[State of the art and scientific evidence on the role of unidirectional airflow ventilation systems in reducing surgical site infections]. / Stato dell'arte ed evidenze scientifiche sul ruolo dei sistemi di ventilazione a flusso unidirezionale nella riduzione delle infezioni del sito chirurgico.

The use of unidirectional airflow ventilation systems in operating rooms is frequently recommended for the prevention of Surgical Site Infections (SSI). However, scientific evidence is lacking to clearly support this technology which entails high investment costs and operating expenses, as compared with traditional ventilation systems. This sparse evidence is mainly related to the small number of interventions analyzed in each study and the difficulty to distinguish the effects of ventilation and other important confounding factors, such as antibiotic prophylaxis, special operating staff clothing and adoption of educational and training programs against SSI for the surgical personnel. The different behavior of the industrialized countries towards this issue, as it comes out analyzing the existing Rules and Guidelines concerning operating rooms ventilation, reflects a precautionary approach towards a technology which, until recently, has clearly demonstrated neither benefits nor limitations. In 2008, a relevant scientific study was published, reporting results from 63 departments of 55 German hospitals for a total of 99.230 surgical interventions, in which a standardized SSI surveillance was performed. Unexpectedly, the study concluded that unidirectional airflow ventilation showed no benefit and was even associated with a significantly higher risk for severe SSI, as compared with turbulent clean air. The present review collects updates from the scientific literature and national and international Rules and Guidelines concerning the use of unidirectional airflow ventilation systems in operating rooms, analyzing all aspects involved in this issue, from the debated efficacy of these systems in reducing the incidence of SSI to the "side effects" associated to their use, as the relevant costs and the reduction of the environmental comfort for the operators.

Radiometric survey of teletherapy treatment rooms in Brazil.

The Brazilian national regulatory authority, National Commission of Nuclear Energy, requires that dose rates in the vicinity of teletherapy treatment rooms do not exceed the permissible limits for workers as well as members of the public, depending on the place considered. At the end of 2005, the Brazilian national regulatory authority reduced the permissible dose limit for controlled areas from 1000 to 400 microSv week(-1). Therefore, the aim of this work is to verify the adequacy of structural shielding to this new limit for telecobalt units that had their sources changed and clinic linear accelerators (ALs) installed before the end of 2005. Considering the ALs, measurements of dose rates in controlled areas did not exceed the new permissible limit, excepting for a single case. In the case of (60)Co units, a similar situation is observed for controlled areas, although several non-conformities to the limit of uncontrolled area could be observed.

Dosimetric audits of photon beams in radiation therapy centres in Rio de Janeiro, Brazil.

Data related to 11 y of high-energy photon radiotherapy beam dosimetry are presented and analysed. Dosimetric evaluations were carried out using water phantoms and thimble ionisation chambers and are part of the radiation protection regulatory licensing process for medicine facilities of Brazilian government. Measurements were done at reference conditions for a standard absorbed dose of 100 cGy [cGy (=1 rad)]. The absolute per cent deviation between the measured and presumed delivered doses should not exceed the tolerance level of +/-3%. The first dosimetry survey from 1996 to 1998 showed a situation that was an object of concern. Deviations of 22 and 18.7% could be measured, although small deviations were also obtained. After 1998, the improvement in dosimetry quality control by the radiotherapy centres became clear, with most of the deviations situated within the +/-3% range. The decrease in the measured deviations presents the effective success of the Institute of Radiation Protection and Dosimetry audit programme for the improvement in the control of radiotherapy photon beams in Rio de Janeiro. Also, it is possible to recommend to Brazilian regulatory organisation a decrease in the tolerance level for dosimetric deviations in order to achieve a more precise dose delivered to patients in radiotherapy centres.

[Cost evaluation of a ventilation system for operating theatre: an ultraclean design versus a conventional one]. / Valutazione dei costi di un impianto di ventilazione per un blocco operatorio: confronto tra sistema "ultraclean" e convenzionale.

