Prevalence of multidrug-resistant organisms in migrant children admitted to an Italian cardiac surgery department, 2015-2016.

Screening on hospital admission to identify multidrug-resistant organism (MDRO) colonization is a frequently discussed topic. We report the results of microbiological screening in 141 Italian and 354 migrant children candidates for cardiac surgery conducted in 2015-2016. In all, 25% of Italian children and more than 65.4% of African and Romanian children carried at least one MDRO (meticillin-resistant Staphylococcus aureus; extended-spectrum ß-lactamase enzymes; carbapenemase producers; and vancomycin-resistant enterococci). Based on our findings, we propose that non-geographically limited approaches are needed to improve infection prevention and control.

[Hepatic haemorrhage in pregnancy: a case report]. / Emorragia epatica in gravidanza: caso clinico.

Spontaneous hepatic haemorrhage in pregnancy (SHHP) is a rare event (1 woman out of 15,000). It is generally considered as an advanced state of the microangiopathic hemolytic anemia (HELLP, Hemolysis, Elevated Liver enzyme levels, Low Platelet count). Furthermore, the HELLP is considered as a different form of preeclampsia. The patient, a 33-year-old-woman at 30 weeks' gestation, was admitted to hospital for preeclampsia, underwent an emergency Stark caesarean section with the extraction of an alive foetus and evidence of massive intraperitonal haemorrhage from a large hepatic haematoma. A haemostasis with gauzes of Surgicel was performed, with consequent arrest of the haemorrhage. After approximately 6 hours, a recurrence of the intraperitonal haemorrhage led to a new surgical intervention with hepatic packing with gauzes. After 4 days the patient died. The etiopathogenesis of disease is uncertain, both foetal and maternal mortality are high, and the slight number of reported cases (27) of SPPH from HELLP in international literature offer elements for debate. The following points have been put forward: 1. the monitoring of the counts of the platelets represent the only valid predictive test of HELLP. These concerned women in the third trimester of pregnancy, especially those with a history of preeclampsia; 2. the treatment must be immediate, intensive and multidisciplinary, the plasmapheresis has remarkably improved the prognosis; 3. surgical treatment performed in order to control the SPPH makes use of packing, embolization and/or fastening of the common hepatic artery and, in extreme cases, total hepatectomy with transplantation. The Authors believe it is useful to suggest a national epidemiological research in order to estimate the real incidence of the syndrome in Italy and to establish the guidelines for the medico-surgical treatment.

[Surgical complications for gastric and small bowel metastases due to primary lung carcinoma]. / Complicanze chirurgiche per metastasi gastriche e digiuno-ileali da carcinoma primitivo polmonare.

Lung carcinoma is the first cause of death for tumors; in Italy there are from 35,000 to 40,000 new cases a year, with a global survival to 5 years from the diagnosis in 13% of cases. The gastric and small bowel metastases are rare, respectively 0.4% and 1.1% and the cases reported in the literature are rare. There is often a poor symptomatology and diagnosis is usually based on post-mortem examination. Yet, sometimes, the first and only demonstration of the secondary illness is a surgical complication, whether it be a haemorrhage, a perforation or an occlusion. The authors report their experience, from April 1999 to March 2003, of 3 cases of small bowel metastases, presented in 1 case with a perforation and in 2 cases with an occlusion and of 1 case of gastric metastasis, which presented with a haemorrhage. These patients were treated by emergency surgery, with 1 case only of postoperative mortality. The 1st patient died 6 months after surgery, and the 2nd patient 6 days after, the 3rd patient 4 months after the 1st operation and the 4th patient is still in follow-up after 6 months. The authors present a review of the literature and some considerations of diagnosis and surgical treatment.

[The meshes of polypropylene in emergency surgery for strangulated hernias and incisional hernias]. / La protesi di polipropilene in chirurgia d'urgenza per laparoceli ed ernie strozzate.

