Simultaneous Diagnosis of Acute Crohn's Disease and Endometriosis in a Patient Affects HIV.

This is the case report of a 45-year-old woman affected by HIV, who was hospitalized for diffuse abdominal pain, constipation, and weight loss present for over one month. A colonoscopy showed the presence of a nontransitable stenosis of the ascending colon. A right hemicolectomy was performed. The histological examination reports CD with outbreaks of endometriosis. CD and the HIV infection may coexist in the same individual and it seems that HIV reduces the relapse rate in IBD patients. CD and intestinal endometriosis can also occur simultaneously. The diagnosis is often only made after surgical resection of the diseased segment. These patients were more likely to have stricturing CD but endometriosis does not seem to impact the natural history of CD.

Detraining in young soccer players.

BACKGROUND: Two types of detraining can be described: short-term detraining with a period of less than 4 weeks, and long-term detraining (period longer than 4 weeks). The purpose of this study is to verify the presence and eventually the magnitude of physiological cardiorespiratory changes in young team sport players after a period of long-term detraining. METHODS: Fourteen young soccer players (15 ± 1 year) were studied with two incremental tests at the end of the regular season and after a six-week total break period from training activities. Physiological variables were evaluated: heart rate (HR), oxygen uptake (VO2), volume of ventilation (VE), aerobic (VA) and anaerobic (Van) running speed at thresholds and maximum effort were recorded. RESULTS: This study shows the magnitude of the physiological changes in young players after a period of long-term detraining. The results showed significant decreases at the end of the detraining period of VO2 at VA of 22.7% (44.54 ± 4.56 vs. 34.41 ± 4.57 mL/kg/min, P<0.05), of 25.8% of VO2 at VAn (54.60 ± 5.81 vs. 40.48 ± 5.07 mL/kg/min, P<0.05) and of 21.2% in VO2 max (62.83 ± 5.77 vs. 49.46 ± 6.51 mL/kg/min, P<0.05). Speed at VA (11.5 ± 0.96 vs. 10.7 ± 0.97 km/h; P<0.05), speed at VAn (15.3 ± 1.05 vs. 14.2 ± 1.48 km/h; P<0.05), peak running speed (18.8 ± 1.20 vs. 17.2 ± 1.1 km/h; P<0.05). CONCLUSION: It is likely that alteration of metabolic parameters may significantly affect the range of physical condition and especially, aerobic-anaerobic resistance and maintenance training would be advisable in young athletes during the transition period. Given the relevance of worsening demonstrated by our data, coaches should avoid very long periods of complete rest (no more than 15 days) at the end of the season.

Retrospective histologic comparison of Helicobacter pylori infection in gastric carcinoma, ulcerous disease and non-ulcerous dyspepsia.

Although a number of epidemiological, biological and clinical studies have been published, the effective role of Helicobacter pylori infection in gastric carcinogenesis remains unclear. In the present work we retrospectively compared Helicobacter infection rate, by means of histologic examination of gastric bioptic samples, in 70 patients affected by gastric carcinoma, 70 with ulcerous disease and 70 with non-ulcerous dyspepsia. The analysis was carried out by a single pathologist. The differences between the 3 groups were not statistically significant. From our present and previously reported data, the Helicobacter infection cannot be considered per se a significant risk factor for malignant gastric disease and further studies are needed to evaluate the role of Helicobacter infection in the development of some preneoplastic conditions such as chronic atrophic gastritis and intestinal metaplasia.

Is there an association between Helicobacter pylori cytotoxin Cag A seropositivity and risk for gastric cancer?

BACKGROUND: Since discovered in 1990, Cag A, a protein expressed by specific strains of Helicobacter pylori, was thought able to explain why only a few Helicobacter infected patients develop peptic diseases and gastric cancer. However, clinical trials provide discordant results. MATERIALS AND METHODS: In this study we evaluate Helicobacter pylori and Cag A seropositivity in 35 cancer affected patients, in 36 gastritis affected patients and in 40 healthy blood donors by means of two commercially available fluorescence enzyme-immunoessay (ELISA). RESULTS: Odds ratios determination strongly suggests that Cag A bearer Helicobacter strains play a pathogenetic role in gastric diseases (OR 4.23, 95% CI 3.22-5.24 for cancer versus healthy volunteers, OR 3.2, 95% CI 2.19-4.21 for gastritis versus asymptomatic patients), but is unable to demonstrate a direct carcinogenic activity (cancer-gastritis difference is not significant: OR 1.32, 95% CI 0.39-1.25). CONCLUSIONS: Cag A seropositivity can be considered a risk factor for peptic disease, and only indirectly for gastric carcinoma. The paper also discuss some sampling, laboratory and statistical bias that can explain a wide eterogenity of the results reported in the literature.

