OBJECTIVES:To evaluate the incidence of bacterial colonization in the throat and in urines of children admitted to a paediatric ward in the year 1994. To test the sensitivity of isolates on the most common antibiotics used in therapy.METHODS:The investigation was carried out on a group of 270 children (125 male and 145 female), aged between 3 months and 12 years, hospitalized with feverish infectious pathology in the department of infectious and Tropical Diseases of the University "La Sapienza" of Rome. The cultures of the throat swabs and on urines were performed on the admission of the children before the beginning of the therapy.RESULTS:The throat-swab cultures showed pathogenous microrganisms in 232 samples (85.9%) with a slight prevalence of Gram-negative bacteria (122) with respect to Gram-positive (110) and saprophytic microbial flora (38). The urine cultures proved to be positive in 81 cases (30%) with a prevalence of Gram-negative (56) above Gram-positive isolates (25).CONCLUSIONS:The two/thirds of paediatric patients hospitalized in an Infectious Diseases Department appeared to be colonized in the upper respiratory tract, whereas in about 10% of them a marked bacteriuria was clearly evident, often in the absence of specific symptoms. A few isolates either from the throat or from urines, showed resistance to the common antibacterial agents.
The authors point out the possible relationship between the biochemical and immunological components of nasal mucus in subjects affected by allergic rhinitis and/or olfactory disorders. Fifty seven subjects (33 F, 24 M) aged between 19 and 73 years, (median age 65 SD 14.60) were studied. Twenty seven of them were normosmic affected by allergic rhinitis and taken as control group, (14 were positive to allergometric tests and/or RAST, while the other 13 were negative), 30 were dysosmic, and subdivided into parosmic (n = 6), anosmic (n = 15) and hyposmic (n = 9) (only one was negative both to allergometric tests and to RAST). In all patients we assessed: nasal mucus (it was analysed for: mucus quantity, pH, protein concentration, K+ concentration and the SIgA antibodies, tested both by radian immunodiffusion and by ELISA), allergometric tests, PRIST, RAST, anterior rhinomanometry, evoked olfactory potential. As regard to allergometric tests, we have no observed statistically significant differences between the control and the dysosmic group, although all the dysosmic patients (except one) were positive both to allergometric tests and to RAST. Total (PRIST) and specific (RAST) IgE values (except for the anosmic subjects who had IgE values moderately higher) were similar to the results obtained by allergometric tests. As regards to nasal secretion quantity, it was reduced (p: n.s.), like the pH (p: n.s.), in the parosmic subjects. On the other hand, proteins concentration of nasal secretion was lowered in hyposmic (p: n.s.) and anosmic (p = 0.05) subjects, while there were no differences between parosmic subjects and control group. The values of SIgA in controls and hyposmic subjects were not too different and similar to those observed by other authors; however they were slightly increased in controls affected by allergic rhinitis with positivity both to RAST and/or allergometric tests (p: n.s.), while they were reduced in the parosmic and significantly in the anosmic patients (p < 0.01). On the basis of that data, the authors conclude that, (though related to a limited case reports) being the secretory IgA values inversely proportional to the gravity of olfactory pathology, a their protective role (if the anatomic-functional substratum is efficient), in the pathologies examined, can be easily hypothesized. Besides, that data highlight that their concentration is slightly decreased in those patients affected by allergic rhinitis, without olfactory disorders (p: n.s.).
To investigate the prevalence of asymptomatic hypothyroidism and hyperthyroidism in hospitalized people, we performed thyroid function tests on a group of 2545 elderly patients consecutively observed in a General Hospital in Rome, during a six year period. The rate of asymptomatic hypothyroidism was as high as 0.71% in female patients and only 0.20% in male patients. In asymptomatic hyperthyroid subjects the prevalence rate was 0.58% in females and 0.20% in males. On the whole, prevalence rate of asymptomatic thyropathies resulted 0.94%, showing a clear difference in sex (women 1.29% and men 0.40%). The asymptomatic thyropathies screening of hospitalized elderly women may result in a very low cost diagnosis of many new cases of hypothyroidism and hyperthyroidism.
