Diagnosis and management of fetal ductus arteriosus constriction-closure

Pathognomonic features of in utero premature restriction/closure of the ductus arteriosus (DA) are increased right ventricular afterload, impaired right ventricular function, and consequently tricuspid regurgitation and right heart dilation. The most common reason for constriction-closure of DA is maternal administration of non-steroidal anti-inflammatory drugs (NSAIDs) during the 3rd trimester of gestation. The idiopathic form is a rare event and, maybe, an underestimated abnormality that, if it is not promptly recognized, may result in severe fetal-neonatal compromise. We describe a case of a 38-year-old woman presenting at 34+0 weeks of gestation with a normally grown male fetus whose fetal echocardiography had shown right ventricular hypertrophy, a tortuous S-shaped DA and a significant pulmonary hyperflow. All signs were consistent of an idiopathic severe constriction of DA with a significant fetal cardiac involvement. The patient was admitted to a tertiary care center equipped with Neonatal Intensive Care Unit (NICU), and delivered by cesarean section at 34+4 weeks with a good maternal and neonatal outcome. Based on our experience and a review of the Literature we propose a management algorithm to use when dealing with preterm or early term pregnancy complicated by this fetal hemodynamic malfunction.

Three-dimensional dynamics of a fermionic Mott wedding-cake in clean and disordered optical lattices

Non-equilibrium quantum phenomena are ubiquitous in nature. Yet, theoretical predictions on the real-time dynamics of many-body quantum systems remain formidably challenging, especially for high dimensions, strong interactions or disordered samples. Here we consider a notable paradigm of strongly correlated Fermi systems, the Mott phase of the Hubbard model, in a setup resembling ultracold-gases experiments. We study the three-dimensional expansion of a cloud into an optical lattice after removing the confining potential. We use time-dependent density-functional theory combined with dynamical mean-field theory, considering interactions below and above the Mott threshold, as well as disorder effects. At strong coupling, we observe multiple timescales in the melting of the Mott wedding-cake structure, as the Mott plateau persist orders of magnitude longer than the band insulating core. We also show that disorder destabilises the Mott plateau and that, compared to a clean setup, localisation can decrease, creating an interesting dynamic crossover during the expansion.

[Electrocardiography by the neonatologist]

An electrocardiogram is a simple, non-invasive and inexpensive test, whose knowledge and interpretation should be an essential skill for neonatologists. It is a basic, easy and handy tool, very useful for the right approach to the child with suspected heart disease. The test provides important information on the heart rhythm and is essential to diagnose and therefore treat arrhythmic problems. It gives also information on the ventricular dimensions and volume and/or pressure overload of one or both ventricles. In case of malformative pathologies, the test enables to suspect the type of malformation. The aim of this report is to explain a normal electrocardiogram in a practical and simple way, through the definition of the necessary basic criteria to detect heart rate and rhythm, electrical axis of QRS complex, normal wave morphology in all leads and atrioventricular conduction (PR interval). Some basic information will also be provided on how to recognize a pathological electrocardiogram and heart rhythm disorders. Then we will use interactive methods to discuss some tracings through which it will be possible to reach a diagnostic orientation.

Day hospital for incisional hernia repair: selection criteria

AIM

The authors report their experience with incisional hernia repair and set criteria for the safe performance of the procedure on a day hospital basis.

MATERIALS AND METHODS

From January 1994 to July 2005, 29 day hospital procedures for incisional hernia were performed under local anaesthesia. Selection criteria included: a hernial defect < 10 cm, a reducible hernial sac and negative history for obstructive symptoms. The repair was achieved with a polypropylene plug in defects < 3 cm and a double layer mesh in larger defects.

RESULTS

All patients were discharged within 7 hours of surgery. Postoperative pain was mild and required hospital analgesia in 30% of cases. Back at home analgesia was needed in only three patients (10%). Six patients (20%) developed a seroma that reabsorbed spontaneously. During a follow-up ranging 6 to 120 months (mean 75), no recurrence has been recorded.

CONCLUSIONS

In selected patients, incisional hernia repair as day hospital procedure is feasible, safe and absolutely effective. The use of polypropylene plugs and meshes accounts for a sound repair with low risk of complications.

Adverse events after infusions of cryopreserved hematopoietic stem cells depend on non-mononuclear cells in the infused suspension and patient age

BACKGROUND

Adverse events (AE) represent a significant clinical problem after infusion of cryopreserved HPC. However, the factors playing a role in the pathogenesis have not yet been fully established.