INTRODUCTION: The Authors present their experience on the use of meshes of polypropylene in septic surgery of the abdominal wall defects. MATERIALS AND METHODS: From April 1999 to October 2003, 23 patients underwent intestinal resection (20 small intestine, 3 large intestine) for ischemic necrosis strangulation caused by defects in the abdominal wall (inguinal hernia 8, crural hernia 4, umbilical hernia 3, post-incisional hernia under umbilicus 3, post-incisional hernia epigastric 3, giant post-incisional hernia 2). RESULTS: No patient died and the removal of the mesh was never required in cases of infection of the surgical wound; 2 surgical wounds festered, with the reopening of the cutaneous wound and showing of the prosthesis, 5 hygromas were all treated in a conservative way. DISCUSSION: The macroporous structure of the meshes of polypropylene, with pores of diameter larger than 70 microns, allows contact among the bacteria, which measure one micron in diameter, and the cells of the immune system, granulocytes and macrophages, with a diameter of 15-20 microns, allowing the recovery from infections, and determining an high resistance rate to infections. CONCLUSIONS: Polypropylene prostheses, thanks to their macroporous structure, are sufficiently resistant to infections and therefore may be safely used in the surgery of the defects of the abdominal wall, when, following ischemic necrosis, an intestinal resection is necessary.

[Emergency surgery for neoplastic left colon obstruction: resection and primary anastomosis (RPA) versus Hartmann resection (HR)]. / Chirurgia d'urgenza per occlusione neoplastica del colon sinistro: resezione ed anastomosi primaria (RPA) versus resezione secondo Hartmann (HR).

UNLABELLED: This retrospective study compares: hospitalization time, morbidity and mortality (patients operated for neoplastic occlusion of the left colon in emergency, without perforation), considering hanestesiologic risk and surgical technique (RPA versus RH). MATERIALS AND METHODS: From April 1999 to February 2003 the Emergency Surgery of AORN of Caserta has operated, in urgency, 60 neoplastic patients with left colon occlusion realizing: 46 (76.5%) RPA [36 ASA < or = III, low hanestesiologic risk (LAR), 10 ASA = or > IV high hanestesiologic risk (HAR)], 12 (20%) RH (2 LAR and 10 HAR) 2 (3.5%) palliative colostomics. RESULTS: 36 LAR patients with RPA had 5% of specific complications and 5% of medical complications. 2 LAR patients with R-H: no complication. 10 HAR patient with RPA brought 10% of specific complications and 10% of medical complications. 10 HAR patients with RH had 20% of specific complications and 10% of general complications. The middle hospitalization of LAR patients with RPA was 11 days versus 9 days of RH pz. (equal hanestesiologic risk ). The HAR pz., treated with RPA, had as middle hospitalization 15 ggs in comparison to the 9 ggs of the HRA pz. treated with RH. MORTALITY: 1/36 for LAR pz. with RPA (3%), and 0/0 for LAR pz. with RH; 1/10 for HAR pz, with RPA (10%) and 1/10 for HAR pz. with RH (10%). CONCLUSIONS: Resection and primary anastomosis, (correct indications and expert surgeon), gives prevalence of complications and mortality similar to the repeated surgical procedure, a better life quality, but an higher number of post-operating hospitalisation days.

[Psychological consequences in women with symptomatic HPV infection]. / Conseguenze psicologiche in donne con infezione sintomatica da HPV.

OBJECTIVE: Evaluation of psychological and social aspects of women with diagnosed genital HPV-infection. EXPERIMENTAL DESIGN: A retrospective study of 40 women with a diagnosis of HPV-genital infection has been made. INTERVENTIONS AND MEASURES: A questionnaire for gathering information on social life, sexuality and emotional relationship with the partner was submitted to the patients. RESULTS: There is a high percentage of sexual impairments after diagnosis of HPV-infection. CONCLUSIONS: HPV infections, as many genital pathologies, lead to problems with sexuality as well as hypochondriac fears.

[Diagnosis and therapy of CIN in pregnant women]. / Diagnosi e terapia della CIN in donne gravide.

BACKGROUND: CIN is the most frequent neoplasm in pregnancy. At present, in Italy, Pap test and colposcopy are not included in routine examinations in prenatal visits. METHODS: In this study, we submitted 560 pregnant women to Pap test during prenatal visits. In case of abnormal or doubtful smears a colposcopy and target biopsy were performed. RESULTS: Of the 560 women studied, 124 had genital bleeding and the other 436 were asymptomatic. Six cases of CIN symptomatic women and 5 cases in the asymptomatic ones. In no cases we thought necessary a therapeutic operation. We limited the therapy to a follow-up. CONCLUSIONS: In our opinion, it is necessary to treat CIN during pregnancy.

