Simit epidemiological multicentric study on hospitalized immigrants in Italy during 2002

The aim of this article is to retrospectively evaluate the patient characteristics and the most common infectious diseases in immigrant patients hospitalized in 46 Italian infectious disease clinics during 2002. The main Italian infectious disease clinics were invited to fill in a questionnaire that regarded the number and type of hospital admissions, the country of origin, and demographic features (age, sex, and resident state) of immigrants. A total of 46 clinics including 2255 patients participated in the study. Most patients were men (63%) with an age between 16 and 40 years (63.4%) covered by the National Health Service (71%) and coming from Africa (44.3%). The main infectious diseases observed were: 378 (16.76%) cases of HIV infection, 303 (13.43%) cases of tuberculosis diseases, 282 (12.5%) cases of various forms of viral hepatitis, 177 (7.84%) cases of respiratory diseases, and 196 (8.69%) gastrointestinal diseases. Tropical diseases found were 134 (5.94%) including 95 cases of malaria (70.9%). In conclusion, a broad range of diseases was noted in immigrants which were directly correlated with conditions of poverty. Only a few tropical diseases were diagnosed and therefore the immigrant should not be considered as an infectious disease carrier.     

Emphysematous pyelonephritis. Two cases

The emphysematous pyelonephritis is a rare and severe renal infection characterized by the presence of gas in renal parenchyma and its perirenal spaces. We report two cases of emphysematous pyelonephritis in two diabetic women (53 and 50 years old respectively). In the first case, the treatment was based on nephrectomy because of the presence of a septic shock and three risk factors, which are acute renal failure, hematuria and thrombopenia. In the second case, the treatment was only medical. The evolution was favorable in the two cases. We insist in this article that this diagnosis should be considered in every female diabetic patient having severe acute pyelonephritis resistant to a well-conducted medical treatment.     

Effect of cyclic tensile strain on proliferation of synovial cells seeded onto synthetic ligament scaffolds--an in vitro simulation

OBJECTIVE: Cyclic tensile strain is pivotal to the remodeling of tissue induced in implants used in reconstruction of anterior cruciate ligaments whether these implants were of autogenous tissues or synthetic materials. However, this process is poorly understood. The objective of this study was to investigate the short and medium-term effect of cyclic tensile strain on the proliferation of synovial cells seeded on ligament scaffolds. METHODS: 206 ligament scaffolds made from plasma treated polyester with an ultimate tensile strength of 320 N were used in this study. Synovial cells were obtained from the metatarsophalangeal joints of 2 years old bovines. After expansion of these, they were seeded onto the scaffolds which were subjected, in a specialized apparatus, to a cyclic tensile strain of 4.5% at a frequency of 1 Hz. Initially, the strain was applied for a period of 4 h, which was subsequently reduced in further experiments to 1.0 h and 0.5 h. In further tests, strains of approximately 2.5%, 1% and 0.6% were applied for 1 h at the same frequency. In all the above tests, which were short-term tests (lasting for approximately 1 day), cell proliferation was investigated by the uptake of thymidine with which cells were labeled according to prescribed protocols. Cell proliferation was further examined with light microscopy after 5 weeks and the degree of fill of inter-yarn spaces was quantified for strain amplitudes of 1, 2.5 and 4.5%. Equal number of control (not strained) specimens was used at each time point. RESULTS: In the 1-day experiments, for all durations of application of cyclic strain (exercise), the effect of strain on cell proliferation was inhibitory during the period of exercise and up to 18 h from its commencement, but was stimulatory 22-24 h afterwards. This stimulatory effect was maximal at an exercise period of 1 h. The study has also shown that there is a threshold for the amplitude of the strain (1%), at and below which cell proliferation was not significantly different from that observed in control specimens (P was <0.05 for all data). After 5 weeks of cyclic strain application, it was shown that the higher the amplitude of strain the larger was the area occupied by cells of the intra-yarn space. CONCLUSION: Both the amplitude of cyclic strain and duration of its application affect the proliferation of synovial cells seeded on ligament scaffolds. The data should be useful when selecting or designing an implant, and when prescribing a postoperative exercise regime.     

Dermatology for the urologist

Dermatoses of the male genital area are widely diverse clinically and etiologically. Both dermatologists and urologists are involved in diagnosing and treating those dermatoses. This article will focus mainly on the important or commonly encountered entities classified according to their etiology as infectious, inflammatory, autoimmune, vascular, nervoid or other.     

Enterocutaneous Fistula: a Rare Complication of Laparoscopic Adjustable Gastric Banding

Morbid obesity is a refractory disease with serious co-morbidities. Laparoscopic adjustable gastric banding (LAGB) has generally been a safe and effective method for achieving sustained weight loss. We report a man who presented after LAGB with persistent wound infection at the access port-site, which failed conservative management. Diagnostic laparoscopy found an enterocutaneous fistula from herniated bowel (in a Richter's hernia) into which the catheter had eroded. The small bowel and fascial defect were repaired. The catheter was then clipped and divided, and the port was removed.     

