Intracesarean removal of two huge fibroids occupying the whole uterine fundus: a case report.

Uterine fibroid is an estrogen-dependent mass growing during pregnancy. Caesarean myomectomy (CM) is a controversial procedure. A 35-year-old obese (106 Kg) patient gravida 2 para1 (caesarean section), undergoing caesarean section, had two myomas occupying the whole uterine fundus (104.2 mm and 50 mm respectively). Intracesarean myomectomy was carried out after extraction foetus (Apgar score: 9/10). Postoperative course was uneventful and patient was discharged after four days.

[Umbilical acid-base status of term infants: correlation with delivery mode]. / Equilibrio acido-base sul sangue cordonale di neonati a termine: correlazioni con il tipo di parto.

OBJECTIVE: To determine possible relations between Apgar score, umbilical artery haemogasanalysis and delivery mode. METHODS: 948 babies were considered; preterm infants and charts with incomplete data were excluded. 762 newborns and their respective umbilical artery blood gas parameters at delivery were evaluated. The collected Data were related to mode of delivery: vaginal with and without analgesia, elective caesarean section (CS), CS after labour, emergency CS for non reassuring trace. RESULTS: Mean pH (+/- DS) was 7.26 (+/- 0.08). The comparison vaginal delivery vs. CS was statistically significant (p < 0.0001). Analyzing the CS only, the babies born by emergency CS for non reassuring trace had pH statistically lower (ANOVA p < 0.004) and, in the latter group, there was a statistically difference between Italian newborns and those from other ethnicities (p < 0.02). No difference were found on Apgar score, excluding babies by vaginal delivery with analgesia that showed lower scores both at 1 (p < 0.02) and 5 (p < 0.002) minutes versus newborns without analgesia. CONCLUSIONS: Normal labour causes frequently a mild degree of acidosis, but it is not always related to neonatal asphyxia. The differences found between different delivery modes are, probably, the expression of causes related to the obstetric choice. That is also remarked by the statistically difference found in emergency CS for non reassuring trace in Italian population and in other ethnicities, showing a probably different cultural level, mainly about the "obstetric emergency" poorly understood by the pregnant. In vaginal deliveries the analgesia does not modify the neonatal metabolism, but can be a reason of delayed adaptation of extrauterine life.

Cascade approach of red macroalgae Gracilaria gracilis sustainable valorization by extraction of phycobiliproteins and pyrolysis of residue.

Phycobiliproteins extraction (primary refining) from Gracilaria gracilis seaweed, harvested in Lesina Lagoon (Italy) and further valorization of the residual algal via pyrolysis (secondary refining), were investigated with a cascade biorefinery approach. R-phycoerythrin (7 mg/g d.w.), allophycocyanin (3.5 mg/g d.w.) and phycocyanin (2 mg/g d.w.) were the main phycobiliproteins extracted. Pyrolysis of G.gracilis residue followed, aiming to investigate the production of bio-oil and biochar within a pyrolysis temperature range of 400-600 °C. Results showed that the bio-oil yield is high (∼65 wt%) at pyrolysis temperature ∼500 °C, but its high content in nitrogenous compounds prevents its use as a biofuel, unless some further de-nitrogenation takes place. Biochar yield ranged between 33 wt% (400 °C) and 26.5 wt% (600 °C). Interestingly, inorganic nutrients including P, K, Ca, Fe and Mg were detected in biochar, suggesting its potential use as recovering system of natural mineral resources from the oceanic reservoir.

Overnight growth hormone secretion in short children: independence of the sleep pattern.

PURPOSE: to analyze the interrelationships between GH secretion and pattern of sleep. PATIENTS: 18 children (10 male, 8 female; mean age 9.1 yr, range 5.1-14.3 yr), with short stature (mean height standard deviation score (SDS) -2.52, range -3.86-(-)1.88; mean height velocity SDS -1.1, range -2.40-(-)0.08), including 9 children with genetic short stature and 9 with idiopathic short stature. METHODS: blood samples were taken every 15 min from 2000 h-0800 h, and GH profiles were analyzed by the PULSAR computerized peak identification algorithm; simultaneous sleep was analyzed by electroencephalogram recording. RESULTS: no significant correlation was noted between GH secretion parameters and any of the electroencephalogram parameters evaluated: stage 1 (S1) percent, stage 2 (S2) percent, slow-wave sleep (SWS) percent, rapid eye movement sleep percent, wakefulness (W) percent, and sleep efficiency (EFF); there was no significant difference in GH secretion between children with EFF less than 76% and those with EFF more than 76% (P > 0.5). Maximal GH peak coincided 9 times (50%) with SWS, 3 times (17%) with S2, 3 times with W, twice (11%) with S1, and once (6%) with rapid eye movement sleep. First GH peak coincided 12 times (67%) with W, 3 times with S2, twice with SWS, and once with S1. There was no significant difference comparing the percentage of sleep stages occurring in the 15 min of maximal GH increment, in the 15 min preceding it, and in those following it; there was no significant difference comparing the percentage of sleep stages occurring in the 15 min preceding the onset of a GH peak and in those following it. CONCLUSIONS: GH secretion in short children seems independent of the sleep stage and efficiency; in children it is possible that GH secretion relates with sleep per se and with neurohormonal changes occurring at nighttime rather than with a specific sleep stage or sleep stage sequence.