[Incidence of CIN in HIV-positive women]. / Incidenza della CIN in donne HIV-positive.

BACKGROUND: The aim of this study was to evaluate the incidence of CIN in HIV-seropositive women. METHODS: A group of 23 women with a mean age of 28 years was recluted. Three of them were clinically affected, and 20 were non-AIDS HIV-seropositive. The patients underwent cervical cytology, colposcopically directed biopsy and T-cell studies. In addition, HPV using the in vitro hybridization, was investigated. RESULTS: Eight of 23 patients (24.78%) had CIN. Patients with CIN had significantly lower CD4 cell counts and CD4/CD8 ratios than those without CIN. Patients with AIDS had higher grade lesions than those non-AIDS HIV-sero-positive. CONCLUSIONS: The data obtained suggest that abnormal cervical pathology is common among HIV seropositive women, and so cervical colposcopy should be part of the routine management of HIV-seropositive women.

[Authors' experience with medical therapy of herpes genitalis in pregnancy]. / Nostra esperienza nella terapia medica dell'Herpes genitalis in gravidanza.

BACKGROUND: Neonatal risk in herpes infections is very high: in the USA it is 1:2,000, in Japan 1:15,000 and in England 1:65,000. These differences seem to be due mostly to the different risk factors associated to the mother infection. The best strategy to cure herpes infection is to examine every patient during pregnancy and to identify the high risk ones. METHODS: In this study, 1,860 pregnant women have been submitted to a colposcopic and cytologic screening for the research of HSV. RESULTS: HSV was found in twenty (1.07%) women. Two groups have been made: the first with 14 HSV positive women at 3-6 months of pregnancy and second with 6 HSV positive women at eight months of pregnancy. Both groups were treated with acyclovir per os. The 14 women of the first group underwent vaginal delivery. The women of the second group underwent cesarean section. Only in 1 case a neonatal infection has been observed.

[Triptorelin therapy in uterine leiomyomatosis. Study of 18 cases]. / Terapia con triptorelina nella leiomiomatosi uterina. Studio di 18 casi.

BACKGROUND: The validity of tryptoreline treatment in uterine myomatosis is demonstrated, both as alternative therapy to surgery in patients in fertile age and as preoperative therapy reducing myomatosis volume. MATERIALS AND METHODS: In the outpatients department of Gynecologic and Obstetric Institute of the Second University of Naples, eighteen women, from 35 to 56 years old, with symptomatic uterine myomas, diagnosed by clinical examination and confirmed by pelvic ultrasonographic were treated with a delayed-release microcapsule preparation of D-Trp-6-LHRH (triptorelin) injected im, every 28 days. The duration of treatment was 6 months. RESULTS: The results are statistically significant for 16 patients that have completed the therapy with maximal reduction in uterine and leiomyomas volumes after 3 months of treatment. Minor side effects such as hot flushes, vaginal dryness, headache, dyspareunia were frequently encountered, but they disappeared progressively after the end of therapy. CONCLUSIONS: Four months after treatment, no significant increase in uterine and myoma volume, was noted.

[Estrogen therapy in women with postmenopausal osteoporosis]. / Estrogeno-terapia in donne con osteoporosi post-menopausale.

BACKGROUND: The effects of estrogen-therapy on bone mineral density and the incidence of fractures in 132 women with postmenopausal osteoporosis have been studied. MATERIALS AND METHODS: The patients were randomly assigned to receive placebo or estrogens (0.15 or 0.3 or 0.625 mg) for 64 months. Bone mineral density of the lumbar spine was measured by dual-energy X-ray absorptiometry with the use of Hologic QR-1000 densitometers, in all women. RESULTS: A significant increase in bone mineral density was observed in women receiving estrogens, whereas in those receiving placebo there was a decrease in bone mineral density.

Current etiopathogenetic views in vulvar cancer.

