Dismenorrea in donne lavoratrici dell'industria

La dismenorrea è una delle più comuni indisposizioni nelle donne. La frequenza varia in differenti lavori, probabilmente ciò è dovuto alla differenza nei gruppi di popolazione studiati. In alcune industrie Norvegesi, con molto personale femminile, l’inabilità periodica al lavoro dovuto ai fastidi mestruali è stato un problema di una certa importanza e la domanda è sorta nel caso in cui l’assenza è medicalmente giustificata nella visione di un moderno trattamento ormonale. Per avvicinarci al problema abbiamo pianificato di esaminare l’evento dei fastidi mestruali, particolarmente la dismenorrea, tra il personale femminile in alcune industrie Italiane in quello che appariva essere un problema. I soggetti esaminati erano impiegati di una compagnia elettrica-tecnica e di una industria tessile. Un questionario preparato da una infermiera dell’industria, è stato compilato da donne in età mestruale che erano state visitate per esami medici periodici e di pre-assunzione tra il 2002-2003. Ogni donna assistita soffriva di dolore, e quando tutti i sintomi erano considerati il 61% aveva mensilmente disturbi che ovviamente riducevano la loro capacità sul lavoro. Visto che il 9% delle donne assumevano estroprogestinici, che riducevano o eliminavano la dismenorrea, la vera prevalenza potrebbe essere leggermente superiore. Circa il 30% delle donne erano confinate a letto. Circa il 30% si assentava dal lavoro, il che illustra la grandezza del problema sia medico che economico

Residual disease and presence of human papillomavirus after conization

The development of invasive carcinoma following treatment by loop excision biopsy is considered a failure of treatment In this study we evaluate human papillomavirus deoxyribonucleic acid testing after conization in predicting residual disease. In 56 of 58 patients (96.6%), HPV DNAs were detected in their primary cervical lesions prior to conization. Up to August 2000, all of the 58 patients have been followed with a mean follow-up period of 31.8 months (range: 12 to 73 months). After treatment, HPV DNA was persistently detected in 11 (19.6%) but negative in 45 (80.4%) of 56 HPV DNA-positive patients. Five of 11 persistently HPV DNA-positive patients (45.5%) developed CIN recurrence, while none of 45 persistently HPV DNA-negative patients did. This study confirms an exellent sensitivity and negative predictive value of HPV-DNA testing after conization in predicting residual cervical neoplasia

Transpulmonary thermodilution detects rapid and reversible increases in lung water induced by positive end-expiratory pressure in acute respiratory distress syndrome

Purpose: It has been suggested that, by recruiting lung regions and enlarging the distribution volume of the cold indicator, increasing the positive end-expiratory pressure (PEEP) may lead to an artefactual overestimation of extravascular lung water (EVLW) by transpulmonary thermodilution (TPTD). Methods: In 60 ARDS patients, we measured EVLW (PiCCO2 device) at a PEEP level set to reach a plateau pressure of 30 cmH2O (HighPEEPstart) and 15 and 45 min after decreasing PEEP to 5 cmH2O (LowPEEP15′ and LowPEEP45′, respectively). Then, we increased PEEP back to the baseline level (HighPEEPend). Between HighPEEPstart and LowPEEP15′, we estimated the degree of lung derecruitment either by measuring changes in the compliance of the respiratory system (Crs) in the whole population, or by measuring the lung derecruited volume in 30 patients. We defined patients with a large derecruitment from the other ones as patients in whom the Crs changes and the measured derecruited volume were larger than the median of these variables observed in the whole population. Results: Reducing PEEP from HighPEEPstart (14 ± 2 cmH2O) to LowPEEP15′ significantly decreased EVLW from 20 ± 4 to 18 ± 4 mL/kg, central venous pressure (CVP) from 15 ± 4 to 12 ± 4 mmHg, the arterial oxygen tension over inspired oxygen fraction (PaO2/FiO2) ratio from 184 ± 76 to 150 ± 69 mmHg and lung volume by 144 [68–420] mL. The EVLW decrease was similar in “large derecruiters” and the other patients. When PEEP was re-increased to HighPEEPend, CVP, PaO2/FiO2 and EVLW significantly re-increased. At linear mixed effect model, EVLW changes were significantly determined only by changes in PEEP and CVP (p < 0.001 and p = 0.03, respectively, n = 60). When the same analysis was performed by estimating recruitment according to lung volume changes (n = 30), CVP remained significantly associated to the changes in EVLW (p < 0.001). Conclusions: In ARDS patients, changing the PEEP level induced parallel, small and reversible changes in EVLW. These changes were not due to an artefact of the TPTD technique and were likely due to the PEEP-induced changes in CVP, which is the backward pressure of the lung lymphatic drainage. Trial registration ID RCB: 2015-A01654-45. Registered 23 October 2015