[An important variability factor in determination of urinary activity of N-acetyl-beta-D-glucosaminidase: contamination of urine with semen]. / A proposito di un importante fattore di variabilità nella determinazione dell'attività urinaria della N-acetil-beta-D- glucosaminidasi: la contaminazione delle urine con liquido seminale.

BACKGROUND: Urinary N-acetyl-beta-D-glucosaminidase (U-NAG) and its isoenzyme B (U-NAG-B) have been demonstrated useful and early markers of renal damage, although they are present in many other tissues and organs. OBJECTIVES: To evaluate semen contamination of the urine and its role in variability of U-NAG. METHODS: To assess control group values beta2-microglobulin, retinol-binding protein and U-NAG were measured in the urine of 30 healthy, non-smoking and non metal-exposed adults (19 females and 11 males). RESULTS: In four urine samples U-NAG was higher than the method reference value (5 U/g creatinine), without increases in other functional markers. Microscope examination revealed the presence of sperm in these samples. U-NAG variability decreased after the exclusion of these four values. The role of contamination was confirmed by adding semen to urine: when semen to urine ratio was 1:1000, enzyme activity was more than twice the basal level. CONCLUSIONS: U-NAG variability is strongly increased by contamination with semen, where enzyme concentration (especially NAG-B) is very high. Increased excretion of U-NAG and of its iso-form (U-NAG-B) in males, not correlated with other renal alterations or with exposure to heavy metals or other renal toxic substances, should be carefully evaluated and microscopic observation is advisable to detect the presence of sperm in urine.

Automated analysis of urinary catecholamines by high-performance liquid chromatography and on-line sample pretreatment.

A simple and automated solid-phase extraction for the selective and quantitative HPLC analysis of free catecholamines in urine is described. The urinary catecholamines react with diphenylboric acid, giving a complex at pH 8.5 which is strongly retained on a PLRP-S cartridge; elution is accomplished with the same mobile phase used for HPLC analysis. Separation is performed by ion-pair reversed-phase HPLC, with sodium heptanesulphate as counter-ion, and a totally end-capped C18 analytical column. Quantitation is achieved with an electrochemical detector. A Spark Holland Prospekt system controls the on-line solid-phase extraction, preconcentration and direct elution to the LC column. Chromatography run-time is 10 min and the total time to process one urine sample is ca. 12 min.

Platelet activation by emotional stress in patients with coronary artery disease.

We studied the effects of experimentally induced emotional stress (mental arithmetic) on different hemodynamic parameters, catecholamine levels, and serum and platelet function tests in 25 postinfarction patients and in 10 apparently healthy, age-matched control subjects. Mental stress (10 minutes) induced significant increments in heart rate, systolic blood pressure, diastolic blood pressure, double product, and cardiac output, indicating a sympatho-adrenal stimulation that was confirmed by a significant increase in serum epinephrine and norepinephrine levels. All of the effects disappeared at minute 10 of recovery. Concomitantly, the test produced a significant increase in platelet aggregation (induced by 3 microM ADP or 1 microgram/ml collagen), the formation of circulating platelet aggregates, and an increase in thromboxane B2 levels in plasma and serum. These effects were also rapidly reversible. Similar activation of hemodynamic parameters and a similar but less evident increase in platelet function by emotional stress were observed in control subjects. A possible artifact due to factitious platelet activation by catheter sampling was excluded with experiments in which a 40-minute rest was introduced after the baseline period and before mental stress; platelet activation did not occur during baseline or rest periods, only after emotional stress. Furthermore, the antiplatelet drug dipyridamole reduced the stress-induced formation of platelet aggregates in postinfarction patients. These results demonstrate the existence of a direct link between emotional stress and platelet function and offer an explanation of one of the mechanisms through which mental stress may be involved in the development of coronary artery disease.

Proposal of an easy method to improve routine sputum bacteriology.

