A cluster of fulminant Clostridium difficile colitis in an intensive care unit in Italy.

We describe, for the first time, a cluster of lethal fulminant health-care associated Clostridium difficile (CD) colitis in Italy, observed in the intensive care unit (ICU) of an Italian tertiary care hospital in Rome. For all cases the cause of ICU admission was CD-related septic shock. Three out of seven patients were residents in a long-term care facility in Rome, and the others had been transferred to the ICU from different medical wards of the same hospital. Five patients died within 96 h of ICU admission. Because of a clinical deterioration after 4 days of adequate antibiotic therapy, two patients underwent subtotal colectomy: both of them died within 30 days of surgical intervention. In four cases, ribotyping assay was performed and ribotype 027 was recognized. This high mortality rate could be attributable to three findings: the extent of disease severity induced by the strain 027, the delay in antimicrobial therapy administration, and the lack of efficacy of the standard antibiotic treatment for fulminant CD colitis compared to an earlier surgical approach. In order to contain a CD infection epidemic, control and surveillance measures should be implemented, and empirical therapy should be administered. Because of potential 027 ribotype CD spread in Italy, CDI should be regarded with a high index of suspicion in all patients presenting with shock and signs or symptoms suggesting abdominal disease, and an early surgical approach should be considered.

Insulin growth factor 2 (IGF2) as an emergent target in psychiatric and neurological disorders. Review.

Insulin-like growth factor 2 (IGF2) is abundantly expressed in the central nervous system (CNS). Recent evidence highlights the role of IGF2 in the brain, sustained by data showing its alterations as a common feature across a variety of psychiatric and neurological disorders. Previous studies emphasize the potential role of IGF2 in psychiatric and neurological conditions as well as in memory impairments, targeting IGF2 as a pro-cognitive agent. New research on animal models supports that upcoming investigations should explore IGF2's strong promising role as a memory enhancer. The lack of effective treatments for cognitive disturbances as a result of psychiatric diseases lead to further explore IGF2 as a promising target for the development of new pharmacology for the treatment of memory dysfunctions. In this review, we aim at gathering all recent relevant studies and findings on the role of IGF2 in the development of psychiatric diseases that occur with cognitive problems.

Phenotypic diversity of lactic acid bacteria isolated from fermented sausages produced in Basilicata (Southern Italy).

AIMS: to evaluate the evolution of lactic acid bacteria (LAB) populations in traditional fermented sausages (salsiccia and soppressata) produced in artisanal and industrial plants in Basilicata (Southern Italy). METHODS AND RESULTS: Four hundred and fourteen lactic acid bacteria (LAB) cultures were isolated from samples of sausages at different stages of ripening. A phenotypic characterization of the isolates was carried out using a set of 28 tests, and 34 clusters were identified at the 80% similarity level using hierarchical cluster analysis. Of the isolates 50% were identified as Lactobacillus sakei (with several biotypes), 22% as Pediococcus spp. (mainly Ped. pentosaceus), 7% as Leuconostoc (Leuc. carnosum, Leuc. gelidum, Leuc. pseudomesenteroides), 6% as Lact. plantarum, 1% as Lact. curvatus. Other lactobacilli, including unidentified species, were present in lower numbers. CONCLUSION: The phenotypic diversity and composition of the LAB flora varied as a function of the production plant, product type and ripening time. SIGNIFICANCE AND IMPACT OT THE STUDY: A new procedure based on bootstrapping and Multidimensional Scaling was successfully used to obtain a graphical representation of the evolution of the LAB populations.

Evolution of microbial populations and biogenic amine production in dry sausages produced in Southern Italy.

