An observational study on the epidemiology of respiratory tract bacterial pathogens and their susceptibility to four injectable beta-lactam antibiotics: piperacillin, piperacillin/tazobactam, ceftazidime and ceftriaxone.

Bacterial infections of the respiratory tract account for a large proportion of total medical consultations in general practice. In recent years, antibiotic resistance has increased alarmingly in a number of bacterial species that are common causes of these infections. The aim of this observational study was to determine the antibiotic resistance of microbial agents isolated from patients with acute or acutely exacerbated respiratory infections. Subjects recruited as potential sources of bacteria were either outpatients seen in a number of specialized clinics and hospital practices, or hospitalized patients. Overall, 648 consecutive patients (67% male, mean age 48.1+/-27.0 years) with infection of the upper or lower respiratory tract were observed during a 13-month period. A total of 551 pathogenic microbial strains were isolated and tested for their in vitro susceptibility to piperacillin, piperacillin/tazobactam, ceftazidime, and ceftriaxone. Among all isolates, the four most frequent pathogens were Pseudomonas aeruginosa (132 isolates, 24%), Streptococcus pyogenes (99 isolates, 18%), Staphylococcus aureus (93 isolates, 17%), and Klebsiella pneumoniae (46 isolates, 8%). The susceptibility of gram-positive isolates ranged from 97.5% to 95.1%, and no remarkable difference was found in the antibacterial activity of tested b-lactam antibiotics. The susceptibility of gram-negative isolates to piperacillin and piperacillin/tazobactam was also similar: 96.5% and 97.1%, respectively. In contrast, differences were found between piperacillin (or piperacillin/tazobactam) and either ceftazidime (p=0.003) or ceftriaxone (p<0.0003) in gram-negative isolates. We conclude that, despite the extensive use of beta-lactam antibiotics (piperacillin, ceftazidime, and ceftriaxone) in medical practice during the past three decades, the susceptibility of the most common pathogens involved in the etiology of upper and lower respiratory tract infections to these antibiotics is still high. In particular, bacterial resistance developed by gram-positive organisms against piperacillin is negligible and not alarming.

Doppler echocardiographic assessment of left ventricular diastolic function in patients with primary lung cancer treated with doxorubicin.

Eighteen patients were examined by Doppler echocardiography before and after treatment with doxorubicin (DXR). Early left ventricular filling rate decreased from 66 +/- 15 to 51 +/- 10 cm/sec whereas late filling rate increased from 48 +/- 12 to 61 +/- 9 cm/sec (p less than 0.05) with inversion of the E/A ratio suggesting an impairment of left ventricular diastolic function; conversely no significant changes were found in systolic function indexes. These results suggest that follow-up of patients treated with DXR must include left ventricular diastolic function studies. Doppler echocardiography can be successfully used to detect the presence of diastolic abnormalities.

Chronic bronchitis: reflex on the pulmonary circulation.

Chronic obstructive pulmonary disease (COPD) is characterized by lower alveolar oxygen content and hypoxia. Hypoxia itself is able to evoke a vascular reflex in a pulmonary vasoconstriction, the explanation of which is, in part, unknown. Pulmonary vasoconstriction leads to different degrees of pulmonary artery pressure (PAP) increase which statistically suggests that the higher the PAP, the poorer the survival rate. Many substances are involved in the vascular homeostasis. An important role is played by cyclooxygenase as well as lipoxygenase pathways metabolites, the antagonists of which have been extensively used in the treatment of pulmonary hypertension in subjects suffering from COPD. An even more important role is played by the endothelium. It is able to modify its metabolism towards the production of substances (e.g., endothelin, EDRF, etc.) which are able to negatively influence the vascular tone. Complete identification of such substances, when possible, would allow us to have a better understanding of the complexity of the mechanism which controls the pulmonary vascular district. In this direction we could hopefully look forward to the detection of specific new drugs able to improve the management of the disease by preventing it from worsening to that extent which statistically and drastically correlates with the worst prognosis.

[Quality of life in the aged after surgery. IV. Pathology of the esophagus]. / Qualità della vita nel vecchio dopo intervento chirurgico-Nota. IV: Patologia dell'esofago.

Following a careful examination of the literature on the subject, the authors examine the follow-up records of all patients operated over the past 10 years for non-neoplastic and neoplastic esophageal pathologies. From the results it emerged that all those operated for non-neoplastic pathologies were still living and their quality of life was good with a very high proportion of patients presenting a score of 100 for Karnofsky's index. With regard to neoplastic forms, on the other hand, many patients had died (approximately 50%), but the majority of those living, who had undergone gastro-esophageal resection and consequent esophago-gastrostomy with thoracization of the stomach, were well with a Karnofsky score of 100. The authors explain these results by taking into account the general conditions (biological age) of patients and conclude that surgery is advisable in both non-neoplastic and neoplastic forms, given that it is important to try to improve the quality of life even in the latter.

