Bilateral femur fracture as the first manifestation of multiple myeloma: a case report.

Abstract: The authors aimed to elaborate on an interesting clinical case of a subject that came to our attention following a low-energy traumatic event, producing a bilateral femur fracture. During the instrumental investigations, findings pointing to multiple myeloma were described, in fact later confirmed by the histological and biochemical investigations. In this specific case, unlike manifestations in most patients with MM, the classic correlated pathognomonic symptoms, such as lower back pain, weight loss, recurrent infections, asthenia, were not present. Furthermore, the inflammatory indices, the values of serum calcium, renal function and hemoglobin were completely normal, although numerous bone localizations of disease already coexisted, and these were all unknown to the patient.

[An unusual case of "complicated" adrenal hemorrhage]. / Un insolito caso di emorragia surrenalica "complicata".

This case report concerns a newborn with bilateral adrenal massive hemorrhage complicated by inferior cava vein thrombosis, hypertension and encephalopathy to elaborate diagnostic and therapeutic problem of neonatal thromboembolic events. Increasing of risk population (extreme prematurity), improvement of imaging, laboratory and neonatologist care enhanced in recent years the diagnosis of this group of diseases. Even if literature about this subject is poor, we remark the significant effort of neonatologist to revise and update neonatal guidelines and the relevance of the institution of the National Registry of Neonatal Thrombosis (RITI).

Rotational dynamics of trehalose in aqueous solutions studied by depolarized light scattering.

High resolution depolarized light scattering spectra, extended from 0.5 to 2x10(4) GHz by the combined used of a dispersive and an interferometric setup, give evidence of separated solute and solvent dynamics in diluted trehalose aqueous solutions. The slow relaxation process, located in the gigahertz frequency region, is analyzed as a function of temperature and concentration and assigned to the rotational diffusion of the sugar molecule. The results are discussed in comparison with the data obtained on glucose solutions and they are used to clarify the molecular origin of some among the several relaxation processes reported in literature for oligosaccharides solutions. The concentration dependence of relaxation time and of shear viscosity are also discussed, suggesting that the main effect of carbohydrate molecules on the structural relaxation of diluted aqueous solutions is the perturbation induced on the dynamics of the first hydration shell of each solute molecule.

The low frequency phonons dynamics in supercooled LiCl, 6 H2O.

We report the results of a series of ultrasound, Brillouin scattering, and optical heterodyne detected transient grating experiments performed on a LiCl, 6H(2)O solution from room temperature down to the vicinity of its liquid-glass transition, T(g) approximately 138 K. Down to T approximately 215 K, the supercooled liquid has a behavior similar to what is expected for supercooled water: its zero frequency sound velocity, C(0), continuously decreases while the corresponding infinite frequency velocity, C(infinity), sharply increases, reflecting the increasing importance of H bonding when temperature is lowered. Below 215 K, specific aspects of the solution, presumably related to the role of the Li(+) and Cl(-) ions, modify the thermal behavior of C(0), while a beta relaxation process also appears and couples to the sound propagation. The origin of those two effects is briefly discussed.

Respiratory disorders and hospitalization rates during the second RSV season in preterm infants who received palivizumab prophylaxis during their first RSV season.

This prospective study evaluated the frequency and severity of respiratory symptoms during the second respiratory syncytial virus (RSV) season in an italian cohort of preterm infants (< or = 35 weeks) who had received palivizumab prophylaxis in their first year of life (October 2004-April 2005) and who had not previously been hospitalized for RSV-induced lower respiratory tract infection (LRTI). infants were evaluated at enrolment (May-September 2005), in October/November 2005 and in April 2006. The occurrence of any respiratory episode, the rate of hospitalization for respiratory-related LRTI, total length of stay in hospital, physician-documented recurrent wheezing (>or = 3 physician-documented episodes of wheezing) and use of airway medication/antibiotics were recorded during follow-up. All infants had prior palivizumab prophylaxis during their first RSV season. In the total evaluable population (n=260), 32.3% of infants experienced at least one respiratory episode, 3.8% required short hospitalization because of LRTI, 8.5% had physician-documented recurrent wheezing, and 48.8% required airway medications/antibiotics during follow-up. in this study the rate of airway morbidity, hospitalization and physician-documented recurrent wheezing during the second RSV season was low among preterm infants who had received prior palivizumab prophylaxis.

Light scattering spectra of water in trehalose aqueous solutions: evidence for two different solvent relaxation processes.

Light scattering spectra on aqueous solutions of trehalose were recorded in a wide frequency range combining the use of a double monochromator and a multipass Fabry-Perot interferometer. Experimental results indicate the presence of a slow relaxation mode related to the solute dynamics, which is clearly separated from the solvent one. The spectral analysis reveals the existence of two separate solvent relaxation processes assigned to hydrating and bulk water molecules. The picosecond dynamics of water molecules directly interacting with the solute (proximal water) is consistently delayed with the corresponding relaxation time increase is about 5-6 times compared to the bulk. The slowing down induced by the sugar on the water dynamics mainly involves a restricted hydration layer constituted of 16-18 water molecules. These results improve our knowledge about the influence of carbohydrates on the fast rearrangement dynamics of water and may serve as a model to gain important insight on basic solvation properties of other biorelevant systems in aqueous media.

