Retrospective observational study to investigate Sinerga, a multifactorial nutritional product, and bacterial extracts in the prevention of recurrent respiratory infections in children.

In this retrospective observational clinical study, 167 children, aged 3 to 7 years, of both sexes, with a clinical history of recurrent respiratory infections, administered with bacterial extracts of first and second generation or Sinerga a nutritional product containing palmitoylethanolamide, bovine colostrum, phenylethylamine and the new generation of probiotic kluyveromyces FM B0399, were observed. The goal of the study was to compare the supplementation with Sinerga with the supplementation with bacterial extracts, for the effect on the frequency of episodes of respiratory infection that had resulted in a prescription for antibiotics. The study focused retrospectively on the months from March 2013 to November 2012. The results showed a greater reduction in the frequency of respiratory infections with antibiotic therapy in the group of children supplemented with Sinerga than in the group treated with bacterial extracts. In particular, it was observed that 49.3% of the children supplemented with Sinerga, against 5% of those supplemented with extracts, had no infectious episodes requiring the administration of an antibiotic. 100% of subjects supplemented with Sinerga have had no more than two episodes of respiratory infection, while this condition, in the cohort treated with bacterial extracts, was observed in only 51% of cases.

Lysophosphatidylcholine-arbutin complexes form bilayer-like structures.

Arbutin is known to suppress melanin production in murine B16 melanoma cells and inhibit phospholipase action. This encourages the possibility to stabilize it in lipid aggregates for its administration in medical applications. Thus, it was of interest to demonstrate that monomyristoylphosphatidylcholine (14:0 lysoPC) and arbutin may form association complexes. This was studied by Electron Microscopy (EM), 31P Nuclear Magnetic Resonance (31P NMR), Electronic Paramagnetic Resonance (EPR) and Fourier Transform Infrared Spectroscopy (FTIR). EM images show the formation of particles of c.a. 6 nm in diameter. For a 1:1 lysoPC-arbutin molar ratio 31P NMR shows a spectrum with a shoulder that resembles the axially symmetric spectrum characteristic of vesicles. The addition of La3+ ions to the arbutin-lysoPC complex allows one to distinguish two phosphorous populations. These results suggest that arbutin-lysoPC forms vesicles with bilayers stabilized in an interdigitated array. FTIR spectroscopy shows that arbutin interacts with the hydrated population of the carbonyl groups and with the phosphates through the formation of hydrogen bonds. It is interpreted that hydrophobic interactions among the phenol group of arbutin and the acyl chain of lysoPC are responsible for the decrease in acyl chain mobility observed at the 5th C level by EPR. A model proposing the formation of interdigitated bilayers of arbutin-lysoPC could explain the experimental results.

Arbutin blocks defects in the ripple phase of DMPC bilayers by changing carbonyl organization.

The effect of arbutin, a 4-hydroxyphenyl-beta-glucopyranoside, on dimyristoylphosphatidylcholine (DMPC) bilayers was studied by turbidimetry, EPR and FTIR spectroscopies. The disruption of DMPC multilamellar vesicles (MLV's) with monomyristoylphosphatidylcholine (lysoPC), a product of hydrolysis of phospholipase A(2) (PLA(2)), is more efficient at 18 degrees C, where DMPC MLV's are known to be in the ripple P(beta') phase, than at 10 degrees C (L(beta') flat gel phase). Disruption at 18 degrees C was inhibited by increasing concentrations of arbutin in the solution. This inhibition was correlated with the disappearance of the ripple phase in MLV's when arbutin is present. Shifts in FTIR carbonyl bands caused by arbutin or by temperature changes allow us to propose a model. It is interpreted that the changes in the water-hydrocarbon interface caused by arbutin, forcing a reaccommodation of the carbonyl groups, eliminate the topological defects in the lattice due to mismatches among regions with different area per lipid where lysoPC can insert.

Limits imposed by ionizing radiation on the long-term survival of trapped bacterial spores: beta radiation.

PURPOSE: A model is presented for determining the survival time T(F) of a fraction F of a population of bacterial spores trapped within a fluid inclusion and subject to genetic damage from beta radiation. METHODS: The limiting factor to survival is the production of double-strand breaks (DSB) in the DNA resulting from single-track cleaving and from the cumulative effects of single-strand breaks (SSB) induced by the presence of ionizing radiation in the environment. The model considers the probability that radicals and ions formed by the passage of high-energy particles will interact with a DNA molecule and induce damage. RESULTS: The survival time T(F) for a fraction F of a trapped population is a weak function of both F and the length L in base pairs of the genome. For irradiation due to a beta source trapped with the spores within the inclusion, the survival time is also inversely proportional to the concentration of the radionuclide, the dominant factor in limiting survival time. CONCLUSIONS: The predictions of the model are consistent with measured DSB formation rates, the observed survival of trapped spores over time periods as long as 250 Ma, and track structure models which address low physical dose rates.

