Clostridium difficile-related pancolitis in lung-transplanted patients with cystic fibrosis.

C. difficile (C. d.) is the main cause of antibiotic-associated diarrhea and colitis. It is shown in literature a high asymptomatic carriage rate of C. d. in patients with cystic fibrosis (CF), though C. d.-related colitis is an uncommon complication in these patients, despite the use of multiple high-dose antibiotic regimes and the frequency of hospital admissions. Lung transplantation with the associated immunosuppression and aggressive antibiotic therapy may increase the risk of the clinical manifestation of C. d. In this paper, we describe three cases of severe C. d. colitis in patients with CF following lung transplantation and illustrate our experience in the diagnosis and management of these patients.

Greenhouse gases emissions and energy use of wheat grain-based bioethanol fuel blends.

This study focuses on the potential energetic and environmental impacts associated with the production of wheat grain-based bioethanol in Lombardia (Italy), with a "seed-to-wheel" approach (i.e. taking into account the production and use phase). Greenhouse gas emissions (GHGs) were estimated through the CML 2 baseline 2000 methodology counting the CO(2) equivalent emissions, while the energy flow indicator was estimated using the Ecoindicator 95 methodology. The impact of the different phases involved in the production and use of bioethanol have been analysed: the agricultural production of wheat grain, its transformation into bioethanol, the production of gasoline and the use of 5 different blends (from pure gasoline to pure ethanol). The results show that ethanol fuel, used in the form of blends in gasoline, can help reduce energy use and GHGs. In particular, the use of pure ethanol was found to be the best alternative presenting the lowest GHGs (saving about 32% of CO(2)eq emissions in comparison to gasoline) and the minor energy use (63% saving). Differences between low-ethanol blends and gasoline are minimal and dependent on the specific fuel consumption of the vehicle. The sensitivity analysis performed to test the robustness of results through the change of some basic assumptions (specific fuel consumption, N(2)O emissions from agricultural phase, allocation method) shows the sensitivity of GHGs saving to the adopted allocation method.

Lung transplantation for cystic fibrosis in Italy.

Lung transplantation (LT) is the only effective form of therapy for cystic fibrosis (CF) associated with end-stage pulmonary failure. In Italy, the management of CF is regulated by national law, which has instituted regional centers for care and follow-up of all CF patients. LT has been performed since 1992 in only nine LT certified centers. The structured national organization has led to a unified database for LT for CF. As of December 2006, 197 bilateral LT (96 male and 94 female patients; 7 retransplants) have been performed. Of these, four had also liver or heart and liver transplantation, and three are long-term survivors. Overall median survival is 7 years. Mean age at transplantation is 26.5 years, and the mortality on the waiting list is 33.6%. Patients listed for transplant either received a suitable donor within a mean of 10 months or died within a mean of 5.5 months. The most frequent cause of death is bronchiolitis obliterans syndrome (BOS). Our nationwide database indicates the excellent results obtained by LT in FC. Still, mortality on the waiting list remains a challenge and long-term outcome is limited by BOS.