[Well ageing in the XXI century. Political, social and individual strategies]

Population ageing is a triumph, but because to the tendency to the increase of the phenomenon in all countries of the globe, it is also a concern and a challenge for national governments and societies. Starting from the current picture in the States of European Union and the future predictions, it's provides an overview of the relationship between ageing and health, emphasizing some social, political and person-related aspects. In particular, it's examined the theoretical models, strategies and multilevel actions proposed to well-ageing and with dignity, focusing on the model of "active and healthy ageing" promoted in 2012 by the World Health Organization and the European Union.

[Hip fractures in the elderly. Observational study in an unit of intermediate care]

ASL TO4-ICU inpatients with hip fracture over 5 month-period were 45, 12 men and 33 women, average age 81. In 42 patients the fall was accidental or environment-related, and in 40 cases it occurred at home. More than 3 coexisting diseases were found in 22 patients (48%), and polipharmacotherapy with more than 3 drugs in 27 (60%). Only 4 (8%) patients presented a diagnosis of osteoporosis, and only one treated with antiosteoporotic drugs. Before the fracture occurred, 35 (77%) subjects walked without help; 28 (62%) were functionally independent, 17 (38%) dependent; cognitive impairment was diagnosed in 11 (24%) patients. Side-fracture was intracapsular in 17 (38%), extracapsular in 28 (62%). Surgery treatment was osteosinthesys in 26 (58%), endoprosthesis in 11 (24%), total hip prosthesis in 8 (18%). Surgery-timing was of 3 or more days in 23 (51%) patients. In the elderly osteoporosis is underdiagnosed and undertreated, and surgery of hip fracture is always delayed.

[The problem of the chronic recurrent pain among older in-patients]

Epidemiological data of pain prevalence, with particular attention to hospitalised subjects, are described as well as the problems of pain detection, its evaluation and management in older patients. The authors underline that chronic pain is the most frequent type of pain in advanced age, and it is often unrecognized and undertreated. Advanced age is not a sufficient reason to exclude an analgesic treatment which could improve the quality of life of these subjects. Elderly persons are at increased risk for adverse drug reactions, on the other hand, there is evidence that an appropriate use of analgesic drugs can provide significant relief and result in functional restoration, with a low risk of serious adverse effects. In the medical literature there are strategies and guidelines ad hoc. In Italy, since 2001 there is a plan drawn up by the Department of Health containing indications to fight against pain in hospital, but the adhesion of a number of hospitals to this plan seems to be not optimal.

Extremely low frequency-modulated static magnetic fields to treat cancer: A pilot study on patients with advanced neoplasm to assess safety and acute toxicity

Results of a toxicity pilot human study approved by the competent ethical Committee are reported. Eleven patients with heavily pre-treated advanced cancer were enrolled in a pilot study with different schedules of time exposure to static magnetic fields (MF), amplitude modulated by ELF. An area including the neck, thoracic and abdomen was MF exposed daily, 5 days/week for 4 weeks according to two different schedules: 20 min daily (4 patients) and 70 min daily (7 patients). ECOG performance status was 1 (2 patients), 2 (8 patients), 3 (1 patient). Toxicity was assessed according to WHO criteria. ECG, Chest X-ray, physical examination, blood cell count and complete blood chemistry were performed before and at the end of the treatment. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevation (grade 2 toxicity) in 1 patient and microscopic urinary abnormalities in 5 patients were the only negative effects observed. We conclude that MF can be safely administrated according to the MF exposure schedules.

Static and ELF magnetic fields enhance the in vivo anti-tumor efficacy of cis-platin against lewis lung carcinoma, but not of cyclophosphamide against B16 melanotic melanoma

