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Introduction: The aim of this study was to assess the correlation between oxidized phospholipids on apolipoprotein B-100 particles (OxPL/ApoB), lipoprotein(a) and low-density lipoprotein (LDL)-producing oxidized phospholipid (OxLDL) biomarkers and cardiovascular disease (CVD) in chronic hemodialysis (HD) patients., Methods: In 52 HD patients, we measured OxPL/apoB by antibody E06, IgG/IgM autoantibody titers to copper-oxidized LDL (Cu-OxLDL) and malondialdehyde (MDA)-LDL, IgG/IgM apolipoprotein B-100-immune complexes (IC/apoB), C-reactive protein (CRP) and lipoprotein(a) (Lp(a)). In all patients, the presence of CVD was assessed., Results: OxPL/ApoB, IC IgG/IgM, MDA-LDL Ig G/IgM, Cu-OxLDL IgG/IgM and Lp(a) levels were similar in patients with and without CVD. At multiple logistic regression analysis, the association between age and CVD was independent (OR=1.078; 95% confidence interval, 1.005-1.157; p=0.03)., Conclusion: In HD patients, OxPL/apoB, lipoprotein(a) and OxLDL biomarkers are not associated with CVD.

Objective: Over the past years both donor and recipient profiles have changed in heart transplantation. Satisfactory clinical outcomes of marginal donors in candidates >60 years of age have led us to allocate suboptimal donors to younger recipients as well. Therefore, we retrospectively reviewed our experience., Methods: Among 199 patients undergoing heart transplantation from January 2000 to February 2010, there were 83 (41%) aged 61-72 years. The other 116 (59%) ranged in age between 18 and 60 years. According to their clinical conditions as heart transplantation candidates, They were classified into 4 groups: younger recipients (n=116) of either optimal donors (n=72; group 1 [G1]) or marginal donors (n=44; group 2 [G2]) and older recipients (n=83) of either marginal grafts (n=70, group 3 [G3]) or optimal grafts (n=13; group 4 [G4]). The gender distribution, cause of end-stage heart failure, preoperative pulmonary hypertension incidence, pretransplantation clinical status, and mean follow-up were not significantly different among the 4 groups., Results: Overall 30-day survival was 90 ± 1% and 10-year rate was 78 ± 9%. Among the groups, 30-day and 10-year actuarial survival rates were, respectively: 94 ± 4% and 87 ± 1% for G1; 86 ± 5% and 84 ± 7% for G2; 88 ± 4% and 71 ± 7% for G3 and were 100% and 82 ± 7% for G4 (P=.7). In comparison among the 4 groups, there was no significant difference regarding freedom from graft failure (P=.3), right ventricular failure (P=.3), acute rejection episodes (P = .2), chronic rejection (P=.2), neoplasia (P=.5), or chronic renal failure (P=.1). Older recipients of marginal donors [G3] had a 4% (n=3) prevalence of permanent pacemaker implant, versus G2: 3% (n=2) among (P=.1)., Conclusion: Our results suggest that extended donor and recipient criteria do not compromise clinical outcomes after transplantation., (Copyright © 2011. Published by Elsevier Inc.)

Background: We aimed to evaluate the relationship between serum leptin and the leptin/body mass index (BMI) ratio with prevalent cardiovascular disease (CVD), and their influence on all-cause and CVD-related mortality in patients on hemodialysis (HD)., Methods: 118 stable HD patients (50 women, median [interquartile range] age, 65.1 [54.7-72.2] years) were studied. All patients had baseline measurement of serum leptin concentrations. Relationships between leptin and all-cause and CVD mortality were studied by means of survival analysis and Cox regression analysis., Results: The leptin/BMI ratio was similar in patients with and without CVD at baseline (0.65 [0.29-2.23] vs. 0.68 [0.29-1.49] ng·m2/ml·kg, respectively, NS). Multiple logistic regression analysis showed that there was not an independent association between leptin/BMI ratio and prevalent CVD. During the follow-up time, 52 (44.1%) patients died. CVD was the cause of death in 27 out of 52 (51.9%) deceased patients. Survival analysis and Cox proportional multivariate regression analysis showed that there were no significant relationships between leptin levels or the leptin/BMI ratio and all-cause and CVD-related mortality., Conclusion: These results do not support that, in stable HD patients, serum leptin concentrations and the leptin/BMI ratio are related with prevalent CVD. Leptin/BMI ratio seems not to be a risk factor for mortality in these patients.

