Nonalcoholic fatty liver disease and decreased bone mineral density: is there a link?

PURPOSE: Liver diseases are associated with decreased bone mineral density (BMD) and evidence suggests that nonalcoholic fatty liver disease (NAFLD) affects several extra-hepatic organs, interacting with the regulation of multiple endocrine and metabolic pathways. This review focuses on the rapidly expanding body of evidence that supports a strong association between NAFLD and the risk of decreased BMD, expression of low bone mass (osteoporosis), or reduced mineralization (osteomalacia). METHODS: We identified studies by searching PubMed for original articles published in English through March 2015 using the keywords "nonalcoholic fatty liver disease" or "fatty liver" combined with "bone mineral density", "osteoporosis", or "osteomalacia". RESULTS: Recent cross-sectional and case-control studies involving both adults and children have consistently shown that patients with NAFLD exhibit a greater prevalence of decreased BMD compared with age-, sex-, and body mass index-matched healthy controls. Accumulating clinical and experimental evidence suggests that NAFLD may contribute to the pathophysiology of low BMD, possibly through the direct contribution of NAFLD to whole-body and hepatic insulin resistance and/or the systemic release of multiple pro-inflammatory, pro-coagulant, and pro-fibrogenic mediators. CONCLUSIONS: Although more research is needed before firm conclusions can be drawn, it appears that there is a non-chance, statistical association between NAFLD and low BMD. This finding argues for more careful monitoring and evaluation of BMD among patients with NAFLD. The potential contribution of NAFLD itself to the development and progression of decreased BMD warrants further study.

Non-Healing Burn Wound Treatment With A Sterile Silicone Gel.

Treatment of burn wounds can be complicated due to fluid and electrolyte loss and the increased chance of infectious complications. Silicone-based products have become increasingly used for non-healing wound treatment, but no study has specifically addressed its potential on burn patients. The purpose of this study was to compare the use of sterile silicone gel with conventional medication in improving the healing of burn wounds. Between November 2019 and March 2020, 12 patients with mid-deep and deep burn wounds were included in the present study (average TBSA approximately 29%, range 13-51%). Patient average age was 49 years (range 29-67 years), 7 were male. In each patient two clinically similar areas were identified and treated every 48 hours with topical application of silicone gel in the form of Stratamed® (Group 1) and conventional medication (Group 2). All the cases healed without requiring skin grafting. No secondary wound infection nor allergic reactions were found. The mean days from commencing the treatment to 95% re-epithelialization in Groups 1 and 2 were 5.4 and 12.5, respectively. Culture samples were negative for common pathogens. Silicone gel has shown to be particularly effective in speeding up the re-epithelialization process. The protective film formed by the silicone helps to reduce possible infectious complications. Finally, silicone gel is easy to apply and associated with greater pain control during medication.

La cicatrisation des brûlures peut être obérée par les pertes hydro- électrolytiques et les infections. Les produits à base de silicone sont de plus en plus utilisées dans le traitement des brûlures d'évolution torpide mais n'ont pas été évalués. Cette étude compare un gel de silicone stérile à un traitement conventionnel dans cette indication. Douze patients avec des brûlures intermédiaires et profondes ont été inclus dans cette étude, qui s'est déroulée entre novembre 2019 et mars 2020. Ils étaient brûlés sur 29% SCT (13 à 51%), avaient 49 ans et 7 étaient des hommes. Deux zones comparables étaient traité l'une par silicone (Statamed®, groupe 1), l'autre par traitement conventionnel (groupe 2), changés toutes les 48 h. Une cicatrisation spontanée a été obtenue chez tous les patients, il n'a été observé ni infection (clinique comme bactériologique) ni allergie. Cette cicatrisation sur 95% de la surface traitée était observée à J5,4 dans le groupe 1 et J12,5 dans le groupe 2. La silicone semble être particulièrement efficace pour accélérer l'épithélialisation et le film formé permet de prévenir les infections. Il est facile à mettre en place et permet une meilleure analgésie.

Effectiveness Of Reactive Oxygen Species In An Oil-Based Medication For Healing Burn Wounds: A Case Series.

