Human papillomavirus vaccination: what is the best choice? A comparison of 16 strategies by means of a decisional model.

Some European countries decided to include human papillomavirus (HPV) vaccines in national immunization schedules. In order to help decision makers choose the best vaccination policy for females, a decisional model has been developed. The study was performed from the National Health Service perspective. Several hypotheses of multi-cohort vaccination policies were compared. 'Potentially avoidable infections' were chosen as the outcome. The model envisioned a short-term scenario (2008-2011). The best policy was that of vaccinating 12-year-olds and, a year later, those aged 14-16 years; the most expensive strategy was that of vaccinating 12-year-old females and, after 1 year, vaccinating those aged 15, 18 and 25 years. The sensitivity analysis showed that coverage rate has a great effect on the cost of avoidable infections. The study offers stake-holders an important datum-point for the choice of the best HPV policy vaccination in the short term. Indeed, it could generate interesting savings for the National Health Service and a rapid HPV immunization of young girls.

Assessment and prevention of radioactive risk due to 222Radon on University Premises in Genoa, Italy.

From October 2004 to September 2005, Radon222 activity in high-risk indoor spaces used by employees and students at the University of Genoa was measured with CR-39 nuclear track detectors. The mean concentration in winter (78.9 Bq/m3 +/- 74.92 S.D.) was low in relation to the microenvironment considered. When data were broken down by type and location of the spaces, no significant differences were found, despite the fact that the Genoa conurbation lies on soil of variable geological composition. The dose absorbed by employees was 0.42 mSv/year, with a relative risk of 4.2/1000 cases of Radon-related lung cancer. The dose absorbed by students was 0.28 mSv/year, with a relative risk of 2.5/1000 cases of Radon-related lung cancer. The level of radon activity detected never exceeded the limit of 500 Bq/m3 established by Italian law. Nevertheless, the value of the compound uncertainty index suggested that the real level of Radon contamination could have exceeded 400 Bq/m3 in selected spaces, a value requiring annual concentration tests.

Factors affecting individual exposure to NO2 in Genoa (northern Italy).

The individual exposure to nitrogen dioxide (NO2) of 89 volunteers living in Genoa, a large port city of northern Italy, was investigated with personal passive diffusion tubes in February-March 2000. The data were related to NO2 concentration in the kitchen and bedroom as measured by static samplers. Volunteers included students, workers and housewives living in three areas of Genoa differing by street traffic and industrial plant location. The kitchen samples showed higher (47.00+/-16.5 microg/m3) NO2 concentrations than those from the bedroom (24.78+/-9.8 microg/m3); overall indoor NO2 concentrations were lower in the Eastern area of Genoa, where outdoor pollution is lower. Students were the volunteer group with the lowest exposure rate (24.9+/-7.8 microg/m3 vs. 44.3+/-10.1 microg/m3 for workers and 40.0+/-13.4 microg/m3 for housewives). This difference is related to the fact that students spend more time indoors, where pollution levels are lower. The main household characteristics which were shown to affect personal NO2 exposure were (a) the presence of a chimney equipped with an active aspiration device in the kitchen and (b) the heating system.

Madelung's disease: case report and discussion of treatment options.

Madelung's disease was first described in 1846. Since then, approximately 200 patients have been reported in the literature. Its three main characteristics-typical location of the lesions, symmetry, and the diffusive nature of the fat-are more often found in men of Mediterranean descent. A clear association with alcohol abuse is reported, but the etiology remains uncertain. Patients usually complain of their cosmetic appearance, but treatment can be rendered for decreased neck motion and/or aerodigestive problems. Given the benign nature of the lesion, surgical debulking is the treatment of choice, with liposuction reserved for smaller lesions. A standard facelift pattern can be used for skin incisions and removal, with good cosmetic results.

[Fournier syndrome: multidisciplinary approach]. / Sindrome di Fournier: approccio multidisciplinare.

