Outcome of congenital diaphragmatic hernia: analysis of implicated factors.

AIM: Congenital diaphragmatic hernia remains a significant challenge for neonatologists and pediatric surgeons. Over the last years, new therapeutic approaches, as high-frequency oscillatory ventilation, inhaled nitric oxide, permissive hypercapnia, extracorporeal membrane oxygenation, have been used for the management of these newborns. We conducted a retrospective study of all infants who were managed for congenital diaphragmatic hernia in our NICU in order to identify possible clinical characteristics which were predictive for survival. METHODS: We reviewed a single institution's experience with 42 consecutive neonates with congenital diaphragmatic hernia admitted to our NICU from 1993 to 2009. RESULTS: Prenatal data and side of congenital diaphragmatic hernia were similar in survivors and no-survivors infants except for the lung-to-head ratio (LHR), which was higher and measured later in survivors than non-survivors. Multiple regression analysis showed that a gestational age ≥39 weeks, Apgar score at 5 min ≥7, FiO2<0.35, MAP<13 cmH2O, OI<10 and AaDO2 >282 before surgical repair, and the absence of persistent pulmonary hypoplasia were independent predictive factors of survival. CONCLUSION: Our study suggests that the outcome of newborns with congenital diaphragmatic hernia still depends on the severity of lung hypoplasia, despite the different respiratory and therapeutical approaches.

Completely isolated enteric duplications cysts: a survey of four cases.

Enteric duplication cysts are uncommon congenital abnormalities with epithelial lining. They are cystic or tubular structures intimately attached to a portion of the gastrointestinal tract; they are usually located on the mesenteric site of the digestive tract sharing common blood supply. Isolated cystic duplications are an extremely rare variant with their own blood supply: in literature only five cases have been reported. We present our four cases series of this uncommon anomaly.

[Characteristics, use and toxicity of fluorochemicals: review of the literature]. / Caratteristiche, uso e tossicità dei fluorurati: revisione della letteratura.

Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) are perfluorinated surfactants used to produce polymers and telomers whose carbon chain can be differently long. Polytetrafluoroethylene (PTFE), namely Teflon, is the chief fluoropolymer and it has been widely utilised over the last decades and all over the world. Indeed, its particular physical and chemical properties make it difficult to replace this substance in several industries (textile, paper, chemical, fire-fighting foam industry). Perfluoroalkyl-compounds may be considered ubiquitous and, in particular, it has been shown that PFOS may be concentrated in the food chain. Concerns about possible toxic effects of these chemicals date back to seventies, but only in 2000 the Environmental Protection Agency (EPA) stated PFOA and PFOS withdrawal to avoid environmental pollution. In 2002 the Organisation for Economic Co-operation and Development reported that these substances are bio-persistent, tend to accumulate in different tissues of living organisms and are toxic to mammalians. In 2006 EPA established that every PFOA emission will be eliminated not later than 2015. Actually, health effects of perfluoroalkyl-compounds on humans remain controversial, in spite of a number of experimental and epidemiological studies. Research focuses on possible endocrine disruption, thyroid and liver carcinogenicity, and development alteration. Our article reviews the main studies concerning PFOS and PFOA industrial and environmental toxicology.

Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996-2003).

