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Biomedical subjects

A Ferrara

Publications and source records attributed to A Ferrara.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

Antimicrobial resistance patterns in respiratory pathogens isolated in an Italian university hospital during a period of eight years: a statistical analysis.

The antimicrobial resistance patterns of respiratory pathogens isolated during an 8-year period (1990-1997) in an Italian hospital from patients with bronchopulmonary infections were investigated. A global variation in the resistance of Staphylococcus aureus to all relevant antibiotics was observed during the years 1990-1997. With the exception of penicillin and amoxicillin, to which Staphylococci were always resistant, and vancomycin, to which they were always susceptible, in the first period (1990-1992) the percentage of resistance to beta-lactams, aminoglycosides, macrolides, fluoroquinolones and cotrimoxazole was about 15%, while in the last period (1993-1997) it was about 35%. No global variation in resistance to the antimicrobials examined during the study period was observed for gram-negative bacteria. The percentages of resistance to the more recent beta-lactams, aminoglycosides and fluoroquinolones were generally less than 10% for the KES group, less than 20% for Pseudomonas aeruginosa, and less than 30% for other Pseudomonas species. A high percentage of resistance was observed for the KES group to amoxicillin + clavulanic acid (60%) and to cefoxitin (48%).

Anti-Bacterial Agents↗
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High-level gentamicin-resistant enterococci: in vitro activity of double and triple combinations of antimicrobial drugs.

The ability of double and triple combinations of antimicrobials with different mechanisms of action, such as teicoplanin, meropenem, gentamicin and sparfloxacin, to achieve synergisms was investigated in vitro on some moderate-level gentamicin-resistant (MLGR: 8 < or = MIC < or = 256 mg/l) and high-level gentamicin-resistant (HLGR: MIC > 500 mg/l) enterococci. On MLGR strains, a constant synergistic effect was achieved by a combination of teicoplanin with gentamicin or with meropenem, while generally addition, sometimes close to synergism, was exhibited by gentamicin-meropenem, gentamicin-sparfloxacin and teicoplanin-sparfloxacin associations. Triple combinations of teicoplanin, meropenem and gentamicin, or teicoplanin, sparfloxacin and gentamicin, always showed a remarkable advantage in terms of synergism over double combinations. On HLGR enterococci, the only double association showing an additive effect, sometimes close to synergism, was teicoplanin plus meropenem, while the triple combination of teicoplanin with gentamicin and meropenem always showed a marked synergistic effect. An effect very close to synergism was also shown by the combination of teicoplanin with sparfloxacin and gentamicin.

Anti-Bacterial Agents↗
PubMedDate not supplied

Combined ranitidine and pirenzepine in the treatment of duodenal ulcer: a multicentre double-blind study using endoscopy.

The efficacy of a combination of ranitidine and pirenzepine in the short-term treatment of duodenal ulcer was evaluated in a double-blind trial. In a multicentre study, 352 patients with active duodenal ulcers were randomly allocated to be treated with 300 mg/day ranitidine plus placebo (group I), 300 mg/day ranitidine plus 50 mg/day pirenzepine (group II), or 300 mg/day ranitidine plus 100 mg/day pirenzepine (group III) for 4 weeks. The respective healing rates assessed using endoscopic examination after 2 and 4 weeks' treatment were 40% and 70% in group 1, 44% and 82% in group II, and 37% and 77% in group III. The differences between the treatment groups were not significant, although 300 mg/day ranitidine plus 50 mg/day pirenzepine tended to be superior to the other treatments. Analgesic activity was the same in the three groups with 33%, 34% and 33% reductions, respectively, in the numbers of patients experiencing pain after 2 weeks. Side-effects (mainly dry mouth and blurred vision) were significantly more frequent in group III patients.

Adult↗
PubMedDate not supplied

A case of allergy to globe artichoke and other clinical cases of rare food allergy.

We describe herein four unusual clinical cases of rare allergy to foods in patients affected by allergic rhinitis and asthma. The patients were skin tested both with commercial food extracts and using prick-prick procedure with fresh foods. Total and specific IgE in serum were determined by REAST. Grapes, lupine seeds, black mulberry and artichoke resulted positive in the patients under study. This is the first time allergy to ingested artichoke has been described.