Previous works showed that exposure to static and extremely low frequency (ELF) magnetic fields (MF) over 3 mT slows down the growth kinetics of human tumors engrafted s.c. in immunodeficient mice, reducing their metastatizing power and prolonging mouse survival. In the experiments reported here, immunocompetent mice bearing murine Lewis Lung carcinomas (LLCs) or B16 melanotic melanomas were exposed to MF and treated respectively with two commonly used anti-cancer drugs: cis-diamminedichloroplatinum (cis-platin) and N,N-bis (2-chloroethyl)tetra-hydro-2H-1,3,2-oxazaphosphorin-2-amine 2-oxide (cyclophosphamide). The experiment endpoint was survival time. The survival time of mice treated with cis-platin (3mg/kg i.p.) and exposed to MF was significantly (P<0.01) longer than that of mice treated only with cis-platin or only exposed to MF, superimposing that of mice treated with 10mg/kg i.p. of the drug, showing that MF act synergically with the pharmacological treatment. On the contrary, when mice treated with cyclophosphamide (50mg/kg i.p.) were exposed to MF no synergic effects were observed, the survival curve being exactly the same as that of mice treated with the drug alone. No clinical signs or toxicity were seen in any of the mice exposed to MF alone or along with cis-platin or cyclophosphamide treatment, compared to mice given only the two known drugs.A possible explanation for the synergic effect of MF being found in mice treated with cis-platin could be that the platinum ion stimulates radical production and that MF enhance active oxygen production bringing about changes in tumor cell membrane permeability, influencing positively the drug uptake. Alternatively, or in addition to this, it has been demonstrated that the rate of conversion of cis-platin to reactive species able to bind to DNA, is increased by localized production of free radicals by MF.

Increased mouse survival, tumor growth inhibition and decreased immunoreactive p53 after exposure to magnetic fields

The possibility that magnetic fields (MF) cause antitumor activity in vivo has been investigated. Two different experiments have been carried out on nude mice bearing a subcutaneous human colon adenocarcinoma (WiDr). In the first experiment, significant increase in survival time (31%) was obtained in mice exposed daily to 70 min modulated MF (static with a superimposition of 50 Hz) having a time average total intensity of 5.5 mT. In the second independent experiment, when mice bearing tumors were exposed to the same treatment for four consecutive weeks, significant inhibition of tumor growth (40%) was reported, together with a decrement in tumor cell mitotic index and proliferative activity. A significant increase in apoptosis was found in tumors of treated animals, together with a reduction in immunoreactive p53 expression. Gross pathology at necroscopy, hematoclinical/hematological and histological examination did not show any adverse or abnormal effects. Since pharmacological rescue of mutant p53 conformation has been recently demonstrated, the authors suggest that MF exposure may obtain a similar effect by acting on redox chemistry connected to metal ions which control p53 folding and its DNA-binding activity. These findings support further investigation aimed at the potential use of magnetic fields as anti-cancer agents.

Static and ELF magnetic fields induce tumor growth inhibition and apoptosis

The ability of static and extremely low frequency (ELF) Magnetic Fields (MF) to interfere with neoplastic cell function has been evaluated. In vitro experiments were carried out to study the role of MF characteristics (intensity, frequency, and modulation) on two transformed cell lines (WiDr human colon adenocarcinoma and MCF-7 human breast adenocarcinoma) and one nontransformed cell line (MRC-5 embryonal lung fibroblast). Increase in cell death morphologically consistent with apoptosis was reported exclusively in the two transformed cell lines. Cell-death induction was observed with MF of more than 1 mT. It was independent of the MF frequency and increased when modulated MF (static with a superimposition of ELF at 50 Hz) were used. Based on the in vitro results, four different MF exposure characteristics were selected and used to treat nude mice xenografted with WiDr cells. The treatment of nude mice bearing WiDr tumors subcutaneously. with daily exposure for 70 min to MF for 4 weeks caused significant tumor growth inhibition (up to 50%) by the end of the treatment when modulated MF were used for at least 60% of the whole treatment period and the time-averaged total MF intensity was higher than 3.59 mT. No toxic morphological changes induced by exposure were observed in renewing, slowly proliferating, or static normal cells. A discussion on the possible biophysical mechanism at the base of the observed biological results is also offered.

[Findings on standard electrocardiograms of elderly in-patients with diagnosis other than cardiac]

OBJECTIVE

To investigate the frequency of cardiac arrhythmias, conduction disturbances and other electrocardiographic abnormalities in elderly in-patients without clinical evidence of heart disease, and in relation to different age groups.

DESIGN

Retrospective analysis of the standard 12-lead electrocardiogram recordings.

