Effect of beta-glucan, inositol and digestive enzymes in GI symptoms of patients with IBS.

BACKGROUND: Irritable bowel syndrome (IBS) is a very common functional gastrointestinal (GI). Diagnosis of IBS is based on the fulfilment of the Rome III criteria. Common GI symptoms are lower abdominal pain, bloating and disturbed defecation, such as urgent diarrhoea and/or episodes of chronic constipation. Many agents have been employed in the management of IBS, although only few have been demonstrated to show a relevant efficacy. AIM: To evaluate the effectiveness of the administration of a mixture of beta-glucan, inositol and digestive enzymes (Biointo) in improving GI symptoms in patients affected by IBS. PATIENTS AND METHODS: 50 IBS patients (20 males, 30 females; mean age 51 +/- 19) were treated with Biointo (group A) while another group consisting of 40 IBS patients (15 males, 25 females; mean age 50 +/- 18) did not receive any therapy (group B). RESULTS: Biointol administration improved significantly bloating, flatulence and abdominal pain, with a slight increasing of urgency for bowel movements. On the contrary, Biointol did not show any significant effect on the other IBS symptoms. CONCLUSIONS: Currently, only few agents used in the management of IBS have been proven to be effective. Biointol administration has shown to improve some IBS symptoms, such as bloating, flatulence and abdominal pain, all connected to the presence of gas inside the intestinal lumen.

[The risk of inhalable wood dust: assessment of workers exposure wood working factories]. / Il rischio da polveri di legno inalabili: valutazione dell'esposizione professionale nelle falegnamerie.

The International Agency for Research on Cancer RC) has classified wood dust as carcinogenic to humans based on demiological and experimental evidence. Exposure to wood dust may use respiratory and dermal symptoms and diseases. The aim of this work was to estimate occupational exposure to inhalable wood dust adopting the formal procedure described by UNI EN 689/97. The exposure of 23 workers in three different working day was measured. In total, 69 personal air samplings were carried out at five wood working factories. Inhalable fraction of airborne dust was collected on 5 microm pore size, 25 mm diameter PVC filters utilizing the IOM samplers. The quantity of the wood dust was determined with gravimetric method. The results show that about 13% of the exposure values exceed the limit of 5 mg/m3 specified by the Italian Law Decree 66/2000 and about 48% of personal exposures are lower then the limit value. Prevention measures, technological solutions and personal protection equipment should be adopted in order to reduce worker's exposure.

[Evaluation of occupational exposure to biological agents, endotoxins and PNOC in a sewage treatment plant]. / Valutazione dell'esposizione professionale ad agenti biologici, endotossine e PNOC in un impianto di depurazione.

The aim of this work has been to determine the occupational exposure to the biological agents and airborne dust in a sewage treatment plant in south Italy. The air samplings were performed in a sewage treatment plant in Calabria, in two different seasons (spring and summer) at 5 sites associated with various phases of sewage treatment process. In addition we have estimated the concentration of airborne endotoxins and PNOC (Particles Not Otherwise Classified) by using personal samplers. The results showed a significant variation in exposure to bioaerosols, endotoxins and PNOC depending on the sampling season: the PNOC concentration increase as much as the endotoxins concentration in spring and decrease in summer

Relationship between antigen density and immunotherapeutic response elicited by monoclonal antibodies against solid tumors.

The relationship between the level of cell surface antigen expression and solid tumor immunotherapy with monoclonal antibody (MoAb) was evaluated. Two MoAb's that were shown effective in the passive therapy of breast carcinomas of human origin, established and growing in female Swiss nude mice, were used for these studies. Several groups of tumors were produced from cell cultures of different passages; each cell culture possessed a distinct target antigen level. Results from immunotherapy experiments demonstrated that the amount of tumor reduction response after MoAb therapy was proportional to the antigen density at the cell surface. Analysis of these data indicated a theoretical improbability of a single MoAb treatment being able to completely eradicate solid tumors and may necessitate the use of multiple MoAb's to circumvent this problem.

[Mount Reventino greenstone: assessment of tremolite fibre dispersion in the workplace]. / Le pietre verdi del Reventino: valutazione della dispersione di fibre di tremolite nelle attività lavorative.

