Zenker's diverticulum: a cause for complete esophageal obstruction and its management

Besides the gastroenterologists, we as gastroenterology nurses and associates are probably the first line of help for patients with this disorder. By having a sound background knowledge of the mechanisms by which Zenker's diverticulum can occur and the possible complications that can arise, we can coordinate a task force of appropriate paramedical personnel: the nutritionist who can instruct the patient on good healthy dietetics, the social worker who may be able to arrange "meals on wheels," the physical therapist who can teach the patient to re-think the way he or she swallows and good deep breathing exercises. We can give our patients a sound understanding of their problem by educating them in language that they understand. By so doing we will be encouraging them in their own preventative measures to promote wellness, which is one of endoscopy's major aims in health care.     

Multidrug and broad-spectrum cephalosporin resistance among Salmonella enterica serotype enteritidis clinical isolates in southern Italy

From 1992 to 1997, only six sporadic isolates of Salmonella enterica serotype Enteritidis from patients with cases of gastroenteritis in southern Italy exhibited resistance to broad-spectrum cephalosporins. Five isolates produced SHV-12, and one isolate encoded a class C beta-lactamase. The bla(SHV-12) gene was located in at least two different self-transferable plasmids, one of which also carried a novel class 1 integron.     

Associations between performance on the Rey-Osterrieth Complex Figure and regional brain volumes in children with and without velocardiofacial syndrome

Ninety-two children with velocardiofacial syndrome (VCFS), a genetic disorder caused by a microdeletion of chromosome 22q11.2 and an age, race, and gender-ratio comparable sample of 59 control participants were included in the project. Participants received an MRI as well as a comprehensive neuropsychological battery; the primary outcome measure in the current report is the Rey-Osterrieth Complex Figure (ROCF). Children with VCFS performed less well on the ROCF and have lower whole brain volume compared to controls. After controlling for whole brain volume differences, children with VCFS have bilaterally less parietal lobe gray and white matter yet more frontal lobe white matter. Brain-behavior relationships include: (a) for both groups, parietal volumes (both gray and white matter) predicted ROCF Copy Organization performance and frontal volumes (both gray and white matter) predicted ROCF Copy Accuracy performance; (b) for controls, frontal white matter also predicted ROCF Copy Organization performance; (c) ROCF Recall Organization performance was best predicted by frontal gray matter volume only in our controls; ROCF Recall Accuracy performance was best predicted by frontal gray matter volume in both groups; and (d) in children with VCFS, performance on the ROCF-Copy Structural Elements Accuracy scale was predicted by right hemisphere white matter volume. Our hypotheses were also retested using IQ-matched and whole brain volume-matched subsamples. Identical results were obtained in these analyses. Assumptions about the organization of and the localization of the brain structures that subserve specific cognitive functions in the typically developing brain may not apply in the abnormally developing brain.     

Characterization of Listeria monocytogenes Isolates from Human Listeriosis Cases in Italy

