Asbestos containing materials in schools of Rome and surrounding area (Italy)

Despite Italy banning use and production of asbestos in 1992, it continues to represent a risk to human health due to its permanence in the places where it was located. The aim of this work is to estimate how many schools in Rome (Italy) have asbestos containing materials (ACM), and to assess whether the location, condition and nature of ACM can influence the level of risk for student health. 3,672 schools were contacted and 1,451 participated to asbestos survey. 692 bulk samples were collected and analyzed by optical and electron microscope and Fourier transform infrared spectrometer. About 16% of the surveyed schools had ACM. Most of the ACM were not accessible to students (water tanks, boiler thermal insulations). Asbestos-cement materials and vinyl floor tiles were the most common non-friable materials found in schools and equipment insulation linings and Bunsen burner gauze mats were the friable ACM found in science laboratories. Measures to prevent or reduce asbestos hazards were applied where necessary. This study allowed to develop the awareness of the asbestos health hazard among headteachers and the need to manage these hazards appropriately. It represents the beginning of a larger study leading to ACM national mapping in schools.     

Muscle MRI findings in a three-generation family affected by Bethlem myopathy

We report clinical and muscle magnetic resonance imaging (MRI) findings in three individuals (aged 6, 26 and 73 years) from a three-generation family with Bethlem myopathy, confirmed by molecular genetic analysis which showed an exon skipping mutation in the COL6A1 gene. The clinical severity ranged from mild proximal weakness and distal laxity in the younger patients, to inability to stand or walk and severe contractures in the 76-year-old grandmother. The pattern of muscle involvement showed variable severity in parallel with the severity of motor function impairment. Although there was a marked variability in the severity of the MRI findings, it was possible to recognize a specific pattern of muscle involvement in all three patients. This consisted of involvement of the peripheral region of the vastus lateralis and hamstrings muscles with relative sparing of their central part. This was best appreciated in the third decade of life, but could also be identified both in the younger patient with minimal MRI changes and in the oldest patient, despite her more severe and diffuse muscle involvement. This report suggests that muscle MRI could be used as an additional tool to establish the pattern and the degree of muscle involvement in patients with Bethlem myopathy. Further studies in a larger cohort are needed to evaluate the specificity of these findings.     

Long-Term Outcomes of CRT-PM Versus CRT-D Recipients

Objective: To compare the rates of all-cause mortality in recipients of cardiac resynchronization therapy devices without (CRT-PM) versus with defibrillator (CRT-D).
Methods: Between February 1999 and July 2004, 233 patients (mean age = 69 ± 8 years, 180 men) underwent implantation of CRT-PM or CRT-D devices. New York Heart Association (NYHA) heart failure functional class II was present in 11%, class III in 69%, and class IV in 20% of patients; mean left ventricle ejection fraction (LVEF) was 26.5 ± 6.5 %, 48% presented with idiopathic dilated cardiomyopathy and 49% with ischemic heart disease. Cox multiple variable regression analysis was performed in search of predictors of death.
Results: The clinical characteristics of the 117 CRT-PM and 116 CRT-D recipients were similar, except for LVEF (28.2 ± 6.2% vs 25.0 ± 6.5%, respectively; P < 0.001), and ischemic versus nonischemic etiology of heart failure (41% vs 56%, respectively P = 0.02). Over a mean follow-up of 58 ± 15 months, no significance difference in overall mortality rate was observed between the two study groups. Male sex, NYHA functional class IV, and atrial fibrillation at implant were significant predictors of death.
Conclusions: There was no difference in long-term survival rate among patients with CRT-D versus CRT-PM, although CRT-D more effectively lowered the sudden death rate. Male sex, NYHA functional class IV, and atrial fibrillation predicted the worst prognosis.     

Permanent Mechanical Catheter Ablation of an Accessory Pathway in a Child

Permanent mechanical ablation of an accessory atrioventricular pathway was observed in an infant during intracavitary electrophysiological mapping. The persistent lack of preexcitation was confirmed during a 15-month follow-up period.     

