Hypertrophic osteoarthropathy in two children with cholestatic hepatic disease

AIM

To describe two children with hypertrophic osteoarthropathy associated with cholestatic hepatic disease. Both patients suffered from chronic progressive cholestatic liver disease and developed digital clubbing, polyarthritis and periosteal reaction. In one of them, clinical and radiological features normalized after liver transplant.

CONCLUSION

Hepatic hypertrophic osteoarthropathy is a rare disabling condition that responds poorly to conservative management, while liver transplantation appears to be the only effective therapeutic intervention.

Surgical treatment of sequelae of fractures of the proximal third of the humerus. The role of osteotomies

Between 1996 and 2003 a total of 19 humeral head osteotomies were performed to treat post-traumatic malunion of the proximal humerus. Mean age was 46 years, ranging from 17 to 71 years. The period of time between traumas and surgeries ranged from 6 to 22 months. Osteotomy procedure was as follows: one after two-part fracture of the greater tuberosity, three after two-part fracture of the surgical neck, five after three-part fracture of the greater tuberosity, eight after four-part fracture, two after complex head splitting fracture, one after two-part fracture with anterior dislocation. Three different types of osteotomies were performed: osteotomy of the humeral neck for varus deformity, isolated osteotomy of the greater tuberosity, and a new osteotomy technique (two-plane and three-plane osteotomy) for three- and four-fragment fracture sequelae. At the time of follow-up evaluation, all 19 patients were questioned regarding pain and function. Excellent results in 14 patients and satisfactory results in 5 were obtained. None of the patients required revision surgery. Findings were recorded using the Constant rating scale. All patients had had significant pain relief after shoulder osteotomy. Range of motion was increased in all patients treated by osteotomy. The success of osteotomy in these cases was based on: patient selection, extensive preoperative evaluation, surgical technique and postoperative rehabilitation.

Anterior-inferior shoulder instability: treatment based on the Thal method

Purpose of this study is to analyze the results of a consecutive series of 139 patients affected with anterior-inferior shoulder instability and treated by arthroscopic capsuloplasty using the Thal method with absorbable and non-absorbable Mitek knotless anchors. Much attention was paid to the preoperative and intraoperative selection of patients, excluding from the arthroscopic procedure those with bony Bankart lesions measuring more than 25%, with an inverted-pear glenoid, with engaged Hill-Sachs lesions and patients with HAGL lesions. Pre- and postoperative clinical evaluation was carried out using the Rowe scale. Scores rose from 45-55 to 96 postoperatively. Intra-articular mobilization of the anchors did not occur and peri-metallic lysis was not manifested. Areas of bone resorption were observed in 7 cases (7/38, 18.4%) with the presence of peri-insertional geodes with biological anchors, but this had no effect on the clinical results.

Staphylococcus aureus septicemia in non-neutropenic adult patients hospitalized in internal medicine units

PURPOSE

Staphylococcus aureus septicemia (SAS) is usually described in immunocompromised patients and during serious weakening diseases, associated with a neutropenic condition. Over the last recent years, clinic relevance of SAS has become more prominent owing to the progressive rise of methicillin-resistent strains in hospital-acquired infections and to its development in non-neutropenic patients.

MATERIAL AND METHODS

The aim of our study was to evaluate the clinical features and outcome of non-neutropenic patients with positive blood culture for Staphylococcus aureus (SA) hospitalized in Internal Medicine Wards of our hospital during 1 year of observation. 24 patients with those characteristics were retrospectively recruited; five of them were then excluded from the analysis because of concomitant oncohematologic disease. The median age of the study group of patients (19 cases) was 56 years (range 18-87); 10 (52.6%) patients were male.

RESULTS

Infection was hospital-acquired in 10 patients (52.6%). Predisposing factors were: central venous catheter (CVC) (47.4%), recent surgical intervention (21.0%), drug-addiction (15.8%). Main comorbidities were diabetes mellitus in 10 patients (52.6%), heart disease in 4 (21.0%), chronic renal failure in 3 (15.8%), cerebral vascular disease in 3 (15.8%). Fever >38 degrees C was found in all patients at the moment of SA isolation in blood culture. SA isolated-strains were methicillin-resistant in 7 patients (36.8%). Complications of bacteremia were: pneumonia in 4, endocarditis in 3, vertebral osteomyelytis in 2, septic splenic embolization in 1 and endophtalmitis in 1 patient. The septicemia-attributable mortality was 36.8% (7 patients).

CONCLUSIONS

SAS in non-neutropenic patients observed in Internal Medicine Units are associated with significant morbidity and mortality, closer to that reported for neutropenic illnesses.

