[Medical treatment in abnormal uterine bleeding: evaluation of a GnRH therapy versus danazol therapy in perimenopausal women]

BACKGROUND

Dysfunctional uterine bleedings are uterine hemorrhage, frequent in the climacteric period and are a usual gynecologic pathology in ambulatorial controls (10%).

METHODS

60 premenopausal women, have been enrolled, all affected by hyper-polymenorrhea or dysfunctional uterine bleeding; than they were subdivided them into 2 groups; Group I: 30 patients with GnRH analogues treatment (Decapeptyl da 3.75 mg/month, 6 months of therapy); Group II: 30 patients with Danazol treatment (danatrol, 200 mg/daily, 6 months of therapy). Clinical controls were performed by visit, a questionnaire compilation (Kuppermann index) and biochemical examinations, with this frequency: 0, 3, 6 and 9 months. Statistical evaluation was performed by Student "t" test.

RESULTS

In both groups, either amenorrohea and symptomatic improvement after 3 months of therapy were observed, without statistical differences; a statistical difference (p>0.01) was assessed in patients compliance, since were observed, without statistical differences a major frequency in collateral effects in II Group, with danazol therapy was observed. The results of this study show that, the limited occurrence of side effects in perimenopausal patients affected by dysfunctional uterine bleeding, treated with GnRH analogues, could affect the choice of pharmacological therapy in favor of these one.

Hepatitis C virus (HCV) genotypes, human leucocyte antigen expression and monoclonal gammopathy prevalence during chronic HCV infection

Patients with chronic hepatitis C virus (HCV) infection (530 in toto), and 294 individuals with chronic liver disease of different aetiology, were enrolled in this study to investigate the prevalence of monoclonal gammopathies (MG) during chronic liver dysfunction. A monoclonal band was detected in 61 HCV+ patients and in nine HCV subjects only. In both instances, a correlation between MG presence and advanced age or degree of hepatic injury was noted. The prevalence of HCV genotype 2a was higher in HCV+ patients with, rather than in those without, MG. The MG+ HCV+ subjects did not exhibit human leukocyte antigen (HLA)-A33, B8, B65 and DR16 expression, while an increased frequency of DR15 structure was seen in the same group of individuals in comparison with MG- HCV+ patients and healthy donors. These findings suggest a possible relationship between HLA haplotype expression, virus genotypes and the occurrence of MG during the course of chronic HCV infection.

[Primary aorto-enteric fistula]

Aorto-enteric fistula, i.e. communication between the aorta and the digestive tract, is a clinical condition that usually appears in patients who have already been submitted to aneurismectomy. Primary fistula, in patients not submitted to surgical treatment, is uncommon. The authors describe a case of primary aorto-enteric fistula which was diagnosed and operated on early, with a favourable outcome. The critical analysis of the authors' experience and the literature data stress that an early diagnosis and suitable therapy can reduce mortality.

Olfactory sensitivity in early-stage Parkinson patients affected by more marked unilateral disorder

Two groups of subjects, 6 medicated Parkinson patients at an early stage of disease and affected by more marked right unilateral disorder and 12 normal elderly people, were examined on matching and naming olfactory tasks. On the former, subjects had to recognize among four previously sniffed odours, while on the latter they had to label an odour by choosing among four alternatives proposed by the examiner. Stimuli were administered to both nostrils. Analysis indicated that Parkinson patients were less efficient with the left nostril in the matching task, supporting the hypothesis of a larger compromise in the nostril contralateral to the side of the body more affected by the disease. Such a difference was not observed for the elderly people. Data are discussed with reference to the loss of dopamine in Parkinson patients.

[Unusual cause of ileal occlusion: a coconut bezoar]

A coconut phytobezoar was detected in the distal ileum of a 4-year-old boy, admitted for suspected appendicitis. While persimmon or citrus fruit ingestion has been previously reported as cause of phytobezoar intestinal occlusion, it is the first time that coconut pulp is described to cause ileal obstruction in children. No predisposing factor as previous gastric surgery or Meckel's diverticulum was present. The bezoar was successfully milked past the ileocecal valve into the right colon.

