Post-immunobiotics increase resistance to primary respiratory syncytial virus infection and secondary pneumococcal pneumonia.

Previously, we demonstrated that post-immunobiotics derived from Lactobacillus gasseri TMT36, TMT39, and TMT40 strains (HK36, HK39 and HK40, respectively) differentially regulated Toll-like receptor 3 (TLR3)-mediated antiviral respiratory immunity in infant mice. In this work, we investigated whether the HK36, HK39 and HK40 nasal treatments were able to improve the resistance against primary respiratory syncytial virus (RSV) infection and secondary pneumococcal pneumonia. Our results demonstrated that the three treatments increased the resistance to primary viral infection by reducing variations in body weight, RSV titers and lung damage of infected infant mice. Post-immunobiotics significantly enhanced the expressions of interferon (IFN)-λ, IFN-ß, IFN-γ, interleukin(IL) - 1ß, IL-6, IL-27, Mx1, RNAseL and 2'-5'-oligoadenylate synthetase 1 (OAS1) genes and decreased tumour necrosis factor (TNF)-α in alveolar macrophages of RSV-challenged mice. In addition, the studies in the model of RSV-Streptococcus pneumoniae superinfection showed that the HK39 and HK40 treatments were capable of reducing lung damage, lung bacterial cell counts, and the dissemination of S. pneumoniae into the blood of infant mice. The protective effect was associated with increases in IFN-ß, IFN-γ, IL-10, and IL-27 in the respiratory tract. This study demonstrates that the nasal application of the post-immunobiotics HK39 and HK40 stimulates innate respiratory immunity and enhances the defences against primary RSV infection and secondary pneumococcal pneumonia offering an alternative to combat respiratory superinfections in children, which can be fatal.

Update on postoperative analgesia in children.

Postoperative pain treatment is the challenge of the new century; we know that even starting from the 24(th) week of gestational age, the fetus can feel pain and that memory of uncontrolled pain can change the pain threshold in children. We have now new drugs and new tools for an optimal pain control also in children and this review is an update on the new therapies and devices which can help us in the daily clinical practice.

Postoperative analgesia in infants and children: new developments.

Nowadays, postoperative pain control in infants and children is a big challenge. The only effective solution is a multidisciplinary work with accurate guidelines, starting from the preoperative period throughout the surgery and arriving at the postoperative period. The approach must be scientific, based on the recent studies and research. In recent years, there has been a renaissance in regional anesthesia in children, in part because of a greater concern about postoperative pain management in young patients, and in part because of technical advances in equipment to perform the blocks. In fact several techniques and routes can be used for pain treatment but all have side effects. We await data from the use of COX2 inhibitors, surely the future of NSAIDs, with valid anti-inflammatory action and fewer side effects in children. When possible/not controindicated, regional analgesia is often the best choice. Recently continuous peripheral infusion is successfully applied in infants and children, due to its safety, efficacy and well limited localisation of analgesia. All the variety of peripheral nerve blocks used in adults can be used in pediatrics. The indications to place a catheter for a continouos peripheral nerve blocks are the followings: major orthopedic procedures; the procedure is scheduled to last more than two hours; congenital malformation of foot or hand; fracture reduction; traction of femur fracture; when postoperative pain therapy is necessary for several days; painful physical therapy. The commonly performed continuous peripheral blocks in children are the brachial plexus block (parascalene or axillary), the femoral nerve block, the fascia iliaca block, the sciatic nerve block with the lateral or with the popliteal approach. In these last two years also our group performed several continuous peripheral nerve blocks particularly axillary, femoral and sciatic for major orthopedic surgery and trauma. In our institution, we use a bolus dose of 0.5-1 ml/kg (depending on the nerve to be blocked) of ropivacaine 0.2% or levobupivacaine 0.25% with clonidine 2 microg/kg and then in infants older than 6 months and children we use a continuous infusion of 0.1-0.3 ml/kg/h of 0.2% ropivacaine or 0.25% levobupivacaine with clonidine 3 microg/kg/24h for 48-72 hours. For older children doses and concentrations are usually the same used in adults.

