Outcome of oral provocation test in egg-sensitive children receiving semi-fat hard cheese Grana Padano PDO (protected designation of origin) containing, or not, lysozyme.

PURPOSE: Lysozyme, obtained from egg white, is a potential food allergen used in the dairy industry to prevent late blowing of the loaf caused by the outgrowth of clostridial spores (Cl. butyricum and Cl. tyrobutyricum) during cheese aging. The aim of this study was to evaluate the possible correlation between egg protein allergy in pediatric age and sensitization to egg lysozyme, used for the preparation of Grana Padano cheese. METHODS: The tolerability of Grana Padano cheese has been evaluated in pediatric patients allergic to egg proteins through an oral provocation test with increasing amounts of cheese containing, or not, lysozyme at 12 and 24 months of aging. RESULTS: When lysozyme-sensitized children received 12-months aged and lysozyme-containing cheese, several immediate and late adverse reactions such as itching, abdominal pain, vomiting, nausea, dermatitis, rhinitis, bronchial asthma, urticaria, and angioedema were seen in 5 out of 21 subjects; only 1 out of 21 children showed an adverse reaction after challenge with 24-months-ripened lysozyme-containing cheese. CONCLUSIONS: There is a possible relationship between the severity of allergic reactions and the lysozyme-specific IgE level in blood. In particular vomiting, hypotension, and abdominal pain were present when IgE level was higher than 7 kU/L. A ripening time of 24 months may reduce allergy problems when lysozyme-containing cheese is given to sensitized subjects, probably due to the hydrolysis of antigenic epitopes during aging.

Application of a protocol for the diagnosis of postweaning multisystemic wasting syndrome in Italy.

Samples of superficial inguinal and bronchial lymph nodes, ileum, tonsil and lung were taken from three to five pigs on each of 61 farms with a clinical history of postweaning multisystemic wasting syndrome (PMWS). The samples were examined histologically and by immunohistochemistry for porcine circovirus type 2 (PCV-2). PMWS was diagnosed in two stages: first, an evaluation of the haematoxylin and eosin-stained sections that identified the cases in which the characteristic PCV-2 cytoplasmic inclusion bodies were apparent, and secondly, a conclusive step in which immunohistochemistry was applied to confirm PMWS in the cases in which there were positive immunohistochemical results that coincided with lesions indicative of PMWS in at least one of the lymphoid and/or lung tissues. The location of PCV-2 in specific lesions (cell depletion in lymphoid organs and interstitial pneumonia) confirmed PMWS in 45 of the 61 farms, 31 of which were also infected with porcine reproductive and respiratory syndrome virus. The lymphoid tissues were more reliable than the lungs for the diagnosis of PMWS, both in individual pigs and in groups of pigs, and farm diagnoses based on a group of pigs were more reliable than diagnoses based on single pigs.

Combined renal and pyelic fusion with crossed ectopia of single ureter.

A case of a forty-five-year-old woman with fused kidneys and intercommunicating pelves drained by a single ureter crossing the midline is reported. A review of the literature is presented.

Severe urinary bladder involvement in systemic sclerosis. Case report and review of the literature.

Lower urinary tract involvement is an uncommon manifestation of systemic sclerosis; however, it may represent a troublesome disturbance affecting the quality of life in systemic sclerosis patients. Here we report the case of a middle-aged woman with a 5-year history of systemic sclerosis, who developed severe and progressive urinary bladder sclerosis. This report is particularly interesting because of the severity of the bladder involvement, which required surgical treatment.

Bladder instability and incontinence after radical prostatectomy.

Thirty-nine patients were evaluated after retropubic prostatectomy, by urodynamic studies. They were divided into three groups depending upon the degree of urinary continence. A statistically significant difference was found between different groups in mean functional profile length and maximal urethral closure pressure. Differences in age, previous prostatic surgery, tumour extension, or preservation of the neurobundles did not have any significant influence on recovery of continence.

Elevated free cortisol plasma levels in patients with prostatic carcinoma undergoing treatment with estrogens.

