Use of ultrafiltrated cow's whey for the production of whey cheese with Kefir or probiotics.

BACKGROUND: In Southern European countries, whey cheeses are normally produced with ovine or caprine whey. Cow's cheese whey can also be used, although the whey cheese yield is low (2-3%, w/v) which discourages its use. In the present study, bovine cheese whey was concentrated by ultrafiltration for the production of four types of whey cheeses (Requeijão): conventional, without any addition (WC); with 10% (w/w) addition of cream (WCC); with cream fermented with Kefir culture (WCCK); and with cream fermented with Bifidobacterium sp. culture (WCCBB12). RESULTS: Whey cheeses with cream presented lower protein content (330-360 g kg-1 , dry basis) and higher levels of total solids (220-250 g kg-1 ) and fat (300-330 g kg-1 , dry basis) than WC. C16:0 and C18:1 were the most abundant fatty acids present, with 31% and 38%, respectively. The small differences found concerning instrumental determination of colour and texture were not perceived by panelists. However, the presence of Kefir and probiotics decreased the elastic modulus (G') of the samples, as well as their viscosity. Fermentation with Kefir presented the highest counts of lactic acid bacteria (7 logUFC g-1 ). However, after 14 days of refrigerated storage, the counts of yeasts and moulds reached 6 logUFC g-1 in all products, indicating the need for appropriate packaging solutions. CONCLUSION: Ultrafiltration of bovine whey allows for the efficient production of bovine whey cheeses. The addition of cream fermented with Kefir or BB12 appears to be an efficient methodology to incorporate Kefir or probiotic bacteria in Requeijão, improving its nutritional and sensory characteristics, alongside the potential for the extension of its shelf-life. © 2020 Society of Chemical Industry.

[Posture and fatigue among surgeons in the operating room]. / Postura e affaticamento dei chirurghi in sala operatoria.

UNLABELLED: It is a documented fact that if work activity entails prolonged static postures, repetitive movements and the assuming of incongruous positions, skeletal muscle disorders can arise. MATERIALS AND METHODS. 100 surgeons (74 M 26 F), average age 40.1, completed a questionnaire regarding work posture, fatigue and pain experienced after working in the operating theatre. RESULTS. 75% work standing up, the average operation duration time is 4.3 hours (max 8 hours); 50% are unable to change position during the operation and the average time spent in a fixed position is 2 hours (max 6 hours). 58% of surgeons report the onset of myoarticular pain after an average of 4.3 hours (1-8) of surgical activity, principally regarding the cervical and lumbar rachis. Only 9% know the ergonomic guidelines for surgery and only 3% apply them. CONCLUSIONS: Applying the ergonomic guidelines, modifying surgical equipment and increasing posture awareness could help improve comfort while operating and reduce skeletal muscle disorders.

[Celiac artery aneurysm: urgent surgical case report]. / Aneurisma del tripode celiaco. Presentazione di un caso clinico in urgenza.

Visceral artery aneurysm account for up to 5-10% of overall artery aneurysm. Celiac artery aneurysm are reported in 4% of these patients. The most common etiologic findings are atherosclerosis and tunica media infective degeneration. The radiological imaging led to more accurate morphological and anatomical definitions of this pathology and improved elective and urgent surgical treatment of selected patients. The Authors report a case of celiac artery aneurysm.

Acoustic intrameatal meningiomas.

