Screening for osteoporosis using L1 vertebral density on abdominal CT in an Australian population.

AIM: To assess the utility of osteoporosis screening using abdominal computed tomography (CT) versus dual-energy X-ray absorptiometry (DXA) T-scores as the reference. MATERIALS AND METHODS: Patients ≥30 years undergoing abdominal CT and DXA within 12 months were assessed retrospectively. Bone mineral density (BMD) was measured using axial CT attenuation at L1, correlating with DXA T-scores. Sensitivity, specificity, area under the curve (AUC), and odds ratio (OR) were calculated. RESULTS: The study cohort comprised 407 CT-DXA pairs (58.2% women). The prevalence of osteoporosis was 11.8%. L1 density and T-score were significantly correlated in both women (r=0.35, p<0.001) and men (r=0.15, p=0.04). The AUC to distinguish osteoporosis from osteopenia and normal BMD was 0.64 (95% CI: 0.56-0.71). In women, a threshold of 190 HU detected T-scores ≤ -2.5 with a negative predictive value (NPV) of 94.4% (OR=4.4, p<0.01). In the entire cohort, a threshold of 180 HU detected T-scores ≤ -2.5 with a NPV of 96.2% (OR=4.7, p<0.01). CONCLUSIONS: CT L1 attenuation correlates with L1 DXA T-scores. Density values < 190 and 180 HU increased the probability of an osteoporosis diagnosis in Australian women and the overall cohort, respectively. Opportunistic screening for osteoporosis using abdominal CT is feasible, enabling identification of at-risk subjects for formal DXA imaging, thereby improving treatment initiation and reducing fracture risk.

Rendezvous endovascular common carotid artery stenting (RECCAS) technique for symptomatic steno-occlusive disease.

This report describes a patient who presented with acute but transient right arm weakness and altered sensation secondary to severe stenosis of the left common carotid artery (CCA) origin. Endovascular stenting of the stenosed origin was achieved utilising a novel rendezvous technique through combined retrograde common carotid artery and anterograde transfemoral approaches. This technique has numerous potential advantages over traditional transfemoral endovascular and open retrograde common carotid artery approaches. It allows increased procedural control and success in traversing the stenosis and provides a smooth transition for the stent delivery catheter. An open cutdown procedure or open surgical technique is not required. Our patient recovered well from the procedure with no complications within the three-month follow up period.

Humanization of care in pediatric wards: differences between perceptions of users and staff according to department type.

BACKGROUND: As the quality and quantity of patient-centered care may be perceived differently by recipients and independent observers, assessment of humanization of pediatric care remains an elusive issue. Herein we aim to analyze differences between the degrees of verified existing vs. perceived humanization issues of a pediatric ward. Furthermore, we examine whether there is concurrence between the degrees of humanization perceived by users (parents/visitors) vs. staff members. METHODS: The study was conducted in the pediatric wards of seven medical centers of the Campania region (Italy) categorized as general (n = 4), children's (n = 1), and university (n = 2) hospitals. The degree of existing humanization was assessed by a multidisciplinary focus group for each hospital through a pediatric care-oriented checklist specifically developed to individuate the most critical areas (i.e., those with scores < 2.5). The degree of perceived humanization was assessed through four indicators: well-being, social aspects, safety and security, and health promotion. RESULTS: The focus groups showed that critical areas common to all centers were mainly concerned with welfare, mediation, translation, and interpretation services. Specific critical issues were care and organizational processes oriented to the respect and specificity of the person and care of the relationship with the patient. Perceived humanization questionnaires revealed a lack of recreational facilities and mediation and translation services. As for specific features investigated by both tools, it was found that mediation and interpretation services were lacking in all facilities while patient perceptions and observer ratings for space, comfort, and orientation concurred only in the general hospital evaluations. CONCLUSIONS: Future humanization interventions to ensure child- and family-friendly hospital care call for careful preliminary assessments, tailored to each pediatric ward category, which should consider possible differences between perceived and verified characteristics.

Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis.

PURPOSE: To report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatography (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL). PATIENTS AND METHODS: A retrospective review of 12 patients who underwent PTBLL for intrahepatic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46±18 (SD) years (range: 23-75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes. RESULTS: Eleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with long-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3-84 months). CONCLUSION: For patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment.

[Quality control in microbiology (author's transl)].