The postoperative infection has been recognized as a critical problem in healthcare, increasing patients'complications and hospitalization costs. At the moment the scientific evidence clearly linking ventilation parameters, such as air changes per hour, bacterial counts and infection, is lacking, with the exception of prosthetic joint surgery. This study aims to evaluate the building and operating costs of an ultraclean system versus a conventional one (which satisfies the minimum performance requested by rules), also considering the debating efficacy of ultraclean ventilation on prevention of postoperative infection. The results of our study show an increase of 24% in the building costs and of 34% in the annual operating costs for the ultraclean system versus the conventional one. The estimated 24% increase of the building costs for the ultraclean ventilation system represents only a 5% increase if compared to the total cost of a not equipped operating theatre. Therefore, the increase on costs linked to the use of high performance ventilation facilities seems to be so small that overcoming current rules towards ultraclean systems could be acceptable.

Considerations on isolation rooms and alternative pressure ventilation systems.

The health-care facility environment is involved in disease transmission in essentially two different situations: 1. in cases where patients are immunocompromised and require protection from infections; 2. in cases of inadvertent exposure to environmental or airborne pathogens that can aggravate patients' existent disease and cause illness among health-care personnel. Environmental infection-control strategies and engineering controls can effectively prevent transmission of these infections. In particular the ventilation system is fundamental to the control of the concentration of airborne contaminants within a hospital isolation room because it establishes and maintains appropriate pressure differentials within special care areas of the building. Thus the incidence of health-care-associated infections can be minimized by adherence to ventilation standards suggested in the guidelines for specialized care environments such as Airborne Infection Isolation rooms (AII, as in situation 2 above), and Protective Environments (PE) rooms (as in situation 1 above). This report is a comparative review of the principal guidelines and strategies existing in the international scientific literature for the prevention of environment-associated infections in healthcare facilities using pressure differentials (positive pressure for PE rooms, negative pressure for AII rooms). The purpose of the review is also to investigate the state-of-the-art use of the "alternative pressure rooms", i.e., areas furnished with a ventilation system capable of switching pressure from positive to negative according to patients' needs. The results of the present analysis indicate an unenthusiastic reaction to these "alternative pressure rooms", although there is no scientific evidence against their use.

[Regional odontodysplasia ("ghost teeth"). A case report]. / L'odontodisplasia regionale ("ghost teeth"). Descrizione di un caso.

The authors present a rare case of developmental anomaly called regional odontodysplasia. It is also called odontogenic dysplasia, ghost teeth. It is a disorder that affects both the ectodermal and mesodermal dental components. The teeth usually fail to erupt and they have wide pulp chambers. Any teeth may be affected, but the disease is usually restricted to single quadrants. The cause is unknown.

Early diagnosis of genito-urinary tumours by urinary cytology.

Urinary Cytology, if performed with accuracy, plays an important (sometimes decisive) role in early diagnosis of genito-urinary tumours. It offers many advantages: easiness in carrying out, possibility to repeat the examination at will, painless execution, no invasiveness and restricted cost. The Authors report on their experience in performing cytologic examination on fresh urine specimens, formalin-fixed in Swinnex milliphore-filter and stained according to a slightly modified Papanicolau method (Alcohol 80 degrees + Haematoxylin-). Thanks to a carefully executed technique of concentration and cellular preservation, the Authors were able to obtain complete specimens, interpreted easily, and to identify the main morphologic changes of neoplastic cells, namely the characteristic nucleo-cytoplasmatic alterations. Between 1986 and 1987 the Authors examined 600 patients, admitted to Urologic Dept. of Saronno General Hospital, employing, amongst others diagnostic procedure (cystoscopy, needle biopsy, CAT, ecc.), urinary cytology: they observed 94% of true results (positive or negative for genito-urinary tumours) in comparison with 4% of false positive and 2% of false negative only; these results compared to others, appeared until now, in Medical literature, lead to regard this technique, further improved by more experience in cytology, as a greatly valuable and highly reliable diagnostic method, mainly in early discovery of genito-urinary neoplasms.

