Cross-sectional echocardiographic features of "absent" pulmonary valve. Report of two cases.

"Absence" of the pulmonary valve was recognized by cross-sectional echocardiography in two infants having relatively atypical clinical manifestations for this cardiac malformation. Both had associated lesions: tetralogy of Fallot and ventricular septal defect, respectively, which were also detected by this non-invasive technique. The findings which strongly suggested the diagnosis were the presence of a ridge of rudimentary pulmonary valvular tissue at the level of the pulmonary annulus and the aneurysmal dilation of the pulmonary arteries. The short axis view at the level of the great arteries was the best approach for visualization of these anatomical abnormalities. The parasternal long axis and sub-costal four-chamber views were also helpful in detecting the associated lesions. In both cases the diagnoses were confirmed at autopsy.

[Insulin secretion and hepatic extraction in juvenile non-insulin-dependent diabetes]. / Secrezione insulinica ed estrazione epatica nel diabete non insulino dipendente giovanile.

Beta-cell secretion is still a point of controversy. As the liver is the major site of insulin metabolism, evaluation of hepatic insulin extraction is crucial for correct measurement of beta-cell secretion. Methods for calculating the secretion and hepatic extraction of insulin indirectly from peripheral C-peptide concentration have been proposed by some investigators. To characterize the low insulin response of a group of young non-insulin-dependent diabetics we evaluated secretion and hepatic insulin extraction during an oral glucose tolerance test by peripheral IRCP determination and IRCP/IRI molar ratio. Our data show that in this population of young non-insulin-dependent diabetics, the low peripheral insulin response to an oral glucose challenge is a possible consequence of diminished beta-cell secretion, as hepatic insulin extraction is at near normal value.

[Diabetic foot. A clinical case]. / Piede diabetico. Un caso clinico.

Diabetic neuropathy may cause an alteration of the function of the muscles of the sole of the foot. This is at the origin of the chronic dislocation of the articular heads, mainly of the little metatarsal bones (neuro diabetes arthropathy), with formation of areas of pathological pressure. The tissues below being chronically under pressure are affected by trophic lesions called "plantar perforating disease". Recovery may be obtained by not exposing the injured area of the foot to pressure and through careful local therapy. This doesn't prevent disease from appearing again, even though some specially conceived soles are being used, aiming at a correct weight redistribution on the sole of the foot. The clinical case we are describing applies to a man affected by insulin dependent diabetes mellitus, with relapsing diabetic foot ulcers, in spite of him using a specifically designed sole. Such lesion is aggravated by a serious infection which, by gradually penetrating in depth, leads to osteomyelitis, affecting the 5th Metatarsal head. The bone area, dislocated by neuroarthropathy, was presumably responsible for the persisting plantar lesion. The amputation of this infected necrotic structure, has led to the overcoming of the serious septic problem. By eliminating the bone link responsible for the transmission of the pathological pressure, the plantar lesion the patient had been suffering from for a long time, has consequently disappeared.

Climatic effects on Salmonella survival in plant and soil irrigated with artificially inoculated wastewater: preliminary results.

The use of wastewater to replace other water resources for irrigation is highly dependent on whether the health risk and environmental impacts entailed are acceptable or not. Total count and species of microorganisms found in wastewater vary widely because of climatic conditions, season, population sanitary habits and disease incidence. Salmonella, one of the genera associated with waterborne diseases, lives in the intestine. Thus, it is widely accepted that they have a limited survival period under environmental conditions. Wastewater management practices and the ability of Salmonella to survival under field conditions would determine the health risk associated with its presence in wastewater. Although chlorination is widely used, there are situations in which Salmonella is able to survive the sudden stress imposed by this technique. The aim of this experiment was to contribute to the study of the climatic and soil effects on pathogen survival under agricultural field conditions in order to assess which were the best wastewater management practices from both health and economic points of view. Five pots filled with soil seeded with Medicago sativa and an automatic weather station were used. A secondary effluent was artificially inoculated with Salmonella. In addition, open plates (filled with sterilised soil) and ultraviolet radiation isolated plates (filled with non-sterilised soil) were used. As soil heat emission contributes to the environmental conditions around the bacteria, standardised meteorological temperature data had to be carefully used in the bacterial survival studies under agricultural conditions. Radiation was the main cause of Salmonella mortality as its effect was more important than natural soil bacteria competence. Higher reduction of Salmonella counts could have been associated with longer spring days. Soil was able to effectively remove Salmonella. Subsurface drip irrigation methods could provide an effective tool to prevent health risk associated with wastewater irrigation.

