Search

We examined the clinical and radiographic results of 93 patients affected by knee arthritis or osteonecrosis subjected to unilateral cementless mobile-bearing total knee arthroplasty with the LCS prothesis (Depuy/Johnson & Johnson). The mean follow-up was 9.5 years (range, 7–12 years). Clinical evaluation was performed using the Knee Society rating system, while radiographic evaluation was done according to the Knee Society roentgenographic system. At the latest follow-up, the mean knee score was 87 points: the functional score improved from 40 to 90. Radiolucent lines were small and not progressive. The implant survival at 12 years was 88%. Six knees (7%) required revision for implant-related problems. We conclude that the mobile-bearing prosthesis is a successful device even at long-term follow-up.

Obiettivo: i molluschi bivalvi possono trasmettere all’uomo vari microrganismi potenzialmente patogeni rappresentando pertanto un problema per la Sanità Pubblica. La normativa vigente non prevede la ricerca dei virus enterici per il controllo igienico dei molluschi mancando un metodo di analisi sufficientemente semplice, rapido ed a costo contenuto da utilizzarsi per il controllo routinario.Le metodiche molecolari oggi disponibili rispondono a questi requisiti. Scopo del nostro studio, è stato quello di rilevare i virus dell’epatite A (HAV) ed E (HEV), Rotavirus (RV), Astrovirus (AV) ed Enterovirus (EV), mediante test di biologia molecolare (RT-PCR), in molluschi bivalvi.Materiali e metodi: sono stati analizzati 87 campionidi molluschi bivalvi (mitili, vongole, ostriche) da avviare al consumo o prelevati a scopo di monitoraggio.Le analisi batteriologiche (Coliformi fecali, E. coli e Salmonella) sono state eseguite in accordo al DM 31/7/1995. L’ analisi virologica è stata eseguita mediante RT-PCR secondo metodiche standard.Risultati: analisi batteriologica: 55 campioni (63.2%) erano conformi alla normativa vigente, 17 (19.5%) superavano i limiti normativi e di 15 (17.3%) non erano disponibili i risultati.Analisi virologica: sono risultati positivi per RV, AV, EV e HAV, 26, 24, 9 e 5 campioni, rispettivamente; nessuno positivo per HEV; 13 campioni sono risultati positivi per due virus contemporaneamente.Inoltre è da sottolineare che, dei 55 campioni che rientravano nei limiti batteriologici previsti dallalegge, solo 19 campioni sono risultati negativi all’analisi virologica e che alcuni campioni erano potenzialmente destinati al consumo perché provenienti da zona A.Conclusioni: i dati evidenziano la necessità di associare i parametri virologici a quelli batteriologici per la valutazione igienico-sanitaria dei molluschi bivalvi e che i test molecolari si sono dimostrati utili per l’analisi virologica dei molluschi eadatti per il controllo routinario.

A new methodology, based on fundamental optical principles relevant to the evanescent wave properties, is developed to evaluate the thinning behavior and the local thickness in different positions for curved aqueous emulsion films, generated in a hydrocarbon matrix. This methodology is applied to test data obtained by a specially-designed bread-board cell. The generated films, constituted by an aqueous sodium dodecylsulfate solution at concentration c = 2.5 times the critical micellar concentration, remain stable during several hours. The results show a slow evolution of the film thickness as a function of time starting from micrometric dimension, at the initial film formation, to a few nanometres prior to film breakage. The action of the gravitational drainage is furthermore assessed by the local thickness values in different positions of the film profile. The illustrated examples demonstrate that the evanescent wave effect can be advantageously adopted as a complementary measurement technique, additional to the usual interferometric technique.

The influence of electric charged molecules on the early phases of enterovirus infection was studied in order to select antiviral compounds able to prevent viral attachment. The effect of different polyelectrolytes on the multiplication of coxsackie virus B3, echovirus 6 and hepatitis A virus was investigated in susceptible cells by adding the drug before, during or after the viral adsorption period. Among polyanions, the polysaccharides heparin and dextran sulfate inhibited viral infectivity, dextran sulfate being the most effective mainly towards hepatitis A virus infection. DEAE-dextran and protamine sulfate, generally recognized as enhancers of infectivity of naked and enveloped viruses, exhibited an inhibitory effect towards the three picornaviruses tested. Only in the case of hepatitis A did DEAE-dextran slightly improve viral antigen synthesis. The inhibitory effect shown by compounds belonging to positive and negative polyions suggests that the electric charge is not sufficient by itself to explain the antiviral activity of these drugs.

In a previous paper, the authors described three paradigms applicable to automated medical text analysis. In this paper, the relative importance of the three paradigms is discussed, viz. the relative value of the linguistic word categorization, the semantic paradigm, and the medical fact delineation. The strategy adopted was to limit the linguistic disambiguation and apply probabilistic rules, in order to speed up the analytic process.

