[Nosocomial infections caused by methicillin-resistant Staphylococcus aureus in a pediatric intensive care unit]

We performed an epidemiological investigation owing to the appearance between February and March 1988, of subsequent MRSA infections in our ICU; we also started a checking scheme. At the same time we performed a retrospective-perspective study of 701 patients (310 newborns 391 not newborns) admitted into ICU from 1-1-1987 to 30-6-1988. This study allowed us to settle the presence of MRSA in ICU and the manner in which they become infected. From our study the 4.9% of our patients contracted hospital infections and the 34.2% of these were MRSA infections. The 39.7% of our colonized patients were MRSA. It is really significant the frequency of MRSA colonization (p less than 0.0005) among newborn patients compared with other age patients; in the meantime there is not statistical significance in the frequency of MRSA hospital infections among the two groups. The results of our study show that infections were probably transmitted by the hands of the members of staff and that the reservoir of MRSA are tracheostomized hosts or long term ventilated patients.

Immunohistochemical evidence of skin immune system involvement in vulvar lichen sclerosus et atrophicus

Biopsies taken from vulvar lesions in 12 women affected by vulvar lichen sclerosus et atrophicus (LSA) have been processed for immunohistological study. Activated (HLA-Dr+) T cells, associated with CD1a+ accessory cells, were found in the dermis in all cases, with architectural patterns varying in relation to the histological phase (early, well developed, old) of the lesion. Interestingly, the number of epidermal CD1a+ Langerhans cells (LCs) was increased in all cases, without any correlation with the amount of the dermal infiltrate and with the histological phase of the lesions. In fact, also in old lesions the number of epidermal CD1a+ LCs was increased, and the sparse dermal lymphoid cells showed a persistent HLA-Dr antigen expression. These data, indicating the persistent activation of epidermal antigen-presenting cells and lymphoid cells in all the evolutive phases of vulvar LSA, suggest a possible involvement of the skin immune system in the pathogenesis of LSA.

[The relationship between ligation of the ductus arteriosus and intracranial hemorrhage in preterm infants]

Surgical closure of patent ductus arteriosus (PDA) and perioperative time have been proposed as conditions of increased risk of peri-intraventricular hemorrhage (PVH-IVH) in preterm infants. We examined by pre- and postoperative ultrasound (US) scan 15 low birth-weight neonates who underwent PDA ligation within the first two weeks of life. They were assessed with regard to clinical state, perioperative management and development of PVH-IVH. Fourteen did not show onset or extension of intracranial hemorrhage in the immediate postoperative period. One patient developed a wide III grade IVH in the 24 perioperative hours. His conditions were particularly severe, suggesting that many factors such as acidosis, hypoxia, hypercapnia and hypotension might have combined to lead to hemorrhage. We conclude that PDA ligation is not likely to increase the risk of PVH-IVH per se.

[Role of Mycoplasma hominis in acute infections of the female genital system]

A study was carried out on the role of mycoplasma hominis in obstetric and gynecological infections, and the paper reports a case report of acute pelvoperitonitis in a woman fitted with an IUD. The important role of early preoperative diagnosis in underlined and the current criteria for correct antibiotic therapy are discussed.

[The use of automatic injectors in hysterosalpingography]

The paper describes 168 cases of HSP in which a low-pressure automatic injector, as is normally used in angiography, was used to inject the contrast medium and controlled from the booth of a remote-control X-ray device. Having analysed the clinical indications for this X-ray method, the paper stresses the advantages for the patient, in the form of a lower dose of irradiation and a shorter duration of the test in comparison to traditional methods of manual injection of the contrast medium, and for the operator who is completely protected from irradiation.

[Surgical stress and anesthetic protection]

Surgical pain triggers a series of neuro-endocrine change in the patient's organism both during the operation and at the post-operative stage, exposing the patient to a parapathological and quite afinalistic situation. It is the task of anaesthesia to prevent these adaptation reactions setting in or at least to attenuate them. Various anaesthesiological techniques are compared and results are examined with a view to establishing what technique is capable of procuring most anaesthesiological "protection".

A case of acid lipase deficiency: Wolman's disease

We report a case of Wolman disease, an unusual autosomal recessive disease characterized by storage of lipid in histiocytes. Storage of cholesteryl esters and triglycerides is caused by lysosomal acid lipase deficiency. This enzyme hydrolyses the cholesteryl esters of LDL thus allowing their peripherical metabolism. Onset of the disease occurs after the first month of life with hepatosplenomegaly, diarrhea, vomiting, abdominal distension, failure to thrive. Diagnosis, suspected because of calcifications of the adrenals was achieved by demonstration of lysosomal acid lipase deficiency in lymphocytes and cultured skin fibroblasts. Carriers of the disease can be identified by enzyme assays in lymphocytes and fibroblasts and prenatal diagnosis can be accomplished by lysosomal acid lipase assays in cultured amniotic fluid cells and chorionic villi.

Two mutations of dihydropteridine reductase deficiency

Two patients with dihydropteridine reductase (DHPR) deficiency, in one case due to the absence of any enzyme protein (DHPR- cross reactive material (CRM)-) and in the other case due to the production of a mutant type devoid of catalytic activity (DHPR- CRM+) were examined. This latter form of malignant phenylketonuria, whose relative frequency seems to be higher in the Italian population, possibly has a worse prognosis. The earlier onset and the greater severity of clinical symptoms are associated with a more pronounced hydroxylation defect, as shown by higher degree of neonatal hyperphenylalaninaemia, unresponsiveness to an oral tetrahydrobiopterin load, lower concentrations of neurotransmitter metabolites, and reduced tyrosine production after an oral phenylalanine load.

[Trial of indirect screening of tetrahydrobiopterin deficiency]

The possibility of an early diagnosis of tetrahydrobiopterin deficiency among hyperphenylalaninemic infants, when specific screening tests cannot be performed, was evaluated. Three tetrahydrobiopterin deficient patients, two with dihydropteridine reductase deficiency and one with dihydrobiopterin synthetase deficiency were examined together with their parents and compared with twelve phenylketonuric patients, their parents and sixteen normal subjects. The parameters considered in the hyperphenylalaninemic patients (degree of neonatal hyperphenylalaninemia, phenylalanine lowering speed in response to a restricted diet, dietary tolerance to phenylalanine, oral phenylalanine load) were found to be insufficiently or lately indicative. By contrast, heterozygosity tests (molar ratio (Phe)2/Tyr and sigma discriminant function) performed on the parents allowed a suspicion of tetrahydrobiopterin deficiency, the definite diagnosis being of course based upon specific investigations.

Tetrahydrobiopterin non-responsiveness in dihydropteridine reductase deficiency is associated with the presence of mutant protein

Correlation of the response to a load of tetrahydrobiopterin (BH4) in dihydropterin reductase (DHPR) deficient patients to the type of mutation in these patients has led to the conclusion that 4 patients without mutant DHPR molecules in their cells respond to the BH4 load, whereas 3 patients with mutant DHPR in their cells do not respond. Intravenous injection of BH4 in 1 of the cases not responding to BH4 again showed no response.