The aim of this study was evaluate the usefulness of intravescical administration of Bacillus of Calmette Guerin (BCG) in patients with superficial bladder cancer. The BCG, an immunostimulating agent, has been introduced in routine clinical use; according to the international literature, it is reported to offer better result than the above-mentioned drugs. A retrospective analysis was made of 210 patients who had undergone a complete TUR for superficial bladder tumor. The irritative symptoms and systemic effects are acceptables considering the benefit of the BCG. The results are of great interest and encourage us to continue this study to confirm therapeutic strength.
The secondary drug failure is a well known phenomenon in the development of type 2 diabetes mellitus, but an exact definition of this situation is still lacking. The aim of this research was to evaluate the beta-cell reserve in non obese diabetic patients in relation to the metabolic control and the duration of disease. The main aim was to identify values of postprandial plasma C-peptide that can characterize the patients requiring insulin treatment. A daily profile was performed in 135 non obese diabetic patients, within 20% of their ideal body weight. The mean diurnal values (m) and the mean post-prandial increases (delta mpp) of plasma glucose (G), insulin (IRI) and C-peptide (CP) were assessed. Fourty-four patients showed good (NwD-GC: G-m = 138 +/- 3.2 mg/dl) and 91 poor metabolic control (NwD-SF: G-m = 210 +/- 4.8 mg/dl), according to the G-m lower or higher than 150 mg/dl. Beta-cell reserve (CP-delta mpp: 0.70 +/- 0.03 vs 1.39 +/- 0.04 ng/ml) and C-peptide/insulin molar ratio (CP/IRA-delta mpp: 2.36 +/- 0.06 vs 2.80 +/- 0.06) were significantly lower (p < 0.001) in NwD-SF than in NwD-GC. NwD-GC and NwD-SF were respectively divided into three subgroups, according to the duration of disease. A progressive reduction of CP-delta mpp and an increase in SF prevalence, from the first to the third decade of diabetes duration, was observed. In both NwD-Gc and NwD-SF the duration of disease inversely correlated with CP-delta mpp (NwD-GC: y = 1.59-0.019X, p < 0.001; NwD-SF: y = 1.01-0.023X, p < 0.001). The analysis of the two regression lines showed that patients with CP-delta values lower than 1.0 ng/ml require insulin treatment. In conclusion the duration of diabetes and the progressive reduction of beta-cell reserve represent the major pathogenetic factors in secondary failure.
In this study the authors report the case of HIV patients with visceral leishmaniasis. He presented a pancreatitis with evident clinical signs and high increase of amilasis (9876 U/L) the twelfth day of treatment with meglumine antimoniate. The interruption of therapy was followed by a rapid disappearance of signs and symptoms and a normalization of amilasis. In accordance with the most recent studies, it is expedient, for every patients treated with antimonial drugs, to undergo an accurate amilasis monitoring.
Variations of the origin of the medullary artery. The purpose of this study was to define the origin of the medullary artery through medullary angiography in order to prevent paraplegia during surgery of the thoraco-abdominal aorta. Twenty-eight patients, candidate to thoracoabdominal aorta operations, have been studied for the study of the origin of the medullary artery and its eventual reimplantation during surgery. The artery has been localized in 24 of the 28 patients. In 22 cases (78.6%) it originated from an intercostal artery between D8 and D12, while in 6 cases (21.4%) it originated from a lumbar artery between L1 and L2. In 23 (82.1%) cases it originated from the left side, while only in 5 (17.9) from the right side. Although medullary artery originates more frequently at the thoracic level, particularly from the left D9 and D10, its variability is important, and its localization before thoraco-abdominal aortic surgery is often desirable.
BACKGROUND:The diurnal rhythm in the circulating serum levels of erythropoietin (EPO) was investigated in healthy subjects.METHODS:Venous blood samples were drawn during the span of a whole day every four hours, starting from midnight, for the determination of serum Epo levels by RIA in 40 clinically healthy normocytemic subjects, 27 males and 13 females, aged 30-75 years. Statistical analysis was carried out by means of the "cosinor" method.RESULTS:Serum EPO presents a significant (p < 0.05) circadian rhythm with higher levels in the afternoon and lower levels in the nightime.CONCLUSIONS:These data confirm the presence of a circadian rhythm in serum EPO levels. The mechanisms behind the circadian rhythmicity are still unknown. For clinical evaluation of the serum EPO values, the time of day for collection of blood samples has to be taken into consideration.