Fournier's gangrene, a form of necrotizing fasciitis, is an uncommon, fulminant, rapidly progressing subcutaneous infection of the scrotum and genito-perineal region, and may occur in all age groups. Most cases involve a mixed synergistic infection of aerobic and anaerobic bacteria, and occur as a result of one of this mechanisms: local trauma, extension from a perineal, periurethral or ischiorectal infection. It is associated with a high mortality rate. Predisposing factors included diabetes mellitus, steroids or chemotherapy, alcohol abuse, malignancy and radiation therapy. This disease requires prompt treatment: early diagnosis, antibiotic therapy, nutritional support, immediate extensive surgical debridement and hyperbaric oxygen therapy. The use of etherologue serum is a valuable adjunct in the therapy of Fournier's gangrene. We report a case of Fournier's syndrome treated with etherologue serum immuno-therapy, together with the conventional multidisciplinary approach. The postoperative course was uneventful and the patient was discharged on day 50 post intervention in good general conditions. The 3 years follow-up showed no recurrence of the disease. In conclusion we remark that the survival can be improved in patients with Fournier's gangrene by multidisciplinary approach.

Increased urinary excretion of hydroxyproline in runners training in urban areas.

In this study, the authors investigated urinary excretion of hydroxyproline in 120 subjects to test the hypothesis that physical activity is associated with increased exposure to pollution derived from traffic exhaust. The study population comprised active noncompetitive runners (i.e., 21.1% trained < 2.5 hr/wk, 20% trained for 2.5-5.0 hr/wk, and 54.4% trained > 5 hr/wk) who lived in Genoa, an urban area of Northern Italy. The mean hydroxyproline value (24.39 +/- 8.38 standard deviation] mg/24 hr x m2) in a group of 69 runners who trained in tracks and streets located in downtown Genoa was higher (p < .05) than the mean value recorded in a group of 21 runners (13.33 +/- 2.51 mg/24 hr x m2) who trained mainly in a rural environment of Genoa. The difference was even greater (p < .01) when a third comparable group of 30 nonrunners was considered (mean = 12.54 +/- 3.41 [standard deviation] mg/24 hr x m2). In the urban environment, urinary levels of hydroxyproline were correlated significantly with intensity and frequency of running, but they were unrelated to smoking status.

[Zenker's diverticulum. Apropos a case]. / Diverticolo di Zenker. A proposito di un caso.

The authors report a case of Zenker's diverticulum in a patient 72 years old who underwent surgery. The pharyngoesophageal function was investigated before and after cricopharyngeal myotomy and diverticulopexy, with oesophageal manometry. Preoperative manometry showed an incomplete relaxation of the upper oesophageal sphincter and increased of pharyngeal pressure. This diverticulum has a pulsion pathogenesis and in this case is not associated with gastroesophageal reflux. It is important to check whether an associated oesophageal pathology exist once Zenker's diverticulum has been diagnosed: X-ray examination of oesophagus and stomach are capable of identifying the presence of diverticulum as well as other pathological association. In the case showed the clinical manifestation are represented by: cervical dysphagia, sensation of foreign body while eating due to the accumulation of ingested food in the diverticulum, and noisy deglutition. The surgical treatment in this case consist of diverticulopexy with cricopharyngeal myotomy. This case is treated with diverticulopexy for two reason: because is not very big and to reduce post-operative period. In conclusion the authors shows the importance of this surgery for not very large sized pouches, and emphasise the importance of manometric and radiographic control in pre and post-operative period. This kind of surgery reduce post-operative complication and the period to stay in bed.

Transudative right pleural effusion due to compression of the brachiocephalic vein caused by an intrathoracic goitre.

The case presented in this report is of a female patient who suffered recurrent transudative right pleural effusions, due to a giant benign intrathoracic goitre. The latter caused compression of the brachiocephalic vein, which is a very rare cause of pleural fluid accumulation. Magnetic resonance imaging played a crucial diagnostic role.

[Morgagni-Larrey diaphragmatic hernia: report of a case]. / Ernia diaframmatica di Morgagni-Larrey: descrizione di un caso.

The Authors presents a Morgagni-Larrey's diaphragmatic hernia case, observed during subocclusive manifestation. They emphasize the utility to perform always the surgical intervention, also in the asintomatic cases.

