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We evaluated the effectiveness of diabetes mellitus disease management, implemented in Modena province since ten years, on the prevention of complications and early diagnoses at a population level. Time trends show that diabetic patients had significantly decreasing values over time of age, diabetes duration, and glycated haemoglobin; and increasing percentage over time of new-onset diabetes and optimal glycaemic control. That indicates an improved ability of early diagnosis and care of diabetes mellitus. It indicates at a population level that the Local Health Unit, as health system, promoted diabetes prevention and its complications.

Medication errors occur frequently in many clinical settings. Various studies have highlighted that, together with adverse drug events, they represent one of the major causes of adverse events occurring in hospitals. The aim of this study was to perform a detailed retrospective medical record review in order to investigate the incidence of medication errors occurring in the prescription and transcription phases of the medication use process. Overall, 56 medical records were reviewed to determine the incidence of incomplete or incorrect prescriptions and incorrect transcription by nurses of the original medication order. The findings highlight the need to improve medication safety, in particular at the time of prescription and transcription of orders. The study also confirms that the retrospective review of medical records is an effective method for identifying certain types of medication errors that occur during the prescription and transcription phases. However, this type of review is complex and too costly to be used routinely, for continuous monitoring, in clinical practice.

On the basis of 80 cases of traumatic lesion of the pelvis with associated vascular and visceral lesions, observed between 1985 and 1994 at the Department of Surgery in Modena and at the Rizzoli Orthopaedic Institute in Bologna, the options for diagnosis as related to the specificity of lesions are examined, and the choices of indications and surgical technique are illustrated.

Day hospital (DH) activity may avoid in-staying of patients resulting in an increase of efficiency and in a more satisfying diagnostical-therapeutical process for the patient. All the same, it is quite difficult to identify parametres and indicators to be used in the evaluation and quantification of DH, so that both scientific literature reporting experiences and law are lacking. One of the reasons is probably due to the lack of nosological characterization of patients and protocols of DH activity, so that the definition relies only on organizational and technical parameters. Characterization of protocols of intervention is the basic approach to the present DH investigation. Parameters such as: multiplicity of services, weekly planning of the activity and surveillance needed by the patient are considered the fundamental criteria to identify and quantify DH in the present research carried out at the University Regional Hospital of Pisa. The aim of this article is, on one side, to give a methodology of investigation based, as far as possible, on "explicit" indicators and parameters, so that the experience may be exported into other contexts and on the other, to give an example of resource analysis and efficiency evaluation which were internally used for "audit" review.

Our study aimed to verify whether patients with spine accident injury present altered plasma levels of IL-6 and whether the levels of this cytokine are related with the production of acute phase proteins which are elevated after trauma and infection. 34 subjects admitted to an Intensive Care Unit for spine injuries were examined: 26 presented fever over 38.5 degrees C and in 13 of them blood or local cultures were positive for pathogenic bacteria. IL-6, C-reactive protein (CRP), haptoglobin (HPT), alpha 2-macroglobulin (alpha 2Mg), C3c and C4 Complement factors were determined on admission and in the course of their hospital stay. No changes in IL-6 systemic levels were present in the subjects examined and only CRP was constantly high. Although within the normal range IL-6 levels inversely correlated with fever. Our results show the difficulty to utilize the IL-6 circulating levels as prognosis parameter in patients subjected to spine accident injuries.

The consensus conference on blood saving has allowed us to formulate some interesting guidelines. The autologous and homologous transfusion require the patient's consent. For volemic replacement crystalloid solutions are used for phlebotomies below 10-15%, and colloid solutions for those greater than 10-15% of the blood mass. Severe isovolemic hemodilution (Ht < 20%) necessitates the reduction of the dosage of some drugs. A limit of Hb around 9 g/dl after phlebotomy may be acceptable in the absence of cerebral and coronary vascular disease. Phlebotomies are therefore possible also when the Hb values are 10 g/dl (Ht 30%). Hb values around 7 g/dl in the late postoperative period (from day 3 to 6) may be accepted only if well tolerated. The blood salvaged during surgery and at the beginning of the postoperative phase must always be centrifugated, washed and microfiltered. Subsequently, in the first 8 hours it is possible to reinfuse red cells after sedimentation and microfiltration. The techniques of predeposit, hemodilution and recovery are valid especially if associated with careful control of postoperative bleeding by means of aspiration under controlled pressure (at minimum negative values and sometimes positive ones), monitoring of blood loss from drainage and application of elastic compression bandages.