METHODS

Resting electrocardiograms of 595 in-patients aged 65 years and older, without cardiac diagnoses, over a period of one year were examined. There were 148 subjects aged from 65 to 69 years (group I of age), 258 from 70 to 79 (group II), 189 older than 80 (group III).

RESULTS

Abnormal ECGs were in 108 (73%) subjects of group I of age, 199 (77%) of group II, 174 (92%) of group III (between group I and III, and group II and III: p-value < 0.01). Conduction disturbances were observed in 200 (33.6%) patients: 65 (10.9%) had right bundle branch block, 59 (9.9%) first-degree atrioventricular block. Supraventricular arrhythmias were found in 117 (19.6%) patients: 65 (11%) had atrial premature beats, 40 (6.7%) atrial fibrillation. Ventricular arrhythmias were seen in 65 (10.9%) patients: simplex ventricular premature beats in 55 (9.2%), complex in 10 (1.7%).

CONCLUSIONS

The variation of frequency of ventricular premature beats between age group I and III, and of first-degree AV block between age group II and III was at p-value < 0.05. Our results indicate that the prevalence of electrocardiographic abnormalities in elderly subjects without other clinical manifestations of heart disease is very high and some of these increase significantly with the age.

[Genes, molecules, and mechanisms regulating programmed cell death]

Apoptosis is a morphologically distinct form of programmed cellular death that plays a central role during embryogenesis, tissue homeostasis, and to remove not necessary or potentially dangerous cells. Moreover, disregulation of genes mediating or modulating apoptosis contributes to the pathogenesis of a number of human diseases, including cancer, autoimmune diseases, neurodegenerative disorders, viral infections and acquired immunodeficiency syndrome. A number of genes and molecules promoting or protective against cell death is at present-day known and an important information about the external and internal signals involved in stimulation and suppression of apoptosis is also emerging. In the intracellular pathway of the death deregulation of [Ca2+](i) plays a pivotal role. Increased ionized intracellular calcium stimulates both the activation of enzymes (protein kinases, endonucleases, proteases and phospholipases) and plasma membrane K+ channels. This calcium-mediated activation leads to morphostructural changes, such as cell shrinkage, cytoplasmatic blebbing, nuclear chromatin condensation and DNA degradation into oligonucleosomal fragments. At least some genes of the cell death pathway have been conserved throughout animal evolution; ced-3 e ced-9 that regulate the initiation of cellular suicide in the nematode Caenorhabditis elegans are homologous to genes that in mammalian cells are thought to play a similar role (interleukin-1 beta converting enzyme [ICE] family, Bcl-2). It is possible to suppose that these regulators could constitute a target for treatment of disorders related with disregulation of apoptosis.

[Genetic alterations and molecular mechanisms underlying colorectal tumorigenesis]

Tumor cells are cells that have acquired damage to genes that directly regulate their cell cycles. In the multistep process leading to colorectal carcinoma, the adenoma-carcinoma sequence is characterized by progressive accumulation of genetic abnormalities (K-ras oncogene mutation, allelic deletion on chromosome 5q, 18q, 17p). In a hereditary non-polyposis syndrome (Lynch syndrome II) and in about a quarter of the cases of sporadic colorectal cancer there is a DNA micro-instability which contributes to the acquisition of mutations that cause loss of tumor-suppressor function. The p53 tumor-suppressor gene is the most frequently mutant gene in human cancer. In colorectal cancer cells missense p53 mutations and allelic deletion on chromosomal locus 17p13.1 are found with very high frequency. One of biological roles of p53 gene is to ensure that, in response to genotoxic damage, cells arrest in G1 and attempt to repair their DNA before it is replicated. In addition, p53 is required for apoptosis in response to severe DNA damage, included the damage induced by chemotherapeutics drugs and ionizing radiation. The loss of p53 function results in genomic instability and has been implicated in the evolution of normal cells into cancer cells.

