Background-The rate of failure of noninvasive mechanical ventilation (NIMV) in patients with chronic obstructive pulmonary disease (COPD) with acute respiratory insuYciency ranges from 5% to 40%. Most of the studies report an incidence of "late failure" (after >48 hours of NIMV) of about 10-20%. The recognition of this subset of patients is critical because prolonged application of NIMV may unduly delay the time of intubation. Methods-In this multicentre study the primary aims were to assess the rate of "late NIMV failure" and possible associated predictive factors; secondary aims of the study were evaluation of the best ventilatory strategy in this subset of patients and their outcomes in and out of hospital. The study was performed in two respiratory intensive care units (ICUs) on patients with COPD admitted with an episode of hypercapnic respiratory failure (mean (SD) pH 7.23 (0.07), PaCO 2 85.3 (15.8) mm Hg). Results-One hundred and thirty seven patients initially responded to NIMV in terms of objective (arterial blood gas tensions) and subjective improvement. After 8.4 (2.8) days of NIMV 31 patients (23%; 95% confidence interval (CI) 18 to 33) experienced a new episode of acute respiratory failure while still ventilated. The occurrence of "late NIMV failure" was significantly associated with functional limitations (ADL scale) before admission to the respiratory ICU, the presence of medical complications (particularly hyperglycaemia), and a lower pH on admission. Depending on their willingness or not to be intubated, the patients received invasive ventilation (n=19) or "more aggressive" (more hours/day) NIMV (n=12). Eleven (92%) of those in this latter subgroup died while in the respiratory ICU compared with 10 (53%) of the patients receiving invasive ventilation. The overall 90 day mortality was 21% and, after discharge from hospital, was similar in the "late NIMV failure" group and in patients who did not experience a second episode of acute respiratory failure.Conclusions-The chance of COPD patients with acute respiratory failure having a second episode of acute respiratory failure after an initial (first 48 hours) successful response to NIMV is about 20%. This event is more likely to occur in patients with more severe functional and clinical disease who have more complications at the time of admission to the ICU. These patients have a very poor inhospital prognosis, especially if NIMV is continued rather than prompt initiation of invasive ventilation.

The prevalence of gallstone disease and associated factors in the entire population of subjects aged 15-65 years born and resident in Chianciano Terme (Siena - Tuscany) was examined in the years 1985 and 1986. The investigation included gallbladder ultrasonography, administration of a questionnaire on personal and family history, physical examination and blood chemistry. A total of 1809 subjects (attendance rate 87.7%) participated in the study. Personal history and physical examination showed that Chianciano inhabitants have a low prevalence of obesity (4.3%) and only 4.4% of the female population had more than two pregnancies. Overall prevalence of gallstone disease (cholecystectomy+cholelithiasis) was 5.9% (3.7% for males and 8.4% for females). Age standardized relative risk of gallstone disease for females was 2.25 (95% confidence limits = 1.68-2.68). Prevalence of cholelithiasis was 3.5% (2.7% for males and 4.2% for females). Prevalence of gallstone disease increased with increasing age in both sexes, being extremely low in the age interval of 15-29 years (0.25%). The overall gallstones/cholecystectomy ratio was found to be lower (1:1) in females than in males (2.7:1). Although subjects with gallstones reported more frequently biliary colics and non-specific dyspeptic symptoms, the diagnostic power of all symptoms in identifying cholelithiasis was very poor due to low sensitivity. Only one third of subjects with gallstones was aware of having the disease. Age, obesity and number of pregnancies were positively associated with gallstone disease in univariate analyses. The association with obesity and parity disappeared in multivariate analysis. Blood lipids and glucose were not associated with the disease both in univariate and multivariate analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

According to some authors, prior tonsillectomy and/or appendectomy increase the frequency of certain types of neoplasm. 731 cases of malignant lymphoma, Hodgkin's disease (HD) and non‐Hodgkin lymphoma (NHL), and an equal number of controls were reviewed retrospectively to evaluate the frequency of tonsillectomy and appendectomy and the age at onset of the lymphomas. The results exclude that prior tonsillectomy and/or appendectomy increase the probability of development of lymphomas. Likewise, the age at onset of HD or NHL was not influenced by the surgical ablation of the palatine tonsils and the appendix.

SUMMARY This study surveyed 237 schoolchildren in a lead‐polluted industrial area in northern Italy to assess the relationship between various biological indicators (lead in blood, hair and teeth, and delta‐aminolevulinic dehydratase [ALA‐D] activity) and some neuropsychological functions, assessed by a battery of five psychometric tests. The geometric means of lead measured in blood, hair and teeth were 10·99μg/dl, 6·79μg/g and 6·05/·g/g, respectively. Mean ALA‐D activity was 51mU/ml RBC. By analysis of covariance, after regressing out the variance accountable to confounding variables (age, sex, occupation/education of parents), Total and Verbal WISC‐R IQ and Toulouse Pieron test results were significantly affected by the levels of lead in teeth. ALA‐D values also appeared to be related to WISC‐R IQ results (Total, Verbal and Performance). RÉSUMÉ Relation entre l'exposition au plomb et les performances neuropsychologiques durant I'enfance Cette étude a porté sur 237 écoliers dans une zone industrielle polluée au plomb, du nord de l'ltalie, pour apprécer la relation entre des indicateurs biologiques variés (plomb dans le sang, les cheveux et les dents, I'activité de la déhydratase delta‐aminolévulinique (ALA‐D)) et quelques fonctions neuropsychologiques, appréciées par une battrie de cinq tests psychométriques. Les moyennes géométriques du plomb mesuré dans le sang, les cheveux et les dents étaient respectivement de 10·99 microg/dl, 6·79 microg/g et ·05 microg/g. L'activité ALA‐D moyenne était de 51mU/ml RBC. Par analyse de covariance, après élimination de la variance liée aux variables perturbantes (âge, sexe, occupation/éducation des parents), les réultats aux tests de Toulouse et Piéron, aux échelles totale et verbale du WISC étaient significativement affectés par les taux de plomb dans les dents. Les valeurs d'ALA‐D sont aussi apparues reliées aux Q.I. du WISC (total, verbal et performance). ZUSAMMENFASSUNG Relation zwischen Bleiexposition und neuropsychologischen Befwiden bei Kindern In dieser Studie wurden 237 Schulkinder in einem bleiverseuchten Industriegebiet Norditaliens untersucht, um die Relation zwischen verschiedenen biologischen Indikatoren (Bleigehalt des Blutes, der Haare und Zähne und Delta‐aminolävulindehydratase ALA‐D Aktivität) und neuropsychologischen Funktionen, die anhand von fünf psychometrischen Tests beurteilt wurden, herauszufinden. Die Mittelwerte für des Bleigehaltes in Blut, Haar and Zähen waren 10·99/μg/dl, 6·79/μg/g und 6·05μg/g. Die mittlere ALA‐D Aktivität betrug 51mU/ml Erythrozyten. Durch Bestimmung des Variationskoeffizienten, nach Ausschluß der durch andere Variablen bedingten Varianz (Alter, Geschlecht, Beschäftigung/Bildung der Eltern) fand sich, daß der Gesamt‐ und Verbal WISC IQ und die Ergebnisse des Toulouse Pieron Tests signifikant mit den Bleiwerten in den Zähnen korrelierten. Die ALA‐D Werte schienen ebenfalls mit den WISC IQ Befunden (Gesamt, Verbal und Performance) in Relation zu stehen. RESUMEN Relación entre la exposición al plomo y la realizatión neuropsicol...

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