BACKGROUND: The purpose was to assess in Italy the clinical features at diagnosis of inflammatory bowel disease (IBD) in children. METHODS: In 1996 an IBD register of disease onset was established on a national scale. RESULTS: Up to the end of 2003, 1576 cases of pediatric IBD were recorded: 810 (52%) ulcerative colitis (UC), 635 (40%) Crohn's disease (CD), and 131 (8%) indeterminate colitis (IC). In the period 1996-2003 an increase of IBD incidence from 0.89 to 1.39/10(5) inhabitants aged <18 years was observed. IBD was more frequent among children aged between 6 and 12 years (57%) but 20% of patients had onset of the disease under 6 years of age; 28 patients were <1 year of age. Overall, 11% had 1 or more family members with IBD. The mean interval between onset of symptoms and diagnosis was higher in CD (10.1 months) and IC (9 months) versus UC (5.8 months). Extended colitis was the most frequent form in UC and ileocolic involvement the most frequent in CD. Upper intestinal tract involvement was present in 11% of CD patients. IC locations were similar to those of UC. Bloody diarrhea and abdominal pain were the most frequent symptoms in UC and IC, and abdominal pain and diarrhea in CD. Extraintestinal symptoms were more frequent in CD than in UC. CONCLUSIONS: The IBD incidence in children and adolescents in Italy shows an increasing trend for all 3 pathologies. UC diagnoses exceeded CD.

[The significance of enviromental and biological monitoring in workers employed in service stations after the elimitation of tetraethyl lead from gasoline]. / Il significato del monitoraggio ambientale e biologico nei lavoratori addetti alle stazioni di servizio dopo la eliminazione del piombo tetraetile dalle benzine.

The chemical risk in service stations may be due to toxic compounds present in fuel (particularly benzene and additives) and to the emission of exhausts and fine particulate from vehicles. Owing to the elimination of lead (Pb) from fuel and to the necessity of lowering CO emission, several oxygenated additives have been added to fuel, in particular methyl-tert-butyl-ether (MTBE), whose toxic properties are at present under investigation. The introduction of reformulated gasoline (RFG) and the use of catalytic converters (with possible release of platinum (Pt) in the environment) may have modified the risks for workers employed in service stations. The paper shows data collected from 26 subjects (divided into three specific tasks, namely: fuel dispenser, "self-service" attendant and controller, and cashier) to estimate the actual chemical risk and to compare it with the previous data taken from literature. For this purpose, besides performing the usual medical surveillance, we measured the environmental concentrations of benzene, MTBE and formaldehyde, the urinary levels of benzene metabolites S-phenylmercapturic acid (S-PMA) and t,t-muconic acid (MA) and of unmodified MTBE, and the blood concentrations of Pb and Pt for each subject. Mean values of these compounds were, respectively: 38.81 microg/m3; 174.04 microg/m3; 10.38 microg/m3; 2.36 microg/g creatinine; 96.57 microg/g creatinine; 1.41 microg/L; 7.00 microg/100 mL; 0.0738 ng/ml. The above values were much lower than the corresponding limit values reported by ACGIH and DFG. In particular, after the introduction of vapour recycle systems and the widespread use of "self-service" systems, airborne benzene concentration dropped from 300/400 microg/m3 to lower than 100 microg/m3, without noticeable increasing of exposure to formaldehyde. The disappearing of Pb from gasoline leads to a progressive lowering of its blood levels, while the possible risks due to the very low amounts of Pt released from catalytic converters have still to be defined exactly. Taken all in all, our results seem to indicate that, after the elimination of tetraethyl lead, the chemical risk for workers employed in service stations is now lower than in the past.

Efectividad del té verde en el tratamiento de periodontitis crónica / Greentea effectiveness in chronic periodontitis treatment