METHODS

We prospectively collected data on AE that occurred with 179 HPC infusions performed on patients affected with hematologic neoplasm after high-dose chemotherapy. The stem cell source was hemopoietic progenitor cells aphaeresis (HPC-A) in 157 cases and hemopoietic progenitor cell BM (HPC-BM) in 22 cases. In all cases, an endotoxin-free DMSO was used.

RESULTS

One or more AE were registered in 51/179 infusions (28.6%). The frequency of AE was higher after HPC-A than after HPC-BM (31.3% vs. 4.5%; chi(2) test, P =0.008). With univariate logistic regression, other factors found important for AE were age (P =0.028), number of total nucleated cells infused per kilogram (P =0.002), volume per kilogram infused (P =0.057), volume of packed RBC (P =0.019), a content of non-mononuclear cells >0.5 x 10(8)/kg (<P =0.0001) and actual time of infusion (P =0.058). When all aforementioned factors were evaluated with a multivariate logistic regression, only age of patient (P =0.024) and a content of non-mononuclear cells >0.5 x 10(8)/kg (P =0.0003) remained significant. A significant correlation existed between reduction of cardiac frequency both with volume per kilogram infused (r =0.221, P =0.02) and actual time of infusion (r =0.269, P =0.005).

DISCUSSION

Cardiovascular changes are influenced by volume per kilogram infused and by actual time of infusion, while non-cardiovascular AE are dependent on patient age and contamination by non-mononuclear cells in apheretic harvests.

Male breast cancer: report of 2 cases and review of the literature

Male breast cancer is rare and accounts for 1% of all breast cancers. The authors report two cases of male breast cancer at Stage III and review the literature. A Madden mastectomy with axillary clearance was performed. Patients were given adjuvant chemotherapy and started on tamoxifen. At one year follow-up the patients are alive and free from disease. Modified radical mastectomy is the preferred surgical approach for localized disease. Adjuvant hormonal therapy with tamoxifen is recommended as first-line treatment. Adjuvant chemotherapy has a role in node-positive cancer and locally advanced disease. Men should be made more aware of the disease and multicentric clinical trials encouraged to ensure an appropriate treatment on the basis of prospectively collected data.

Plug-technique for small incisional hernia

OBJECTIVE

The authors report their experience with a new prosthetic technique for the repair of incisional hernia defects smaller than 3 cm.

METHODS

From January 1995 to September 2002, 16 operations for small incisional hernias have been performed. Local anaesthesia was used in 12 out of 16 patients (75%). The repair was achieved by insertion of a polypropylene plug sutured to the margins of the hernial defect.

RESULTS

All patients were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in 25% of cases. Back at home analgesia was needed in only 1 patient. During a follow-up ranging 3 to 91 months (mean 46), no recurrence has been recorded.

CONCLUSION

The proposed technique allows a sound repair of small incisional hernias with minimal pain, quick rehabilitation and early return to unrestricted work.

Analogic evaluation of pain during inguinal hernioplasty under local anaesthesia

OBJECTIVE

The authors evaluate intraoperative pain in patients undergoing tension-free inguinal hernioplasty under local anaesthesia.

MATERIAL AND METHODS

One hundred and fourteen primary inguinal hernia repairs were carried out at the Department of General Surgery I of Catania University Polyclinic from January to September 2002. 2% Mepivacaine cloridrate was the local anesthetic of choice. Intraoperative pain was measured by a visual analog scale.

RESULTS

A mean analogic score of 1.9 (range 0-2.9) was obtained. Intraoperative complications were recorded only in 2 patients (1.7%). There was no operative mortality. All patients were up and about straightaway after surgery, had a light meal two hours later and were discharged within one day of operation.

CONCLUSIONS

Inguinal hernia repair under local anaesthesia is well tolerated and is associated with a low risk of complications.

[Tension-free prosthetic repair in the surgical treatment of epigastric hernia]

From November 1994 to June 2001, the authors have performed 16 operations for epigastric hernia. Local anaesthesia was used in 8 patients with small hernias, in the remaining 8 general anaesthesia was preferred. In defects smaller than 4 cm, the repair was achieved by insertion of a polypropylene dart plug sutured to the margins of the hernial defect. In larger defects a double layer mesh placed in the pre-peritoneum was used. All patients were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in 25% of cases and domiciliary analgesia in 1 patient only. During a follow-up ranging 3 to 79 months (mean 31.2), no recurrence has been recorded. The proposed technique is simple, safe and absolutely effective, allows immediate rehabilitation with a low risk of complications.