The total cortisol concentration (TCC), the percentage of free cortisol (%FC) and the apparent free plasma cortisol concentration (AFCC) have been determined in plasma samples of 9 patients affected by prostatic carcinoma undergoing treatment with estrogens measured by an equilibrium dialysis system and a radioimmunological method. The values found in this group of patients were compared to those obtained in 9 untreated control patients and in normal healthy persons. The mean TCC values found in treated patients were significantly higher than in the controls, both in basal condition (circadian rhythm) and after dynamic tests, while the mean %FC values were significantly lower than the controls except for the results obtained after an ACTH stimulation test. The mean AFCC values in treated patients were elevated both in basal condition and after the dexamethasone suppression test (DST), but the difference between the two groups of patients was statistically significant only after DST. This study demonstrates that patients with prostatic carcinoma undergoing treatment with estrogens can have markedly increased free plasma cortisol levels with an impairment of the hypothalamus-pituitary-adrenal axis.

Tributyrin and lactitol synergistically enhanced the trophic status of the intestinal mucosa and reduced histamine levels in the gut of nursery pigs.

This study determined whether tributyrin and lactitol could synergistically facilitate the transition from milk to solid feed in nursery pigs. At 21 d after birth, 64 piglets were moved from the piggery to a production barn and fed a medicated diet. At 28 d after birth, the piglets were weighed and allotted into four groups and fed a standard nonmedicated diet (control) or the control diet with tributyrin (butanoic acid 1,2,3-propanetriyl ester; 10 g/kg), or with lactitol (beta-D-galactopyranosyl-(1-->4)-D-sorbitol; 3 g/kg), or with tributyrin (10 g/kg) plus lactitol (3 g/kg). On d 0, 14, and 42 after being fed the control or experimental diets, the animals were weighed, and animal health, feed intake, and feed conversion ratio were determined. On d 42, four piglets from each treatment were killed to measure the empty and full weight of the gut, as well as the weights of the liver and kidneys. The jejunum and cecum were sampled to analyze the luminal concentrations of lactic acid; short-chain fatty acids; and mono-, di-, and polyamines and to assess the mucosal status. Mortality after 42 d ranged from 19% for animals fed the control diet, to 6% for animals fed the tributyrin or lactitol diets, and to 0% for animals fed the tributyrin+lactitol diet. After 14 d, the ADG was 127% greater (P < 0.05) in animals fed the tributyrin+lactitol diet than in animals fed the control or tributyrin diets. After 42 d, animals fed the tributyrin+lactitol diet were heavier (P < 0.05) than animals fed the tributyrin diet. At slaughter, no differences (P > 0.05) in organ weights were observed. With the exception of animals fed the lactitol diet, wherein cecal lactic acid levels increased threefold (P < 0.01), the luminal concentrations of lactic acid and short-chain fatty acids were not different (P > 0.05). Among the various amines analyzed, the only response (P < 0.05) was a 66 and 49% decrease in histamine levels in the jejunum and cecum, respectively, in animals fed the tributyrin+lactitol diet compared to the control diet. In the jejunum of animals fed the lactitol or tributyrin+lactitol diets, the length of the villi was increased by 12% (P < 0.05) compared to animals fed the control diet, whereas the tributyrin diet did not have any effect on the villi (P > 0.05). In the cecum, the depths of the crypts were reduced (P < 0.001) by 18% in animals fed the lactitol diet and 45% in animals fed the tributyrin or tributyrin+lactitol diets compared to animals fed the control diet. In conclusion, a diet containing tributyrin and lactitol as nutribiotics resulted in lower histamine levels in the jejunum and cecum, as well as longer jejunal villi and shallower cecal crypts.

[Liposarcoma of the spermatic cord. Clinical case]. / Liposarcoma del funicolo spermatico. Caso clinico.

