[Role of beta-glucan in the treatment of recurrent candidiasis and HPV-correlated lesions and reparative process of epidermis]. / Beta-glucano e terapia delle candidosi recidivanti e delle disepitelizzazioni cutanee iatrogene.

AIM: The aim of the study was to examine the effects of beta-glucan treatment in women with recurrent vulvar candidiasis or previously treated with diathermocoagulation (DTC) for vulvar lesions caused by human papillomavirus (HPV) infection. METHODS: From January to March 2008, 23 women with a history of recurrent candidiasis and 209 women who underwent to DTC for HPV-correlated vulvar lesions were recruited at the Department of Obstetrics and Gynaeco-logy of San Camillo-Forlanini Hospital of Rome. The two groups were treated with two cycles of a daily topical application of beta-glucan for 15 consecutive days with a suspension of 20 days. The effects of beta-glucan were analyzed at the 1st and the 3rd month from the start of the therapy. RESULTS: A total of 209 women, 21 with recurrent candidiasis and 188 who underwent to DTC for HPV-correlated lesions, completed the study. After the first month of treatment we not found any evidence of disease in both groups; otherwise we observed, a month after the term of the therapy, 5% and 3% of recurrence of candidiasis or lesions secondary to HPV infection, respectively, even if with low grade. CONCLUSIONS: Our results demonstrate the efficacy of beta-glucan treatment for recurrent candidiasis, HPV-correlated lesions and in the reparative process of epidermis.

Peripheral insulin-like factor 3 concentrations are reduced in men with type 2 diabetes mellitus: effect of glycemic control and visceral adiposity on Leydig cell function.

BACKGROUND AND AIM: Hypogonadism frequently occurs in men with type 2 diabetes mellitus (T2DM), while the role of glycemic control and visceral obesity is still unclear. This study aimed to assess the Leydig cell function, including the new sensitive marker insulin-like factor 3 (INSL3), in T2DM patients without overt hypogonadism and the influence of either glycemic control or visceral adiposity. SUBJECTS AND METHODS: Thirty T2DM patients (age 57.1+/-6.2 years, body mass index (BMI) 28.0+/-4.3) without overt hypogonadism and 30 age- and BMI-matched controls were studied. Anthropometric, glycometabolic parameters and testosterone, SHBG, LH, INSL3 levels, bioavailable and free testosterone (BT and cFT) were evaluated. The human chorionic gonadotrophin (hCG) test was also performed. RESULTS: Patients had lower total testosterone (452.6+/-130.0 vs 512.6+/-117.3 ng/dl, P=0.06), BT (189.7+/-36.4 vs 237.1+/-94.1 ng/dl, P=0.002), cFT (8.1+/-1.6 vs 10.1+/-4.0 ng/dl, P=0.002), and higher LH levels (3.5+/-1.6 vs 2.6+/-1.2 mU/ml, P=0.01) versus controls. Serum INSL3 concentrations were also lower in patients (1.1+/-0.3 vs 1.5+/-0.7 ng/ml, P=0.01). These hormonal parameters, including INSL3, did not differ between T2DM patients with poor or good glycemic control (HbA1c>9 or <7% respectively). In patients, waist circumferences (97.9+/-12.4 cm) negatively correlated with INSL3 (P=0.03) and basal, as well as hCG-stimulated testosterone levels (P=0.04 and 0.004 respectively). Basal or stimulated hormonal levels and INSL3 concentrations were not different between patients with (40%) or without erectile dysfunction. CONCLUSIONS: An early impairment of the overall Leydig cell function is present in men with T2DM, mainly related to visceral adiposity rather than to glycemic control.

Role of adrenal gland scintigraphy in patients with subclinical hypercortisolism and incidentally discovered adrenal mass.

