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Background: Percutaneous Endoscopic Gastrostomy (PEG) is an endoscopic procedure for placing a feeding tube into the stomach through the skin, primarily to avoid malnutrition. Malnutrition can increase the risk of wound infection, whose incidence can be decreased by using antibiotic prophylaxis., Aim: The purpose of our study was to evaluate the efficacy of a new antibiotic regimen in preventing acute post-PEG procedure complications., Patients and Methods: Ninety-seven consecutive patients were put on combined antibiotic therapy of clindamycin 600 mg and cefotaxime 1,000 mg every eight hours, starting with the insertion of the PEG tube and maintained for 48 hours. Pain/tenderness, leakage/drainage, bleeding fever, maximum white blood cells (WBC) count, pus/discharge, and PEG tube function were evaluated within 48 hours and 1 week from PEG insertion., Results: Infection at the site of PEG insertion occurred in 3 cases (3.1%) within 48 hours and in 1 case (1.0%) within 7 days. Within 48 hours from the procedure, incidence of fever and increased WBC count was 10.3% and 9.3%, respectively, though at 7 days all were resolved. Pain, leak, and bleeding at the site of PEG placement were prevalently mild within 48 hours (74.2%, 12.4%,13.4% of patients, respectively) and subsided within 7 days (2.1%, 0%, 0%). One case (1.0%) of minor antibiotic side effect occurred. Two patients died due to complications not related to the procedure., Conclusion: The combined use of short-term cefotaxime and clindamycin seems to be effective in reducing incidence of acute complications due to PEG placement without increasing side-effects.

Background: Abnormal intestinal clearance is involved in the pathogenesis of small intestinal bacterial overgrowth (SIBO). It is known that partially hydrolysed guar gum affects intestinal motility. Eradication therapy of SIBO is based on antibiotic treatment: no data are available on the role of fibre supplementation in eradicating SIBO., Aim: To assess whether the combination of partially hydrolysed guar gum and rifaximin is more effective than rifaximin alone in the treatment of SIBO., Methods: A 50 g-glucose breath test was given to 500 consecutive patients. Patients with a positive glucose breath test and predisposing conditions to SIBO entered into the study, and were randomized to receive rifaximin 1200 mg/day or rifaximin 1200 mg/day plus partially hydrolysed guar gum 5 g/day for 10 days. Patients completed a symptom questionnaire and glucose breath test both in basal condition and 1 month after withdrawal of therapy., Results: Seventy-seven patients had SIBO. Eradication rate of SIBO was 62.1% in the rifaximin group (both on per-protocol and intention-to-treat analyses), and 87.1% (per-protocol, P=0.017) and 85.0% (intention-to-treat, P=0.036) in the rifaximin-plus-partially hydrolysed guar gum group. Clinical improvement was observed in 86.9% and 91.1% of eradicated cases in rifaximin and rifaximin-plus-partially hydrolysed guar gum groups respectively (P=0.677)., Conclusion: The combination of rifaximin with partially hydrolysed guar gum seems to be more useful in eradicating SIBO compared with rifaximin alone., (© 2010 Blackwell Publishing Ltd.)

Infectious complications contribute to significant patient morbidity and mortality in orthotopic liver transplant (OLT) recipients. Early central nervous system (CNS) involvement (within the first month after OLT) by infectious disease is essentially set off by aggressive surgical procedures, severe morbid conditions of the pretransplant period, initial graft dysfunction, permanence of intravascular catheters, and prolonged mechanical ventilation. The type and severity of CNS infection may be determined by many factors, such as posttransplant adverse events; prolonged or repeated surgery with massive intraoperative transfusions, net state of immunosuppression, recurrence of infections by immunomodulating viruses, and retransplantation. Bacteria, viruses, and fungi can spread to the CNS just as they affect the abdomen, blood stream, respiratory tract, urine, drainages, etc. Because immunosuppressive drugs may modify the clinical presentation of CNS infections, it is very important to maintain vigilance and attend to minor neurologic symptoms. Special attention should therefore be given to cerebral investigation in patients with prolonged pulmonary contamination, unresponsive fever, and heavy corticosteroid therapy, primarily when they became disoriented, develop seizures, or exhibit focal neurologic signs. Clinical response to medical therapy may sometimes be poor because of chronic encapsulation of the pathogen, development of resistance, and/or catastrophic hemorrhagic complications., (Copyright (c) 2010. Published by Elsevier Inc.)

