Surveillance of hospitalised patients with influenza-like illness during pandemic influenza A(H1N1) season in Sicily, April 2009-December 2010.

This paper describes the epidemiology of hospitalised cases with influenza-like illness (ILI) and laboratory-confirmed influenza A cases in Sicily (Italy) during the 2009 influenza pandemic. The first ILI case diagnosed as infected with pandemic influenza A(H1N1)2009 in Sicily was reported in June 2009 and it rapidly became the dominant circulating strain. In the period from 30 April 2009 through 31 December 2010, a total of 2,636 people in Sicily were hospitalised for ILI and 1,193 were laboratory-confirmed for influenza A. Basic demographic and clinical information for all hospitalised patients was collected and population mortality rates (PMRs) and case fatality ratios (CFRs) were calculated. The median age of hospitalised patients infected with pandemic influenza A(H1N1)2009 was significantly lower than that of hospitalised ILI cases in general (18.0 vs. 32.1 years; p<0.0001). Among adults, women were more susceptible than men. The majority of clinical presentations were mild, but 6.6% of hospitalised patients required admission to an intensive care unit, of whom 26.3% had confirmed influenza A. Twenty-four fatal cases were documented. The age group of 45­54 year-olds showed the highest PMRs once hospitalised, while CFRs were higher in elderly patients of 65 years and older. All fatal cases were confirmed as influenza A(H1N1)2009 and most of them had established risk factors for influenza complications.

Clinical burden of screening asymptomatic patients for coronary artery disease prior to liver transplantation.

The aim of this study is to assess the clinical burden of silent coronary artery disease (CAD) in cirrhotic candidates for liver transplantation (LT), and to evaluate the usefulness of a CAD screening approach. Between July 1999 and January 2006, we evaluated 627 LT candidates. All of them underwent a detailed clinical history. Sixteen had a previous diagnosis of CAD or symptoms suggestive (2.5%). The remaining 611 underwent further tests according to a predefined protocol, including EKG, echocardiogram and, on the basis of CAD risk factors, heart stress tests. Selective coronary angiography (SCA) was performed in the 30 patients with positive heart stress test: in only 2 did SCA show any CAD, and in both it was subcritical disease requiring neither intervention nor contraindicating LT. The 611 screened patients continued their follow-up until study closure or death. No coronary events occurred in the study population in a mean follow-up of 32.50 months (+/- 23.67 DS). No perioperative mortality related to CAD occurred in the 233 transplanted patients. In conclusion, no prognostic advantage was achieved by following a strict CAD screening protocol, leading us to believe that the cost-effectiveness of a similar screening can be unacceptably high in our setting.

A safe immunosuppressive protocol in adult-to-adult living related liver transplantation.

BACKGROUND: In this series of 32 adult-to-adult living related liver transplantations, we assessed the efficacy and safety of basiliximab in combination with a tacrolimus-based regimen. Basiliximab, a chimeric monoclonal antibody directed against the alpha chain of the interleukin-2 (IL-2) receptor (CD25), has been extensively evaluated as induction therapy for cadaveric liver transplant recipients. PATIENTS AND METHODS: Thirty-two adult-to-adult living related liver transplantations were performed in the last 3 years. All patients received two 20 mg doses of basiliximab (days 0 and 4 posttransplantation) followed by tacrolimus (0.15 mg/kg/d; 10-15 ng/mL target trough levels) and steroids (starting with 20 mg IV switched to PO as soon as the patient was able to eat and weaned within 1-2 months). The average follow-up was 395 days after transplantation. RESULTS: Of the patients, 93.75% remained rejection-free during follow-up with an actuarial rejection-free probability of 92.59% within 3 months. Two patients (6%) had one episode of biopsy-proven acute cellular rejection (ACR). Actuarial patient and graft survival rates at 3 years were 86.85% and 81.25%. One patient (3%) experienced one episode of sepsis. There was no evidence of cytomegalovirus infections or side effects related to the basiliximab. We found zero de novo malignancy but we observed two patients with metastatic spread of their primary malignancy during the follow-up. CONCLUSION: Basiliximab in association with tacrolimus and steroids is effective as prophylaxis of ACR among adult living related liver transplant recipients.

Acceptance of marginal liver donors increases the volume of liver transplant: early results of a single-center experience.