Late complication of aortocoronary venous bypass grafting

The problem of symptomatic, diffuse coronary artery disease not amenable to the established methods of medical or revascularizing therapies remains unsolved. Aortocoronary venous bypass grafting is a rare treatment modality bearing considerable risks. We report on a further complication of the method.     

Electric waves recorded from the testicle: are they capsular or from the testicular tissue?

We demonstrated in a previous study that electric waves could be recorded from the testicle by applying the electrodes either directly to the tunica albuginea (TA) or transcutaneously. As the TA contains smooth muscle fibres which presumably transmit the electric waves, we investigated the hypothesis that the electric waves recorded from the testicle originated from the TA. During the repair of inguino-scrotal hernia in 24 men [age 36.6 +/- 8.6 years (mean +/- SD)], the tunica vaginalis was everted because of the presence of hydrocele. The electric activity of the TA was recorded by three surface electrodes and that of the testicle by three needle electrodes. The recorded potentials were amplified and displayed on an electromyographic apparatus. Triphasic slow waves (SWs) were recorded from the TA. They showed similar frequency, amplitude and conduction velocity from the three electrodes of the individual subject and were reproducible. They were followed or superimposed by bursts of action potentials (APs) which occurred randomly. No waves were recorded from the three needle electrodes inserted into the testicular tissue. The current study could demonstrate that the electric waves recorded from the electrodes applied to the testicle were derived from the TA and not from the testicular tissue. This finding apparently denotes that the TA has a resting tone and probably motile activity, the role of which in testicular function needs to be studied.     

Comparison of the outcome of intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia in the first cycle: a report of case series and meta-analysis

To investigate the outcome of intracytoplasmic sperm injection with fresh and cryopreserved-thawed testicular spermatozoa in the first cycle in patients with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA), a total of 90 cases, 48 OA and 42 NOA were studied. All patients underwent sperm retrieval by testicular sperm extraction (TESE) while their wives received conventional ovarian hyperstimulation. The hormone levels, testicular histology, the rates of sperm retrieval, fertilization, implantation and pregnancy were analysed and evaluated. This study and other four similar studies were subjected to meta-analysis. Sperm retrieval was successful in 100% OA and 61% NOA. Fresh spermatozoa were used in 87.5% and 92.4% of OA and NOA cases respectively; while cryopreserved-thawed spermatozoa were used in 12.5% and 7.6% of OA and NOA, respectively. The fertilization, implantation and clinical pregnancy rates were 65.5%, 15% and 25% respectively in OA group, and 54.2%, 5% and 23.1% respectively in NOA group. Sperm status (fresh or thawed), male partner's age, female age and male serum follicle-stimulating hormone had no significant effect upon fertilization rate, implantation rate, or pregnancy rate per embryo transfer. The results of meta-analysis indicate that there is no statistically significant difference in clinical pregnancy rates between the two groups. There was a significantly higher fertilization rate among OA patients in all analysed studies (95% CI = 14.29-15.71, d.f. 832, T = 1.96). In conclusion, although the fertilization rate was significantly higher in the OA group in our study and from the given meta-analysis, there were some differences as regards pregnancy rates. Although the overall effect was more or less similar pregnancy rates in both subtypes of azoospermia, this may not be true if non-male infertility variables were controlled for in all studies.     

Polytrauma bei Fahrradfahrern

Background

In our region we have noticed an increasing number of cyclists and consequently a rise in bicycle-related accidents in recent years. A large number of our polytraumatized patients are victims of bicycle-related accidents.

Material and methods

Retrospectively we analyzed the data of our polytraumatized patients recorded between May 2003 and June 2004 for bicycle-related injuries. Of 153 polytraumatized patients treated in our emergency room 32 were cyclists (21%). The average age of our polytraumatized cyclist was 42 years, and the male-to-female ratio was 1:1.

Results

The median score on the Glasgow Coma Scale (GCS) after the accident was 8 (min. 3, max. 15), the median Injury Severity Score (ISS) was 24 (min. 18, max. 41), and the median Polytrauma Score (PTS) was 23 (min. 14, max. 51). A total of 30 patients (94%) suffered a head injury; in 28 patients (88%) the head injury was the leading diagnosis. The median score on the Abbreviated Injury Scale (AIS) Head was 4 (min. 1, max. 5), the AIS Thorax 3 (min. 2, max. 4), and the AIS Extremities 3 (min, 2, max. 5). Our data were also compared with the official injury statistics of the region and the current literature.

Conclusion

The most frequent and most severe injury was the head injury (94%). Of the 32 polytraumatized cyclists 30 did not wear a helmet. Successful prevention could possibly be practiced if all cyclists wear helmets.