BACKGROUND: Mount Reventino, a massif located in the Calabria Region of Italy, has several ophiolite outcrops of greenstone. These deposits are an important economical resource in the surrounding area. Some rock layers contain tremolite, a type of asbestos fibre. OBJECTIVES: The aim of this paper was to analyze the chemical and physical structure of the outcrops of Mount Reventino, and to assess and reduce the risk to workers associated with exposure to airborne fibres. METHODS: Personal and environmental samples were collected and analysed by Scanning Electron Microscopy equipped with energy-dispersive X-ray analysis. RESULTS: The analysis of samples showed a difference in mineralogical features not only between the quarries under study, but also between the two opposite sides of the mountain. Exploitation of the quarries produces a fibre dispersion that is higher than the natural emission. Occupational exposure to asbestos fibres during greenstone transformation was confirmed by by the results of analysis of the collected samples. CONCLUSIONS: This study made it possible to identify working activities with highest exposure to asbestos and establish the correct procedures to abate fibre dispersion, in order to reduce the correlated risk. Environmental samples collected in the urban area surrounding the quarries showed that the asbestos fibre concentrations were very low, however, further studies are needed in order to confirm these findings.

Metabolic syndrome in patients with coeliac disease on a gluten-free diet.

BACKGROUND: Several studies have shown that weight changes are common in patients with coeliac disease after starting a gluten-free diet (GFD), but data on the prevalence of metabolic syndrome in this population are still scarce. AIMS: To assess the prevalence of metabolic syndrome in patients with CD at diagnosis and 1 year after starting GFD. METHODS: We enrolled all consecutive patients with newly diagnosed coeliac disease (CD) who were referred to our third-level CD Unit. For all patients we collected: waist circumference, BMI, blood pressure, lipid profile (HDL cholesterol, triglycerides) and levels of blood glucose. Diagnosis of metabolic syndrome was made according to the International Diabetes Federation (IDF) criteria for European countries. The prevalence of metabolic syndrome was re-assessed after 12 months of GFD. RESULTS: Ninety-eight patients with CD were assessed, two patients with CD (2%) fulfilled the diagnostic criteria for metabolic syndrome at diagnosis and 29 patients (29.5%) after 12 months of GFD (P < 0.01; OR: 20). With regard to metabolic syndrome sub-categories 1 year after GFD compared to baseline respectively: 72 vs. 48 patients exceeded waist circumference cut-off (P < 0.01; OR: 2.8); 18 vs. 4 patients had high blood pressure (P < 0.01; OR: 5.2); 25 vs. 7 patients exceeded glycemic threshold (P = 0.01; OR: 4.4); 34 vs. 32 patients with CD had reduced levels of HDL cholesterol (P = 0.7); and 16 vs. 7 patients had high levels of triglycerides (P = 0.05). CONCLUSIONS: Patients with coeliac disease show a high risk of metabolic syndrome 1 year after starting a gluten-free diet. We suggest that an in-depth nutritional assessment is undertaken for all patients with coeliac disease.

Multicenter dose-response study of the effect of indapamide in the treatment of patients with mild to moderate hypertension.

This study, carried out in three centers in the United States, investigated the antihypertensive effect of three dosages of indapamide in 87 patients with mild to moderate hypertension. The dosages studied were 1 mg, 2.5 mg, and 5 mg daily. A double-blind, parallel study design was used with a six-week placebo run-in period followed by an eight-week treatment period and a two-week follow-up period. Compared with placebo, all dosages caused a significant decrease (P less than 0.05) in blood pressure, with an average decrease of approximately 6 mmHg diastolic and 13 mmHg systolic. The antihypertensive effect seemed to be fully manifest after six weeks of treatment. At all dosage levels, indapamide produced markedly greater therapeutic success rates than did the placebo. Success was defined as either a standing phase-5 diastolic blood pressure of less than 90 mmHg or a decrease by at least 10 mmHg from baseline. Although the decrease in mean serum potassium concentration was dose-related, the decrease was not clinically significant with any dose. A reduction in serum chloride and increases in serum uric acid and glucose were also observed. These changes were slight and did not cause the discontinuation of treatment for any patient. The most frequently observed side effects were mild to moderately severe dizziness, weakness, and headaches.

Life supporting first aid (LSFA) teaching to Brazilians by television spots.