Acute idiopathic pseudo-obstruction of the colon, or Ogilvie's syndrome, is a rather unfrequent condition. Although it has been associated to a variety of pathological conditions, the etiology is still unknown. The authors refer upon a case of Ogilvie's syndrome observed by them and, confronting the data that emerged reviewing the literature with their experience, they retain that if the conservative therapy fails, and in absence of perforations or ischemic lesions, the treatment to prefer is the positioning of a cecostomy tube in local anesthesia. For elderly patients with unsufficiently good general conditions who present a recurrent acute pseudo-obstruction of the colon, it is advisable to confection a definitive cecostomy.
The serum concentrations of circulating ICAM-1 (cICAM-1) and soluble receptors for interleukin-2 (sIL-2R) were evaluated on 48 patients with B-cell chronic lymphocytic leukaemia (B-CLL) and on 15 healthy control subjects. The mean +/- SD concentration of cICAM-1 was significantly higher (p < 0.002) in B-CLL patients (407.7 +/- 164.3 ng/ml) than in healthy controls (245.4 +/- 76.7 ng/ml). Patients with progressive disease had higher cICAM-1 levels than patients with "indolent" disease (440.38 +/- 32.3 ng/ml versus 321.36 +/- 14.45 ng/ml; p < 0.0001). Serum levels of cICAM-1 were also significantly higher (p < 0.0002) in patients with advanced stage (III-IV) than in those with early stage (I-II). The increase of cICAM-1 levels was positively correlated to increases of soluble receptors for interleukin-2 (r = 0.9; p < 0.0001). These results seem to show that the measurement of serum levels of cICAM-1 may be an useful tool for monitoring disease activity and tumoral mass in patients with B-CLL. However, further studies are needed to define the functional role of high cICAM-1 levels in the immunological dysregulation of patients with malignancy.
In order to define the relationship, if any, between serum uric acid and insulin pattern in different types of diabetes mellitus, 4 groups of subjects (controls, and affected by type 1 and type 2 diabetes mellitus, with and without obesity) were considered. In each group, successively cleared of the long-term and complicated diabetic patients, serum and urinary uric acid and insulin secretion (serum C-peptide values) were determined. Serum uric acid and C-peptide values were higher in type 2 obese diabetic subjects vs the other groups of patients and controls (p < 0.001). No difference was found, on the contrary, between creatinine clearance and urinary excretion of uric acid among the groups. Moreover, serum uric acid values were in positive correlation (p < 0.02) with serum C-peptide values considering, among the diabetic subjects, only those with duration of diabetes less than 5 years and without micro-macrovascular complications. In conclusion, these data lead to presume that diabetic patients with short duration of disease and without complications show a different serum uric acid pattern, strictly related to beta-cellular secretion.
Percutaneous emptying of benign renal cysts represents the adopted treatment for this kind of pathology. The introduction of pure ethilic alcohol (95 degrees) is usually associated with emptying because it determines the necrosis of the secreting epithelious with recurrences and little significant complications. This treatment is the less bloody solution that can be executed in surgery and for this reason it is proposed in the time as an alternative to surgery treatment of removal.
A case of low molecular weight heparin induced thrombocytopenia is reported. Mechanisms and treatment of this condition are discussed.
This brief commentary is focused on the experimental procedures employed in the evaluation of both cognitive and balance impairments of aging patients. This is an important ergonomic issue that might be used for research purposes. In fact, the corrected assessment of impairments during aging may favor the development of new integrated ergonomic strategies to ameliorate ADL together with the reduction of environmental risks.
BACKGROUND:Abnormalities in proteinase metabolisms have been found in psoriasis and higher concentrations of neutral proteinases in psoriatic skin lesions than in unaffected skin of psoriatic patients have been observed.AIM:The aim of the study was to determine whether repeated whole body UV-(UVB and PUVA) irradiation is associated with changes in proteinase inhibitor alpha 2-macroglobulin (alpha 2-M) in patients with active plaque psoriasis.PATIENTS AND METHODS:In this study, the sera alpha 2-M levels were evaluated in cases of active plaque psoriasis before UV-, four weeks UVB (15 patients) and PUVA (11 patients) irradiation, and two weeks after completed treatment.RESULTS:Both UVB and PUVA treatment had no significant influence on alpha 2-M levels in psoriatic sera, it was, however, sufficient to treat most of the skin lesions.DISCUSSION:The beneficial effect of phototherapy in psoriasis seems not to be mediated through increased binding of proteinases by proteinases inhibitor alpha 2-M from serum.