[What posttreatment monitoring in Whipple's disease? A case report]

The authors--which publish an overview about Whipple's disease in this issue, pages 609-611--report the case of a 67-year-old man admitted to the hospital because of migratory arthralgia, low-grade fever, lymphadenopathy, diarrhea, and impaired intestinal absorption. The microscopical examination of the intestinal mucosa showed an infiltration of the lamina propria by foamy PAS-positive macrophages. The patient was treated with antibiotics for 1 year and obtained clinical remission. The authors discuss if it is opportune, in subjects with this disease, to repeat the small-bowel biopsies at the end of the antibiotic treatment in absence of clinical manifestations of relapse or not.

[Strongyloides stercoralis in a region of northwestern Italy. An epidemiological note and presentation of a case of eosinophilic infiltration of the lung]

The Authors report a case of Strongyloides stercoralis infection in an autochthonous farmer from Piedmont (Northern Italy) presenting as an eosinophilic lung disease. After having briefly considered the epidemiological and clinical characteristics of the Strongyloides stercoralis infection, the Authors conclude by affirming that the appearance of migratory pulmonary infiltrates in autochthonous subjects or resident in Canavese area (Piedmont), especially if blood and sputum eosinophilia is present, should raise the possibility of Strongyloides-induced lung disease and lead to appropriate examination of sputum, feces, and eventually duodenal contents.

Occlusion of a branch of the central retinal vein as a manifestation of hypercoagulability in a patient with lung cancer. A possible paraneoplastic event

The author describes the case of a patient with occlusion of a branch of the retinal central vein associated with lung carcinoma. He attributes the occlusive event, at the level of the retinal venous microcirculation, to a condition of hypercoagulability induced by cancer in coexistence with a slowing down of the blood flow as a result of a slight increase of serum viscosity. In the clinical discussion the author first considers the pathogenesis of the clinical and laboratory alterations concerning the coagulation observed in patients with cancer, and then hypothesises that the retinal vein thrombosis in the patient under question might be produced by way of a mechanism of interaction between tumor cells, plasmatic systems of the coagulation, leucocytes, platelets and endothelial cells.

[Thoracic empyema caused by anaerobes. 78-month retrospective study. Clinical and microbiological aspects]

The authors considered the microbiological and clinical aspects of the thoracic empyemas caused by anaerobic bacteria observed at the Ivrea-Castellamonte Hospital, Turin, over a period of 78 months. In this period 321 patients were subjected to thoracentesis in order to take samples of the pleural fluid (PF) which was in turn subjected to culture investigations. 31 patients (9.6%) had one or more cultures which were positive for bacterial growth. A good 12 patients (38.7%) had cultures which were positive for anaerobes alone or associated with aerobes. The average age of these patients (8 male, 4 female) was 62.5 years (range, 42 TO 84 Y.). Underlying diseases and predisposing conditions were as follows: malignancy (4 patients), neurological disorders (4p), severe hypoalbuminemia (5 p), bronchial obstruction (3 p), previous gastroenteric or chest surgery (3 p), diabetes mellitus (2 p), alcoholism (2 p), atherosclerosis (1 p), alveolar hypoventilation caused by chest wall disorder (1 p). The etiopathogenesis of the empyema was as follows; postpneumonic, 5 cases (41.7%); postsurgical, 4 cases (33.3%); esophageal fistula, 1 case (8.3%); idiopathic, 2 cases (16.7%). In 5 cases (441.7%) empyema developed in hospital, in 7 cases (58.3%) in community. Forty-one percent of the empyemas were described as foul-smelling. The anaerobic bacteria most frequently isolated were Bacteroides spp, Fusobacterium nucleatum, Peptostreptococci in this order. Thoracentesis was performed on 6 patients, chest tube drainage was required in 6, and antibiotics were administered to all the patients. Length of Hospitalization averaged 33>2 days. Three patients (30%) died. These patients died during the same hospitalization period while empyema was an active problem.(ABSTRACT TRUNCATED AT 250 WORDS)

[Osteolysis in an aged woman with recurrent urinary infections]

Hematogenous osteomyelitis has two incidence peaks; the first in childhood, the second in elderly people. The vertebrae are frequently involved in the case of elderly people and the diagnosis is difficult to make in as much as the radiological control of osteolysis is often attributed to malignant metastasis. The Authors describe a case of vertebral osteolysis in an elderly woman with relapsing urinary infections. The clinical history of the patient is described and the diagnostic procedure is critically discussed. In this way the diagnosis of osteomyelitis of the thorax-lumbar tract is reached. The Authors go on to consider the possibility of an infectious genesis of isolated osteolytic lesions, especially in patients with risk factors and ones prone to certain conditions such as urinary infections, above all because the complications of osteomyelitis can be extremely serious.