[An alternative to postmenopausal Hormone Replacement Therapy? Selective Estrogens Receptors Modulators (SERMs)]

Hormone Replacement Therapy (HRT) represents the first and probably sole therapeutically approach for prevention and treatment of medical postmenopausal disease. Nevertheless, the adverse effects and the risks HRT associated, suggested, to clinical and pharmaceutical research new pharmacological treatment options. Actually a group of compounds, SERMs (Selective Estrogen Receptor Modulators), allows a large interest. These pharmacological agents, due to their estrogen agonist/antagonist properties, are able to bind Estrogen Receptors in female target tissues (bone, brain, heart, etc) with different actions; so, by these properties, SERMs represent actually a possible alternative to HRT.

Influence of traditional brine washing of smear Taleggio cheese on the surface spreading of Listeria innocua

The influence of a traditional procedure of washing of smear Taleggio cheese on surface spreading of Listeria innocua was studied. This practice is carried out during ripening to remove molds, to select the surface microflora, and to control the ripening process. One cheese, both of 2 (i) and 4 (ii) weeks of ripening, was surface-inoculated with approximately 3 log CFU of L. innocua per entire cheese surface. The inoculated cheeses and others of the same age were weekly washed with brine solution. Listeria was spread both on the surface of the inoculated cheese and on the other cheeses, and it was also found in the brines and on the wooden boxes where the cheeses were ripened. The time of ripening when contamination occurs influenced the behavior of Listeria. At the moment of contamination, the smear surface microflora of (i) cheese was approximately 2 log CFU/g higher than of (ii) cheese. Listeria inoculated on 2-week-ripened cheese was able to colonize the entire surface of the cheese and to cross-contaminate the other cheeses. On the contrary, Listeria inoculated on a 4-week-ripened cheese was partially spread on the surface of the originally inoculated cheese, and the transfer of contamination by the washing procedure was restrained. Because a random distribution of Listeria on cheese surface was observed, the importance of the mode of sampling was discussed. Because of the lack of critical control points during ripening of Taleggio cheese, the Listeria hazard needs to be controlled by taking appropriate control measures to break off the contamination cycle (cheese --> brine --> wooden boxes --> cheese).

DNA/nuclear protein content in the evaluation of cell cycle modifications during colon carcinogenesis

OBJECTIVE

To investigate the colorectal adenomacarcinoma sequence by biparametric DNA/nuclear protein flow cytometry with the aim of evaluating cell cycle modifications during carcinogenesis.

STUDY DESIGN

Paraffin-embedded specimens of 27 adenomas with mild/moderate dysplasia, 20 adenomas with severe dysplasia/intramucosal adenocarcinomas, 28 adenocarcinomas and 14 normal colon mucosa specimens were analyzed by biparametric DNA/nuclear protein content flow cytometric analysis in order to evaluate cell cycle modifications during colorectal carcinogenesis.

RESULTS

The mean G0-G1A fraction of the cell cycle was 50.6% (SD +/- 17.2), 25.7% (SD +/- 15.1), 27.8% (SD +/- 11.7) and 29% (SD +/- 13.8) for normal mucosa, adenomas with mild/moderate dysplasia, adenomas with severe dysplasia and adenocarcinomas, respectively. The difference between normal mucosa and the other groups was statistically significant (P < .05), while no significant differences were detectable between adenomas with different degrees of dysplasia and adenocarcinomas.

CONCLUSION

Our results show a decrease in G0-G1A in adenomas with mild/moderate dysplasia, suggesting that modification of the cell cycle may represent an early step in colon carcinogenesis, and they support the hypothesis that disregulation of cell cycle-controlling genes is an early event in the adenoma-carcinoma sequence.

Radiation-induced gadd45 expression correlates with clinical response to radiotherapy of cervical carcinoma

BACKGROUND

Recent work has identified a category of genes devoted to the control of genomic stability and prevention of cellular evolution. They encode components of cell cycle checkpoint, i.e., regulatory pathways committed to ordered cell cycle transition and fidelity of replicated DNA under adverse environmental conditions, such as those following exposure to genotoxic agents. Gadd45 belongs to the class II family of DNA damage-inducible (DDI) gene, and its role in DNA repair has been proved in many experimental models. The aim of our study was to correlate gadd45 radio-induction with the responsiveness to radiotherapy of cervical carcinomas, a type of cancer most commonly treated with radiotherapy alone.

