Analysis of two cross-contamination cases of Campylobacter jejuni foodborne disease in fragile subjects in the territory of a Local Health Authority in Tuscany, Italy

Campylobacteriosis is the most reported foodborne disease in the European Union, with more than 100,000 confirmed cases annually. Human infection can be caused by a low infectious dose, and in fragile populations, the food disease can manifest itself in acute and severe forms. This study aims to analyze two cases of campylobacteriosis in fragile people caused by Campylobacter jejuni in 2023 in Tuscany and the actions of the Local Health Competent Authority. From the results of the related investigations, it was possible to attribute both cases of foodborne diseases to unsafe food management during preparation/administration. Given the peculiar characteristics of the etiological agent, it is necessary to focus the attention of the population, especially those who deal with fragile subjects, on the good hygiene practices to be followed both at home and in collective catering.

Behaviour of Staphylococcus aureus in the Rearing Substrate of Tenebrio molitor Larvae

Tenebrio molitor (mealworm) is one of the most promising insect species to produce sustainable feed and food with high nutritional value. Insects may harbour microorganisms both in the gut and on the exoskeleton originating from the rearing environment. Staphylococcus aureus is a pathogenic microorganism frequently involved in food poisoning due to its enterotoxin production. This study aimed to evaluate the S. aureus growth and enterotoxins production following an experimental inoculation into the T. molitor rearing substrate (about 7 log CFU/g). Analyses on the substrate and larvae were performed over a testing period of seven days. The microbial population dynamics were also evaluated through total viable count and lactic acid bacteria count. The effects of fasting, washing, and cooking on the microbial loads of mealworms were evaluated. The results highlighted that mealworms and substrates can maintain their microbial loads of S. aureus over the tested period. Moreover, fasting and washing were generally not able to significantly reduce (p-value > 0.05) S. aureus count in mealworms. On the other hand, cooking significantly reduced (p-value < 0.001) the microbial load in almost all cases. No production of enterotoxins was revealed during the trial. Therefore, microbiological risks can be reduced by a wise choice of substrate, appropriate control measures, and thermal treatment of larvae.

Food safety culture in food companies: evaluation of the perception of food safety culture in three Tuscan food companies

The Commission Regulation (EU) No. 2021/382 (European Commission, 2021), amending the Regulation (EC) No. 852/2004 (European Commission, 2004), introduced the obligation for companies to establish and maintain a food safety culture (FSC). The methodology to evaluate, implement, and enhance the level of FSC is up to the individual companies. This study aimed to investigate the perception of FSC among the employees of 3 Tuscan medium-sized enterprises in the food sector, producing cured meat (A), dairy products (B), and frozen fish products (C). The survey was conducted through the development and administration of a questionnaire based on a 5 points Likert scale, referring to different aspects of FSC, organized in 6 sections with 5-6 statements each and subjected to a percentage of employees between 76 and 85%, classified also by the length of service (≤3 and >3 years). For all the companies, the minimum median and mode value for scores obtained by the different sections was 4, and the minimum median and mode value for the single statement was 3 (A, B; except for a bimodal value 2-4) and 4 (C). The section awareness and perception of risk showed the highest mean scores in all companies. As for the length of service, senior employees gave lower scores than junior ones in all sections in B and 3 sections in C. Overall, the results of the questionnaires showed a good perception of FSC, even though it was possible to identify some partial weaknesses.

Kasabach-Merritt Syndrome Associated to Angiosarcoma of the Breast. A Case Report and Review of the Literature

Introduction

Kasabach-Merritt syndrome is characterized by the association of a consumptive thrombohemorrhagic disorder and angioma occurring usually in children. In the present study, a case of Kasabach-Merritt syndrome associated to an angiosarcoma of the breast is reported.

Clinical History

The tumor together with the thrombohemorrhagic disorder manifested in a 28-year-old woman. The patient underwent mastectomy. The tumor recurred in the same site 2 years later. The patient died of severe anemia 8 years after the first appearance of the angiosarcoma.

Material and Methods

Tissues were formalin fixed and paraffin embedded; in addition, selected sections were immunohistochemically stained.