Ketamine: a new look to an old drug.

Ketamine is an NMDA receptors antagonist, with a potent anaesthetic effect. NMDA receptors are involved in nociceptive modulation, in the wind-up phenomenon, in peripheral receptive fields expansion, in primary and secondary hyperalgesia, in neuronal plasticity. Ketamine effects are well-known: it produces a state of "dissociative anaesthesia", amnesia, and, at the same time, it mantains the respiratory drive effective and supports the sistemic arterial blood pressure. Anaesthesiologists are also familiar with its side-effects, like the increase of salivar and bronchial secretions, the possible increase of intracranial and pulmonary pressures and the dysphoric effect that may produce vivid and sometimes unpleasant dreams. Reviewing scientific data and studies about the use of ketamine in children, many considerations come out: at first they considered the effects of the racemic ketamine, then they evaluated the S-enantiomer. Many surveys studied the effects (analgesia, sedation, side-effects) of different doses or different routes of administration. Other studies were designed to compare ketamine to clonidine or opioids as adjuvants in paediatric regional anaesthesia with local anesthetic drugs, in order to prolong analgesia. In our Children's Hospital, we use ketamine in the operating room, in intensive care unit and for any procedure in hospital wards. The suggested doses are: Epidural or caudal route (as an ajuvant for local anaesthetic agents, in the treatment of postoperative pain): 0.5 mg/kg. Sedative/analgesic effect (for algesic procedures): 1-2 mg/kg i.v. Continuous infusion (intensive care unit): 0.5 mg/kg/h, with a range from 20-30 microg/kg/min to 80 microg/kg/min, depending on the age of the patient.

[A case of retroperitoneal leiomyosarcoma]. / Su di un caso di leiomiosarcoma retroperitoneale.

Leiomyosarcoma is a rare malignant tumour originating from the smooth muscular tissue in any part of the organism, including retroperitoneum where it is particularly aggressive. It is nearly always characterized by a silent development causing diagnostic delay. The results of the primary therapy, which is always surgical, are limited because of the tumoral mass extension and the high local aggressiveness. The Authors present a clinical case which was under their observation and seize the opportunity of making a revision of the literature about it.

[Verrucous carcinoma of the penis. A case report and review of the literature]. / Il carcinoma verrucoso del pene. Descrizione di un caso e revisione della letteratura.

The Authors report a case of a verrucous carcinoma of the penis. Among male malignant epithelial tumors the verrucous carcinoma represents a very rare form, with a typical oesophitic development, of vegetating sometimes ulcerated appearance, with slow evolution that rarely presents metastases. Although a therapeutic preservation approach is possible, a surgical operation is the treatment of choice.

Extracorporeal shock-wave lithotripsy in patients with spinal cord dysfunction.

Patients with spinal cord dysfunction are at an increased risk for urolithiasis. A retrospective study was undertaken to determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) in this population. Thirteen kidneys received 19 treatments averaging 2,350 shocks per renal unit. All but one of the stones showed good fragmentation; however, none of the patients was stone-free at three months. Four of 9 patients with long-term follow-up were stone-free at five to fifteen months. Our poor stone-free rate is similar to that found in other studies of patients with spinal cord dysfunction. ESWL was well tolerated in this population, however, the clearance of stones is poor and delayed.

Renal handling and physiologic effects of the paramagnetic contrast medium Gd-DOTA.

