Bilateral papilledema in a patient with brucellosis

The authors report bilateral papilledema in a 14 year old boy with brucellosis. Papilledema disappeared completely about one month after the clinical recovery of brucellosis, treated with rifampicin and minocicline, without associated steroids or non steroidal anti-inflammatory drugs.     

"Child health from birth to adolescence", a booklet issued by the Region of Piedmont. A study on the 1st year of life of 1,000 neonates

An investigation has been carried out on the use by parents during the first year of life of the booklet "Child health from birth to adolescence" published by the Region of Piedmont as part of a programme of preventive medicine of infancy and health education. The research was based on a questionnaire submitted to parents of 1,000 newborns, representative of the population of Turin. The results provide useful information about the development of the child and about the parent-child relationship and also on the utilisation and the utility of the booklet. The investigation also provided invaluable suggestions about modifications required in the booklet in the interests of regional programmes of preventive medicine in infancy.     

The role of intraoperative angiography in arterial thromboembolectomy for non-traumatic acute upper limb ischaemia

The aim of the study was to investigate the influence of intraoperative arteriography on the outcome of upper limb acute arterial thromboembolectomy. In a retrospective study, 63 thromboembolectomies were analysed in 59 patients with acute ischaemia of the upper limbs (51 embolectomies and 12 thrombectomies). In 19 interventions, intraoperative angiography was performed either routinely or because of difficulty in passing the Fogarty catheter and/or absence of backflow. No angiography was performed in 44 interventions because the surgeons were dubious as to the benefits of the procedure. In 6/19 cases (32%) intraoperative angiography led to an extension of the intervention, with 1 intraoperative transluminal angioplasty, 2 patchplasties, 4 distal thromboembolectomies and 2 thromboendarterectomies. In patients with embolic occlusion, the adoption of routine intraoperative angiography resulted in a significantly lower re-occlusion rate at 6 months in comparison with patients who were not submitted to angiography (P<0.05). Also in patients with thrombotic occlusion, the adoption of angiography resulted in a lower re-occlusion rate at 6 months compared to patients not submitted to angiography (P<0.05). There were no amputations at 1 month. We recommend intraoperative arteriography as a routine procedure due to its positive influence on the outcome of thromboembolectomy for acute upper limb ischaemia.     

Management of patients with LUTS suggestive of BPH

The QUIBUS study offers some insights into the current diagnosis and treatment of LUTS suggestive of BPH in Italy. As diagnosis is concerned, uroflowmetry and PSA testing were performed in a high percentage of cases (64 and 89%, respectively). Both transrectal ultrasonography and prostate biopsy were more frequent for increasing values of PSA, this suggesting that are used as screening procedures for prostate cancer. However, transrectal ultrasonography was performed overall in a large proportion of patients (61%), representing a routine examination in some centers. As treatment is concerned, the majority of QUIBUS patients had undergone or were undergoing medical therapy. Alphalytics were the drugs most commonly prescribed by urologists while primary care physicians showed the attitude to prescribe more frequently finasteride. On the surgical side, transurethral prostatectomy and open surgery were the most commonly employed procedures, suggesting that little room is left at present to minimally invasive procedures in Italy.     

Antibiotic prophylaxis in the surgical treatment of inguinal hernia: need or habit?

BACKGROUND: Prophylactic antibiotics are recommended for clean-contaminated and selected contaminated surgery. In clean surgery antibiotics are suggested if the operation involves the insertion of prosthetic devices and a potential infection is expected to cause serious morbidity or mortality. Inguinal hernia repair is a clean operation, infections are rare; they can usually be cured without removing the prosthesis and recurrence is uncommon even after removal of the mesh. Aim of the study is to evaluate whether the lack of antimicrobial prophylaxis increases the risk of postoperative infections in patients treated for groin hernia, compared to those treated with prophylaxis. METHODS: One hundred and forty-eight patients underwent inguinal hernia repair with mesh: 64 patients (43%) received 2 g cefotaxime by intravenous bolus about 30 minutes before the operation, 84 patients (57%) did not receive any antimicrobic prophylaxis. Mean follow-up was 13 months (range 1-31 months) for both groups. RESULTS: We did not observe any major complication. Among both groups, no patient had developed infection at one week and one month after surgery. CONCLUSIONS: In personal experience, any advantage in terms of prevention of infections with antibiotic prophylaxis in patients operated on for groin hernia has been observed. A review of the literature showed no general agreement on this subject with different risk of infections in different trials. A new prospective randomized trial is necessary to clarify this topic.     

Nicotine induces platelet-derived growth factor release and cytoskeletal alteration in aortic smooth muscle cells

BACKGROUND: Cigarette smoking is implicated in atherosclerotic plaque formation, but the role of nicotine in this process is not completely understood. The release of platelet-derived growth factor (PDGF) by the bovine aortic smooth muscle cell (SMC) after nicotine administration at a concentration similar to that ingested by active and passive smokers and the role of PDGF in SMC cytoskeletal modification were studied. METHODS: SMC, harvested with enzymatic digestion from calf aorta, were stimulated in a serum-free medium for 72 hours with (-)-nicotine (from 6 x 10(-4) mol/L to 6 x 10(-8) mol/L). The release of PDGF was assessed by inhibition antibody-binding assay and confirmed by Western blotting. Mitogenic activity of nicotine on SMCs was also determined. The SMC cytoskeleton was studied with specific antibodies anti-alpha-actin fibers, anti-vimentin, and anti-beta-tubulin, and the modification induced by PDGF was assessed by blocking PDGF activity with specific antibodies. RESULTS: The greatest PDGF release (1.24 +/- 0.14 ng/10(4) cells vs control 0.43 +/- 0.07 ng/10(4) cells) was noted at a (-)-nicotine concentration of 6 x 10(-7) mol/L (P < .001). The addition of monoclonal antibody anti-PDGF decreased the tritiated thymidine uptake of SMCs exposed to (-)-nicotine compared with the control (29% vs 5%-P < .001). SMCs exposed to (-)-nicotine concentration of 6 x 10(-7) mol/L and 6 x 10(-8) mol/L had a significant alteration in the expression of alpha-actin fibers, vimentin, and beta-tubulin compared with control. The administration of antibody anti-PDGF in the culture medium reversed cytoskeletal alteration. CONCLUSIONS: Nicotine enhanced the release of platelet-derived growth, which in turn caused an alteration in cytoskeletal organization.     

4-aminobiphenyl-DNA adducts and p53 mutations in bladder cancer

Epidemiologic studies have suggested that smokers of air-cured tobacco (rich in arylamines) are at higher risk of bladder cancer than smokers of flue-cured tobacco. The risk has been shown to be modulated by the N-acetyltransferase genotype. We analyzed the biopsies of 45 patients with bladder cancer. p53 mutations were sought by direct sequencing, and 4-aminobiphenyl-DNA adducts were measured by negative ion gas chromatography-mass spectrometry. 4-Aminobiphenyl-DNA adducts were higher in smokers of air-cured tobacco and in current smokers, but no relationship with the number of cigarettes smoked was found. Adducts were higher in more advanced histologic grades of tumors. No pattern was evident for p53 mutations. Seven of 9 mutations occurred in grade 3 tumors. No association was found between 4-ABP adducts and GSTM1 or NAT2 genetic polymorphisms. Int. J. Cancer 75:512–516, 1998.© 1998 Wiley-Liss, Inc.