Oxygen is considered a key element in the complex tissue repair process. O3-Oil antiseptics are obtained from the chemical reaction between ozone and unsaturated fatty acids of vegetable oils. The purpose of this study was to assess the effectiveness of a commercially available O3-Oil in the management of recalcitrant burn wounds. This study involved 20 patients with mid-deep and deep burn wounds (average TBSA approximately 23%, range 7-35%). Patient average age was 47 years (range 26-74 years), 8 were male. The presence of exudate, pain and delayed re-epithelialization, absence of tissue necrosis and/or sepsis were the inclusion criteria for the topical use of O3-Oil. In each patient two clinically similar areas were identified and treated every 48 hours with O3-Oil (Group 1) and conventional medication (Group 2). All the patients had positive bacterial culture results before treatment. A quicker reduction of exudates and pain and a progressive and faster bacterial load reduction was observed in Group 1. Negative cultures were obtained after 4 days on average in Group 1 (range 1-7 days) and 8 days in Group 2 (range 5-11 days). The present study demonstrated that Novox® provides a significant antibacterial effect, while stimulating reparative processes. According to our experience, the use of gel or pad is useful for re-epithelializing lesions, while the impregnated gauzes, which tend to adhere to the wound, are better used on lesions with granulation tissue.

L'oxygène est un élément- clé du processus complexe de réparation tissulaire. Les antiseptique O3-huile sont obtenus par réaction chimique entre l'ozone et des acides gras polyinsaturés d'origine végétale. Cette étude avait pour but d'évaluer l'efficacité d'un tel produit sur les brûlures d'évolution torpide. Elle a concerné 20 patients (dont 8 hommes) de 47 ans d'âge moyen (26- 74) ayant des brûlures intermédiaires à profondes sur 23% de SCT (7 à 35). Les indications de mise sous O3- huile pouvaient être la persistance d'exsudation, la douleur, l'absence d'épithélialisation, l'absence de séparation de l'escarre, l'infection (tous les patients ayant d'ailleurs une bactériologie cutanée positive avant le début du traitement). Chez chaque patient, deux zones similaires recevaient toutes les 48 h soit de l'huile ozonée (groupe 1) soit un traitement conventionnel (groupe 2). La réduction des exsudats, de la douleur et de la charge bactérienne était plus rapide dans le groupe 1, les cultures se négativant à J4 (1 à 7) dans ce groupe contre J8 (5 à 11) dans le groupe 2. Cette étude montre que le Novox® a un effet antibactérien significatif et stimule la cicatrisation. Dans notre expérience, l'utilisation de gel ou de plaques imprégnées sont plus efficaces pour promouvoir l'épithélialisation quand les compresses saturées, qui adhèrent à la plaie, sont préférables sur des tissus hyperbourgeonnants.

Effectiveness of topical α-Tocopherol Acetate in burn infection treatment.

Infection following burn injury is critical, especially for patients with large total body surface area burns and in skin graft donor sites. Although various aspects of α-tocopherol acetate (α-TA) beneficial effects on wound healing have been validated, it appears that no study has specifically addressed its antimicrobial potential. The purpose of this study was to explore the therapeutic efficacy of topical application of α-TA in terms of bacterial load reduction. Between January 2018 and June 2018, 20 patients with mid-deep and deep burn wounds were included in the present study (average TBSA approximately 42%, range 25-67%). Patient average age was 47.75 years (range 25-72 years), 8 were male. In each patient two clinically similar areas were identified and treated every 24 hours with topical application of α-TA in the form of Filme Olio® (Group 1) and conventional medication (Group 2). All the patients had positive results for bacterial cultures before treatment. Despite the presence of initial bacterial infection, a quicker reduction of exudates and pain and a progressive and faster bacterial load reduction was observed in Group 1. Negative cultures were obtained after 3 days on average in Group 1 (range 1-6 days) and 8 days in Group 2 (range 5-9 days). This study clearly shows the importance of the therapeutic targeting of infection in the treatment of burns. α-TA may represent a safe, simple and inexpensive method for improving the healing of difficult wounds with local infection.