[Bacteriology of abdominal pus in 43 cases of acute appendicitis and appendiceal abscess at the Ivrea-Castellamonte Hospital, isolation of aerobic and anaerobic bacteria and drug sensitivity]

A retrospective study on the microbiology of abdominal pus from acute appendicitis or peritonitis was carried out by the authors. A total of 45 specimens were examined, 38 of them (84.4%) where found to be positive, of which 29 (76.3%) were polymicrobial and 9 (23.7%) were monomicrobial. The most represented species were Escherichia coli (28.4%), Bacteroides fragilis (7.8%), Streptococcus milleri (7.8%), Bacteroides oralis (3.9%) and Pseudomonas aeruginosa (3.9%). The polymicrobial associations more represented include Bacteroidaceae, Enterobacteriaceae and streptococcus genus. The most active drugs in vitro were found to be Piperacillin and Chloramphenicol, Cephalosporin (cefotaxime, ceftriaxone and cefoxitin) showed a good capability of being active against isolated microorganisms although they were less effective when used against anaerobic microorganisms then aerobic ones. On the contrary, Rifampicin, Metronidazole and Clindamycin were found to be quite effective against the anaerobes.

[Blastocystis hominis in Canavese: a retrospective study of samples received for fecal parasitological examination at the Ivrea- Castellamonte Hospital over 42 months]

In the last ten years the interest in the controversial Blastocystis hominis microorganism of the intestine has greatly increased. The authors conducted a retrospective study of feces for parasitology investigations at the Ivrea-Castellamonte hospital. These investigations lasted 42 months (1/1/1988-31/6/1991) and the authors focused their attention on samples with 5 or more Blastocystis hominis at the microscopically examination with a 40X phase objective. During the study 2,138 samples of feces (belonging to 1552 patients) arrived. 284 samples (13.3%), corresponding to 200 patients (12.9%), proved to be positive for one or more parasites. In 155 samples (7.2%) regarding 109 patients (7.0%)--53 males, 56 females--Blastocystis was present. These patients were between 2 and 78 years of age. In 19 (17.4%) of these patients other parasites were associated, parasites such as Giardia lamblia (in 6 cases), Entamoeba coli (in 4 cases), Entamoeba spp. (in 2 cases), Entamoeba histolytica (in one case), Entamoeba hartmanni (in one case), Iodamoeba butschlii (in one case), Hymenolepis nana (in one case); helminths (in 3 cases). The most effect proved to be those patients between 21 and 50 years of age (53 of 98 patients). Few infants were affected. The greatest incidence of Blastocystis hominis infection occurred during the months of January to June. The authors conclude by considering how the incidence data of such parasitosis in the Canavese region can be superimposed on as much as has been observed in territories which are very different regarding social-economic and geoclimatic conditions. The authors think it is necessary to start a prospective clinical-epidemiological investigation in the Canavese region with a view to defining the clinical approach to the parasite under discussion in a better way.

[Bacteremia and localized suppurative Salmonella non-typhi infections in the elderly: a study of 4 cases observed at the Ivrea-Castellamonte Hospital]

Over a period of 60 months 137 cases of intestinal and extra-intestinal salmonellosis were registered in the microbiology department of the Ivrea-Castellamonte hospital. The authors conducted a retrospective study relative to the extra-intestinal salmonellosis manifested in elderly patients. In order to carry out such a study the authors considered only patients who were in the hospital, who were over the age of 65, and who had a clinical history different from the usual one of gastroenterocolitis. Out of 61 patients who were in hospital 50 were with complete registration data; 9 (18%) were over 65 years of age. The analysis of the clinical cards permitted the identification of 4 cases with unusual clinical histories due to the presence of serious systemic complications (sepsis with prolonged fever and positive blood cultures) or focal infections in extra-intestinal tissues (abscess of soft tissues, osteomyelitis). The authors focused their attention on these and described the general clinical characteristics of each patient, the type and the position of the isolated microorganism, the manifestations or extra-intestinal complications of the infection and the predisposing factors regarding the same complications. For each patient the essential clinical history and the treatment of the disease have been described. The authors conclude by affirming that in the cases of elderly patients with salmonellosis, apart from those infections in positions different from intestinal one, it would be opportune to consider an antimicrobe treatment also for enteritis infections and cases of asymptomatic infection.

