Antimicrobial potential of Sicilian honeys against commensal Escherichia coli and pathogenic Salmonella serovar infantis.

INTRODUCTION: The purpose of this study was to investigate the antibacterial effect of 71 locally produced honeys from different botanical sources collected from apiarist's open markets in Sicily. METHODS: Antimicrobial activity was determined against Escherichia coli (ATCC 25922) and Salmonella serovar Infantis (ATCC 1523) by an agar-diffusion assay from the estimation of the diameter of the inhibition zone produced by the honeys. Statistically) significant differences (P < .000) regarding inhibition were observed for the honeys tested. RESULTS: The chestnut and polyfloral honey samples exhibited the largest and highest inhibition (diameter of the inhibition zone > 25 mm) against both E. coli and S. Infantis. The honey of oregano origin showed intermediate or low activity against E. coli and S. Infantis, respectively. Prickly pear and erica honeys showed no antimicrobial activity against the two reference strains. DISCUSSION: The results may partially suggest the usefulness of the Sicilian honeys on treating multi-resistant enterobacteria. In light of the enormous potential for application of honey in the clinical practice, it is important that research continues not only into those honeys well recognized as antimicrobial, but also into other locally produced and yet untested honeys.

[Retained rectal foreign bodies by trans-anal introduction. Case report]. / Corpi estranei endorettali introdotti per via anale. Case report.

The Authors refer about two cases of retained rectal foreign bodies by trans-anal introduction as consequence of anal eroticism: a deodorant aerosol-can cap and a sizeable phallic object. These reports represent an occasion to talk about the etiology (the wide variety of foreign bodies) and the motivations (eroticism or sadism, clumsy diagnostic and therapeutic procedures, true or presume accidents) responsible for this pathological condition and to consider every therapeutic options employed during the past years, without forgetting that, despite difficulties, non-surgical extraction is to prefer, if possible, because of the negative prognostic implications often related to the surgical treatment. The Authors finally confirm, because of the severity of this pathological condition - with negative outcomes especially in that cases with complete or incomplete perforative complications (produced during introduction through the anus or during several attempts of extraction of the object or caused by its long staying in the rectum because of the patient's denial of medical care) - the surgeons can't put aside possible indication for surgical treatment.

[Acute abdomen due to jejunal perforation secondary to metastatic lung carcinoma]. / Addome acuto da perforazione di metastasi digiunale di carcinoma polmonare operato.

INTRODUCTION: Lung cancer metastases of small bowel are rare (1,1%), often with few or not symptoms. This aspecific onset and the difficult physical-instrumental approach to small bowel, led often to diagnosis at autopsy. This is not true for intestinal metastases that cause complications (haemorrhage, obstruction, perforation); in this cases emergency surgery leds to the diagnosis. CASE REPORT: We describe a case of a male 56 years old patient with acute abdomen due to perforation (X-ray and CT). He refers, about 6 months before, an upper right lobectomy for lung cancer, followed by adjuvant chemo-radiotherapy, because the presence of brain and bone metastases. During the emergency surgery we found out a perforation of the Treitz tract, treated with intestinal resection and immediate end-to-end anastomosis with manual suture. Histological examination shows the perforation of the intestinal wall tract with lung cancer metastases. CONCLUSIONS: Our case shows that any acute abdomen in patient with lung cancer can be considered as expression of intestinal metastases. Negative prognosis of this complication imposes to surgeons only a local treatment.

[Gastrointestinal stromal tumors (GISTs). Personal experience on three cases of the tumors of the small intestine complicated and emergency surgically treated]. / I tumori stromali gastrointestinali (GIST). Esperienza personale su tre casi a localizzazione nel tenue mesenteriale trattati in urgenza.