Clinical practice of medicine is highly information-intensive. At the bedside, past experience is the primary justification of reasoning and decisions. This past medical experience is an amalgamation of textbook information and personal experience. During the last 2-3 decades, both of these major sources of clinical information have appeared less and less effective. The pace of progress, resulting in better diagnostic tools and new therapies, has undermined our personal experience, and for the same reason, the time lapse between drafting the manuscripts and distributing the textbooks has become a growing problem. Emphasis has shifted from textbooks to scientific journals with shorter publishing delays, and the role of daily newspapers and television programs seems to be growing. The traditional ways of gathering clinical knowledge and experience seem to fail more and more. In addition to textbooks and scientific journals, current clinical experience is described in millions of patient records, stored in hospitals and ambulatory care offices. However, we have no easy access to patient charts, and we are lacking a method for cost-effective merging of clinical case histories to make them suitable for much-needed statistical inferences. Computers could make a major contribution in this area, but first we must bridge the gap between the narrative text in the medical record and computer technology. Recently, much encouraging progress has been made in automated medical text processing, the topic of this paper.

The article deals with some issues of forensic medicine relevance, as well as ethical one, about HIV+/AIDS condition, which still represent open problems in regulations and in the case-law. Particularly, in the light of the specific Italian regulations (namely, the Law 5 June 1990 no. 135), the Authors address the juridical fundaments of the care of HIV+/AIDS patients, reaffirming the obligation for all the healthcare professionals to give care in every case of infection from HIV. Secondly, the issue of the diagnostic tests and the screenings is faced, sustaining the obligatoriness to gain an adequate previous consent by the subject and, however, only for clinical necessity and in his/her best interest. Finally, the delicate matter of the professional secrecy is examined, of the guardianship of confidentiality and of the partner notification is examined. In general, although the doctrine and jurisprudence not justify the transmission of HIV+/AIDS patient's personal data, yet the specific matter is not easily resolvable exclusively in juridical terms, because it is necessary remind also the extra-juridical--that is ethical--nature of deontological norms.

The ethical debate regarding the AIDS is very rich both at the theoretical and practical level, but--unlike what it is happening for other sectors, e.g. the euthanasia--these two aspects are integrated, shaping a true interdisciplinary job of ethical evaluation, in which clinicians, medical examiners, ethicists, nurses, clinical psychologists, economists and politicians are met. The utilized methodology will be to identify the human act in the light of the patient's good and the common good of the society. These are strong references and broadly shared in general sense, but they become problematic if we want to identify, and we should have to do it, the contents of such "goods". The authors intend to appraise the quality of a Centre for Research and Healthcare for AIDS patients, also considering the "performance measures".

Eighty-seven samples of shellfish were collected considering: type of mollusc, origin, growing area, monitoring or for human purpose. The bacteriological parameters were: Fecal Coliforms, Escherichia coli, and Salmonella; whereas the virological parameters included: Hepatitis A and E virus, Rotavirus, Astrovirus and Enterovirus. In total, 63.2% of samples had normal bacteria values, only one sample was Salmonella positive. The percentage of positive samples for Hepatitis A virus was 5.7%, Rotavirus 29.9%, Astrovirus 27.6%, Enterovirus 10.3%. The recovery of hepatitis E virus was always negative, whereas 13 samples (14.9%) were positive for two viruses.

Several epidemiological data confirm the presence of enteric viruses in drinking water. The present paper deals with several problems tied to the virological analysis, such as the concentration of the samples, the isolation and the identification of enteric viruses.

A total of 202 serum and stool samples from acute hepatitis patients attending the Fever Hospital of Alexandria, Egypt, have been studied to reveal markers of hepatitis virus infection. Anti-HAV IgM were detected in 21 out of 202 sera (10.4%), whereas 201 sera (99.5%) had anti-HAV IgG. The first age attack was in the class-age 0-9 years with 64.7% of anti-HAV IgM positive sera. Among 202 patients, anti-hepatitis E IgG (sample/over cut off1.0) was identified in 90 patients (44.5%). The anti-HEV seropositivity ranged from 17.6% to 60.0% in the different age groups, with the highest level in the class-age 20 29 years. Anti-hepatitis E IgM were identified in 49 patients with the first age attack in the class-age 10-19 years (39.4%). HAV RNA was identified by nested PCR in 7 samples out of 15, whereas HEV RNA was present in 4 out of 75 stool samples. Direct DNA sequence of the latter PCR products confirmed the presence of the HEV genome; comparison of the sequences of the isolates from Egypt with those in data banks revealed the highest homology to the Burma strain. Our data confirm that HAV and HEV are common causes of acute sporadic hepatitis in Alexandria but with different peak age positivity. Occasionally, but not infrequently, dual infections (HAV-HEV and HEV-enteric viruses) were also found. The risk analysis indicates that patients living in rural areas are exposed to a higher risk of hepatitis E infection compared to the urban population, whereas the presence of anti-HEV IgG was significantly associated with consumption of common village water and use of indoor dry pit and oral therapy for schistosomiasis.