[Plug-technique for umbilical hernia repair in the adult]

BACKGROUND

Umbilical hernia represents 6% of all abdominal wall hernias in the adult. Surgical repair should always be carried out due to possible occurrence of complications. Aim of this paper is to evaluate the efficacy of the plug-technique.

METHODS

From October 1995 to April 2000, the authors performed 21 operations for acquired umbilical hernia with a defect smaller than 4 cm. Local anesthesia was used and a light intravenous sedation added in particularly anxious patients. The repair was achieved by insertion of a polypropylene dart plug sutured to the margins of the hernial defect.

RESULTS

All patients were up and about straightaway and were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in only 19% of cases and domiciliary analgesia in 24%. During a follow-up ranging from 6 to 60 months (mean 30), only one recurrence has been recorded.

CONCLUSIONS

This tension-free technique allows immediate rehabilitation, with few complications and a low recurrence rate.

Retroperitoneal gas gangrene complicating elective inguinal hernia repair

Gas gangrene is a well recognised complication of contaminated military wounds. A case of Clostridial myonecrosis following elective inguinal hernia repair is described. The pathology, clinical features and management of this life-threatening condition are reviewed.

[Current approach in the treatment of desmoid tumors of the abdominal wall]

Desmoids of the abdominal wall are rare tumours with an incidence of 2-4 cases per million. From our experience which is reported here in detail (5 cases observed over the past 20 years), we draw the conclusion that the only completely reliable diagnosis is still histological, in spite of the use of ultrasound, CT scans and the new imaging possibilities afforded by NMR. After comprehensive excision of at least 2 cm of macroscopically healthy tissue from the tumour margins, reconstruction using prosthetic materials, such as Mersilene, PTFE or Prolene was performed. Neither radiotherapy nor chemotherapy were used, since there were doubts as to their usefulness. The functional and cosmetic results were satisfactory in all cases. Over follow-up periods ranging from 3 to 13 years, none of the patients has presented recurrences or incisional hernias.

[Tension-free lumbar hernioplasty]

The authors report a case of a 51 year-old woman with spontaneous Grynfeltt's hernia. Computerized tomography accurately displayed the anatomy of the lumbar region, thus aiding diagnosis and treatment. A double layer polypropylene mesh was used for the repair, placed in the pre peritoneum and sutured to the margins of the hernial defect avoiding muscles and fascias. The use of a double layer prosthesis and reduction of tension on the suture line allow a sound repair, with minimal postoperative pain and immediate resumption of daily activities.

rrn operons in Haemophilus parainfluenzae and mosaicism of conserved and species-specific sequences in the 16S-23S rDNA long spacer

The mosaic organisation of short-sequence boxes was analysed in the cloned and sequenced long ribosomal spacer (547 bp) of Haemophilus parainfluenzae GR. Comparison and alignment of both the long and the short spacer were performed in H. parainfluenzae and H. influenzae Rd. The long spacer contained two tRNA genes (tRNA(Ala) and tRNA(Ile)) which are highly homologous to the corresponding genes found in the spacers of other species, such as Haemophilus spp., Actinobacillus spp., and Plesiomonas shigelloides. At the 3' end of tRNA(Ala) a putative ribosomal spacer loop was found, showing a strong secondary structure. Pulsed field gel electrophoresis (PFGE) analysis after restriction of the genome of H. parainfluenzae GR with I-Ceu I and subsequent polymerase chain reaction (PCR) analysis of PFGE-separated DNA fragments demonstrated that the H. parainfluenzae genome contained six operons and that the long spacer was present in three copies of them. Two short DNA segments were identified as being species-specific, allowing us to design PCR primers which were useful in the molecular identification of H. parainfluenzae isolates.

[Inguinal hernioplasty with calibrated prosthesis (personal modification of the Trabucco technique]

From January 1994 to December 1997, the authors operated on 636 patients with primary inguinal hernia, using an original modification of Trabucco's tension-free and sutureless technique. The hernial defect is sized according to Gilbert's classification modified by Rutkow and Robbins and repaired with one or more plugs (up to four in the authors' experience) in relation to its extent. The posterior wall is reconstructed over the plugs encompassing the transversalis fascia and a wing of the plug superiorly and the iliopubic tract inferiorly. The double-layer polypropylene mesh is fashioned intraoperatively and the key-hole tailored to the variable distance between the spermatic cord and the pubic tubercle. All patients ambulated immediately after the operation, had a light meal two hours later and were discharged within one day of surgery. During a 3 months to 4 year follow-up only one recurrence has been recorded (0.16%). The proposed technique allows to perform a repair to measure ("calibrated") with minimal pain, immediate rehabilitation and early return to unrestricted activity.