[Non-Hodgkin's lymphoma in multiple places and uterine involvement]. / Linfoma non-Hodgkin a localizzazioni multiple con interessamento uterino.

Multiple locations of non-Hodgkin lymphoma, in cases of recurrence of disease, may affect all the lymph node stations. The case reported, sited in the uterus, constitutes a very rare event and whenever it occurs the preoperative diagnosis may present serious difficulties. Surgery, which must be prompt and radical, is mandatory for histopathological staging of the disease and for the implementation of an appropriate chemotherapy protocol. In the case reported here the diagnostic work-up enabled us to achieve correct preoperative staging.

[Surgical rehabilitation of stomal disease]. / La riabilitazione chirurgica delle patologie stomali.

The Authors report their experience in the surgical rehabilitation of patients with complicated ileo- or colostomy. Mechanical and psychosocial implications as well as different rehabilitative methods are discussed. The results of a surgical protocol in the treatment of stomal diseases observed in 63 patients are herein reported. In 14 patients the surgical treatment was performed in general anaesthesia, while in 49 local anaesthesia was used. The latter was better tolerated by the patients. In conclusion, surgery should play a major role in this rehabilitation protocol, either in terms of prevention or definitive treatment.

[Bizarre gastric leiomyoblastoma. A case report and review of the literature]. / Leiomioblastoma gastrico bizzarro. Analisi di un caso e revisione della letteratura.

Gastric leiomyoblastoma of Martin's myoid tumour or Stout's smooth muscle cell bizarre tumour is a rare benign mesenchymal neoplasia, that may become malignant. A personal clinical case is reported and the most important clinical and anatomopathological aspects are reviewed, stress being laid on the importance of identifying the macroscopic and histological features that can point with certainty to malignity and so influence the choice of surgery.

A new treatment for premature ejaculation: the rehabilitation of the pelvic floor.

This study evaluated pelvic floor rehabilitation as a possible treatment for premature ejaculation. In this treatment it is assumed that the pelvic muscles are involved in the control of the ejaculatory reflex. The treatment avails itself of a method already used for fecal and urinary incontinence. Eighteen patients with premature ejaculation were recruited. Fifteen (83%) of them had suffered from this disturbance for at least five years. Most of them had experienced other therapies without success. After 15-20 sessions of pelvic floor rehabilitation, 11 (61%) patients were cured and are able to control the ejaculatory reflex; seven (39%) patients had no improvement. All patients were followed for a minimum of 6 months to a maximum of 14 months. This therapy is easy to perform, has no side effects, and can be included among the therapuetic options for patients with premature ejaculation.

[A novel diagnostic method to study the residual pelvic cavity after Miles abdomino-pelvic resection]. / Proposta di una metodica diagnostica originale per lo studio dello scavo pelvico residuo dopo RAP secondo miles.

Local pelvic perineal recurrence represents the most frequent site of failure following abdominoperineal resection (APR) for rectal cancer. Patients con be studied at this level by Computerized Tomography (CT) scan, Magnetic Resonance Imaging (MRI), suprapubic or, in women, endovaginal ultrasound (US). CT scan and MRI show sensitivity and specificity in excess, respectively, of 70 and 90%, but the high cost and the invasiveness of CT scan controindicate their frequent use. Suprapubic US has no value in terms of diagnostic accuracy, whereas endovaginal US shows a good specificity, but it is quite refused by the patients since the discomfort of the examination. 34 patients from the Rehabilitation Unit of Colostomy Patients at the University of Rome, "La Sapienza", have been blindly followed by transperineal US. The results have been compared with those obtained by CT scan or MRI. Specimens have been obtained of any suspicious mass by needle biopsy. The diagnostic accuracy of transperineal US has resulted comparable to CT scan and MRI. The authors also describe the morphology and US pattern of the pelvic hollow as demonstrated by transperineal US and the distinctive features of abnormality seen.

[Multicenter study on the application of a continence device for ++ostomized patients]. / Studio multicentrico sull'applicazione di un dispositivo di continenza per pazienti stomizzati.