A comparative study on peracetic acid and sodium hypochlorite in inactivating bacteria and viruses was carried out. Therefore the disinfection actions of peracetic acid, in comparison with sodium hypochlorite, was evaluated against the usual indicators of faecal contamination, the pathogen Salmonella, Pseudomonas spp., bacteriophages anti-Escherichia coli, F+/phage and the phage of Bactericides fragilis B40-8 and enteroviruses. Under the experimental conditions, no representative results were obtained for enteroviruses and phages because of their low concentration in the sewage effluent. On the other hand, the indicator organisms were reduced substantially by the sodium hypochlorite and peracetic acid concentrations, while more variable results were obtained against Pseudomonas and bacteriophages anti-Escherichia coli.

Random sera, in a total of 192, were collected in the Fever Hospital of Alexandria, Egypt, and analysed for the presence of antibodies against polioviruses. The results show good antibody levels, only three sera (1.5%) were negative for poliovirus type 1, 5 (2.6%) for poliovirus type 2 and 10 (5.2%) for poliovirus type 3; one subject was completely negative.

Several human and animal cell lines have been used to grow hepatitis E virus. The strain SAR-55 was adapted only on PLF/PLC/5 cell line without any visible cytopathic effect. The growth of the SAR-55 was monitored by examining the positive and the negative strands of HEV-RNA. Stool samples, obtained from hospitalised acute hepatitis patients at the Fever Hospital of Alexandria (Egypt), were used to confirm the susceptibility of PLF/PLC/5 cells. After more than one-week's cultivation, three stool samples out of 17 IgM anti-HEV positive and 1 from 52 IgG anti-HEV positive patients showed a specific RT-PCR amplification product. The nucleotide sequences of the methyltransferase region of the genome in the isolates revealed the maximum homology with Burma strain with several point mutations.

The aim of the present study was to evaluate the quality of the seawater in Alexandria, Egypt. Samples were collected in 6 different points: Kayet Bay, El Shatby, Camp Cesar, Sporting, Beir Massoud and El Max. In total, 24 samples were analyzed. For each point the analysis included estimation of the following parameters: Esherichia coli, total coliform and fecal streptococci, Yersinia, Shigella, Salmonella, bacteriophages and enteric viruses. Just one sample (El Max) was positive for the presence of Salmonella, neither Shigella or Yersinia were isolated from any of the analyzed points. E. coli was identified in 10 samples while the ratio between total coliform and fecal streptococci showed variable results with the exception of El Max that resulted constantly high. Three samples were positive for the presence of enteric viruses: El Shatby, Beir Massoud and Sporting. The analysis of phages showed a variable pollution values.The bacteriological virological parameters were evaluated on seawater samples taken at different points on the coast of Alexandria, Egypt. Samples were collected at 6 different points: Kayet Bay, El Shatby, Camp Cesar, Sporting, Beir Massoud, and El Max. A total of 24 samples were analyzed by estimation of the following parameters: Escherichia coli, total coliform and fecal streptococci, Yersinia, Shigella, Salmonella, bacteriophages, and enteric viruses. The virological analysis included the isolation and identification of cytopathogenic enteroviruses and three phages: somatic coliphage, F-specific, and B 40-8. The bacteriophage analysis was performed by the plaque assay method using the double-layer method, whereas the membrane filtration method was used to estimate bacterial populations in the samples. During the summer period no E. coli could be isolated from any point during the study, whereas in autumn E. coli were identified in all the points except for Sporting. E. coli was identified in 65% of the qualitative analyses. The limit was exceeded in 12 samples out of 24; for fecal streptococci, in 15 samples out of 24. The ratio over 4.4 relating to fecal coli and fecal streptococci indicated human fecal pollution. The El Max sample was positive for the presence of Salmonella; neither Shigella nor Yersinia were isolated from any of the analyzed points. In the El Max sample (autumn period), total coliform and fecal streptococci exceeded the European Community (EC) limit, whereas the ratio was 10, confirming human fecal pollution. E. coli was identified in 10 samples, while the ratio between total coliform and fecal streptococci showed variable results with the exception of El Max, which was constantly high. Three samples were positive for the presence of enteric viruses: El Shatby, Beir Massoud, and Sporting. The enteric viruses were confirmed by a secondary passage on cell culture. The analysis of phages showed variable pollution values.

Computers enable us to rethink the documentation of patient care. Longitudinal records call for fundamental changes of goals and allow better clinical self-review. This article examines this new paradigm.