El té verde ha mostrado un amplio rango de efectos fisiológicos y farmacológicos. En los últimos años se han llevado a cabo estudios sistemáticos principalmente por investigadores japoneses en los cuales se evidenciaron las acciones antimicrobianas útiles y variadas que poseen los extractos de té. El objetivo de este trabajo fue determinar, mediante el uso de registros cuantificables, la efectividad clínica y microbiológica del té verde en el tratamiento de las periodontitis crónicas. Fueron evaluados 50 pacientes de ambos sexos, con diagnóstico de periodontitis crónica y con un mínimo de tres bolsas periodontales por cuadrante con profundidad de sondaje ≥ 5 mmy pérdida de inserción ≥ 2 mm por proximal, que concurrieron a la Cátedra de Periodoncia de la Facultad de Odontología de la Universidad Nacional de Rosario, Argentina. Las variables clínicas consideradas fueron Indice Gingival (Loe y Silness, 1963), Sangrado al Sondaje (Val del Verden, 1979), Profundidad de sondaje con sonda milimetrada tipo Marquis y Nivel de inserción epitelial vertical. Para determinar la eficacia microbiológica del tratamiento se extrajeron muestras de placa subgingival con conos de papel estéril del fondo de las bolsas periodontales. Se sembró en medio de Agar Schlaeder – sangre enriquecido con 1% de hemina y vitamina K en atmósfera anaeróbica a 37°C durante 5 días. La tipificación fue realizada con el método comercial semi-automatizado Api 20 A Biomerieux – France. El uso de extracto de té verde asociado a la terapia periodontal mecánica ha sido sensiblemente eficaz en la reversión de estas variables en el tratamiento de la periodontitis crónica, si bien su uso asociado o no al raspaje y alisamiento radicular no mostró diferencias significativas respecto del raspaje y alisamiento como monoterapia para el control de la flora anaeróbica en esta patología (AU)

Green tea has been shown to have a wide range of physiological and pharmacological effects. In recent years, systematic studies performed mainly by Japanese researchers have evidenced the wide range of very useful antimicrobial properties of tea extracts. The aim of the present study was to quantitatively evaluate the clinical and microbiological efficacy of green tea in the treatment of chronic periodontitis. Fifty male and female patients who attended the Department of Periodontics, Faculty of Dentistry, National University of Rosario, Argentina, and had been diagnosed with chronic periodontitis were included in the study. The selected patients had at least 3 periodontal pockets per quadrant, depth on probing ≥ 5 mm and proximal attachment loss ≥ 2 mm. The clinical endpoints assessed were Gingival Index (Loe y Silness, 1963), Bleeding on Probing (Val del Verden, 1979), Depth on Probing with a Marquis type probe and Level of Vertical Epithelial Attachment. Samples of subgingival plaque were obtained with sterile paper cones from the bottom of the periodontal pockets to evaluate microbiological efficacy. The samples were seeded in Agar Schlaeder medium – blood enriched with 1% hemine and vitamin K in anaerobiosis at 37°C for 5 days. Typification was performed employing the commercial semi-automatic method Api 20 A Biomerieux – France. The use of green tea extract coupled to mechanical periodontal therapy for chronic periodontitis was efficient in controlling these variables. However, when it was used coupled to root scaling and planing it did not significantly improve the control of anaerobic flora as compared to scaling and planing used alone (AU)

[Intestinal intussusception: easy diagnosis in the 21st Century? Outcome of five years experiences]. / Invaginazione intestinale: una diagnosi facile nel 21 degrees secolo? Outcome degli ultimi 5 anni.

UNLABELLED: Intussusception is an entity well codify in pediatric surgery, with guidelines well defined since years in terms of imaging and procedures. MATERIAL: From January '99 to Dec. '03, 25 children were admitted to the Department of Pediatric Surgery of the Children's Hospital of Milan. All the aspects related to the pathology have been evaluated in the study. RESULTS: 25 patients have been studied. 23/25 presented severe pain, 19/25 normal bowel movements in the last 3 hours and in 9/25 a mass were detected at clinical examination.19/25 were submitted to laparotomy after failure of reduction through barium enema, and in 17/19 a manual reduction were performed. Only 2 patients required a bowel resection with primary anastomosis. The analysis of the delay of diagnosis, the delta-T between beginning of the symptoms and first medical evaluation was of 16,23 h. (3-72), and the delta-T between the first evaluation and diagnosis was 18,7 h. The interval between diagnosis and surgery was of 4,3. CONCLUSION: Authors believe that intussusception still represent a challenge for medical and surgical emergency team, supported by the data in literature. Imaging procedures must not be constricted in case of minimal suspicions of intestinal intussusception.

