[Anticonvulsant-induced rheumatism: does a possible role of carbamazepine exist? A clinical case with a 20-month follow-up].

The rheumatism induced by anticonvulsants has been described in literature mostly because of phenobarbital therapy. The possible onset of this clinical picture due to other antiepileptic drugs is unusual and not well defined. We report the case of a 87-year-old female, affected by partial seizures treated with carbamazepine for 20 years, who came to our observation for the onset of disturbances that clearly resemble the classic syndrome of rheumatism induced by barbiturates: the diagnostic hypothesis of a drug side effect was confirmed by the marked clinical improvement of the patient after carbamazepine was stopped and substituted by gabapentin.

[Gait in patients with Parkinson's disease after surgically treated hip fracture].

Background: The aims of this study were: 1) to evaluate the degree of walking of patients with Parkinson s syndrome after hip fracture surgically treated; 2) to reexamine the evidence for internal fixation versus endoprosthesis.

Methods: Forty-one patients with Parkinson s syndrome after hip fracture surgically treated have been studied. Twenty-four fractures (20 femoral neck, 4 subcapital) were treated by endoprosthesis, and 17 by internal fixation (pertrochanteric fractures).

[Sampling of allergens in dust deposited in the workplace].

Some workplaces share with domestic dwellings many characteristics favouring house dust mite growth. Moreover it has recently been shown that pets owners can bring allergens to public places with their clothes. So it is possible that significant exposure to indoor allergens can occur outside homes, at the workplace.

[Assessment of problems associated with caregiving: the family strain questionnaire].

Our study concerns a questionnaire for the evaluation of caregiving-related problems: the Family Strain Questionnaire. The questionnaire, which is composed by a structured interview and 47 dychotomous items, was administered to 409 caregivers of patients with different kinds of chronic diseases. Factorial analysis shows a structure of 5 factors named: emotional strain, social involvement, knowledge of the disease, family relationships and thoughts about death.

Health-related quality of life assessment in young adults with seasonal allergic rhinitis.

Background: In health-related quality of life (HRQL) studies on allergic rhinitis, both disease-specific and generic questionnaires have been extensively used. Seasonal allergic rhinitis (SAR) has been studied mainly by focusing on symptomatology. The present study aimed to evaluate the SAR-HRQL by means of two questionnaires, the Medical Outcome Study Short Form Health Survey (SF-36) and a new instrument examining satisfaction in 32 aspects of daily life: the Satisfaction Profile (SAT-P).

Immunotherapy: on the edge between experimental and clinical oncology.

Cancer immunotherapy is still largely confined to the laboratory bench and experimental animal models. Yet the field is rapidly moving forward and some immunological tools are now entering into clinical use. The first and perhaps best example of such progress is given by bioengineered humanized monoclonal antibodies of which some have been already approved for therapy in B-cell lymphoma and breast cancer.

Microbiological confirmation of tuberculosis cases at diagnosis and at the end of treatment in Italy.

Microbiological findings at diagnosis and at the end of treatment are relevant for evaluating tuberculosis (TB) treatment programmes. The objectives of this study were to describe the microbiological findings at diagnosis and at the end of treatment in pulmonary and extrapulmonary TB patients treated under programme conditions in Italy. The study was a prospective monitoring activity based on the collection of standard recording and reporting forms from a representative sample of Italian TB Units.

[Stratification of the arrhythmia risk after acute myocardial infarct].

Recent studies clearly support the role of the cardioverter implantable defibrillator in reducing arrhythmic and all-cause mortality in patients with a previous myocardial infarction. However, the use of the cardioverter implantable defibrillator cannot be extended to all myocardial infarction patients despite its effectiveness because implantation is an invasive procedure and the cost of the device is high. Thus, the correct and effective identification of patients at high risk of life-threatening ventricular arrhythmias represents a clinically relevant problem owing to the availability of an effective but expensive therapeutic tool.

[Physical exercise in the prevention of musculoskeletal diseases in the elderly worker].

This paper reviews the impact of ageing on physical work capacity in the elderly worker and the benefits of exercise programmes designed for the prevention of musculo-skeletal complaints. Physical work capacity generally declines significantly after 50 years of age as a consequence of a reduction in aerobic capacity and muscle strength. The latter is accompanied by a decline in the fatigue threshold.