The objective of this study was to characterize by serotyping, pulsed-field gel electrophoresis (PFGE), and PCR amplification of virulence genes and markers of epidemic clones I, II, and III (ECI, ECII, and ECIII) 54 human isolates from apparently sporadic cases of infection occurring in the Lombardy region and in the province of Florence, Tuscany, Italy, in the years 1996 to 2007. Listeria monocytogenes isolates were provided by the clinical microbiology laboratories of the Lombardy region and the “Careggi” Hospital of Florence, Tuscany, Italy. Serotyping, PFGE after digestion with the AscI and ApaI enzymes, and PCR amplification for the inlA, inlC, and inlJ genes and ECI, ECII, and ECIII markers were performed according to procedures described previously. Twenty-five (46.3%) L. monocytogenes isolates were assigned to serotype 1/2a, 23 (42.6%) to serotype 4b, and 6 (11.1%) to serotype 1/2b. Thirty-one AscI pulsotypes were recognized among the 54 human isolates. Eleven molecular subtype clusters, of which eight included indistinguishable pulsotypes and three included closely related pulsotypes, were shared by two to seven isolates. Fifteen isolates exhibited unique AscI pulsotypes. Three groups of clustered isolates and two apparently sporadic isolates generated EC amplicons. All strains tested positive for the inlA, inlC, and inlJ genes. Based on the results of serotyping and molecular typing, there were 11 occasions when L. monocytogenes strains with the same subtype were isolated from more than one listeriosis case. A total of 39 out of 54 isolates (72.2%) were attributed to molecular subtype clusters. The results of the study suggest that routine subtyping of L. monocytogenes strains from human listeriosis cases could allow more-timely detection of outbreaks possibly caused by food-borne isolates from a common source and could lead to control of ongoing food exposure, thus preventing the occurrence of more cases.Listeria monocytogenes is the etiological agent of listeriosis, a food-borne disease occurring primarily in immunocompromised individuals, causing septicemia and central nervous system infections, and in pregnant women, who may suffer preterm delivery, miscarriage, or stillbirth (8, 18). Healthy adults may suffer a febrile gastroenteritis after ingesting large numbers of L. monocytogenes cells (24).Most industrialized countries, including those within the European Union (EU), have an annual listeriosis incidence of 2 to 10 reported cases per million people per year (13). However, listeriosis has a high case fatality rate that can exceed 30% (8, 28). Recently, several European countries have experienced apparently increasing incidences of listeriosis, mainly among persons aged 65 years and older (6, 13).In Italy, notification of listeriosis cases has been mandatory since 1993, but data are transmitted to the national level quarterly. A second, syndrome-based surveillance system, which covers infections of the central nervous system, is in place. A National Reference Laboratory, which receives strains and epidemiological and clinical information on a voluntary basis, is also present. The incidence of cases reported by the Ministry of Health is lower than those in most EU countries; in recent years (2004 to 2006), it has been 0.8 case per million inhabitants annually (12; http://www.simi.iss.it/banca_dati_simi.htm). This low incidence must be considered with care because of the poor sensitivity of the universal passive surveillance system and the difficulties posed by L. monocytogenes infection epidemiology and natural history. Indeed, a recent report about a 1-year (2002-to-2003) period of enhanced laboratory-based surveillance showed an incidence of 1.3 cases per million inhabitants (12).Throughout Europe and the United States, the majority of cases of listeriosis reported to public health authorities apparently are not linked to a common source and therefore are defined as sporadic (25, 27). However, because of the unique epidemiological and clinical characteristics of human food-borne listeriosis, traditional epidemiological surveillance systems alone are unable to detect most common-source outbreaks, particularly when a limited number of cases are scattered over a wide geographic area (25, 26, 29). Furthermore, when one is attempting to trace food exposures and transmission routes through food-processing chains, a further challenge is posed by the wide spectrum of L. monocytogenes strains, many of which are virulent and associated with significant morbidity and mortality while others are avirulent and unable to establish an infection in mammalian hosts (1, 19). Consequently, rapid and discriminatory subtyping methods, such as various DNA-based methods, e.g., pulsed-field gel electrophoresis (PFGE), PCR and restriction fragment length polymorphism analysis, or sequencing of some specific sequences, are essential for the epidemiological investigation of L. monocytogenes and the tracking of specific clones along food-processing chains (5, 26, 29). Recently, a rapid PCR-based method for the detection of epidemic clones I, II, and III (ECI, ECII, and ECIII) of L. monocytogenes has been reported by Chen and Knabel (2). Moreover, Liu et al. (20) have described a multiplex PCR assay where a combined application of inlA, inlC, and inlJ gene primers makes it possible to determine potential virulence rapidly.Our study is a retrospective subtyping analysis of 42 human isolates identified from apparently sporadic cases of infection in the Lombardy region and in the province of Florence, Tuscany, Italy, in the years 2006 to 2007. Twelve further isolates from human cases occurring in the same geographic areas since 1996 were available and were included in the study. The objectives were to assess the molecular clustering of L. monocytogenes isolates by using serotyping and PFGE and to evaluate the distribution of EC markers and genetic determinants of virulence among the human isolates under investigation.     

Shigella sonnei biotype g carrying class 2 integrons in southern Italy: a retrospective typing study by pulsed field gel electrophoresis

Background  

Emergence and global dissemination of multiresistant strains of enteric pathogens is a very concerning problem from both epidemiological and Public Health points of view. Shigella sonnei is the serogroup of Shigella most frequently responsible for sporadic and epidemic enteritis in developed countries. The dissemination is associated most often to human to human transmission, but foodborne episodes have also been described. In recent years the circulation of multiresistant strains of S. sonnei biotype g carrying a class 2 integron has been reported in many countries worldwide. In southern Italy a strain with similar properties has been responsible for a large community outbreak occurred in 2003 in Palermo, Sicily.     

