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Biomedical subjects

S Esposito

Publications and source records attributed to S Esposito.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Clinical comparison of cefaclor twice daily versus amoxicillin-clavulanate or erythromycin three times daily in the treatment of patients with streptococcal pharyngitis.

The present study was undertaken to compare the efficacy and safety of a new regimen of cefaclor (25 mg/kg BID) with amoxicillin-clavulanate and erythromycin TID at standard doses for the treatment of pediatric patients with acute pharyngotonsillitis (APT). A total of 673 children (age range, 2 to 12 years) with signs and symptoms of APT were enrolled; 245 of these children who had a positive throat culture for group A beta-hemolytic streptococci (GABHS) entered the study and were randomly assigned to receive cefaclor 25 mg/kg BID, amoxicillin-clavulanate 15 mg/kg TID, or erythromycin 15 mg/kg TID. A 10-day antibiotic course was prescribed for each patient. Clinical and bacteriologic responses were assessed at the end of treatment (day 10) and at the follow-up visit (day 30). All GABHS strains isolated from throat cultures were tested for in vitro sensitivity to the antibiotics used in the study. Side effects (mainly nausea) were rare and mild in each group and did not require discontinuation of therapy. No GABHS strain was resistant to cefaclor or to amoxicillin-clavulanate; 37.9% of the strains were resistant to erythromycin. The results indicated that cefaclor given BID seems to be as effective as amoxicillin-clavulanate given TID (cure rate, 91.9% and 90.5%, respectively) and more effective than erythromycin given TID (cure rate, 76.8%) for the treatment of patients with APT. Erythromycin resistance among GABHS is an emerging problem in many geographic areas.

Amoxicillin-Potassium Clavulanate Combination↗
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Ultrastructural pathology of pediatric myocardium in acute ischemia: bioptic study before and after treatment with cardioplegic solution.

Protecting the myocardium from the risk of acute ischemia during heart surgery is still an unsolved problem; the problem is even more open and more pressing in pediatric heart surgery. To meet this greater risk it is advisable to use a cardioplegic solution with a composition that is better suited to the particular morphofunctional conditions of the myocardium in the child, i.e., a solution offering greater protection. To this purpose the authors experimented with Celsior cardioplegic solution during heart surgery in children to evaluate the efficacy compared to the standard St. Thomas solution. In this comparative study 15 children were treated with Celsior cardioplegic solution and 15 others with St. Thomas cardioplegic solution. Each patient underwent 2 biopsies of the myocardium, the first before cardioplegic treatment and the second immediately after reperfusion. In both groups, focal lesions involving both the cardiomyocytes and the vascular-stromal structures were randomly found. The former had undergone a necrotic-regressive process with changes in the myofibrils and the mitochondria. The vascular-stromal structures showed changes in the permeability of the capillary endothelia, with interstitial edema. The results show the lesions to be similar in the 2 groups both on a quality and quantitative level.

Capillary Permeability↗
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Erythromycin resistance in group A beta hemolytic streptococcus.

The incidence of erythromycin resistance and the phenotypic pattern of resistance have been studied in 130 group A beta-hemolytic streptococcus (GABHS) strains, isolated from throat swab obtained in children affected by acute pharyngotonsillitis. A total of 56 (43%) GABHS strains of 130 were resistant to erythromycin. Among these 56 strains, we found that 7 (12.5%), 18 (32.1%) and 31 (55.3%) showed the cMLS, iMLS and M phenotype, respectively. The iMLS and M phenotypes appear to be the most widely represented ones. Their low level of resistance to macrolides could allow the use of the more recent macrolides characterized by higher tissue concentration which could overcome such a resistance.

Anti-Bacterial Agents↗
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In vitro activity of moxifloxacin compared to other fluoroquinolones against different erythromycin-resistant phenotypes of group A beta-hemolytic streptococcus.

The aim of the present study was to evaluate the in vitro activity of moxifloxacin (BAY 12-8039) compared to ciprofloxacin, ofloxacin and sparfloxacin against 156 group A beta-hemolytic Streptococcus strains. Sixty strains were macrolide-, lincosamide- and streptogramin-B-susceptible; 16 strains exhibited a constitutive resistance phenotype; 32 strains exhibited an inducible phenotype, and 48 strains were characterized by the M-type efflux-dependent phenotype. The minimum inhibition concentrations were determined by an agar dilution method according to NCCLS-approved guidelines. Moxifloxacin showed an enhanced activity compared with the other fluoroquinolones against the different macrolide-resistant phenotypes.

