Etiology of prosthetic joint infections in a tertiary care centre in Italy.

Prosthetic joint infections (PJIs) represent a severe complication in orthopaedics. Coagulase-negative staphylococci (CoNS) and Staphylococcus aureus represent the most frequent cause, but Gram-negatives have also been reported. With a view to describing the aetiology of PJIs diagnosed from January 2005 to September 2007 at S. Corona Hospital in Pietra Ligure, Italy, we conducted retrospective analysis of pathogens isolated from PJIs by means of surgical specimens, needle aspirates or swabs of fistula (3 samples). During the study period 228 PJIs were described and 141 (62%) were microbiologically documented and evaluated. Early and delayed infections represented 45% of episodes, while late infections were observed in 55%. The aetiology was mono-microbial in 84% of cases, and polymicrobial in 16%. CoNS and S. aureus were the most frequently isolated pathogens. In early and delayed infections methicillin resistant CoNS were 30% and 24%, respectively, while in late infections they were 17%. Methicillin-resistant S. aureus was isolated in 13% of early, 22% of delayed and 15% of late infections. Gram-negatives were described in 16% of episodes without differences being found in the three groups. In our report staphylococci represented the most frequent cause of PJIs. Methicillin-resistant strains were more frequently isolated in early and delayed infections, but their frequency in late episodes was not negligible. Polymicrobial infections and Gram-negative infections were also frequent.

Rhabdomyomatous (mesenchymal) hamartoma of the tongue: report of a case.

A 12-year-old girl presented with three yellowish polypoid lesions in the lateral border of tongue since birth. Histological examination showed oral mucosa covered by squamous epithelium and an underlying vascularized fibrous stroma, containing small and short bundles of striated muscle, corresponding to a rhabdomyomatous hamartoma.

Carcinoma de células transicionales del tracto urinario superior: factores pronósticos / Transitional cell carcinoma of the upper urinary tract: prognostic factors

El carcinoma de células transicionales del tracto urinario superior representa aproximadamente el 5 por ciento de todos los tumores de urotelio. El tratamiento estándar es la nefroureterectomía, aunque en años recientes se ha producido un mayor desarrollo de técnicas conservadoras para tumores superficiales y de bajo grado. El objetivo de este trabajo es presentar una descripción de los pacientes operados por esta enfermedad tumoral durante los últimos 10 años en nuestra institución, evaluando la importancia de los probables factores pronósticos de recurrencia y sobrevida después del tratamiento quirúrgico. Los datos fueron obtenidos mediante revisión de fichas clínicas, informes de anatomía patológica y certificados de defunción, además de seguimiento telefónico, de los pacientes operados un nuestro centro entre 1992 y 2001. Fueron registradas las características de los pacientes y de los tumores, la forma de presentación, el estudio diagnóstico, el tratamiento recibido, las recurrencias y las muertes, señalando la causa de éstas. Para el análisis estadístico se compararon curvas de Kaplan-Meier mediante log-rank test. Se obtuvieron datos de 25 pacientes, 16 hombres y 9 mujeres. El seguimiento fue de 100 por ciento, con una mediana de seguimiento de 13,8 meses (1-56 meses). La edad promedio fue de 69±13 años. El tumor primario se localizó en pelvis, uréter y unión pieloureteral en 76 por ciento, 16 por ciento y 8 por ciento de los casos respectivamente. El factor de riesgo más importante fue el tabaquismo (40 por ciento de los pacientes). El 88 por ciento de los pacientes tuvo hematuria macroscópica como forma de presentación. En el 90 por ciento de los casos fue necesario realizar dos o más estudios de imágenes para el diagnóstico. El tratamiento inicial de todos los pacientes fue quirúrgico: nefrectomía en 18 pacientes (72 por ciento), nefrectomía en 4, nefrectomía parcial en 1 y nefroureterectomía distal en 1. El tumor fue superficial (Ta/T1) en 20 por ciento e invasor (T2-T4) en el 80 por ciento de los casos. El 70 por ciento de los tumores tuvo grado III o IV de Broders. La linfadenectomía fue positiva en 2 de 6 pacientes. Se empleo quimioterapia y/o radioterapia adyuvante en 4 pacientes. La tasa de sobrevida actuarial cáncer-específica a 5 años fue de 100 por ciento para los tumores superficiales (Ta/T1) y de 40 por ciento para los tumores invasores (t2-t4)...

Bullying and sexual harassment in the school setting.

This article defines bullying and sexual harassment, identifies associated characteristics of the aggressor and the victim, and describes implications for school nurses. The background of federal laws with a focus on the most current 1999 Supreme Court decision, holding a school district liable for damages under federal law (Title IX), is addressed with a case study. Health promotion issues and prevention concepts are outlined in a 10-Point Action Plan to facilitate the prevention and management of bullying and sexual harassment in schools. A survey tool to assess bullying and teaching plans for parents of victims and aggressors are provided. Suggested linkages among approved nursing languages, North American Nursing Diagnosis Association (NANDA) nursing diagnoses (NANDA, 1998), Nursing Interventions Classification interventions (Iowa Intervention Project, 2000), and Nursing Outcomes Classification outcomes (Iowa Outcomes Project, 2000) are included for use in developing nursing care plans for both aggressors and victims of harassment.

[Thymostimulin in the therapy of bronchiolitis: clinical evaluation in a controlled study]. / La timostimolina nella terapia della bronchiolite: valutazione clinica in uno studio controllato.

Twenty-eight infants with bronchiolitis were randomized divided into two groups. Clinical diagnosis was made by scores indicated by the Bronchopneumology Study Laziale. Group one received thymostimulin (TP-1 Serono: 1.5 mg/kg/die for five days), while in the second group it was not administered. Interferon concentration in frozen serum (-20 degrees C) was evaluated at entry and after 48 hours. Etiology, severity grade and clinical characteristic were similar in both groups; this has made reliable the present evaluation. Although, in the first four days clinical score was slightly lower in the first group than in the second, there were not observed differences with statistics significance and hospitalization was similar in both groups. Because there has been described in literature an increase in interferon's production after TP-1 administration we evaluated the influence of this hormone on interferon's production. There were no differences with statistics significance with or without treatment. This study has not showed an important TP-1's efficiency in the treatment of bronchiolitis.

Defective interferon-alpha production in children with recurrent respiratory tract infections. A primary or secondary deficiency?

Interferon-alpha and -gamma production was assayed in 44 children with recurrent respiratory tract infections, in 9 patients with recurrent stomatitis and in 32 control subjects. A partial, transitory deficiency in interferon-alpha production was found in 2 children with recurrent respiratory tract infections. The deficiency may be either cause or effect of the recurrent infections. Many data support the latter hypothesis.

Evidence of circulating interferon-gamma in newly diagnosed diabetic children.

Acid-stable interferons (IFN-alpha or IFN-beta) are produced by nucleated cells infected by virus, while acid-labile interferon (IFN-gamma) is synthesized by activated T-lymphocytes. IFN-gamma or an atypical form of acid-labile IFN-alpha have been observed in the circulation of some patients with autoimmune disease. It is believed that autoimmunity and/or viral infections are involved in the pathogenesis of insulin dependent diabetes mellitus. We therefore examined the sera of newly diagnosed diabetic children for the presence of virus-induced or acid-labile IFN. Significant IFN levels (greater than or equal to 8 U/ml) were observed in 11 of 29 patients when compared to 31 healthy children in the same age range. The inhibitor is characterized by species specificity, acid-lability and neutralization with anti-serum for IFN-gamma.