We considered 59 patients, from 19 to 79 years, treated for vulvar neoplastic pathology (32 of 59 had multiple squamous neoplasias of the anogenital region). It appeared that vulvar cancer is a disease of aged women and in particular between sixty and seventy years, while it isn't common under the age of thirty years. It is a hormone-independent pathology. 85% of vulvar malignant tumors is constituted by squamous cell carcinomas. The principal risk factors are: 1) chronic vulvitis (in particular Lichen sclerosus); 2) leucoplachia, 3) immunosuppression, 4) coitus in a young woman with different partners, multiple abortions, 5) HPV infection (mostly HPV type 6 and 16), 6) other genital carcinomas, 7) capacity to activate or not protoncogenes and to produce interferon, 8) tobacco smoking, 9) VIN.

A case of malignant melanoma of the vagina during pregnancy: immunological problems.

BACKGROUND: A clinical case of malignant melanoma of the vagina diagnosed during late pregnancy is described. Prompt histological examination showed a malignant melanoma at an early stage. The treatment of choice for malignant melanoma is surgical exicision. At present we are trying to associate immunological and chemotherapeutic treatments with surgical ones. CASE: A 27-year-old primipara was diagnosed with malignant melanoma at 38 weeks' gestation. The patient underwent a cesarean section. Careful evaluation of the immunological characteristics of the patient induced us to treat the melanoma with human leukocyte alpha interferon. The result was an increase in T4 cells with respect to T8 cells, with an enhancement in the ratio of CD4 to CD8. CONCLUSION: The results suggest the immune system plays a major role in the modification and regulation of neoplasias of the genital tract.

Therapeutic protocol of vulvar and cervical HPV-infection.

BACKGROUND: The stages of HPV (Human Papilloma Virus) infection are under the control of the immune system, which is inhibited by the virus itself. Thus, at present the treatment of condyloma acuminata is based on the use of interferon (IFN). The aim of the present study was to evaluate immune system activation and clinical response to IFN therapy. In addition, in the most serious cases, medical treatment with IFN was associated with diathermocoagulation (DTC) of persistent warts. The effectiveness of the combined therapy was also assessed. METHODS: 7 women (age range: 16-52) suffering from cervix condylomata were selected for our study. All of them were injected intramuscularly with doses of 3 million UI of IFN-alpha leucocytar every three days for six weeks together with daily applications of alpha-IFN for six weeks. The women that were still ill three months after IFN therapy, were treated with DTC. In one case, another cycle of IFN treatment was necessary. RESULTS: Clinical response to IFN treatment was complete in 46 cases, partial in 20 cases and unsuccessful in 4 cases. After three months of medical therapy, 30 women were treated with DTC. After this therapy, in 21 cases, the warts were resolved. After 24 months the percentage of relapse was 37.9% when only IFN was used, and 4.51% when IFN was combined with DTC. CONCLUSIONS: These data suggest that a successful protocol for the treatment of condyloma acuminata consist of IFN therapy associated with DTC when warts persisted.

Role of ultrasonography in the early diagnosis of ovarian cancer.

BACKGROUND: Malign ovarian carcinomas are the main cause of death from gynaecological cancer. In fact, only in 30% of cases is it diagnosed at an early stage. In our study the possibility of an early diagnosis of the ovarian malignant neoplasia was evaluated. METHODS: One hundred and thirty-nine women with adnexal swelling were subjected to pelvic echography. The sample was selected during routine gynaecological checkups. RESULTS: All the cases showing a mass diameter exceeding 25 mm were classified as positive. Echotomography showed 129 cases of positive ovarian mass with an accurate diagnosis in 92.27%. Integrating the results of echography with those of radioimmunoassay an early diagnosis of ovarian cancer was achieved in 92.53 of the cases. CONCLUSIONS: A routine pelvic examination associated with pelvic echotomography represent an effective protocol for the diagnosis of ovarian cancer at an early stage.

[Folic acid and cervix dysplasia]. / Acido folico e displasia cervicale.

The localized folate deficiency, which is sometimes misdiagnosed as cervical dysplasia, because of morphological similarities between the cytologic features of megaloblastosis seen with folate deficiency and the changes associated with dysplasia, could be a component of the dysplastic process. In this study we attempted the effect of oral folic in women with cervical dysplasia. A total of 154 subjects with grade 1 or 2 CIN were randomly assigned either 10 mg of folic acid or a placebo daily for 6 months. Clinical status, human papillomavirus type 16 infection and blood folate levels were monitored at 2 month intervals. After 6-months no significant differences were observed between supplemented and unsupplemented subjects regarding dysplasia status, biopsy results, or prevalence of human papillomavirus type 16 infection. Folate deficiency the initiation of cervical dysplasia, but folic acid supplements do not alter the course of established disease.