Accidents in developing countries are frequent and have high mortality and morbidity rates. In Brazil, in 1995-1996, the year of this study, life supporting first aid (LSFA), which includes cardiopulmonary resuscitation (CPR) basic life support (BLS) was not taught in schools. With the population of 165 million, the only way to teach the adult population on a large scale would be by television (TV), that is widely viewed. This study compares two groups of factory employees - 86 controls without TV exposure to LSFA and 116 exposed to brief LSFA skill demonstrations on TV. Their ability to acquire eight LSFA skills was evaluated: external hemorrhage control; immobilization of a suspected forearm fracture; treatment of a skin burn by cold flush; body alignment after a fall; positioning for shock and coma; airway control by backward tilt of the head; and CPR (steps A-B-C). Simulated skill performance on the evaluating nurse or manikin was tested at 1 week, 1 month, and 13 months. In the control group, 1-31% performed individual skills correctly; as compared to 9-96% of the television group (P<0.001). There was excellent retention over 13 months. Over 50% of the television group performed correctly five of the eight skills, including positioning and hemorrhage control. Television viewing increased correct airway control performance from 5 to 25% of trainees, while it remained at 3% in the control group. CPR-ABC performance, however, was very poor in both groups. We conclude that a significant proportion of factory workers can acquire simple LSFA skills through television viewing alone, except for the skill acquisition of CPR steps B (mouth-to-mouth ventilation) and C (external chest compressions) which need coached manikin practice.

Multiple giant intracranial aneurysms associated with lymphomatoid granulomatosis. A magnetic resonance imaging and angiographic study.

Lymphomatoid granulomatosis is an uncommon lymphoproliferative disorder that frequently has central nervous system manifestations. Lymphomatoid granulomatosis has clinical features similar to both vasculitis and lymphoma. The pathological hallmarks of this disease include necrotic angiocentric and angiodestructive infiltrations of premalignant or malignant lymphoid cells. There are, to the authors' knowledge, only a few magnetic resonance imaging reports and no magnetic resonance angiographic reports of this disorder. Presented here is a case of lymphomatoid granulomatosis producing multiple giant fusiform and saccular aneurysms throughout the major intracerebral arteries, along with patterns of vascular beading typically seen with vasculitis demonstrated by magnetic resonance angiography.

Seizures and cerebritis associated with administration of OKT3.

The development of a self-limited aseptic meningitis usually following the first dose administration of OKT3 therapy (an anti-pan-T-cell monoclonal antibody) in the treatment of renal transplantation rejection is well-documented. This report describes a patient with renal transplantation rejection who developed lateralizing seizures and cerebritis documented by magnetic resonance imaging. These findings were associated with the initiation of OKT3 therapy. To our knowledge, both cerebritis and seizures have not been described in association with OKT3 therapy.

[Wolff-Parkinson-White, a study on the prevalence of the site of accessory pathways: relations between stability of pre-excitation, symptoms, cardiac arrhythmias and association of mitral valve prolapse with localization of pre-excitation]. / Wolff-Parkinson-White, studio sulla prevalenza della sede dei fasci anomali: rapporto tra la stabilità della pre-eccitazione, i sintomi, le aritmie cardiache e l'associazione del prolasso valvolare mitralico con la localizzazione della pre-eccitazione.

The aim of this study was to evaluate the prevalence of the anatomic site of accessory pathways using surface electrocardiogram in patients affected by Wolff-Parkinson-White (WPW), and compare it to the stability of preexcitation, symptoms, incidence of arrhythmias, and the possible association of mitral valve prolapse with the localization of preexcitation. From March 1992 to August 1993 at the Cardiology Service of the Civil Hospital "Augusto Murri" in Fermo, USL 21 of the Marche Region, a total of 40 subjects suffering from WPW syndrome were examined prospectively (28 males and 12 females aged between 13 and 75 years). Using surface ECG to evaluate the axis of the delta wave in 12 standard derivations, the authors identified the anatomic site of the accessory pathways. Preexcitation stability was analysed for each patient together with the reported symptoms and the various forms of arrhythmia using dynamic ECG and effort ECG performed using a cycloergometer. Wherever possible an echocardiogram was performed to identify the possible presence of mitral valve prolapse. Out of a total of 40 patients the authors identified 3 cases with an accessory right antero-septal pathway, 13 with an anomalous postero-septal fasciculus, 11 with a right lateral and 13 with a left lateral anomaly. The statistical analysis of data revealed the stability of pre-excitation in 52.5% of cases 55% of patients were found to have a positive record with regard to past symptoms, and supraventricular or ventricular cardiac arrhythmia were diagnosed in 52.5% of the patients examined.(ABSTRACT TRUNCATED AT 250 WORDS)

[Iatrogenic torsade de pointes induced by thioridazine]. / Torsione di punta iatrogena indotta da tioridazina.

