Unsuspected strongyloidiasis in hospitalised elderly patients with and without eosinophilia.

The prevalence and associated factors of chronic uncomplicated strongyloidiasis were estimated among 200 consecutive elderly patients (aged >or= 60 years) admitted to a general hospital in northern Italy. One-hundred patients had a peripheral eosinophil concentration >or= 500 cells/microL (group A), and 100 were age- and gender-matched controls (group B). Measurements included serum IgG anti-Strongyloides antibody titre by an indirect immunofluorescence assay, combined with faecal culture for Strongyloides stercoralis. Anti-Strongyloides antibodies were detected in 28 patients (at high titre in 11 patients). Seropositivity was significantly more common among group A than among group B patients (OR 4.85). Strong seropositivity for anti-Strongyloides antibodies was associated with farm work (p < 0.001), but not with other patient characteristics or with signs and symptoms of strongyloidiasis. In conclusion, strongyloidiasis was relatively common among elderly in-patients; eosinophilia and a history of farm work were the most useful indications for this diagnosis.

Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy.

OBJECTIVE: To obtain data on correlates of climacteric symptoms in women around menopause attending menopause clinics in Italy. METHODS: Since 1997 a large cross sectional study has been conducted on the characteristics of women around menopause attending a network of first level menopause outpatient's clinics in Italy. A total of 66,501 (mean age 54.4 years) women are considered in the present paper. RESULTS: The odds ratios of moderate and severe hot flashes/night sweats were lower in more educated women and (for severe symptoms only) in women reporting regular physical activity. Depression, difficulty to sleep, forgetfulness and irritability tended to be less frequent in more educated women and (depression only) in women reporting regular physical activity. Parous women reported more frequently these symptoms. CONCLUSIONS: This large study confirms in Southern European population that low education, body mass index and low physical activity are associated with climacteric symptoms. Parous women are at greater risk of psychological symptoms.

Bloodstream infections in HIV-positive patients: a review of sixty-eight episodes.

A retrospective review of all episodes of bloodstream infection (BSI) in HIV-positive patients admitted to the Infectious Diseases Unit at the Pisa General Hospital from 1991 to 1994 was performed. Sixty-eight episodes of BSI were recorded in 61 patients (5.8% of all patients admitted for HIV infection). BSI was community-acquired in 64.7% of cases. The patients were mainly male and i.v. drug abusers with a mean age of 33.8 yrs +/- 5.6 S.D. Sixty-four episodes occurred in AIDS patients (CDC criteria). CD4 count was less than 100 in 49 patients. The most frequent isolates were coagulase-negative staphylococci 33, S. aureus 7, Pseudomonas spp 7, fungi 1, non-typhoidal Salmonella 4. The most common sources of BSI were the skin or subcutaneous tissue infections and intravascular catheters. The overall mortality associated with BSI was 27.3%. Vancomycin and teicoplanin were active in vitro against all but one of the staphylococcal isolates.

[The influence of lunar phases on the frequency of deliveries]. / Influenza delle fasi lunari sulla frequenza dei parti.

Common tradition encourages the belief that deliveries take place more frequently during some phases than others. It is known that multiple factors (also medical) may influence birth timing postponing or anticipating it. To verify the veracity of this belief, we studied the frequency of home deliveries of Maputo (Mozambique), without any medical assistance according to lunar cycle. A study of 5226 births in 37 lunar cycles didn't show a significative increase of deliveries during specific lunar phases and week days. The same result has been achieved expanding the examination period to 2 days before and after lunar phase. Therefore, on the basis of this study, the hypothesis that lunar phase may influence the process of birth is disproved.

[Fetal growth in hypertensive women]. / Accrescimento fetale in gravide ipertese.

The Authors examine the correlation between hypertensive disorders of pregnancy and fetal growth. The results of a study of 342 pregnancies, confirm a significant correlation between hypertension and fetal growth retardation. These findings, so evident in moderate and severe hypertension, have also been confirmed in cases of mild hypertension. The medical treatment also in the pregnancies with mild hypertension, and a larger utilisation of operative deliveries, determined a decrease in perinatal mortality and morbidity.

A case of prune-belly syndrome: prenatal diagnostic problems.

The authors discuss a case of "Prune-belly syndrome" which could be diagnosed prenatally thanks to echography; they stress the importance of echographic controls since the first gestational weeks to better recognize pathological findings, and describe their attempts to drain the megavesica. However these attempts could not reverse the ominous prognosis.