Les infections sont une complication majeure des brûlures, en particulier chez les patients largement atteints et au niveau des sites donneurs. Alors que ATA a été évalué, et considéré bénéfique, dans de nombreux aspects de la cicatrisation, aucune étude ne s'est penchée sur son potentiel antimicrobien. Cette étude a exploré l'effet de ATA topique sur la réduction de l'inoculum bactérien. Vingt patients dont 12 femmes, ayant des brûlures intermédiaires et profondes, ont été inclus dans cette étude, qui s'est déroulée entre janvier et juin 2018. Leur âge était en moyenne de 47,75 ans (25- 72), la surface brûlée de 42% (25- 67%). Chez tous les patients, deux zones similaires, à la culture bactérienne positive, étaient traitées par ATA (groupe 1) ou traitement conventionnel (groupe 2). La diminution des l'exsudation, de la douleur et de la charge bactérienne était plus rapide dans le groupe 1. Les cultures se négativaient en 3 jours (1- 6) dans le groupe 1 contre 8 (5- 9) dans le groupe 2. Cette étude montre l'intérêt du traitement local des infections de zones brûlées, ATA apparaissant dans ce cadre comme un traitement simple, sûr et peu onéreux.

Association between non-alcoholic fatty liver disease and decreased lung function in adults: A systematic review and meta-analysis.

AIM: Recent observational studies assessed the association between non-alcoholic fatty liver disease (NAFLD) and lung function in adults, but the magnitude of this association remains uncertain. We estimated the magnitude of the association between NAFLD and lung function on spirometry (predicted forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]). METHODS: We searched publication databases using predefined keywords to identify studies (published up to October 4, 2018), in which NAFLD was diagnosed by imaging or biochemistry (no studies with biopsy-proven NAFLD were available). Data from selected studies were extracted, and meta-analysis was performed using random-effects modelling. RESULTS: Six observational studies (5 cross-sectional and 1 longitudinal) with aggregate data on 133,707 individuals (27.8% with NAFLD) of predominantly Asian ethnicity (74.6%) were included in the final analysis. There were significant differences in predicted FEV1 (n = 5 studies; pooled weighted mean difference [WMD]: -2.43%, 95% CI: -3.28 to -1.58; I2 = 69.7%) and predicted FVC (pooled WMD: -2.96%, 95% CI: -4.75 to -1.17; I2 = 91.7%) between individuals with and without NAFLD. Decreased FEV1 and FVC at baseline were also independently associated with a ∼ 15% increased risk of incident NAFLD (n = 1 study in Korean individuals). Subgroup analyses did not materially modify these findings. CONCLUSIONS: NAFLD is associated with significant reductions of both FEV1 and FVC in Asian and United States adults, and such small, but significant, reductions of lung volumes at baseline may be also associated with increased NAFLD incidence in Asian individuals. Further research is needed to better elucidate the link between NAFLD and impaired lung volumes.

Enzymatic escharolysis with nexobrid® on partial thickness burn wounds: pre- and post-debridement histological assessment.

Enzymatic escharolysis is an innovative, non-surgical treatment method for severe burn patients as it allows very early, nontraumatic removal of necrotic tissue even on patients whose overall clinical conditions would mandate delaying traditional surgical escharectomy. The aim of this work was to examine aspects related to the "quality" of enzymatic debridement, which is inherently different from surgical debridement. To this end, biopsies harvested from partial thickness burn wounds, before and after enzymatic treatment, were histologically assessed. As is well known, surgical escharectomy removes the necrosis as well as some of its neighbouring healthy tissue, sharply and radically, leaving a perfectly clean and viable wound bed. On the other hand, enzymatic escharolysis is more selective, as it completely wipes out the necrotic portion while sparing unharmed and partially damaged tissue. In this study, only mid-deep partial thickness wounds were examined, and it was observed that partially damaged dermis was always spared by the lytic action. This dermis, however, showed some "homogenization" characteristics, had few vital skin annexes in it, and therefore looked very similar to the scaffold of dermal matrices currently available on the market. This scaffold should be safeguarded with a view to possibly achieving a more complete and functional spontaneous tissue regeneration. Conversely, if this dermal portion is mismanaged, it could desiccate, thus leading to the formation of a neo-eschar with unpredictable clinical evolution. Understanding how escharolysis actually works allowed us to extrapolate fruitful usage suggestions to optimize the procedure and fully exploit its potential.