Torsade de pointes is a form of polymorphous ventricular tachycardia in which the polarity of the QRS complex exhibits phasic alterations in both axis. Traditionally, torsade de pointes has been described in association with a congenital or acquired (including drug and metabolic) causes of QT prolongation. Clinical outcomes range from asymptomatic, self-terminating arrhythmias to ventricular fibrillation resulting in cardiac arrest. For the treatment of torsade de pointes, the conventional antiarrhythmic drugs cannot be relied on, cardiac pacing should be instituted as soon as possible; however, as this technique may not always be immediately available, isoproterenol infusion may be the first-choice treatment. Potassium and magnesium repletion appear to be essential in abolishing drug-induced torsade de pointes. This report describes a case of thioridazine-induced torsade de pointes treated efficaciously with magnesium sulphate and overdrive right ventricular pacing.

[Arrhythmogenic right ventricular dysplasia. Report of a familial case]. / Displasia aritmogena del ventricolo destro. Descrizione di un caso di familiarità.

Arrhythmogenic right ventricular dysplasia is a pathologic condition of unknown origin that primarily affects the right ventricle free wall characterized by progressive atrophy with fibrous-fatty substitution of the myocardium. The patient affected may present in childhood or as an adult with cardiomegaly or/and ventricular arrhythmias with a left bundle branch block configuration. The reports of familial occurrence suggest the etiologic role of a genetic defect with autosomal dominance and variable expression and penetrance, an alternative, myocarditis (toxic or infectious) is a possible cause. The aim of the present study is an non-invasive instrumental evaluation of the family of a young patient affected by arrhythmogenic right ventricle dysplasia. The authors evaluated 10 patients, 7 women and 3 men, all asymptomatic, with electrocardiography, exercise stress test on a bicycle ergometer, 24-hour Holter monitoring and two-dimensional echocardiography. A patient had certain ARVD diagnosis, while in the other 9 patients all the instrumental investigations were normal. This observation seem to confirm that ARVD may be familial and justify a systematic in-depth familial study in all demonstrated cases of ARVD and the follow-up of all patients identified who had arrhythmias or isolated right ventricular morphologic anomalies.

[Atrial fibrillation induced by massage of the carotid sinus in patients with orthodromic reciprocal supraventricular tachycardia and Wolff-Parkinson-White syndrome]. / Desincronizzazione atriale indotta da massaggio del seno carotideo in paziente con tachicardia sopraventricolare reciprocante ortodromica e sindrome di Wolff-Parkinson-White.

A 46 years old man with WPW syndrome, due to a posteroseptal accessory pathway, was admitted because of orthodromic reciprocating tachycardia, 210/m'in frequency. At the end of the carotid sinus massage, for accomplish the conversion of tachycardia to sinus rhythm, the orthodromic reciprocating supraventricular tachycardia degenerated into atrial fibrillation associated with high ventricular rate and the presence of hemodynamic instability, reverted to sinus rhythm by intravenous propafenone. Vagal stimulation, induced by carotid sinus massage, probably caused dispersion of atrial refractorines and intraatrial reentry, converting the orthodromic tachycardia into atrial fibrillation. The transesophageal electrophysiologic study, executed in treatment with propafenone, not documented the accessory connection and atrial fibrillation or reciprocating tachycardia were not inducible.

[Right atrial thrombosis and pulmonary embolism: role of echocardiography]. / Trombosi atriale destra ed embolia polmonare: ruolo dell'ecocardiografia.

The echocardiographic detection of a right thromboembolus, although rare, should be considered as a cardiological emergency that could lead to death for massive pulmonary embolism. The case of a 70 year-old man admitted to our Institution with the suspicion of pulmonary embolism is described. The echocardiogram performed showed a large mobile thrombus in the right atrium prolapsing through the tricuspid valve during diastole. After thrombolytic therapy with r-TPA, the patient faced a progressive hemodynamic deterioration and died of electromechanical dissociation.

Atypical pathogens and asthma: can they influence the natural history of the disease?

The association between respiratory infections and asthma exacerbations was first observed in the early '70s. In particular, the role of viral upper respiratory tract infections has been evaluated both in pediatric and adult populations. More recently, evidence of Mycoplasma and Chlamydia pneumoniae involvement in asthma attacks has been reported. These pathogens are also involved in chronic asthma, and both in vitro and animal model studies indicate that atypical agents may play a role in the pathogenesis of the disease. Further research is required to determine whether specific antibiotic treatment may alter the natural history of asthma.