Results and Conclusions

A well-differentiated angiosarcoma was visible throughout the removed organ. A review of the literature showed that only 6 cases of Kasabach-Merritt syndrome associated to malignant vascular tumors have been previously reported. All these 6 cases occurred in adult patients. On the contrary, Kasabach-Merritt syndrome associated to benign vascular tumors affects children. This is the first case occurring in the breast.

Visuospatial working memory in Turner's syndrome

Turner's syndrome is a genetic disorder, specific to women, in which one of the X chromosomes is partially or completely deleted. This syndrome is associated with physical features such as short stature or failure in primary and secondary sexual development, together with a specific pattern of cognitive functions. It has been suggested that women affected by Turner's syndrome perform poorly in tasks measuring visuospatial abilities and have a verbal IQ significantly higher than performance IQ. Although this result has received strong empirical support, the nature of the visuospatial deficit is still unclear. Recent studies on visuospatial processes have highlighted that the underlying cognitive structure is more complex than previously suggested and several dissociations have been reported (e.g., visual vs spatial, sequential vs simultaneous, or passive vs active processes). In the present study we analyze in detail the characteristics of the visuospatial deficit associated with Turner's syndrome by presenting four young women with a comprehensive battery of tasks designed to tap all aspects of visuospatial working memory. Results confirm that Turner's syndrome is associated with a general visuospatial working memory deficit, but the pattern of performance of different cases can be different, with a greater emphasis on active visuospatial processes. and on either sequential or simultaneous spatial processes.

Radiation-induced cerebral meningiomas. Case reports

Two cases are presented of meningiomas following external cranial irradiation in which several features clearly indicate a causal relationship between radiotherapy and tumour development. In one patient multiple recurred meningioma was diagnosed 30 years after low-dose X-ray treatment of Tinea capitis; in the other patient the meningioma was diagnosed approximately 18 years after high-dose radiation therapy for astrocytoma. The features distinguishing radiation-induced meningiomas from other meningiomas are reviewed. The use of radiation therapy only in those cases in which there is clear evidence that it will have beneficial effects and that these effects will outweigh the risks is emphasized.

Combined transcranial Doppler and electrophysiologic monitoring for carotid endarterectomy

The results of carotid endarterectomy can be improved by reducing the perioperative embolic and hemodynamic risks. Electrophysiologic monitoring, although reliable, cannot provide full information. In this study, we report on the combined use of transcranial Doppler (TCD) and electrophysiologic monitoring in 153 patients undergoing 166 carotid endarterectomy procedures. TCD monitoring confirmed the low incidence of intolerance to cross-clamp (1.8%), showing a good correlation with electrophysiologic monitoring. In addition, it frequently showed embolic signals immediately after clamp release, but never during carotid dissection or in the final operative phases. Furthermore, TCD allowed the detection of hyperperfusional flow patterns in four cases, making immediate and aggressive control of arterial pressure possible.

Electrophysiological (EEG-SSEP) monitoring during middle cerebral aneurysm surgery

SSEPs were monitored during 38 procedures for aneurysms of the middle cerebral artery. In 13 selected patients intraoperative barbiturate protection with sodium thiopental was performed during temporary M1 occlusion. Combined EEG monitoring, showing burst suppression typical pattern of electrical cortical activity, allows a minimal dosage (3-6.5 mg/kg) of thiopental to achieve brain protection. Any patient with TYPE I SSEP changes had a new postoperative neurological deficit. Five patients during temporary middle cerebral artery clipping showed TYPE II SSEP changes and only one, not achieving burst suppression EEG pattern, had transient postoperative neurological deficit. In two other patients, a progressive worsening of TYPE II SSEP was observed; this was due to excessive brain retraction without brain protection and had a prolonged postoperative neurological deficit. Four patients showed TYPE IV SSEP changes during temporary M1 occlusion, one of whom was a 52-year-old woman, who, in spite of brain protection with thiopental, had serious postoperative neurological sequelae. In this patient N20 amplitude and central conduction time did not have full recovery to the preocclusive values. This study suggests that combined electrophysiological monitoring may reduce complications due to excessive retraction of cerebral tissue, make temporary clipping safer and improve the results of middle cerebral artery aneurysm surgery.