La détersion enzymatique est une technique innovante non chirurgicale permettant l'ablation très précoce et non traumatique des tissus nécrosés même chez des patients dont l'état général nécessiterait de repousser une excision chirurgicale. Le but de ce travail était d'évaluer la « qualité ¼ du débridement enzymatique, par essence différent du traitement chirurgical. À cette fin, nous avons examiné histologiquement des biopsies réalisées avant et après détersion. Il est bien connu que la chirurgie emporte totalement et radicalement la nécrose et une partie du tissu environnant, laissant en place un tissu parfaitement propre et viable. Le débridement enzymatique est plus sélectif, emportant tout le tissu nécrosé sans affecter les tissus sains ou viables. Cette étude ne s'est intéressée qu'aux brûlures intermédiaires et nous avons observé que les régions saines étaient toujours préservées. Ce derme restant apparaît toutefois homogénéisé, avec peu d'annexes viables ce qui fait penser aux matrices des dermes artificiels actuellement commercialisés. Il doit être préservé afin de promouvoir une régénération tissulaire complète et fonctionnelle. Ainsi, si ce derme restant n'est pas correctement pris en charge, il peut se dessécher et aboutir à la formation d'un nouvel escarre, d'évolution imprévisible. Le compréhension du mécanisme exact de la lyse de la brûlure permet de développer des protocoles d'optimisation de la technique de lyse enzymatique.

HCV and diabetes. A two-question-based reappraisal.

We used available studies to answer two clinically relevant questions, i.e. whether those with type 2 diabetes should undergo hepatitis C virus screening and whether hepatitis C virus positive individuals should be screened for diabetes. Four reasons argue against the hypothesis of screening diabetics for hepatitis C virus. First, although it induces insulin resistance, hepatitis C virus is not directly diabetogenic. Second, the clinical phenotype of hepatitis C virus-associated type 2 diabetes might be a clue to target the specific diabetic population to be screened. Third, diabetic patients are expected to be poor responders to antivirals and evidence that this might result in recovery from type 2 diabetes is insufficient. Fourth, no econometric data are available in the specific subset of those with type 2 diabetes. Case finding of type 2 diabetes in those with hepatitis C virus infection, in contrast, might be considered in those patients with type 2 diabetes who have cirrhosis, in whom--due to increased prevalence and severity of hepatic encephalopathy--diabetes is associated with increased mortality. Preliminary evidence suggests that the prognosis of cirrhosis might benefit from improved glycemic control and thus from earlier diagnosis of type 2 diabetes. Finally, studies are needed to ascertain the most cost-effective strategy of case-finding type 2 diabetes among those who are hepatitis C virus-infected. In conclusion, available data enabled us to answer the two questions. Hepatitis C virus screening should best be restricted to those (lean) diabetic patients with (advanced) liver disease. Glucose tolerance testing should best be performed in those with hepatitis C virus-related cirrhosis. However, additional studies are needed to support the cost-effectiveness of our conclusions.

Non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease: an open question.

AIMS: To review available data concerning the basic science and epidemiological-clinical evidence for an association of NAFLD and cardiovascular disease. DATA SYNTHESIS: Non-alcoholic fatty liver disease (NAFLD) defines alcohol-like hepatic histological lesions seen in the non-alcoholic, insulin resistant patient representing the hepatic counterpart of the metabolic syndrome. Along with insulin resistance, additional genetic, endocrine and vascular changes together with environmental stimuli--which are also involved in the pathogenesis of atherosclerosis--play a prominent role in the development and progression of NAFLD. Clinical and epidemiological studies seem to indicate that NAFLD is associated with an increased risk for cardiovascular disease but further studies are needed to confirm the available data. The mainstay of NAFLD treatment is based on the correction of the same metabolic changes that predispose to atherosclerosis. CONCLUSIONS: Non-invasive evaluation of risk for cardiovascular events is recommended in all individuals presenting with NAFLD and conversely, the presence of NAFLD should always be looked for in subjects with features belonging to the metabolic syndrome. Further studies are needed on the mechanisms linking fatty liver and vascular diseases.

