In vitro antimicrobial activity of several antimicrobial agents against Escherichia coli isolated from community-acquired uncomplicated urinary tract infections.

AIM: For frequency Escherichia (E.) coli is the agent of urinary tract infections (UTIs). The objective of the present study was to evaluate in vitro activity of several antimicrobial agents to guide empirical treatment of uncomplicated UTIs. In vitro antimicrobial susceptibility of 429 E. coli strains, isolated in urine specimens from community-acquired uncomplicated UTIs in outpatients, was studied during the 1st semester 2011. MATERIALS AND METHODS: Urine samples were processed with Robobact/Uriset system. E. coli strains were identified with GN card for VITEK-2 system and API 20E gallery, as confirmatory assay. E. coli strains were tested, for antimicrobial susceptibility, using VITEK-2 system and confirmed with disk diffusion method. RESULTS: Penicillins have exhibited sensitivity percentage of 50.9%, inhibitor-protected penicillins 88.9%, cephalosporins 91.6%, carbapenem 100%, aminoglycosides 91.5%, fluoroquinolones 71.8%, nitrofuran 99.3% and sulfonamide 74.1%. CONCLUSIONS: In vitro imipenem, nitrofurantoin, cephalosporins and aminoglycosides (>90% of isolates) have the best sensitivity in community-acquired UTIs. In particular nitrofurantoin has showed a low MIC distribution and high sensitivity percentage. Therefore, could be suggested in empirical treatment of these infections.

Prognostic impact of macrometastasis linear size in sentinel node biopsy for breast carcinoma.

AIM: The aim of the present study was to evaluate the risk of axillary non-sentinel lymph-node metastases (ALN) in breast cancer patients presenting macrometastasis (Mac-m) in the sentinel lymph node (SN). MATERIALS AND METHODS: A retrospective series of 1464 breast cancers from patients who underwent ALN dissection following the diagnosis of Mac-m in the sentinel node (SN) was studied. In all the cases the MAC-m linear size was evaluated and correlated with presence or absence of non-SN ALN metastases. RESULTS: Non-SN metastases were detected in 644∖1464 cases (43.98%). The risk of further axillary metastases ranged from 20.2% (37/183) in cases with Mac-m between 2 and 2.9 mm, to 65.3% (262/401) in cases with Mac-m measuring > 10 mm. The risk of non-SN ALN metastases showed a 3% increase, parallel to each mm increment in SN metastasis size. The data evaluated with the receiver operating characteristic (ROC) curve showed that the Mac-m could be subdivided according to a new cut-off of 7 mm. pT1 tumours, with Mac-m < 7 mm had a risk of non-SN ALN metastases of <30%. Furthermore 109/127 of these (85.8%) had 3 or less non-SN ALN -metastases. CONCLUSIONS: The present data give a detailed description on the risk of non-SN ALN involvement, that may be useful in the evaluation of breast cancer patients. It is suggested that a Mac-m size of <7 mm is related to a low residual axillary disease burden in breast cancer patients with small (pT1) tumours.

Severe hypoxia enhances the formation of erythroid bursts from human cord blood cells and the maintenance of BFU-E in vitro.

Incubation in severe hypoxia (1% oxygen) increased the number of erythroid bursts generated from full-term CD34+, or premature mononucleated, human cord blood (CB) cells, in semisolid cultures containing stem cell factor (SCF), interleukin (IL)-3 and erythropoietin (EPO). Severe hypoxia also enhanced the maintenance of erythroid burst-forming units (BFU-E) in CB cell liquid cultures. These positive effects of hypoxia on the maintenance and cloning efficiency of BFU-E did not extend to the other progenitors assayed. Hypoxia, on the other hand, markedly reduced the size and level of hemoglobinization of bursts and, in liquid cultures, suppressed the growth factor-stimulated numerical increase in BFU-E and inhibited the expression of CD36, a marker of erythroid colony-forming units and maturing erythroid precursors. However, when transferred to clonal assays incubated in air, cells from liquid cultures incubated in hypoxia or in air generated fully expanded and hemoglobinized bursts, suggesting that in hypoxia the clonogenic potential of BFU-E was maintained and the development of erythroid clones reversibly inhibited. These results indicate that hypoxia inversely regulates two subsequent phases of erythropoiesis, i.e., it enhances the maintenance of BFU-E and the early development of erythroid clones but inhibits the terminal expansion and maturation of these clones. The cloning of CB cells selected for CD34 positivity, when compared with that of the total population of mononucleated CB cells, revealed that the early development of erythroid bursts was either hypoxia-enhanced or hypoxia-insensitive, reflecting the existence of two different types of BFU-E. Hypoxia-enhanced BFU-E are relatively immature, are maintained in hypoxia but not in air, and account for a large part of CD34+ BFU-E and for a high percentage of the BFU-E in premature CB. Hypoxia-insensitive BFU-E are mostly CD34- and are largely predominant in full-term CB, and most probably correspond to a more mature type of BFU-E.