Effect of Steroid Eluting Versus Conventional Electrodes on Propafenone Induced Rise in Chronic Ventricular Pacing Threshold

The aim of this study was to evaluate chronic ventricular pacing threshold increase after oral propafenone therapy. Eighty-three patients affected by advanced atrioventricular hJock and sick sinus syndrome were studied at least 3 months after pacemaker implantation, before and after oral propafenone therapy (450–900 mg/day based on body weight). The patients were subdivided into three groups according to the type of unipolar electrode that was implanted: group I (41 patients)Medtronic CapSure 4003, group II(30 patients)Medtronic Target Tip 4011, and group III (12 patients)Osypka Vy screw-in lead. In all cases a Medtronic unipolar pacemaker was implanted: 30 Minix, 23 Activitrax, 14 Elite, 12 Legend, and 4 Pasys. Propafenone biood level was measured in 75 patients 3–5 hours after propafenone administration. The pacing autothreshoid was measured at 0.8 V, 1.6 V, and 2.5 V by reducing puise width. At the three different outputs before and after propafenone, threshold increments were significantly lower in group I in comparison with group II and group III (propafenone ranging from < 0.001 to < 0.05). No significant difference was found in pacing impedance or in propafenone plasma concentration in the three groups. Strength-duration curves were drawn for each group at baseline and after propafenone administration. Before propafenone, in group I, the knee was markedly shifted to the left and downward as compared to the classic curve, so that the steep part was predominant; in group II and group III this shift was progressively less evident. After propafenone we found the curve shifted to the right with the flat part progressively more evident in group II and group III as compared to group I. We conclude that steroid eiuting leads cause less threshold increase than conventionol and screw-in ones after oral propafenone, thus leading to safer chronic pacing. Chronic pacing at 2.5-V amplitude and 0.6-msec width was feasible in 97% of group I patients and in 80% of group II patients, but not in group III due to an insufficient safety margin. propafenone, pacing threshold     

BLASTOMYCOSIS-LIKE PYODERMA (PYODERMA VEGETANS) RESPONDING TO ANTIBIOTICS AND TOPICAL DISODIUM CHROMOGLYCATE

Background. Blastomycosis-like pyoderma is a disorder of uncertain etiology that has been described in association with a variety of underlying conditions, including inflammatory and neoplastic pathologic conditions and in association with a primary immunodeficiency state. The response to therapy, antibiotics in particular, is said to be variable or poor. Methods. We examined two patients with blastomycosis-like pyoderma in whom no underlying pathologic or immunologic abnormalities were found. We treated them with antibiotics according to bacterial resistance tests. In the second case topical disodium chromoglycate was added. Results. Treatment cleared or markedly improved the lesions. Conclusions. Antibiotic treatment guided by susceptibility tests is recommended. The addition of topical disodium chromoglycate may be useful.     

Transesophageal Color Flow Echocardiographic Evaluation of Supravalve Mitral Ring in an Adult Patient

Supravalve mitral ring (SVMR) is an extremely rare form of congenital left ventricular inflow obstruction in which a left atrial membrane causes an obstruction keeping the left atrium from emptying into the left ventricle. Cardiac catheterization and angiography are not reliable means to diagnose this lesion. Transthoracic echocardiography (TTE) has proved to be the most sensitive tool for diagnosis of this form of left ventricular inflow obstruction; however, its diagnostic accuracy has been recently questioned. We report the complementary roles of TTE and transesophageal echocardiography in a case of SVMR in an adult patient. (ECHOCARDIOGRAPHY, Volume 11, May 1994)     

SERUM {gamma}-GLUTAMYL-TRANSPEPTIDASE ISOFORMS IN ALCOHOLIC LIVER DISEASE

-Glutamyltranspeptidase (GT) appears in serum in multiple forms;their significance and clinical utility in hepatobiliary andpancreatic diseases are still a matter of controversy. Electrophoreticseparation of the multiple forms of GT on agarose gel was performedin 20 alcoholic patients (six with cirrhosis and 14 with fattyliver) and the results compared with those obtained in 50 healthyvolunteers, 43 patients affected with chronic hepatitis C, 36patients with posthepatitic cirrhosis and in 52 epileptic patientson long-term anti-epileptic medication. Multiple forms of GTwere separated into several bands (up to 11), labelled 0a, 0b,la, lb, 2a, 2b, 2c, 3a, 3b, 4a, 4b. In the alcoholic patientsnine fractions were detected, and the electrophoretic patternobserved was significantly different from that observed in healthyvolunteers and in patients with chronic hepatitis C or posthepatiticcirrhosis. No differences were observed in the electrophoreticpatterns in the alcohol abusers and epileptic patients. In alcoholicpatients significant differences were observed in the electrophoreticpatterns in relation to the degree of liver injury; the electrophoreticpatterns in patients with alcohol-related cirrhosis and posthepatiticcirrhosis differed significantly. The separation of multipleforms of GT has high sensitivity and good reproducibility. Itmay be proposed as a complementary test in the diagnosis ofalcoholic liver disease.