AIMS: To evaluate the occurrence and evolution of biogenic amines during ripening of fermented sausages and their relationship with physico-chemical and microbiological properties of the product. METHODS AND RESULTS: Salsiccia and Soppressata were obtained from artisanal and industrial plants in Basilicata and pH, aW, microbial counts and biogenic amine content were measured. A high variability in amine content was observed. 2-Phenylethylamine and histamine were rarely found, while the tyramine, putrescine and cadaverine content increased during ripening. No correlation was found between individual biogenic amine content, microbial counts or physico-chemical parameters. CONCLUSION: Starter cultures did not necessarily prevent the production of biogenic amines whose total contents were usually higher in Soppressata, a product with a larger diameter and aW compared with Salsiccia. SIGNIFICANCE AND IMPACT OF THE STUDY: Literature findings on biogenic amine content and the evolution of microbial populations were confirmed. Normal ranges for amine content in Salsiccia and Soppressata are reported.

Production of mouse monoclonal antibodies directed against the oolemma of human and hamster oocytes by intra-splenic injection of oocytes.

PROBLEM: To develop an additional approach for the study of oolemmal surface moieties involved in gamete interactions, we decided to obtain monoclonal antibodies by intrasplenic injection of human and hamster oocytes in Balb/c mice. METHOD: Two Balb/c males were injected three times intrasplenically at 15-day intervalS with approximately 40 zona-free hamster and 3-5 zona-free human oocytes. After the third injection, spleen cells were fused and hybridomas developed. We used a novel screening system based upon the use of sections of frozen human and hamster eggs, tested by means of indirect immunofluorescence. The antibodies that we produced were evaluated for their ability to interfere with the zona-free hamster eggs penetration by human spermatozoa. The B2B5 antibody was also developed as ascitic fluid and further characterized. RESULTS: Seven antibodies reactive with hamster oocytes were produced. Six of them also reacted with human oolemmas. The binding was confined to the oolemma, and no staining of the zona nor the cytoplasm was present. One of these antibodies reduced the penetration of zona-free hamster eggs by human spermatozoa. This antibody, B2B5, an IgM kappa, was confirmed to interact with the oolemma by means of indirect immunofluorescence of fresh eggs and Covasphere binding. B2B5 did not react with other human or hamster tissues except capacitated human spermatozoa. The reactivity with the oolemma of hamster oocytes was not lost after egg penetration by human sperm. CONCLUSIONS: Intrasplenic immunization using zona-free human and hamster oocytes allows the production of anti-oolemma antibodies. A system of screening based upon the use of sections of frozen eggs also allows an easy and quick scoring of many supernatants. B2B5 monoclonal anti-oolemma antibody deserves further studies in that is able to interfere with fertilization and its antigen appears to be confined to the gametes surface.

Utilización de Anillo de polietileno en luxación recidivante de artoplastia total de cadera: método de salvataje / Use of polyethylene ring in luxación recidivante of total artoplastia of hip: salvataje method

El propósito de nuestro trabajo es revisar los casos de los pacientes complicados (pacientes con problemas renales, pacientes mayores de 75 años, pacientes con más de 5 revisiones o cardiópatas), con luxación recidivante de prótesis total de cadera con componentes sin signos de aflojamiento, a quienes se les ha intervenido quirúrgicamente y se les ha colocado un anillo de polietileno el cual se fija con tornillos a su antiguo inserto de plástico. Fue realizado un análisis retrospectivo de un grupo de 18 pacientes tratados en forma consecutiva en nuestra Unidad de Cirugía de Artritis y todos sus datos obtenidos de sus respectivas historias médicas de la clínica donde fueron llevadas a cabo las intervenciones. Fueron tratados quirúrgicamente y se les colocó un anillo de polietileno para reforzar el acetábulo y constreñir la articulación. Desde Febrero de 2001 hasta Marzo de 2006, han sido colocados 18 anillos de polietileno para el reforzamiento del componente del acetábulo en 18 pacientes como procedimiento de revisión en casos especiales de luxación recurrente de prótesis total de cadera. El abordaje realizado fue postero-lateral con artrotomía anterior en todos los casos. El promedio de duración en el seguimiento ha sido de 25 meses (rango de 1 a 65 meses) y la edad promedio de los pacientes al momento de la cirugía fue de 66 años de edad (36 a 82 años). Las diferentes indicaciones para el uso del anillo de polietileno fueron: Pacientes sanos mayores de 75 años del anillo de polietileno fueron: Pacientes sanos mayores de 75 años y componentes fijos (5 pacientes), Pacientes cardiópatas mayores de 75 años y componentes sin signos de aflojamiento (4 pacientes), pacientes con enfermedad renal (3 pacientes), pacientes con más de 5 revisiones y luxaciones recurrentes (1 paciente). Pacientes con ausencia del trocánter mayor y prótesis fija (5 pacientes).