BACKGROUND: The role of adrenal scintigraphy (AS) in the diagnosis of subclinical hypercortisolism (SH) in adrenal incidentaloma (AI) is debated. AIM: To evaluate the possible role of AS in identifying SH in AI patients. SUBJECTS AND METHODS: In the retrospective phase (2000-2004), 102 AI patients [71 females (F)/31 males (M)] referred to our center were reevaluated for SH. In the prospective phase (2005-2006), 42 patients (32F/10M) with suspected SH were evaluated performing AS and biochemical assessment of cortisol secretion. We report data of the prospective phase of the study. In these patients AS was performed at baseline; the difference between the uptake of the affected and the controlateral gland [mean Delta uptake (MDeltau)] was calculated. Cortisol secretion was evaluated in 3 different occasions. Patients were considered affected with SH if they presented at least twice 2 of the following criteria: urinary free cortisol >193 nmol/l, cortisol after 1 mg dexamethasone suppression test >83 nmol/l, ACTH levels <2.2 pmol/l. RESULTS: MDeltau was higher in patients with SH (no.=27, 5/22 M/F) than in patients without SH (83.7+/-12.5 vs 54.7+/-24.1%, p<0.001), and directly correlated with UFC (beta=0.387, p=0.015) and was predictive of SH (odds ratio 1.12, 95% confidence interval 1.03-1.22, p=0.009) regardless of age, body mass index, and diameter of the mass. A 75% MDeltau cut-off has 86.7% specificity and 81.5% sensitivity in diagnosing SH. CONCLUSIONS: AS is not recommended as screening test in AI patients, but it can be useful to exclude the presence of a subtle cortisol excess in patients with unclear biochemical diagnosis of SH.

Metabolic parameters after BioEnterics Intragastric Balloon placement in obese patients.

BACKGROUND: BioEnterics Intragastric Balloon (BIB) is a non-invasive, temporary and relatively safe procedure shown to be effective in the short-term treatment of obesity. Nowadays, BIB does not show convincing evidence of significant long-term weight loss, as compared with conventional management, and data regarding changes in metabolic and nutritional parameters are lacking. METHODS: Forty obese patients [11 males, 29 females, age 36.65+/-10.6 yr, body mass index (BMI) 44.9+/-8.9 kg/m2] were evaluated before and 3 and 6 months after BIB placement by assessment of anthropometric and biochemical parameters as well as nutritional habits. RESULTS: Patients showed a significant reduction in weight (-13.2+/-6.5%), BMI (-13.2%), waist circumference (-6.5 cm), and percentage of fat mass (-19.5%), but not fat-free mass. A significant improvement in insulin sensitivity but not in lipid pattern was seen. After BIB insertion, a significant reduction in caloric intake was paralleled by a redistribution of nutrients; in particular, increased lipid (12.8%) and decreased carbohydrate (-11.7%) percentage, but not absolute intake was observed. CONCLUSION: These data show that BIB improves anthropometric parameters, with reduction of fat mass and preservation of fat-free mass, as well as insulin resistance, but not other metabolic features. The observed change in dietary habits, with a relative increase in lipid intake, once BIB is removed, might favor body weight regain and impact negatively on body weight composition and the other traits of the metabolic syndrome.

Patients with macroprolactinaemia: clinical and radiological features.

BACKGROUND: Macroprolactinaemia may represent a relevant cause of misdiagnosis, unnecessary investigation and inappropriate treatment. The aim of this study was to investigate the clinical and neuroradiological characteristics of patients with and without macroprolactinaemia and to evaluate the impact of macroprolactin determination on the diagnostic work-up of hyperprolactinaemic patients. MATERIALS AND METHODS: Retrospective analysis in 135 consecutive hyperprolactinaemic patients (111 women and 24 men; mean age 37 +/- 11.6 years) whose archived sera were subsequently tested for macroprolactin. Recoveries

Reduced levels of adiponectin in sleep apnea syndrome.

