Detection of venous gas emboli after repetitive breath-hold dives: case report.

INTRODUCTION: Neurological symptoms after breathhold (BH) diving are often referred to as "Taravana" and considered a form of decompression sickness. However, the presence of "high" gas embolism after BH diving has never been clearly shown. This study showed high bubble formation after BH diving. MATERIALS and METHODS: We performed transthoracic echocardiography on a 53-year-old male spearfishing diver (180 cm; 80 kg; BMI 24.7) 15 minutes before diving and at 15-minute intervals for 90 minutes after diving in a 42-meter-deep pool. Number of dives, bottom time and surface intervals were freely determined by the diver. Dive profiles were digitally recorded for depth, time and surface interval, using a freediving computer. Relative surface interval (surface interval/diving time) and gradient factor were calculated. REULTS: High bubble grades were found in all the recorded echocardiograms. From the first to third recording (45 minutes), Grade 4 Eftedal-Brubakk (EB) bubbles were observed. The 60-, 75- and 90-minute recordings showed a reduction to Grades 3, 2 and 1 EB. Mean calculated GF for every BH dive was 0.22; maximum GF after the last dive was 0.33. CONCLUSIONS: High bubble grades can occur in BH diving, as confirmed by echocardiographic investigation. Ordinary methods to predict inert gas supersaturation may not able to predict Taravana cases.

Josephson effect in MgB(2) break junctions.

We present the first observation of the dc and ac Josephson effect in MgB(2) break junctions. The junctions, obtained at 4.2 K in high-quality, high-density polycrystalline metallic MgB(2) samples, show a nonhysteretic dc Josephson effect. By irradiating the junctions with microwaves we observe clear Shapiro steps spaced by the ideal Delta V value. The temperature dependence of the dc Josephson current and the dependence of the height of the steps on the microwave power are obtained. These results directly prove the existence of pairs with charge 2e in MgB(2) and give evidence of the superconductor-normal metal-superconductor weak link character of these junctions.

Use of branched chain amino acids for treating hepatic encephalopathy: clinical experiences.

The efficacy of branched chain amino acids in two consecutive clinical studies in patients with severe hepatic encephalopathy was tested. In the preliminary uncontrolled study 19 patients with grade 3-4 hepatic encephalopathy were given an intravenous solution containing leucine 11 g/l, isoleucine 9 g/l, and valine 8.4 g/l in 20% dextrose. A complete recovery of mental state was obtained in all patients in a mean time of 20.5 hours. In a subsequent controlled study 40 patients with grade 3-4 hepatic encephalopathy were randomly assigned to receive intravenous branched chain amino acid in 20% dextrose (group A) or oral lactulose (group B). Twelve patients (70.6%) in group A and eight (47%) in group B regained consciousness in a mean time of 27.6 and 31.5 hours, respectively. The difference in the recovery rate between the two groups, although evident, was not significant. Intravenous branched chain amino acids are thus at least as effective as lactulose in reversing hepatic coma. These data argue strongly in favour of a therapeutic effect of branched chain amino acids in the treatment of hepatic encephalopathy in patients with chronic liver failure.

Chronic neutrophilic leukemia and myeloma. Report on long survival.

A case of chronic neutrophilic leukemia associated with multiple myeloma is described. The patient appears to be the longest surviving case reported in the literature. Since myeloma developed several years after leukemia, the possible precancerous role of myeloproliferative syndromes is proposed.

Preliminary results of immune response to hepatitis B (HB) vaccine (Pasteur) in adults.

Antibody responses were estimated in 42 healthy high risk volunteers submitted to three monthly intradeltoid inoculations of a 5 micrograms HBs vaccine containing both subtypes adw and ayw. The presence and concentration of anti-HBs varied according to individual responses and the number of injections. One month after the 1st dose those responding numbered 19%, one month after the 2nd the number rose to 83,3%, and reached 100% one month after the 3rd dose. In a few cases antibody levels were low (less than or equal to 50 mIU/ml), while in most subjects they rose after the 2nd dose, reaching high titres. Concordance and comparability of anti-HBs concentration were achieved by three different measurements (S/N, RIA Units, mIU/ml). No important side effects were observed. The timing of booster doses is discussed.

Cephalothin, cefoxitin, or metronidazole in elective colonic surgery? A single-blind randomized trial.