The restoration of continence is a fundamental step in the rehabilitation of stomised patients. The latest generation of continence prosthesis, represented by Conseal must be seen in this context. The authors performed a multicentre study based on a protocol using Conseal Uni in patients with low terminal digestive stomies (ileum or colostomy). The only criteria for patient selection was the absence of marked stomal and peristomal pathologies (large prolapse, fistula). The three centres taking part in the study inserted the new device in 50 patients (25 M; 25 F) with a mean age of 57.5 years (range 18-87) of whom 45 had undergone left terminal colostomy and 5 terminal ileostomy. A weekly evaluation was made of the use of the prosthesis for 4 weeks and a follow-up control was performed after 24 months in 22 patients. The results obtained shown that Conseal received a positive judgement in 88% of patients, better results were obtained in colostomized patients receiving irrigation (positive judgement in 100% of cases), whereas the success rate in non-irrigated patients only amounted to 50%. An additional application for the use of Conseal emerged from the study, namely its utilisation by ileostomised patients. Using various technical procedures, it was possible to obtain 8-hour continence in ileostomised patients. This result is of considerable importance since it shows the research, technological and clinical effort that has been made to achieve a form of continence in ileostomised patients.

[Lymphoma of the residual gastric stump]. / II linfoma del moncone gastrico residuo.

The authors report a case of non-Hodgkin's lymphoma (lymphoplasmocytoid type) arisen on the gastric stump of a patient operated 18 years before according to Billroth II gastric resection for peptic ulcer. They underline the extraordinary rarity of the event because this type of neoplasia never arises on the gastric stump, where would be more likely to find, due to irritative chemical stimuli of the biliary reflux, phenomena of intestinal metaplasia or severe dysplasia highly predisposing to adenocarcinomas. Furthermore, they stress the importance of a "deep" bioptic examination for a diagnosis as early as possible of this type of pathology.

Pre-surgery information and psychological adjustment to enterostomy.

The post-surgery psychological adjustment to enterostomy was examined in a longitudinal study of 120 patients. Subjects were representative of the general enterostomy patients population. All had undergone surgery in various hospitals located in Rome and its surroundings. Adjustment to enterostomy was longitudinally evaluated by interviewing patients at various intervals after enterostomy: soon after surgery; 1 year after surgery; more than 1 year after surgery. When patients were initially interviewed, information was requested on how they were informed of their clinical condition which led to surgery, as well as of enterostomy and its consequences. 42% reported a low level of understanding about enterostomy on the basis of information received during hospitalization. Patients were consequently divided into two groups, one including those judged as adequately informed (AI), and the other including those judged as not adequately informed (NAI). These groups were compared, for immediate adjustment to enterostomy (within 3-6 mos. since surgery), delayed adjustment (1 yr. since surgery), and prolonged adjustment (more than 1 yr. since surgery). Patients of NAI group demonstrated a consistently poorer pattern of adjustment in all parameters under study (emotional, cognitive, behavioral, social) and their adjustment to enterostomy did not show any spontaneous improvement over the time. AI patients, on the other hand, showed a more favorable level of adjustment since after surgery and a more positive pattern in the follow-up period. Adequate information before surgery and during hospitalization has been evidenced as a necessary component of patient care and a very important element in determining the optimal functional and psychological recovery of patients with enterostomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Habitual alcohol consumption and nutritional status of the elderly.

The interrelationship between habitual alcohol consumption, dietary intakes and vitamin status was examined in 393 elderly subjects (188 men, 205 women, age range 65-90 years) resident in seven retirement homes throughout Italy. Individual food intake was assessed by the 7-day precise weighing method. Fasting blood was tested for riboflavin (erythrocyte glutathione reductase activity coefficient), thiamine (erythrocyte transketolase activity), retinol (fluorimetry) and folic acid status. Alcohol contributed on average 12 per cent of total energy intake in men, and 6 per cent in women. Forty-eight per cent of males and 39 per cent of females were classified as heavy drinkers (HD) with 48 and 28 g/d average alcohol intakes respectively. There was a general tendency for women to add alcohol to their habitual diet, as revealed by the positive correlation between total energy intake and alcohol intake. The higher energy intakes of HD women were also reflected in their higher body weights. Men tended to displace food energy partially by alcohol. Dietary risk of malnutrition, high for vitamin A, and moderate to low for vitamins B1 and B2, did not increase with alcohol consumption. Biochemical evidence of malnutrition indicated a significant deterioration of folate status in HD of both sexes, and for B1 in HD males only; there was no change in riboflavin status. Plasma levels of retinol were higher, and prevalence of vitamin A deficiency lower, in HD, a finding that warrants further investigation.(ABSTRACT TRUNCATED AT 250 WORDS)

Determinants of nutritional status in hospital patients in Italy.

