The addition of respiratory muscle strength training to facilitate swallow and pulmonary rehabilitation following massive tissue loss and severe deconditioning: A case series.

INTRODUCTION: Impaired respiratory and swallow function in patients with intensive care unit-acquired deconditioning, such as associated with massive tissue loss, is not uncommon and can require prolonged rehabilitation. AIM: The aim of the study was to examine the effect of combined inspiratory and expiratory respiratory muscle strength training (RMST) on respiratory and swallow function in two critical care patients with marked deconditioning after massive tissue loss. METHODS: Case 1 was a 19-year-old male patient with 80% body surface area burns; case 2 was a 45-year-old man with group A streptococcus myositis necessitating quadruple amputation. Both required prolonged intensive care and mechanical ventilation. Both received routine intensive pulmonary and swallow rehabilitation before the trial; however, chronic aspiration and poor secretion clearance remained. At 25 and 26 weeks after initial injury, RMST was performed using EMST150 (expiratory) and Threshold IMT (inspiratory) devices, respectively. At baseline and throughout treatment, data collected included peak expiratory flow (PEF), anthropometry measures, aspiration risk (Penetration-Aspiration Scale [PAS]), pharyngeal clearance (Yale Pharyngeal Residue Scale), secretions (New Zealand Secretion Scale [NZSS]), and functional diet (Functional Oral Intake Scale [FOIS]) via endoscopy. RESULTS/DISCUSSION: At baseline, the PEF score of case 1 was 41% (predicted age-height norm) and the PEF score of case 2 was 14%, indicating severe expiratory compromise. Both had extreme energy requirements (3300 kcal/day; 3500 kcal/day). The baseline swallowing scores of case 1 and 2 were as follows: PAS, 8 and 8; Yale, 9 and 10; NZSS, 4 and 7; and FOIS, 1 and 1, respectively, indicating profound dysphagia. At week 3 of 7 of RMST, swallow function improved to allow both to commence oral intake, followed by tracheostomy decannulation. At weeks 10 and 11, full dysphagia resolution was achieved (FOIS = 7; PAS = 1, Yale = 2, NZSS = 0), with PEF at 70% and 48% predicted respectively. Both patients continued RMST, and at discharge from the acute facility, PEF was 84% and 80% predicted respectively. CONCLUSION: The addition of RMST assisted swallow and pulmonary rehabilitation in both cases and was clinically viable to deliver. Controlled validation trials are now required.

Profile of secreted hydrolases, associated proteins, and SlpA in Thermoanaerobacterium saccharolyticum during the degradation of hemicellulose.

Thermoanaerobacterium saccharolyticum, a Gram-positive thermophilic anaerobic bacterium, grows robustly on insoluble hemicellulose, which requires a specialized suite of secreted and transmembrane proteins. We report here the characterization of proteins secreted by this organism. Cultures were grown on hemicellulose, glucose, xylose, starch, and xylan in pH-controlled bioreactors, and samples were analyzed via spotted microarrays and liquid chromatography-mass spectrometry. Key hydrolases and transporters employed by T. saccharolyticum for growth on hemicellulose were, for the most part, hitherto uncharacterized and existed in two clusters (Tsac_1445 through Tsac_1464 for xylan/xylose and Tsac_1344 through Tsac_1349 for starch). A phosphotransferase system subunit, Tsac_0032, also appeared to be exclusive to growth on glucose. Previously identified hydrolases that showed strong conditional expression changes included XynA (Tsac_1459), XynC (Tsac_0897), and a pullulanase, Apu (Tsac_1342). An omnipresent transcript and protein making up a large percentage of the overall secretome, Tsac_0361, was tentatively identified as the primary S-layer component in T. saccharolyticum, and deletion of the Tsac_0361 gene resulted in gross morphological changes to the cells. The view of hemicellulose degradation revealed here will be enabling for metabolic engineering efforts in biofuel-producing organisms that degrade cellulose well but lack the ability to catabolize C5 sugars.

[Anomalous immunoelectrophoretic behavior of ceruloplasmin in severely burned patients]. / Anomalo comportamento immuno-elettroforetico della ceruloplasmina nei grandi ustionati

Laurell's two-dimensional technique was employed in a study of the immunoelectrophoretic behaviour of caeruloplasmin in 10 major burn cases. A double peak was noted throughout the entire course. The second peak disappeared on recovery whereas it persisted and was well marked in the case of those who died. It is suggested that this pattern reflects the severe liver damage sustained by burn patients.

