[Accidents due to biological risk in health personnel: descriptive epidemiological analysis of the decade 1994-2003]. / Infortuni a rischio biologico nel personale sanitario: analisi epidemiologica descrittiva nel decennio 1994-2003.

The study evaluates the body fluid exposure among health care workers (HCW) at IRCCS Policlinico San Matteo of Pavia from the 1994 through 2003 years. Our data showed that all HCW for less than 5 years of employment, nurses, mid-wifes and surgeons are the most exposed occupational groups. Some variables were compared with a previous study performed from 1983 to 1994 at the same Institution. The study documented 1 case of seroconversion to hepatitis C virus among a physician after percutaneous exposure. In order to reduce the body fluid exposure among the HCW, the authors underline the importance of the administrative and educational interventions carried out in collaboration with the Infection Control Committee and Occupational Medicine Service.

Utilization of suboptimal kidney donors.

In recent years over 30% of cadaver donors utilized in the Emilia Romagna (ER) region are over 60 years of age often with some additional risk factors. The organs of these Suboptimal Kidney Donors (SOKD) had been seldomly accepted from 1996 to 1999 (Group 1). From 2000, marking the beginning of use of double transplantation for marginal kidneys, a routine biopsy was performed for SOKD using the Score System proposed by Remuzzi. (Group 2) The 40% of marginal kidneys harvested were utilize in 76% of cases. The few biopsies available for Group 1 patients testify that good kidneys had been discarded, but even in Group 2, when we followed the biopsy Score, strictly several mistakes were suspected: kidneys discarded for an unbelievable difference of 2 points between two kidneys of the same size, cases with an high score based on only a few glomeruli, double kidney transplants that become single and still had fair functions. In the future the utilization of SOKD should probably be improved: (1) with scores only based on a biopsy specimen with more than 25 glomeruli, (2) a score system for incorporating clinical data, and (3) continuous perfusion preservation of kidneys whose characteristics provide some more information that may mitigate some of the damage of marginal donor kidneys.

[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).

Multidetector CT-urography in the study of urological complications in renal transplant.

PURPOSE: To evaluate the value of CT-urography in the diagnosis and follow-up of the urological complications of renal transplantation. MATERIALS AND METHODS: We performed 19 CT-urography examinations (3 of which were follow-up) on 15 patients by using a spiral multislice CT scanner and multiplanar reconstructions. The examinations were carried out directly after administration of 100 ml of iodinated contrast medium by slow iv infusion, with acquisitions starting 5 minutes after the end of the infusion. Surgery was regarded as the gold standard for the diagnosis of urological complications in the operated patients, whereas in patients who had undergone medical therapy or stent placement the gold standard was 1 month ultrasound and clinical follow-up with evaluation of diuresis and renal function. RESULTS: Between January 1999 and December 2001 a total of 210 kidney transplantations were performed at our hospital. There were 34 urological complications in 28 patients with a 16.1% prevalence, consistent with the major international studies. The complications detected were 14 urine leaks and 19 ureteral obstructions secondary to stones, oedema, blood clots and stricture. We observed one case of reflux in the allograft ureter. Fourteen out of 16 CT-urography examinations yielded important clues for the diagnosis of urological complications in kidney allografts, completely replacing standard urography. In particular, CT-urography correctly detected 5 urinary fistulas by demonstrating iodinated contrast material leaks along the ureteral tract, and 8 cases of obstructive uropathy due to different causes (1 submucosal tunnel edema, 1 blood clot, 1 stone and 5 cases of ureteral stricture). One case of urinary fistula and one of obstructive uropathy were not detected. DISCUSSION AND CONCLUSIONS: CT-urography proved to be an important diagnostic tool in the evaluation of urological complications of kidney allografts, showing a diagnostic accuracy over 90%; it is useful for confirming the type and site of urological lesions, and therefore to provide guidance for a targeted surgical approach. Compared with excretory urography, which is no longer used in this diagnostic field, CT-urography is more complete and precise as it provides information not only about the urinary tract, but also about the kidney parenchyma and pararenal fluid collections. The only disadvantage, which limits its use to selected cases, is the risk associated with the use of iodinated contrast agents in patients with impaired renal function.

Evaluation of the resistive index (RI) for the diagnosis of acute renal rejection in renal allografts from the same donor.