Anti-Bacterial Agents↗
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Comparative in vitro activity of older and newer fluoroquinolones against respiratory tract pathogens.

The aim of this study was to evaluate the antibacterial activity of older (ciprofloxacin and ofloxacin) and newer (moxifloxacin, grepafloxacin, sparfloxacin and levofloxacin) fluoroquinolones. Minimal inhibitory concentrations (MICs) were determined, according to the NCCLS guidelines, against the following respiratory tract pathogens: penicillin-susceptible and -resistant Streptococcus pneumoniae, beta-lactamase-positive and beta-lactamase-negative Haemophilus influenzae and beta-lactamase-positive Moraxella catarrhalis. In addition, we evaluated the minimal bactericidal concentrations of the same antibiotics against all the pneumococci and the haemophili. Finally, the activity of ciprofloxacin, ofloxacin, sparfloxacin and moxifloxacin against 15 pneumococci were investigated by time-kill analysis. All fluoroquinolones tested exhibited a similar, good activity against H. influenzae and M. catarrhalis. Against S. pneumoniae, irrespective of penicillin susceptibility, moxifloxacin, grepafloxacin, sparfloxacin and levofloxacin exhibited excellent activity, better than ciprofloxacin and ofloxacin. Time-kill analysis showed that 99.9% killing of all strains was obtained after 24 h with moxifloxacin at 2 x MIC, whereas other antimicrobials obtained similar results at 4 x MIC. Moxifloxacin is characterized by an improved activity against respiratory pathogens, including penicillin-resistant and -susceptible S. pneumoniae. Its activity is not influenced by beta-lactamase production. These results suggest that moxifloxacin represents a promising alternative for treatment of respiratory tract infections.

Anti-Infective Agents↗
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Activity of moxifloxacin and twelve other antimicrobial agents against 216 clinical isolates of Streptococcus pneumoniae.

BACKGROUND: An increased incidence of macrolide resistance in penicillin-resistant Streptococcus pneumoniae has been described. METHODS: With this in mind, 216 S. pneumoniae isolates were evaluated for their in vitro susceptibility to a new fluoroquinolone, moxifloxacin, which was compared with penicillin, amoxicillin, cefuroxime, cefotaxime, ceftriaxone, erythromycin, clarithromycin, ciprofloxacin, sparfloxacin, ofloxacin, vancomycin and teicoplanin. A broth microdilution assay was performed in cation- adjusted Mueller-Hinton broth with 5% (v/v) lysed horse blood according to NCCLS guidelines. RESULTS: Erythromycin resistance was observed in all the 22 penicillin-resistant S. pneumoniae (10.1%). All the penicillin- susceptible S. pneumoniae were susceptible to cephalosporins, whereas all the penicillin-resistant ones showed resistance to cefuroxime and only intermediate susceptibility to cefotaxime and ceftriaxone. The 216 tested strains were inhibited by sparfloxacin and moxifloxacin at concentrations of 0.12-0.5 mg/l and 0.06-0.25 mg/l, respectively, regardlesss of whether the strain was penicillin and/or erythromycin resistant. Seven penicillin-resistant strains displayed resistance to ofloxacin. All isolates were susceptible to vancomycin; teicoplanin MIC values ranged from 0.03 to 0.12 mg/l. The excellent in vitro activity of moxifloxacin against S. pneumoniae was not affected by penicillin and/or macrolides. CONCLUSION: Moxifloxacin appears to be a promising choice for the treatment of pneumococcal infections, including situations where therapeutic choices are limited due to penicillin and macrolide resistance.

Amoxicillin↗
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Gene expression and morphological changes in surgically injured carotids of spontaneously hypertensive rats.

The expression profiles of genes involved in cell proliferation, differentiation and programmed death were investigated in carotids of spontaneously hypertensive rats (SHR) treated with a model of surgical injury that mimics events occurring during arterial grafts, endarterectomy and organ transplantation. The mRNA level of the c-myc, angiotensin II receptor 1 (AT1), Rb/p105, Rb2/p130, Bcl-2 and Bax-alpha genes was assessed by a semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) technique at different times up to 48 h after injury, while the morphological changes were evaluated 30 days after injury. The proliferation marker c-myc increases almost immediately, peaks after 4 h and returns to basal levels after 24 h; the AT1 receptor mRNA reaches its maximal level 48 h after injury. The level of cell cycle exit markers Rb/p105 and Rb2/p130 gradually decreases after injury. The apoptosis marker Bcl-2/Bax-alpha ratio shows a significant reduction only 4 h after injury, resuming the initial value after 24 and 48 h. Morphological analysis reveals that surgical injury in SHR induces adventitial and medial constrictive remodeling changes rather than intima proliferation as in balloon angioplasty. Both molecular and histological data show substantial differences with respect to normotensive rats.

