Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background: Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods: We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results: 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions: In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care

Vertical distribution of 137Cs in the lacustrine areas and preliminary results of 7Be activity in snow samples at terra nova bay (antarctica)

137Cs activity in samples from lacustrine areas around the Italian base in Antarctica is reported as an integration of a previous work. Preliminary data of cosmogenic 7Be activity determined in snowfalls, total atmospheric depositions, soil and air particulate collected during the 1990–91 and 1991–92 Italian expeditions in Antarctica is presented. The results obtained point out the efficiency of snow in the processes of air particulate scavenging and provide useful information for the development of research in Antarctica in the study of air/snow transfer processes by means of natural radionuclides. © 1994 Gordon and Breach Science Publishers S. A

Determination of atmospheric radionuclides at Mt. Cimone observatory

Measurements of cosmogenic and natural airborne radiotracers were carried out at Mt. Cimone, Italy (44°11N, 10°42E; 2165 m a.s.l.). This work concerns measurements of 7Be, 210Pb and 222Rn in order to point out the detection and the identification of air masses of different origin reaching Mt. Cimone. Some preliminary data are presented

Acne: in vivo morphologic study of lesions and surrounding skin by means of reflectance confocal microscopy

Background: Acne vulgaris is a common disease of the pilosebaceous unit, clinically showing alteration of the keratinization process leading to comedos formation and subsequent inflammatory process. Objective: To characterize the morphology of acne lesions and pilosebaceous units by means of in vivo reflectance confocal microscopy, in order to non-invasively define the microscopic alterations occurring during the acne process. Methods: A set of standardized clinical pictures and a set of reflectance confocal images were acquired from 25 volunteers, presenting mild-to-moderate acne, and 10 healthy volunteers, using Vivascope 3000, and 10 mosaics on apparently normal skin were acquired by 5 acne patients and 5 healthy volunteers by Vivascope 1500, and evaluated by experts. Results: Confocal microscopy enabled to identify morphological aspects characterizing different types of acne lesions. Apparently normal skin of acne patients, compared with healthy skin of patients with no history of acne, revealed peculiar confocal features, such as bright rings around hair follicle that may represent the early events in acne lesion formation. Conclusion: The fast and reliable characterization of acne lesions and identification of subclinical alterations in acne-prone skin through confocal examination, corresponding to infundibular hyper-keratinization, may have important clinical consequences in the assessment of acne severity, therapeutic decisions and treatment efficacy monitoring

Mt. Cimone observatory: Baseline station for the measurement of gaseous substances and radioactive tracers in the atmosphere

An extensive research program to record atmospheric physicochemical parameters and to track climatological trends was established at a remote Alpine station at Mr. Cimone Observatory in Italy. The main features of the study are outlined briefly and the results thus far collected, including surface ozone, carbon dioxide, stratospheric NO 2 and O 3, and airborne radioactivity are provided