Patient registries are organized systems of data collection for scientific, clinical or health strategy purposes. Aims of our review were to document scientific literature based on data and information from cystic fibrosis (CF) registries; to understand which clinical problems have been addressed and for which of these the studies concerned have correctly answered the questions raised (i.e. a methodological critique) and to identify clinical issues in need of further investigation. The review included primary studies starting from a formally constituted CF registry of at least national level, using data from the registry to evaluate research hypotheses. This article is an overview of the research undertaken, focusing in detail on the issues of mortality and survival. The studies considered here focused mainly or secondarily on survival in CF, the aim being to ascertain an improving trend, identify any prognostic factors and, in some cases, attempt to provide a predictive model of survival.

Bronchial artery embolization is a well accepted and widely used technique in the management of massive haemoptysis in cystic fibrosis (CF). It can be a complex procedure requiring a deep knowledge of the bronchial artery anatomy including the possible bronchial anastomoses. We report a case of complex vascular anatomy of the left bronchial artery with multiple anastomoses with the ipsilateral subclavian artery as cause of non-attempted embolization., (Copyright 2003 European Cystic Fibrosis Society)

The case of a 30-year-old woman who, many years after a trauma to the neck, developed a hard tissue mass in the posterior midline at C5-C6 level is reported. The patient underwent surgical excision of the mass. Nucal fibrocartilaginous pseudotumor (NFP) was diagnosed. This is a very rare non-neoplastic lesion, probably arising throug a post-traumatic metaplasia of the nuchal ligament, and only 14 cases have been reported to date in the literature. The clinicopathologic and neuroradiologic features of NFP are described.

We report the embolization of an aberrant origin of haemoptysis - from the internal branch of the lateral thoracic artery - in a patient affected by cystic fibrosis. The technical implications for embolotheraphy in case of an aberrant origin of a haemorrhage are emphasized. Many different systemic arteries may contribute to the blood supply of the lung and many connections may exist between the systemic, bronchial and pulmonary circulations. The presence of non-bronchial systemic arteries supply should be investigated when inconclusive findings are seen during bronchial artery embolization for haemoptysis.

Background/aims: Very few studies have been performed on the long-term clinical advantages of neonatal screening programs for cystic fibrosis (CF) and these have been inconclusive. This is a preliminary report of two observational cohort studies on this subject., Methods: In the first study, CF patients born between 1973 and 1981 in northeastern Italy were split into 4 groups according to the modality of diagnosis: screening by meconium test (58 patients); meconium ileus (45 patients); symptoms and pancreatic insufficiency (PI; 75 patients), or symptoms and pancreatic sufficiency (PS; 19 patients). The patients were followed for up to 26 years by three CF centers sharing common treatment protocols. In the second study, two cohorts of CF patients born between 1983 and 1992 were compared. Patients from one cohort (126 patients) were born in the Veneto region, where a neonatal screening program had been established based on immunoreactive trypsinogen. Patients from the other cohort (152 patients) were born in Sicily, where an intensive program of early diagnosis by symptoms was implemented. The cohorts were comparable for CF incidence, CFTR genotypes, gender proportion and common treatment protocols. Statistical analyses were performed by Kaplan-Meier survival curves, a Cox proportional hazard model for survival and cross-sectional comparisons by 2-year periods for weight z score, height z score and body mass index., Results: In the first study, the patients detected by newborn screening (PI) showed better survival and nutritional status compared to patients diagnosed through meconium ileus or symptom presentation with PI. PS patients diagnosed by symptoms showed the best outcome, but most of them had a mild genotype. In the second study, the Veneto cohort showed better outcome with regard to survival and nutritional status over 16 years of follow-up., Conclusions: Observational cohort studies cannot give definitive evidence of the clinical benefit of neonatal CF screening; however, data have been accumulated which strongly suggest a better clinical outcome for CF patients born in an area where a screening program is performed.