[Lateral calcaneal flap in the reconstruction of the calcaneal and malleolar region]

The authors discuss the efficacy of the lateral calcaneal artery flap in repairing the calcaneal and malleolar regions. The lateral calcaneal artery flap is a safe flap, with constant vascularization represented by the lateral calcaneal artery and the external saphenous vein; the flap has a sensory nerve (the sural nerve) and is a sensory flap. Its use in the calcaneal and malleolar region is very safe, because the vascular pedicle is constant and surgical transfer easy.

Reconstruction of the umbilicus: a simple technique

The author proposes a simple technique for umbilical reconstruction. The new umbilicus is represented by an island flap that is sunken and then sutured to a circular skin defect drawn at the intersection of the xiphoid-pubic line and the transverse umbilical line. Before sinking, an accurate excision of the subcutaneous fat of the skin island is performed. A natural-looking elliptical scar is obtained, without any additional scar and providing good aesthetic results. The technique proposed can provide a good alternative to existing umbilicus reconstruction techniques.

[Total reconstruction of the lower lid by the Mustardé's technic]

The total lower lid loss reconstructive technique of Mustardé is reported. The technique is presented step by step. The morphological and aesthetic results and the low incidence of complications are discussed.

Spinal cavernous angioma producing subarachnoid hemorrhage. Case report

A case of subarachnoid hemorrhage due to intramedullary cavernous angioma at the T9 level is presented. Literature dealing with subarachnoid hemorrhage due to intraspinal lesions is reviewed. The majority of cases of spinal subarachnoid hemorrhage are due to arteriovenous malformations, whereas bleeding by cavernous angioma is extremely rare. The subarachnoid hemorrhage is rare event (1.8%) in our series too. The clinical presentation of severe back pain with radicular component associated with signs of meningism (Fincher's syndrome) led us to carry out magnetic resonance imaging. This gave accurate diagnosis for surgical treatment. Laminectomy at T9-T10 level and total microsurgical removal of the vascular malformation were performed with total functional recovery.

[Tissue expansion in head and neck regions]

The Authors describe their experience with the use of 56 tissue expanders implanted in the head and neck regions of 45 patients observed in a follow-up of an average of 25 months. They emphasize the various possibilities of reconstructive surgery with the use of tissue expanders and the different mental approach required in order to organize surgical when this technique is employed. The criteria used in the selection of the type of tissue expanders is outlined and useful advice concerning the formulation of a surgical plan which employs the most favourable approach in making to avoid poor functional or aesthetic results or secondary complications is presented. Furthermore the surgical technique used to obtain adequate pockets for the insertion of tissue expanders in the different anatomical areas of the head and neck is described. The Authors affiem that in order to avoid damage to the surrounding neurovascular structures and to obtain good tissue expansion, the correct level of dissection is imperative. The options of using different anatomical areas during reconstructive surgery are discussed. For example, the insertion of a tissue expander in the forehead permits the availability of a large amount of usable tissue during nasal reconstruction, thus leaving the donor area without tension and with minimal scarring. Many different causes of baldness can be treated with the use of tissue expanders, such as posttraumatic injury, burns or infections. Tissue expansion can be utilized in the cheek area for the reconstruction of the lower eyelids, the paranasal and the mandibular area. Tissue expanders used in the cervical area can be utilized for reconstructive surgery of the lower lip or the mandibular area. In addition, the Authors discuss possible complications of this technique such as infection, suture distension and tissue expander extrusion. Recommendations are discussed in order to prevent these major complications. Having reviewed their personal experience the Authors feel they can confirm the reliability of this revolutionary technique in the field of plastic and reconstructive surgery. The use of tissue expanders permits the surgeon to obtain improved functional and aesthetic results which only a few years ago were not conceivable.

[Non-hypertrophic breast ptosis: classification and surgical treatment]

Non-hypertrophic breast ptosis are common diseases. Various degree of ptosis and different involutions of the breast tissue can condition the surgical treatment. Plastic surgery must provide the best surgical treatment in any case.

[Idiopathic unilateral hypoplasia of the breast]

Unilateral hypoplastic breast is a rare anomaly. The correction of the asymmetry is usually achieved by the use of breast implants or breast expanders. Sometimes the controlateral breast must be modified to gain a good symmetry.

