Emerging and re-emerging infectious disease in otorhinolaryngology.

SUMMARY: Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.

Long-term results of the Leeds-Keio anterior cruciate ligament reconstruction.

This paper discusses the long-term results of the anterior cruciate ligament (ACL) reconstruction with the Leeds-Keio (LK) prosthetic ligament. For this type of reconstruction we used arthrotomy and an arthroscopy-assisted technique. The fixation was obtained with two bone plugs, and the distal portion was also attached with a staple. A postoperative protocol was used with a progressive range of motion and weight bearing after 50 days. We performed 50 LK operations in professional and amateur athletes aged 17-39 years with an isolated anterior instability. We reviewed at follow-up (5-7 years) 37 patients; 8 were lost, and 5 had a subsequent failure. At the Lysholm score the patients were classified: 19 excellent, 13 good, 3 fair, and 2 poor. At the IKDC grading the patients were classified as follows: 2 class A, 22 B, 8 C, and 5 D. The Lachmann test was 1+ in 15 patients, 2+ in 7, 3+ in 2, and negative in 13; pivot shift was 1+ in 9, 2+ in 7, 3+ in 2, and negative in 25. Results of the KT 1000 test at 30 lb side to side was < 3 mm in 23 patients, 3-5 mm in 6, 6-10 mm in 6, and > 10 mm in 2. In view of the results observed and the progressive deterioration over the years, this procedure should no longer be performed as an ACL substitute.

Comparison of "catheter" and conventional arthroscopy in the diagnosis of knee derangements.

The diagnostic efficiency of the Optical Catheter System (OCS), which uses a 1.7-mm arthroscope, was compared with that of conventional arthroscopy in 50 patients with various knee derangements in standard arthroscopic conditions. Correct diagnoses were obtained with the OCS in 98% of anterior cruciate ligament derangements--92%-98% of those involving the medial and lateral meniscus, respectively--and 96% of cartilage disorders. No false-positives were noted for anterior cruciate ligament and meniscus injuries. False-negatives were caused by abundant intraarticular bleeding (no tourniquet was applied) and peripheral meniscus tears and false-positives by synovial superposition resulting in a mistaken diagnosis of patellar chondromalacia. The OCS proved a good diagnostic tool. Its employment, especially in an outpatient setting, should be restricted to a small number of patients and entrusted to expert arthroscopists.

Medial patellar synovial plica syndrome: the influence of associated pathology on long-term results.

The results obtained after 4-8 years in 42 patients submitted to arthroscopy for the treatment of medial patellar synovial plica syndrome are analyzed. There was a considerable difference in the values obtained depending on whether the plica was isolated, or associated with meniscal or cartilaginous lesion. In fact, based on the Lysholm score, treatment of isolated plica obtained 17 excellent or good results in 21 patients, while in the 21 cases where the lesion was associated with other pathologies excellent or good results were observed in only 9 subjects. Thus, associated lesions definitely influence long-term results.

[2 cases of arthralgia associated with infection by Clostridium difficile]. / Due casi di artralgia associati ad infezione da Clostridium difficile.

The Clostridium difficile is the etiologic agent most often isolated in patients with antibiotic-associated colitis. Rarely this symptomatology is complicated by postinfection arthritis. The following describes 2 cases of acute colitis by clostridium difficile associated with acute polyarthritis.

Ambroxol in the treatment of idiopathic respiratory distress syndrome. An interim report on a controlled double-blind multicenter study versus placebo.

In a double-blind multicenter study versus placebo, the therapeutic effects of ambroxol (10 mg/kg, i.v. twice daily for 7 days) were studied in an appropriately selected population with severe respiratory failure. Treatment was given to 28 neonates with birth weight less than or equal to 2,000 g, appropriate for gestational age with idiopathic respiratory distress of such severity as to require assisted ventilation (IMV or IPPV) within 12 h of birth. The preliminary results showed that ambroxol treatment, and not placebo, increased survival, reduced the time during which mechanical ventilation was required and improved the FiO2/PaO2 ratio and the biochemical indices of pulmonary maturity. This latter improvement suggests that the amelioration of the IRDS clinical picture and the reduction of ventilatory requirement might be due to an increase in pulmonary surfactant. No side effects attributable to ambroxol therapy were observed in the treated infants.

[Urinary tract infections in a general medicine department. Comments on cases collected over 3 years]. / Le infezioni delle vie urinarie in un reparto di medicina generale. Considerazioni sulla casistica raccolta in un triennio.