Polyvinilpyrrolidone-iodine (P.V.P.-I) bladder irrigation for prevention of catheter-associated urinary infections in patients treated by T.U.R.

The incidence of urinary infection in catheterized patients is very important in those undergoing T.U.R. for bladder neck and prostatic obstructions because the risk of jatrogenic defilement, and any method of preventing, reducing or delaying the occurrence of infection in catheterized patients, should be tooking considerations. Between March 1984 and September 1985 300 male patients, requiring catheterization after T.U.R. for out-flow obstruction (80% benign, 40% malignant prostatic disease, 16% bladder-neck obstruction), were introduced to the trial. All patients were managed by closed drainage system and treated, immediately after T.U.R., by continuous bladder irrigation with saline solution of iodine and polyvinylpyrrolidone (1:150-1:50 in 3000 ml) until elective removal of the post-operative catheter; use of antibiotics was restricted to preoperatory stage. At the elective removal of the post-T.U.R. catheter (between 3d and 7th day) the urino-culture in 79% showed no bacteriuria, in 15% showed mild infection (less than 500.000 organisms/ml) and in 6% revealed a severe infection (greater than 500.000 organisms/ml). At the same time 300 other patients-the control group-underwent to T.U.R. for the same diseases (out-flow obstruction) and received pre- and post-operative antibiotics only without P.V.P.-I irrigation. This treatment revealed sterile urine only in 40% of cases and persistent bacteriuria in 60% of cases. This original method in preventing and treating catheter infection of patients operated of T.U.R. has revealed itself as effective, simple, not too much expensive and without severe side effects.

[Evaluation of 3 different methods for determining triiodothyronine (T-3) and thyroxine (T-4)]. / Valutazione di tre differenti metodiche per la determinazione della triiodotironina (T-3) e della tiroxina (T-4).

The authors compare three methodologies based on the immunology (RIA, FPIA, LIA) in the determination of two important parameters of the so-called thyroid outline: triiodothyronine (T-3) and thyroxine (T-4). The correlations between the analytic systems examined are presented and discussed.

Hormone treatment and sex steroid receptors in metastatic renal cell carcinoma: report of a multicentric prospective study.

Twenty-eight patients with metastatic renal cell carcinoma entered a multicentric prospective study to evaluate the response to high-dose medroxyprogesterone acetate (MPA) and testosterone in MPA failures in relation to sex steroid receptors. No objective remission was seen in the 24 evaluable patients, and only disease stabilizations of short duration were achieved in one-third of treated patients. Stabilizations achieved with second line testosterone were all seen in patients unresponsive to MPA. Receptor studies demonstrated that estrogen, progesterone, or androgen receptors were found in low concentrations and in only 6 of 23 tumors (26%) and 13 normal tissue samples (56%). Surprisingly, no disease stabilization was achieved in patients positive for receptors. It can be concluded that the occasional objective responses to hormone therapy reported in the literature may have been due to some cytotoxic effect of hormone therapy rather than to a true hormonal mechanism.

Adjunctive medroxyprogesterone acetate to radical nephrectomy in category M0 renal cell carcinoma. Preliminary report of a prospective randomized trial.

From July 1979 to December 1981, 83 patients from 6 centers in the Lombardy underwent radical nephrectomy for category M0 renal cell carcinoma. Postoperatively they were randomly allocated to adjunctive medroxyprogesterone acetate (MPA) or to a control group. After the first year of follow-up, the relapse rate was 13% in the controls (5 of 38 evaluable patients) versus 28% in the MPA treatment group (9 of 32). Sex steroid receptors were studied in both the tumor and in the surrounding healthy parenchyma by the dextran-coated charcoal technique in 52 of 70 clinically evaluable patients. There was no significant correlation between receptor studies and the relapse rate. Besides, receptors were more often detected in the healthy than in the neoplastic tissue, and values rarely exceeded 10 fmol/mg protein. Due to the negative trend in the MPA treatment group, the admittance of patients to this study was stopped after 120 patients had been accepted.