Molecular epidemiology of enterococci with high-level resistance to aminoglycosides

DNA-based methodologies are considerably more powerful than other phenotype-based typing systems, providing a finer level of epidemiological discrimination, differentiating both closely and distantly related independent isolates that otherwise may appear as identical. In this study, plasmid analysis and pulsed-field gel electrophoresis were used to compare 28 isolates of Enterococci (respectively 13 strains of Enterococcus faecalis and 15 strains of Enterococcus faecium) with high-level resistance to aminoglycosides, isolated in Catania (Italy). Plasmid profile analysis resolved 20 different patterns among 24 plasmid harboring strains; many isolates showed one or two plasmids of the same size, but different plasmid content. Analysis of the PFGE-based RFLP patterns after SmaI digestion of genomic DNA resolved 26 different clones from 28 isolates: particularly, it resolved two different clones from three isolates showing identical plasmid profiles, and it identified as a single clone two isolates exhibiting different plasmid profiles. Thus, on the basis of our PFGE-based RFLP analysis data, we concluded that all the strains included in the study were genetically unrelated with two exceptions.

[Hernia repair with local anesthesia]

The authors report the results of their own personal experience with inguinal and femoral hernioplasties (424 cases) performed under loco-regional anaesthesia. This anaesthetic approach together with the use of prosthetic techniques (tension-free and suture-less) represent the "Gold Standard" in the surgical treatment of hernia. The absence of mortality, the remarkable reduction in terms of postoperative complications, days of hospitalization (one day surgery) represent outstanding advantages. The cooperation of the patient and the stress test at the end of the operation are further advantages of the proposed technique.

[The role of lymphadenectomy in colorectal neoplasms]

BACKGROUND

The role of lymphadenectomy in the treatment of large bowel cancer is still controversial, not only because it is deemed to be a basic element for a correct postoperative staging, but also because it brings about, according to some authors, an enhancement of survival and of "disease free survival" rates. The difficulty to collect case histories with homogeneous data and the impossibility to identify preoperatively with certainty the lymph nodes involved, makes it difficult to codify the most suitable surgical treatment, even if it is agreed at present, to extend lymph nodes dissection at least as far as Level II nodes. As a matter of fact, despite of slight enhancement of 5-year survival rate (6-8%), a significant increase in morbility occurs, as reported in the literature, particularly in terms of urological and neurological lesions. However, a few authors, perform systematically Level III dessection, reporting a 20% increase in survival.

METHODS

Our study, has been carried out on 84 patients affected by large bowel neoplasm and admitted to the Institute of Surgical Pathology I of "Vittorio Emanuele" Hospital of Catania between 1990-1995.

RESULTS

This study showed an involvement of Level I lymph nodes in 77% of patients and of Level II in 33%, while Level III nodes were affected only in 4.7% of cases.

CONCLUSIONS

On the basis of these data and of those reported in the literature, the conclusion is drawn that the most suitable and responsible attitude is, at present, to perform invariably Level I and Level II dissection, reserving the lymphadenectomy of Level III only to selected cases or when an involvement is documented pre and intraoperatively.

Effect of nitric oxide synthase induction on the expression of mitochondrial respiratory chain enzyme subunits in mixed cortical and astroglial cell cultures

In the present study we evaluated the effects of NO synthase (NOS) induction on the regulation of cytochrome c oxidase (CO) and F0F1-ATPase subunit expression in astroglial and mixed cortical cell cultures. In mixed cortical cell cultures, 18 h of treatment with lipopolysaccharide (LPS, 0.1 microgram/mL) plus interferon-gamma (INF-gamma, 10 U/mL) caused an increase of mRNAs for CO-I, F0F1-ATPase 6 and also for iNOS at 20 DIV. The induction of both CO-I and F0F1-ATPase 6 was abolished by the NOS inhibitor N-monomethyl-L-arginine (NMMA) or by the enzymatic scavenger superoxide dismutase/catalase (SOD/CAT). In primary astroglial cell cultures, treatment for 18 h with increasing concentrations of LPS and INF gamma, produced an increase in the amount of mitochondrial encoded CO-I and -II subunits, with no significant modifications of nuclear encoded subunit IV. An increase was also observed at level of transcription for CO-I and -II, and F0F1-ATPase 6 mRNAs. These effects were abolished by addition of NMMA or SOD/CAT. mRNA induction of CO-I was higher in mixed cortical than in astroglial cell cultures while that of F0F1-ATPase 6 was similar in both cell types. These results suggest that the expression of mitochondrial encoded subunits (CO-I, CO-II and F0F1-ATPase 6) is up-regulated in response to oxygen and NO reactive species. The activity of cytochrome c oxidase decreased after LPS/INF gamma treatment in both astroglial and mixed cortical cultures. The activity of ATP synthase was unmodified, while ATP content drastically decreased after LPS/INF gamma treatment, in both astroglial and mixed cortical cultures. The enzymatic activities of catalase and Mn-SOD (mitochondrial) showed a significant increase after LPS/INF gamma treatment, which was abolished by NMMA.