PURPOSE: To investigate the importance of the resistive index (RI) in the diagnosis of acute renal rejection, compared with the RI of the twin kidney from the same donor, transplanted in two different patients. MATERIAL AND METHODS: From January to December 2000, we studied retrospectively 25 pairs (50 patients) of renal allografts from the same donor considering the RI obtained with by eco color-Doppler ultrasound, daily diuresis and renal function (serum creatinine level) in the first six days following surgery. Improvement of diuresis and renal function after corticosteroid therapy was considered the gold standard for the diagnosis of acute rejection. RESULTS: Medical complications (acute renal rejection) in the first six days were occurred in three cases, two in the first transplanted kidney as first and one in the second; all three cases showed disappearance of the diastolic waveform component. Considering a RI variation >0.15 with respect to the initial value, the sensitivity, specificity and diagnostic accuracy in the Doppler diagnosis of acute rejection were 100%, 97.1% and 97.3% respectively, with a prevalence of 7.8%. There were no statistically significant correlations between the RI variation of the renal transplant and the twin kidney from the same donor. DISCUSSION AND CONCLUSIONS: Doppler ultrasound is an important diagnostic tool in the detection of medical complications in the immediate postoperative period and during renal transplant follow-up. RI analysis, when studied serially and in the right clinical settings, allows an early diagnosis of renal rejection with high sensibility and specificity.

Effect of hinged lamellar keratotomy on postkeratoplasty eyes.

PURPOSE: To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topography of postkeratoplasty eyes with high-degree astigmatism. DESIGN: Noncomparative, interventional case series. PARTICIPANTS: A hinged lamellar keratotomy was performed on nine eyes of nine patients at least 9 months after penetrating keratoplasty and with high-degree astigmatism. All patients were spectacle and contact lens intolerant. INTERVENTION: A superiorly hinged lamellar keratotomy (corneal flap), 160 microm in thickness and 9 mm in diameter, was created on all eyes included in this study. Each patient was examined 1 day, 1 month, and 3 months after surgery. MAIN OUTCOME MEASURES: Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography. RESULTS: At each postoperative examination time, there was a significant reduction in both average spherical equivalent (P < 0.05) and average absolute value of astigmatism (P < 0.01) over mean preoperative values. The major changes were seen as early as 1 day after surgery, but both progression and regression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully corrected either with spectacles (n = 2) or with gas-permeable contact lenses (n = 2). There were no surgical flap or corneal graft complications. CONCLUSIONS: Hinged lamellar keratotomy improves vision and refraction of postkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary.

Intraoperative cauterization of the cornea can reduce postkeratoplasty refractive error in patients with keratoconus.

OBJECTIVE: This study aimed to evaluate the effect of intraoperative corneal cauterization on the postkeratoplasty refraction of patients with keratoconus. DESIGN: A randomized clinical trial. PARTICIPANTS: Thirty eyes of 29 patients with keratoconus undergoing standard penetrating keratoplasty by the same surgeon were evaluated (MB). INTERVENTION: Standard penetrating keratoplasty included the use of an 8.0-mm donor button sutured into a 7.5-mm recipient bed by means of two running 10-0 nylon sutures with 16 bites each. Before trephination of the recipient bed, superficial cauterization causing tissue shrinkage was applied to a 6-mm central area of the cornea of only 15 eyes (group A). The remaining 15 eyes (group B) did not undergo intraoperative cauterization. Before surgery, 6 months, and 13 months after surgery, a complete ophthalmologic examination was performed on each patient, including uncorrected and best-corrected visual acuity, refraction, keratometry, computerized corneal topography, as well as A-scan contact ultrasonography. MAIN OUTCOME MEASURES: Postkeratoplasty refractive error was measured. RESULTS: Both 6 months (sutures still in place) and 13 months (suture removal performed in all patients) after surgery, the average spherical equivalent was significantly less myopic in the patients undergoing cauterization. At 6 months, it was +1.72 diopters (D) +/- 1.13 D in group A and -3.16 D +/- 2.84 D in group B; at 13 months, it was +0.09 D 1.52 D in group A and -3.89 D +/- 3.01 D in group B. The average keratometric astigmatism also was significantly lower in group A than in group B both at 6 (2.5 D +/- 1.6 D vs. 4.1 D +/- 2.3 D) and 13 months (2.7 D +/- 1.5 D vs. 4.4 D +/- 2.4 D) after surgery. CONCLUSION: Cauterization of the central cornea improves the postkeratoplasty refractive results of patients with keratoconus.