BACKGROUND: The sporadic finding of an acoustic intrameatal meningioma stimulated the authors to the present study. An analysis of the cases previously reported in the literature aimed to outline a preliminary account about biological, radiological and surgical specific hallmarks of these tumours. METHODS: Eight previous cases of meningiomas, meeting the prerequisite of origin and situation within the internal acoustic canal, have been discovered in the known literature since 1975. A further case was recently observed in our experience. The cases in the series showed no sex prevalence and in most of them the age of incidence was comprised between the fifth and sixth decade of life. Hearing loss was the prevalent symptom, lasting 1 month to 7 years before presentation. Myelocisternography, myelo-CT or high resolution CT/MR revealed no specific radiological features to distinguish small intrameatal meningiomas from the more frequently occurring vestibular schwannomas, while CT scan with bone algorithm could point out valuable indirect details for differential diagnosis. Various surgical approaches, i.e. middle fossa, translabyrinthine and retromastoid, were utilized by the different authors. RESULTS: Basing on apparent individual surgical preference, one of three different surgical routes (translabyrinthine, middle fossa, retromastoid) was chosen for 10 procedures in 9 patients. In all, except two cases the impression at surgery was of complete tumour removal. CONCLUSIONS: The possibility for meningiomas to recur and invade the surrounding bone requires a differential diagnosis from vestibular schwannomas. In the absence of intrinsic distinctive signs, radiological evaluation of peritumoral bone alterations could help diagnosis. Although the various surgical routes have often proved effective, temporal bone invasion justifies more extensive approach even in small tumours.

Functional therapy in hemifacial microsomia: therapeutic protocol for growing children.

PURPOSE: This study evaluates the skeletal response to functional orthodontic therapy in growing children with hemifacial microsomia (HM). A method of classification for mandibular growth subsequent to treatment is also suggested. MATERIALS AND METHODS: Sixteen growing children with unilateral HM were treated. Each patient was graded according to the skeletal, auricular, tissue (SAT) classification. Patients graded S4-S5 were excluded because the severity of the malformation made them unsuitable for functional orthodontic treatment. All patients initially underwent a period of treatment with an asymmetrical functional activator (AFA). RESULTS: In 7 of 16 cases (43.7%) classified as S1-S2/T1, regardless of the value of A, functional therapy brought about mandibular growth greater on the side of the malformation (G3-G4), re-establishing structural and functional harmony of the entire stomatognathic apparatus. Of the five cases (31.2%) classified as S2/T2, four required surgical intervention at about 10 years of age after an initial period of functional therapy that produced mandibular growth classified G1-G2. In the other case, functional treatment was sufficient to correct the malformation. In four patients (25%) classified as S3/T3 or S3/T2, it was necessary to combine surgical treatment with functional therapy. CONCLUSION: Use of the AFA in growing children with HM makes it possible to induce harmonious maxillomandibular growth. Statistically, in S1-S2/T2 cases, functional therapy brings about an overall resolution of the malformation whereas in more severe cases (S2/T2), it needs to be combined with orthodontics using fixed appliances and surgical intervention.

Dental agenesis in hemifacial microsomia.

Hemifacial microsomia (HM) is an asymmetrical congenital deformity of the head and face caused by anomalous development of the structures derived from the first and second branchial arches. This study evaluates the incidence of agenesis and dental inclusions in HM patients. Sixty-three HM patients, 27 male and 36 female, ranging from 7 to 43 years had monolateral (61) and bilateral (2) presentation. From clinical examination, photographs, and various radiographs, the following manifestations were noted: 11 patients had tooth agenesis with at least one on affected side and 5 patients had dental inclusions. The greater the severity of HM, the greater likelihood of agenesis. Third molars were most commonly missing. Dental inclusions did not show a relationship to severity.

Severe ulcerative colitis, dural sinus thrombosis, and the lupus anticoagulant.

Thromboembolic disease is a well-recognized but very uncommon complication of inflammatory bowel disease. The mechanisms of the increased risk of thrombosis are not well understood: although several coagulation abnormalities have been described in inflammatory bowel disease patients, it is not clear whether they actually contribute to hypercoagulation or whether they are nonspecific markers of inflammation. Antiphospholipid antibodies (anticardiolipin antibodies and/or lupus anticoagulant) have recently been associated with an increased risk of thrombosis, particularly cerebrovascular disease in young patients. We report the case of a 33-yr-old female with severe ulcerative colitis at first attack who developed thrombosis of the superior and inferior longitudinal dural sinuses. No risk factors for thrombosis or coagulation abnormalities were observed; however, lupus anticoagulant was detected in the serum. The patient was successfully treated with osmotic agents, prophylactic anticonvulsant, and antiplatelet therapy, combined with i.v. steroids. After 6 months, the colitis is in remission, and the neurological recovery is good even if not yet complete.