Epidemiologic reports on food-borne diseases from different countries show not infrequently outbreaks due to histamine toxicity. The Authors were interested in assessing the relative importance of this nosological entity in Italy and made a global review of old and recent literature on the subject referring also their earliest data on a recently performed laboratory work. Several foods can show histamine contents potentially toxic for man; amongst the most frequently incriminated products fish, especially the scombroid species (tuna, mackerel), plays a pre-eminent role in the etiology of the so called scombrotoxic fish poisoning. This syndrome begins from a few minutes to two hours from incriminated meals and presents itself with the characteristic signs and symptoms of histamine activity on various organs and is very rarely, if ever, life threatening. Histamine formation in food is due to the decarboxylase activity of some microorganisms, mainly enterobacteria; they can be part of its normal flora or represent a secondary contamination and find a favourable environment for outgrowth if food is not stored or processed in proper conditions. An international outlook on the epidemiology of this syndrome is then given, including some considerations on the real dimension of the problem in Italy, at present widely underestimated. Though a pioneer work was accomplished by Pergola, who started his researches in 1910 after receiving several reports of food poisoning related to consumption of tuna and finally established the causative role of histamine, we are lacking at present an up to date picture of this problem in our country, notwithstanding a few sporadic notifications. Two of the most relevant ones concern a survey in Rome on a collection of 110 cases observed in the seventies and an outbreak occurred in Palermo in 1979 affecting nearly 250 people. The relationship between the intake of histamine and the clinical effects on man of a given dose are then evaluated together with histamine catabolic pathways in the gut, where possible interference by enhancing substances may occur. Finally a brief review of the analytical methods currently employed gives the Authors the possibility to refer about their first data of a survey on the hygienic quality of scombroid species commercialized in their metropolitan area.

In this work data of isolation of halophilic vibrios from coastal water of central Tyrrhenian sea are reported, and the epidemiological significance of such strains is discussed. V. Parahaemolyticus was identified in 8 out of 20 samples of sea water. V. alginolyticus was identified in 8 out of 26 samples of fishes and mussels examined and in 8 out of 20 sea water samples. Halophilic vibrios had not been isolated from 12 samples of sewage water and from 27 healthy or pathological human stool samples. From 6 different samples (sewage water and human stools included) bacteriophages active against V. parahaemolyticus were isolated. This study demonstrates that in our geographical area V. parahaemolyticus is present. The pathogenicity of such strains cannot be demonstrated because of the lack of available experimental models in vitro and/or in vivo. It is also impossible to assume their etiological rôle in human pathology, due to the absence of specific epidemics or single cases in our country.

Seventy-six halophilic vibrio strains were isolated from different marine sources such as coastal waters, fishes and mussels. Twenty strains were identified as Vibrio parahaemolyticus, 44 as Vibrio alginolyticus and 12 other strains could not be classified because of their atypical biochemical activities. Further investigations are necessary in order to assess if the present strains of V. parahaemolyticus can have a role in food poisoning outbreaks or human sporadic enteritis in our geographic area.

A new Salmonella serotype with the antigenic formula 16:i:l,w and named S. pisa is described. The strain was recovered from the feces of a healthy person who had suffered enteritis during a previous sojourn in Ghana. The W.H.O. Salmonella Centre of Paris confirmed the antigenic structure and agreed with this designation.

After a review of the taxonomic history of the genus Arizona culminated in the insertion of these bacteria in the Kauffmann-White schema, the most significant references concerning their pathogenicity and occurrence are related. In this paper, the outbreaks and sporadic cases by S. arizonae which occurred in Tuscan area during 1969-1978 are reported; between several animal species, turkeys were found frequently infect and the same serotype (S. arizonae 18:Z4,Z32:-) was identified. The epidemiological connections with the infection of turkeys and of other animals, humans inclusive, are discussed.

After having outlined the routine methods for the study of drug resistance plasmids used at highly specialized centres such as the London Enteric Reference Laboratory, the AA. examine the most practical methods of a pure and simple way of discovering R factors in enterobacteria. A brief reference is made to some of the in vivo transfer techniques before reducing the various possibilities of in vitro survey to essentials. The experimental conditions realized by some AA. for mating in liquid media which represent the most commonly used method for the study of R factors in enterobacteria are pointed out as an example. Finally, a brief reference is made to other technique such as the mating possibilities on membrane filter in solid media and "facilitated mating" in the cellophane device according to Chabbert.

Only ninety-three strains of Shigella, eightyseven of which have been identified as S. sonnei and six as S. flexneri were collected during 1969-1976 at the Pathogen Enterobacteria Centre of Pisa in Central Italy, as evidence of an epidemiological situation marked by a rare occurrence of syndromes related to these organisms. The collected strains were tested with disks of nine antibacterial drugs in common use: the survey detected sensitivity of all the strains to cephaloridine, ampicillin, carbenicillin, kanamycin and gentamicin, whereas a fair percentage of resistance appeared to streptomycin, tetracycline, chloramphenicol and cotrimoxazole. Both within multiresistant strains and those characterized by single resistances (forty-three of them in all), were present strains capable of transferring different drug resistance patterns to E. coli K-12, as evidence of being under extrachromosomial genetic control.

A series of cases of postoperative gastroenteritis by Salmonella bredeney in a general surgical ward has been described. The particular serotype of Salmonella in question, the widerange of drug-resistance of the strains, the epidemiological stages of the outbreak and the kind of the ward interested have been considered of uncommon occurrence.