Mutation rates at Y chromosome specific microsatellites.

A collaborative work was carried out by the Spanish and Portuguese ISFG Working Group (GEP-ISFG) to estimate Y-STR mutation rates. Seventeen Y chromosome STR loci (DYS19, DYS385, DYS389I and II, DYS390, DYS391, DYS392, DYS393, DYS437, DYS438, DYS439, DYS460, DYS461, DYS635 [GATA C4], GATA H4, and GATA A10) were analyzed in a sample of 3,026 father/son pairs. Among 27,029 allele transfers, 54 mutations were observed, with an overall mutation rate across the 17 loci of 1.998 x 10(-3) (95% CI, 1.501 x 10(-3) to 2.606 x 10(-3)). With just one exception, all of the mutations were single-step, and they were observed only once per gametogenesis. Repeat gains were more frequent than losses, longer alleles were found to be more mutable, and the mutation rate seemed to increase with the father's age. Hum Mutat 26(6), 520-528, 2005. (c) 2005 Wiley-Liss, Inc.

Review article: hepatic steatosis and insulin resistance.

Hepatic steatosis may be both an adaptive phenomenon and an example of lipotoxicity. Its prevalence ranks in the same order of magnitude of insulin resistance in the general population. Studies support the finding that hepatic steatosis is secondary to insulin resistance and not vice versa. A steatotic liver will further contribute to the development of insulin resistance through impaired clearance of insulin from the portal blood, creating a vicious cycle. Insulin resistance is the leading force in the pathogenesis and natural history of non-alcoholic fatty liver disease. Dysfunction of energetic homeostasis and the interaction of adiponectin, leptin and tumour necrosis factor-alpha are key events in the pathogenesis of steatosis and insulin resistance. Insulin resistance represents the frame within which hepatic and extrahepatic non-alcoholic fatty liver disease-related clinical manifestations are to be anticipated and interpreted.

Review article: the metabolic syndrome and non-alcoholic fatty liver disease.

Metabolic syndrome represents a common risk factor for premature cardiovascular disease and cancer whose core cluster includes diabetes, hypertension, dyslipidaemia and obesity. The liver is a target organ in metabolic syndrome patients in which it manifests itself with non-alcoholic fatty liver disease spanning steatosis through hepatocellular carcinoma via steatohepatitis and cirrhosis. Given that metabolic syndrome and non-alcoholic fatty liver disease affect the same insulin-resistant patients, not unexpectedly, there are amazing similarities between metabolic syndrome and non-alcoholic fatty liver disease in terms of prevalence, pathogenesis, clinical features and outcome. The available drug weaponry for metabolic syndrome includes aspirin, metformin, peroxisome proliferator-activated receptor agonists, statins, ACE (angiotensin I-converting enzyme) inhibitors and sartans, which are potentially or clinically useful also to the non-alcoholic fatty liver disease patient. Studies are needed to highlight the grey areas in this topic. Issues to be addressed include: diagnostic criteria for metabolic syndrome; nomenclature of non-alcoholic fatty liver disease; enlargement of the clinical spectrum and characterization of the prognosis of insulin resistance-related diseases; evaluation of the most specific clinical predictors of metabolic syndrome/non-alcoholic fatty liver disease and assessment of their variability over the time; characterization of the importance of new risk factors for metabolic syndrome with regard to the development and progression of non-alcoholic fatty liver disease.

Combined endoscopic and surgical management of Dieulafoy vascular malformation.