[Organizational and surgical-technical aspects of the service of abdominal hernioplasty]

The authors guided by the experience matured from 1/01/94 to 30/06/97 (435 abdominal hernioplasties performed, mainly inguinal and femoral) illustrate the organizational formalities and the technical aspects of a Hernia Surgery Service. In particular, they highlight the advantages of the routine use of local anaesthesia and of tension-free techniques, carried out on a day surgery rule (immediate rehabilitation, greater facilitation to elective surgery, access to the elderly at high anaesthetic risk). Eventually, they emphasize the remarkable reduction of sanitary costs and the outstanding social, practical and didactic value of such Hernia Centers.

Cloning and sequencing of a 16S/23S ribosomal spacer from Haemophilus parainfluenzae reveals an invariant, mosaic-like organisation of sequence blocks

A 16S/23S ribosomal spacer from a Haemophilus parainfluenzae rrn locus was cloned and sequenced. Analysis of PCR-amplified genomic fragments showed that this region is strongly conserved among unrelated isolates; computer analysis of database homologies showed that the spacer consists of sequence blocks, arranged in a mosaic-like structure, with strong homologies with analogous blocks present in the spacer regions of Haemophilus influenzae, Haemophilus ducreyi and Actinobacillus spp. It also contains a tRNA(Glu) gene, which is highly homologous to tRNA(Glu) genes found in spacers of other species. These data strongly support the hypothesis that recombination events are involved in the organisation of the sequence of the spacer, as a result of horizontal gene transfer.

Molecular epidemiology and phylogenetic analysis of Haemophilus parainfluenzae from chronic obstructive pulmonary disease exacerbations

This study was undertaken to characterize serial Haemophilus parainfluenzae strains from epidemiologically unrelated chronic obstructive pulmonary disease (COPD) patients and from healthy carriers. A comprehensive approach was used including different phenotypical and molecular typing methods: biotyping, antibiotyping, conventional ribotyping, pulsed field gel electrophoresis (PFGE) assay, and PCR-ribotyping. Conventional ribotyping and PFGE analysis were confirmed as excellent procedures to differentiate isolates of the same species and biotype. Conversely, in our study, PCR-ribotyping proved to be suitable for taxonomic purposes, unambiguously identifying H. parainfluenzae from H. influenzae but not discriminating strains at the intraspecific level for epidemiological typing. Phylogenetic analysis of restriction fragment length polymorphism (RFLP) data of sequences related to the rrn operon demonstrated that H. parainfluenzae strains associated to COPD are spread among many diverging lineages.

Regulation of cytochrome c oxidase and FoF1-ATPase subunits expression in rat brain during aging

In the present study we analyzed the age-dependent changes of mRNA levels for cytochrome c oxidase and FoF1-ATP synthase subunits in rat cerebral cortex and cerebellum. To establish whether the regulation of expression is transcriptional or post-transcriptional, the results were compared to those related to protein subunits levels, of the same enzymatic complexes, previously observed. The different patterns of age-related changes of mRNA subunits, in particular the lower increments, compared with those related to protein subunits, indicate that post-transcriptional mechanisms of regulation might be involved in the coordinated expression of the various subunits of each complex. Northern blotting analyses of RNA from the cerebellum of rats at the various ages, showed also differences in age-dependent patterns of transcription between cerebral cortex and cerebellum. Moreover, the major age-dependent changes of mitochondrial-encoded subunits, compared with the nuclear-encoded ones, previously observed at proteins level, occur also during transcription.