Sarcomas are neoplasms originating from connective tissues of any anatomical region; the sarcoma of spermatic cord is a rare neoplasm with only little more than two hundred cases described in the literature. Rhabdomyosarcomas in childhood and leiomyosarcomas in adults are the most frequent histological types. Liposarcomas, fibrosarcomas and osteosarcomas are less frequent. The spermatic cord liposarcoma originates from the spermatic cord fatty tissue and therefore it consist of adipose cells, fibroblasts and myxomatosus cells; such neoplasms are usually very well differentiated. Diagnosis is suggested by the appearance of a progressively enlarging mass and by echotomography which shows a solid or liquid mass of the spermatic cord. Therapy consists of surgical intervention (orchifunicolectomy) which also allows a correct histological diagnosis. The case of a 56 year-old male who underwent left orchifunicolectomy for a sarcoma of spermatic cord occasionally discovered during surgical repair of a left groin hernia is reported. Six months after the intervention the patient is in good condition and there is no evidence of relapse.

[Adenoid cystic carcinoma of the prostate. Clinical case]. / Carcinoma adenoido-cistico della prostata. Caso clinico.

The authors report an extremely rare case of adenoid cystic carcinoma of the prostate. No satisfactory clinical and pathological classification exists for this tumour, creating particular difficulties for therapeutic decisions and prognosis. Descriptions of cases with excellent survival rates are reported in the literature, to the extent that this is sometimes regarded as a low-malignancy tumour, but other reports also exist of massive diffusion of the pathology with fatal consequences. Advances in the knowledge of this tumour have enabled a number of earlier pathogenetic hypotheses to be ruled out, namely its possible derivation from ectopic salivary cells, ectopic periurethral glands or metaplastic urethral mucosa, but the origin of this carcinoma is still not certain. It is also difficult to differentiate this form from the typical adenocarcinoma and to make a prognosis for survival. In the case reported here, the final diagnosis was made on the lymph node biopsy obtained during surgery, given that a preoperative biopsy was not feasible owing to the scarcity of material available. The patient received standard hormonal therapy for prostate carcinoma.

[Unusual development of urothelioma of the upper urinary tract]. / Insolita evoluzione di urotelioma delle vie urinarie superiori.

A case of extrarenal spreading of transitional cell carcinoma caused by rupture of ureterohydronephrosis by ureteral transitional cell carcinoma is reported. Ultrasonography and CT revealed the presence of a severe right ureterohydronephrosis with large septa and a 2 cm diameter exophytic neoplasia of the middle ureter. Nephroureterectomy was performed with excision of a perirenal mass. Histologic examination revealed the presence of transitional cell carcinoma in the perirenal mass, caused by dissemination after renal rupture. CT and ultrasonography were not able to differentiate hydronephrosis from pericapsular spreading because of the extreme disruption of the renal parenchyma.

Bladder replacement with modified Studer pouch using absorbable staples.

The use of absorbable staples may allow to reduce the operating time of orthotopic bladder replacement. We report our experience in 14 patients with a modification of the Studer technique using absorbable PolyGIA instruments. The technique has been shown to be simple and quick to perform (time for pouch creation 15-40 minutes, mean 16 minutes) with no significant intraoperative difficulties. Urodynamic data and continence are satisfactory and seem comparable to different procedures and not related to staples' use. The main question remains if the reduced operating time equalizes the high cost of staple devices.

Urinary tract endometriosis: report of 2 cases and a review of the literature.

Endometriosis of the urinary tract is a relatively rare condition. Since clinical signs are not specific the diagnosis is difficult and the therapy is not well defined. Two cases and a review of the literature are presented.

Painless treatment of hydrocele: EMLA cream anaesthesia and fibrin adhesive sclerotherapy.

Sclerotherapy for hydroceles was performed in 18 patients. Cutaneous anaesthesia was induced with an anaesthetic cream (lidocaine and prilocaine, EMLA cream) and a fibrin sealant (Tissucol) was injected into the sac after fluid aspiration. Patients experienced no pain during needle insertion and sclerosant procedure; 2 recurrences were observed during follow-up. EMLA cream anaesthesia and fibrin adhesive sclerotherapy represent a useful alternative to surgical treatment of hydroceles.

Correlation between Gleason score of needle biopsy and radical prostatectomy tissue.