BACKGROUND: Dieulafoy's disease (exulceratio simplex) is an uncommon cause of gastric hemorrhage as a result of an abnormally large, submucosal, eroded gastric artery, often located in the upper part of the stomach. It represents a clinical challenge because of the intermittent nature of massive bleeding accounting for a constantly fatal course in conservatively (nonsurgically or nonendoscopically) treated patients. Published therapeutic options include techniques of endoscopic hemostasis or operative procedures. STUDY DESIGN: Herein we report two patients in whom a combined endoscopic and operative approach was performed to obtain a definitive prevention of rebleeding and an undoubted anatomopathologic diagnosis. RESULTS: Our innovative combined endoscopic and operative approach has offered three significant advantages: endoscopic preoperative diagnosis and control of the bleeding; valid aid in the intraoperative localization of hemorrhagic lesions, which is erratic intraoperatively, requires gastrotomy, and prolongs the duration of operation; and endoscopy-guided limited wedge resection as opposed to standard techniques involving gastrotomy for simple ligation or oversewing of the involved vessel, local excision, or wide wedge resections that used to be recommended until the recent past. CONCLUSIONS: We confirm that seemingly obscure origins of massive recurring hemorrhage of the upper part of the gastrointestinal tract should increase the suspicion of Dieulafoy's disease, prompting careful examination of the gastric fundic area and greater curvature. Endoscopic hemostasis is the first choice; whenever operative treatment is indicated (because of the endoscopic or clinical situation), it should be as conservative as possible because of intraoperative endoscopic localization of the bleeding source.

Fasting insulin and uric acid levels but not indices of iron metabolism are independent predictors of non-alcoholic fatty liver disease. A case-control study.

BACKGROUND: Non-alcoholic fatty liver disease is a common reason for hepatological consultation and may herald severe hepatic and extra-hepatic disease. The aetiopathogenesis of this condition is an area of increasing interest. AIM: To evaluate anthropometric and biochemical factors associated to non-alcoholic fatty liver disease in a case-control study. Methods. Demographic and biochemical data of 60 consecutive patients with bright liver absent-to-low alcohol consumption, no evidence of viral, genetic and autoimmune diseases, were compared to those of 60 age- and gender-matched historical controls without fatty liver by univariate and multiple logistic regression analysis. RESULTS: Patients were more often hypertriglyceridaemic, obese and diabetic than controls (p<.01). Mean values of alanine transaminase, gammaglutamyltranspeptidase, triglycerides, uric acid, fasting and log insulin, transferrin percent saturation and ferritin were significantly higher in the patients, while transferrin and quantitative insulin sensitivity check index, a quantitative insulin sensitivity index, were lower. No iron storage was found in those who underwent liver biopsy At univariate analysis the relative risk for non-alcoholic fatty liver disease significantly increased (p<0. 05) with increasing body mass index, fasting insulin, alanine transaminase, uric acid, triglycerides and gammaglutamyltranspeptidase; it decreased with increasing transferrin and quantitative insulin sensitivity check index. Multiple logistic regression analysis disclosed only fasting insulin and uric acid to be independent predictors of non-alcoholic fatty liver disease (p<0.05). CONCLUSIONS: Fasting insulin and serum uric acid levels indicating insulin resistance, but not indices of iron overload, are independent predictors of non-alcoholic fatty liver disease.

Interferon inhibition of neoplastic phenotype in cell lines harbouring human papillomavirus sequences.

The transformed phenotype is markedly affected by Interferon (IFN) long term treatment in HeLa and Siha cell lines. Two months of continuous exposure to 100 and 1000 International Units (IU)/ml of human recombinant alpha IFN causes a drastic reduction of anchorage independent growth in soft-agar. No effect on in vitro growing potential was observed at the same concentrations. This antiproliferative effect in soft-agar was more pronounced in Siha than in Hela cells and was concentration and time dependent. The Human Papillomavirus (HPV) sequences inserted in the cell genome apparently were unaffected as their RNA expression, indicating that IFN may modulate aspects of transformed phenotype regulated by genes other than HPV sequences.

Multiple primary cancers and HPV infection: are they related?

Multiple primary cancers have been reported with increasing frequency in recent years, but the presence of foreign DNA sequences of infectious agents in tumours arising in the same patient has so far not been investigated. We report a case of a patient with Hodgkin's lymphoma, an "in situ" cervix carcinoma and an adenocarcinoma of the right and left mammary gland. In all the tumour samples we detected the presence of DNA genomic sequences of Papillomavirus type 16. Our results suggest that HPV infection may be an exogenous risk factor even in second primary tumours of non-epithelial origin.

HPV 16 in multiple neoplastic lesions in women with CIN III.