[Current epidemiological and clinical aspects of tuberculosis: A study in the Hospital of Pisa]. / Attuali aspetti epidemiologici e clinici della tubercolosi: indagine nell'Ospedale di Pisa.

OBJECTIVES: To describe epidemiological and clinical features of tuberculosis (tbc) cases identified recently in the Pisa area (Tuscany, Italy). MATERIALS AND METHODS: We performed a retrospective study of all cases of tbc notified to the Public Health Service in Pisa during January 1996-December 1998. The diagnosis of tbc was made following the criteria of the Public Health Ministry. RESULTS: Eighty-eight patients affected by tbc were identified. Diagnosis was microbiologically proven (positive culture for M. tuberculosis) in 42 patients. Sixty-nine patients had pulmonary tbc, 14 extrapulmonary and 5 mixed tbc. Mean age was 56.4 years (range 16-87 years). Nineteen patients were extra European Community citizens. The incidence of tbc (N./100,000) was 8.4 in 1996, 10 in 1997 and 3.2 in 1998. In 5.7% of the cases tbc was associated with advanced HIV infection. The chest X-ray showed pleural effusion in 12 patients and cavitation in 26 patients. Fever was not present in 36.4% of the patients at the moment of diagnosis. 12% of the isolated strains of M. tuberculosis were in vitro multidrug-resistant. CONCLUSIONS: The data presented showed an important rate of tbc in Pisa, similar to the incidence of tbc reported by other studies carried out on a national scale. We have yet to understand if the decreased rate observed in 1998 represents a new trend. The isolation rate of multidrug-resistant strains of M. tuberculosis in Pisa seems higher than the rates reported in other geographical areas. Therefore monitoring of M. tuberculosis susceptibility to antimicrobial agents is necessary.

[Arthroscopy in acute dislocation of the patella: a new surgical technique]. / L'artroscopia nella lussazione acuta di rotula: nuova tecnica chirurgica.

The adequate treatment for acute patellar dislocation is still controversial. The Authors describe a new surgical arthroscopic technique to repair medial retinaculum rupture, which is the most common lesion in the acute patellar dislocation. Compared to arthrotomy arthroscopic treatment eliminates post-operative pain and shows the same advantages in reducing recurrences.

Risk factors for type 2 diabetes in women attending menopause clinics in Italy: a cross-sectional study.

OBJECTIVE: To analyze risk factors for type 2 diabetes among women attending menopause clinics in Italy for counselling about the menopause. SUBJECTS: Women attending a network of first-level outpatient menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. METHODS: Cross-sectional study with no exclusion criteria. Type 2 diabetes was defined according to National Diabetes Data Groups Indications and the fasting blood glucose at an oral glucose tolerance test within the previous year. RESULTS: Out of the 44 694 considered in this analysis, 808 had a diagnosis of diabetes type 2 (1.8%). In comparison with women aged < 50 years, the multivariate odds ratios (OR) of type 2 diabetes were 1.31 (95% confidence interval (CI), 0.99-1.74) for women aged 50-52 years, 1.66 (95% CI, 1.27-2.17) at 53-56 years and 2.84 (95% CI, 2.20-3.67) in women aged > or = 57 years. Type 2 diabetes was less frequently reported in more educated women (OR high school/university vs. primary school = 0.44 (95% CI, 0.36-0.55)). Being overweight was associated with an increased risk of type 2 diabetes. In comparison with women reporting a low level of physical activity, the multivariate OR of type 2 diabetes was 0.67 (95% CI, 0.54-0.84) for women reporting regular physical activity. In comparison with premenopausal women, the multivariate OR of type 2 diabetes was 1.38 (95% CI, 1.03-1.84) in women with natural menopause. This finding was present also after allowing for the potential confounding effect of age. The multivariate OR of diabetes for users of hormonal replacement therapy was 0.58 (95% CI, 0.46-0.73). CONCLUSIONS: This large cross-sectional study suggests that postmenopausal women are at higher risk of type 2 diabetes after allowance for the effect of age. Other main determinants of risk of type 2 diabetes in women around menopause were low socioeconomic status and being overweight. Diabetes was found less frequently in those taking hormone replacement therapy.

Isokinetic evaluation of the knee after arthroscopic meniscectomy: comparison between anterolateral and central approaches.

Twenty patients had undergone arthroscopic meniscectomy for medial bucket-handle meniscal tears. Half had undergone meniscectomy with central approach, and half had been treated by anterolateral technique. Isokinetic evaluation, with a Cybex II isokinetic dynamometer, was done preoperatively and at 14 and 28 days postoperatively. Two weeks after operation, there was only a slight and insignificant decrease of quadriceps function with the central approach as compared with the anterolateral. However, at 4 weeks, no differences were shown between the two portals. The flexor muscles generally recovered more rapidly with the central technique.