Adolescent↗
PubMedDate not supplied

Therapeutic indications for autonomous adenoma of the thyroid: 71 cases.

The Authors, on the basis of personal experience relative to 71 cases of Autonomous Adenoma of the thyroid treated by surgery or percutaneous ethanol injections (PEI), analyze the results in terms of complications and function. After comparing their results with the data in the literature relative to radioiodine therapy, the Authors conclude that surgery should be the primary treatment for plurifocal nodules or nodules greater than 2 cm in diameter, while PEI can be used for single nodules smaller than 2 cm. The point is that radioiodine often induces hypothyroidism, while our knowledge of the results of percutaneous ethanol injections is still limited in terms of number of cases and length of observation periods. Therefore, the authors think that the treatment of Autonomous Adenomas should be surgical, while non-surgical therapy should be limited to specific cases (dimensions, age, or general contraindications to the operation).

Adenoma↗
PubMedDate not supplied

[Activity of purified diosmin in the treatment of hemorrhoids].

Several theories on the etio-pathogenesis and physio-pathology of hemorrhoids have been up to now proposed. From the fisio-pathological viewpoint, particular importance is retained by the vascular factor, which in its turn is influenced by mechanical and sphinceric factors, that impair the venous back-flow. In the evidence of an hemorrhoidal crisis, characterized by local oedema, pain and bleeding, the use of bioflavonoid drugs is deemed to be the first choice. We investigated the use of purified diosmin, given at a dose of two 450 mg tablets bid for the first 7 days, then at 1 tablet bid for up to 2 months, in a group of 66 patients suffering from primitive hemorrhoids of grade 1-4. Our results confirmed diosmin efficacy in decreasing both pain and bleeding: reduction rates of 79% and 67%, respectively, were reached in the first treatment week. In the second week, figures were 98% and 86%, respectively. Diosmin tolerability was excellent: this characteristic makes the drug very easy to handle by the general practitioner and also useful to the proctologist in the preparation of patient to further treatments.

Adolescent↗
PubMedDate not supplied

[Direct experience in the treatment of unusual, primary, and secondary malignant tumors of the stomach].

The reduced incidence of gastric cancer, due to a better patients surveillance and more accurate understanding of prophylactic measure, has allowed a detection of early stages as well as cancers with different origin cells. Either the difficulty of differential diagnosis or the various surgical and integrated approaches, make these neoplasm hard to enroll in standard treatment protocols. Our experience consists of 5 clinical cases with four different histology: lymphoma, leiomioma, carcinoid and gastrinoma. A rare case of secondary involvement of the stomach by an adrenal adenocarcinoma is also described. Lymphomas benefit of the surgical therapy only in early stages (IE, IIE), eventually associated to chemio- and radiotherapy, in relationship with local diffusion of the disease; gastric resection is more supported than gastrectomy. Polychemotherapy, with or without radiotherapy, is used for advanced stages (IIIE and IVE), leaving to surgery the role of controlling hemorrhagic or occlusion compliances. GIST have a different therapeutic approach: surgery represents the only choice since chemio- and radiotherapy have no benefits for the biological characteristics of such neoplasm. Surgery is the ideal choice for the carcinoids with some indications for chemio radiotherapy in the palliative surgery or in the relapsing. We emphasize the rarity of the secondary gastric neoplasm coming from the suprarenal glands. We analyze our diagnostic and therapeutic protocols, comparing them with the current literature.

Adenocarcinoma↗
PubMedDate not supplied

[Strategies to face the shortage of nurses in 11 health settings: descriptive analysis].

A survey on the perceived severity and criteria for defining the nursing shortage was made by interviewing with a semistructured questionnaire 11 nurses responsible for nursing services of 11 Italian hospitals and districts. The questionnaire was administered by interview. Ten hospitals suffer a medium-severe nursing shortage. The main solutions adopted to overcome the nursing shortage are: the closure of wards, the merge of wards, with comparable patients; the employment of support personnel; the mobility of nursing personnel, whereby nurses change wards and are move where they are most needed; modification of shifts. Interestingly, criteria for defining the nursing shortage vary from hospital to hospital, but they are not based on objective data (c.g. number of "missing" nurses). The payment of overtime hours is also different, ranging from 20 to 35 dollars/hour. Since the shortage of nurses will last for the next 5-8 years, a study of criteria for assessing it, of solutions adopted and of their effectiveness is pivotal for gaining a better understanding of the problem.