Lack of effect of cholestyramine on phenytoin bioavailability.

The effect of cholestyramine (4 g qid for 5 days) on the kinetics of phenytoin (400 mg orally) was investigated in normal subjects. Apart from a trend toward faster phenytoin absorption, the serum level profile of the drug during concurrent cholestyramine coadministration was similar to that observed in a control session. Areas under the serum phenytoin concentration curves were virtually identical in the two occasions. It is concluded that cholestyramine does not significantly affect the bioavailability of a single dose of phenytoin.

Effects of different sports on bone density and muscle mass in highly trained athletes.

PURPOSE: It is known that participating in sports can have a beneficial effect on bone mass. However, it is not well established which sport is more beneficial for increased bone mineral density (BMD) and appendicular muscle mass (AMM). This study investigated the effects of different high-intensity activities on BMD and AMM in highly trained athletes. MATERIALS AND METHODS: Sixty-two male subjects aged 18--25 yr participated in the study. The sample included judo (J; N = 21), karate (K; N = 14), and water polo (W; N = 24) athletes who all competed at national and international level. Twelve age-matched nonathletic individuals served as the control group (C). All athletes exercised regularly for at least 3 h x d(-1), 6 d x wk(-1). Segmental, total BMD, and AMM were measured with a dual-energy x-ray (DXA) absorptiometry (Lunar Corp., Madison, WI). DXA analysis also includes bone mineral content (BMC) and fat and lean masses. RESULTS: Total BMD(C) was significantly lower (mean +/- SD: 1.27 +/- 0.06 g x cm(-2), P < 0.05) than either judo or karate athletes (total BMD(J) (1.4 +/- 0.06 g x cm(-2)) and total BMD(K) (1.36 +/- 0.08 g x cm(-2))) but not different from the W athletes (total BMD(W) (1.31 +/- 0.09 g x cm(-2))). AMM was significantly lower in the C group compared with the three athletic groups (P < 0.05). Fat mass was higher in the W versus J and K athletes but not different from the C group (P < 0.05). CONCLUSIONS: This cross-sectional study has shown that athletes, especially those engaged in high-impact sports, have significantly higher total BMD and AMM than controls. These results suggest that the type of sport activity may be an important factor in achieving a high peak bone mass and reducing osteoporosis risk.

Enzyme-potentiated desensitization in children with asthma and mite allergy: a double-blind study.

The aim of this study was to evaluate the efficacy and safety of enzyme-potentiated desensitization (EPD) in children with asthma. Twenty asthmatic children (14 males and 6 females; median age: 8.5 years) were included in the study. They had positive skin tests to Dermatophagoides pteronyssinus (Dpt), no history of other allergy and had suffered from asthma for at least two years. The children were examined before starting the trial, at the first EPD dose, after 8 weeks, at the second EPD dose and 3 months after the second EPD dose. Blood samples for PRIST and RAST were drawn before the first and at the second EPD dose, and at the last follow-up. Conjunctival provocation tests (CPT) and skin test endpoint determinations were performed with dilutions of a freeze-dried Dpt extract (10-100,000 SQ-U/ml) at the start of the trial and at the last follow-up. Parents kept a diary record of the days with asthma and daily drug usage. The children were randomized to receive either two intradermal placebo injections or the active material with an 8-week interval (November 1991 and January 1992). Ten children received EPD and 10 children placebo. The intradermal injection of EPD (0.05 ml) contained 0.01 ml of beta-glucuronidase (40 Fishman units) and 0.04 ml of a mixture of inhalant allergens (1 Noon unit). The placebo injection consisted of buffer solution only. The EPD-treated children had significantly fewer days with asthma (p = 0.00000). In addition, the EPD-treated children used significantly less medication for the management of asthma attacks (p = 0.00000). At the start of the trial, three out of 10 children in the EPD group and two out of 10 in the placebo group reacted only to the highest dose of allergen used in the CPT (100,000 SQ/ml) (NS). At the last follow-up, the threshold dose in the CPT was 100,000 SQ/ml or more in nine out of 10 children in the EPD group and in four out of 10 children of the placebo group (p = 0.0349). At the last follow-up, one child in the EPD group had a negative CPT with all doses tested. Global clinical evaluation by the investigators showed that eight out of 10 EPD-treated children improved, in comparison with three out of 10 children in the placebo group (p = 0.0349). Assessment by the parents was six out of 10 and four out of 10 improved, respectively (NS). Specific IgE to Dpt, total IgE and skin prick test endpoints before and after EPD showed no significant changes. One child in the placebo group experienced mild urticaria several hours following the second injection. No other local or systemic side effects were reported. The results of the present study provide further data on the effectiveness and safety of EPD in patients with asthma.