[Quality of life in geriatric patients after surgery. Note V. Pancreatic surgery]. / Qualità di Vita del paziente geriatrico dopo intervento chirurgico. Nota V. Interventi sul pancreas.

After a brief review of the literature on this topic, the authors examine the Quality of Life in patients undergoing surgery for neoplasia of the pancreas. They found that radical pancreatic surgery for cancer in elderly patients produced better results than hepatic surgery, even if the death rate was again very high (45.95%). It is very important to underline that the patient's general conditions are very important in this form of surgery. They provide the basis for selecting derivative, endoscopic or percutaneous surgery, with the possible application of an endoprosthesis so as to treat jaundice and improve the patient's Quality of Life.

[The quality of life of the elderly after a surgical intervention. II. Gastric carcinoma]. / Qualità di vita del vecchio dopo intervento chirurgico. Nota II--Carcinoma gastrico.

Having reviewed the literature on this topic, the authors examined the "quality of life" of elderly patients undergoing surgery for gastric carcinoma over the past 5 years. From the results obtained it was seen that the most frequent operation was total gastrectomy (51.1%), followed by gastric resection (48.9%); it was therefore possible to assert that living patients were all well, with a score of 100 on Karnofsky's scale (22.40%), despite the high percentage of deaths during the period examined. The authors therefore concluded that, given that the "quality of life" of those undergoing surgery was satisfactory, it is worthwhile operating whenever possible to give geriatric patients the possibility of leading a normal life.

[The quality of life of the geriatric patient after a surgical intervention. VI. Interventions on the biliary tract]. / Qualità di vita del paziente geriatrico dopo intervento chirurgico. Nota VI: interventi sulle vie biliari.

After reviewing the literature on this subject, the authors examine the quality of life of geriatric patients after biliary tract surgery secondary to biliary tract carcinoma or non-neoplastic pathologies. From an analysis of the results the authors conclude that surgery is useful not only in non-neoplastic forms, but also in the event of carcinoma given that it is possible to improve the quality of life of these patients.

[The quality of life of the elderly patient after a surgical intervention. I. Interventions on the colon]. / Qualità di vita del vecchio dopo intervento chirurgico. Nota I--Interventi sul colon.

Following a brief review of the literature on this topic, the paper analyses a series of geriatric undergoing surgery for cancer of the large intestine and controlled during follow-up over the past years. From the results obtained, the authors assessed the quality of life of these patients according to Masera and Esposito's classification, as a state of well-being, intermediate or illness: it was found that 78.7% were in a state of well-being, 10.3% were unchanged, 12.1% were in a state of illness, and only 6.9% had died. The authors therefore concluded that the quality of life in the majority of elderly patients undergoing surgery is good, thus encouraging surgeons to intervene.

[Tumors of the breast in old age]. / I tumori della mammella nell'età geriatrica.

After reviewing the literature on this topic the authors studied all patients admitted to the Institute of Surgical Pathology I at the University of Pavia for breast cancer between 1-1-1974. An analysis of the findings revealed that: (a) Out of 993 patients with breast cancer, 204 (20.54%) belonged to the geriatric age group (> 65 years old) and of the latter 135 (66.17%) belonged to the 3rd age group and 69 (33.82%) belonged to the 4th age group (> 75 years old). (b) In the 3rd age group 25 (18.51%) were benign tumours and 110 (81.48%) were malignant, whereas in the 4th age group 4 (5.79%) were benign and 65 (94.20%) were malignant. (c) Familial patterns were also examined and were found to be positive in 47 (23.03%) cases in the 3rd age group and in 30 (14.71%) in the 4th age group. (d) In the physiological anamnesis it is interesting to note that there was 1 menarche before 12 (0.9%) in the 3rd age group; delayed menopause (after 50) in 66 cases (60%) in the 3 rd age group and in 29 cases (44.61%) in the 4 th age group. (e) In the pathological anamnesis of the patients in question it was observed that the most frequent site of previous tumours was the breast (72 cases, equivalent to 10.9% in the 3rd age group; 9 cases, 13.8% in the 4th age group). (f) In the next pathological anamnesis and at EOL it was observed that the tumours was most often found in the supero-external quadrant, in the right breast in the 3rd age group (66 cases, 48.89%) and in the left one in the 4th age group (42 cases, 60.87%). (g) Test included breast cancer scan, mammography, aspirated needle and biopsy where required. (h) Surgery in the form of Halsted's mastectomy was the preferred therapy and as early as possible. Some Authors use conservative therapy. (i) Histological tests were performed in all patients and revealed that the most frequent malignant tumour was ductal carcinoma. (j) Postoperative complications took the form of wound suppuration. (k) Only one tumour (carcinoma) was observed in male patient aged 83 years old, without metastasis. From the above findings it can be concluded that the most evident risk factor for breast cancer is the influence of the estrogen hormone.