Gleason score has been identified as an important variable to predict disease extent and biologic behaviour of prostate cancer. However, the correlation between Gleason score of needle biopsy and surgical specimen is often poor. We studied 72 patients who underwent needle biopsy and radical prostatectomy to correlate Gleason score with PSA, clinical and pathological tumour stage. Only 47.2% of Gleason scores were identical in the biopsy and specimens, 37.5% were undergraded and 15.2% were overgraded. Correlations between clinical and pathological stage were identical in 30.5% of patients, 61.1% of patients were understaged and 8.3% overstaged. In conclusion, accuracy of clinical staging and grading of prostate cancer is low. Although the Gleason score on needle biopsy might be useful to predict the final stage and grade, correlation with surgical specimen is poor.

[Fracture of the penis: description of a case]. / Frattura del pene: descrizione di due casi.

Fracture of the penis is not a frequent event and it consists of a rupture of the tunica albuginea of the corpora cavernosa and sometimes of the urethra; the lesion occurs when the penis is erect because during erection the tunica albuginea is very thin and not flexible and it can be easily damaged by a trauma; most lesions occur during intercourse for impact of the erect penis against the female perineum or the pubic synphisis, but lesions during masturbation, fightings or falling off the bed are also described [1-2-3]. Clinically there are pain, detumescence, hematoma and recurvatum of the penis toward the opposite side of the lesion and hematuria if also the urethra is damaged. Usually diagnosis is quite easy with a good anamnesis, clinical examination and echotomography which can reveal presence of hematoma and hypoechogenic areas along the tunica albuginea or the urethra that appears irregular. Nowadays, fractures of the penis need a surgical approach to obtain good results avoiding consequences such as recurvatum or fibrotic areas [3-4-7-8]. We describe two cases of fracture of the penis occurred in two young men during masturbation and treated surgically with excellent results: twelve and eighteen months respectively after surgery patients are well and can enjoy a normal sexual activity with no problems at all.

[Role of color-Doppler in the assessment of erectile impotence: personal experience]. / Ruolo del color-Doppler nella valutazione dell'impotenza erettile: esperienza personale.

We present our experience with colour duplex sonography in the assessment of 38 impotent men, whose ten underwent radical prostatectomy, following intracavernous pharmacological stimulation with PGE1. All patients with a clinical good response following PGE1 injection had peak cavernosal artery velocities > 30 cm/sec. The remaining suboptimal responders who presented an elevated end-diastolic velocity (> 5 cm/sec) showed a venous leakage demonstrated with cavernosography. Colour duplex sonography is a valuable and non-invasive tool in the assessment of impotence and can provide valuable information in the diagnosis of vasculogenic erectile dysfunction.

[Electrovaporization of the prostate]. / Elettrovaporizzazione della prostata.

Electrovaporization is a new and potentially useful modification of transurethral resection of the prostate which is rapidly becoming a treatment of choice for symptomatic benign prostatic hyperplasia. We report our experience with 22 patients treated using the Circon Acmi Grooved Vaportrode vaporization electrode. Procedures were carried out using the standard technique of electrovaporization with general or regional anaesthesia. Mean operative time was 40 minutes (range 25-65 minutes) and all patients were discharged without catheter after 1 or 2 days. Symptom score, peak uroflow and postvoid residual urine showed statistically significant improvement at 3 months (p < 0.01). There were no significant complications. Transurethral electrovaporization of the prostate seems to be a easy and safe procedure with significantly lower costs and excellent results. However, long-term efficacy and complications need to be evaluated in multicentre clinical trials.

[Prostatic endoprosthesis in the treatment of prostatic obstruction: preliminary experience with the new Trestle model]. / Le protesi endoprostatiche nel trattamento dell'ostruzione prostatica: esperienza preliminare con il nuovo modello Trestle.

The urethral stent is a relatively new treatment modality for benign prostatic hypertrophy ostruction. Although the ultimate prostatic endoprosthesis has yet to be developed, various stents have been produced and investigated with good results. We review the several currently available stents and we report the preliminary clinical experience with a new device (Trestle).

Microencapsulated lysine and low-protein diets: effects on performance, carcass characteristics and nitrogen excretion in heavy growing-finishing pigs.