[Meigs' syndrome: its clinical picture and treatment]. / Sindrome di Meigs: inquadramento clinico e trattamento.

Meigs' syndrome is a rare clinical entity characterised with ovarian benign tumour, ascites and hydrothorax. Between January '94-September '98 we observed three patients with: ovarian neoformation, light (1 patient), moderate (2 patients) monolateral pleural effusion, moderate (2 patients) and considerable (1 patient) ascites. In all patients the preoperative evaluation (sero-haematologic routine, Ca 125 and other oncologic markers, chest X-ray, abdominal and pelvic ultrasonography, total-body Tc, cytological analysis of pleural and abdominal effusion) was suggestive for malignancy but not confirmed it. So an explorative laparotomy with histological extemporary analysis was performed. The results were: 1 fibrothecomas, 1 fibroma, 1 ovarian inflammation with cystic luteinization areas and fibromatosis uterine. All three patients had a good postoperative course. The symptomatology and the effusions disappeared 7-10 days after operation. The first two cases were diagnosed as classic Meigs' syndrome, the third one, instead, as a pseudo-Meigs's syndrome. In conclusion the A.A., according to literature and their experiences, underline: 1) an ovarian mass with pleural and abdominal effusion not always represents an advanced malignancy; 2) even if elevated Ca 125 value is usually associated to a ovarian malignancy, there are some benign lesions in which we observed elevated level of this marker 3) the removal of the ovarian mass is the only resolutive treatment for these patients.

[Complicated Spigelian hernia: our experience]. / Ernia di Spigelio complicata: nostra esperienza.

We present a case of complicated Spigelian hernia presented with symptoms of intestinal occlusion, in a 50 years old woman. Spigelian hernia represents 1-2% of all abdominal hernias and can occur anywhere along the semicircular line of Douglas. The patient underwent emergency surgery followed by polypropylene plastic repair. The postoperative course was uneventful and the patient was discharged on day 8 post intervention in good general conditions. The 2 years follow-up showed no recurrence of the disease. Clinical examination is the foundation of the diagnosis, whereas radiological findings (ultrasonography, TC) allow the exclusion of other pathologies in the differential diagnosis. The preoperative diagnosis is difficult, mainly because of the non-specificity of symptoms as well as the few cases reported in the literature. In conclusion, we remark that the surgery remains the most effective treatment of Spigelian Hernia.

Reduction in 222radon concentration due to water treatment processes.

In 40 samples of drinkable water taken from public fountains in the Province of Genoa determinations of 222Rn concentration were performed. The results were related to data obtained in a previous study on 222Rn concentration in spring water in the same areas, in order to assess a possible variation due to water treatment and to the aqueduct piping length. Radon concentration was also related to the main geographical areas in the Province and to the different geological formations. The average concentration was 0.92 +/- 0.86 Bq/l, and it can be related to equivalent dose to the population of 0.16 mSv/year. Our data show that water treatment processes cause a reduction in Radon concentration ranging between 58% and 93%, from picking up to utilization.

Long-term decline of radiocesium concentration in seafood from the Ligurian sea (northern Italy) after Chernobyl.

The activity of 137Cs, 134Cs and 40K in tissues from fish, molluse and shellfish of the Ligurian sea was measured during 1987-1988. The mean annual concentrations in 1987 were 5.92 +/- 4.1 Bq/kg (wet tissue) for 137Cs and 2.7 +/- 1.5 Bq/kg for 134Cs and 2.46 +/- 1.82 and 0.33 +/- 0.57 Bq/kg respectively in 1988. The mean value of 40K activity was 138.6 +/- 22.1 Bq/kg. Contamination was significantly higher in the littoral area up to 1000 m from the coast (8.39 +/- 7.6 and 1.74 +/- 2.08 Bq/kg respectively versus 2.91 +/- 1.87 and 0.58 +/- 0.59 Bq/kg respectively in the open sea). The common octopus (Octopus vulgaris) had the highest radioactivity values and could be utilized as an indicator of radioactivity pollution. There were no significant differences regarding the trophic level, the seafood phylum, or the east and west Ligurian sea areas. Long-term reduction in the sea habitat was estimated at about 200 days for 137Cs and 110 days for 134Cs, reflecting differences in the physical half-life of these radionuclides. These values were lower than those found in terrestrial foodstuff and could have reflected dilution of the contaminants in the open sea. The effective dose equivalent for the Ligurian population of radiocesium originating from seafood was estimated at 1.3 microSv in 1987 and 0.5 microSv in 1988. These va ues represent 0.8 and 0.3% respectively of the annual dose (180 microSv/year) due to 40K intake with the diet.