To expand the donor pool, clinicians are continually modifying criteria to accept organs, particularly those in the so-called expanded or marginal donor pool. The concept and definition of a marginal donors continues to evolve. The impact of their use is the result of a combination of donor and recipient factors. Most clinicians accept steatosis above 30%, donor age over 60 years, prolonged ischemia time, prolonged intensive care unit stay, hypernatremia, previous cardiac arrest, prolonged episodes of hypotension, large use of inotrope drugs, and elevated liver function tests as criteria for designation of a marginal organ. In June 2003, we started to use marginal donors each year tripling the number of transplants per year at our center.

Hepatic sickling: an unusual cause of liver allograft dysfunction.

Orthotopic liver transplantation can be performed successfully in thalassemia. In this article, we describe a case of liver transplantation in a patient with sickle cell/beta-thalassemia complicated by liver sickling. Intrahepatic sickling must be considered in case of allograft dysfunction. This condition can easily be diagnosed by biochemical investigation and liver ultrasonography.

Anti-alpha interferon antibodies after alpha interferon treatment in patients with chronic viral hepatitis.

Thirty-five patients with chronic viral hepatitis (B, D or non A, non B), treated with alpha interferon were evaluated by a highly sensitive enzyme immunoassay for the presence of alpha interferon neutralizing antibodies before and after three months of treatment. Although 4 subjects (11.4%) became immunized against alpha interferon, treatment with the drug was successful in inhibiting viral replication in 3 of them. We conclude that the appearance of anti alpha interferon antibodies does not affect the effectiveness of the drug, and is therefore not worth monitoring.

[Effects of administration of gastric mucoprotein and vitamin B 12 on rats fed Hauk's and Osers standard diet and Wynn's cariogenic diet]. / Effetti della somministrazione di mucoproteina gastrica e vit. B12 nei ratti alimentati con dieta standard di Hauk e Oser e con dieta cariogena di Wynn (emory)

An increase in dental decay of 48.89% over controls fed with a cariogenic diet was noted when gastric mucoprotein and vitamin B12 were administered to rats receiving a standard diet.

[Method of functional impression in prosthetic treatment with distal extension with dental-mucosal support]. / Metodica d'impronta funzionale nella protesi dentaria ad estensione distale con appoggio dento-mucoso.

Having examined the biomechanical problems regarding free-end tooth-tissue borne dentures caused by the different resilience of denture support structures and changes in the resilience of fibre-mucosa, and having reviewed the impression methods now in use, the authors describe a functional impression method used to obtain a clinical and instrumental record of the individual conditioning of fibre-mucosa support by functional occlusal stress. The aim was to reduce the resilience of fibre-mucosa to levels comparable to periodontal and articular levels. The purpose was to achieve an optimal functional morphology of the prosthetic occlusal surface in order to guarantee the static and dynamic equilibrium of the denture. The authors describe a protocol based on weekly relining sessions and clinical and instrumental controls performed at every other session until optimal results have been obtained. Instrumental tests were carried out using the computerised occlusal analyser: T-SCAN version II. The authors used this device to measure the redistribution of occlusal forces acting on the occlusal surface in an antero-posterior and latero-lateral direction in subsequent sessions and the corresponding position of the centre of forces in the central area. In line with the results of earlier studies carried out by other researchers, the authors confirm that when maximum conditioning of the fibre-mucosa support is achieved, it only retains a slight residual elasticity.

[Stability of complete dentures. 3]. / La stabilità nella protesi totale. Nota III.

The author analyzes the fundamental parameters of the complete denture; stability occlusal in the eccentric mandibular movements. They are: a) Correlation between condylar and incisal guide and occlusal morphology of the dental-arches. b) Presence of interincisive and intercanine functional free space.

[Stability of complete dentures. 1]. / La stabilità nella protesi totale. Nota I.

The Author considers the necessary requisites for the complete denture's stability during masticatory function. This is due to the following anatomic and functional factors: a) Support tissues' morphology. b) Morpho-functional characteristics of the prosthetic tooth: unitary nupolivalent function in the different occlusal sectors. c) Linear arrangement of the teeth with unitary function along the "structural sagittal axis" or "central axis of dinamic and muscolar stabilization" of the mandible. d) Teeth's arrangement in the neutral or muscolar equilibration zone. e) Interalveolar axis' verticality of the teeth with unitary grinding function.

