At present, PID is considered to be the most severe gynecological infection of young women as well as one of the most important problems of public health involving high social and economical costs. There are two pathogenetic aspects of PID. The primary form results from an ascending infection sustained by the microbic flora of the inferior genital tract, subsequently involving its higher anatomical districts. The secondary form derives from the pelvic diffusion of microorganism primarily involved in extra-genital infections. The analysis of the epidemiological aspects of the disease identifies in the sexual habits, the contraceptive procedures as well as the invasive instrumental practices (iatrogenic factors) the risk factors of the disease. PID has a multimicrobial origin based on a complex interplay between synergic infectious agents, vectors of etiological factors, interferon-gamma and intrauterine devices. The anatomopathological aspects of PID, including Fitz-Hugh-Curtis syndrome are discussed. The literature concerning the diagnosis and the therapy of the disease is extensively analyzed.
Infective endocarditis is best characterized as a disease in evolution. The list of patients at risk, which formerly included almost exclusively patients with rheumatic heart disease, is being continuously modified and expanded. Nowadays, patients with prosthetic heart valves, users of illicit intravenous drugs, and patients with mitral valve prolapse rather than patients with rheumatic heart disease account for the majority of cases of infective endocarditis. Moreover, due to the widespread use of indwelling atrial catheters for parenteral nutrition as well as for intensive cytotoxic therapy, catheter-related right-sided endocarditis is emerging among nosocomial infections. With the advent of successful antimicrobial therapy, complications rather than endocardial infection pose the major therapeutic problems. In addition to progressive heart failure, myocardial abscesses, fungal endocarditis, relapsing infection, and major systemic emboli in the presence of large protuberant vegetations constitute indications for replacement of the valve. Despite progresses in diagnosis and therapy, infective endocarditis will most likely continue to challenge physicians even in the next future.
Tissue-type plasminogen activator (t-PA) is a serine protease that converts a zymogen plasminogen into an active serine protease, namely, plasmin. Plasmin is the proteolytic enzyme that degrades fibrin. In the absence of fibrin, e.g., in circulating plasma, t-PA activates plasminogen at a very slow rate. However, when fibrin is present, this activity is enhanced two to three orders of magnitude. As a consequence of these kinetic characteristics, plasmin is predominantly generated on the fibrin surface. This in turn results in a relative sparing of circulating fibrinogen and other plasma proteins to plasmin--mediated degradation. Following the demonstration of the potential of natural t-PA as a thrombolytic agent, an intensive effort was launched to enhance its production by recombinant DNA technology. The pharmacological action and the clinical efficacy of t-PA has been tested by several Authors in the treatment of acute myocardial infarction (AMI), and more recently, of pulmonary embolism, a condition for which this drug seems to be very promising: from this point of view this short article provides evidence that the various thrombolytic agents are of equal ability in mediating the rapid lysis of a coronary thrombus after i.v. administration when given appropriately and at the proper time; clinical experience provides little support for the contention of the superiority of t-PA over other thrombolytic agents, particularly for coronary thrombolysis. We are waiting for the results that will come from the GISSI-2 study, that is comparing streptokinase (SK) vs. t-PA in AMI's patients.
In Italy three epidemic peaks of meningococcal meningitis have occurred reflecting pandemic recrudescence of the disease. The seasonal distribution of the disease is similar in the epidemic or non-epidemic periods. There is no significant difference in the regional distribution of the disease. The disease is more prevalent among young males. The prevalent serogroup of Neisseria meningitidis is C. There has been a decrease in resistance to suphonamides and an increase to rifampin among the isolated strains.
Primary hyperparathyroidism is a quite frequent disease, the incidence of which has been found to increase over the past two decades. At the same time there has been a remarkable change in its clinical presentation; therefore this endocrine disorder earlier considered rare but almost always associated with complications, now appears a quite common and uncomplicated disease.In our series of 150 patients diagnosed between 1966 and 1989 the female/male ratio was found to be 1.77. The ratio has significantly increased (2.09), beginning from 1983; this was mainly due to the availability of a bone densitometer at our Mineral Metabolism Service with consequent greater demand of serum calcium determination as a part of routine metabolic screening for prevention of postmen-opausal osteoporosis.Whilst the percentage of patients with renal manifestations of the disease has not significantly changed during these years, the amount of asymptomatic patients (yrs 1966-1983 = 3.7% vs yrs 1984-1989 = 39.7%) has progressively increased to the detriment of patients with skeletal symptoms.Serum intact parathyroid hormone determination by immunoradiometric assay (and possibly by immunochemiluminometric assay) seems to have overcome some of the methodological problems inherent in conventional radioimmunoassay.Surgical treatment of primary hyperparathyroidism is safe and highly effective in experienced hands. Recurrence has been observed only in three cases after resection of parathyroid adenoma, thus indirectly supporting a monoclonal origin of the tumor.Medical behaviour (conservative or surgical management) in respect to patients with the mild or asymptomatic form of the disease, especially when diagnosed in old age, is uncertain at this point in time. Future prospective studies carried out on a large number of patients are needed to better clarify this tissue.
This review focuses on the advances made in the pathophysiology, diagnosis and treatment of gastroesophageal reflux disease.During the last five years, the factors responsible for the disease have been extensively investigated and are now relatively well understood. Little progress, however, has been made with regard to diagnostic techniques, but the roles of endoluminal pH-monitoring and esophageal manometry have greatly increased.Finally, the therapy of the disease has substantially been improved, particularly by the availability of new anti-secretory and prokinetic compounds such as omeprazole and cisapride.
There is an increasing concern about HIV infection in paediatric age, due to its increasing incidence in some countries, especially in Europe, and due to its social aspects. HIV infection has particular features, while occurring during paediatric age: infection of child frequently occurs during pregnancy (perinatal form of HIV infection), a period characterized by the immaturity of the immune system of the host. Encephalopathy is a frequent manifestation of the disease, recurrent fever episodes have a different pathogenesis than in adults, LIP (Lymphocytic Interstitial Pneumonia) is a common manifestation of the disease and there is a higher progression rate to AIDS. Antiretroviral therapy, as Zidovudine (AZT) in paediatric age is still on clinical trials, and only few preliminary data are available.