Health Care Surveys↗
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[Modulation of the axillary lymph node dissection in breast cancer].

UNLABELLED: Several studies showed the reliability of the sentinel lymph node (SN) technique in the evaluation of the N parameter in breast cancer so much to induce surgeons to limit the axillary dissection to the biopsy of the SN alone (SNB) in case this is negative to the extemporaneous examination. After a period of focusing on the identification technique, biopsy and histological examination of the SN (October 97-January 98) always followed by a complete dissection of the three axillary node levels (ALND), we started a study to evaluate the reliability of a limited dissection of the 1st level of the axilla (FLND) in women with T < 3 cm, N0-1a, M0, that did not undergo any neoadjuvant treatment and in which the SN resulted free from metastases. We started this phase of the study in February 1998 till May 2001. In the present paper we show the results related to this period. MATERIALS AND METHODS: We enrolled 256 women with T < 3 cm, N0-1a, M0. In 49 cases we used vital dye, in 23 dye + radioguided surgery (RGS) and in 184 RGS only. The extemporaneous histological examination of the SN has been performed with thin sections, dyed with EE. When SN was negative to the intraoperative examination, we limited the dissection to the 1st level of the axilla, except that in 3 patients, with SN located to the 2nd level, in which we did an ALND. The FLND has been performed in 17 cases with a minimally invasive technique. The definitive histological examination of the SN always included the immunohistochemistry. If the SN was positive, usually underestimated to the intraoperative examination, the patients had an adjuvant chemotherapy. RESULTS: In 203/207 patients (98.1%) SN was found to the pre-operative lymphoscintigraphy. During surgery the SN was identified in 46/49 (94%) using the vital dye, in 22/23 (96%) using the vital dye + RGS and in 176/179 (98.3%) using RGS. To the extemporaneous histological examination SN was negative in 140, metastatic in 101; to the histological definitive results of the SN we noticed 6 false negative, since others lymph nodes than SN were positive (4 cases) or for evidence of micrometastases at the immunohistochemistry which were not detected at the extemporaneous examination (2 cases). On 107 cases of N+ the SN was the only metastatic lymph node in 42 (39.3%). The false negative percentage was 5.6% and the diagnostic accuracy of the SNB was 97.5%. In the group treated with FLND we only noticed two cases of light lymphedema (1.4%). CONCLUSIONS: Our results are in concordance with the international literature and they induced us, from June 2001, to begin a new phase of the study in which we limit the dissection of the axilla to the SN only, if not metastatic, in women with T1 breast carcinoma.

Adult↗
PubMedDate not supplied

Role of arterial hypertension in plasma secretion of prostacyclin during renal failure in man.

Cardiac function and morphology in chronic hemodialyzed patients are modified in consequence of both vascular and neurohormonal factors. In the present study we investigate on the role of prostacyclin (PGI2) vasodilator agent, during hemodialytic (HD) treatment. Twenty-four patients (13 males and 11 females; 9 hypertensive and 15 normotensive) aged 58.5 +/- 14.4 years were studied; 2.5 ml of venous blood were collected before (time 0) and 15', 120', and 240' of dialytic session. The PGI2 levels were measured in plasma, after extraction in ethyl acetate by RIA method, as levels of 6-Keto-PGF1 alpha, a stable metabolite. The results have shown as increase of PGI2 levels at 15' in hypertensive HD patients (HHD) from the begin of dialysis that increased until 240'. This phenomenon was more significant in hypertensive than in normotensive group (NHD) (p < 0.05 vs NHD). These preliminary data suggest that in HHD patients the role of PGI2 is more important than in NHD patients as regards the effects on regulation of circulatory tone. The increment of PGI2 levels could be in relation with the sympathetic activation occurred during hemodialytic treatment.

Aged↗
PubMedDate not supplied

[Adverse reaction following suspected inhalation of nickel tetracarbonyl: case report].