[New biomarkers of exposure]. / Nuovi indicatori di esposizione.

In this paper we have defined the new biomarkers of exposure (NBE) as those biomarkers discovered in the last five years and, among previously validated biomarkers, also those applied in different ranges of doses or those determined in biological matrices which differ from matrices originally considered. We examined the results from the surveys carried out by the main Italian research units involved in biological monitoring, i.e. those from the Universities of Brescia, Milan, Naples, Padua, Parma, Pavia, Turin and Verona. The data were collected using a standardized model and included the following: type of element or organic compound, type of biomarker, analytical technique and method, their relationship with environmental monitoring data, their relationship with effect indicators or effects in general, improvement with respect to old biomarkers, reference values. Twenty two NBEs were identified: 14 elements and chemical compounds as such or as metabolites, 4 examples of mixtures, 3 of new matrices, one of speciation. Among the others, aspects such as interest in requiring NBE, quality assurance, availability, cost-benefit ratio were discussed. We conclude that development of this specific field of research appears to be a crucial point for future improvement in risk assessment and health surveillance procedures.

[Excretion kinetics of phenylhydroxyethyl mercapturic acids (PHEMAs), ethanol consumption, and chronic exposure to styrene: preliminary data on humans]. / Cinetica di escrezione degli acidi fenilidrossietilmercapturici (PHEMAs), consumo di etanolo ed esposizione cronica a stirene: dati preliminari sull'uomo.

Styrene (S) is a widely used aromatic hydrocarbon, responsible for several adverse effects. In humans, the metabolism of S is well characterized: besides the major metabolites (mandelic and phenylglyoxylic acid), a minor metabolic pathway leads to phenylhydroxyethyl mercapturic acids (PHEMAs) [N-acetyl-S-(1-phenyl-2-hydroxyethyl)-L-cysteine (M1) and N-acetyl-S-(2-phenyl-2-hydroxyethyl)-L-cysteine (M2)], that are potentially useful for biomonitoring purposes. A pilot study on a volunteer exposed under controlled conditions to S, with or without ethanol administration, allowed us to characterize the excretion profile of PHEMAs and the ethanol-induced interference on PHEMAs metabolic pathway. We further considered a group of 9 workers exposed to S during the working week to determine the confounding role of chronic exposure. Our results confirm the wide interindividual variability of both the biotransformation rate of S into PHEMAs and of the excretion rate of these metabolites. Moreover, both the above parameters changed during the working week, suggesting the existence of a large intraindividual variability as a consequence of the exposure to S and to other solvents. As a practical rule, the data indicate that it is necessary to collect samples at the beginning of the working week when studies on the correlation between genotype and phenotype are carried out. Finally, the results emphasise the importance of excluding an even extemporary ethanol assumption when practicing a biological monitoring programme based on the determination of urinary PHEMAs.

[Spontaneous regression of an adrenal mass detected in utero]. / Risoluzione spontanea di massa surrenalica diagnosticata in utero.

The case of a left adrenal mass detected by ultrasonography in a male fetus at the 37th week of gestation is presented. After an uneventful delivery at the 38th gw, the newborn was sonographically monitored, and during the follow-up clinical evaluations were performed, in order to make a differential diagnosis between an adrenal hemorrhage and a congenital neuroblastoma. VMA and HVA were within normal levels, and MIGB scan was negative. A MR of the the abdomen performed at the age of one month was suggestive for an adrenal hemorrhage in involution. We therefore decided to keep monitoring the mass by ultrasound, avoiding any surgical approach. The sonographic complete disappearance of the disease was documented at the end of the fourth month.

[Biological monitoring of occupational exposure to desflurane]. / Monitoraggio biologico dell'esposizione occupazionale a desflurane.