Two studies were conducted to assess the effects of dietary protein and Lys reduction on growth performance, carcass quality, N excretion, and plasma N profile in growing-finishing pigs from 35 to 180 kg. The growing trial was conducted with 72 gilts and 72 barrows with 6 pens per treatment and 6 gilts or 6 barrows per pen. Four diets with the same DE and NE were compared: 1) control diet, 2) diet with protein content reduced by 3% units compared with the control diet and supplemented with Lys HCl to match the requirements according to the 2012 NRC (FLys), 3) diet similar to FLys for protein level but supplemented with only 50% of the Lys HCl provided with FLys (-50% FLys), and 4) diet similar to FLys and -50% Flys for protein level with microencapsulated Lys added to supply 20% of the Lys provided by FLys (-80% MLys). Pigs fed the FLys diet performed in a similar manner and showed similar carcass characteristics to the control pigs. Pigs fed the -50% FLys diet had the lightest BW (P < 0.01) as well as the lightest carcass (P = 0.02) and trimmed thigh (P = 0.04) weights. Pigs fed the -80% MLys diet showed growth performance and carcass characteristics similar to the control pigs. The N balance study was conducted with 8 barrows arranged in a double replicated 4 × 4 Latin square design. The control pigs had greater (P < 0.01) N intake and urinary and total N excretion compared with pigs fed the low-protein diets. The reduction of the dietary protein concentration by 3% units decreased total N excretion by an average of 24.5% and the greatest reduction of total N excretion was obtained by the -80% MLys diet (26.12%) compared with the control diet throughout the trial. No effect of dietary treatment was observed on the plasma concentrations of ammonia, urea, and total AA in the 80-kg pigs. Decreased plasma ammonia (P < 0.01) and urea (P = 0.03) concentrations were detected in the 120-kg pigs fed the low-protein diets. The 160-kg pigs fed the -80% MLys pigs had less total AA, indispensable AA in particular (P < 0.01), than pigs fed the other diets and decreased ammonia (P < 0.01) and urea (P = 0.05) concentrations than the control pigs. The results showed that the use of microencapsulated Lys, compared with both Lys HCl and dietary protein-bound Lys, can save CP and synthetic AA in diet formulation and can reduce N excretion in manure without adversely affecting the growth performance and carcass quality of heavy growing-finishing pigs.

Influenza A pandemic (H1N1) 2009 virus outbreak in a cat colony in Italy.

In April 2009, a novel H1N1 influenza A virus (pH1N1) was recognized as the cause of the flu pandemic in humans. Here, we report the isolation of pH1N1 virus from the lung homogenates of two cats, which died after severe respiratory symptoms. The cats belonged to a cat colony consisting of 90 caged cats and were found dead following a 2-week period of respiratory and gastrointestinal diseases in the colony. During the outbreak, 25 cats died and 50% of the animal colony showed anorexia, depression, respiratory and gastrointestinal symptoms. Histological examination of the lungs of the two tested cats displayed lesions centred on terminal airways with epithelial bronchiolar hyperplasia and alveolar necrosis. Influenza A virus was detected in the lung tissues by immunohistochemistry and real-time RT-PCR (rRT-PCR). Partial sequences of haemagglutinin (HA) genes and complete sequences of neuraminidase (NA) genes of the two isolates displayed high similarity to the pH1N1 viruses circulating in humans (99% for HA gene and 100% for NA gene). To determine whether the pandemic virus had circulated among cats, serum samples and pharyngeal swabs were collected from 38 cats of the colony. Serum samples were tested by ELISA to detect antibodies against pH1N1 nucleoprotein and by hemagglutination-inhibition test, while pharyngeal swabs were examined by pH1N1 specific rRT-PCR. Twenty-one (55%) of the tested cats carried antibodies against the isolated strain and two swabs were positive for the presence of pH1N1 RNA. Our results confirm that the pH1N1 virus was able to infect cats and raise the hypothesis of the circulation of the virus within the colony being due to cat-to-cat transmission. The case reported here provides, to the best of the authors' knowledge, the first description of the pH1N1 infection involving numerous cats that lived in a restricted area with limited contact with humans.