BACKGROUND: To investigate adiponectin levels in an obese population with and without obstructive sleep apnea syndrome (OSAS) and the acute modifications in adiponectin after a whole-night control by auto continuous positive air pressure (CPAP). METHODS: 46 obese subjects [22 males, 24 females, age 55.1+/-11.4 yr, body mass index (BMI) 38.9+/-6.5 kg/m2]: 11 OSAS with apnea/hypopnea index (AHI) from 10/h to 30/h, 14 OSAS with AHI >30/h and 21 without OSAS. Thirty-seven normal weight healthy subjects (20 males, 17 females, age 31.3+/-9.5 yr, BMI 21.5+/-1.8 kg/m2). Serum adiponectin levels, biochemical parameters, anthropometric measurements, pulmonary function, pulse-oxymetry and polisomnography. RESULTS: The 3 groups of obese patients were comparable for gender, BMI, age, fat mass, fat free mass, hip and waist circumference, waist-to-hip ratio (WHR), systolic and diastolic blood pressure and glycometabolic parameters. Adiponectin levels were significantly reduced in obese patients compared to healthy normal weight subjects (8.1+/-3.5 vs 11.3+/-4.8 microg/ml p<0.001) In particular, adiponectin showed a trend to decrease according to the severity of OSAS. No differences in adiponectin levels were found after a whole-night control by Auto CPAP. CONCLUSIONS: OSAS is associated with reduced levels of adiponectin independently of insulin-resistance and BMI. These low adiponectin levels may contribute to the increased mortality seen in such patients.

Cervical ectopic pregnancy: clinical review.

Cervical pregnancy is a rare kind of intrauterine ectopic pregnancy. Diagnosis and treatment of cervical pregnancy have enormously changed in the last 15 years. Before 1980, diagnosis was made when dilation and curettage for presumed incomplete abortion resulted in sudden and uncontrollable hemorrhage. Hysterectomy was practiced in order to save the patient's life. Today, cervical pregnancy is diagnosed by ultrasound (US) during the Ist trimester of pregnancy, so that the patient's fertility can be preserved. Therefore any physician should consider the possibility of a cervical pregnancy in a woman with abdominal pain and vaginal bleeding during the first trimester of pregnancy. In this study we reviewed the literature on the epidemiology, etiology, diagnosis and treatments of cervical pregnancy.

Cervical pregnancy: a case report.

The case of a patient with cervical pregnancy diagnosed by ultrasound (US) at nine weeks of gestation is described. US showed a cavity of 4.5 x 3.5 cm in diameter located on the right lateral wall of the cervix containing trophoblasts. In order to preserve the patient's fertility conservative treatment was administered: methotrexate (MTX), ligature of the uterine arteries, and hysterosuction. Due to intense bleeding uncontrolled by the use of a Foley's catheter total hysterectomy with conservation of the adnexae was performed.

Dissociation between carotid artery lesions and lipid parameters in recipients of successful kidney graft.

BACKGROUND: The relationships between lipid levels and atherosclerotic lesions of carotid arteries in kidney graft recipients are still unclear. METHODS: We evaluated carotid morphology in 53 recipients of functioning renal transplantation, and studied the relationship of carotid artery wall lesions with relevant clinical and laboratory risk factors for cardiovascular disease. The patients were on stable, cyclosporine-based immunosuppressive therapy. RESULTS: The main clinical characteristics of patients were: age, 46.5 +/- 10.1 years; males/females, 40/13; body mass index, 25.8 +/- 4.4 kg/m2; duration of transplantation, 43 +/- 52 months. Ultrasonographic scanning of carotid arteries showed the presence of lesions (intimal-media thickness and/or plaque) in 28 patients (52.8%). These recipients differed from patients without carotid lesions in terms of age (50.4 +/- 9.0 vs 42.2 +/- 9.7 years, p < 0.01) and duration of pre-transplant dialysis (4.6 +/- 3.4 vs 2.3 +/- 1.9 years, p < 0.01), whereas no statistically significant difference was observed as for total cholesterol (230 +/- 44 vs 235 +/- 35 mg/dl), LDL-cholesterol (142 +/- 32 vs 143 +/- 30 mg/dl), HDL-cholesterol (52 +/- 12 vs 58 +/- 20 mg/dl) and triglycerides (178 +/- 94 vs 167 +/- 89 mg/dl). The percentage of post-transplant diabetes was 3-fold higher in patients with carotid lesions (25 vs 8%). No difference was observed as for the following parameters: body mass index, duration of transplantation, fibrinogen levels, DDimer concentrations, reactive C-protein values, prevalence of hypertension, percentage of smokers vs non-smokers. CONCLUSIONS: The present study supports the view that carotid artery lesions in kidney graft recipients on stable, cyclosporine-based immunosuppressive therapy may not be related to circulating lipid values.