METHODS

By means of a competitive polymerase chain reaction strategy, we compared in 14 patients the gene expression levels before and during external beam radiotherapy, when a dose ranging from 18 to 25 Gy was delivered to the target.

RESULTS

We found a correlation between the lack of gadd45 induction and a good clinical response to radiotherapy, in terms of both local control and disease-free survival.

CONCLUSION

Our results support the measure of the induction of gadd45, and possibly of other genes required for regulated G1-S checkpoint, as a method useful for prognostic evaluation of cervical carcinoma patients.

CagA-positive Helicobacter pylori infection may increase the risk of food allergy development

The aim of this study was to test whether patients with symptomatic food allergy and significant levels of immunoglobulin E (IgE) to alimentary antigens were more likely infected by H. pylori, especially by strains expressing the CagA protein, with respect to controls. A group of 38 patients with symptomatic food allergy and 53 age-matched controls were examined serologically for H. pylori infectious status, and for CagA seropositivity. IgE to alimentary allergens were measured by a commercial kit. The prevalence of H. pylori infection in patients with food allergy and controls was similar (42.1%, and 48.3%, respectively). However, anti-CagA antibodies in H. pylori-infected persons were detected in 62.5% of patients with food allergy, and 28% of controls (P = 0.030, odds ratio = 4.29). The mean level of IgE to the most common alimentary antigens in serum samples from infected patients with anti-CagA antibodies was significantly higher than in CagA-negative infected patients: 3.28 kU/L (SD 3.93), vs. 1.99 kU/L (SD 1.53), P = 0.002, 95% confidence interval = 0.61 to 2.53). Infection by CagA-positive H. pylori increases the risk of developing food allergy.

Acute cardiovascular diseases and respiratory sleep disorders

Respiratory sleep disorders are a risk factor, sometimes independent, for acute cardiovascular diseases which are the most frequent cause of death among populations of industrialized countries. Snoring and obstructive sleep apnea (OSA) are generally involved, while the pathogenetic role of acute exacerbation of COPD seems less evident. The most important acute cardiovascular events related to sleep respiratory disorders are angina pectoris, acute myocardial infarction, cardiac arrhythmias (in some instances as paroxysmal attacks), systemic hypertension with hypertensive crisis, ischemic stroke. A respiratory sleep disorder should be suspected in all obese, cigarette smokers, alcoholics, hypertensives, who present symptoms of obstructive sleep apnea, where snoring may be a marker, and in patients with COPD. The diagnosis is readily established by performing polysomnography and, when needed, by 24-hour Holter monitoring and blood pressure ambulatory recording. Therapy aims at correcting risk factors with particular attention to weight reduction in obese patients. Furthermore, upper airway anatomic abnormalities should be eliminated. In obstructive sleep apnea, nasal continuous positive airway pressure during sleep is to be used, when necessary, while tracheostomy must be performed only in more severe cases.

Food allergy and Helicobacter pylori infection

BACKGROUND

Most antigens reach the immune system through mucosae. Gastrointestinal mucosa is a barrier for alimentary antigens. Inflammatory processes, such as Helicobacter pylori-associated gastritis, could alter the integrity of the gastric barrier, increase the mucosal permeability, and enhance crossing of food antigens which may stimulate allergic reactions.

PURPOSE

The aim of this study was to establish whether patients with symptomatic food allergy and detectable immunoglobulin E (IgE) to alimentary antigens were infected by Helicobacter pylori more often than controls, and to determine the phenotype of the infecting Helicobacter pylori.

PATIENTS AND METHODS

Thirty-eight consecutive patients with symptomatic food allergy and serum IgE to alimentary antigens, and 53 consecutive age-matched controls (subjects without food allergy and detectable levels of IgE anti-alimentary antigens) living in the same area and attending the same institution were investigated serologically to determine the prevalence of Helicobacter pylori infection, and an immune response to CagA, a marker of the most pathogenic strains. IgE to alimentary allergens were measured by a commercial kit.

RESULTS

The prevalence of Helicobacter pylori infection in patients with food allergy and controls was similar (42.1% and 47.1%, respectively). Anti-CagA antibodies in Helicobacter pylori-infected persons were detected in 62.5% of patients with food allergy, and 28.0% of controls (p = 0.030, odds ratio = 4.29, RR = 2.23). The mean IgE level to the most common alimentary antigens was increased in CagA-positive, with respect to the CagA-negative, patients.