This paper briefly summarizes the characteristics of a computer-based medical terminology constructed by the author. Its size is around 140,000, systematized by meaning using a single attribute as key: similarity among instances covered by the term. This systematization resulted in a single hierarchical tree. Initial term typing was based on the knowledge patterns of the terms, represented by the arcs (relationships) among terms (nodes). Six different types of medical terms could be identified. For coding of a medical term, its position on the hierarchical tree was used, the semantic address. It is recommended that the semantic address should be used for worldwide compatibility.

A new, comprehensive, computer-based medical nomenclature is briefly described in this paper. The terms of this nomenclature are organized into a single hierarchy. Laboratory test names have been made an integral part of the nomenclature, applying classification rules the same way as in the rest of the hierarchical tree.

Recent progress in clinical informatics resulted in two new tools: a comprehensive medical nomenclature and a prototype medical text processor. The direction of further progress is apparent. The technology is ready for large-scale computerization of health care documentation. The new progress-limiting factors seem to be related to the reorientation of the record writers and the entire health care industry. The true challenge of the 1990s is to make clinical data readily available, without jeopardizing the cherished values of medical data confidentiality and provider privacy.

In this research the Enteroviruses presence in sea water was studied. In previous studies presumptive Enteroviruses were revealed in 43% and in 77% of sea water samples analyzed. It was necessary to identify viral particles isolated from marine water because the detection of this kind of virus was performed only on the basis of cytopathic effect appearance on cell cultures. The aim of this research was to verify the suitability of Indirect Immunofluorescence for identification of presumptive Enteroviruses isolated from marine waters. 13 field strains from RC 37 cells (Cercopithecus Kidney cell line) were tested. Pools of Horse immune sera against COXS, POLIO and ECHO, and anti-horse antibodies conjugated with fluorescein were used. The results revealed the presence of Coxsackie virus and Echo virus. There were many problems related with ECHO identification for the presence of cross-reactions with COXS. The IIF method cannot be performed routinely, because it did not show high level of specificity and sensibility, and it is expensive. This methodology can be used only in particular cases and in laboratories with competent virologists and related facilities. In the future, the only suitable methodology for identification of Enteroviruses isolated from field samples is based on the use of RNA and DNA probes.

The hepatitis A virus (HAV) and poliovirus 1 were added to estuarine water samples and their stability in maintenance medium was compared to that in water samples untreated and treated by heat and filtration. The inactivation curves show that the inactivating factor is biological in nature.

Adverse drug reaction vocabulary is not different from the terminology of clinical manifestations due to diseases. A computer-based automated drug monitoring system can detect all the signals which may indicate an adverse drug reaction, a clinical manifestation of the disease treated, or both. Various statistical models are discussed which may be applied for separating adverse reactions from clinical manifestations.

Using his natural language medical text analyzing system, the author has computer-processed the discharge summary segment of the patient record. The output of the text analyzer is a list of medical facts. The low-cost, high productivity process is eminently suited for screening the quality of clinical care provided in the hospital.

Summary(1) Following in vitro labeling of erythrocytes with Na2Cr51O4, a considerable amount of the Cr51 was found unattached to hemoglobin. (2) This unattached Cr51 lost the ability to label erythrocytes, and when given intravenously, was excreted rapidly by the kidneys. (3) Hemoglobin-bound Cr51 was cleared from the blood the same as was previously reported with I131-hemoglobin. After clearance, however, much tissue retention of Cr51 was noted. (4) Rats metabolized homologous and canine hemoglobin similarly, with slow excretion of Cr51 by the kidneys. (5) The clinical implications of these findings indicating some peculiar metabolic characteristic of Cr51-tagged erythrocytes are discussed.

SummaryA reproducible and simple chromatographic method with DEAE-Sephadex was used for fractionation of GOT isoenzymes. In the sera of health individuals three distinct isoenzymes were found. In patients with liver diseases, the SGOT isoenzyme distribution was distorted. Two isoenzymes, (A1 and B), were substantially increased, whereas the third one (A2) remained the same. More striking changes were noticed in acute viral hepatitis. Isoenzyme A2 was not detectable, and the isoenzyme pattern was similar to that in liver homogenates. A possible explanation of this altered isoenzyme distribution was discussed. The change of isoenzymes in the sera reflect more precisely the extent of the hepatocellular damage, rather than the total GOT activity.

A new specific assay for urinary creatinine is described. The procedure is based on the separation of creatinine from other urinary components by Sephadex gel filtration, and subsequent measurement of the compound at 235 nm against a phosphate buffer blank. No interference by other substances has been encountered. The standard deviations in a series of assays using standard solutions are less than 2%, and the recovery of added known amounts of creatinine from urine is excellent. The method has been found satisfactory for simultaneous determination of creatinine and hippuric acid in urine.