Urinary infections often complicate the clinical course of hospitalised patients especially those with immunological diseases or under antibiotic treatment for other infectious pathologies. Urethral catheterisation is also a well known cause of such infections. The problem of urinary infections was examined in a general medical division. Over a three year period (1982-84), 384 urinary tract infections (UTI) with one infecting organism and 21 UTI with two bacterial species in urine cultures were found. UTI was more often found to be caused by gram negative than gram positive bacilli in both catheterised and non-catheterised patients and E. Coli accounted for most infections. Pseudomonas, Serratia and Acinetobacter were only found in catheterised patients and Enterobacter cloacae almost exclusively so. Among gram-positive bacilli, Enterococcus was the most common. Staphylococcus aureus was rare but created major pathogenetic and therapeutic problems. The results are discussed with particular reference to the high incidence of Escherichia coli and the significance of the different distribution of Pseudomonas, Serratia, Acinetobacter and Enterobacter cloacae between catheterised and non-catheterised patients. Finally the pathogenic and therapeutic problems of UTI caused by more than one germ are considered.

[Effects of handgrip on cardiovascular and respiratory apparatus of healthy young subjects (author's transl)]. / Effetti dell'esercizio isometrico sugli apparati cardiovascolare e respiratorio in soggetti giovani sani.

We have studied, in eight healthy subjects, aged 22-26 years, some cardiovascular and respiratory effects, during maximal and half-maximal isometric effort, four minutes lasting, performed with hand (handgrip). During contraction and 15 minutes lasting recovery, heart rate, arterial systolic pressure at resting arm and at limb, pulmonary ventilation, VO2 and VCO2 have been evaluated. The data of the two tests have been submitted to the Student's test. During isometric contraction and recovery, heart rate rapidly increases and decreases, respectively, without significant differences between the two contractions. The abrupt increase of the systolic arterial pressure is greater during maximal work, at resting arm; arterial pressure at limb increases rapidly during contraction, but do not varies between the two efforts. These arterial pressure responses to isometric contraction presumably are related to a neurogenic vasoconstriction. During recovery of maximal work, the systolic arterial pressure, at limb, is significantly greater than basal values from 5th to 15th minute and versus the half maximal effort at 7th, 10th and 15th minute, presumably because the vasoconstriction is still effective. Pulmonary ventilation, VO2 and VCO2 increase during contraction; VO2 and VCO2 further increase after 10 minutes of recovery, probably because the debt of O2 is repaid.

Ventilatory and pressor response to isometric exercise in normal subjects.

We studied in 8 young, healthy males, the behaviour of heart rate (HR), systolic blood pressure at the upper (SBPUL) and lower (SBPLL) resting limbs, pulmonary ventilation (VE), oxygen uptake (VO2) and production of CO2 (VCO2) during and after two levels of isometric effort (handgrip at 50 and 100% maximum voluntary contraction; MVC). HR, SBPLL, VE, VO2, and VCO2 did not vary between the two efforts, but SBPUL is significantly different between them. The possible mechanism and predominant role of nervous reflexes upon the pressor and ventilatory response to isometric exercise are discussed.

Bone metastases from breast cancer treated with calcitonin. Case report.

A case of bone metastases from breast cancer is reported. After 6 months of therapy with calcitonin, the skeletal radiological examination showed an evident change in the roentgenographic pattern of a large metastasis of the left femur. A possible relationship between the calcitonin treatment and the radiological change is discussed.

[Effort test on a treadmill in peripheral arteriopathic obstructions (author's transl)]. / Test da sforzo su ergometro nelle arteriopatie obliteranti periferiche.

20 males, 48 to 66 of age, whose 10 normal and 10 with chronic arteriopatic obstruction at inferior limbs, were submitted to effort on a treadmill for 5 minutes or until pain. The clinostatic systolic aterial pressure was obtained in the four limbs before and at fixed intervals of time from the exercise. Arterial pressure increases after effort in the normal limbs; the length and the amount of the systolic pressure decrease after exercise are in correlation with the degree of the arterial involvement. The exercise on treadmill seems useful when the clinical and other diagnostic data are inadequate for a reliable diagnosis and to evaluate the progression of the arteriopathy through a non-invasive, and easy to repeat, method. The possible mechanisms of the pressor decrease in the arteriopatic limbs are discussed.

Combined chemotherapy for unresectable carcinoma of the lung: a randomized trial.

A selected case file of 32 patients with carcinoma of the lung which had passed the stage of surgical cure was randomized in 3 arms and treated with different schedules: regimen A, adriamycin plus cyclophosphamide; regimen B, the BACON combination, slightly modified; regimen CVP, cyclophosphamide plus vincristine plus prednisone. Response rate and survival curves were analyzed. Statistical evaluation showed a significant increase in survival of B versus A, but not versus CVP, while other factors such as the initial performance status and the response rate seemed to have a marked influence on survival time. No significant correlation was observed with different histiotypes within each regimen. All three regimens compare favorably with patients who received only supportive treatment.

Primary carcinoma of the colon and hyperlipemia: a paraneoplastic syndrome.

The human counterpart of the association of hyperlipidemia with cancer is rare, as compared with the relative frequency of the syndrome in experimental animals. A case is presented of adenocarcinoma of the colon with a non casual relationship between the presence and the progression of the tumor and hyperlipemia. Surgical resection and antiblastic chemotherapy moreover seemed to influence the metabolic anomaly.