[Statistical studies of street traffic noise in the city of Pescara, based on findings on 24-hour periods]. / Indagine statistica sul rumore da traffico stradale a Pescara basata su rilevamenti effettuati durante tutto l'arco delle 24 ore.

The level of acoustic pollution from road traffic in Pescara has been measured in 10 residential areas with commercial activity. Measurements have been carried out during 24 hours, by means of a magnetic recorder Nagra IV-SJ, joined with a statistic level analyzer Brüel & Kjaer 2312 in connection with an alpha digital printer. Cumulative statistic levels, standard deviation, equivalent level, noise pollution level and traffic noise index, have been calculated. Composite indexes of acoustic pollution expressed as equivalent level 24 hours (Leq 24), level day-night (Ldn) and composite noise equivalent level (CNEL) have been calculated elaborating the data obtained. All collected data resulted to exceed the limits of stated rules.

The presence of anti-endomysial antibodies and the level of anti-tissue transglutaminases can be used to diagnose adult coeliac disease without duodenal biopsy.

BACKGROUND: The new ESPGHAN guidelines for diagnosis of paediatric coeliac disease suggest to avoid biopsy in genetically pre-disposed and symptomatic individuals with positive anti-endomysial antibodies (EMA) and anti-tissue transglutaminases (a-tTG). However, duodenal biopsy remains the gold standard in adult coeliac disease. AIMS: To establish the cut-off values of a-tTG, which would: predict the presence of duodenal histology (Marsh ≥2) diagnostic for coeliac disease; and predict the presence of villous atrophy (Marsh 3) in adults. METHODS: We performed an observational prospective study including all consecutive adult patients with suspected coeliac disease. All subjects were tested for EMA and a-tTG. Coeliac disease diagnosis was made in presence of Marsh ≥2, a-tTG >7 U/mL and positive EMA. A ROC curve was constructed to establish the best specificity cut-off of a-tTG levels, which would predict the presence of Marsh ≥2 and Marsh 3 at histology. RESULTS: The study included 310 patients with positive antibodies. Histology showed Marsh 1 in 8.7%, Marsh 2 in 3.5%, Marsh 3 in 87.7%. The best cut-off value of a-tTG for predicting Marsh ≥2 was 45 U/mL (sensitivity 70%; specificity 100%; PPV 100%; NPV 24.1%); the best cut-off for predicting villous atrophy was 62.4 U/mL (sensitivity 69%, specificity 100%; PPV 100%; NPV 31%). CONCLUSIONS: The diagnosis of coeliac disease can be reached without histology in adult patients with positive EMA and a-tTG levels >45 U/mL. An a-tTG level >62.4 was diagnostic for villous atrophy. These results could contribute to improving the diagnosis of coeliac disease by allowing for a significant reduction in diagnosis-related costs.

Role of gluten intake at the time of hepatitis B virus vaccination in the immune response of celiac patients.

Some reports have demonstrated an inadequate response to hepatitis B vaccination in patients affected by celiac disease. The aim of our study was to evaluate hepatitis B vaccination response in relation to gluten exposure status in patients with celiac disease. To measure the gluten exposure status at the time of vaccination, we considered three groups: group A (exposed to gluten), including patients vaccinated as 12-year-old adolescents (the celiac disease diagnosis was established after vaccination); group B (not exposed to gluten), including patients vaccinated as 12-year-old adolescents on a gluten-free diet at the time of vaccination; and group C (infants), including patients vaccinated at birth. The response of celiac patients to hepatitis B vaccination was compared to that of healthy subjects, i.e., those in the control group (group D). This study included 163 celiac patients (group A, 57 patients; group B, 46 patients; and group C, 60 patients) and 48 controls (group D). An inadequate response to hepatitis B immunization was present in 43.9% of patients in group A, 34.8% of patients in group B, 58.3% of patients in group C, and 8.3% of patients in group D (group A versus group D, P < 0.001; group B versus group D, P = 0.002; group C versus group D, P = 0.001) (no significant difference for group A versus group B and group A versus group C was evident). Our data suggest that gluten exposure does not influence the response to hepatitis B immunization and that the human leukocyte antigen probably plays the main immunological role in poor responses to hepatitis B-vaccinated celiac patients.