INTRODUCTION: GISTs, a new nosological entity recently described, represent a peculiar model of solid tumor: the identification of the molecular mechanism responsible for the oncogenesis led to the development of a new drug (imatinib) active on the specific molecular target, represented by the product of the mutated proto-oncogene c-kit which is a tyrosine kinase receptor that becomes constitutively active by mutation. Surgical resection, nevertheless, is still the primary treatment and it has to be as complete as possible. These two treatments can be integrated. GISTs are not uniformly kit-positive, and they can be alternatively due to mutations of the PDGFRA gene or, in patients with neurofibromatosis type 1 (NF-1), to generally isolated mutations of the NF-1 gene. PATIENTS AND METHODS: We describe 3 cases of kit-positive GISTs of the small intestine (SISTs), complicated and emergency surgically treated: case 1--53 years, female, with small bowel obstruction and concomitant acute intestinal bleeding; case 2--71 years, male, with NF-1 and acute intestinal bleeding; case 3--47 years, male, with perforation of the Treitz tract. The first two cases have been treated with intestinal resection and immediate mechanical anastomosis; the third one with resection of the pedunculated tumor at its base, where is situated the perforation too. CONCLUSIONS: SISTs (20-30%), with little or no symptoms in the initial phases, show notable diagnostic difficulties. Their aspecific and late clinical presentation--typical of this site and of the pathology that we are talking about--and the difficult physical-instrumental approach to small bowel limit the possibility of an accurate diagnosis and expose the patient to potentially fatal acute complications and to risks related to emergency surgery treatment that decreases the possibility of a radical resection.

Plasmid-mediated multiple antibiotic resistance of Escherichia coli in crude and treated wastewater used in agriculture.

A total of 273 Escherichia coli isolates from raw and treated municipal wastewaters were investigated to evaluate the frequency and persistence of antibiotic resistance and to detect the occurrence of conjugative R plasmids and integrons. The highest resistance rates were against ampicillin (22.71%), tetracycline (19.41%), sulfamethoxazole (16.84%) and streptomycin (14.28%). Multiple antibiotic resistance was present in 24.17% of the isolates. Several multiple antibiotic-resistant isolates proved to be able to transfer en bloc their resistance patterns by conjugative R plasmids with different molecular sizes and restriction profiles. Class 1 integrons of 1 or 1.5 kbp were found in 5 out of 24 representative multiresistant E. coli isolates. Although wastewater treatments proved to be effective in eliminating Salmonella spp. and in reaching WHO microbiological standards for safe use of wastewater in agriculture, they were ineffective in reducing significantly the frequency of plasmid-mediated multiple antibiotic resistance in surviving E. coli. Since multiple antibiotic-resistant bacteria carrying integrons and conjugative R plasmids can constitute a reservoir of antibiotic-resistance genes in wastewater reclaimed for irrigation, risks for public health should be considered. Bacterial strains carrying R plasmids and integrons could contaminate crops irrigated with reclaimed wastewater and transfer their resistances to the consumers' intestinal bacteria.

[Management of perforations as adverse events of ERCP plus ES. Personal experience]. / Trattamento degli eventi perforativi post-colangiopancreatografia retrograda con sfinterotomia endoscopica. Esperienza personale.

UNLABELLED: INTRODUCTION. ERCP has brought real progress in the study and treatment of pancreatic and biliary diseases, because of its ambivalence as diagnostic and therapeutic procedure. Among its complications, perforations occur in fewer than 1% of patients, but are associated with a mortality rate of 16% -18%. CASE REPORTS: CASE 1- F, 89 years old with obstructive jaundice by choledocholithiasis submitted to ERCP plus ES, during which occurs type II lesion; the partial removing of stones from choledochus during the procedure allow us to opt for a conservative treatment, with resolution on post-ERCP day 12. CASE 2- F, 53 years old with recurring cholangitis and post-cholecystectomy stenosis of choledochus already treated by stenting; for the occurrence of type I lesion during ERCP, the patient undergoes surgery in emergency with healing in postoperative day 23. CASE 3- M, 84 years old with lithiasic cholecystitis, obstructive jaundice, lung emphysema and ischemic heart disease; after percutaneous cholecystostomy in emergency, we attempt to ERCP with evidence of type I lesion. Because of comorbility, we opt for a conservative treatment, not resolving, and then proceed to surgery. Exitus for cardio-respiratory complications. CASE 4- M, 89 years old with obstructive jaundice; ERCP is suspended for respiratory complications and then a PTC is perform; during it we note a type IV lesion, which is treated conservatively with resignation in day 12. CASE 5- F, 68 years old with cholecystitis and choledocholithiasis; during ERCP plus SE a type II lesion occurs with worsening signs of acute abdomen. Because of clinical conditions and the impossibility of carrying out stones from choledochus by endoscopy, we opt for a surgical treatment in emergency. Exitus for respiratory complications. DISCUSSION: Because of the controversy exists on what should be the management of perforations as adverse events of ERCP plus ES (immediate surgery or conservative therapy), we can only hope an eclectic approach based on the anatomical and clinical peculiarity of each case.