[Strongyloidosis in Canavese: 4 cases seen at the 'Ospedale di Ivrea-Castellamonte. Epidemiological and clinical considerations]

From May 1988 to September 1990 the microbiology laboratory of the Ivrea-Castellamonte Hospital (Province of Turin) carried out 1464 coproparasitological investigations. 0.5% of the samples, coming from 5 patients, proved to be Strongyloides stercoralis positive. 4 cases were diagnosed in recovery conditions, and on these we carried out a retrospective study (taking into consideration some epidemiological and clinical aspects). The average age of these patients, three men and one woman, was 70.5; all native of the Canavese and resident in agricultural zones; two farmers still working, a worker and a retired worker. All of them presented one or more associated pathologies and/or a tendency to parasitosis. The clinical picture was characterized by abdominal pain, present in three cases, while diarrhoea was observed in only one case; a slight temperature in two, a high temperature in one; nettle-rash manifestations in one case and breathing symptomatology in two. In two cases there appeared abdominal relaxation (meteorism) and in one of these there was a serious paralytic ileus. Eosinophilia was present in all the patients, even if at different levels (from 5.9% to 20%). The treatment was carried out with different drugs: mebendazole in two cases, thiabendazole in one and "pyrvinium pamoate" in another. Our conclusion is that there exist in the Canavese the climatic, environmental and social-economical conditions which can favour Strongyloidiasis.

[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. III. Microbiological aspects]

A retrospective study was made of all blood cultures performed over a 40-month period at the Ivrea-Castellamonte Hospital (Turin, Italy). A total of 4386 vials from 619 patients were examined. There were 619 positive vials (14.1%) from 131 patients (21.2%) corresponding to 145 bacteremia episodes, including 129 monomicrobial (89%) and 16 polymicrobial (11%). Ten patients (1.6%) had more than one episode. There were 73 polluted vials (1.7%). A total of 165 microorganism were isolated: Gram-positive (52.7%) and Gram-negative (46%) bacteria, and mycetes (1.2%), anaerobic flora (9.7%). The predominant families were: Enterobacteriaceae (29.5%), Micrococcaceae (27.3%), Pseudomonadaceae (4.8%), Bacteroidaceae (4.8%) and Streptococcus "Genus" (18.8%). The species frequencies were: Escherichia coli (20%), Staphylococcus aureus (15.8%), Enterococcus (8.5%), Staphylococcus epidermidis (7.3%), Pseudomonas aeruginosa (4.8%), Proteus mirabilis (4.2%), Brucella spp. (2.4%), Bacteroides fragilis, Streptococcus bovis e Propionibacterium acnes (1.8%). These findings are compared with those published in the Italian and international literature. Stress is laid on periodical review of the isolations from samples of this kind as a useful aid towards the diagnosis and treatment of hospital infections, and in their monitoring and epidemiological evaluation.

[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. I. Epidemiologic aspects]

Data on all blood cultures from patients admitted to the Ivrea-Castellamonte Hospital (Turin, Italy) from June 1986 to September 1989 were collected and processed in a retrospective study of the quantity of cultures prepared in the hospital as a whole and per department, the percentage of culture positivity and the incidence of bacteremias. The results were: 1) mean incidence of cultures: 12.37 per 1000 patients, increasing through the period; almost 2/3 of the cultures were requested by the three medical division; 2) positivity 21.2%; 3) incidence of bacteremias: 3 per 1000 patients. These findings are critically compared with others obtained both in Italy and abroad (United States, United Kingdom, South Africa), and it is suggested that the increased request for cultures observed should lead to an increase in the number of bacteremias diagnosed.