Treatment of type C chronic active hepatitis with interferon-alpha 2a. Treatment duration does not influence biochemical remission but does decrease the relapse rate.

Few data are as yet available on the influence of interferon (IFN) treatment duration on biochemical remission and posttreatment relapse of chronic type C hepatitis. We investigated whether duration of recombinant IFN-alpha 2a treatment influences the remission and relapse rates in type C chronic active hepatitis (CAH). Sixty-two CAH patients were randomly assigned to receive 3 MU of i.m. recombinant IFN-alpha 2a three times per week for either 3 (group A, 32 patients) or 6 (group B, 30 patients) months. A complete biochemical remission was cumulatively observed in 62.5 and 63.3% of patients in groups A and B, respectively (p = NS). One and two patients in groups A and B, respectively, showed a biochemical relapse during treatment. In all cases biochemical remission was observed within the first 3 months of treatment. Among responders, 84.2 and 52.9% (p = 0.04) cumulatively had relapses in groups A and B, respectively. We conclude that IFN treatment duration does not influence the biochemical remission rate in type C CAH, but lowers the relapse rate of those who are treated for a longer period. The IFN treatment should be stopped if the patient is a nonresponder after 3 months of treatment. In responders, treatment should be continued for at least 6 months.

Usefulness of the Nd:YAG laser in parenchyma-sparing resection of pulmonary nodular lesions.

AIMS AND BACKGROUND: The neodymium:yttrium-aluminium-garnet (Nd:YAG) laser has been successfully employed in parenchyma-sparing resection of pulmonary nodular lesions. We report our experience with limited resection using a noncontact Nd:YAG laser applied through a thoracotomic approach. METHODS: During the period March 1987-October 1993, we performed parenchyma-sparing resections of 66 pulmonary nodular lesions with a noncontact Nd:YAG laser in 47 patients. Nodules were approached through postero-lateral thoracotomy (n = 40), median sternotomy (n = 5) or staged bilateral thoracotomy (n = 2). Fifty-two lesions were located in a peripheral position and the others (n = 14) at various depths within the parenchyma. RESULTS: Fifteen lesions were benign: hamartoma (n = 5), chronic pneumonic infiltrate (n = 3), tuberculoma (n = 3), asbestosis (n = 2), Wegener's granuloma (n = 1). Twelve lesions were attributable to primary lung cancer and 33 were metastatic lesions. Another 6 lesions turned out to be necrotic metastases following chemotherapy. There were no perioperative deaths. Pulmonary re-expansion was shortly obtained: mean drainage time was 4.31 +/- 3.9 days. Only one patient presented a prolonged drainage time (11 days); in this case, the air leak was successfully treated by tissue glue sealant trans-drainage infiltration. Follow-up ranged from 2 to 96 months. No case of relapse on the resection site has been observed. CONCLUSIONS: The results suggest that Nd:YAG laser resection is safe and worthwhile in patients with multiple lesions and borderline pulmonary function.

[Transjugular intrahepatic porto-systemic shunt (TIPS): indications and results]. / Derivazione porto-sistemica intraepatica transgiugulare (TIPS): indicazioni e risultati.