Paraffin embedded material of multiple primary cancers and other hyperplastic tumours from fifteen patients were analyzed by PCR and in situ hybridization for the presence of HPV DNA in the lesions. All patients had also high grade cervical intraepithelial dysplasia (CIN III) and breast carcinomas and were selected from a previous study enrolling 46 women with CIN III and breast carcinomas. HPV 16 was detected by PCR in 8/15 patients (53%), with eleven HPV 16 positive tumours. HPV 16 was detected in two malignant melanomas, one basal cell carcinoma, one squamous cell carcinoma of the vulva, one Bowen disease of the vulva, two high grade vaginal intraepithelial neoplasias, one cancer corporis uteri, one bronchial carcinoma and two lymphomas. Three cases, two high grade vaginal intraepithelial neoplasia and a squamous cell carcinoma of the vulva, were also reported to be positive by in situ hybridization. 5/8 patients (63%) with HPV 16 positive second cancers had also HPV 16 positive breast carcinomas. All fifteen patients with second cancers after CIN III had HPV 16 positive CIN III lesions; 53% of the patients had also a familial cancer history. We assume that HPV 16 may be involved in the development of different second cancers in women with HPV 16 positive CIN III.

Increased burn patient survival with once-a-day high dose teicoplanin and netilmicin. An Italian multicenter study.

This is the final report of a large, controlled, multicenter Italian study on immuno- and chemotherapy in adult patients with burns affecting 20 to 95% of total body surface area (mean 35%). The antibiotic treatment of burn patients consisted of topical silver sulfadiazine, short-term antimicrobial chemoprophylaxis with pefloxacin (800 mg i.v. qd) for the first 4 days and polychemotherapy with teicoplanin (800 mg i.v. qd) together with netilmicin (300 mg i.m. qd) in one or more cycles of 5-12 days. At random, half of the patients received thymostimulin, 70 mg i.m. qd for the first month and every other day thereafter. The analysis at completion of 634 valid cases showed that when the results are stratified by means of the Roi risk index, 396 of the 530 patients who contracted wound infection (84%) after chemoprophylaxis were in the first three categories and a mean of 95% survived. Of the remaining 134 patients (Roi index 4-5) only 50% survived. There was no difference in survival of the immunotherapy group in comparison with the parallel group without thymostimulin. The short-term antimicrobial prophylaxis prevented wound infection in only 104 of 634 patients (16%) and they were at low risk (84% Roi index 1). Of the bacterial pathogens involved in septic complications Staphylococcus aureus and Pseudomonas aeruginosa were prevalent (86%): eradication was achieved in 43% of patients and clinical cure or improvement were seen with combination chemotherapy in 64% of all patients, mainly with only one treatment cycle. This value increased to 79% for the 395 protocol-complying patients and went down to 20% in the 135 non-compliers. The total survival of complier and non-complier patients was 447 of the 530 valid patients (84%). The overall mortality of the 634 evaluable patients was 13.1%, ranging from less than 2% to 68%. Burn mortality was directly proportional to the percentage of burned body surface area, to increasing age and other variables of the Roi index, a 50% mortality being associated with a 72.5% total body surface area burned. Normoergic burn patients had a mortality rate of 9.1% versus 35.7% in anergic patients.

[Variability of the clinical and laboratory aspects in the presentation of chronic liver diseases in relation to their etiology. Analysis of a case study and review of the literature]. / Variabilità del quadro clinico e laboratoristico di presentazione delle epatopatie croniche in rapporto all'eziologia. Analisi di uno studio casistico e rassegna della letteratura.

247 cases of patients suffering from chronic liver diseases were reviewed. These cases were divided according to "risk areas" (viral, alcoholic, viral and alcoholic, cryptogenic) and diagnosis (CAH, compensated cirrhosis, decompensated cirrhosis). Differences found in clinical and laboratory aspects of liver diseases from different risk areas are described but it is concluded that no single aetiology affects the liver functional reserve more than the others. Laboratory tests give more information in the early stages of chronic liver diseases while clinical analysis is more varied in the terminal ones. Literature on the subject is reviewed. Our data neither confirm nor disprove that HBsAg+ Alcohol+ patients display a characteristic clinical picture and this hypothesis should be further investigated.