Arthroscopic arthrolysis of the knee.

The authors report their experience in the arthroscopic treatment of joint-related stiffness of the knee. Arthroscopic arthrolysis is the treatment of choice for numerous conditions (stiffness subsequent to inflammatory processes, stiffness associated with marked osteoporosis, etc.) in which open arthrolysis is contraindicated. The totally atraumatic nature of arthroscopy and the more accurate lysis of the adhesions allow for postoperative management without complications or pain. This is of particular importance as it permits passive and active kinesitherapy from the moment the patient recovers from anaesthesia, without pain and therefore with greater commitment on his part. Furthermore, arthroscopic arthrolysis can be used successfully to treat extensor muscle stiffness where endoscopic study has revealed the presence of adhesions or calcification in the anterior compartments.

The clinical significance of absent or reverse end-diastolic flow in the fetal aorta and umbilical artery.

The clinical utility of Doppler blood flow investigations of the fetal and fetoplacental vessels is still under debate as far as timing of the delivery is concerned. However, in cases of absent or reverse end-diastolic flow, fetal compromise is usually very severe. As a consequence, we have investigated the possibility of using this information as a guide to obstetrical management. Altogether, 32 fetuses with absent or reverse end-diastolic flow in the fetal descending aorta and/or umbilical artery were studied. Reverse flow was observed in 11 cases and absence of end-diastolic flow in 21 cases. The two groups are considered separately. No significant difference was found in the mean gestational age at delivery. However, a highly significant difference was found in the mean birth weight and perinatal mortality rate. All the cases of perinatal mortality were encountered in the group presenting with reverse flow (mortality rate, 63.6%). All the live fetuses were delivered by Cesarean section and no neonatal mortality was observed in this group. Two cases of handicap were observed, one in each group. In our experience, reverse flow indicates the necessity for immediate delivery if no other clinical contraindications are present. Absence of end-diastolic flow can be observed for longer periods without adverse outcome. Absence of end-diastolic flow always precedes the appearance of fetal distress. Therefore, we believe that, after exclusion of conditions such as fetal abnormalities or extreme prematurity, a planned delivery should be considered.

Current microbiological and clinical aspects of urinary tract infections.

OBJECTIVES: To evaluate some risk factors which could affect the isolation rates of various uropathogens and their in vitro susceptibility to antibiotics in ambulatory and hospitalized patients. PATIENTS AND METHODS: A prospective study was conducted in a microbiological laboratory at Pisa Hospital. Nine-hundred and seventy-two consecutive patients with documented urinary tract infection were enrolled from April 1996 to October 1999. Data on age, sex, current or previous bladder catheterization, some underlying diseases as diabetes mellitus, and previous antibiotic therapy were recorded. The distribution of bacteria isolates and their in vitro susceptibility to antibiotics was evaluated. RESULTS: Escherichia coli was responsible for 54.7% of urinary tract infections. Isolation of E. coli is decreasing in comparison to previous observations, especially in males and in patients with indwelling bladder catheters who instead show higher Pseudomonas spp. and Enterococcus spp. isolation rates than females and non-catheterized patients. Diabetes mellitus does not affect the isolation rate of uropathogens and their patterns of susceptibility. Multivariate analysis of multiresistant uropathogens showed a positive significant correlation with indewelling bladder catheter and age. An upward trend in the resistance of E. coli to cotrimoxazole, ampicillin and fluoroquinolones was observed from 1996 to 1999; more than 50% of Pseudomonas spp. strains were resistant to fluoroquinolones and gentamicin. CONCLUSIONS: The empirical antibiotic therapy of patients with urinary tract infection should be guided by an accurate anamnesis evaluating not only age and sex but also the presence of a bladder catheter at the moment of urine collection or a history of recent bladder catheterization and previous courses of antimicrobial drugs.

Fetal blood sampling in labor.

Cardiotocography is the most widely used method to monitor fetal well-being during labor. It has been shown that this technology is affected by a large intra and interobserver variability, that reduces its reliability. Moreover, it should be remembered that CTG is in condition to detect early fetal heart rate patterns that may indicate fetal hypoxaemia but it is not able to assess precisely the level of fetal compromise. This assessment can be done by examining fetal blood for pH that can be easily obtained in labor. If present, the level of acidemia, is established by measuring the pH which can be of practical use in clinical management. Values above 7.24 are considered normal, and pH values lower than 7.20 are expression of fetal acidemia requiring a quick delivery. The technique of FBS can be easily performed with very few complications. The main indication is one of the abnormal or suspicious CTG patterns. By using FBS is a complementary diagnostic tool to CTG it is possible to reduce the number of false positive thus reducing the number of unnecessary obstetrical interventions.