This study aimed at evaluating the possible relationship between anorexia and fatigue in hemodialysis (HD) patients and at measuring the plasma levels of interleukin-6 (IL-6) and C-reactive protein (CRP) in HD patients with or without anorexia and/or fatigue. The first question of the Hemodialysis Study Appetite questionnaire was used to assess the appetite of the HD patients and the vitality scale of the SF-36 to assess fatigue. The Charlson Comorbidity Index was assessed in each patient. Seventy-six HD patients were studied. Forty-four were males and 32 females. Thirty-two were classified as not-anorexic and not-fatigued, 12 as not-anorexic but fatigued, 6 as anorexic and not-fatigued, and 26 as anorexic and fatigued. Plasma IL-6 levels (pg/mL) were significantly higher in anorexic and fatigued patients (10.9 ± 11.9) than in not-anorexic and not-fatigued (1.6 ± 0.6) (p < 0.001) and in anorexic but not-fatigued patients (1.8 ± 1.7) (p < 0.01). With respect to not-anorexic but fatigued patients (3.1 ± 1.5), the difference was not statistically significant (p = 0.058). The plasma CRP levels (mg/dL) also were significantly higher in anorexic and fatigued patients (9.2 ± 6.3) than in not-anorexic and not-fatigued patients (4.1 ± 4.5), in anorexic but not-fatigued patients (2.5 ± 1.6), and in not-anorexic but fatigued patients (4.1 ± 4.4) (p = 0.001). The presence of both anorexia and fatigue in chronic HD patients is associated with significantly higher levels of plasma IL-6 and CRP and a higher frequency of comorbidities.

Background: During the last few decades the mean age of subjects on chronic dialysis (CD) significantly increased. The effects of these changes on mortality rates, causes of death, early and long-term predictors for mortality have not yet been clarified. We analysed this issue through a study performed over a period of 12 years., Methods: We studied 8977 patients enrolled on the Lazio Dialysis Registry (Italy) in 1995-2006. We analysed annual mortality rates, causes of death, probability and determinants of the survival., Results: The overall mortality rate was 14.6 deaths (95% CI: 14.2-14.9) per 100 person-years on CD, remaining essentially unchanged over the 12-year period, despite a 5-year increase in the median age. A reduction in mortality was found for patients >74 years from 29.8 (95% CI: 24.8-34.9) in 1995 to 22.5 (95% CI: 20.0-25.1) in 2006. No statistically significant differences were found over time in annual mortality rates by cause of death. The probability of survival was 0.86 1 year after starting dialysis and 0.33 after 12 years. We found a higher association between haematocrit levels, serum albumin, self-sufficiency and survival within 1 year of dialysis and between diabetes and survival after 1 year., Conclusions: The finding that the mortality rate of CD patients did not change over the last 12 years, despite concomitant and significant ageing of patients, supports the public health policy of providing CD to very old subjects. The identification of the clinical factors that predict survival underlines the role of clinicians in preventing and treating these conditions after the start of CD.

Background: The gradual increase of substances coming onto the market, many of which are still not classified in terms of hazard for worker's health, in addition to those classified as carcinogens by the European Economic Community, imposes a review of the implementation of protective measures foreseen in specific regulations, also with the aim of assessing worker exposure., Objectives and Method: For this purpose, the SPSAL (Prevention and Safety at the Workplace Service) of ASL (Local Health Unit) No. 2, Umbria Region, in 1996, when Law No. 626/94 came into force, started a project aimed at identifying the companies located in the Unit's territory that used and/or produced carcinogens in their production cycle. In a sample of these companies, divided by category (wood,fuel distributors, engineering, galvanization,foundries, brickworks, ceramics processing, tobacco industries, and companies specializing in removal and recovery of asbestos-containing materials) environmental investigations were carried out to verify the levels of worker exposure to the carcinogens thus identified. In some cases, sampling was repeated even after the implementation ofspecific remedial measures in order to verify their effectiveness in terms of reducing risk., Results and Conclusions: The production cycle, the use or production of carcinogenic substances was investigated in 811 companies, where the number of exposed workers was 3821. The environmental sampling carried out showed levels of exposure to various carcinogens that were below the limits specified by law or recommended by the major industrial hygiene associations. Checks carried out after the improvements confirmed their effectiveness and a significant reduction in risk. The exposed workers were identified for the purposes of entry in a special register that could, in the long term, facilitate the reconstruction of occupational exposure to carcinogens. This will also facilitate correct insurance and pension benefits and any legal action that might be taken.