A randomized controlled trial aimed at comparing the individual efficacy of cephalothin, cefoxitin, and metronidazole in the prevention of postoperative wound infection was performed among 74 colorectal surgical patients. Of 28 patients on cephalothin, seven (25 per cent) developed a postoperative infection, but among 23 patients in each of the other two groups, only one (4 per cent) in each group became infected. These results confirm the primary importance of anaerobes in the causation of postoperative sepsis after colorectal surgery.

Branched-chain amino acids vs lactulose in the treatment of hepatic coma: a controlled study.

A controlled study was carried out in two groups of 20 patients with cirrhosis of the liver and deep coma in order to compare the efficacy of intravenous branched-chain amino acid solutions in 20% glucose (group A) vs lactulose plus glucose in isocaloric amount (group B). There were 3 drop-outs from each group. Plasma amino acids and ammonia were assayed at fixed intervals throughout the 10-day observation period. Routine tests were assayed daily. Complete mental recovery was obtained in 70% of patients in group A and in 47% in group B. The difference was not significant, likely due to the lack of placebo group. With the exception of free tryptophan/all competing amino acids ratio, the modifications in plasma amino acid levels showed no correlation with the clinical course under either treatment. Ammonia, like free tryptophan, decreased significantly upon mental recovery, paralleling the clinical course throughout the study. In conclusion, branched-chain amino acids are at least as effective as lactulose in deep hepatic coma. It is suggested that branched-chain amino acids may reverse coma either by competing with brain entry of the aromatic amino acid or by metabolically decreasing free tryptophan and ammonia.

IgA deficiency and circulating immune complexes in Neapolitan children with fatal acute respiratory infections.

Immunoglobulins, C3 and C4 levels and circulating immune complexes have been measured on admission sera from 34 children admitted to a Naples hospital during the winter of 1978/79 with severe, usually fatal, acute respiratory infections and in age-matched controls from Rome. The Naples sera were characterised by low IgA, C3, and C4 levels, increased IgM and IgG concentrations, and high titres of circulating immune complexes. These immunological abnormalities could explain the high concentration of fatal cases.

[Approaches to antibiotic therapy in anaerobic infections]. / Indirizzi di antibioticoterapia nelle infezioni anaerobie.

After a short introduction pointing out the difficulties faced by an italian clinician when he has to apply a correct aetiologic therapy to the non-sporing anaerobe infections, difficulties which are especially due to the lack of an efficient microbiologic support, the A. examines the main infections caused by these bacteria and shows the treatment for each case according to the more recent literature and to his own experience.

Excess mortality from influenza in a large urban population, Rome, Italy, 1956--76.

Influenza activity was studied in the Rome population from 1956 to 1976 by analysis of mortality from respiratory causes and from all causes. During cold weather months, type A influenza virus was associated, as a rule, with epidemic excess deaths at two year intervals while type B virus was prevalent twice during isolation data were also compared with epidemic excess mortality during four consecutive years. The evidence obtained indicated that influenza virus isolation alone does not represent a reliable index of epidemic influenza activity in this population. The proportion of deaths attributed to respiratory causes consistently increased in every epidemic, the most pronounced increases occurring during large epidemics. The break-down by age of deaths from respiratory causes in the course of two epidemic periods showed that the percentage distribution of deaths was essentially the same as in non-epidemic periods. This evidence indicates that the same factors influencing the age-related distribution of mortality from respiratory causes during non-epidemic periods, probably affect the fatal outcome of influenza during epidemics.

Synergistic treatment of enterococcal endocarditis: in vitro and in vivo studies.

Combinations of penicillin G sodium or ampicillin plus streptomycin sulfate do not produce synergism against all strains of enterococci. This lack of synergism was considered the cause of the failure in the treatment of enterococcal endocarditis. The effect of various combinations of antibiotics on 15 enterococcus strains, which had been isolated from patients with enterococcal endocarditis, was examined. The antibiotics included those that interfere with cell-wall synthesis and those that act on cell metabolism. The in vitro results have shown that while penicillin- or ampicillin-streptomycin combination was not synergistic in eight of 15 strains, penicillin- or ampicillin-gentamicin sulfate combination was synergistic in 100% of the cases. We report seven cases of enterococcal endocarditis that were successfully treated with penicillin- or ampicillin-gentamicin combination, thus confirming the effectiveness of this therapeutic regimen.