The prevalence of protein-calorie malnutrition (PCM) and micronutrient deficiency (MND) at the time of admission and discharge from hospital was evaluated in 91 patients consecutively admitted to the Surgery Clinic of the University Hospital of Rome. Anthropometric parameters and circulating levels of vitamins (A, E, C, B1, and B2) and visceral proteins [retinol-binding protein (RBP, prealbumin (PA), and transferrin] were measured. Twenty-one patients (23%) had moderate to severe PCM, and 70 patients (77%) had normal nutritional status (NNS) at admission. Two patients with PCM died in the hospital. At discharge, the prevalence of PCM was unchanged in the remaining 19 patients. Single or multiple MND was observed initially in 71% of patients with PCM and in 36% with apparently normal nutritional status. Despite vitamin supplementation, MND was present at the time of discharge in 73% of patients with PCM and 44% with NNS. Nutritional status at the time of admission was assessed in hospitals in six different Italian cities. The criterion for admission to the study was the diagnosis of chronic (greater than 1 yr duration) illness (excluding cancer and multiple organ disorders). Two hundred eighty-four patients (145 males, 139 females), ages 25-88 yr, were selected. The findings indicated a high prevalence of MND (64%). Also, in disorders that usually do not have significant alterations of digestion or absorption, such as uncomplicated cardiorespiratory disease, the prevalence of MND was high (9-38%). The prevalence of MND was not related to body mass index (BMI). PCM was more common among patients with chronic gastrointestinal disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hodgkin's disease and the liver. Study of 50 biopsies]. / Enfermedad de Hodgkin e hígado. Estudio sobre 50 biopsias.

A study of 50 liver biopsies (LB) is presented from a series of 45 patients with Hodgkin's disease as diagnosed by node biopsy in 40, by laparoscopic liver biopsy (LLB) or surgery in 5, with a simultaneous positive bone marrow study in one case. A total of 34 LLB and 16 blind liver biopsies were carried out For diagnosis of the disease the LB was positive in 2/7 or 28.5%. In order to establish the clinical status as a pre-treatment staging procedure in 30 cases, the biopsy was useful in 10% of the cases; whereas during the evolution of the disease in order to establish restaging in 13 patients, positivity was observed in 1 case (7.6%). In 7/34 with laparoscopic changes of the hepatic surface, invasion was later determined by LLB, surgery or autopsy in 71%, whereas with a normal surface infiltration was only established in 18.5% In 12 patients with liver invasion as demonstrated by LLB, laparotomy or autopsy, alkaline phosphatase was increased in 91.6%. We consider that the elevated number of false negatives (58.3%) is due fundamentally to the single biopsy technique performed some years ago with the Vim-Silverman needle instead of the procedure in use at present o repeated biopsies in both lobes when possible. Our experience of 50 LB in these 45 patients has been most useful in arriving at a diagnosis in 2, determining a change in stage on 3 occasions, demonstrating peritoneal and spleen involvement in 2 cases in addition to revealing other hepatic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Enfermedad de Hodgkin e hígado. Estudio sobre 50 biopsias. / [Hodgkins disease and the liver. Study of 50 biopsies]

A study of 50 liver biopsies (LB) is presented from a series of 45 patients with Hodgkins disease as diagnosed by node biopsy in 40, by laparoscopic liver biopsy (LLB) or surgery in 5, with a simultaneous positive bone marrow study in one case. A total of 34 LLB and 16 blind liver biopsies were carried out For diagnosis of the disease the LB was positive in 2/7 or 28.5

. In order to establish the clinical status as a pre-treatment staging procedure in 30 cases, the biopsy was useful in 10

of the cases; whereas during the evolution of the disease in order to establish restaging in 13 patients, positivity was observed in 1 case (7.6

). In 7/34 with laparoscopic changes of the hepatic surface, invasion was later determined by LLB, surgery or autopsy in 71

, whereas with a normal surface infiltration was only established in 18.5

In 12 patients with liver invasion as demonstrated by LLB, laparotomy or autopsy, alkaline phosphatase was increased in 91.6

. We consider that the elevated number of false negatives (58.3

) is due fundamentally to the single biopsy technique performed some years ago with the Vim-Silverman needle instead of the procedure in use at present o repeated biopsies in both lobes when possible. Our experience of 50 LB in these 45 patients has been most useful in arriving at a diagnosis in 2, determining a change in stage on 3 occasions, demonstrating peritoneal and spleen involvement in 2 cases in addition to revealing other hepatic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)