Neonatal bacterial meningitis

Neonatal bacterial meningitis (NM) continues to be a serious disease with an unchanging rate of adverse outcome of 20-60%, despite a worldwide decline in mortality. The 3 major pathogens in developed countries are: Group B streptococcus, gram negative rods and Lysteria monocytogenes. Signs and symptoms of NM may be subtle, unspecific, vague, atypical or absent. In order to exclude NM, all infants with proven or suspected sepsis should undergo lumbar puncture. Positive culture of cerebrospinal fluid may be the only way to diagnose NM and to identify the pathogen, as CSF parameters Smay be normal at early stages and NM may occur frequently (up to 30% of cases) in the absence of bacteraemia. When NM is suspected, treatment must be aggressive, as the goal is to achieve bactericidal concentration of antibiotics and to sterilize CSF as soon as possible. Antibiotics should be administered intravenously, at the highest clinically validated doses. Empiric antibiotic treatment should include agents active against all main pathogens; currently the recommended empiric treatment of NM is ampicillin, plus an aminoglycoside and a third-generation cephalosporn. Therapy should be reassessed after cultures and antibiotic susceptibility is available. Prevention of neonatal sepsis, early recognition of infants at risk, prompt treatment and future adjunctive therapies will improve prognosis. Finally, we present the first preliminary Italian data on GBS meningitis. Data are obtained from an area-based study conducted In Emilia-Romagna during 2003 to 2009.

Gemcitabine plus cisplatin in the treatment of patients with advanced non-small cell lung cancer: a phase II study

BACKGROUND

Lung cancer is the leading cause of cancer death in men worldwide; most cases are not suitable for radical surgery at diagnosis and palliative treatment remains the primary goal of therapy. Cisplatin and gemcitabine are among the most active cytotoxic agents for the treatment of non-small cell lung cancer (NSCLC): they have non-overlapping toxicity and preclinical studies have demonstrated their potential synergistic interaction.

PATIENTS AND METHODS

The aims of the present study were to assess the activity and tolerability of cisplatin 80 mg/m2 on day 1, combined with gemcitabine 1000 mg/m2 on days 1 and 8, administered every 3 weeks. A total of 46 consecutive patients with advanced NSCLC entered this study; all of them were evaluable for toxicity and for activity.

RESULTS

According to an intent-to-treat analysis, 15 patients attained a partial response (33%), 9 (20%) obtained a disease stabilisation and 22 (47%) progressed. This regimen appeared to be modestly toxic, with grades 3-4 leukopenia and thrombocytopenia observed in 10% and 6% of cases respectively; grade 3 vomiting appeared in 12 patients (26%) and grade 3 mucositis in 1 patient. The median time-to-progression and overall survival were 200 and 400 days, respectively.

CONCLUSION

Our study of gemicitabine + cisplatin on stage IV NSCLC patients achieved favourable results in terms of toxicity and overall survival.

Scleral fixation of an intraocular lens in the absence of capsular support

PURPOSE

To ascertain the best surgical technique for fixating an intraocular lens (IOL) in the posterior chamber in the absence of capsular support.

SETTING

From the Institute of Ophthalmology, Pavia University, Pavia, Italy.

METHODS

Using the SFVT System, the phases of IOL fixation were evaluated in cadaver eyes. In addition, IOLs were implanted in the posterior chamber in 340 eyes of patients without capsular support. One of several IOL fixation methods was used; IOL power was calculated using the same parameters as when the lens is positioned in the sulcus. Mean follow-up was 3.5 years (range 2 months to 5 years).

RESULTS

Intraocular lens placement was accurate only when the loops were positioned in the sulcus, with the best approach being internal with suspension sutures placed at 3 and 9 o'clock. In most cases, refractive results were good; 152 eyes were within +/- 1.00 diopter of the predicted value.

CONCLUSION

In eyes without capsular support, IOL implantation in the sulcus was possible only when sutures were placed exactly through the sulcus. An internal approach using suspension sutures at 3 and 9 o'clock gave the best results.

Total hip arthroplasty in patients dialyzed or with renal transplants

The authors present 15 cases of hyp arthroplasty implanted in patients affected with necrosis of the femoral head, which were undergoing periodic hemodialitic treatment, or with renal transplants. Ceramic-ceramic prostheses were prevalently used and only in 1 case was a metal-polyethylene prosthesis used. Because of precarious mineralization a cemented prosthesis was implanted in dialyzed patients; in renal transplants, instead, cemented or cementless prosthesis were used depending on the state of the bone. There was a high percentage of excellent results after 2-8 years (87%), and this confirms the validity of surgical indications for the use of arthroplasty in hips affected with epiphyseal necrosis in order to favor functional recovery: considering the young age od the patients, this helps them to go back to being a part of society, and to recover psychologically.

Carpal tunnel syndrome in hemodialyzed patients

A total of 18 hemodialyzed patients submitted to surgery for the treatment of carpal tunnel syndrome are examined. In all of the cases pre- and postoperative EMG and biopsy were performed. Six months after surgery all of the patients showed improved pain symptoms, in 66% there was good recovery of sensitivity and of the function of the hand: these results were confirmed by EMG monitoring. In all of the biopsies amyloid deposits, particularly diffused in the tendinous and nervous sheaths, were observed. At 2-year follow-up 75% of the patients showed recurrence of pain symptoms. Thus, surgery does not seem to definitively resolve symptoms.