[External version in the breech presentation: a review of the literature and our experience]. / Il rivolgimento per manovre esterne nella presentazione podalica: revisione della letteratura e nostra esperienza.

OBJECTIVE: To evaluate the possibility to decrease the rate of cesarean delivery for breech presentation through use of a protocol that calls for cephalic version. STUDY DESIGN: Between january 1991 and april 1994 we offered cephalic version under tocolysis to patients whose fetuses were in breech position beyond 36 weeks' gestation and who were not in active labor. The protocol included real time ultrasonic scanning and pre- and post-procedure electronic fetal monitoring. A variety of maternal and fetal factors considered likely to affect success were coded for each patient. RESULTS: The conditions for an attempt at external cephalic version were satisfied in 47 cases. External version was accomplished in 32 cases (68%). Among patients in whom version was successful 20% required cesarean delivery for routine obstetrical indications. No major complications were noted. Successful version was more likely in women with amniotic fluid index > 50 and in those with posterior placental situation. CONCLUSIONS: We conclude from our experience and previous studied that the external cephalic version is a reasonable alternative in the management of pathological presentations near term, provided that only low risk pregnancies are included.

[Echographic measuring of the length of the fetal femur in the screening for Down syndrome]. / Misurazione ecografica della lunghezza del femore fetale nello screening della sindrome di Down.

OBJECTIVE: Our purpose was to assess the value of sonographic measurement of fetal femur length in the second trimester, as a screening tool for Down's syndrome. STUDY DESIGN: We evaluated a consecutive series of fetuses scanned by a single sonologist at the time of amniocentesis between 15 and 19 weeks. The study group consisted of fetuses with Down's syndrome (N = 16); the control group comprised normal fetuses (N = 1163). A linear regression model of the normal femur length based on biparietal diameter (BPD), was established for our population; the ratios of measured to expected femur length for a viven BPD (FL M/E) were calculated in the two groups. To test statistical significance of observed differences between case and control population, unpaired t test was used. The ability of specific FL M/E cut-off values to discriminate between Down syndrome and normal fetuses was assessed by Fisher's exact test. RESULTS: The mean ratio of measured to expected femur length was significantly lower in the Down syndrome as compared with control population (0.9473, DS 0.0795) versus 1.0, DS 0.0745) (p < 0.0045). The ratio of 0.91 or less predicted Down's syndrome with a sensitivity of 43.7% and a false-positive rate of 8.6%. For women with risk of one in 250 and one in 1000 of having an affected fetus based on maternal age, a shortened femur yielded positive predictive values of one in 26 and one in 105, respectively. CONCLUSION: These results suggest that the sonographic measurement of fetal femur length for the screening of Down syndrome in the low-risk population is hindered by a high false positive rate (about 9%). It follows that the percentage of women requiring an amniocentesis would increase to un unacceptably high level. The utilization of this biometric marker may be helpful, in our opinion, for identifying fetuses at risk for Down syndrome in women between 35 and 38 years of age. These women in fact, are not offered amniocentesis for the prenatal diagnosis of Down's syndrome in the majority of italian institutions. The sonographic measurement of fetal femur length could detect about 45% of fetal Down's syndrome, offering an amniocentesis to 9% of women, with a consequent reduction of the cost required. Only a prospective study can evaluate the efficacy of this method to predict Down syndrome in such group of women.

[The use of Rossavik's mathematical model in determining individual intrauterine growth curves. Our experience]. / Utilizzazione del modello matematico di Rossavik nella determinazione delle curve individuali di crescita intrauterina. Nostra esperienza.