Organochlorine residues in human adipose and hepatic tissues from autopsy sources in northern Italy.

Organochlorine compounds have been analyzed in human samples from residents of Genoa, a city in Northern Italy. Twenty-eight specimens of adipose tissue from 17 males and 11 females deceased from accidental causes in March and April 1989 were examined. In 12 of the 17 males, liver tissue specimens were also analyzed. DDE was the major organochlorine pesticide (OCP) found in all human adipose tissues (395 +/- 264 ng/g); additional OCPs found in our series of human subjects with an occurrence greater than 80% included p,p-DDT (64 +/- 31 ng/g), lindane (104 +/- 93 ng/g), and beta-BHC (213 +/- 260 ng/g). Statistical analysis showed positive correlation of DDE and p,p-DDT with age with an annual increase of 7 ng/yr and 0.9 ng/yr, respectively. No statistically significant differences were found for OCPs concentration between sexes. In DDE to sigma DDT (o,p-DDT + p,p-DDT + o,p-TDE + p,p-TDE) ratio changed in the last two decades from 0.95 (1966) to 5.2. Significant correlation was found between paired liver-adipose tissues concentrations of DDE and p,p-DDT (1:2 ratio). No correlation was found between age of subjects and the DDE to sigma DDT ratio. This study indicates that the ban on DDT use as a pesticide has been largely effective in Liguria, as supported by the lower concentrations of the compound in youngsters and the increase in the DDE to sigma DDT ratio with time. However, other data, such as the lack of correlation between age of subject and the DDE to sigma DDT ratio, indicate that intake of minimal amounts of DDT may have taken place even recently. This intake could depend on contamination of food imported from abroad or on illegal, or incorrect, use of these compounds in Italy.

Increased blood lead levels in runners training in urban areas.

In an attempt to examine the hypothesis of whether physical activity causes increased uptake of lead in humans, blood lead levels were measured in 231 individuals. Included in the study were subjects who lived in Northern Italy and who practiced noncompetitive running in urban areas or along the countryside. The mean values (1.25 +/- 0.27 mumol/l) measured in a group of 28 runners who trained at tracks and on roads of a large town, characterized by heavy traffic and high atmospheric lead levels, were slightly higher than those recorded in a group of 10 runners of the same town who trained mostly in a rural environment (0.99 +/- 0.29 mumol/l) and, with a striking and significant difference, in a comparable group of 182 nonrunners (0.46 +/- 0.22 mumol/l). These background figures were similar to those found in 11 runners who lived in a smaller, less polluted urban area who trained in country roads (0.40 +/- 0.11 mumol/l). Blood lead levels were correlated significantly with the intensity and frequency of the running practice and were unrelated to smoking habits.

[Determination of cesium in human placenta 3 years after Chernobyl]. / Determinazione del cesio in placente umane tre anni dopo Chernobyl.

Three years after the nuclear reactor accident in Chernobyl, 80 human placentae were tested to determine concentrations of cesium 134 and cesium 137 radionuclides. The activities of radionuclides were measured using a low-back ground gamma-ray spectrometry system. Human placentae were obtained from normal and at term pregnancies in women who lived in rural areas of northern-Italy and north-west of Yugoslavia and who in particular used locally grown vegetables and meats. According to the data of other Authors, the low cesium isotopes 134 and 137 levels detected (inferior to 2 Bq/kg) in human placentae suggest that, in the observed geographic areas, the fetal risk following the reactor accident in Chernobyl was negligible.