Consequences of presentation with advanced HIV disease in pregnancy : data from a national study in Italy

Among 469 women with a diagnosis of HIV in pregnancy, 74 (15.8%) presented with less than 200 CD4 cells per cubic millimeter. The only variable significantly associated with this occurrence was African origin (odds ratio: 2.22, 95% confidence intervals: 1.32 to 3.75, P = 0.003). Four women with low CD4 (5.6%), compared with none with higher CD4 counts, had severe AIDS-defining conditions (P < 0.001) during pregnancy or soon after delivery, and one transmitted HIV to the newborn. Early preterm delivery (<32 weeks) was significantly more frequent with low CD4 (6.2% vs. 1.4%, P = 0.015). An earlier access to HIV testing, particularly among immigrants of African origin, can prevent severe HIV-related morbidity

La fibrillazione atriale come complicanza del tumore del colon

We undertook a study to provide a quantitative basis to the clinical observation of an unexpected high frequency of atrial fibrillation in patients with colorectal cancer. In our study we considered a total of 1463 patients admitted during a period of 12 years (1987-1998) to the Department of Surgery of our Hospital for surgical treatment of colorectal cancer (case group: mean age 66 years) or non-neoplastic diseases including inguinal hernia, cholelithiasis, varicose veins and hemorrhoids (control group: mean age 65.6 years). We found a three times higher likelihood of having atrial fibrillation in patients with first diagnosis of colorectal cancer compared to controls. Logistic analysis was used to exclude an effect of age. Our study suggests that atrial fibrillation could be considered a non metastatic effect of colorectal cancer. Several pathophysiological mechanisms could explain this observation. A recent study, which reports a significant elevation of C-reactive protein in patients with atrial fibrillation, suggests that this arrhythmia could be promoted by a systemic inflammatory state. In conclusion, atrial fibrillation could be considered a pathological condition not only dependent to organic heart diseases; further studies are needed to evaluate the real impact of systemic inflammatory state or other non-cardiovascular diseases on the excess of mortality in the patients with atrial fibrillation

First diagnosis of colorectal or breast cancer and prevalence of atrial fibrillation

Aim of the present study was to assess the prevalence of atrial fibrillation (AF) in patients with two different types of cancer. Recent epidemiologic and clinical studies support the hypothesis that AF is promoted and maintained by a broad spectrum of modulating factors. A total of 2,339 patients admitted to the Surgery Department of "Luigi Sacco Hospital, Milan," over the period 1987-2004 were eligible for the study. One thousand three hundred and seventeen patients were admitted consecutively with a first diagnosis of colorectal or breast cancer (cases). The remaining 1,022 were patients admitted to undergo non-neoplastic surgery (controls). Routine pre-surgery electrocardiogram available in patient charts was analysed by a cardiologist who was not aware of the present study to evaluate the presence of atrial fibrillation or other arrhythmias. Overall, AF was present in 3.6% cases and 1.6% controls. This corresponded to at least two times higher likelihood of having AF in cases compared to controls. Prevalence of AF increased with age both in cases and controls. Our study describes an increased prevalence of AF in two different types of cancer. Autonomic, endocrine, coagulation, and inflammatory alterations were previously described in both AF and cancer, and can provide the physiopathological basis to our clinical observation

Costi della colecistectomia dopo l\u2019avvento della chirurgia videolaparoscopica

variazione del costo della cvolecistectomia dopo l'avvento e la diffusione della chirurgia mini-invasiv

Diritti e doveri del chirurgo nella gestione delle risorse alle soglie del 2000

relazione su diritti e doveri del chirurgo alle soglie del nuovo milleni

Effective nocturnal oxygen therapy increases circulating level of tumor necrosis factor-[alpha] in heart failure

OBJECTIVES: Tumor necrosis factor (TNF)-\u3b1 is elevated in chronic heart failure (CHF). The cause of this increase is not well known. Several hypotheses have been investigated. Previous experimental and clinical studies detected changes in TNF circulating levels related to arterial oxygen (O2) saturation. The aim of the present study was to evaluate whether standard O2 hospital therapy affects plasma concentration of TNF-\u3b1 in stable CHF patients. METHODS: A total of 18 patients (New York Heart Association class II and III) were enrolled and randomly assigned to two different orders of treatment: nine patients underwent a first night of O2 applied by nasal prongs and a second night of air delivered by nasal prongs, whereas the other nine patients were assigned to the contrary order of treatments (i.e. first night with air and second night with O2) in a crossover design. RESULTS: Ten patients out of 18 had O2 saturation above 95% for at least 360 min. In these ten patients, the TNF-\u3b1 plasma level increased after O2 compared to the basal condition (delta 5.47 \ub1 1.72 pg/ml; P < 0.05) whereas, in the same patients, the TNF-\u3b1 plasma level did not change after the night with air (delta -0.05 \ub1 3.03 pg/ml). A linear positive correlation (r = 0.62, P < 0.01) between minutes of O2 saturation above 95% and TNF-\u3b1 circulating differences from basal to post-O2 therapy was found. CONCLUSIONS: Effective nocturnal hospital O2 therapy affects TNF-\u3b1 plasma levels and the increase of TNF-\u3b1 appears to be linearly related to the time of blood O2 saturation above 95%

Valutazione di materiali biocompatibili nella riparazione di difetti della parete addominale

VALTUTAZIONE DELL'UTILIZZO DI MATERIALI BIOCOMPATIBILI NELLA CORREZIONE DEI DIFETTI DELLA PARETE ADDOMINALE: STUDIO SPERIMENTAL