The microbiology quality control importance is emphasized and some particular problems that quality control presents in microbiology are also indicated. There are two types of microbiology quality control as well as for hematology and chemical chemistry: collective quality control, between more laboratories, and individual quality control, in the sphere of each laboratory. A.M.O.I. (Associazione Microbiologi Ospedalieri Italiani) and I.S.V.T. (Istituto Sieroterapico Vaccinogeno Toscano) Sclavo collaborating, have organized a collective quality control between laboratories of different hospitals during the year 1974 and 1975. The results of this control are reported. Although preliminary, they indicate practical importance of microbiology control. During 1975, in fact, the pathogens isolated have been in high percentage than 1976. At last, the future quality control's program aiming at methods's standardization and technical, methodical instructions is indicated.

[Bacteriological sensitivity "in vitro" and therapeutic response (author's transl)]. / Sensibilità batterica "in vitro" e risposta terapeutica.

After some general considerations on the validity of antibiograms as a therapeutic guide, three methods are described and analyzed. Bacterial chemosensitivity to antimicrobic drugs were tested by the following methods: diffusion, dilution and automized methods. Only when transferred into routine laboratory methods that would reveal the results of chemosensitivity in quantitative values will a valid guide to antimicrobic chemotherapy be possible. Expressing chemosensitive bacteria directly in values of minimum inhibiting concentrations would evaluate the pharmokinetic action of single chemotherapeutical agents in relation to infective organ or apparatus pathologies which limits the practical significance of posology. Unfortunately, the collaboration between the clinical bacteriologist and the chemoterapist is still a long way off because of technical and laboratory difficulties delineating the pharmokinetic aspects in the use of the many chemoterapeutical agents in man.

In vitro activity of rifaximin and rifampicin against some anaerobic bacteria.

Activity of rifampicin and of a new rifamycin, rifaximin, was tested in strains of anaerobic bacteria belonging to the Bacteroides genus (75 B. fragilis group and 17 Bacteroides non-fragilis group) and in Clostridium perfringens (15 strains). It turned out that the bactericidal activity of both rifamycins could be overlapped and that it equalled 100% in the case of the non-fragilis Bacteroides and Clostridium species.

[Sensitivity to chemoantibiotic therapy of new isolated Salmonellae strains (author's transl)]. / Sensibilità ai chemioantibiotici di stipiti di Salmonelle di recente isolamento.

The results of chemoantibiotic sensitivity tests carried out on 626 Salmonellae strains, isolated in 1973, 1974 and 1975 at the Bacteriol. Laboratory of S. Maria Nuova Hospital, Florence (Italy), are here related. The lowest percentages of antibiotic resistance have been noted to gentamycin and colimycin. Significant differences of antibiotic resistances were observed in single tested strains: the Salmonella wien strains were polyresistant, while the Salmonella panama strains showed a very high sensitivity to all the antibiotics. The conclusion is that in order to conduct a correct and useful antibiotic therapy, the microbic sensitivity test on isolated Salmonellae strains should be always performed.

[Comparative evaluation of methods for research on Australia antigen]. / Valutazione comparativa di metodi di ricerca dell'antigene Australia

490 blood samples have been examined for the comparison of the various methods concerned with the detection of the Australia Antigen (Au). The following methods have been comparatively examined: immunodiffusion (ID) counterelectrophoresis (CEP), complement fixation (CF) passive hemoagglutination (HA) and solid phase radioimmunoassay RIA. On the basis of the results so far obtained the RIA appears the most sensitive and specific method, followed by the HA. In order to obtain reproducible results for diagnostic purposes we suggest to carry out routinely two different techniques together (possibly RIA and HA), while for screening purposes just one technique, choosed between the two most indicative ones, shall be employed.

[Comparison of the streptozyme test with titration of antistreptolysin, antistreptokinase and antistreptohyaluronidase]. / Confronto del "test streptozyme" con i titoli antistreptolisinico, antistreptochinasico antistreptojaluronidasico

Streptozyme is a new serologic assay which is able to evidentiate 5 antistreptococcal antibodies at the same time (TAS, ASHA, ASK, DNase, NADase). This test has been carried out on 355 samples together with TAS, ASK and ASHA methods in order to value this method comparatively. The results showed that Streptozyme is a poorly reliable technique, looking at the false-positive or negative results obtained, but principally looking at the phenomena of no good reproducibility. We feel that at present it cannot be used in substitution of the classic serologic methods.