Regional migratory osteoporosis: a pathogenetic hypothesis based on three cases and a review of the literature.

Regional migratory osteoporosis (RMO) is a migrating arthralgia of the weight-bearing joints of the lower limb which mainly affects middle-aged males. Its aetiology is unknown. The association of RMO with generalised osteoporosis has recently been reported. A concurrent systemic osteoporosis was also reported in some cases of transient osteoporosis of the hip (TOH), a disorder closely related to RMO. In its turn, TOH is considered a reversible stage of avascular necrosis of the hip (AVN), and the aetiopathogenesis of both of them remains strongly debated. We report three cases of RMO associated with generalised severe idiopathic osteoporosis. Three men, in the fourth and fifth decades of life, complained of at least four episodes of arthralgia in the lower limbs, with a migratory pattern, radiographic focal osteoporosis and final clinical resolution. The most striking common feature of these patients was the presence of a severe systemic osteoporosis with a prevailing trabecular involvement. We suggest that a prolonged or exaggerated activation of regional acceleratory phenomena (RAP) is the cause of transient osteoporosis. Bone tissue microdamage due to osteoporosis may be the most frequent noxious stimulus that turns RAP on, and, bone tissue microfracture is the most prevalent consequence. When this pathogenetic pathway is activated, the progression from focal osteoporosis and bone marrow oedema to avascular necrosis is associated with the amount of structural damage.

Pharmacokinetics of ifosfamide administered according to three different schedules in metastatic soft tissue and bone sarcomas.

Ifosfamide is a leading drug in soft tissue sarcoma therapy. Recently high dose therapy (>9 g/m2) has been introduced in different schemes to obtain a higher response rate. All these higher doses can be administered following two different schedules: continuous infusion 24 hours a day for 4-5 days or bolus administration for 5 consecutive days. In this study we compare the differences in the pharmacokinetic profile between the two schedules. In both schemes we saw a very important autoinduction phenomenon, with a corresponding half-life decrease and total body clearance increase during the days of therapy. The clearances were not directly correlated with the administered dose. We can conclude that ifosfamide continuous infusion therapy is equivalent to fractionated administration, at least from a pharmacokinetic point of view. Short-term infusion is subjectively better tolerated and is therefore preferred.

The extensor digitorum brevis muscle island flap for soft-tissue loss around the ankle.

The extensor digitorum brevis muscle flap, which has already been suggested as a local flap for the foot, has been applied by us in 2 cases with excellent results. This flap, as with other muscle flaps, provides an excellent bed for the skin graft. Furthermore, because of its width, it allows for covering an area of skin loss 5 X 7 cm in size in areas that are difficult to cover by other reconstructive means. The arch of rotation of this flap allows for coverage of the lateromedial and posterior surfaces of the ankle with no functional loss at the donor site. The relative ease of elevating this flap presents a reasonable justification for its wider application as a single local procedure for skin problems around the ankle.

Effect of flurithromycin, a new macrolide antibiotic, on carbamazepine disposition in normal subjects.