Bilateral traumatic abducens nerve palsy. Case report

Bilateral traumatic abducens nerve palsy after head injury is a rare event. We present a case associated with skull fractures and intracranial hematoma, with complete recovery of abducens nerve palsy after six months. The mechanism of the lesion, the clinical conditions and the radiological findings are presented.

Primary cauda equina tumors

During the last seven years (1985-91) 28 primary tumours in the cauda among 104 intraspinal tumors were observed. The largest group (71%) comprised ependymomas and neurinomas. The rest included 5 lipomas, 2 astrocytomas and 1 epidermoid. Low-back pain without or with sciatic or crural irradiation was the most common initial symptom. The length of symptomatology is generally measured in months, because pain is erroneously referred to discal pathology for long time. The X-ray standard test and the CT scan have been of modest utility in the diagnosis of these lesions, but however they have been necessary for diagnostic screening. The MNR, a bloodness test, showed an important diagnostic value for the identification of these tumors; it is also useful in follow-up to exclude recurrence. The lipoma's and ependymoma's surgery, although performed by microsurgical techniques, showed great problems. Total removal of the ependymomas assured no recurrence at the follow-up. Sphincter disturbances were frequent after the operation, but they disappeared after some months. In most patients with lipomas the resection was partial, but at follow-up they were symptomless. Neurinomas' surgery presented less technical difficulties and the postoperative course was more favorable. Astrocytomas underwent to radiotherapy but their prognosis is not favorable.

Spontaneous regression of intracranial arteriovenous malformation

Spontaneous regression of an arteriovenous malformation is rare. When complete or partial regression occurs, an associated factor is usually involved, such as intracranial hemorrhage, surgery, radiation therapy, or a new neurological deficit. Another case in which the resolution was totally spontaneous is presented here. We discuss the importance of transcranial doppler revealing the hemodynamic changes in the cerebral arteries in the presence of an AVM and when the latter is thrombosed. Several mechanisms for regression are considered, and we focus on the dissection of the afferent vessel, pointing out the role of such an event in the natural history of AVM.

Reduction mammaplasty and correction of ptosis: a personal technique

New upper pedicle reduction mammaplasty and mastopexy techniques are presented. The surgical steps are described point by point. An analysis is made of the results obtained in 25 patients who underwent surgery between November of 1987 and November of 1988 and were examined in December of 1990 with a mean follow-up of 31.5 months. An assessment was made of the postoperative ptosis, which was minimal in 76 percent of patients. The overall assessment of breasts was satisfactory (good mammary morphology and a correct position of the nipple-areola complex). Nipple-areola complex sensitivity was unchanged in 80 percent of patients. Good-quality inframammary scars were observed in 92 percent of patients, with scar length never exceeding 4 cm. The overall complication rate was 32 percent, but only 12 percent were major complications. The technique presented is excellent when the quantity of glandular tissue to be removed is less than 400 gm, and it is not therefore recommended for gigantomasties.

Cosmetic reconstruction of the mons veneris and lower abdominal wall by skin expansion as the last stage of the surgical treatment of bladder exstrophy: a report of three cases

The results of the correction of the medial scar depression and diastasis of the pubic hair of the mons veneris in three postpuberal female patients operated on for bladder exstrophy are reported. The reconstructive surgery is carried out using skin expanders. The expanded skin is utilized to create two dermoadipose flaps to fill the medial depression, to outline again the public hair areas, and to allow sutures without tension.

[Macromastia in adolescents: notes on clinical aspects and therapy]

The surgical correction of macromastia is justified on both physical and psychological grounds. Hypertrophy of the breast may alter the development of the body, causing severe damage to the spinal cord. It may also condition the psychological or mental development of the patient, even going so far as to bring about fully fledged psychoses. The definitive scars of the surgical correction are generally accepted by the patients.