[Study of phospholipid components in bronchoalveolar wash surfactants in laryngectomized patients]. / Studio della componente fosfolipidica del surfactante mediante lavaggio bronco-alveolare (B.A.L.) nei soggetti laringectomizzati.

Surfactants serve to keep the dimension of the lower airways normal. They regulate alveolar stability, guaranteeing uniform lung insufflation. In order to evaluate pulmonary surfactant modifications during chronic obstructive disorders of the airways, the phospholipid component in the surfactants was studied using the Broncho-Alveolar Wash (BAW). Ten subjects who had undergone laryngectomy and who were suffering from stable, chronic obstructive broncho-pneumopathy (COBP) with marked hypersecretion were studied along with a control group of 7 smokers showing no signs of COBP. As compared to the controls, the laryngectomy patients showed a statistically significant reduction in the total phospholipid content and a different concentration of some important phospholipid fractions. The laryngectomy patients showed varying degrees of COBP because of their previous smoking history: as in ex-smokers where a the "biochemical" damage induced by cigarette smoking is partially repaired. On the other hand, while in the group of smokers the damage, expressed as the total phospholipid content, was quite noteworthy (reduction in this content was up to 10 times that found in the non-smoking subjects), the ex-smoking laryngectomy patients revealed less marked, yet still significant, damage.

[Bronchoalveolar lavage in lower respiratory tract infections in patients with bronchopulmonary carcinoma. Our experience]. / Il lavaggio broncoalveolare nelle infezioni delle basse vie respiratorie nei pazienti con carcinoma broncopolmonare. Una nostra esperienza.

UNLABELLED: In order to evaluate the usefulness of the endoscopic procedures with BAL, we conducted a study on 92 patients with diagnosis of lung cancer, underwent to chemotherapy, identifying pathogenic species involved and the antibiotic sensibility and antibiotic resistance. Moreover, to evaluate possible modifications of alveolar cell population in neutropenic patients, we studied the specimens from BALs performed via fibreoptic bronchoscopy. METHODS: The cellular pattern of BALs in terms of concentration of total cells, concentrations of alveolar macrophages (AMs), of polymorphonucleates (PMNs) and lymphocytes (Ls) were compared in neutropenic and non-neutropenic patients. RESULTS: In the statistical analysis of our study we found a correlation, statistically significant, between patients with neutropenic episodes on the previous chemotherapy courses and incidence of LTRI. The mean concentrations x 100,000/ml of BAL fluid of total alveolar cells, AMs, PMNs and Ls were significantly lower, after chemotherapy, in group of neutropenic patients than in non neutropenic patients, respectively. CONCLUSIONS: In this study we found that during neutropenia the alveolar cell population was quantitatively deficient, confirming the hypothesis, proposed by other authors, of "lung aplasia" as a consequence or a concomitant event of chemotherapy-induced marrow toxicity.

[A controlled clinical study of Pneumorel Retard tablets in the treatment of chronic bronchitis (author's transl)]. / Etude clinique controlée du Pneumorel Retard comprimés dans la bronchite chronique.

The authors studied the action of Pneumorel retard tablets in the treatment of chronic bronchitis, comparing 2 groups of 20 patients each, one group was prescribed 1 pneumorel retard tablet in the morning and evening and the other group was treated with a speciality associating proteolytic enzymes and balsamics; the 2 groups also received an antibiotic treatment. The duration of the treatments was 20 days, with controls at entry, 10 days and 20 days later. Pneumorel retard showed to be significantly more active on the criteria studied (cough, dyspnea, expectoration, signs of auscultation) and this more often than not from the 10th day of treatment. Clinical and biological tolerance was perfect concerning the hepatic sphere, gastrointestinal, renal or cardiovascular systems. The convenience of the use of Pneumorel retard is particularly indicated in the thorough long-term treatment of chronic bronchitis, in preventing episodes of over-infection, worsening the disease.

[The usefulness of monoclonal antibodies in the diagnosis of lung carcinoma]. / Utilità degli anticorpi monoclonali nella diagnosi di carcinoma polmonare.

Monoclonal antibodies detection represented a turning point in field of immunological and biological research. Their application has rapidly extended at immunopathology as well as immunodiagnosis and immunotherapy fields. In oncological field monoclonal antibodies has proved a great usefulness in diagnosis of several districts neoplasm. Monoclonal antibodies are utilized in differential diagnosis of different histologic types of lung cancer; in bone marrow metastasis early detection; and, experimentally, in "in vivo" diagnosis of lung cancer via peripheral blood sample examination. Authors relate about more recent literature about this specific topic.