[Cases of endometrial hyperplasia diagnosed at a regional hospital in the Province of Pavia]. / Le iperplasie dell'endometrio rilevate in un Ospedale di zona nella Provincia di Pavia.

Two hundred and fourteen cases of endometrial hyperplasia were diagnosed at the Hospital of Casorate (USSL 77, Pavia) between 1 january 1984 and 31 december 1989. Cases were subdivided as follows: 60 glandular hyperplasias, 54 glandular cystic hyperplasias, 83 adenomatous glandular hyperplasias, 13 atypical glandular hyperplasias and 24 cases of endometrial cancer. The analysis of data shows an increase in hyperplasia, but only the adenomatous and atypical varieties have a potentially carcinomatous evolution.

[Preventive and therapeutic use of cefriaxon in gynecologic surgery]. / Il ceftriaxone nella profilassi e terapia della chirurgia ginecologica.

The Authors have been investigating the behaviour of ceftriaxone in gynecological surgery employing 1 g of the drug through intravenous injection an hour before the operation, after executing a cutaneous pomphus the night before. They obtained satisfactory results since out of 25 cases analyzed nowhere had they to intervene with other antibiotics. The drug, despite the 15 cases of infectious pathology observed, has been showing great tolerance and an utmost ease and usefulness of usage.

[Prophylactic and therapeutic use of ceftriaxone in cesarean section]. / Il ceftriaxone nella profilassi e terapia del taglio cesareo.

Authors did the antibiotic-prophylaxis with ceftriaxone in twenty cesarean sections (1 phial EV). Prophylaxis was sufficient in thirteen cases; on the other hand, in the remaining seven prophylaxis was followed by the three days therapy (1 phial EV). A good tolerance of the medicine was revealed in all cases. Moreover, it was tested a wide antimicrobial action with resolution of all the verified infections, except for one bacterial resistance case where some other antibiotic was used.

[Risk factors of endometrial carcinoma]. / I fattori di rischio del carcinoma dell'endometrio.

The authors base their experience on 12 women affected by endometrial carcinoma. Problems have been diagnosed in the post-menopausal and climacterium period, considering the clinical, hormonal and lipidic profile and some tumoral markers. The most risk factors for the endometrial adenocarcinoma have been collected in the adiposity with hypertension and hyperglycemia, above all in nullipara women with late menopause and dyslipidemia.

[Laparoscopic total hysterectomy and its complications]. / L'intervento di laparoisterectomia totale e sue complicanze.

The Authors base their experiences on 135 total laparohysterectomy operations. Of a sample of 39 cases the postoperative lapses have shown complications with a percentage of 28.87% so divided: 25 infectious complications (18.51%); 9 thrombophlebitis (6.66%); 3 vascular lesions (2.22%); 2 intestinal lesions (1.48%). They end by saying that to have good clinical conduction of such operations it is necessary to respect the specific hygienic and preventive rules.

[The Pap test in menopause]. / Il Pap-test in menopausa.

In a study covering 156 Pap-tests in menopause, the Authors observed a reduction in infectious phlogosis, in dysplasias and neoplasias. They suggested that even during menopause in the Pap-test showed be conducted to monitor the VIN and a physiological senescence of the female genitalia.

[Value of the Pap-test in the cervical cytological screening]. / Il valore del Pap-test nello screening citologico cervicale.

Fourteen thousand three hundred fifty six cervical smears were performed in the Obstetric and gynaecologic Department of Casorate Primo Hospital (USSL no. 77) and Oncologic Center of Milan (USSL no. 75/II) between 1-1-1987 and 30-6-1991. The incidence and mortality of uterine cervix neoplasm are discussed and the uterine cervix neoplasm are discussed and the analysis of data shows a reduction of this cancer in all countries. In italy it is estimated that the incidence is of 20.88 per 1000,000 women of all ages.

[Use of seat belts during pregnancy]. / Sull'impiego delle cinture di sicurezza in gravidanza.

After a review of the world literature on the advantages and compulsiveness of seat belts, the authors recommend pregnant women to use them. Moreover, they invite gynaecologists and midwives to favour their use during psycho-prophylaxis courses.

[Piperacillin in prevention and therapy in gynecological surgery]. / La piperacillina nella profilassi e terapia della chirurgia ginecologica.

The authors have studied the use of sodic piperacillin in surgical gynecological prophylaxis. The drug, used in the intravenous tract, has proved efficacious for broad spectrum of antibacterial action versus gram+, gram-, and anaerobic and aerobic. It has shown an excellent tolerability by reducing hospital surgical infections (11% of cases) and sepsis (9.2% of cases) with social, economic and professional advantages.