Microbial quality of wastewater: detection of hepatitis A virus by reverse transcriptase-polymerase chain reaction.

AIMS: The persistent circulation of hepatitis A virus (HAV) in the Mediterranean area suggests the need for monitoring its presence in the environment. A reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the presence of HAV in several consecutive raw sewage and final effluent samples, collected over an 8-month period from an activated sludge treatment plant in southern Italy. METHODS AND RESULTS: Two distinct purification protocols, either based on antigen-capture with monoclonal antibody (AC) or RNA extraction, were compared. The possible influence of the antibody used in the AC phase was evaluated in preliminary experiments on HAV-spiked samples, using two different monoclonal antibodies. Hepatitis A virus RNA was detected in all but one sewage environmental sample examined. The contemporary presence of enteroviruses, reoviruses and phages was observed, while HAV growth in cell culture was hampered. CONCLUSIONS: The RT-PCR technique was confirmed to be a valuable tool for the rapid monitoring of HAV in sewage samples. In addition, this study demonstrated that application of different sample purification methods can result in different levels of sensitivity of the assay and that, in the antigen-capture method, the choice of antibody can have a crucial role. SIGNIFICANCE AND IMPACT OF THE STUDY: This work underlines the need for technical uniformity in environmental studies from different laboratories for a correct and useful comparison of the results.

Beneficial effects of low doses of ethinyl-estradiol on the lipid profile in postmenopausal women.

The purpose of this study was to investigate the beneficial effects of low doses of ethinyl-estradiol on the lipid profile in postmenopausal women. One hundred and five patients (mean age [+/-S D] 42.9 +/- 5.0 years) who underwent a hysterectomy and bilateral salpingo-oophorectomy were included in the study. For the present study serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B (apoB), and lipoprotein(a) [Lp(a)] were investigated. When all patients were considered together (Table 1), EE2 therapy significantly increased serum levels of total cholesterol, HDL cholesterol and LDL cholesterol. The ratio of HDL to LDL cholesterol, Lp(a) and triglyceride concentrations did not change significantly from the baseline value. Although our study was not randomized or controlled with a placebo, the beneficial metabolic effects of ethinyl-estradiol on lipid patterns should be considered in patients needing hormonal replacement therapy in postmenopause.

Giardia and Cryptosporidium in water: evaluation of two concentration methods and occurrence in wastewater.

Giardia and Cryptosporidium are important agents of water-borne parasitic diseases. In this work we have examined the recovery efficiency of two methods for concentrating Giardia cysts and Cryptosporidium oocysts from water: a membrane filtration method and a crossflow filtration method. Results demonstrated a higher recovery efficiency for crossflow filtration method in comparison to the membrane filtration method. In addition, Giardia cysts and Cryptosporidium oocysts concentration was evaluated in wastewater samples submitted to chemical flocculation or chemical flocculation followed by slow sand filtration. Results showed that slow sand filtration was capable of reducing the number of Giardia cysts, but not of Cryptosporidium oocysts in wastewater.

Laparoscopic splenectomy. How to make it easier using an innovative atraumatic suction grasper.

BACKGROUND: With the evolution of laparoscopic surgery comes the need for specific instruments that apply traction to parenchymal tissue, like the spleen, without exposing the organ to the associated high risk of bleeding. To meet this need, we designed and developed a suction-cup grasper that allows easy grasping and manipulation of the spleen. Some of the difficulties usually encountered during laparoscopic splenectomy may be overcome by using this device. MATERIALS: The instrument consists of a cone-shaped, silicone rubber suction cup designed with an antislip internal surface. The cup is connected to a support arm with a flexible distal end that can be rotated. Traction is exerted with a commonly available suction system. The device is inserted through a 12-mm-diameter guide sheath. RESULTS: The two interventions performed with the atraumatic device were completed with laparoscopic technique. No complications arose during or after the operations. The average operating time was 110 min. The patients were discharged after 4 and 5 days postoperative, respectively. CONCLUSIONS: As a device specifically designed for grasping parenchymal organs, the atraumatic suction grasper affords the operator a faster and safer technique in laparoscopic splenectomy.