The study of bacterial flora of the lower respiratory tract is very important for the diagnosis of pulmonary infections and proper therapy but it has to face important methodologic problems. The main problem is contamination of the sputum during its passage through the upper airways. The present study suggests an improved procedure aiming first of all at reducing the specimen contamination by upper airway bacteria by means of a preliminary mouth wash, and secondly at comparing qualitative and quantitative cultures of spit with those of sputum. In our study bronchial lavage aspirate (BLA) cultures were used as a control. Both definite (80 patients) and random (20 patients) sequence sampling procedures were considered to show the importance of a correct sequential specimen collection. Bacteria isolated in the sputum and/or in BLA but absent in the spit were considered the most probable responsible for an eventual pulmonary infection. On the contrary a germ found in the spit and eventually in the sputum but not in BLA was considered responsible for only an eventual inflammation of the upper respiratory tract. Doubtful cases were solved by comparing the different bacterial concentrations in the various samples. A preliminary mouth washing procedure decreased the mean concentration of contaminants in the sputum: 3.6 +/- 7.5 x 10E8 (E = exponent) versus 3.7 +/- 7.2 x 10E7 CFU/ml spit versus sputum (80 patients) p less than 0.001. On the contrary if sputum preceded spit (12 out of the 20 randomly treated subjects), bacterial counts were not significantly different (2.1 +/- 5.7 x 10E8 vs. 1.3 +/- 2.9 x 10E8 CFU/ml, respectively, p = NS). In the group of correctly treated patients (80 subjects) only infrequently oral contaminants were found in BLA (12.5%). The finding of bacteria in BLA but absent in spit and/or sputum was rare (4.8%) suggesting that, at least in chronic obstructive lung disease (COLD) patients, spit and sputum quantitative and qualitative cultures may be sufficient for a good microbiologic examination in almost all the cases.

[Para-albuminemia and alloalbuminemia: 1st case report of a VR/VR B genetic variant in the Novara area]. / Paraalbuminemia e alloalbuminemia. Prima osservazione nel novarese della variante genetica VR/VR B.

The 12th case of alloalbuminaemia in Piedmont, and the 1st in the Novara area, coded NO/PN, are reported. Although alloalbuminaemia is at present purely a clinically asymptomatic scientific curiosity, future investigations could link it to other genetic marks with consequent practical advantages. It is also important to distinguish this form from acquired para-albuminaemia, often the only sign of pancreatic fistulisation.

Cefoperazone versus cefotaxime, plus amikacin or sisomicin, in fever and infection in hematologic granulocytopenic patients.

Forty patients with leukemia or aplastic anemia were randomized to receive one of the following antibiotic regimens at the onset of fever during granulocytopenia: cefoperazone + amikacin (regimen A), cefoperazone + sisomicin (regimen B), cefotaxime + amikacin (regimen C), cefotaxime + sisomicin (regimen D). All patients were receiving gut decontamination at the time of randomization. Patients were monitored twice weekly with swabs and cultures for bacteria and fungi. Overall, there were 56 febrile episodes: 31 were proven bacterial, 3 were probable, and 16 were of unknown origin. Response rates were comparable in all 4 treatment regimens: 90%, 91%, 92% and 92%, respectively. Three patients died of bacterial infections (2 Gram+, 1 Gram-), one patient died with probable infection, 6 febrile episodes were related to fungal infection (Candida), and 2 patients died. The mortality rate was comparable in all groups. Two patients died of renal failure. Abnormalities in liver function tests were observed, but were without consequences. There were no statistical differences in renal-hepatic toxicity in the 4 arms.

Fletcher factor deficiency (Report of a new case).

A new case of Fletcher factor (prekallikrein) deficiency is described. The patient did not have any abnormal bleeding tendency, but showed defective intrinsic thromboplastin production and reduced fibrinolytic system activity; he had no factor VIII, IX, XI and XII deficiencies. His plasma did not contain any detectable prekallikrein levels.

[Bacterial antagonism of oral secretions towards staphylococci]. / Aspetti di antagonismo batterico nelle secrezioni orali nei confronti degli stafilococchi.

Bacterial antagonism may be one of the mechanism which regulates the bacterial flora of the pharynx. We have investigated the bacterial antagonism exerted in oral secretion by alpha-hemolytic streptococci against S. aureus and S. epidermidis. We cultured viridans streptococci and staphylococci in human saliva and we noted a bactericidal activity towards staphylococci. Such activity, referable to the salivary system (peroxidase-thiocyanate) activated by hydrogen peroxide produced by streptococci, was greater on S. epidermidis. The remarkable sensitivity of S. epidermidis could explain the rare presence of this species in pharynx and oral cavity.

[Preferential staphylococcal colonizing site in the upper airway]. / Sede preferenziale di colonizzazione degli stafilococchi nelle vie aeree superiori.

150 healthy individuals and 162 tonsillopathic patients were investigated for the presence of Staphylococcus species in the upper respiratory tract. S. epidermidis was isolated from the throat in a very small percentage of all the people examined. A great number of healthy individuals (40%) and of patients (70%) were colonized by S. aureus either in the nose or in the throat; 30% of the carriers harboured S. aureus exclusively in the tonsils and in the pharynx.