The authors report the data concerning 2295 women tested for toxoplasmosis immunodiagnosis, in the Department of Infectious and Tropical Diseases of "La Sapienza" University of Rome in the years 1993-1994. Four hundred eleven cases (17.9%) were positive for IgG only; 2 cases (0.1%) for IgM only; 15 cases (0.6%) for both IgG and IgM while 1867 cases (81.4%) were negative. 1668 women were pregnant. In this group 260 (15.6%) were positive for IgG only, 2 (0.1%) for IgM only, and 10 (10.6%) for both IgG and IgM; in one case there was a spontaneous absorption in the 10th week of pregnancy, in another case a still-birth in the 20th week with brain lesions; a child was born with phocomelia of the right arm and one with a clubfoot. While it is possible to explain the absorption and the still-birth with the toxoplasma infection, it is difficult to understand the causes of the abnormality of the limbs.
Arterial hypertension is a common finding in climacteric women even though the role of reduced estrogen levels in promoting this condition remains unclear. The purpose of the present survey was to evaluate the effects of hormone replacement therapy in hypertensive postmenopausal women. 180 patients were studied; they had been postmenopausal for 12-18 months and afflicted with mild or moderate essential arterial hypertension for less than 2 years. Patients were randomly divided into two groups and treated with progestin-estrogen therapy (group I, 96 patients) or with antihypertensive drugs (group II, 84 patients). Fourty-one cases in group I (42.7%) responded adequately to hormone therapy with persistent normalization of blood pressure levels; antihypertensive drugs were effective in 61 patients in group II (72.5%). The 23 unresponsive patients in group II were subsequently treated with progestin-estrogen therapy and a normalization of pressure values was achieved in 10 of these (43.5%). These results suggest that hormonal treatment determines, in at least one third of the cases, a significant reduction in blood pressure values. Moreover, hormone replacement may be effective even in patients that have not responded to antihypertensive drugs.
The authors valued the incidence and clinical therapeutic aspects of Haemophilus influenzae type b (Hib) meningitis in children. They report a retrospective study, in children, with diagnosis of acute purulent meningitis, from January 1982 to December 1994, aged between 1 month and 14 years. Particular attention was direct to Haemophilus influenzae type b meningitis (20 cases). The incidence rate of Hib meningitis in the overall cases (89) was 22.47% (20), while among children younger than 5 years Hib was the most frequently pathogen isolated (20/58-34.47%). In 1/4 of cases, particularly in children younger than 1 years, exordium was aspecific and unclear. At admission culture and examination of Cerebrospinal Fluid (CFS) have been done. CFS was cultured on blood agar and chocolate plates. A latex agglutination test was used for rapid detection of the bacterial antigens. In some cases we looked for bacterial antigens in urine. 20% of children had complications and 10% had sequelae (1 years of follow-up). We didn't have any dead. Antibiotic treatment was principally with Ampicillin, Cephalosporin and Chloramphenicol. The results of this study confirm the Hib gravity and suggest that the administration of conjugate vaccine against Hib to all living in Italy is justified.
In epidemiology of osteoporosis, obesity is to be considered one of its protecting factors. However there are in the literature discordant opinions: some authors describe a protective effect of obesity on the trabecular bone, others on the cortical one, others no effects at all and others finally a positive influence on both the trabecular and the cortical bone. However, only few studies on obesity's impact on bone metabolism are available. Bone mineral density at forearm and serum osteocalcin levels, a specific and sensitive marker of bone turn-over, in a group of postmenopausal obese women with those of a nonobese control group were compared. Obese women showed higher densitometric measurements than nonobese, but only the values of the third distal site of forearm resulted higher in a significant way. Serum osteocalcin values were similar between the two groups but the obese women showed a greater dispersion of the values (8.15 +/- 4.96 ng/ml) compared to nonobese (8.35 +/- 1.63 ng/ml). This high variability suggests an heterogeneity of bone turn-over in obese subjects and could explain the discordant results of the literature.