Gadolinium DOTA (Gd-DOTA) is a magnetic resonance (MR) contrast agent similar to Gd-DTPA but with greater stability in vitro. The effects of a high intravenous dose (0.5 mmol/kg) of Gd-DOTA (1360 mOsm/kg) on renal excretory function and its general systemic effects are examined in this animal study. This dose was selected to accentuate and better define the qualitative nature of these effects. A decrease in arterial pressure of 8% (131.9 +/- 6.8 at 120 minutes versus a control of 142.8 +/- 3.7 mm Hg, mean +/- standard error of mean, no significant change in electrocardiogram (ECG) lead II, a 16% increase in renal blood flow (106.0 +/- 5.4 at 7.5 minutes versus 91.2 +/- 3.2 ml/min), and a decrease in arterial hematocrit of 9% (38.9 +/- 1.5 at 120 minutes versus 41.9% +/- 1.7%) were noted. In general, qualitatively similar effects have been noted as a nonspecific effect of other hyperosmolar solutions. The filtration fraction decreased (0.23 +/- 0.01 at 7.5 minutes versus 0.28 +/- 0.02) followed by a rapid return to baseline values. No significant change was noted in glomerular filtration rate throughout the experimental protocol. Urine flow increased nearly 1.5-fold and osmolal clearance (Cosm) increased approximately 1.5 times. A natriuresis occurred as the fractional excretion of sodium (FENa+) increased from a control value of 3.5 +/- 0.3 to 5.2 +/- 0.5 at 7.5 minutes. The systemic and renal physiologic effects of high-dose intravenous Gd-DOTA on the kidney reflects a nonspecific, osmotically induced alteration. These data suggest that the main systemic and renal physiologic actions of Gd-DOTA are a nonspecific response to agent osmolality that is similar qualitatively to conventional, water-soluble contrast media.

Testicular torsion or acute epididymitis? Diagnosis and treatment.

The differentiation between torsion and epididymitis can be extremely difficult because only 50% or less of cases involving testicular torsion exhibit the classically expected findings. Therefore a careful history and complete analysis of the physical and laboratory findings are warranted. When needed, the judicious use of collaborative tests will point the clinician toward the appropriate diagnosis.

[Carcinoid tumor of the appendix]. / Il tumore carcinoide dell'appendice.

The Authors report a case of tumour carcinoid of the appendix incidentally found at operation for appendicitis in a young patient. Diagnosis was confirmed at histologic analysis of the operating piece. Appendiceal carcinoid is the most frequent carcinoid tumor of the gastrointestinal tract and rarely becomes malignant. The Authors emphasize the importance of the knowledge of this not rare neoplasm.

[5-Fluorouracil in the treatment of acute pancreatitis. Our experience]. / Il 5-fluorouracile nel trattamento della pancreatite acuta. Nostra esperienza.

A report is presented on 24 cases of acute pancreatitis treated with infusion of 5-fluorouracil. Though the action mechanism of the drug is still uncertain, fairly satisfactory results were obtained in terms of both clinical symptoms and laboratory findings, while the effect of the drug on the pain symptom could even be called spectacular. It is therefore considered that the treatment of acute pancreatitis with 5FU deserves serious consideration.

Effects of the magnetic resonance contrast medium ferrioxamine methanesulfonate on systemic and renal hemodynamics in the anesthetized dog.

Ferrioxamine methanesulfonate (S-FDF) is a new magnetic resonance (MR) contrast agent developed to improve magnetic resonance imaging of the abdomen and pelvis. This stable complex of deferoxamine methanesulfonate and iron is excreted in the urine by glomerular filtration modified by active renal tubular resorption. This study examines the acute systemic and renal hemodynamic responses to this agent after intravenous administration either as an infusion of 25 mg/kg over 5 minutes or as a rapid bolus at a dose of 50 mg/kg. In eight anesthetized dogs, renal plasma flow (RPF) was measured with an electromagnetic flowmeter, and GFR was determined by the renal extraction of technetium-99m-DTPA. Mean arterial pressure (MAP), pulse rate, and a lead II ECG were assessed. At a dose of 25 mg/kg over 5 minutes, MAP decreased significantly (control 146.0 +/- 6.5 mm Hg vs. 107 +/- 18 mm Hg at 2 minutes; P less than .05). In two of the eight animals, the MAP dropped below 60 mm Hg. Significant decreases in GFR and RPF also were noted. All four of the animals receiving the rapid injection of S-FDF experienced profound hypotension (MAP less than 50 mm Hg). The drop in heart rate from 152 +/- 11.6 bpm to 121 +/- 4.9 bpm was associated with a marked depression of the ST wave in the lead II ECG. Further animal studies are needed to assess the mechanism of toxicity and a potential synergism of action with pentobarbital anesthesia.