This study was aimed at describing some technical features of the transjugular portosystemic shunt (TIPS). December 1991 to November 1993, fifty-five TIPS were performed in our department. The right internal jugular vein, which is the most direct path to the inferior vena cava, was punctured in 48 cases, the left one in seven cases. The right suprahepatic vein was catheterized in 43 cases, and the median suprahepatic vein in 12 cases. The puncture of the portal vein was performed in 21 cases in the right portal branch, in the left one in 23 cases, and in the portal bifurcation in 11 cases. In all cases in which the puncture site was questionable, an X-ray exam with lateral or oblique projection was performed, to be sure that the needle had entered the intrahepatic portion of the portal vein. A landmark to locate the portal system, such as a catheter in the hepatic artery, a skin landmark or a metallic coil near the porta, were positioned in 30 patients. Particularly, in 20 patients, a 0.018-inch guidewire with platinum tip was placed at the bifurcation; in seven cases a 3F catheter was advanced over the guidewire, to visualize the portal bifurcation directly with contrast medium injection. In our experience, a total number of 83 stents were positioned in 55 patients: 53 Wallstents, 13 Palmaz stents, and 17 Strecker-Nitinol stents. One single stent was placed in 31 patients, two stents in 21 patients, three stents in two patients, and, finally, four stents were positioned in one patient. In our series the technical success rate was 100%. The use of a metallic landmark significantly decreased procedures duration, ranging 40 minutes to 2 hours, and, above all, it allowed for significantly fewer puncture attempts, which varied from a minimum of 1-2 in 80% of cases, to a maximum of 20 especially in these patients with ascitis and with small and hard liver.

Comparative stability study of wire osteosynthesis versus rigid fixation in the treatment of Class III dentoskeletal deformities.

The study analyzed two samples of 10 patients with Class III dentoskeletal deformities and maxillary and mandibular involvement. Surgery was performed on both jaws at the same time, using different techniques for the stabilization of bone. In one group, osteosynthesis by wire fixation was performed (WF); and in the other group, bicortical screws were used for the mandible (RIF) and plates for the maxilla. At 20 and 40 days after the operation, radiocephalometric examinations were performed, and the differences in structural stability verified, by comparing the efficiency of the two methods of bone stabilization. Results indicate that in the postoperative period analyzed, dentoskeletal movements in the RIF group were inferior compared with the WF group. On the basis of these results, the advantages and the disadvantages offered by these two techniques of bone stabilization are analyzed.

Long-term control of the stability of skeletal structures in Class II dentoskeletal deformities after surgical-orthodontic therapy.

This study analyzes long-term findings in a group of 10 patients with Class II dentoskeletal malrelationship and who have undergone orthognathic surgical procedures. Changes in cephalometric values relative to the bony structures of the upper jaw and of the mandible are discussed in detail. Patients were reexamined on average, 5.8 years after surgery to show possible modification of the skeletal regions in patients who underwent surgical-orthodontic treatment for malformation of the facial continuum. For each case we made a cephalometric analysis of the lateral cephalograms, as well as the superimposition of tracings relative to the various stages of treatment: at the end of preoperative orthodontic treatment, after surgery, and at the long-term control. Cephalometric values for all patients who took part in this long-term control were recorded and a structural assessment was made.

Circadian rhythm of peak expiratory flow in children passively exposed and not exposed to cigarette smoke.

BACKGROUND: Because airway calibre shows a circadian rhythm and since exposure to passive smoking reduced lung function this study was undertaken to investigate whether passive smoking affects the circadian rhythm of peak expiratory flow (PEF) in schoolchildren. METHODS: Twenty schoolchildren (12 boys and 8 girls, aged 10-11 years) exposed to passive smoking were matched for sex, age, and height with 20 children who had not been exposed to cigarette smoke. Exposure to passive smoking was assessed by questionnaire and by urinary cotinine concentrations. A portable spirometer was used to measure PEF at 16:00, 20:00, 22:00, 06:00, 08:00, and 12:00 hours on a consecutive Saturday and Sunday. The circadian changes in PEF were measured by the cosinor method. RESULTS: Both groups showed diurnal fluctuation in PEF values with a noticeable circadian rhythm. PEF peaks were the same in the two groups and occurred around 15:00 hours. The cosinor mean was approximately 10% lower in children exposed to passive smoking and the amplitude was approximately 60% higher than in the unexposed children. CONCLUSION: Passive smoking in children is associated with a reduction in the cosinor mean and an increase in the amplitude of the normal circadian rhythm of airway calibre. This increased PEF rhythm amplitude may be considered as an early indication of airway obstruction.

Persistence of human growth hormone circadian rhythm in patients with homozygous beta-thalassemia.