Animals↗
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[Epidemiology of meningitis, pneumonia and acute otitis due to Streptococcus pneumoniae in pediatric in Italy].

Streptococcus pneumoniae is one of the most important bacterial pathogens in pediatrics, both from a quantitative and from a qualitative point of view. It can cause severe diseases such as occult bacteremia, sepsis, meningitis and it is also involved in the determination of a relevant part of very common illnesses such as pneumonia, acute otitis media and rhinosinusitis. However, most of the data regarding the epidemiology of pneumococcal infections in pediatrics have been collected in the U.S.A. and in other industrialized Countries different from Italy. In Italy only studies concerning meningitis and the carrier state of pneumococcus are at the moment available. They indicate that also in Italy S. pneumoniae seems to play a significant role in the determination of several pediatric diseases and that quite similar are the group of serotypes mainly involved in the determination of both invasive and not invasive diseases.

Child↗
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[Efficacy of the heptavalent pneumococcal vaccine against meningitis, pneumonia and acute otitis media in pediatric age. Theoretical coverage offered by the heptavalent conjugate vaccine in Italy].

All the clinical trials carried out to evaluate the heptavalent pneumococcal conjugate vaccine have clearly demonstrated that it is safe, well tolerated and, despite some differences in the different diseases, effective in the prevention of all the pneumococcal illnesses. Considering that the available data demonstrate that the serotypes involved in the determination of pneumococcal diseases are, in Italy, the same found in the U.S.A. where the vaccine has been formulated, it is reasonable to think that it will be very effective also in our country. We hope that this vaccine can be systematically prescribed also in Italy: this could permit to reduce the number of both common and severe pneumococcal diseases at the moment largely present among italian children.

Acute Disease↗
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Aneurysms of azygous anterior cerebral artery. Report of two cases treated by surgery.

The occurrence of a so called azygous anomaly of the distal ACA, consisting in a single branch, is rare. Authors report two cases of azygous aneurysm on which surgery was performed successfully, and describe their angiographic characteristics, the frequent association of an aneurysm with azygous and the morphological anomalies of azygous. A literature review is made.

Adult↗
PubMedDate not supplied

Microsurgical DREZ-lesion in the treatment of deafferentation pain.

The lesion of the dorsal root entry zone (DREZL) of the spinal cord, recently introduced by Nashold and performed with radiofrequency or with laser, may be carried out with a microsurgical technique. Since 1978 up 1982 we have treated a series of 12 patients suffering from Pancoast's syndrome with a C8-T2 selective posterior rhizotomy (SPR). It has been observed that every deafferentative aspect of the pain was completely relieved. Such effect on the deafferentative aspect of the pain was most probably due to a lesion on the perforating vessels feeding the posterior grey horn. The lesion of this structure was therefore ischemic and this operation had to be indicate for the treatment of such pain. A series of 8 patients, suffering from cancer pain projected to anaesthetic areas, and 2 patients with benign post-thoracotomy pain, underwent to microsurgical DREZ lesion. The relief from pain was complete and no complications concerning pyramidal or posterior pathways involvement was observed. Preliminary good results suggest that a more selective lesion is possible with the microsurgical DREZ. It should be interesting a comparison between more large series of microsurgical DREZL and the more tested radiofrequency lesion.

Adult↗
PubMedDate not supplied

Enterogenous cyst of the spinal cord terminal cone. Clinical and radiological aspects (CT and MRI).

Enterogeneous cyst of the spinal cord are rare. They are the result of a dysembriogenetic error occurred in the third week of the embryo life. The cervical tract, followed by the caudal tract of the spinal cord, are their favourite sites. This work describes a case of neuroenteric cyst localized in the terminal cone of the spinal cord; CT and myelographic findings point to a generic cystic lesion; MR shows a sharp edge lesion, hypointense at T1 and hyperintense at T2, with signal uniformity similar to C.S.F. MR also allows the evaluation of any CSF pulsation in the cystic lesion and, in the presence of a cystic neoplasm, any signal changes in the adjacent parenchyma.

Cysts↗