Objective: Implementation of preventive services guidelines is performed inconsistently. In an attempt to reduce variation in guideline implementation, we developed a patient questionnaire based on the US Preventive Services Task Force Guide and the Health Plan Employer Data and Information Set 3.0 performance measures of the National Committee on Quality Assurance., Subjects: 100 hospitalized patients of five primary-care physicians., Methods: In a pilot study, 100 hospitalized patients of five primary-care physicians were questioned about their compliance with evidence-based, preventive healthcare recommendations. Information was requested on blood pressure measurement, cholesterol screening, fecal occult blood testing, smoking-cessation counseling, Pap testing, mammography, postmenopausal hormonal replacement therapy counseling, prostate examination and prostate-specific antigen (PSA) testing, use of aspirin and beta-blockers following an acute myocardial infarction, testing of diabetics for hemoglobin A1c and retinal eye examinations, questioning of the elderly for auditory and visual problems, and receipt of influenza and pneumococcal vaccines. Information on variations from the recommended preventive service was fed back to their physicians. Six months after the initial survey, the patients were requestioned to determine if compliance had improved with the recommendations., Results: We found significant improvement in fecal occult blood testing, smoking cessation, Pap smear testing, mammography use, prostate examinations and PSA testing, hemoglobin A1c testing, seeing or hearing loss follow-up, and the administration of influenza and pneumococcal vaccines., Conclusions: Improving implementation of preventive services recommendations is a challenge. This pilot study suggests that involving the patient more in the process and informing the physician of the results may improve the process.

1. The effects of norbormide on the contractility of endothelium-deprived rat, guinea-pig, mouse, and human artery rings, and of freshly isolated smooth muscle cells of rat caudal artery were investigated. In addition, the effect of norbormide on intracellular calcium levels of A7r5 cells was evaluated. 2. In resting rat mesenteric, renal, and caudal arteries, norbormide (0.5-50 microM) induced a concentration-dependent contractile effect. In rat caudal artery, the contraction was very slowly reversible on washing, completely abolished in the absence of extracellular calcium, and antagonized by high concentrations (10-800 microM) of verapamil. The norbormide effect persisted upon removal of either extracellular Na+ or K+. The contractile effect of norbormide was observed also in single, freshly isolated smooth muscle cells from rat caudal artery. 3. In resting rat and guinea-pig aortae, guinea-pig mesenteric artery, mouse caudal artery, and human subcutaneous resistance arteries, norbormide did not induce contraction. When these vessels were contracted by 80 mM KCl, norbormide (10-100 microM) caused relaxation. Norbormide inhibited the response to Ca2+ of rat aorta incubated in 80 mM KCl/Ca2(+)-free medium. Norbormide (up to 100 microM) was ineffective in phenylephrine-contracted guinea-pig and rat aorta. 4. In A7r5 cells, a cell line from rat aorta, norbormide prevented high K(+)- but not 5-hydroxytryptamine-induced intracellular calcium transients. 5. These findings indicate that in vitro, norbormide induces a myogenic contraction, selective for the rat small vessels, by promoting calcium entry in smooth muscle cells, presumably through calcium channels. In rat aorta and arteries from other mammals, norbormide behaves like a calcium channel entry blocker.

The tuberculous meningitis is an uncommon but severe complication of the tuberculosis mainly in childhood. Neurological sequelae are frequent and high mortality rate, till now, occurs. We reviewed the medical records of 71 cases and we evaluated the most frequent symptoms before the admission and signs and symptoms on the admission according to prognosis. An early diagnosis and specific anti-tuberculous treatment are essential in order to prevent permanent neurological sequelae and fatal outcome

A dramatic shortage of kidneys available for transplantation, due do the widespread reduction in consent, has urged us to explore alternative sources of kidney harvesting, in the attempt to reduce the current gap between the small number of donations and the large number of patients on waiting-list. We set our attention on non-heart-beating donors (NHBD). In the "first step" of our research, we tested an experimental technique, by using commercial pigs' kidneys, that has been useful to determinate the maximum warm ischemic time that a kidney of NHBD could tolerate. Parameters of this research were the resistance of the kidney in perfusion machine and the renal scintigraphy. Our results permitted to establish that the maximum warm ischemic time that a kidney of NHBD could tolerate, is 50 minutes (p > 0.001). This experimental technique could be employed to remove every doubt about the effective condition of NHBD kidney before the transplant, in the outlook, by using those kidneys, to reduce the organ shortage.