[Drug therapy of condylomata acuminata]. / Trattamento farmacologico dei condilomi acuminati.

This study seeks to evaluate two candidate regimens (5-fluorouracil and interferon) as adjuvants to optimally performed laser surgery in the treatment of condylomata acuminata. Skillful laser ablation can remove any volume of human papillomavirus-associated vulvar disease but cannot prevent reactivation of the surrounding latent viral reservoir during postoperative healing. Conversely, interferon and 5-fluorouracil are relatively ineffective as primary therapies. This study involves 118 evaluable patients: 32 in the laser-CO2 group, 34 in the 5-fluorouracil group and 52 in the interferon group. At assessment of final outcome, it was found that 43 of 52 (82%) assessable patients in the adjuvant interferon arm were controlled by a single laser ablation as compared with only 17 of 34 (50%) in the 5-fluorouracil group and 13 of 32 (40%) in the laser alone group. There was no statistical difference in outcome within the 5-fluorouracil and laser only arms. Conversely, a relatively low dose of recombinant interferon, used in combination with effective surgical deleulking, can markedly reduce the risk of postoperative recurrence.

[Extrauterine pregnancy: epidemiology and etiology]. / Gravidanza extrauterina: epidemiologia ed eziologia.

The aim of the present study is to determine the epidemiological characteristics and etiological factors of ectopic pregnancy. The pool of women at risk is determined by different factors such as contraceptive practices, fertility rate, sterilization, gynecological and pelvic infection. Serological evidence of previous Chlamydia infection was much more common when ectopic pregnancy occurred in abnormal tubes than in normal tubes or compared to intrauterine pregnancies. The influence of endometriosis and ovarian cyst was limited to a very few cases. The analysis of contraceptive habits shows a much higher number of extrauterine pregnancies (45%) when the woman is using progestin-only pill than when she is on combined oral tablets (20%). This higher rate of ectopic gestation can be interpreted to suggest either that the POP might be less effective in preventing ectopic than intrauterine pregnancies or that the POP can delay ovum transport by inhibiting the motility of the fallopian tube.

[Anencephaly: a still unresolved problem]. / Anencefalia: un problema ancora irrisolto.

The anencephaly is a congenital malformation, characterized by the absence of the cerebral structures and of the skull. In this study we have considered 5 cases of anencephaly, occurred in the decade 1985-1994. All the pregnant women have been interviewed and underwent ultrasonographic evaluation. Four out of 5 pregnant women have voluntarily interrupted pregnancy. In only 1 case, having achieved woman the 40th week of pregnancy, the delivery has been spontaneous: the fetus has died after few hours. The results of this study suggest that, being the anencephaly the most commonly indications for the abortion, would be important to help the women bearers of anencephalic fetuses to consent taking the organs, using them for transplantations on children that necessitate them.

[Incidence of HPV and CIN in HIV positive women]. / Incidenza dell'infezione da HPV e della CIN in donne HIV-positive.

Cervical intraepithelial lesions associated with genital human papilloma virus (HPV) infection occur with increased frequency and severity among women with immunodeficiency. In this study, we considered 24 HIV-seropositive and 12 HIV-seronegative women. Each woman was interviewed and underwent a cytologic and colposcopic evaluation. Then colposcopic and cytologic findings were correlated with histologic and differences between HIV-seropositives and seronegatives were analyzed. Ten (41%) of 24 HIV-seropositive and one (9%) of 12 HIV-seronegative women had human papilloma virus infection. Among seropositives, eight (34%) had cervical intraepithelial (CIN): of those eight, 5 had CIN I, 2 CIN II and 1 CIN III. There (24%) of the 12 HIV-seronegative had CIN: two had CIN I and one CIN II. Six of the HIV-seropositive women were found to have multicentric disease (two or more sites). The objective of this study is to determine the relationship between human immunodeficiency virus (HIV) and human papilloma virus infection, sexual habits, reproducive history, and risk of cervical intraepithelial neoplasia (CIN). The results of this study suggest that cervical intraepithelial neoplasia is a common finding in HIV-infected women. Papanicolaou tests should be effective for detecting cervical disease in this population.