In these last years Desflurane (D) has become used, alone or in combination with nitrous oxide, in surgical procedures. Occupational exposed groups include anesthesiologists, other physicians, (e.g. surgeons) and operating room nurses. Desflurane is a halogenated methylethylether which is administered by inhalation. Desflurane is halogenated exclusively with fluorine. The blood/gas partition coefficient of Desflurane is 0.42. Changes in the clinical effects of Desflurane rapidly follow changes in the inspired concentration. Studies in man indicate that Desflurane washes into the body rapidly. It also washes out of the body rapidly, allowing flexibility in adjustment of the depth of anaesthesia. Desflurane is eliminated via the lungs, undergoing only minimal metabolism (0.02%). In order to investigate the role of urinary D as an indicator of occupational exposure to Desflurane (CI, ppm), CI was measured in 21 members of operating room staffs. For the measurement of environmental concentration of Desflurane (CI), the ambient air was sampled using personal passive dosimeters. The analyte was desorbed by a water-methanol mixture and was analysed by means a gas chromatograph--mass spectrometer (GC-MSD) and headspace technique. The biological monitoring of exposed workers was conducted by determining the concentration of Desflurane in urine (Cu, microgram/L). Urine concentrations of Desflurane were determined by headspace analysis using GC-MSD. Significant correlations were found between the environmental Desflurane concentration and the urinary concentrations. The correlation between CI (ppm) and Cu (microgram/L) was: Log D (Cu, microgram/L) = .191 + .922 * LogCI; r = .916 On the basis of the equation it was possible to establish tentatively the biological limit values corresponding to the respective occupational exposure limit values proposed for Desflurane.

[Monitoring air dispersed concentrations of aldehydes during the use of ortho-phthalaldehyde and glutaraldehyde for high disinfection of endoscopes]. / Monitoraggio delle concentrazioni aerodisperse di aldeidi durante l'utilizzo di orto-ftalaldeide e glutaraldeide per l'alta disinfezione degli endoscopi.

Solutions of glutaraldehyde (GTA) and ortho-phthalaldehyde (OPA) can both be used for low-temperature disinfection of endoscopes. Currently, GTA is being replaced by OPA (an aromatic dialdehyde) at the San Matteo Hospital, as OPA is less dangerous for health care workers than GTA, but has a similar capacity to kill viruses, bacteria and spores. The aim of the study was to compare air levels of GTA and OPA in several endoscopy units at our hospital. The air samples were analysed by means of both Infrared Spectroscopy (IR) and HPLC-UV (High Performance Liquid Chromatography with UV detection). The HPLC method gave a much lower aldehyde value when using OPA (8.4 micrograms/m3) compared to that obtained when GTA was used to disinfect endoscopes (21.279.3 micrograms/m3). Both HPLC and IR methods detected low levels of OPA in air, the mean values being below 10 micrograms/m3. In addition, we studied the resistance of various types of gloves to OPA. Tests showed that OPA permeated vinyl gloves more rapidly (26,628 ng/cm2 per hour) than nitrile gloves (13.9 ng/cm2 per hour).

Poor metabolization of n-hexane in Parkinson's disease.

Although genomic screening studies have identified several genes associated with Parkinson's disease (PD), there is evidence that environmental factors are also involved in the pathogenesis of the disease and that hydrocarbon-solvents may be one of them. The genetic component is less evident in late-onset PD. To assess whether age and PD may affect the catabolism of the hydrocarbon n-hexane, a two-part study was performed. In the first part the urinary levels of its main metabolites, 2,5-hexanedione and 2,5-dimethylpyrroles, were measured in 108 patients and 108 healthy controls, matched by age and sex. Metabolite urinary excretion was significantly reduced in PD patients as compared with controls and was inversely related to age in both groups. In the second part the same comparison was made between 24 non-smoking and 10 smoking patients, matched to controls, after smoking of a hydrocarbon-rich cigarette. In these subjects also n-hexane and 2,5-hexanedione blood levels were measured. There was no appreciable difference in n-hexane blood levels between patients and controls in non-smokers, whereas there was a significant increase in patients over controls in smokers (p < 0.01). 2,5-hexanedione blood levels were significantly lower in patients than in healthy controls, both in non-smokers and in smokers, but the reduction was more pronounced in smokers (-46.3 % versus -10.7 %). The same was true for 2,5-hexanedione and 2,5-dimethylpyrrole urinary levels. This study suggests that aging and PD may be associated with a reduction in the capacity to eliminate the hydrocarbon n-hexane. This metabolic alteration may play a role in the pathogenesis of PD.

