No need for routine closed suction drainage in elective arthroplasty of the hip: a prospective randomized trial in 104 operations

BACKGROUND: The purpose of this study was to determine the utility of closed suction drainage (CSD) in elective total hip arthroplasty (THA). PATIENTS AND METHODS: We randomized 104 elective, consecutive THAs to receive drainage (53) or no drainage (51). 60 arthroplasties were cemented and 44 hybrid. RESULTS: In the drainage group, 2 hematomas and 2 superficial wound infections occurred; there were no wound complications in the undrained group (p = 0.04). Patients receiving drainage had a greater reduction in hematocrit (10.4 vs 7.4) (p = 0.03), and longer hospital stay (5.1 days vs 4.7) (p = 0.01). At the 3-month follow-up, we found no deep wound infections in either group. INTERPRETATION: We no longer use CSD in elective, primary, routine THA.     

The precautionary principle: scientific evidence and decision processes

We analyse conceptual and procedural approaches to the precautionary principle. Moreover, we describe the implications of its use in evaluation of scientific evidence and in decision making. In many cases evaluation of possible risks is influenced by individuals or groups with personal interests different from those of public health. Their actions discredit positive studies, giving rise to forced controversies and discouraging new studies. The result is to hinder checking of causal patterns. We report examples of historical cases and of issues rising from electromagnetic fields. The use of the precautionary principle is desirable both in issues related to global change and in possible risks associated with specific biological, chemical and physical agents. The precautionary principle should be included between values of public health evaluations and its use requires institutional subjects to take high responsibility for it. Both time and quality of analysis of causal patterns are linked to the sincere desire to solve doubts and defend public health interests for those who are active in public health.     

Comparison of Bayesian-utilitarian and maximin principle approaches

The Precautionary Principle implies the adoption of a set of rules aimed at avoiding possible future harm associated with suspected, but not ascertained, risk factors. Several philosophical, economical and societal questions are implied by precaution-based public health decision making. The purpose of the present paper is to specify the scope of the principle examining the notion of uncertainty involved, and the implication of different approaches to the decision-making process. The Bayesian-utilitarian approach and the approach based on the maximin principle will be considered, and the different meaning of prudence in the two settings will be discussed. In the Bayesian-utilitarian approach the small number of attributable cases will end up in a low average expected value, easily regarded as acceptable in a cost-benefit analysis. In a maximin approach, on the other hand, the issue will be to consider the high etiologic fraction of a rare disease in the highest category of exposure. In the light of the aforementioned cautions in interpretation, the core difference between the two approaches has to do with the choice between averaging knowledge or equitably distributing technological risks.     

Late diagnosis of severe colchicine intoxication

A 4-year-old Turkish girl was referred to our hospital with the findings of encephalopathy and pancytopenia. She had a history of severe abdominal cramps and gastrointestinal bleeding. A confused state, muscle pain and weakness, erythema-bullous and erythema-nodosum-like skin lesions, and alopecia were observed at her hospitalization. All of these symptoms resolved on follow-up. On laboratory investigation severe thrombocytopenia and leukopenia, mild anemia, a moderate increase in aspartate aminotransferase and alanine aminotransferase levels were detected. After reevaluating her medical history, it was learned that she had accidentally taken 1.3 to 1.5 mg/kg of colchicine 3 to 4 days before her first hospitalization. The possibility of misdiagnosis of colchicine intoxication should be borne in mind, and pediatricians must be aware of its toxic effects, especially in areas where patients with familial Mediterranean fever are present.     

Malignant mesothelioma in Rome and Latium region, 1993-2001

AIMS AND BACKGROUND: Epidemiological studies on malignant mesothelioma have provided evidence on the etiologic role of occupational asbestos exposure and, to some extent, domestic and residential exposures. Less attention has been given to the occurrence of mesothelioma in urban areas where large quantities of asbestos have been employed in the past. The purpose of the study was to investigate the occurrence of mesothelioma in patients living in the urban area of Rome and in other parts of the Latium Region and the patterns of asbestos exposure. METHODS AND STUDY DESIGN: A pathology-based, malignant mesothelioma archive operating in Rome, Italy, was the source of cases. Included in the survey were cases resident in Latium and diagnosed in the period January 1, 1993, through December 31, 2001. Information on asbestos exposure was derived from interviews to the patient or his/her next of kin and from available medical records. RESULTS: The case series included: 114 males and 53 females; total, 167. Information on asbestos exposure was available for 138 cases (83%). Occupational exposure was ascertained or suspected for 33% of cases resident in Rome and 63% of those resident in other municipalities of Latium. Sex ratio was 1.6 in Rome and 3.3 in Latium. CONCLUSIONS: The high prevalence of women among mesothelioma cases and lower proportion of occupational exposure in Rome versus the other municipalities of Latium suggest a possible role of environmental asbestos exposure in the urban area.     

Risk of soft tissue sarcomas and residence in the neighbourhood of an incinerator of industrial wastes

Aims: To investigate the association between occurrence of soft tissue sarcomas (STS) in Mantua and residence near an incinerator of industrial wastes.     

Communicating with health authorities and the public about asbestos risk in Biancavilla (CT)

The high incidence of pleural mesothelioma observed in Biancavilla (Catania) is causally associated to the presence of amphybolic fibres in the volcanic rock used by the local construction industry. This paper examines risk communication in this setting, with respect to presentation of the epidemiologic findings and decision making in the field of environmental clean up. The central issues in communicating with health authorities have been evaluation of the causal link and connections between available knowledge and subsequent action. The public has been rapidly informed, through press and local broadcasting stations. It has been made clear that recommended interventions were of preventive nature, namely paving with asphalt roads that were previously paved with the local quarry's byproducts. It has been stated that expected benefits would be delayed in time. Compliance of the local community may be jeopardized by further delay in the implementation of this intervention.