OBJECTIVE: To evaluate the performance of Rossavik growth models, derived from II trimester ultrasound measurements, to predict growth in normally growing fetuses. DESIGN: Comparison between observed measurements after 25 weeks and those predicted by Rossavik growth models determined from the data collected in 2 ultrasound examinations at approximately 16 weeks and 24 weeks. SETTING: Teaching hospital obstetric unit, in Florence. SUBJECTS: Thirty women who delivered normal term fetuses in our unit, between January 1991 and December 1992. MAIN OUTCOME MEASURES: Determination of the expected growth curve after 25 weeks from the appropriate growth models, for these fetal parameters: biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). The differences between sonographic measurement of each parameter, at various time points, and predicted values were expressed as a percentage of the predicted values. Head circumference and weight measured in each infant were also compared with the predicted values at term. RESULTS: Mean percent deviation values were comprised between -0.02% (+/- 2 SD: 3.9%) for BPD and +0.75% (+/- 2 SD: 4.6%) for FL. Pearson's correlation coefficients between predicted and observed fetal parameters, ranged from 0.89 for AC and 0.94 for BPD. For HC and estimated weight at birth, the percent deviations were 0.84% (+/- 2 SD: 5.6%) and 1.23% (+/- 2 SD: 10.5%), respectively. The mean percent deviations for all parameters, were not significantly different from zero. CONCLUSIONS: Our results confirm the accuracy of Rossavik growth model in predicting growth after 25 weeks in normally growing fetuses.

The impact on a health care system of a program to facilitate self-care.

BACKGROUND: High utilization for self-limiting conditions has challenged health care systems to be innovative. The facilitation of self-care has been identified as a viable concept to control demand and encourage efficient use of resources. A Self-Care Intervention Program (SCIP) coupled with a Health Promotion Pharmacy (HPP) was implemented in an Army health care system to determine the impact on the use of self-care. METHODS: A questionnaire was mailed to 283 SCIP participants at the 6-month interval to assess achievement of program objectives. Use of the HPP was documented during the same interval. The response rate was 67.5% (n = 191). RESULTS: A positive response was obtained for all six program OBJECTIVES: Increased knowledge of personal health issues (84.3%); increased confidence to treat minor illnesses (77%); improved opinion of the health care system (74.9%); increased practice of healthy behaviors (64.9%); and an increased commitment to seek preventive medicine (62.8%). Seventy-two percent of the respondents reported avoiding at least one clinic visit, and 39.8% reported avoiding at least one visit to the emergency room. The calculated return on investment was 11:1. CONCLUSION: A formal self-care program supported by a pharmacy can have a positive effect on participants' health and health care, resulting in cost-effective demand management.

[Tumors of the excretory urinary tract in workers of the textile industry in the Prato area]. / Tumori delle vie urinarie escretrici negli addetti all'industria tessile nell'area pratese.

A hospital-based case-control study on bladder and lower urinary tract cancers was conducted in the Prato area, where the textile industry is the main manufacturing sector (about 50,000 employees). "Cases" were male subjects, aged over 15 years in whom urothelial cancer had been diagnosed in the period 1980-1985; controls (two for each case) were subjects of the same sex and age with other urological diseases or cancer of the prostate or testis. Cases and controls were interviewed via a questionnaire on occupational history and personal habits. A positive association was found for subjects who had worked in the textile industry (O.R. = 1.42; C.I. = 1.0-2.0). Analysis by job titles showed positive association for "rag selectors" (O.R. = 4.09; C.I. = 1.39-11.96), whereas no association was found for dyers (O.R. = 0.74; C.I. = 0.29-1.87).

Hemangiopericytoma-solitary fibrous tumour of soft tissue: description of a case showing atypical histological features.

Extrathoracic solitary fibrous tumours have been reported in almost all anatomic sites, but reports of tumours in the extremities or in intramuscular locations, as well as of tumours with atypical histological features and malignant behaviour, are rare. Herein the authors describe a case of hemangiopericytoma-solitary fibrous tumour that arose in the gluteal region of a 47-year-old woman. The tumour showed atypical histological features, such as high cellularity, increased mitotic activity and focal expression of cytokeratins.

Dynamic echohysteroscopy: new perspectives for diagnostic sonography in female infertility.

Dynamic echohysteroscopy is a new diagnostic method which can be applied to the clinical problems of infertility, providing informations on the morphology of the internal genitals. The Authors underline the clinical validity of this diagnostic technique, even though more experience is required in order to define a better standardization of the method.

[Radiological considerations of cranio-facial volumetry in the newborn (author's transl)]. / Osservazioni radiologiche di volumetria cranio-facciale nel neonato.