Plasma levels of human growth hormone (hGH) were measured for an entire day every two hours, starting from midnight, in 6 healthy male subjects and in 6 male patients with homozygous beta-thalassemia, without evidence of any endocrine disease. The data were analyzed by the "cosinor" method, and the results show the presence of a significant (p < 0.05) circadian rhythm for hGH in both groups. Whereas no differences were found in mesors and acrophases between the two studied groups (p > 0.05), a statistically-significant (p < 0.05) difference was observed regarding amplitudes, being higher in the controls. These data suggest that in patients with beta-thalassemia major without evidence of any endocrine abnormality, the circadian secretory pattern of hGH is preserved, even if the rhythm amplitude is reduced: this could be a compensatory mechanism in order to stimulate growth.

Classification and prognostic evaluation in multiple myeloma. A retrospective study of relationship of survivals and responses to chemotherapy to immunological types, 20 single prognostic factors, 15 clinical staging systems, and 6 morphological classifications.

In a group of 136 completely followed up patients with multiple myeloma, the prognostic significance of the immunological myeloma types, of 20 different single prognostic factors, of 15 clinical staging systems, and of 6 morphological classifications was retrospectively investigated by means of the calculation of mean survivals, survival curves, and responses to chemotherapy. A univariate analysis was employed in order to correlate each prognostic parameter at presentation with the survival in the whole group; a multivariate analysis according to the Cox's hazards regression model was used in order to select the most powerful prognostic variables. The patients were grouped according to the myeloma immunological types, to the mean value of each single prognostic factor, and to each stage of the clinical and morphological systems. Causes of death were also related to immunological multiple myeloma types. All single variables, except age and serum calcium, presented a significant relationship with the survival, even if at different significance levels. Cox's regression model selected among them, serum levels of beta 2-microglobulin, percentage of bone marrow plasma cells, hemoglobinemia, lytic bone lesions, and Bence-Jones proteinuria as the most significant factors related to survival. Each clinical and morphological staging system divided groups of patients with significant differences in mean survivals, or in survival curves, or in response to therapy. Multiple myeloma type IgA and micromolecular, with Bence-Jones proteinuria, and type lambda were associated with a poor prognosis, with low therapeutical response, and with the development of fatal renal failure. All these parameters, together with new prognostic factors, are useful in the prognostic evaluation, and, when applied in different steps of the diagnosis and the therapy, allow of studying the clinical course of multiple myeloma under different perspectives, in order to have a more complete picture of the disease and of the single patient.

[Epidemiologic chronorisk of acute cardio-cerebrovascular diseases]. / Cronorischio epidemiologico della malattie cardiocerebrovascolari acute.

This review summarizes the accumulated data demonstrating that several cardio-cerebrovascular diseases do not occur with casual periodicity, but present a predictable critical time of ultradian, circadian, or infradian recurrence in their onset. In fact, during the last years, it has been clearly established that there is a prominent increase in a definite period of the day, of the week, and of the year in the frequency of onset of acute myocardial infarction, sudden cardiac death, stroke, and fatal pulmonary thromboembolism. Morning hours, week-end, and winter seem to be the periods at higher risk, since a number of physiological processes that could contribute to the onset of the disease are intensified. Also environmental and behavioural conditions could contribute to these peaks. Consequently, the periodicity in the occurrence of these diseases may be due to the relationships between the exogenous factor rhythms, the endogenous biological rhythms, and the disease. These epidemiological and chronopathological observations suggest the introduction of time as a measurable structure for the clinical risk, and the term "chronorisk" as a predictable condition of temporally periodic or permanent risk for human health, which is generated by a temporal-quantitative disorder in the physiological course of the biological oscillating functions. The temporal recurrences in the onset of the acute diseases are not only epidemiological data, but, since the reasons for these rhythm changes in pathology are likely multifactorial, the study of such rhythms will probably help in the understanding of the pathogenesis and the triggering mechanisms. Moreover, further investigations of these rhythmicities may help the planning of more effective preventive therapy.