Microwave-induced thermal escape in Josephson junctions

We investigate, by experiments and numerical simulations, thermal activation processes of Josephson tunnel junctions in the presence of microwave radiation. When the applied signal resonates with the Josephson plasma frequency oscillations, the switching current may become multivalued in a temperature range far exceeding the classical to quantum crossover temperature. Plots of the switching currents traced as a function of the applied signal frequency show very good agreement with the functional forms expected from Josephson plasma frequency dependencies on the bias current. Throughout, numerical simulations of the corresponding thermally driven classical Josephson junction model show very good agreement with the experimental data.

A high neonatal serum eosinophil cationic protein level is a risk factor for atopic symptoms

AIM

To show whether neonatal eosinophil counts (EC) and eosinophil cationic protein (ECP) can be used in assessing the risk of atopy, alone or in combination with family history of atopy (FHa).

PATIENTS AND METHODS

A group of 63 newborns was included: 38 with FHa, 25 without FHa. A blood sample was collected on the 4th day of life for EC and ECP evaluation. Clinical follow-up was conducted after 1, 3, 6, 12, 18, 24 and 36 mo. The chi2 test and the Student's t-test were used to compare dichotomic and continuous variables, respectively. Variables shown to be significant by univariate analysis were evaluated with a multivariate regression model and the relative risks (RR) were estimated.

RESULTS

Twenty-six newborns (41%) displayed atopic manifestations during the follow-up. Twenty-one (55%) of 38 newborns with FHa displayed atopic symptoms versus 5/25 (20%) without FHa (p 0.012). Neither EC nor serum ECP levels were significantly different between newborns with FHa and newborns without. ECP levels did not differ between newborns with single heredity and newborns with dual heredity. EC did not differ significantly between newborns who developed atopy and those who did not. Instead, serum ECP levels were significantly higher in newborns who developed atopy (mean 27.9 microU/l vs 16.8 microU/l). Atopic manifestations appeared in 16 (62%) of 26 newborns with ECP > or = 18 microU/l compared with 10 (27%) of 37 with ECP < 18 microU/l (p = 0.006). In the multivariate regression model, with ECP < 18 microU/l and no FHa as reference class, the class 1 (no FHa and ECP > or = 18 microU/l) has a low RR (1.4), class 2 (FHa and ECP < 18 microU/l) an intermediate RR (2.7) and class 3 (FHa and ECP > or = 18 microU/l) a very high RR (16.3).

CONCLUSIONS

Neonatal serum ECP levels, in contrast with EC, were significantly higher in newborns who developed atopic manifestations during follow-up. The risk of atopy was about twice as great when ECP was > or = 18 microU/l (and four times as great in multivariate analysis). When serum ECP was combined with FHa, the RR for newborns with FHa and ECP > or = 18 microU/l was 16 times greater than for those without FHa and ECP < 18 microU/l. The identification of newborns at "extremely high atopic risk" (FHa and ECP > or = 18 microU/l) may be expecially useful--in clinical practice--in newborns with only one atopic parent or sibling, for whom it is not universally agreed that dietary and environmental prevention measures should be applied.

Clinical survey of Leishmania/HIV co-infection in Catania, Italy: the impact of highly active antiretroviral therapy (HAART)

The clinical and parasitological features of visceral leishmaniasis (VL) were investigated, retrospectively, in 27 HIV-infected patients who attended the out-patient clinic of Catania University's Department of Infectious Diseases between 1990 and 1998. The aim was to evaluate the epidemiological, clinical, therapeutic and prognostic characteristics of the co-infection, to determine if there were any interactions between the two infections, and to see if the use of highly active antiretroviral therapy (HAART) had any impact on the leishmaniasis. The most dramatic observation was a marked, HAART-attributable reduction in the annual incidence of VL relapses among the patients.

Visceral leishmaniasis in those infected with HIV: clinical aspects and other opportunistic infections

Cases of visceral leishmaniasis (VL) in HIV-positive individuals have been reported from most areas of the world where the geographical distributions of the two infections overlap. The majority of the co-infected cases that have been recorded, however, live around the Mediterranean basin. In these subjects, the length of the incubation period of VL is presumably very short, particularly in those who have severe immunodepression. At diagnosis, almost all cases of VL/HIV co-infection have been found to have fewer than 200 CD4+ cells/microl blood, and about 50% meet the AIDS-defining criteria during their first episode of VL. The clinical manifestations of VL in HIV-infected individuals may be similar to those seen in HIV-negative cases; fever, pancytopenia and hepato-splenomegaly, for example, are found in 75% of all the HIV-positive cases. Following the dissemination of the parasites, however, the HIV-positive cases may develop unusual, multi-organ pathology. Almost all the cases of co-infection are very prone to VL relapses, even after carefully managed antileishmanial treatment. The opportunistic infections that are often seen in HIV-positives frequently develop during VL episodes, the signs and symptoms of the leishmaniasis then confusingly overlapping with those of the other infections.