Although symptoms are common and frequently severe in patients on maintenance hemodialysis, little is known about the relationship between cultural background and symptom burden. The aim of this study was to explore differences in the prevalence and severity of symptoms between American and Italian hemodialysis patients. We administered the 30-item Dialysis Symptom Index to American and Italian patients receiving maintenance hemodialysis during routine dialysis sessions. The prevalence and severity of individual symptoms were compared between patient populations, adjusting for multiple comparisons. Multivariable logistic regression and ordinal logistic regression were used to assess the independent associations of cultural background with the prevalence and severity of symptoms, respectively. We enrolled 75 American and 61 Italian patients. American patients were more likely to be black (36% vs. 0%, P<0.001) and diabetic (53% vs. 13%, P<0.001). Italian patients were more likely to report decreased interest in sex, decreased sexual arousal, feeling nervous, feeling irritable, and worrying (P<0.001, respectively). Adjustment for demographic and clinical variables had no impact on these cultural differences in symptom prevalence. The median severity of 11 symptoms including muscle soreness, muscle cramps, and itching was greater among Americans (P<0.001, respectively), although nearly all of these differences were rendered nonstatistically significant with adjustment for race, diabetes, and/or Kt/V. Italian patients receiving chronic hemodialysis report a greater burden of symptoms than American patients, particularly those related to sexual dysfunction and psychosocial distress. These findings suggest that cultural background may affect adaptation to chronic hemodialysis therapy.

Background: A retrospective study was conducted to determine incidence and predisposing factors of incisional hernia after an emergency midline laparotomy., Patients and Methods: The study population consisted in 197 patients of whom 138 were followed-up for 2 years after surgery., Results: An incisional hernia developed in 25 (18.1%) patients at a mean follow-up of 11.2 months. Multivariate analysis showed the importance of age (> 60 years, p < 0.004), obesity (p < 0.008) and occurrence of post-operative wound infection (p < 0.00001) for the development of an incisional hernia. Univariate analysis showed that intestinal occlusion (p < 0.02), peritonitis (p < 0.006), upper abdominal access (p < 0.04) and post-operative wound infection (p < 0.003) in older patients and obesity (p < 0.003) and the presence of a neoplasm (p < 0.006) in younger patients, played a significant role. The comparison between young and old patients showed that upper abdominal access (p < 0.007), interrupted and layered wound closure (p < 0.02 and p < 0.01, respectively) and contamination of the operative field (p < 0.004) played a statistically significant role in older patients., Conclusions: The rate of incisional hernia after an emergency midline laparotomy is higher than after elective procedures. However, it could be reduced with proper attention to the suture technique, i.e. mass and continuous suture, better preparation of the operative field and scrupulous sterility throughout the procedure in order to decrease the incidence of post-operative wound infection.

In order to evaluate the risk connected with wood dust exposure in millwork on a group of 13 craft industries, 74 area dust samplings and 74 personal dust samplings were made. In personal samplings both the total portion and the respirable fraction were calculated. Area samplings showed dust levels (average, standard deviation, fiducial limit, FLS95%) under ACGIH TLV-TWA for soft wood dust: TLV-TWA for hard wood was basically reached, and OTL levels gave evidence for high risk of exceeding TLV-TWA in the medium-long term. The exposure levels by personal samplings (average, standard deviation, fiducial limit, FLS95%) were clearly over TLV-TWA, both for hard woods and, although less clear, for soft woods. OTL levels gave evidence for a frankly unacceptable exposure condition in the medium-long term. Differences between average levels of total dust exposure (2.5 mg/m3) and respirable portion (2.3 mg/m3) were not statistically significant (p > 0.05) as well as the differences among the 4 groups of companies with homogeneous product activity (p > 0.05). In consideration of toxicological peculiarity of wood dust and carcinogenicity of wood manufacture as exposure circumstances classified in group 1 by IARC, the results show the need for prevention measures to reduce workers' exposure risk, by means of environmental improvement and better work organization, technological structures, individual attitudes and personal protection.