[Ogilvie's syndrome: clinical reality or nosographic error?]. / La sindrome di Ogilvie: realtà clinica o errore nosografico?

The authors report their experience in the management of Ogilvie's syndrome, a rare form of large bowel acute pseudo-obstruction. The study includes fifteen cases of the disease. There were ten males and five female, with a mean age of sixty-two years (range 45-92). Three patients were only treated with medical and conservative measures, one with unsuccessful colonoscopy and twelve (two with colonic perforation) underwent laparotomy. The surgical procedures performed were tube cecostomy (40%), colonic resection with primary anastomosis (27%) and exploratory laparotomy with decompression (13%). The overall morbidity and mortality rate were respectively 0 and 13%. Our epidemiological, clinical and therapeutic results are similar to those reported in the international literature. The pathophysiology of the syndrome is still unknown. It can be "idiopathic" or can complicate other diseases or surgical procedures (urological and gynaecological procedures mostly). Plain abdominal roentgenogram is the most useful diagnostic test, but colonoscopy may be an alternative diagnostic (and therapeutic) weapon. Conservative treatment is the method of choice but when the cecal diameter is more than 12 cm. (impending perforation), when the colon is perforated or when medical measures are unsuccessful, surgical procedure is compulsory. The age of the patient, cecal size, delay in colonic decompression are the most important prognostic factors. Even with a proper management, the prognosis is severe and the mortality rate is high (3-50%).

[Hepatocystic ducts: anatomic curiosity or surgical challenge?]. / I dotti epatocistici: curiosità anatomica o sfida chirurgica?

The Authors report two cases of cysto-hepatic ducts. Clinical and therapeutic patterns of this rare biliary disease are stressed, underlining the surgical hazard related to iatrogenic damage of bile ducts during operative manoeuvres.

[Acute diverticulitis of the cecum. A clinical contribution and review of the literature]. / Diverticolite acuta del cieco. Contributo clinico e revisione della letteratura.

Even if it is a rare disease, acute cecal diverticulitis is a diagnostic and therapeutic challenge for the surgeon. The authors present their experience synthetically and compare their results with the literature. Their experience is not very different from the results reported by many other authors. Five cases underwent radical treatment (right colectomy) and 6 cases were treated with a more conservative operation (diverticulectomy and/or invagination). Only one patient was treated medically. Acute diverticulitis of the cecum requires the solution of three difficult questions: 1) preoperative diagnosis; 2) intraoperative diagnosis; 3) correct therapeutic procedure.

[Clinical case of carcinoid of the gallbladder. Considerations on gallbladder cancer]. / Caso clinico di carcinoide della colecisti. Considerazioni sul cancro della colecisti.

Gallbladder cancer is the fifth of the digestive neoplasms. Diagnosis is often made very late sk that prognosis is really poor. We present 84 patients operated on for gallbladder cancer and 1 for carcinoid. Sixty-eight of them had a complete follow-up.

[Intraoperative calibration of the Vater's papilla using Fogarty's biliary catheter]. / Calibratura intraoperatoria della papilla di Vater mediante catetere biliare di Fogarty.

The study included 20 patients affected by cholelithiasis and choledocholithiasis. Al patients underwent cholecystectomy; after choledochotomy, choledochal stones were removed using a Fogarty's biliary catheter (no. 5) and, subsequently, the papilla was calibrated by inserting the end balloon of the catheter, which and been filled with 0.3 cc of water, beyond the level of the papilla itself. The catheter was then withdrawn. No T-tubes were left in the common bile duct in any patient, no post-operative complications were observed and all patients were dismissed within seven days.