Revisión en dos tiempos de infección periprotésica de rodilla: reporte preliminar / Two-stage review of infected knee periprotésica: preliminary report

La infección profunda es la complicación más temida la artroplastia total de rodilla (A TR), con una incidencia promedio del 2 por ciento. El objetivo de su tratamiento es quitar el dolor y lograr una articulación funcional. Esto se consigue erradicando la infección. Las alternativas terapéuticas de la de la ATR infectada van desde la antibióticoterapia de supresión hasta la amputación del miembro. Las alternativas quirúrgicas más usadas son el desbridamiento con retención del implante y la revisión con retiro de la prótesis y reimplante en 1 o 2 tiempos quirúrgicos. Presentamos nuestra experiencia en el tratamiento de la ATR con infección crónica mediante revisión en 2 tiempos. Establecimientos como criterio de éxito del reimplante. Entre 1998 y el 2006 hemos realizado en nuestra Unidad 22 procedimientos de revisión en dos tiempos de ATR infectada crónica, con éxito en el 81,81 por ciento de los casos.

Reconstrucción tardía con aloinjertos de ruptura del mecanismo extensor después de artroplastia total de rodilla: más frustaciones / Late reconstruction with aloinjertos of rupture of the extending mechanism after total artroplastia of knee: more frustaciones

Entre mayo 2003 y mayo 2006 cuatro pacientes que habian sufrido ruptura del mecanismo extensor después de una artroplastia total de rodilla fueron sometidos a reconstrucción tardía usando aloinjertos liofilizados de tendón de Aquiles. El promedio de edad era de 70,75 (70-72) años. Por lo menos 3 cirugías anteriores en promedio. Todos los pacientes alcanzaron un alivio del dolor con un promedio de seguimiento de 16,75 (3-38) meses. Dos pacientes presentaron en el post operatorio retardo para la extensión de 10 (50 por ciento) y dos de -40° (50 por ciento), comparando al promedio preoperatorio de -65° por ciento. La deambulación apoyando todo el peso fue posible en todos los pacientes; sin embargo dos pacientes usaban bastón (50 por ciento) y dos andadera (50 por ciento).

Experiencia a mediano plazo con el uso de los anillos de reforzamiento acetabular / Medium-term experience with the use of acetabular reinforcement ring

Los defectos óseos acetabulares son frecuentes en revisión de antroplastia total de cadera. Pueden requerirse aloinjertos masivos y anillos de recontrucción para restituir el acetábulo. entre 1997 y 2003 colocamos dieciocho anillos de reconstrucción acetabular con injerto óseo en diecisiete pacientes con edad promedio de 60,67 años. Se hizo seguimiento a trece pacientes (catorce caderas) por 2,36 años en promedio. Usamos dos mallas, dos anillos tipo Müller, siete cajas tipo Ganz y tres tipo Burch-Schneider. No observamos aflojamiento de los anillos y copas acetabulares utilizados. El injerto óseo se integró en once casos. Los pacientes mejoraron en una media de 23,23 puntos en la escala de Harris y 31,57 puntos en la escala de WOMAC. Diez de trece pacientes (76,92) estuvieron satisfechos con la cirugía. Nuestros resultados nos permiten concluir que los anillos de reforzamiento acetabular con injerto óseo producen resultados satisfactorios en el manejo de defectos óseos acetabulares.