[Spontaneous regression of an adrenal mass detected in utero]. / Risoluzione spontanea di massa surrenalica diagnosticata in utero.

The case of a left adrenal mass detected by ultrasonography in a male fetus at the 37th week of gestation is presented. After an uneventful delivery at the 38th gw, the newborn was sonographically monitored, and during the follow-up clinical evaluations were performed, in order to make a differential diagnosis between an adrenal hemorrhage and a congenital neuroblastoma. VMA and HVA were within normal levels, and MIGB scan was negative. A MNR of the the abdomen performed at the age of one month was suggestive for an adrenal hemorrhage in involution. We therefore decided to keep monitoring the mass by ultrasound, avoiding any surgical approach. The sonographic complete disappearance of the disease was documented at the end of the fourth month.

[Small bowel overgrowth: a frequent complication after abdominal surgery in newborns]. / Sindrome dell'intestino infetto: complicanza frequente dopo chirurgia addominale nel neonato.

BACKGROUND/PURPOSE: Surgery for congenital or acquired gastroenterological disorders, and particularly that associated with short bowel, is not infrequently complicated by Small Bowel Bacterial Over growth (SBBO). Aim of this study is to evaluate the clinical course of children undergoing bowel surgery in the newborn period, assessing the development of SBBO and the response to intensive treatment with a "bowel cocktail" of gentamycin, metronidazole and cholestyramine. METHODS: 17 children with various conditions were studied clinically and by Breath Hydrogen Test (fasting and after glucose). 14 children underwent more than one procedure. All children were treated with overall "bowel cocktail" of gentamycin, metronidazole and cholestyramine. RESULTS: 5 children recovered after one course of treatment and 11 children relapsed at least once and required further courses of therapy. One child died from TPN related liver failure and another following a liver and small bowel transplant for short bowel syndrome. A third child required total intestinal tube splinting according to Sauer and another one required a tapering of the preatretic enlarged jejunal loop. CONCLUSIONS: Our study suggests that children undergoing bowel surgery in the neonatal period and those having more than one procedure are at greater risk of developing small bowel bacterial overgrowth postoperatively. Interestingly, loss of the ileocecal valve was not associated with an increased risk of bacterial overgrowth.

Effect of sorbic acid administration on urinary trans,trans-muconic acid excretion in rats exposed to low levels of benzene.

Trans,trans-muconic acid (t,t-MA) is a biomarker of benzene exposure reflecting metabolic activation to trans,trans-muconaldehyde. t,t-MA background urinary levels are highly variable, thus limiting its use to exposure monitoring of levels over 1 ppm of benzene. Actually, sorbic acid (SA) is known to influence background excretion of t,t-MA in man, but only a few examples suggest that SA ingestion can enhance t,t-MA levels occurring together with benzene exposure. In this study, the effect of SA was investigated in benzene-exposed male Sprague-Dawley rats exposed to 1 ppm benzene for 6 h. Exposed animals had a 24-h urinary t,t-MA excretion higher than that observed in non-exposed animals (87+/-13 microg/kg vs 19+/-3 microg/kg body weight). The oral dose of 8 mg/kg body weight SA had no effect on urinary t,t-MA both in control and in benzene-exposed rats. Increases of t,t-MA levels in urine occurred at SA doses of 50-200 mg/kg body weight, and co-exposure to benzene and SA (50 and 100 mg/kg body weight) produced additive enhancement of t,t-MA excretion. These data demonstrate the dose-response relationship between SA administration and t,t-MA excretion. Our study showed that SA ingestion at doses equal to or greater than 50 mg/kg body weight significantly affects the t,t-MA urinary levels in rats exposed to 1 ppm of benzene for 6 h. These data support the conclusion that in man t,t-MA is not suitable for biomonitoring of low levels of benzene exposure.