We describe a middle class Sicilian girl who at 8 months of age suffered acute post-streptococcal glomerulonephritis documented by clinical hist a positive type 12 beta-haemolytic streptococcus throat culture, a raised anti-sterptolysin O titre and a low C3 rising to normal after 8 weeks

Diabetic ketoacidosis is an extremely rare manifestation of glucagonoma. We report such a case in a 72-year-old woman known to be diabetic for seven years. The patient was admitted with diabetic ketoacidosis and associated necrolytic migratory erythrema which suggested the diagnosis of glucagonoma. Plasma glucagon levels were increased (569 to 2298 pg/ml). A vascular tumor of the head of the pancreas without obvious hepatic metastases was visualised by angiography. Duodeno-pancreatectomy including the head of the pancreas led to complete recovery of the mucocutaneous lesions and the plasma glucagon level fell (229 pg/ml). The tumor had several histological characteristics suggesting malignancy and a high glucagon content on extraction. Electron microscopy showed multiple A cells and a few isolated B cells. Most of the cells showed immunoreactivity with anti-glucagon and anti-glicentine antibodies. Three months after surgery, the diabetes was again required treatment with insulin. Plasma glucagon level was again increased and chemotherapy with dimethyltriazenimidazolecarboxamide was undertaken.

The usefulness of working out radiotherapy treatment planes using radiobiological iso-effect curves instead of only iso-dose curves is explained. Examples of the application of iso-TDF curves are presented with reference to the method of Ellis.

Peripheral Atherosclerosis (PA) is a frequent complication of longstanding diabetes. Nevertheless uncertainty exists on defining risk factors (RF) for PA in diabetics. In order to elucidate this matter, at an early stage of the vascular complication, 54 non insulin dependent diabetic (NIDDM) patients, males, age range 40-59 years, without clinical signs of PA, were investigated by digital pulse plethysmography, measuring the inclination time (IT) of the pulse wave. A significant correlation was found between systolic blood pressure (BP) or fasting serum cholesterol (FSC) and IT (r = .28 p less than .05 and r = .34 p less than .05). IT was significantly higher in insulin treated patients compared with those on oral hypoglycemic treatment (154 +/- 41 msec; 122 +/- 25 msec; p less than .05) (M +/- SD). No significant effect on IT was induced by body weight, diastolic BP, serum triglycerides. A positive correlation was found between the number of RF (FSC greater than or equal to 220 mg/dl; systolic BP greater than or equal to 160 mmHg; insulin treatment) in each patient and IT (r = .55 p less than .001). In the absence of RF, IT was similar to that in non diabetic, normocholesterolemic, normotensive men of the same age (119 +/- 27; 116 +/- 15). FSC, systolic BP and insulin treatment are major RF for PA in male NIDDM patients. The condition is worsened by the simultaneous presence of two or more RF together.

Plasma GH levels were studied following acute administration of 2.5 mg of bromocriptine (CB 154) in 12 acromegalic patients. In 9 responders, reduction of GH levels was obvious 2 to 4 hours after bromocriptine administration and the lowest values were achieved between 5 and 8 hours following drug absorption. This pattern suggested the use of bromocriptine at a dose of 2.5 mg six-hourly in chronic treatment of acromegaly. Chronic administration of CB-154 in 10 acromegalic patients was followed by a stable reduction of plasma GH levels in seven subjects. No appreciable variation in GH levels were observed in one patient who was unresponsive to acute administration of CB-154 and in two other subjects treated with 2.5 mg 12-hourly. In three patients who had high plasma GH levels inspite of an anterior treatment by hypophyseal surgery and/or physiotherapy, plasma GH values were normalised under bromocriptine therapy. (9 to 24 months). In the four other subjects, high basal plasma GH levels were reduced with at least 50% reduction rate from baseline. Nevertheless, in two subjects from the latter group bromocriptine daily dose was increased to 20 mg divided in four fractions, because of an escape phenomenon to initial dose regimen. Normalisation or reduction of plasma GH levels was associated with considerable clinical improvement. Tolerance of the drug was excellent in all patients but four who experienced nausea and vomiting; these side effects disappeared when treatment was reduced and then increased gradually.