CONCLUSIONS

The enhanced mucosal and inflammatory lesions commonly found in individuals infected by CagA-positive Helicobacter pylori strains could increase the epithelial permeability and render non-selective the passage of allergens which, in atopic persons, could directly stimulate an IgE response. Infection by CagA-positive Helicobacter pylori may increase the risk of food allergy.

Synthesis of biphenylyltetrazole derivatives of 1-aminopyrroles as angiotensin II antagonists

Based on preliminary molecular modelling study, the synthesis of two different classes of biphenylyltetrazole derivatives of 1-aminopyrroles, as potentially active non-peptide angiotensin II (AII) antagonists, is reported. Some NH-Boc protected l-aminopyrroles were deprotected, N-acylated, N-alkylated with 5-[4'-bromomethyl-1,1'-biphenyl-2-yl]-1-triphenylmethyl-1H-tetrazo le, and then detritylated to give the first class of title compounds. Other 1-NH-Boc protected 1,2-diaminopyrroles were regioselectively subjected to the 1-alkylation with 5-[4'-bromomethyl-1,1'-biphenyl-2-yl]-1-triphenylmethyl-1H-tetrazo le, to the acylation of the amino group at 2-position of the pyrrole ring, and then to the detritylation process to yield the second class of title compounds.

[Epi-myoepithelial tumor (adenomyoepithelioma) of the vulva: case report]

A 29 years old woman was admitted with a nodule of the left labium major. The histological diagnosis was that of epi-myoepithelial tumour (adenomyoepithelioma). Aim of this paper is to recognize epi-myoepithelial tumours in unusual locations from those classically described (i.e., skin, breast and salivary glands) and to understand their biological behaviour.

The preterm infant's antibody response to a combined diphtheria, tetanus, acellular pertussis and hepatitis B vaccine

Several combined vaccines have recently been developed, in order to improve the implementation of immunization programmes and increase the coverage for each vaccine. As the response of preterm infants may vary depending on the vaccination schedule and the vaccine product, it should be evaluated specifically as new vaccines become available. In this study we have examined the antibody response to a combined diphtheria, tetanus, acellular pertussis, and hepatitis B vaccine (DTPa-HBV), given as a primary vaccination course at 3, 5 and 11 months of postnatal age, in 34 preterm infants (mean gestational age (GA) = 32.0 weeks) in comparison with 28 term infants. At the end of the primary course, preterm infants had antibody concentrations for pertussis 69 kDa antigen and diphtheria toxoid that were significantly lower than those of term infants; preterm infants with GA < or = 31 weeks had antibody concentrations for pertussis 69 kDa antigen and HBsAg that were significantly lower than those of preterm infants with higher GA; anti-HBs antibody levels correlated with GA. However, the combined DTPa-HBV vaccine elicited seroconversion to all its components in all but two infants, one term and one preterm, after the second dose and a total seroconversion after the third dose. We conclude that preterm infants may be immunized with a combined DTPa-HBV vaccine, starting at the same chronological age, as term infants.

[Application of chronotherapy to cardiovascular diseases]

Among cardiovascular diseases, hypertension, angina pectoris, acute myocardial infarction and ischemic stroke present a circadian pattern with a greater incidence of unfavourable events between awakening and noon. Chronotherapy aims to use drugs that release their active principles at different times during the day, according to biological needs. In chronotherapy of cardiovascular diseases, a particular attention has been paid to slow-release drugs that assure a 24 hours therapeutic effect with once a day administration. In primary hypertension well controlled by monotherapy (dipper hypertensives), the morning administration of long-acting beta-blockers and calcium antagonists has shown to control blood pressure over 24 hours, whereas ACE-inhibitors have proved more effective when administered at evening. In secondary hypertension (non dipper hypertensives) the administration of calcium antagonists is more effective at evening. Patients with severe hypertension need polytherapy. In that case, at least one of the antihypertensive drugs should be given at evening to lower night blood pressure values, which are particularly elevated also during sleep, and so to prevent an excessive blood pressure rise on awakening. In chronic monotherapy of ischemic heart disease, long-acting beta-blockers and calcium antagonists have shown to be equally effective when they are administered at morning, whereas slow-release nitrates, which need a nitrate-free interval, are to be administered either at morning or at evening, according to the expected time of onset of anginal pain. ASA seems to reduce the morning incidence of acute myocardial infarction, while tissue-type plasminogen activator presents a circadian variation of its thrombolytic activity with a higher efficacy between noon and midnight.