[Pap-smear test today]. / Il pap-test oggi.

Remembering the publication of Papanicolau and Traut's monograph in 1943, the authors have realized the use and the spead of the Pap-Smear until the present. They have analyzed the different risks of cervical carcinoma. They think that to obtain a further reduction of the morbidity and the death-rate of such a neoplasia, it is necessary to do a pap-smear examination once a year for women with HPV infection or other risk factors. It is possible in this way, to improve results till the 90%.

[Use of sulprostone in abortion induced during the first pregnancy trimester in women with previous cesarean section]. / L'impiego del Sulprostone nelle precesarizzate in corso di IVG nel I trimestre.

The paper describes the advantages and negligible side-effects of the use of E2-type (Suprostone) synthetic prostaglandin, administered i.m. in a dose of 250 mg, 2-3 hours before voluntary abortion during the first trimester of pregnancy in pre-cesarean-section patients.

[Clinical evaluation of endometrial biopsy]. / La valutazione clinica della biopsia endometriale.

This study comprehends evaluation of endometrial biopsy performed between June 1986 and June 1989 in the Obstetric and Gynaecologic Department of Casorate Primo Hospital in fertile, perimenopausal and post-menopausal patients with uterine bleeding. The results show that on a total amount of 459 cases we registered 78 cases of initial abortions, 3 vesicular mola, 300 dysfunctional bleeding, 63 precancerous situations and 15 endometrial cancers. We confirm the diagnostic and prognostic validity of endometrial biopsy carried out with fractional curettage. The opportunity to prevent and diagnose precancerous pathology through a multiple screening is also estimated.

[Changes in sexual behavior of women receiving substitution therapy after surgical menopause and women in physiological menopause]. / Studio delle modificazioni della sessualità tra donne in menopausa chirurgica sottoposte a terapia sostitutiva ed in menopausa fisiologica.

We have made this study with the aim of comparing changes in sexuality between women who are in surgical menopause taking a substitutive therapy and those who are in physiological menopause. We have used a questionnaire instrument. It has been filled in by a physician during an individual conversation with the women. The results showed that sexuality valued through the parameters of satisfaction, coital frequency and desire, has been have penalized in the first group than in the second. It can be said that the trauma linked to hysterosalpingo-oophorectomy provokes alterations in sexuality which are not sufficiently counterbalanced by substitutive estrogenic therapy.

[The Pap-test in the study of viral infections of the female genital tract]. / Il pap-test nello studio delle infezioni virali dell'apparato genitale femminile.

The authors underline a synergism of HPV + HSV and HPV + CIN that, together with general immunodeficiency and local factors are responsible for the oncogenesis of cervico carcinoma. This thesis takes on importance after literature reports of an increase of 10% in viral infections from HSV and HPV with a middle incidence of the 1-2% in all the colpocytologic examination cases not in women between 18 and 65 years. To obtain a successful preventive treatment the authors recommend a colpocytologic examination each year, possibly in association with colposcopic, histologic and molecular studies in all HPV positive cases.

[Cytological study of an inflammatory type Pap-test]. / Studio citologico su un campione di pap-test di tipo infiammatorio.

The paper reports the results of the study of 900 s of which 630 were of an inflammatory type (70%). The age group most severely affected by phlogosis was that between 35-45 years old with the highest frequency in the group aged between 35-39 years old. Associated pathologies were found in 191 cases (21.2%), with bacterial infections in 101 cases (11.2%), candida in 43 cases (4.8%), T.V. in 17 cases (1.9%), viral infections in 10 cases (1.1%), CIN in 14 cases (1.5%) and malignant tumours in 2 cases (0.22%).

[Non-stress test. Evaluation of a new scheme for reading the results]. / Non stress test. Valutazione di un nuovo schema di lettura.

The reliability of a new Non-Stress Test reading protocol is assessed. The protocol provides for an assessment time of between 20 and 60 minutes and considers deceleration as an additional parameter to the ones commonly used. The results confirm the importance of both these factors in reducing the number of false positives.

[Extrauterine pregnancy. Critical review of the clinical diagnosis and early echography]. / Gravidanza extrauterina. Revisione critica della diagnosi clinica ed ecografia precoce.

A case of extrauterine pregnancy is reported. After a short review of the literature on the subject, personal experience of early diagnosis is reported and importance is attributed in IUD carriers to menstrual dysrhythmia and pelvic pain. For correct early diagnosis, such symptomatology must be integrated with laboratory tests and pelvic echography.