A Case of Emphysematous Pyelonephritis in an Old Diabetic Female

Emphisematous pyelonephritis is a rare, life–-threatening infection of the renal parenchyma, most frequently found in diabetic patients. It is due to gas forming bacteria such as E. Coli, Kleibsiella or Citrobacter and is linked with an hight mortality rate sometime also after an appropiate therapy. We describe our experience with a case of emphisematous pyelonephritis in an old diabetic female.

ESWL a Legnano: La Nostra Esperienza

ESWL is today the gold standard in the treatment of most cases of urolithiasis. The new generation lithotriptors let an easier patient management, reduce hospitalisation time, optimize therapeutical and economic outcomes. We show our experience first with Storz Modulith SLX from 1996 to 1999 then with Sonolith 4000+ form 1999 until today.

The binding interface database (BID): a compilation of amino acid hot spots in protein interfaces

SUMMARY

To make information about protein interactive function easily accessible, we are mining the primary scientific literature for detailed data about protein interfaces. The Binding Interface Database (BID) organizes the vast amount of protein interaction information into tables, graphical contact maps and descriptive functional profiles. Currently data on 170 interacting protein pairs are available with over 1300 mutations described.

AVAILABILITY

The BID database is freely available at http://tsailab.org/BID/ To have your protein of interest entered, contact Tiffany Fischer (tiffbrink@neo.tamu.edu) or Jerry Tsai at the email below

Investigation of placental stem villi arteries in fetally growth-restricted pregnancies: a multivariate analysis

Thirteen placentas were studied from 5 normal pregnancies and 8 from pregnancies complicated by fetal growth restriction (4 with present, 3 with absent, and 1 with reversed end-diastolic velocities at Doppler interrogation of the umbilical arteries). On immunohistochemically stained slides, the diameter (d) and the wall thickness (t) of the arterial vasculature of the stem villi were measured for a total of approximately 10,000 vessels. A multivariate 'mixed effect model' statistical analysis was performed using d and t as dependent variables and gestational age, delivery mode, fetal and placental weight, the degree of vascular collapse and Doppler blood flow patterns as independent variables. Gestational age, Doppler pattern and the degree of vascular collapse significantly affected both d and t, the mode of delivery influenced d while fetal and placental weights scarcely affected the dependent variables. The above parameters should therefore be taken into account when investigating placental stem vessel morphometry.

[Leptospirosis: epidemiology, diagnosis and clinical aspects]

Leptospires, world-wide distributed spirochetes, affect a great variety of mammalian hosts; several serovars belonging to the L. interrogans s.l. species can cause clinical manifestations in humans, becoming infected through the contact of skin cuts and mucous membranes with water and soil polluted by infected animals' urine; rodents serve as the main reservoirs but the epidemiological importance of pets and cattle, as leptospire shedder is increasing. While the infection remains endemic in tropical regions, there is a new epidemiological trend in developed countries where, with the typical seasonal pattern, sporadic cases and/or outbreaks occur related more to recreational activities and poor sanitation than to occupational activities. The sudden onset presents a "flu-like" syndrome; the course is usually characterised by two clearly defined stages. All of the variable clinical manifestations, often independent of the responsible serovar, arise from the effects of a general vasculitis. The prognostic factors associated with severe forms (renal failure, jaundice, haemorrhagies) are not defined. Within the first days of illness, the leptospires can be isolated from blood and cerebrospinal fluid; serological diagnosis relies on microagglutination, IFA and ELISA; PCR early in the course, before the appearance of specific antibodies, allows etiological diagnosis. Prompt treatment has an enormous impact on outcome.

Caspase-1 inhibitors abolish deleterious enhancement of COX-2 expression induced by HIV-1 gp120 in human neuroblastoma cells

The human CHP100 neuroblastoma cell line has been shown to provide an useful in vitro model to elucidate the mechanisms underlying HIV-1 gp120 neurotoxicity. Here we report western blotting evidence demonstrating that exposure to a cytotoxic concentration of the viral coat protein up-regulates expression of the inducible isoform of cyclooxygenase (COX-2) in neuroblastoma cells and this seems to be due to the previously observed increase in secreted IL-1beta. In fact, here we show that acetyl-Tyr-Val-Ala-Asp-chloromethylketone (Ac-YVAD-CMK) and t-butoxycarbonyl-L-aspartic acid benzyl ester-chloromethylketone (Boc-Asp-(OBzl)-CMK), two inhibitors of Interleukin-1 Converting Enzyme (ICE; also referred to as caspase-1), abolish COX-2 expression enhanced by gp120 and consequent cell death. In addition, NS-398, a selective inhibitor of COX-2 activity, affords neuroprotection strengthening the role of COX-2 in the mechanisms of death. In conclusion, the present data support the notion that IL-1beta is the signal through which gp120 elevates COX-2 expression and the latter is strongly implicated in the mechanisms underlying cytotoxicity.