Periodic breathing in heart failure patients: testing the hypothesis of instability of the chemoreflex loop.

In this study, we applied time- and frequency-domain signal processing techniques to the analysis of respiratory and arterial O(2) saturation (Sa(O(2))) oscillations during nonapneic periodic breathing (PB) in 37 supine awake chronic heart failure patients. O(2) was administered to eight of them at 3 l/min. Instantaneous tidal volume and instantaneous minute ventilation (IMV) signals were obtained from the lung volume signal.

[Visual reaction times in a group of patients with single cerebrovascular lesions in rehabilitation].

Unlabelled: Approximately fifty percent of stroke survivors have neurological deficits. The evaluation of reaction times permits a study of psychomotor performance, which could be very important for a good rehabilitation outcome.

Aim: The aim of the study was the evaluation of visual reaction times in a group of patients with cerebrovascular lesions, during inpatient hospitalisation in a rehabilitation centre.

[Non-invasive evaluation of the hemodynamic profile in patients with heart failure: estimation of right atrial pressure].

The estimation of right atrial pressure is often needed for the diagnosis, management and monitoring of various pathologic hemodynamic conditions and plays a significant role in patients with chronic heart failure. In the past decade several attempts have been made to non-invasively estimate right atrial pressure, and echocardiography has always been considered the most reliable tool. Morphologic parameters such as respiratory motion of the inferior vena cava, its respiratory diameters and percent collapse (caval index), left hepatic vein diameter or right atrial dimension (areas, volumes) were initially studied.

[Remodeling of the left ventricle].

Left ventricular remodeling is a frequent and unfavorable evolution of both ischemic and non-ischemic dilative cardiomyopathy with a significant reduction in left ventricular systolic and diastolic performance. By the term "remodeling" we refer to a variety of alterations in left ventricular morphology and volume; while patients with non-ischemic cardiomyopathy frequently show global and quite homogeneous enlargement of the left ventricle, transmural myocardial infarctions can be followed initially by regional expansion and only in a second stage by a global increase in ventricular size. Cardiologists have a number of therapeutic options from which to choose: ACE-inhibitors and probably angiotensin II antagonists can contrast the unfavorable progression of the phenomenon, while beta-blockers such as metoprolol and carvedilol probably can reverse the process.

Non-invasive estimation of right atrial pressure by combined Doppler echocardiographic measurements of the inferior vena cava in patients with congestive heart failure.

Background: In patients with congestive heart failure, evaluation of right atrial pressure (RAP) provides useful therapeutic, functional and prognostic information. The aim of this study was to investigate whether a combination of inferior vena cava variables measured by Doppler echocardiography could provide a reliable non-invasive estimate of RAP.

Methods: One hundred consecutive patients with severe congestive heart failure (ejection fraction 24 +/- 6%) due to dilated cardiomyopathy were evaluated by simultaneous Doppler echocardiography and hemodynamic studies.

Evaluation of tuberculosis treatment results in Italy, report 1998. Tuberculosis section of the National AIPO Study Group on Infectious Disease and the SMIRA Group.

In Italy no national data on tuberculosis (TB) treatment results were available. In 1995 the AIPO (Italian Association of Hospital Pneumologists) TB Study Group, in collaboration with the Istituto Superiore di Sanità (technical branch of the Ministry of Health), started a prospective monitoring activity based on World Health Organization (WHO) and International Union against Tuberculosis and Lung Disease (IUATLD) recommendations. Data were collected from a representative network of TB units nationwide, managing a significant proportion of all TB cases notified in Italy each year.

Surveillance of anti-tuberculosis drug resistance: results of the 1998/1999 proficiency testing in Italy. SMIRA (Italian Multicentre Study on Antituberculosis Drug Resistance) Study Group.

Objective: To determine the accuracy of drug-susceptibility testing (DST) for isoniazid, rifampicin, ethambutol and streptomycin in a provisional network of 22 regional laboratories in Italy.

Methods: Methods, definitions and reference Mycobacterium tuberculosis strains were derived from the WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance. The laboratories were selected based on technical skills required by the project, the number of DST performed annually and geographic localisation.

Levels of house-dust-mite allergen in homes of nonallergic people in Pavia, Italy.