Aspetti economici nella chirurgia urologica dell'anziano: Economical aspects of urological surgery in the elderly

To assess whether urological surgery in the elderly involves a significant increase in expenses, the consumption of resources was analysed (days of hospitalisation, request for intermediate services, greater request for integrative care, longer operation times, etc.) for patients not yet 70 years old, aged between 70 and 75 and lastly the over-75s who were operated in 1996 in the authors’ unit. Data show that urological surgery in the elderly leads to no greater use of the above resources.

[Enterococcal endocarditis: clinical features and therapeutic approach]

Enterococci are implicated in about 20% of cases of infective endocarditis, topically in aged subjects with gastro-intestinal and/or genitourinary diseases. These forms are usually associated with an increased morbidity and mortality, in that also reflecting the difficulties encountered to set up a specific therapeutic approach. Among the various antibiotics effective against enterococci, particular attention has been recently given to those belonging to glycopeptide group. In the current study we have assessed the efficacy of teicoplanin associated to ampicillin plus sulbactam in 27 consecutive patients with enterococcus-mediated endocarditis, admitted to our hospital between June 1987 and September 1995. In 17 patients the source of infection has been identified in the gastrointestinal tract. The clinical recovery and the bacteriologic eradication have been achieved in 24/27 (88.8%) patients. The results indicate the necessity of a prophylactic antibiotic treatment in aged individuals with diseases affecting the gastrointestinal tract and further suggest the efficacy of teicoplanin and ampicillin plus sulbactam association for the treatment of endocarditis caused by enterococci.

[Evaluation of hyperkinetic cardiac arrhythmia in chronic obstructive bronchopneumopathy]

Patients with chronic obstructive pulmonary disease (COPD), especially during acute exacerbations of their disease, show a greater incidence of cardiac arrhythmias than healthy subjects of the same age. The type of arrhythmias found may be supraventricular (premature atrial beats, paroxysmal supraventricular tachycardia, multifocal atrial tachycardia, atrial flutter, atrial fibrillation) or ventricular (premature ventricular beats, sustained ventricular tachycardia, torsades de pointes, ventricular fibrillation) that may lead to sudden cardiac death. The pathogenesis of arrhythmias is complex and many factors may be involved such as hypoxemia, hypercapnia, respiratory acidosis, metabolic and respiratory alchalosis, hypokalemia, concomitant ischemic heart disease, chronic cor pulmonale, left ventricular diastolic dysfunction. Remarkable attention has been drawn to the possible arrhythmogenic effect of drugs such as theophylline, beta-adrenergic stimulants and digitalis which are commonly used in the therapy of COPD. Both of the main classes of bronchodilators (methylxanthynes and beta-adrenergic agonists), even when used together, apparently do not increase the incidence of dangerous cardiac arrhythmias. However, these drugs should be used with caution in the elderly, in patients with preexisting cardiac arrhythmias, with heart disease or with reduced hepatic function. In these cases Holter monitoring, repeated measurements of plasma drugs concentration and prompt hospitalization of high risk patients in Intensive Care Unit may be needed.

[Vaginal metastasis from renal adenocarcinoma. A clinical case]

We describe a case in which vaginal bleeding has represented the onset symptom of a renal clear cell adenocarcinoma. A 53-year-old patient presented with a bleeding polypoid neoformation of the vaginal forewall for which exeresis was immediately decided for diagnostic and curative purpose. An attentive histological examination was immediately addressed towards the renal origin. Afterwards the search and image staging (abdominal and pelvic ultrasound examination, urography, abdominal and cerebral TAC) has allowed us to confirm the presence of a tumor of the left kidney and audit that the secondary vaginal location to the moment was probably the only manifestation of the illness. Left nephrectomy with complementary associated lymphoadenectomy joined to the auxiliary therapy with progestin and interferone has allowed us to decidedly improve the subjective and general conditions of the patient.