[Chronic idiopathic gastric volvulus in children]. / Il volvolo gastrico cronico idiopatico in età pediatrica.

OBJECTIVE: We report clinical, radiograpic and instrumental data about 18 cases of gastric chronic idiopathic volvulus observed since 1997 to june 2000. METHOD: All cases diagnosed by barium meal, performed for vomiting or after a pHmetric esophageal monitoring, in cases of atipical symptoms of gastroesophageal reflux disease. RESULTS: All patients underwent a conservative treatment (antireflux position and procinectics): 5 recovered after 1 year of treatment and 13 were operated on because they did not improve during medical therapy or relapsed after the end of conservative treatment. CONCLUSION: Abnormal position of the stomach is not an absolute indication for surgical treatment. When medical treatment does not obtain improvement in symptoms, surgical option has to be discussed.

Urinary determination of N-acetyl- S-( N-methylcarbamoyl)cysteine and N-methylformamide in workers exposed to N, N-dimethylformamide.

OBJECTIVES: We conducted this biomonitoring study with the aim of evaluating the correlation between the excretion of N-methylformamide (NMF) (mainly from N-hydroxy- N-methylformamide) and N-acetyl- S-( N-methylcarbamoyl)cysteine (AMCC), and levels of exposure to N, N-dimethylformamide (DMF) among occupationally exposed subjects. METHODS: Exposure levels were determined by personal sampling: breathing zone air samples were collected by means of passive samplers. DMF collected by the charcoal in personal samplers was analysed after extraction with methanol by a gas chromatograph. For the purpose of biological monitoring the levels of NMF and AMCC were measured in pre-shift and post-shift samples. Determinations were carried out by, respectively, gas chromatography and high performance liquid chromatography (HPLC). RESULTS AND CONCLUSIONS: The mean time-weighted average (TWA) exposure was approximately half (13.5 mg/m(3)) of the current threshold limit value, the range of the values was from 0.4 to 75.2 mg/m(3). Environmental DMF concentrations exhibited a significant correlation with the specific mercapturic acid (AMCC) collected at the end of the working week (AMCC Friday morning mg/l=1.384xDMF (mg/m(3))+8.708; r(2)=0.47; P<0.008]; hence urinary AMCC represents an index of the average exposure during several preceding working days, making it possible to calculate the approximate relationship between DMF uptake and excretion of this metabolite. A significant correlation was found also between the daily excretion of NMF and the corresponding levels of DMF in air. The equation of the regression line was: NMF (mg/g creatinine)=0.936xDMF (mg/m(3))+7.306; r(2)=0.522 ( P<0.0001).

[Treatment with sodium alginate of gastroesophageal reflux disease in childhood: efficacy and tolerance assessment]. / Trattamento con sodio alginato della malattia da reflusso gastroesofageo in età pediatrica: valutazione di efficacia e tollerabilità.

OBJECTIVE: Evaluation of efficacy of sodium alginate (Gaviscon) in the treatment of gastroesophageal reflux disease in children 3-12 months old, assessed by 24 hours esophageal continuous pH monitoring. METHOD: 28 children studied by 24 hours pH esophageal continuous monitoring before starting the treatment with Gaviscon 0.5 ml/Kg/dose four times a day, 20 minutes after meal. After 2 months of treatment, a second pH esophageal monitoring was performed, during therapy. Total number of refluxes, number of refluxes longer than 5 minutes and reflux index before and during treatment were evaluated, by multiple regression method. RESULTS: All pHmetric parameters showed a statistically significative improvement after 60 days of treatment.