Two outbreaks of Cl. perfringens food poisoning which occurred in Florence during 1976 have been described. The first one involved three hundred primary school children; processed re-heated turkey meat was thought to have been the vehicle of infection in the school meal. The clinical symptoms consisted of mild diarrhoea in all cases and the duration of the illness was about 12 hours. The possible part played by food storage temperature, post-cooking periods and food trolleys in the spread of infection is discussed. The other outbreak interested three people who ate a dish with gravy in a restaurant; one of these suffered severe haemorrhagic enteritis and died after two weeks. Necroscopy was performed and the results of post-mortem examination as well as histological and bacteriological findings certified that the cause of death was severe enteritis (Necrotizing enteritis) in elderly debilitated patient (with diabetes, chronic bronchitis, arteriosclerosis and previously gastroresected).

A series of 21 patients with cervical spinal trauma, 12 patients with complete spinal lesion and 9 with incomplete spinal lesion, is reported. All these patients have been treated with surgical reduction and stabilization at average 9 hours after trauma. The authors point out pre- and intraoperative anesthesiological problems connected with early surgical operation and discuss the postoperative complications. At the follow-up of average 2 years the results were: among the 12 patients with complete spinal lesion, 2 died, 2 improved until the deambulation, 7 didn't change and 1 had no follow-up; among the 9 patients with incomplete spinal lesion, 7 improved until the deambulation, 1 didn't change and 1 worsened. Independently of the neurological recovery, the early surgical stabilization enables to reduce remarkably the incidence of the complications, to start precociously a rehabilitation, to improve the patient's expectation of life.

Comparative experiments were carried out on samples of sea water at different degrees of natural pollution. The aim of such experiments was the quantitative estimation of coliforms and salmonellae and their respective phages. The results obtained show that it is thus possible to get better informations regarding the nature and degree of water pollution, than these obtained by the E. coli count alone.

The distribution of Salmonella agglutinins among 390 normal sera from people living in the district of Pisa is described, and the relation of these findings with the Salmonella serotypes occurring in the same area is discussed. Clusters of agglutinins for several O and H antigens were found at or above a titre of 1:20, in many samples. In order to explain the significance of such antibodies and their origin an identical survey was carried out on some sera from patients with chronic liver disease, using the same antigens suspensions. The results from healthy persons compared with the increased antibody titres detected in liver patients support the hypothesis that the anti-Salmonella agglutinins may be originate by various antigenic stimuli which may be specific or most frequently non-specific, since it is well established the cross-reactivity between both the somatic and flagellar antigens of Salmonella and those of other organisms.

A study has been carried out in order to evaluate the sensitivity of a group of some 517 strains of salmonella identified by the Pathogenic Enterobacteria Centre of Central Italy in the biennium 1974-75 to various antibiotics and chemotherapeutic agents. As far as the average percentage of sensitivity to the drugs by the strains tested is concerned, the results obtained are indicative of a situation which may be optimistically looked upon as far as our regions are concerned. Some widely used drugs such as chloramphenicol, ampicillin, streptomycin and kanamycin showed a high percentage of activity in vitro towards Salmonellae with the exception of S. wien, whereas gentamicin, co-trimoxazole, nalidixic acid, furoxone and cephradine were more widely active, No substantial differences were found between strains normally present in our regions which are, at present, characterized by a stationary epidemiological situation (S. typhi, S. paratyphi B, S. enteritidis, S. typhi-murium) and sertypes which, having been present in Italy for a long time, appear today to have an increasing diffusion (S. infantis, S. newport, S blockley and S. thompson). As for the Salmonellae of recent appearance and diffusion in Italy (S. panama, S. agona, S. wien) a more resistant pattern of behaviour to various drugs was found; this was particularly remarkable for S. wien which is the last in order of appearance in our population. Finally, the probable reasons for this difference in behaviour are discussed in view of our present knowledge on drug-resistance and on the role played by antibiotics as selective agents at an environmental level.

A subdivision of enterobacteria is made into classic pathogens and saprophytic species which become opportunistic agents of various syndromes. After a review of the epidemiological situation in Central Italy regarding salmonellosis and shigellosis, an analysis of the E. coli types involved in the enteritis syndromes is carried out. Other topics discussed in the article are the sistemic infections by Serratia, Kelbsiella, Enterobacter and Proteus strains; moreover the causative agents of urinary tract infections are reviewed. The role played in human pathology by all the enterobacteria allows to conclude that the work of the laboratorist would be closely cooperative with one of clinician in order to evaluate correctly the etio-epidemiological significance of the microbiological findings.

Several antiseptic and disinfectant compounds have been investigated for their minimal inhibitory concentration (MIC) against antibiotic multiresistant strains of S. wien and S. bredeney as well as S. typhi and S. typhimurium strains characterized by wide spectrum of antibiotic sensitivity. The MICs of AgNO3, merthiolate, NaN3, phenol, Zephiran and Desogen were not substantially different for the former and the latter strains; on the contrary, the HgCl2 minimal inhibitory concentration was significantly higher against S. wien and S. bredeney than against the other strains. The mercury resistance appeared plasmid controlled and transferable to E. coli K-12, always associated with antibiotic resistance. The findings, which confirm the results of other AA., seem unrestrictive of the use of HgCl2, because its not probable selective role in the hospital environment.