[The risk of pulmonary embolism in neurosurgery]

Pulmonary embolism (PE) is a frequent necroscopic finding in neurosurgical patients and this contrasts with the difficult diagnosis of it when the patient is still alive. Such a lack of diagnosis has promoted numerous studies into deep-vein thrombosis (DVT) which is, in most cases, the cause of pulmonary embolism. However, a prophylaxis of DVT cannot be indiscriminately carried out in neurosurgical patients because it is not without potential risks. For this reason we considered it useful to investigate whether among the risk factors for DVT there were any particularly responsible for the development of PE in neurosurgical patients. Our case study was carried out retrospectively on 144 patients hospitalised in the Neurosurgical Institute of Pisa University suspected of PE. In 88 of the cases the suspicion had been confirmed by perfusion lung scanning; in 56, on the other hand, it had been excluded. These two groups of patients resulted homogeneous for sex, age, blood group, and for the presence of any risk factors of cardiovascular diseases. An important difference between the two groups was the pathology which had motivated their hospitalisation; in fact, 50% of the patients with PE were affected by neoplastic pathologies of the CNS, against 28% of the others. The anamenestic evidence of previous neoplastic pathology in different sites of the CNS was much more frequent in patients who had developed PE. As far as the other risk factors we examined are concerned, it resulted that only 12.5% of the patients with PE had presented clinical signs or symptoms of phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of intracranial circle after carotid endarterectomy

To evaluate haemodynamic effects of carotid endarterectomy on cerebral circulation, transcranial Doppler sonography was performed on 69 patients operated for unilateral carotid stenosis greater than 70%. Pre- and post-operative Vm and PI on bilateral middle-cerebral arteries, Vm PI and flow direction on ipsilateral anterior cerebral artery and Vm on basilar artery were evaluated. All patients presented more or less evident preoperative haemodynamic alterations of cerebral circulation and after surgery showed a normal distribution of cerebral blood supply.

Intracranical aneurysm and cerebral embolism

Embolism from the aneurysmal sac is a rare but possible manifestation of intracranial aneurysm; thrombus formation is probably related to the combined action of turbulent flow and a 'stagnant zone'. Three cases are presented: 2 with giant aneurysms (1 internal carotid and 1 sylvian) and 1 with a large aneurysm of the middle cerebral artery. In the latter, surgical treatment was performed, while in the others a conservative therapy was preferred. No ischemic manifestations were observed in the follow-up.

The role of TCD in hemodynamic evaluation of cerebral AVMs

The cerebral AVMs have a considerable hemodynamic complexity and the transcranial doppler sonography may now provide noninvasively accurate hemodynamic information about these vascular lesions. It provides hemodynamic data like blood flow velocity on feeding arteries, intracranial steal phenomena, cerebral autoregulation disease as illustrated in 19 patients.

Multiple keratoacanthomas: a case report with evidence of regression with thymic hormone

A case of multiple keratoacanthomas (KAs) arising on sun-damaged skin in a 63-year-old male is reported. The patient showed a moderate elevation of the T-helper/T-suppressor ratio. Therapy with thymic hormone appeared to improve the condition.

Acute spontaneous subdural haematoma. Description of four clinical cases

Four cases of acute spontaneous subdural haematoma are described. A review of the literature reveals the rarity of this pathology. The several etiological possibilities are discussed. The clinical onset may simulate other cerebrovascular diseases. The prognosis is correlate to the neurological findings at the operations.

The reservoir-pusher in breast reconstructive surgery

This paper describes a surgical instrument designed for the subcutaneous insertion of the Becker expander reservoir. The instrument has proven to be particularly easy to use, and it has several safety features for avoiding rupture of the reservoir and the linkup tube.

The dermal pursestring suture: a new technique for a short inframammary scar in reduction mammaplasty and dermal mastopexy

The author hypothesized the possibility of reducing the extent of the scar formed at the inframammary sulcus in reduction mammaplasty and mastopexy by burying the dogear of excess skin in the region of the inframammary sulcus using a pursestring suture after first removing the epithelium. The results of 15 patients with follow-up periods ranging from 20 to 150 days encourage further application of this technique, which leaves a very small, aesthetically satisfactory scar.

Spontaneous recanalization of carotid artery occlusion following non traumatic dissection

We studied 7 patients with internal carotid occlusion following spontaneous arterial dissection. All presented strokes, in one associated with Horner's syndrome. The doppler examination showed carotid occlusion, but only angiography established the diagnosis of vascular disease. Spontaneous recanalization was observed in 6 cases, treated only by antiplatelet drugs.