The effects of flurithromycin, a new macrolide antibiotic, on the disposition of a single oral dose of carbamazepine (CBZ) (400 mg) were investigated in seven normal subjects. Flurithromycin (2 x 250 mg thrice daily for 10 days) caused a slight increase in the CBZ area under the serum concentration curve and a moderate reduction in carbamazepine-10, 11-epoxide (CBZ-E) levels. These results suggest that flurithromycin can inhibit the conversion of CBZ to CBZ-E, although, at the dosage tested, the magnitude of this effect was significantly smaller than that observed after administration of erythromycin in the same subjects.

Ischaemic isolated retraction of the abductor digiti minimi.

A case of hyperabduction of the little finger due to ischaemic retraction is presented. Operative release of the abductor digit minimi produced good result. The differential diagnosis is discussed.

Carpal tunnel syndrome in Madelung's deformity.

The authors describe a case of carpal tunnel syndrome due to Madelung's deformity. They discuss the pathophysiological causes of median nerve entrapment to explain the compression which occurs in this disease and its clinical implications. They take also into consideration the surgical approach to the carpal tunnel in this particular condition.

Pharmacokinetics of flutoprazepam, a novel benzodiazepine drug, in normal subjects.

The single dose pharmacokinetics of flutoprazepam and its active N-desalkyl metabolite were determined in 8 normal subjects by using newly developed, highly sensitive, GC-MS and HPLC techniques. Following a 2 mg dose of the drug, the concentrations of unchanged flutoprazepam in serum were extremely low (below 5 ng/ml at 2 h) and declined rapidly to undetectable levels within 6-9 h after dosing. At all sampling times, the serum concentration of the N-dealkylated metabolite (N-desalkylflurazepam) was much greater than that of the parent compound. This metabolite appeared in serum rapidly (within 2 h), reached a peak between 2 and 12 h and declined slowly, with an elimination half-life of about 90 h on average. The serum concentration of two additional putative metabolites (3-hydroxy-flutoprazepam and N-desalkyl-3-hydroxy-flutoprazepam) was below the limit of detection (2 ng/ml) in all samples. Mild CNS effects (documented by prolonged choice reaction time) were present at 2 and 4 h but were no longer detectable at 9 h. It is suggested that unchanged flutoprazepam is unlikely to contribute significantly to clinical effects and that the drug exerts its therapeutic activity through conversion to the slowly eliminated N-desalkyl metabolite.

Fate of E. coli across mechanical dewatering processes.

Five UK sludge treatment plants have been monitored for Escherichia coli (E.coli) variation after mechanical belt press and centrifuge dewatering processes. A complementary laboratory trial was also completed to examine the effects of varying centrifugal force on raw sludge E.coli content. An E.coli balance between the numbers contained in the flows entering and exiting four full scale centrifuge dewatering systems indicated a minimum 63 % increase in E.coli numbers between the input feed and sludge cake for a digested sludge input to the centrifuge. For two of the centrifuge sites this increase was statistically significant and corresponded to an increase in E.coli concentration ranging up to 1.4 Log after centrifugation. However, E.coli variation was found to be dependent on the type of sludge, as centrifuge dewatering of raw sludge at full scale resulted in a 40 % decrease in E.coli numbers. The complementary laboratory centrifuge work confirmed that E.coli numbers decreased in raw sludge after centrifugation. E.coli numbers were not observed to increase in digested sludge which had been dewatered using a belt press. A decrease of 44 % was observed.

Medial patellar synovial plica syndrome: the influence of associated pathology on long-term results.

The results obtained after 4-8 years in 42 patients submitted to arthroscopy for the treatment of medial patellar synovial plica syndrome are analyzed. There was a considerable difference in the values obtained depending on whether the plica was isolated, or associated with meniscal or cartilaginous lesion. In fact, based on the Lysholm score, treatment of isolated plica obtained 17 excellent or good results in 21 patients, while in the 21 cases where the lesion was associated with other pathologies excellent or good results were observed in only 9 subjects. Thus, associated lesions definitely influence long-term results.

Giant cell tumor of the hamate bone.

The authors present two cases of giant cell tumor of the hamate bone. The symptoms and signs were similar in both cases: pain, mild inflammatory changes, and localized swelling. The radiographic picture included lacunar osteolysis with interruption of the cortex in one case, intact cortex but more expansive lysis of the cancellous bone in the other. The findings of greatest interest were constituted by the extreme rareness of the localization, problems related to differential diagnosis, long-term follow-up in one case (20 years) and the different methods of treatment used.

Affair of the heart. Pediatric cardiac homecare.

Technology has made it possible for children who are born with heart disease and defects to live. Careful home care coordination has made it possible for these children to live at home. For the families involved, that makes all the difference.