[Stability of complete dentures. 2]. / La stabilità nella protesi totale. Nota II.

There is a necessary correlation between the Monson's curve, due to the mandibular kinematics, and the interalveolar axis' inclination in the different occlusal areas with unitary function. In the triturating area the verticality of the interalveolar axis is necessary for the stability of the cusp-fossa relationship in centric occlusion and for the stability of the prothesis during mastication. The Author shows the occlusal morphology and the arrangement of the prosthetic teeth in the different skeletal classes in relation to functional interalveolar strength's direction.

Detection of anti-HBs antibody by means of an indirect micro-ELISA method.

The Hepanostika micro-ELISA System was used, with some modifications, for the indirect detection of anti-HBs antibodies. The proposed method is rapid, easy to perform, reproducible, and specific and approaches radioimmunoassay in sensitivity (92.6% agreement). An advantage over radioimmunoassay is the possibility of revealing antibodies in sera containing immune complexes, but this will require further investigation.

[Structural modifications induced by ionic implantation on functional surfaces of prosthetic attachments]. / Studio sulle modificazioni stutturali indotte dalla impiantazione ionica sulle superfici funzionali degli attachi per protesi.

Authors present the results on N+ ion implantation of an inox steel matrix set. They show the main utilization of prothesis attachments and their actual classification in prothesis field. The bombarded surfaces show a resistance increase to oxide-reduction processes respect to non implanted ones. Using the SEM technique to different magnifications, Authors demonstrate that the ion implantation increase the material hardness and the wear resistance of treated surfaces. The modifications, that not involve the matrix volume but only the superficial layers, produce an increase in attachment duration and affidability. Authors conclude valuing the possible application on this new technique for material treatment in Dentistry field.

[Ionic implantation in the dental field]. / L'impiantazione ionica in campo odontoiatrico.

Authors present the physics bases and the experimental equipment to obtain ion implant in metals. This new technique is already used in orthopaedic field to increase the metal surface quality as adherence and biocompatibility. In Dentistry field this technique can be employed to increase the surface hardness, the resistance to corrosion processes and the resistance to wear of implanted prosthesis.

Renal failure in fulminant hepatic failure and terminal cirrhosis: a comparison between incidence, types, and prognosis.

Forty patients with terminal cirrhosis and 40 patients with fulminant hepatic failure-all consecutively admitted-were studied with regard to incidence, types, and prognosis of complicating renal insufficiency. Renal failure was considered present when the serum creatinine was greater than 0.20 mmol/l. Of the patients with cirrhosis 26 (65%) developed renal failure. In 15 the type was functional, in three due to acute tubular necrosis, and in eight indeterminable. Of the patients with fulminant hepatic failure 22 (55%) had renal insufficiency; of these 13 had functional renal failure, five acute tubular necrosis, and in four the type was indeterminable. In both categories of patients, renal failure was equally frequent among patients with or without gastrointestinal bleeding and with or without ascites or diuretic therapy. The biochemical tests of liver function were similar in patients with or without renal failure in both categories. The mean renal blood flow in seven unselected patients with fulminant hepatic failure was reduced in the same order as previously observed in patients with cirrhosis. In terminal cirrhosis the mortality rate was 88% in the presence of renal failure, 71% in its absence (p greater than 0.05), while the same figures in fulminant hepatic failure were 100% and 67% (p less than 0.05). The incidence, relative frequency, and prognosis of renal failure were not different in the two conditions, indicating identical pathophysiological circumstances.

[Sonic and ultrasonic instruments for endodontics. 1. Overview]. / Apparecchi sonici ed ultrasonici per endodonzia. NOta I: generalita.

Remembering at the common aim for every endodontic treatment, the authors underline that is basal to clean and shape the root canal. The authors describe technical and anatomical handicaps existing in this stage and discriminate between traditional instruments and endosonic instruments. They also remember the advantages of ultrasonic joined with mechanical smoothing of the canal; after they make clear some concepts of wave physics to clarify the terms utilized in this study. Moreover they discriminate endosonic sets in sonic and ultrasonic devices. The authors conclude their study thinking that the endosonic way in endodontics is the synthesis of physical, chemical and biological effects.