[Enteral nutrition in the critical neurosurgical patient. Effectiveness and tolerance of a prepared liquid diet]

The response of prealbumin was studied in 15 neurosurgical patients following 7 days of enteral nutrition by Nutrisond. Baseline values were compared to day 4 and 7 to assess the degree of change. The prealbumin of day 7 versus baseline value showed a significant increase in the mean serum concentration (16.49 +/- 4.0 vs 19.75 +/- 4.2 mg %). All the patients tolerate well the enteral nutrition with Nutrisond.

Multimodality evoked potentials in myotonic dystrophy

Multimodality evoked potentials were performed in 18 patients affected by myotonic dystrophy (8 males and 10 females); the aim was to make an electrophysiological evaluation of the central nervous system involvement in this disease. We observed brainstem, somatosensory and visual evoked potential abnormalities respectively in 53%, 62.5% and 71.4% of cases, with no apparent relationship to the severity of the disease. Our abnormal findings provide further confirmation of CNS involvement in myotonic dystrophy and occur in various combinations suggesting an aspecific involvement at different levels, reflecting the multisystemic character of this disease.

[Long-term non-deforming urinary infections in childhood. 2. Proposed treatment and results]

In the second part of the Authors work, they report the results obtained in the treatment of 85 female children with recurrent non malformative urinary tract infections. The first group of 15 female children had been treated with phenoxybenzamine and urinary chemyotherapycs with little satisfaction. The other two groups, both of which consisted of 35 children, one group was treated with only chemyotherapycs and the other with chemyotherapycs associated to oxybutynin chloride. The best results were obtained in the last group regarding the improvement of the symptoms and earlier and higher incidence of sterilization of the urine. At the same time in this group the maximum cystometric capacity and vesical compliance were brought back to normal and the detrusorial instability disappeared.

[Long-term non-malformative urinary infections in children. (I)]

Non malformative long term urinary tract infections affect above all the female sex. The specific anatomic conditions explain only in part the predisposition for the female sex. Other determinants are the individual susceptibility and bacterial virulence. The authors studied 169 pediatric patients with recurrent urinary tract infections; of which 159 where females. The study of the blood group in 70 patients showed a net predominance of the groups B and AB. About one-third of the patients studied presented a scarce symptomatology or complete absence. The urodynamic study in 120 patients has revealed an abnormal pattern in more than 80% of the cases. According to the authors the abnormal urodynamic pattern is related to the long-term infection and is reversible in the cases which are curable. In about one-third of the cases with long-term infections which are resistent to the therapy, the cystoscopy has revealed a cystitis cystica. The study carried out by the authors permits precise indications on the specific tests that must be effectuated in this particular type of pathology and the indications of treatment.

[Ureterocele: study of 66 cases observed in 60 children]

Ureterocele is an unfrequent urinary malformation in pediatric age, but frequently it is clinically severe. Ureterocele in a double pyelo-ureteral system often presents very difficult treatment problems not uniformely dealt with. Authors report their experience with 66 ureteroceles observed in 60 children; more than a half of which were less than one year old. In the authors experience simple ureterocele does'nt give any surgical problem. On the contrary ectopic ureterocele, almost always associated with a pyeloureteral duplication, frequently gives some problems of surgical treatment. Treatment is always individualized but in our experience the best results have been achieved with unroofing of the ureterocele and upper heminephoureterectomy in one stage. This treatment can be used successfully in the majority of ectopic ureteroceles in pediatric age.

[Papillomatosis of the bile ducts: a clinical case]

A case of diffuse papillomatosis of the bile duct, treated with external biliary drainage, is reported on account of its rarity. The extent and anatomopathological characteristics of the lesion make radical surgery impossible, so that the above-stated surgical solution appears to the Authors to be the most suitable one for resolving the biliary stasis and consequent cirrhosis.

An unusual vascular pedicle in a deltopectoral free flap

An unusual vascular pedicle of a deltopectoral flap is reported and the case is discussed. We suggest noting any anomalies in the flap's vascularization during its dissection.