[Frequency of isolation and drug resistance of bacterial strains from urine samples tested in the Bacteriology and Virology Laboratory of the U.S.L. 10/D in Florence]. / Frequenza di isolamento e chemioresistenza di stipiti batterici provenienti da campioni di urina esaminati presso il laboratorio di batteriologia e virologia dell'U.S.L. 10/D di Firenze.

Two thousand five hundred and sixty-eight positive monomicrobic urine samples (from general practice and hospital wards) were examined and isolated strains were tested against various antimicrobial drugs. Our findings showed that urinary-tract infections caused by Escherichia coli were the most common in females, whereas those by Pseudomonas aeruginosa, Proteus rettgeri, Enterobacter species, other difficult Gram-negative rods and Streptococcus faecalis were in total the most common in males. If we compare the strains isolated from general practice with those from the hospital, no significant differences were observed. E. coli strains were the most susceptible to the tested drugs; cefotaxime, amikacin, cefuroxime and ceftazidime were the most effective drugs against Enterobacter species, Ps. aeruginosa, P. rettgeri and Proteus mirabilis. P. mirabilis and Str. faecalis strains isolated in the hospital were more chemo-resistant than those isolated in general practice. Ampicillin and trimethoprim/sulphamethoxazole were less active against E. coli strains isolated from children's departments in comparison with the others.

Interaction of copper with DNA and antagonism by other metals.

Copper [Cu(II)] has been shown to enhance DNA damage in several biological systems. Binding of copper to DNA may be a key step in producing these lesions. The results of this study indicate that the DNA double helix contains at least two kinds of binding sites for copper. One site is present once every four nucleotides, has high affinity, and shows a cooperative effect. The other is an intercalating site for copper that is present in every base pair. This site is saturable, has a dissociation constant (Kd) for Cu(II) of 41 microM. In single-stranded DNA, we found an average copper binding site every three nucleotides with lower affinity than in dsDNA. The binding of copper to DNA shows an unexpected high specificity when studied in the presence of other metallic ions. The relative efficacy of several divalent cations to antagonize Cu(II) binding was: Ni = Cd = Mg much much greater than Zn = Hg greater than Ca greater than Pb much much greater than Mn, while Cr(VI) enhanced Cu(II) binding to DNA. We hope this study will broaden the understanding of copper-DNA interactions, particularly as they relate to treatment modalities for diseases associated with disruption of copper homeostasis and potential development of copper antitumor agents.

A waterborne tularemia outbreak.

A waterborne tularemia outbreak is described. Forty nine cases were identified in Sansepolcro, a small Medioeval town in the province of Arezzo, Tuscany, Italy. All cases had laterocervical or sub-mandibular adenitis, and occurred within a period of three weeks during March and April 1982. The study showed association between cases and the consumption of water from an unchlorinated water system. Francisella tularensis type 1 was isolated from wild hares captured in the area.

Cornstarch powder on latex products is an allergen carrier.

Allergic reactions of the upper respiratory tract during use of powdered latex rubber gloves have been recently associated with sensitivity to latex. We have studied the ability of cornstarch powder to bind latex proteins and evaluated allergenic properties of the bound protein. Allergenicity was determined by competitive inhibition of human anti-latex IgE binding to solid-phase latex antigen. Cornstarch extracted from powdered latex products and clean cornstarch exposed to latex protein extracts were evaluated in comparison with clean unexposed cornstarch. Both exposed cornstarch preparations inhibited specific binding of anti-latex IgE antibodies to latex proteins in a dose-response manner. Latex-exposed cornstarch diluted 50% vol/vol produced complete inhibition, whereas greater dilutions exhibited variable levels of inhibition, depending on the source of cornstarch-bound proteins, insolubilized latex proteins, and IgE antibody-containing human serum used. Cornstarch not exposed to latex had no inhibitory activity. The study demonstrates that cornstarch indeed binds allergenic latex proteins and supports the causative relationship between allergic reactions in individuals with latex sensitivity and the exposure to airborne particles from powdered latex products.

Evolutionary conservation of methyl-accepting chemotaxis protein location in Bacteria and Archaea.

The methyl-accepting chemotaxis proteins (MCPs) are concentrated at the cell poles in an evolutionarily diverse panel of bacteria and an archeon. In elongated cells, the MCPs are located both at the poles and at regions along the length of the cells. Together, these results suggest that MCP location is evolutionarily conserved.