The authors have reported that the wide range of sizes of the normal skull, make difficult the assessment of macrocephaly and microcephaly of mild degree. For this fact they studied and applied a simple method based on the measurement of the cranial capacity and facial volume and on their relationship; they have calculated the "cranio-facial ratio" (CFR), in 42 normal newborns (21 females and 21 males), whose range is sufficiently delimited, consenting a more precise judgement in pathological field.

A rare case of cytogenetic discrepancy between extraembryonic and fetal tissue.

We present a case of false-negative discrepancy between extraembryonic and fetal tissue sampled at 14 weeks of amenorrhoea when ultrasound examination showed morphological anomalies of the fetus. The same cytogenetic characteristic was confirmed on tissue samples after abortion.

Evaluation of maternal serum alpha-fetoprotein and ultrasound examination to screen fetal chromosomal abnormalities.

Maternal serum alpha-fetoprotein (MSAFP), anatomic anomalies and precocious defects of foetal growth were shown as possible "indicators" of foetal chromosomal pathology, in particular Down's syndrome, and thus suggested for prenatal screening of risk patients for this chromosomal abnormalities. The Authors carried out a retrospective study on 1472 patients who underwent amniocentesis for prenatal diagnosis. Between the 15th and the 20th week, a dosage of MSAFP was effected, in order to evaluate if the serum concentration of this substance could predict Down's syndrome. A contemporary study by echographic monitoring was effected on 500 patients from the 1st trimester of pregnancy, in order to detect possible foetal growth retardation precociously and to determine the karyotype in these cases. Results are very interesting and suggest both the dosage of MSAFP and the ecographic monitoring for prenatal screening of trisomy 21, especially in maternal age classes younger than 40 years, where the cost/benefit ratio of screening for maternal age is less favourable.

High maternal serum alpha-fetoprotein levels during the 2nd trimester of pregnancy: diagnostic approach.

The limit of the classic diagnostic protocols following the evidence of high maternal serum alpha-fetoprotein levels is represented by the high number of amniocenteses performed and that, in the most part of cases, give false negative results. Now days the introduction of high resolution ecographic equipments allows to us, in many cases, to clarify the diagnostic without further examinations. The Authors propose a diagnostic protocol that include the execution of high resolution ultrasound at the second withdrawal of serum alpha-fetoprotein, limiting the use of amniocentesis only when is necessary to determine the fetal karyotype. An high sensibility diagnostic system with a favourable cost/benefit ratio results from this approach.

[Computerised monitoring of integrated cervical screening. Indicators of diagnostic performance]. / Monitoraggio informatizzato dello screening cervicale integrato. Indicatori di diagnosi.

In a previous issue of this journal, we presented the background, rationale, general methods, and indicators of participation of a computerised system for the monitoring of integrated cervical screening, i.e. the integration of spontaneous Pap smear practice into organised screening. We also reported the results of the application of those indicators in the general database of the Pathology Department of Imola Health District in northern Italy. In the current paper, we present the rationale and definitions of indicators of diagnostic performance (total Pap smears and rate of unsatisfactory Pap smears, distribution by cytology class reported, rate of patients without timely follow-up, detection rate, positive predictive value, distribution of cytology classes reported by histology diagnosis, and distribution of cases of CIN and carcinoma registered by detection modality) as well as the results of their application in the same database as above.

[Reactive lymphoreticular hyperplasia or pseudolymphoma of the stomach]. / L'iperplasia linforeticolare reattiva o pseudolinfoma dello stomaco.

Three cases of reactive lymphoreticular hyperplasia of the stomach (pseudolymphoma) are reported. The histogenesis and the radio-endoscopic aspects are illustrated and the differential diagnosis with the malignant lymphoma and the early cancer is discussed. In each case the radiological examination has shown a granular aspect in the mucosal circonferential area (moth eaten sign) with erosions and multiple ulcers (in two cases).

[Multiple primary tumors of the colon]. / I tumori primitivi multipli del colon.

Nine cases of multiple primary carcinomas of the large intestine are reported in order to emphasize the importance of an accurate pre-operative search of the other neoplastic lesions after a first cancer diagnosis. As the multiple carcinomas are often in various growing stages it is necessary an accurate X-ray examination for the early cancer diagnosis. It can be concluded that all "at risk" patients (including those already treated by surgery) must be yearly controlled by radiological and endoscopic examinations to assure the best long-term results.