[Prevalence of Enterococcus faecalis and Enterococcus faecium with high resistance to aminoglycosides in the cities of Resistencia and Corrientes, Republic of Argentina]. / Prevalencia de Enterococcus faecalis y Enterococcus faecium con resistencia de alto nivel a aminoglucósidos en las ciudades de Resistencia y Corrientes, República Argentina.

BACKGROUND: The objective of this study was characterize the prevalence of high-level aminoglycosides resistance (HLRA) in Enterococcus faecalis and E. faecium, determine the relationship between high-level gentamicin resistance (HLGR) and other aminoglycosides, and their distribution according clinical samples (blood, urine and others). MATERIALS AND METHOD: A total of 177 strain (157 E. faecalis and 20 E. faecium) isolated from 1996 to 1998 were studied. They were identified by using classic methods. Their susceptibility to gentamicin, streptomycin, and kanamycin was tested by the disk diffusion technique using high-level disks in agar Müller Hinton. RESULTS: E. faecalis showed HLRG of 28.7%, streptomycin 28.7% and kanamycin 37.6%, E. faecium showed 50%, 40%, and 60% respectively. The strains with HLRA have a tendency to high-level resistances to streptomycin and kanamycin (p < 0.0005). Statistical analysis demonstrated significative differences among strains with HLRA isolated from blood, urine and other clinical samples (p < 0.0005 to gentamicin and streptomycin and 0.004 < p < 0.007 to kanamycin). CONCLUSIONS: The prevalence of HLRA enterococci found in the area os this study, justify its detection, particularity in cases of serious infections.

[Value of antibiotype and bacteriocinotype for differentiating Shigella strains isolated in Argentina]. / Intérêt de l'antibiotypie et de la bactériocinotypie pour différencier les souches de Shigella isolées en Argentine.

The aim of the present work was to analyse the phenotypical characteristics of Shigella strains in order to evaluate their possible utilisation as epidemiological markers. For one year, we studied 95 strains of Shigella obtained from stool specimens of patients with dysentery. Bacteria came from various health care centres in the states of Chaco and Corrientes (Argentina). Bacteria were identified by using classical biochemical methods. All strains were serotyped and susceptibility patterns were determined using thirteen antibiotics. Bacteriocin typing was determined by the sensitivity to piocins of Pseudomonas aeruginosa and to marcescins of Serratia marcescens. Colicin production in S. sonnei was also studied. Among all the strains examined, the most prevalent was Shigella flexneri (82%) followed by Shigella sonnei (18%). The most frequent serotype among S. flexneri was 2 (93%), followed by serotypes 6 (4%), 1 (1.5%), and 3 (1.5%). S. sonnei strains were classified in 7 antibiotypes, 6 piocin types, 3 marcescin types, and 4 colicin types. Strains of S. flexneri type 2 were divided among 14 antibiotypes, 4 piocin types and 2 marcescin types. Simpson's index of diversity was applied to evaluate the discriminatory power of studied typing methods, both alone and combined. Our results indicate that when taken independently, none of the evaluated typing methods had discriminative power, but when taken together, they may be successfully used for the epidemiological typing of Shigella strains.

[Non fermentative gram negative bacilli isolated in a hospital laboratory]. / Bacilos gramnegativos no fermentadores (BGNNF) aislados en un laboratorio hospitalario.

OBJECTIVE: To report a prospective study on non fermentative gramnegative bacilli, excluded Pseudomonas aeruginosa, isolated at Dr. Julio C. Perrando Hospital in Resistencia (Argentina). The goal of this study was to know their frequency and antimicrobial susceptibility. MATERIAL AND METHODS: For bacterial identifications we used biochemical tests. RESULTS: The greatest percentages of non fermentative gramnegative bacilli isolates were found in blood samples (25%), respiratory secretions and urine (23.9%). Acinetobacter baumannii (34.7%), Pseudomonas fluorescens/Pseudomonas putida (15.2%), Stenotrophomonas maltophilia (9.7%) and Burkholderia cepacia (8.7%) were the non fermentative gramnegative bacilli species most commonly isolated. Distribution of microorganism strains according to samples and area is also assessed. Antimicrobial sensitivity of most commonly isolated non fermentative gramnegative bacilli strain analyzed. CONCLUSIONS: We concluded that non fermentative gramnegative bacilli are most frequently present in hospitalized that in outpatients and antibacterial therapy must be provided according to bacteriological information.

[Non-fermenting Gram-negative bacilli: distribution in clinical specimens and antimicrobial susceptibility]. / Bacilos gram negativos no fermentadores: distribución en materiales clínicos y susceptibilidad antimicrobiana.