[Therapy of trophic ulcers in diabetes mellitus]. / Terapia delle ulcere trofiche in corso di diabete mellito.

Trophic lesions of the lower limbs are very frequent in diabetic patients, especially after long periods of poor glycemic control. These lesions are caused by some diabetic sequelae, namely neuropathy and angiopathy. The human and social cost of trophic lesions is very high; for this reason education of diabetics who are likely to develop such lesions is extremely important. When trophic lesions have developed, conservative management is based on local and general therapy. Amputation is taken into account only when conservative management has failed.

[Clinical experience with a new antibiotic: cefmetazole]. / Esperienza clinica su un nuovo antibiotico: il cefmetazolo.

Cefmetazole is a new semisynthetic derivative with a broad antibacterial spectrum as shown by data from 34 research institutes in Japan. It has antibacterial action against various species of Gram+ and Gram- bacteria and is extremely stable for beta-lactamase because it has a 7-alpha-methoxy group. In addition, it has excellent antibacterial activity against indole-positive Proteus strains against which conventional Cephalosporins are ineffective. Results of clinical trials carried out on urinary tract, respiratory tract and cutaneous infections are reported. A total of 30 patients were examined; the route of administration was intravenous, the most frequent daily-dose was 2 g. Clinical and bacteriological effectiveness of cefmetazole was 80% with excellent activity against E. coli, Proteus, S. aureus and K. pneumoniae. No serious side effect was observed. The above results indicate that CMZ is largely effective and useful for infections due to Gram+ cocci and Gram- bacilli.

[Therapeutic use of glutathione]. / Utilizzo terapeutico del glutatione.

Liver pathology is very frequent in western countries. The numerous therapeutic approaches suggested so far for the prevention or limitation of liver damage in the course of hepatic diseases have often had disappointing results. Considering that at least part of the liver injury is caused by free radicals, the authors have tried an antioxidant, glutathione, as a hepatoprotective agent. Although particularly brilliant results were not achieved, clinical conditions and laboratory findings were improved in hall patients treated with glutathione.

[Evaluation of the changes in glycosylated hemoglobin in a sample of hospitalized diabetic patients. Significance and limitations of this diagnostic method]. / Valutazione delle variazioni dell'emoglobina glicosilata in un campione di soggetti diabetici ospedalizzati. Significato e limiti di questa diagnostica.

Stable glycosylated hemoglobin measurement provides an index for plasma glucose control over an average three month period. It is not clear whether stable HbA1C can undergo rapid changes induced by short-term variations in glucose concentration. The present study was aimed at investigating whether variation of total HbA1C in response to changes in blood glucose, over a short period can be detected by routine methods of determination. Our result show that due to the sensitivity of the methods, stable HbA1C has to be considered only as an index of glucose control over long period of time.

[The clinical evaluation of the hypocholesterolemic effects of an inhibitor of cholesterol synthesis: mevalonic acid]. / Valutazione clinica degli effetti ipocolesterolemizzanti di un inibitore della sintesi del colesterolo: l'acido mevalonico.

Twenty eight patients with heterozygous familial hypercholesterolemia were treated with mevalonic acid (an inhibitor of cholesterol synthesis) for 45 days. Patients received a daily dose of 750 to 1500 mg mevalonic acid depending on plasma cholesterol levels. Results showed a significant reduction in cholesterol values whereas no significant difference was observed in HDL cholesterol and triglyceride levels.

[Evaluation in experimental animals of a mathematical model of foreseeing variations in values of stable glycosylated hemoglobin]. / Valutazione sull'animale da esperimento di un modello matematico per la previsione delle variazioni dei valori di emoglobina glicosilata stabile.

Assay of glycosylated hemoglobin provides reliable information on metabolic control in diabetes mellitus over a period of about 90 days. This is why it is currently used as a parameter of blood glucose control in diabetic patients. However, at present little is known about the kinetics of stable glycosylated hemoglobin variations as a result of circadian changes in blood glucose level. The authors describe a mathematical model which allows to foresee glycosylated hemoglobin variability as a result of alterations of blood glucose equilibrium.