Persistent oral and urinary Candida spp. carriage in Italian HIV-seropositive asymptomatic subjects.

The aim of the present study was to ascertain frequency and persistence of Candida spp. oral and urinary carriage in asymptomatic, HAART-naive HIV-seropositive subjects who had not undergone therapy with antimycotic drugs, and whose CD4+ lymphocyte count was greater than 200/microl. Oral carriage was the most common Candida spp. carriage (63.0% of the subjects), while candiduria was more rarely observed (6.5%). C. albicans was recovered from the majority of the subjects examined (56.5%), followed by C. krusey (4.3%), C. tropicalis (2.2%) and C. dubliniensis (2.2%). C. albicans was also isolated from two urinary carriers (4.3%) and C. glabrata from another one (2.2%). The same C. albicans clone was repeatedly isolated from 14 out of 15 oral carriers while the same clone of C. dubliniensis was repeatedly isolated from one carrier, as shown by the persistence of RAPD fingerprint of serial isolates during one year of follow-up. Since persistence of Candida spp. carriage may influence the development of clinical candidiasis in immunocompromised hosts, monitoring of the carrier status could be useful for preventing clinical thrush in HIV-seropositive subjects.

[Legionella contamination in the hospital environment: monitoring of the hot water distribution systems of three hospitals in Catania (Italy)]. / La contaminazione da legionelle in ambiente ospedaliero. Risultati del monitoraggio delle reti di distribuzione dell'acqua calda in una Azienda ospedaliera.

This study evaluated the presence and extent of contamination with Legionella spp. in the hot water distribution systems of three hospitals in Catania (Italy). In total, 291 hot water samples were collected between September 2002 and August 2005 and these were examined in order to monitor the hospital distribution systems and evaluate the efficacy of decontamination measures. L. pneumophila was detected at variable concentrations up to over 10000 UFC/L at several collection sites in some hospital buildings and branches of the water distribution system while other buildings/branches were found to be free of contamination. The most frequently isolated serogroup was L. pneumophila serogroup 3, occasionally associated with serogroups 4, 5 and 6. Molecular typing of Legionella strains by pulsed-field gel electrophoresis of genomic DNA restriction fragments identified four different genotypes, each recovered from a different branch of the distribution system. Decontamination procedures, including shock hyperchloration and two different thermal shock methods, performed between October 2003 and August 2005, led to only temporary reductions in contamination. In fact, previous concentrations of the same L. pneumophila serogroup were found within 3 to 8 months of decontamination. In order to prevent and monitor Legionella infections, sterilizing filters were installed in water taps of all wards with high-risk patients and urinary antigen testing was performed on all patients diagnosed with nosocomial pneumonia. No cases of Legionella pneumonia were identified in 2005.

[Use of naltrexone in the treatment of opiate addicts. Efficacy and indications for type categories]. / L'utilizzo del naltrexone nella terapia delle tossicodipendenze da oppiacei. Efficacia ed indicazioni per categorie tipologiche.

