year. Most polluted area (zone A) provided almost all "early" and most severe cases, but the territorial distribution of chloracne prevalence rates showed some inconsistencies with the soil TCDD pollution map; interpretations for such findings are discussed. Thirty-eight birth defects were detected in 1977 (none in zones A and B), more than in previous years, but still less than expected in a well controlled "normal" population: no clustering around a given type was observed. Spontaneous abortions, evaluated both as abortion rates and as pregnancy loss rates, showed scattered and statistically non-significant variations, inconsistent with the pollution map. No differences in birth and death rates compared to surrounding areas were observed. Data on ad hoc cytogenetic, neurological and immunological surveys are commented. Limitations of the presently available data are discussed and further research lines are anticipated.