In vitro activity of biapenem against recent gram-negative and gram-positive clinical isolates

The in vitro activity of biapenem, a new carbapenem, against 535 clinical recent isolates was compared with those of other antibiotics. Biapenem showed broad-spectrum activity against gram-negative and gram-positive clinical isolates. The new carbapenem was more active than imipenem against members of the family Enterobacteriaceae with MIC90S ranging from 0.12 to 2 mg/l and from 0.25 to 4 mg/l, respectively. Moreover it was 2-fold more active than imipenem against Pseudomonas aeruginosa (MIC90, 8 and 16 mg/l, respectively). Taken together, these results indicate that biapenem shares the favorable in vitro activity properties of imipenem and merits further study in the treatment of infections caused by a wide range of pathogens.

Cardiac iron overload in thalassemic patients: an endomyocardial biopsy study

Secondary heart failure induced by organ siderosis is the main cause of death in patients affected by thalassemia major. At present it cannot be predicted whether heart siderosis is correlated with iron overload and little is known about the real cardiac histological pattern of post transfusional hemochromatosis in patients with thalassemia major and intermedia. The study aim was to evaluate cardiac iron overload by non invasive and invasive techniques. Fifteen thalassemic patients were investigated and endomyocardial biopsy performed in ten revealed different grades of endomyocardial iron overload with histochemical positivity. Non invasive techniques are not able to furnish an exact picture of the cardiac hemochromatosis. There was a significant correlation between serum ferritin and myocardial iron grade. Patients with elevated ferritin levels and poor compliance to chelating therapy are at high risk of severe heart hemochromatosis. It was seen that endomyocardial biopsy is a useful tool in studying myocardial iron.

Microbiological considerations of the etiological agents of lower respiratory tract infections

One hundred eight-four sputum specimens from the same number of patients with lower respiratory tract infections were examined to determine the bacterial count and the relationship between the microorganisms isolated and the presumptive pathology. The sputa were subdivided into three groups; "high probability", "low probability", and "contaminated sputa", following the criteria of the microscopic readings: sputum with more than 25 white cells and low numbers of squamous epithelial cells represents true lower respiratory tract infections (high probability); those with fewer than 25 white cells represent non-bacterial infections or non-infected sputa (low probability) while sputa with more than 25 squamous cells per field represent contaminated specimens (contaminated sputa). Statistical analysis was carried out to correlate these data. Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus pneumoniae, and Streptococcus pyogenes showed significant differences in the three groups considered.

In vitro activity of a new broad-spectrum, beta-lactamase-stable oral cephalosporin, cefixime, in comparison with other drugs, against Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis and Streptococcus pneumoniae

Cefixime, a new orally absorbed iminomethoxyaminothiazolyl cephalosporin, was tested against some microorganisms involved in upper and lower respiratory tract infections such as Haemophilus (influenzae and parainfluenzae), Moraxella catarrhalis and Streptococcus pneumoniae, isolated in the period from November 1990 to April 1991. Its activity was compared to nine other antimicrobial agents: erythromycin, trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanate, cefaclor, ceftazidime, ceftriaxone, cefotaxime and ofloxacin. Cefixime inhibits 90% of S. pneumoniae, H. influenzae and H. parainfluenzae, both beta-lactamase producers (BLP) or not (NBLP) at concentrations of less than 0.25 mg/l. It inhibits 90% of M. catarrhalis (BLP and NBLP) at concentrations of less than 1 mg/l. In general, cefixime has a superior in vitro activity with respect to cefaclor and the other cephalosporins as well as erythromycin and amoxicillin (the last one in BLP strains). In the evaluation of the antibacterial activity of beta-lactam against Haemophilus and M. catarrhalis, the authors observed different indications in the guidelines for ampicillin. Cefixime is not destroyed by the plasmid-mediated beta-lactamase produced by Haemophilus sp. and M. catarrhalis (TEM and ROB in Haemophilus strains and BRO in M. catarrhalis). In view of its excellent in vitro activity against the commonly encountered respiratory tract pathogens, cefixime is indicated in the therapy of these infections.

[Motor disorders of the esophagus in gastro-esophageal reflux disease]

The Authors report their experience in the study of oesophageal motor abnormalities in patients with gastroesophageal reflux disease. By an electromanometric test in 50 subjects (20 healthy volunteers and 30 patients with oesophagitis), they evaluated the results concluding that: 1) LES low pressure is correlated significantly with oesophagitis; 2) oesophageal peristaltic dysfunction could be the effect of oesophagitis rather than its cause.

[Carcinoma of the male breast]

The Authors, after a brief review of the most important epidemiologic, etiologic, diagnostic and therapeutic problems related to male breast cancer, report their personal experience. They point out the importance of an early diagnosis in order to obtain satisfactory results, comparable to those achieved in female breast cancer treatment.