In the present work was studied the prevalence, distribution in clinical specimens, and antimicrobial susceptibility of non-fermentative Gram-negative bacilli (NFGNB) from patients attended at Hospital "Angela I. de Llano" (Corrientes, Argentina). A total of 125 strains of NFGNB were recovered from various clinical specimens from July, 1997 to December, 1998. Isolates were identified by classical biochemical tests. Drug sensitivity was performed by standard methods with cefotaxime (CTX), ceftazidime (CAZ), piperacillin (PIP), ampicillin-sulbactam (AMS), piperacillin/tazobactam (TAZ), imipenem (IMP), amikacin (AKN), gentamicin (GEN) and ciprofloxacin (CIP). The most common isolates were Pseudomonas aeruginosa (48.8%); Acinetobacter baumannii (16.8%), Acinetobacter spp. (6.4%), Chryseobacterium spp. (5.6%), Stenotrophomonas maltophilia (4%), and others (18.4%). Most of them were recovered from respiratory secretions (36.0%), and urine (26.4%). IMP was the most effective antimicrobial. Many species of NFGNB showed resistance to several antibiotics tested (CTX, GEN, AMS, and CIP). Due to multiresistance found by more prevalent NFGNB, constant survey of antibacterial sensibility are essential for a correct control and management of nosocomial infections, and ambulatory patients with some risk factors.

[Mouth colonization by Streptococcus pyogenes in patients with impetigo]. / Colonización faucial por Streptococcus pyogenes en pacientes con impétigo.

The faucial carrying of Streptococcus pyogenes in patients presenting impetigo was determined as a risk factor for non-suppurative complications (acute glomerulonephritis). The fauces cultures of these patients revealed a S. pyogenes colonization of 65% and all the isolates were penicillin-sensitive. It was concluded that the high percent of faucial colonization made a systemic antimicrobial treatment necessary.

Early and long-term prognostic factors after liver resection for HCC.

The Authors discuss the principal early and long term predictive factors after liver resection in patients with hepatocellular carcinoma (HCC). The Authors report (131 cases) early mortality as 7.6%, entirely confined in the group, numerically prevalent and affected by cirrhosis. None of the 50 patients with chronic hepatitis (29 cases) or normal liver (21 cases) died after hepatic resection. Mortality is higher in Child B patients (20.7%) and in cases in which a massive haemotransfusion was given (p < 0.05), apart from the width of resection and from the number of hepatic resections. None of 41 cirrhotic Child A patients undergoing a limited hepatic resection (< or = 1 segment) died during the perioperative period. In the group of patients which survived to the resection, global survival at 5 years was 45%. The most important prognostic factor is local recurrence while cirrhosis and the degree of liver failure are not statistically significant. No feature can identify a subgroup of patients with a higher risk of recurrence, which is observed in 52% of patients with a follow up observation after more than 1 year. Among the 29 patients alive after more than 4 years from liver resection, only 11 didn't have local recurrence. The others were treated with iterative hepatic resections or with radiological techniques. In conclusion, the present experience suggests that, in selected cases, hepatic resection could be a low risk therapy (in cirrhotic patients as well). The long term results could improve with an aggressive attitude towards recurrence.

D2 lymphectomy in the treatment of gastric cancer: a retrospective view on our experience (1990-1997).

From 1990 to 1997 we observed, in our department, 267 patients affected by gastric cancer. In the first four years of our experience (1990-93) we resected 87 patients out of 136 gastric cancers observed (63.9%): 56 pts. (64.4%) were classified as ASA I-II, 21 (24.1%) as ASA III, 10 (11.5%) as ASA IV. In 2 cases (2.3%), operated in emergency, a DO-1 lymphectomy was performed, with a mean of 4 nodes resected; 67 pts. (77.0%) had a D2, with a mean of 36.5 nodes resected; in 18 pts. (20.7%) we performed a D3, with a mean of 64.3 nodes resected. Post-operative technical complications were 13 (14.9%). We observed 5 post-operatory deaths (5.7%), 3 due to technical complications. Absolutely and relatively curative resections have been 62 (71.3%). In the second period (1994-97) we resected 89/131 patients (67.9%): in this group 50 pts. (56.2%) were classified as ASA I-II, 24 (26.9%) as ASA III, 15 (16.9%) as ASA IV. With the exception of 3 patients (3.4%) who were operated in emergency (D0-1 procedures, with a mean number of 2.3 nodes resected) we adopted D2 lymphadenectomy plus hepatic peduncle as the procedure of choice, performed in 86 pts. (96.6%), with a mean of 34.1 nodes resected. Post-operative technical complications were 5 (5.6%). We observed 5 post-operatory deaths (5.6%), 1 due to technical problems. Absolutely and relatively curative resections have been 76 (85.4%). Morbidity and mortality due to technical complications in the second period are lower than observed in the first period, without any difference in the curability rate. D2 lymphectomy seems to be an effective procedure, safe even in high anesthesiological risk patients. Increasing experience and standardization of the technique reduced risk of surgical complications and mortality.