Long-term assessment of negative arthroscopies.

A study of 75 patients was performed to assess the accuracy of arthroscopy carried out for clinical diagnosis of meniscal tear. In these patients, arthroscopy did not detect any intraarticular pathology that could explain the preoperative symptoms. Of the 75 patients, seven were subsequently reoperated on, but in 68 the typical symptoms of meniscal tear improved after the diagnostic arthroscopy.

Enterococcal glycopeptide resistance at an Italian teaching hospital.

Two thousand one hundred and thirteen strains of enterococci isolated at Pisa General Hospital in 1998 were analysed retrospectively to determine their glycopeptide resistance. Of all the microorganisms isolated in this period, 14.7% were enterococci (1405 Enterococcus faecalis, 19 Enterococcus faecium, six Enterococcus avium and 683 Enterococcus spp.). Two hundred and thirty (10.8%) of these enterococci were resistant or demonstrated reduced susceptibility to vancomycin and/or teicoplanin. The highest rate of resistance was found in outpatient enterococcal strains isolated from the urogenital tract. The frequency of enterococcal glycopeptide resistance at Pisa Hospital is higher than that reported from other areas of Italy.

Urinary tract infection in diabetic patients.

AIM: The aim of the study was to compare the epidemiological, microbiological and clinical features of diabetic patients with urinary tract infection (UTI) to those of nondiabetic ones. METHODS: A prospective study was performed on 490 consecutive patients with proven UTI. The patients were studied on the basis of a specific questionnaire and hospital records. RESULTS: Of 490 enrolled patients, 89 (18.1%) had diabetes mellitus. The mean age of diabetics and nondiabetics was respectively 64.9 +/- 13.2 (SD) and 54.4 +/- 23.3 years. Most diabetics had asymptomatic bacteriuria and had undergone bladder catheterization more frequently than the nondiabetics. The most frequent causative agents of UTI in diabetics and nondiabetics were: E. coli (respectively, 56.1 vs. 56.8%), Proteus sp. (7.9% vs. 7.2%), Pseudomonas sp. (6.7 vs. 8.2%), Enterococcus sp. (6.7 vs. 7.2%). More than 50% of the isolated Pseudomonas sp. strains in both groups were resistant to gentamicin, piperacillin and norfloxacin. Both diabetics (52.8%) and nondiabetics (42.2%) had recurrent UTI during the follow-up period; the difference in the incidences did not reach statistical significance. CONCLUSION: No significant differences in epidemiological, clinical and microbiological evaluated features of diabetics and nondiabetics were pointed out, except for the higher frequency of bladder catheterization of diabetics than nondiabetics. However, the eradication of UTI seemed to be more difficult in diabetics than in nondiabetics.

[Binding capacity of albumin with bromcresol green in a group of women of fertile age]. / Studio della capacita legante dell'albumina con verde di bromocresolo in un gruppo di donne in età fertile.

Albumin binding ability was studied in 551 women of fertile age through the dye-binding test with BCG. In 61 cases (11.0%) no binding was found: 47 women (77.0%) were pregnant at the time the blood test was performed. Such a result agrees with previous studies which indicate a reduced albumin binding ability in the blood of near term pregnant women and in the umbilical cord.

Does amniotic fluid alpha-fetoprotein have diagnostic or prognostic value at the time of second midtrimester genetic amniocentesis?

In order to assess the usefulness of amniotic fluid alpha-fetoprotein (AFP) levels at the time of midtrimester genetic amniocentesis, 4,430 cases were retrospectively studied to compare the high, normal or low AFP values with the karyotype characteristics and fetal anatomy using ultrasound (US) scanning and confirmed by postnatal evaluation or necroscopy in the case of termination of pregnancy. All the cases presenting malformations were correctly diagnosed by US examinations. AFP levels over the 2nd standard deviation (SD) were found in 112 cases (2.52%) and below the 2nd SD in 11 cases (0.24%). The characteristics of these cases are presented and discussed. According to our results, it is concluded that routine assessment of AFP at the time of midtrimester genetic amniocentesis, if coupled with optimal US scanning, is no longer justified.