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OBJECTIVES: This study addressed knowledge of Streptococcus pneumoniae, Neisseria meningitidis and human papillomavirus (HPV), and attitudes and behaviours towards vaccines against them. STUDY DESIGN: This is a cross-sectional, multicentre study. METHODS: Data were collected through a questionnaire administered to 530 adults who accessed four Departments of Prevention of the Italian National Health Service in 2013. RESULTS: Less than 50% of people gave the right answer to all the questions concerning the three diseases, but 96.2%, 94% and 92.7% agreed with the importance of vaccination against N. meningitidis, S. pneumoniae and HPV, respectively, and 58.4% expressed own willingness to have their children vaccinated with N. meningitidis B vaccine. The attitude towards vaccination was more positive in women for N. meningitidis and in people having children for HPV. Furthermore, individuals giving correct answers to all knowledge items were more in favour of both HPV and S. pneumoniae vaccination. A total of 68.8%, 82.6% and 84.5% of respondents vaccinated their own children against N. meningitidis C, S. pneumoniae and HPV, respectively. About 50% of the respondents reported paediatricians' or other health professionals' recommendations as the main reason for vaccination. CONCLUSIONS: Vaccinations may be promoted through actions aimed at increasing citizens' knowledge. Health professionals should be educated to actively provide information on vaccinations in a clear, comprehensive and effective way.

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Meningococcal disease is particularly severe. The case-fatality rate is 7.78% in Europe and 10-14% in the USA. This paper reports the results of a sero-epidemiological study in Italy on meningitis due to Meningococcus C before the introduction of the monovalent conjugate vaccine. In 2003-2004, a total of 577 sera were collected in 17 of the 20 Italian Regions. Serum Bactericidal Assay (SBA) was performed by using rabbit complement serum according to standardized SBA. The results showed that the percentages of protected subjects decreased from 6 to 12 months of age, increased from 1 to 4 years, decreased again until the age of 8 years and from 13 to 16 years, and were particularly high in 9- and 17-year-old subjects. The geometric mean titre of bactericidal antibodies (SBAbs GMT) was low in subjects under 1 year of age, significantly increased in 1-9-year-old children and decreased in adolescents and young adults. Finally, in each one-year age-group, low levels of antibodies were observed in subjects under 1 year of age, in 10-year-old subjects and in 14-16-year-old adolescents. High titres were observed in 3-, 8-, 9- and 17-year-old subjects. Our results therefore indicate that meningococcus C has the highest probability of spreading among 1-4, 8-10 and 14-17-year-old subjects in Italy.

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INTRODUCTION: Air pollution in confined environments is a serious health problem, in that most people spend long periods indoors (in homes, offices, classrooms etc.). Some people (children, the elderly, heart disease patients, asthmatic or allergic subjects) are at greater risk because of their conditions of frailty. The growing use of air-conditioning systems in many public and private buildings aggravates this health risk, especially when these systems are not correctly installed or regularly serviced. The aim of our study was to verify the capacity of Ag+ ions to stop the growth of bacteria and moulds inside the ducts of Heating, Ventilation and Air Conditioning system ducts (HVAC) systems when these ducts were lined with active Ag+ ions zeolite-coated panels. MATERIAL AND METHODS: A Y-shaped HVAC model with two branches was used; one branch was made of traditional galvanized iron, as was the whole system, while the other was lined with active Ag+ zeolite-coated polyurethane panels. During the test, samples of dust present inside both ducts were collected and seeded in liquid and solid media to detect bacteria and moulds. The presence of bacteria was also sought in the air emerging from the outlets of both ducts. RESULTS: Tests made on samples of particulate collected from the two different ducts revealed a lower total bacterial load in the samples collected from the Ag+ zeolite-coated duct than in the samples from the traditional Zn galvanized duct. In addition, the values of bacterial load found in the air emerging from the Ag+ ions zeolite-lined duct were 5 times lower than those found in the air from the traditional galvanized iron duct. CONCLUSIONS: The utilization of Ag+ zeolite-coated panels in air-conditioning systems could improve the quality of the emerging air in comparison with traditional installations in galvanized iron. This innovation could prove particularly advantageous in the event of accidents during the installation of air-conditioning systems or of contaminated aerosols coming from outside.

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The authors present 44 patients operated for hernias (inguinal and/or femoral) with a median pre-peritoneal approach positioning a mersilene mesh with Stoppa's technique. The results are very interesting considering that the hernias treated are all at high risk of recurrence. We had 4 complications (1 bleeding and 3 wound infections) that were conservatively treated, no mortality at all. The follow-up was of 12 months (mean) and no recurrence was discovered.

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The authors studied 118 patients with colon cancer (65 males and 53 female) admitted and operated at the Surgical Department of the Casalpusterlengo Hospital (Milan, Italy); over a period of 5 years (1986-1990). All patients were submitted to a pre-op. work-up with Barium enema, colonoscopy, abdominal ultrasound exam, and PAP-test and mammogram for females patients. We found 7 cases (5.9%) of multiple synchronous colon cancer (in 4 patients 2 cancers and in 3 patients 3 cancers). We also found extracolonic malignancy in the same patients (1 synchronous and 2 metachronous). New criteria are proposed to distinguish multiple colon cancers from multifocal colon cancers. It may be concluded that every patient with colo-rectal cancer requires a complete pre-op. examination of the colon and some tests to rule out other extracolonic malignancy.