[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. II. Clinical observations]

A study was made of 92 bacteremia episodes among patients admitted to the Ivrea-Castellamonte Hospital (Turin, Italy) between June 1986 and September 1989. A single microorganism was isolated in 84 episodes (91.3%), the most common being: Staphylococcus aureus (21.7%), Escherichia coli (18.5%), Enterococcus (9.8%), Pseudomonas aeruginosa (6.5%), and Proteus mirabilis (5.4%). The episodes were of both hospital and community origin: 54.3% vs. 45.7%. Their main sources were: the urinary tract (16.3%), abdominal infections (14.2%), endocarditis (7.6%), and the respiratory tract (5.5%). No source could be identified in 26%. Brucellosis, salmonellosis and listeriosis together constituted 8.7% of the episodes. Abdominal infections were primarily responsible for the 8 cases (8.7%) of polymicrobial bacteremia. The overall mortality was 18.5% (6.5% community vs. 12% hospital episodes). Mortality directly due to bacteremia was 8.7%. Bacteremia was the direct or indirect cause of death in 22.6% of patients greater than or equal to 65, compared with 19% and 10% in those aged 35-64 and 15-44 respectively. The patient's clinical picture at the time of infection was a prognostic factor: mortality was much lower in subjects previously healthy or free from basic diseases (11.8%) than in those with non-rapidly-fatal diseases (21.7%) or rapidly-fatal diseases (54.5%). Bacteremia-linked mortality (direct and indirect) was higher in Gram-positive vs Gram-negative infections: 22.2% vs 15.8%. Mortality was 12.5% in the group of patients with polymicrobial infections.

[Gangrenous and perforating appendicitis in a provincial hospital: a 48-month retrospective study. Clinical and microbiological aspects, course and postoperative morbidity]

The appendectomy for gangrenous or perforated appendicitis is made more serious by a very high frequency of infection. The antibiotic prophylaxis should be able to reduce the frequency of such complications. We have considered retrospectively the patients who underwent appendectomy for gangrenous and perforated appendicitis in the period from June 1st, 1986 to May 31st 1990 in the Ivrea-Castellamonte hospital (Province of Turin), focusing our attention on certain microbiological and clinical variables in relation to the post-operative course. The average age of the 43 patients admitted to the study, 25 male adults and children and 18 female adults and children, was 27.4; the pediatric number totalled 22 subjects of which 14 male; the group of 21 adults included 11 males. 7 adults presented concomitant pathologies. The average stay in bed was 10.7 days (12.9 for the adults--8.6 for the children); 61.9% of the adults had a stay of more than 10 days, 72.7% of the children less than 10 days (P less than 0.05). The incidence of the infective complications in the whole group was 25.6% (33.3% of adults against 18.2% of children); infection of surgical wounds was observed in 18.6% of the cases (28.6% of the adults against 9% of children). The pre-operative antibiotic prophylaxis was activated in 22 patients (11 adults, 11 children) and the antimicrobic treatment was continued in the post-operative phase for an average of 7.3 days in the case of the adults and 5.9 days in the case of the children. Of the 21 patients not subjected to prophylaxis (10 adults, 11 children) all received post-operative antibiotic therapy (an average of 8 days for the adults, 7.8 days for the children). The incidence of septic complications in the group subjected to antibiotic prophylaxis was 18.2% as against 33.3% of the group not subjected; the incidence of infection of the wound being 13.6% against 23.8%. The per-operative cultures of pus coming from the peritoneum cavity were positive in 83.7% of the cases (53.5% mixed aerobe-anaerobe cultures). The microorganism most frequently isolated were: Escherichia coli (27.7%), Bacteroides fragilis (7.9%), other Bacteroides spp. (20.8%), among the positive gram aerobes the Streptococcus milleri (6.9%) prevails; the most common association is the between Bacteroides spp. and Enterobacteria (19 cases); in a good 17 cases the enterobacteriaceae is represented by the Escherichia coli; the Bacteroides, E. coli and Streptococcus association is, however, observed in 10 cases. Our study confirms the usefulness of the peri-operative antibiotic prophylaxis in the cases of a gangrenous or perforated appendicitis.