Background: HDM distribution varies between geographic areas and may be affected by housing characteristics. We quantified Der p 1 and Der f 1 and assessed the relationships between their levels and housing characteristics in homes of nonallergic subjects.

Methods: Der f 1 and Der p 1 were measured by ELISA in dust samples from living-room floors and mattresses of 44 homes of nonallergic subjects in Pavia.

Four-day infusion of fluorouracil plus vinorelbine as salvage treatment of heavily pretreated metastatic breast cancer.

Aims: Anthracyclines-taxanes containing regimens are widely used for breast cancer treatment both in neoadjuvant-adjuvant setting and in metastatic disease. Recently high-dose chemotherapy (HDC) with autologous stem cell support has been introduced as adjuvant treatment for high-risk primary breast cancer and for selected subsets of women with metastatic disease. Therefore, salvage treatment for previously treated patients with progressive disease becomes even more problematic.

Measurement of isometric muscle strength: a reproducibility study of maximal voluntary contraction in normal subjects and amyotrophic lateral sclerosis patients.

Amyotrophic lateral sclerosis (ALS) is a degenerative disease of unknown cause, resulting in the progressive loss of voluntary motor activity. Traditional methods of evaluating patients with ALS (neurologic assessment, manual muscle testing and rating scales) involve subjective elements and lack the sensitivity needed to detect small but meaningful changes in deterioration and therapeutic efficacy. This paper presents a recently developed strength measurement instrument, useful for the long-term monitoring of muscle strength deterioration in ALS.

[Sleep disordered breathing: a new risk factor for accidents].

An estimated 2%-4% of the working population could be affected by sleep disordered breathing, in particular by obstructive sleep apnea syndrome. The main symptom is excessive daytime sleepiness, caused by sleep interruptions induced by respiratory events. The level of sleepiness varies according to the severity and duration of the disease: from a slight decrease in vigilance to an almost total inability to keep alert for more than a few hours.

Iodine deficiency and increased risk from radioactive iodine intake in nuclear medicine personnel.

Since the entity of the stable endogenous iodine pool is inversely related to the probability of thyroid uptake of radioactive iodine isotopes in subjects exposed for professional reasons to radioiodine intake, we evaluated the urinary iodine excretion, which is a reliable indicator of stable iodine daily intake, in 19 subjects of a nuclear medicine department. Seventeen out of 19 subjects showed a reduced iodine elimination < 150 mcg iodine per g of urinary creatinine, while the values of TSH and free fractions of T3 e T4 were within normal limits. Thyroglobulin levels were increased in 5 subjects only, all with reduced iodine excretion.

[Occupational vascular acrosyndromes. Considerations on plethysmographic changes in the fingers resulting from postural variations of the arms: do they have diagnostic relevance or just physiopathologic significance?].

334 subjects all with anamnesis indicating a vascular acrosyndrome (mostly due to their working conditions) were studied using the pulsoplethysmographic method to evaluate whether a relationship exists between the absence of increases to physiological acral posture and the presence of Raynaud's disease successively induced by Cold Test. The results obtained showed marked correlation (which for some of the subgroups examined was also statistically significant) between the lack of postural regolation and abnormal or frankly phatological plethysmographic findings following the Cold Test. The results appeared to be of some relevance in the physiopathologic interpretation of vascular acrosyndromes.

[The use of Internet in occupational medicine and industrial hygiene].

The internet as we know is today includes an array of tools that make information exchange easier than ever before. The best known Internet tools are the World Wide Web and the electronic mail. In the present job we identify those that are the home pages that better can help Industrial Hygienists and Doctors to acquire useful information for the profession.

[Systolic-diastolic arterial hypertension versus isolated systolic hypertension].

The presence of elevated values of both diastolic and systolic arterial blood pressure is one of the most important risk factors for coronary heart disease, stroke, and heart failure; in patients with hypertension, the pharmacological reduction of blood pressure decreases the risk of adverse cardiovascular events, though the optimal blood pressure goal is still being debated. During recent years there has been an increasing interest in isolated systolic hypertension, both as an independent risk factor for cardiovascular disease and as a clinical entity requiring treatment in its own right. The definition of what constitutes isolated systolic hypertension still remains controversial and arbitrary; the criteria generally used is a systolic blood pressure > or = 140 mmHg and a diastolic blood pressure < 90 mmHg.