[Bronchoalveolar lavage in the diagnosis of cancer]. / Il lavaggio broncoalveolare nella diagnosi di cancro.

Bronchoalveolar lavage (BAL) is a widely used clinical procedure. To determine if BAL could provide useful information in the detection of cancer, 850 lavages from 421 patients having BAL for a variety of indications, 50 lavages in patients with Hodgkin's disease and 20 patients with breast cancer undergoing bon marrow transplant were reviewed. BALs were performed with the technique established by Rennard and coll. in which 5 successive 20 cc aliquots are infused in a wedge position. The return from the first aliquot was processed separately from the subsequent four aliquots. Diff-Quick stained cytocentrifuge preparations and Papanicolaou stained millipore filter preparations were analyzed. Thirty-five patients had biopsy-proven lung cancer. In 24 (68.6%) of these, BAL revealed cells diagnostic of malignancy. There were no false positives. Six out of 50 Hodgkin's disease patients had Reed Sternberg cells detected on BAL, and 7/20 breast cancer patients had malignant cells on BAL prior to chemotherapy. In summary, the routine performance of BAL, an easily performed and well-tolerated procedure, may prove to be useful in the routine assessment of patients for cancer.

[The use of recombinant interferon alfa-2b in the follow-up of patients laryngectomized for advanced stage carcinoma]. / Utilizzo dell'interferone alfa 2b ricombinante nel follow-up di pazienti laringectomizzati per carcinoma in stadio avanzato.

The AA. report the results of an experimental investigation on 60 subjects who underwent surgery for advanced stage carcinoma of the glottic larynx and treated with alpha 2b recombinant interferon at the dosage of 3,000,000 ul three times a week, before a six-months follow-up. The patients were examined also as to the respiratory functionality and the monitoring of some biological markers of cancers (CEA, TPA, Ca 125, Ca 15.3). The AA. support the satisfactory tolerability of alpha interferon which showed expected side effects; these effects were controlled by the symptomatic treatment, and their metabolic parameters as well as the ones related to the respiratory functionality kept always their valves in the average. The monitoring of biological markers, seems to support a real usefulness in the treatment with alpha interferon, even if a statistically meaningful record couldn't be noticed.

[The use of echocardiography for diagnosis of right ventricular hypertension (author's transl)]. / Utilita' dell'ecocardiografia nella diagnosi dell'ipertensione del ventricolo destro.

Echocardiographic right ventricular wall thickness (RVWT) and right ventricular dimension (RVD) were performed in 65 patients, undergoing diagnostic heart catheterization. Patients were divided in two groups: 28 patients with right ventricular hypertension (group 1) and 37 patients with normal right ventricular systolic pressure (RVSP) (group 2). 24 patients of group 1 (85.7%) had increased RVWT and 34 patients of group 2 (91.9%) had normal RVWT. In group 1 RVSP was significantly correlated with RVWT (r = 0.92; p < 0.001); an inverse correlation was found between RVSP and RVD (r = -0.63; p < 0.001). Non significative correlations were found in group 2. Our study proves that the echocardiographic evaluation of RVWT can be helpful in separating patients with right ventricular systolic hypertension from patients with normal values of RVSP, and that a positive correlation exists between the increase of RVWT and the increase of RVSP.

[Thymidine kinase as a biological marker in neoplasms of the lung and mediastinum]. / La timidina-kinasi come marcatore biologico delle neoplasie del polmone e del mediastino.

Thymidine kinase (TK) is a biological marker recently used in diagnosis and monitoring of pulmonary and mediastinal malignant neoplasms. Authors report more recent clinical evidences of literature and, in the meanwhile, they report their personal experiences about a 20 patients group suffering of lung cancer and Hodgkin disease. Their study demonstrates a good sensitivity of TK as biological marker of SCLC and a lower sensitivity in case of NSCLC and Hodgkin disease. It has been possible to contribute to establishment of normal range values, on account of 10 healthy volunteer group blood sample assays.

A review of clinical studies carried out in Italy with almitrine bismesylate.

The authors refer to a double-blind versus placebo multicentric study, carried out in Italy on 128 hypoxaemic patients suffering from COLD, with Almitrine bismesylate, a new chemoreceptor stimulant drug, given by mouth for a period of two months. Almitrine induced significant changes (p less than 0.001) of PaO2, with a mean increase of 7.6 mmHg, and of PaCO2, with a mean decrease of 4.1 mmHg, without variations of lung volumes and caliber of large and/or small airways. Almitrine, well tolerated within the time limits of this trial, seems an effective oral respiratory drug, acting through a favourable effect on V/Q mismatching due mainly to a reduction of the shunt effect, but also to an improvement of the ventilatory pattern.