5-Methyltetrahydrofolate or 5-formyltetrahydrofolic acid to modulate 5-fluorouracil’s cytotoxic activity in vivo? A phase II study in patients with advanced colon cancer

 The purpose of this study was to test the hypothesis that 5-methyltetrahydrofolate (Me-THF), a source of reduced folates alternative to leucovorin, could effectively modulate 5-fluorouracil’s (5-FU) cytotoxic activity in patients with advanced colon cancer. A total of 23 patients were enrolled in a phase II trial; they received 5-FU as a 30-min infusion at a dose of 370 mg/m² following a rapid i.v. push of 200 mg/m² Me-THF, both drugs being given for 5 consecutive days. Cycles were repeated every 4 weeks until disease progression. No patient achieved a complete response. In all, 4 patients showed a partial response (17.4%), 7 developed stable disease (30.4%), and the remaining 12 (52.2%) progressed. Toxicity was acceptable and never exceeded WHO grade III intensity. According to our experience, the MeTHF/5-FU combination does not appear to be an effective treatment for advanced colon cancer. Despite its low toxic profile, in our opinion its wider use should be discouraged. Received: 9 September 1995 / Accepted: 30 November 1995     

BNCT dose distribution in liver with epithermal D-D and D-T fusion-based neutron beams.

Recently, a new application of boron neutron capture therapy (BNCT) treatment has been introduced. Results have indicated that liver tumors can be treated by BNCT after removal of the liver from the body. At Lawrence Berkeley National Laboratory, compact neutron generators based on (2)H(d,n)(3)He (D-D) or (3)H(t,n)(4)He (D-T) fusion reactions are being developed. Preliminary simulations of the applicability of 2.45 MeV D-D fusion and 14.1 MeV D-T fusion neutrons for in vivo liver tumor BNCT, without removing the liver from the body, have been carried out. MCNP simulations were performed in order to find a moderator configuration for creating a neutron beam of optimal neutron energy and to create a source model for dose calculations with the simulation environment for radiotherapy applications (SERA) treatment planning program. SERA dose calculations were performed in a patient model based on CT scans of the body. The BNCT dose distribution in liver and surrounding healthy organs was calculated with rectangular beam aperture sizes of 20 cm x 20 cm and 25 cm x 25 cm. Collimator thicknesses of 10 and 15 cm were used. The beam strength to obtain a practical treatment time was studied. In this paper, the beam shaping assemblies for D-D and D-T neutron generators and dose calculation results are presented.     

High-Sensitivity Cardiac Troponin I Levels in Normal and Hypertensive Pregnancy

Purpose

The purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension.

On-site screening and GC–MS analysis of cocaine and heroin metabolites in body-packers urine

The illicit transportation of cocaine and heroin either swallowed or inserted into the rectum and/or vagina of individuals, defined as “body-packers”, is becoming increasingly common. Assessment of smuggling by urinalysis from body-packers has been sparsely reported and on-site rapid screening methods are essentially lacking.     

rRNA gene restriction patterns and biotypes of Shigella sonnei.

Shigella sonnei is a major agent of diarrhoeal disease in developed as well as in developing countries. Several phenotypic methods to define strain differences have been applied to this species of Shigella including, more recently, analysis of extrachromosomal and chromosomal DNA. In this study, 432 endemic and epidemic strains isolated between 1975 and 1991 in Italy, France and Switzerland were submitted to rRNA gene restriction pattern analysis, after digestion of whole-cell DNA by Hinc II, and to concomitant biotyping. Thirteen ribotypes, H1 to H13, and five biotypes, a, d, e, f, g, were detected. Ninety-five percent of the sporadic strains were assigned to ribotypes H1 to H4, which could be subtyped, except for H4, in different biotypes. Strains from each of seven different outbreaks had indistinguishable ribotype-biotype patterns. In contrast, 65 strains, isolated in Sicily in 1980 over an extended period of apparently epidemic increase of isolations and which had previously been considered to be a single bacterial clone on the basis of resistance pattern and phage type, were found to belong to two different and scarcely related ribotypes. Ribotyping and biochemical subtyping appear to be a useful epidemiological tool in studies on the circulation and distribution of strains of S. sonnei.