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Intestinal occlusion is a rare pathologic event during pregnancy occurring mostly in the second and third trimenon when increased volume of the uterus and the consequent displacement of abdominal organs cause complications of pathologies which would otherwise escape notice, such as intestinal adhesions, to become manifest. Diagnosis is difficult for a number of reasons. Vomiting during the first trimenon and mild abdominal pain during the third are often neglected or considered to be part of the normal course of pregnancy; pain is sometimes referred to atypical sites due to the displacement of abdominal organs; in other cases, the high endorphin tonus is apt to reduce the customary defence reaction. All this should not cause time to be lost, and whenever intestinal occlusion is suspected all the necessary diagnostic procedures must at once be carried out and appropriate therapy must speedily be started so as to reduce the risk of mortality and morbidity for mother and fetus. Management of ileus in pregnancy is identical to that for the non pregnant woman, except for the need to empty the uterus in cases in which it prevents treatment or if the fetus has reached a sufficient degree of pulmonary maturity. The paper describes a case of ileal volvulus and revisits the literature analyzing the diagnostic and therapeutic options suggested.

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There is a high incidence of wound dehiscence, ranging from 6.9% to 22%, after surgery for severe obesity. Different surgical techniques to minimize this drawback of the operation have been proposed, but none have seemed to be really effective. A different approach to this problem has been tried using topical treatment with hyaluronic acid through the drains of the laparotomy suture. Twenty patients subjected to jejuno-ileal by-pass for severe obesity were randomized into two treatment groups: hyaluronic acid (80 mg/daily) or placebo (saline), for 5 days, starting at the operation. Granulation tissue was withdrawn from the wound through polyvinyl catheters 1, 3 and 5 days after the operation. It was processed for light, scanning and transmission electron microscopy. Ten days after the operation, the wounds were examined for dehiscence. Hyaluronic acid treatment reduced the incidence and degree of dehiscence macroscopically, increased the maturation of granulation tissue during the first post-operation days and stimulated fibroblasts to synthesize procollagen shortly after the operation.

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Ulcerative colitis with malignant degeneration and dysplasia can be a precancerous lesion. Therefore, it is necessary to prevent or, at least to diagnose as early as possible any development toward neoplasia in the colon or rectum of the colitis patients. The only reliable guide for a risk of malignant tissue degeneration is dysplasia of the mucosa. A group of 31 patients was studied after total colectomy with ileorectal anastomosis and subsequent topical treatment with enemas containing sulphasalazine and corticosteroids. Two of these patients had mild rectal dysplasia before surgery, seen in a biopsy specimen obtained endoscopically. All the patients were followed for a long time after surgery, with endoscopy and microscopic and ultrastructural observation of rectal biopsy material taken from different sites in the mucosa, both from areas that looked dysplastic by endoscopy and from those that appeared normal. The two patients with presurgical dysplasia, when examined later, one 12 months and one 18 months after surgery, had no rectal dysplasia; the mucosal covering was moderately complete and the anastomosis was functioning. It is considered that to prevent development of cancer in the rectal stump, colectomy should always be followed by regular topical treatment and there should be a check-up at short intervals for early diagnosis of any premalignant areas that might develop. Regression of such lesion was observed to lesser degrees after continuous treatment with the topical medication.

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We have studied the effects of PGE2, the anticholinergic pirenzepine and vagotomy on the rat gastric mucosa after challenge with ASA+0.15N HCl or absolute ethanol. The damage was evaluated by quantitative macroscopic examination, light and electron (transmission and scanning examinations) microscopy. We found both macroscopically and microscopically that pirenzepine and PGE2 were effective against ASA+0.15N HCl, but under microscopic examination they were seen to be uneffective 1 hr after absolute ethanol. Vagotomy showed some protection against ASA+0.15N HCl but was totally uneffective against absolute ethanol. The results stress the differences between ASA+0.15N HCl and absolute ethanol damage and show that "cytoprotection" is possible when the mucosa is challenged with noxious agents that do not act by hyperosmolar effects.

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A controlled trial was carried out in patients with biliary dyskinesia to compare the effects of the new calmodulin-independent and antispastic drug tiropramide with those of imecromone. Forty patients were randomly divided into two groups, one treated with 300 mg tiropramide per day and the other with 1200 mg imecromone per day, both treatments lasting for 3 months. The results showed that tiropramide was significantly more effective in decreasing the number of attacks of pain and in improving pain and dyspepsia symptoms than imecromone. In subjects with delayed filling of the gall bladder during cholecystography, tiropramide but not imecromone was able to normalize the condition. These results confirm the antispastic synchronizing effect of tiropramide on the motor activity of the gall bladder and the sphincter of Oddi and indicate that it should be the drug of choice for treatment of motor disorders of the biliary tract.

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