Intra-abdominal extra lobar pulmonary sequestration communicating with gastric duplication -- a case report

Gastric duplications with associated pulmonary sequestration are very infrequent abnormalities. Although often asymptomatic, they should be considered in the differential diagnosis of intra-abdominal or retro-peritoneal masses. The authors report the case of a ten-year-old boy who had an occasional finding of poorly symptomatic intra-abdominal mass, recognised at intervention as a gastric duplication with associated extralobar pulmonary sequestration. The authors describe the surgical treatment of this case and briefly discuss the current views on the embryological pathogenesis of such malformations.

Neuroradiological findings in two cases of isolated amyloidoma of the central nervous system

Neuroradiological findings in two cases of isolated cerebral amyloidoma are reported. Case 1: A 15-year-old male admitted because of left jacksonian seizure. Case 2: A 31-year-old man admitted because of temporal seizures. In both patients, CT scans showed spontaneously hyperdense and enhancing nodules. On MRI, lesions displayed signals isointense with surrounding edema on T1-weighted sequences and mildly hypointense on T2-weighted sequences if compared with edema; peripheral contrast enhancement after gadolinium administration was present. Histopathological examination of both specimens revealed the presence of acellular eosinophilic hyalinized material consistent with amyloid, forming confluent nodular masses in the white and gray matter.

[Acute effects of peritoneal dialysis on muscle protein turnover]

BACKGROUND

Despite continuing glucose absorption and stimulation of insulin secretion, wasting is common in patients with chronic renal failure (CRF) treated with peritoneal dialysis.

METHODS

To evaluate if peritoneal dialysis per se has any effect(s) on muscle protein turnover we employed the forearm perfusion method associated with the kinetics of 3H-phenylalanine in seventeen patients with CRF in the basal state and: a) during the systemic hyperinsulinemia associated with peritoneal dialysis (6 patients) (200-240 min); b) during locally-induced hyperinsulinemia, without systemic effects on aminoacid (AA) availability (6 patients) (80-120 min); c) in time-controls (5 patients) (80-240 min).

RESULTS

Peritoneal dialysis and local infusion of insulin in the brachial artery (0.01 mU/min/kg) induced a similar degree of systemic or local, moderate hyperinsulinemia (19+/-4 e 21+/-3 microU/ml, respectively). During both protocols an insulin-related inhibition of muscle protein degradation occurred; however peritoneal dialysis caused a 20% decrease in forearm phenylalanine rate of disposal (an index of muscle protein synthesis), which correlated with the decline of arterial BCAA and potassium, which were removed via the peritoneal fluid. Furthermore, a persistent negative net phenylalanine and AA balance across the forearm was observed during peritoneal dialysis, while the negative basal net phenylalanine and AA balance was reversed to a positive or neutral one during local hyperinsulinemia.

CONCLUSIONS

We conclude that in CRF patients even a modest elevation in local insulin levels is followed by an anabolic muscle response, while the same effect is not observed during the systemic hyperinsulinemia associated with substrate removal which occurs during peritoneal dialysis. In this setting the antiproteolytic effect of hyperinsulinemia is offset by a decrease in muscle protein synthesis which is accounted for by a decrease in AA availability. Our data indicate that protein metabolism during peritoneal dialysis is characterized not only by decreased, but also less efficient, turnover rates.

Incidence of nosocomial rotavirus infections, symptomatic and asymptomatic, in breast-fed and non-breast-fed infants

Rotavirus is one of the most important aetiological agents of nosocomial infections in childhood. We studied the incidence of nosocomial rotavirus infections in 420 patients (age range 1-18 months) consecutively admitted from 1 December 1999 to 31 May 2000 to the infant ward of the Department of Paediatrics, University of Turin. We also evaluated the protective effect of breast feeding. Faecal specimens were collected from every child (whether developing diarrhoeic symptoms or not) and tested for rotavirus during hospitalization and 72 h after discharge. The incidence of rotavirus nosocomial infections was 27.7%. The incidence of symptomatic nosocomial infections was 16.8%, and the incidence of asymptomatic infections was 10.9%. The attack rate of the infections that occurred during hospitalization was 11.8%, while for those occurring after discharge, it was 15.9%. Rotavirus infection, on average, prolonged hospital stay from 5.2 to 6.4 days. 10.6% of breast-fed infants and 32.4% of non-breast-fed infants contracted rotavirus infection (P<0.005). None of the breast-fed infants who contracted rotavirus infection developed diarrhoeic symptoms.