BACKGROUND: Nickel tetracarbonyl (Ni(CO)4) is a highly toxic chemical that is produced as an intermediate compound in the Mond process of nickel refining. Occupational poisoning due to Ni(CO)4 is not frequent, and up to now about 300 cases have been reported in the medical literature worldwide. OBJECT: A clinical case is reported of an industrial worker who developed clinical symptoms of respiratory distress probably due to accidental exposure to Ni(CO), METHODS: Clinical examination, chest X-ray data, history of exposure to nickel in the presence of carbon monoxide (CO) from a production plant that was located close to the reactor containing nickel, led to diagnosis of respiratory distress due occupational poisoning. RESULTS: Patient history, clinical symptoms that were characteristic of Ni(CO)4 poisoning: mild transient initial symptoms followed within 24 hours by more severe life-threatening events environmental data, history of exposure to nickel near a carbon monoxide (CO) production plant that was located close to the nickel containing reactor, indicated a putative causal relationship between diagnosis and exposure to nickel tetracarbonyl. CONCLUSIONS: The accident that without adequate respiratory therapy might have had fatal consequences, could have been avoided if the rules of technical and procedural prevention had been carefully observed.

Accidents, Occupational↗
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Action of glucomannans on complaints in patients affected with chronic constipation: a multicentric clinical evaluation.

Chronic constipation is a very frequent disease in western countries but fibres can often solve the problem. In the present study, authors tested the efficacy and the acceptability of glucomannans, hydrophylic carbohydrates with a high degree of viscosity, in 93 patients affected with chronic constipation. The multicentric, open and non-controlled study was divided into an initial phase (treatment with 1g of glucomannans t.i.d. for 1 month) and a maintenance phase (1g b.i.d. for one month). We evaluated both objective parameters (number of days per week with bowel movements and number of enemas) and abdominal symptoms. After one month all assessed parameters showed a statistically significant improvement lasting through the second month. Glucomannans were well accepted and devoid of relevant side-effects. In conclusion, considering their efficacy and tolerability, they can be proposed as an ideal therapeutic tool in the management of chronic constipation symptoms.

Adult↗
PubMedDate not supplied

[In vitro antibacterial activity of neomycin, bacitracin and a combination of both].

Bacitracin and neomycin have been used for a long time for local intestinal antisepsis or decontamination, due to their scarce or nonexistent intestinal absorption. The aim of the present study was to determine the activity of bacitracin and neomycin against recent clinical isolates of aerobic and anaerobic microorganisms and to verify their capacity to have a synergistic effect and to prevent the emergence of bacterial resistance when in combination. The results showed that the activity of either antibiotic against recent clinical isolates (even if resistant to cephalosporins and aminoglycosides) is similar to that originally displayed at the time introduction in therapy. Generally the combination of the two antibiotics showed a synergistic or additive effect and prevented the selection of resistant strains.

Bacitracin↗
PubMedDate not supplied

Discrepancies in birth weights between hospital records and health department data for low birth weight infants in New York City.

The study is one of the first to compare corresponding birth weights documented on New York City Health Department Vital Statistics (HDVS) birth tapes and the neonatal medical records of the hospital of birth. Only those infants with birth weights of 2,500 grams (g) or less were studied. Analyses were made of the scope, magnitude of error, and direction of the discrepancies observed. Concordance was considered present if the discrepancy in birth weight was 30 g or less. HDVS birth tapes and the hospital charts of 3,864 neonates were reviewed. The study population came from 48 of 53 hospitals in the metropolitan area. Hospitals were divided into three categories by the level of care offered. Each level of care was subdivided into groups by type of hospital ownership, that is, proprietary, voluntary, and municipal. Concordance was 87 percent overall and ranged from 67 to 96 percent among the study hospitals. More discrepancies were found for levels II and III hospitals than in level I hospitals, those with less sophisticated resources. Municipal hospitals had more discrepancies in birth weights than voluntary hospitals. Infants who had been transported from the birth facility to another facility had significantly higher concordance rates than the nontransported infants, after adjusting for levels of care, type of ownership of the hospital, and birth weight categories. Increased concordance rates were shown to be associated with increased birth weights.

Birth Weight↗