Background: Aortic root replacement is a complex surgical procedure which has undergone major technical modifications with time. In order to assess the early and long-term outcome after aortic root replacement with this procedure, our entire experience of a two decade period was reviewed., Methods: Between January 1979 and March 1997, 156 aortic root replacement operations were performed. One hundred and twenty five patients (80%) were male and 31 female; their mean age was 50 +/- 16 years. Diagnosis was annuloaortic ectasia in 79 patients, aortic dissection in 51 (acute 22, chronic 29), isolated aortic valve pathology in 24 and aneurysm of sinus of Valsalva in 5. Thirty nine patients had aortic root replacement using the standard "Bentall" technique, 73 using the "modified Bentall" technique, 15 using the Cabrol technique. Biologic substitutes of the aortic root were used in 29 patients (19 autografts, 4 homografts, 6 xenografts). Mean follow-up time was 41 +/- 40 months (range 1 month-18 years)., Results: There were 12 (7.6%) hospital deaths. Hospital mortality in elective cases was 5% (7/134) and 22% (5/22) in emergent (p = 0.01). A trend toward reduced early mortality was demonstrated in recent years. Mortality was 5% for the "modified Bentall" group, 3% for the "Biologic root" group, 10% for the "Bentall" group and 20% for the "Cabrol" group. Hospital mortality was significant higher in "Cabrol" group than in "modified Bentall" group (p = 0.04). The overall long-term survival rate was 78 +/- 4% at 5 years, 71 +/- 6% at 10 years and 51 +/- 13% at 15 years. No significant difference in survival rate nor freedom from complications was observed among patient groups. Need for reoperation and valve-related adverse events become prevalent after 10 years of follow-up., Conclusion: The decrease in early mortality and the satisfying late results demonstrate that aortic root replacement is a low risk surgical procedure and an effective and durable treatment. The availability of biologic substitutes for the aortic root has allowed the extension of this operation to all patient age group, with results comparable to these obtained with composite grafts.

Acute allograft rejection is still a leading cause of both early and late mortality and morbidity after cardiac transplantation. Besides cell-mediated acute rejection, a "humoral" form exists which is more frequent in younger patients in the early postoperative period, and less likely to respond to the usual therapy. Cyclosporine therapy has deeply affected the clinical, laboratory and histological aspects of acute rejection. Though endomyocardial biopsy remains the most reliable diagnostic tool, other noninvasive procedures are of great value for a final diagnosis; among these are electrocardiography and two-dimensional echocardiography, which are the two elective techniques for post-transplantation follow-up in children. The laboratory and immunological assays, on the contrary, share a very low specificity. In conclusion, the diagnosis of acute rejection is still a clinical one, though supported by laboratory and histological evidence. In our experience, the natural evolution of many mild and mild-moderate rejection episodes toward regression does not support an excessive prophylaxis or an early treatment of symptom-free acute rejection. In addition, treatment of rejection must be personal and specific to each patient.

The Authors propose an organizational model for a surgical day hospital program, which is being used for a pilot day surgery unit in the I Department of Surgery of the Rome University "La Sapienza". The program requires little capital investment, as it is closely linked, geographically and administratively, to the main surgical unit, and uses the present staff, facilities and support services. The model is based on a computerized LAN (Local Area Network), providing fast recording, scheduling, management and trannsfer of medical data for each patient. The present situation is reported in detail. Data from the authors' outpatient department for 1988, have been recorded and elaborated. The results show a low use of surgical day care, limited to minor surgical procedures, and with not a single operation performed under general anesthesia. The authors hope to see a growth in the use of day surgery and a more selective use of inpatient care.