Naltrexone is a pure narcotic antagonist with optimum pharmacologic properties for the long-term management of opiate addiction. The above study confirms the usefulness of naltrexone for the prevention of relapse in subjects who have been weaned from narcotics. However, the short follow up does not yet permit evaluation of its medium and long-term efficacy. The better course and outcome of treatment are significantly related to certain characteristics and types of addicts. It may be said that by assuring complete, albeit time-limited, remission the antagonist allows the addict to open a window through which to face the world, and offers the therapist the possibility to apply all the instruments at his disposal in an effective manner.

[Folate and vitamin B12 deficiency. Characterization of parameters for early diagnosis]. / Deficit di folati e vitamina B12. Individuazione di parametri per la diagnosi precoce.

True vitamin B12/folate deficiency is more common than is currently appreciated; it appears in many guises and the classic hematological features of megaloblastic anaemia are often absent. The single most reliable predictor of megaloblastic anaemia is serum vitamin B12/folate concentration, but this determination in a screening program for all patients is difficult in terms of laboratory overload and cost. Early recognition of nutritional anaemias is, however, mandatory and we undertook this study to explore the possibility of identifying, on a demographic basis or because of routine laboratory results, a group of subjects at risk for vitamin B12/folate deficiency. Results obtained in simultaneous radioassay of serum B12 and folate levels and erythrocyte folate concentration in 1.200 hospitalized patients are presented. Coexisting iron deficiency was excluded by ferritin assay. We found no significant difference between males and females and no correlation between serum folate and B12 concentrations and aging. Low serum folic and cobalamin levels were found in 53% of patients with macrocytosis and elevated MCH, even in the absence of anaemia. These observations suggest that increased MCV and MCH may be present before a related anaemia and that serum folate and cobalamin levels must be monitored early in these patients to prevent a deficiency.

[Active immunoprophylaxis of type B viral hepatitis. Evaluation of the effectiveness of HEVAC-B vaccine in a population at risk]. / Immunoprofilassi attiva dell'epatite virale di tipo B. Valutazione dell'efficacia del vaccino HEVAC-B in una popolazione a rischio.

Hepatitis B virus (HBV) is the commonest cause of liver disease world-wide, with an estimated 200 million chronically infected individuals. The prevalence of HBV is particularly high in parts of Africa, Far East and South-East Asia. The worldwide distribution of HBV infection with the consequence of chronic liver disease and primary hepatocellular carcinoma implies the need for an efficient and safe vaccine. Three vaccines are today available: HB-VAX (M.S.D.), HEVAC-B (Ist. Pasteur, Paris) and Engerix-B (Smith-Kline Biological) and the first international experience proves that they are harmless, immunogenic and protective. The possibility of eliminating hepatitis B depends on mass vaccination in the high carrier areas of the third world and this in turn depends on supplies of inexpensive vaccine. The present work reports results obtained in Italy in 16 volunteers with high risk, who received HEVAC-B vaccine. Blood samples of the subjects were also tested for HBSAg/IgM complexes.

[Rheumatoid arthritis. Considerations on a rational therapeutic strategy]. / Artrite reumatoide. Considerazioni per una razionale strategia terapeutica.

Rheumatoid Arthritis (RA) is a progressive disease of unknown aetiology which may be caused by faulty immune mechanisms. Early diagnosis and correct treatment can be extremely effective. Fast and lasting results can only be obtained by an appropriate combination of NSAID and DMARD drugs which both reduce subjective symptoms and halt the progression of the disease.

[Idiopathic adult pulmonary hemosiderosis: a new etiopathogenetic hypothesis]. / Emosiderosi polmonare idiopatica dell'adulto: una nuova ipotesi eziopatogenetica.

IPH is an uncommon disease affecting mainly children and adults and has usually a poor prognosis. The basic pathogenesis of the disorder is unknown; many theories have been advanced, but none is proved. A case of IPH in a 35 years old male presenting the atypical feature of a myeloperoxidase deficiency is reported. This unusual feature may be compatible with a generalized redox systems deficiency, which leads, via an impaired flow of iron into alveolar macrophages, to the pulmonary fibrosis.