Concentration-temperature dependencies of structural relaxation time in trehalose-water solutions by brillouin inelastic UV scattering.

A Brillouin scattering investigation has been carried out on trehalose-water solutions in a wide range of concentrations (0

Development and validation of the Cozart DDS oral fluid collection device.

The testing of oral fluid for drugs of abuse has increased significantly over recent years and is now commonplace in drug rehabilitation clinics, the workplace, prisons and custody suites. The global problem of identifying drugged drivers has also led to an increase in oral fluid testing at the roadside. The main requirements for the implementation of roadside drug testing are a rapid sample collection time, collection of a known sample volume and recovery of drugs from the collection device. We report here the development of the Cozart DDS oral fluid collector, an oral fluid collector that combines rapid and adequate sample collection with satisfactory drug recovery. Oral fluid was collected from drug users (n=134) and drug-free individuals (n=137), using the Cozart DDS oral fluid collector. The mean time for the completion of collection (full coloration of the sample presence indicator) was 34 s for drug-free individuals and 44 s for drug users. The average volume collected was 0.34 mL (n=271). No chemical stimulant (to induce salivation) was used to achieve the collection times observed in either the drug-free or the drug-taking sample populations. Drugs were extracted from the collector using the Cozart DDS buffer and drug recovery was determined by Cozart enzyme immunoassays. The recovery studies showed that for amphetamine, Delta(9)THC, cocaine, methadone, methamphetamine, morphine and temazepam over 90% of the drug in the sample was eluted from the collector. The Cozart DDS oral fluid collector provides a reliable mechanism for the collection of oral fluid at the roadside that achieves the rapid collection times required.

Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases.

The objectives of this study were to investigate the usefulness of adrenal vein sampling in identifying the etiology of primary aldosteronism (PA) in patients with equivocal CT and MR findings. Between 1990 and 1999, 104 referred hypertensive patients (45 women and 59 men, aged 49.6 +/- 11.6 yr) were diagnosed to have PA with inconclusive computed tomography scan and magnetic resonance results, based on established criteria. Adrenal vein sampling (AVS) for measurement of plasma aldosterone (A) and cortisol (C) levels was performed in all. Selectivity of AVS was assessed by the ratio between C levels in each adrenal vein and in the infrarenal inferior vena cava plasma (C(side)/C(IVC)). A receiver operator characteristics analysis was carried out to establish 1) the best AVS-derived index, 2) the degree of selectivity that could provide an accurate diagnosis, and 3) whether a correct diagnosis could be made from a unilaterally selective AVS. An aldosterone-producing adenoma (average diameter, 12.2 +/- 0.08 mm) was eventually diagnosed in 41 patients (39.4%) and was excluded in the rest. Adrenal vein rupture leading to partial adrenal loss occurred in 1 patient (0.9% complication rate). By assuming a cut-off value of C(side)/C(IVC) > or = 1.1, AVS was selective in 85.7% and 94.1% of cases on the right and left sides, respectively, and bilaterally in 80.6% of cases. Of all AVS-derived indexes, the A/C of one over the A/C contralateral side [(A/C)(side)/(A/C)(contralateral side)] furnished the best diagnostic accuracy. With a bilaterally selective AVS, a value of (A/C)(side)/(A/C)(contralateral side) > or = 2 provided a conclusive etiological diagnosis of PA in 79.7% of cases. At variance, no accurate diagnosis could be made from unilaterally selective AVS. AVS was feasible and safe in most PA patients with inconclusive computed tomography and magnetic resonance scans. When bilaterally selective (i.e. C(side)/C(IVC) > or = 1.1) a ratio of (A/C)(side)/(A/C)(control) > or = 2 provided the best compromise of sensitivity and false positive rate for lateralization of the etiology of PA.

Predicting culture results for Mycobacterium tuberculosis complex. Amplified mycobacterium tuberculosis direct test and acid-fast bacilli microscopy.

STUDY OBJECTIVE: To evaluate the usefulness of the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (AMTDT; Gen-Probe; San Diego, CA) in predicting the results of cultures in routine laboratory analysis of a patient population with a high incidence of tuberculosis (TB). PATIENTS: Three hundred ten patients suspected of pulmonary mycobacterial infection or receiving antituberculous chemotherapy, accrued between 1996 and 1997. SETTING: Tertiary-care facility located in Northern Italy. DESIGN: We retrospectively compared the AMTDT results with the results of cultures. AMTDT results were also compared with those of acid-fast bacilli (AFB) staining of the same specimens. The study included 360 respiratory specimens from 310 patients collected between 1996 and 1997. In 1996, we used the initial version of AMTDT (50 microL of sediment); in 1997, we used the new version of AMTDT (450 microL of sediment). RESULTS: Compared with cultures, AMTDT and AFB staining had sensitivities of 87.2% and 68.4%, and specificities of 70.0% and 89.7%, respectively. When AMTDT and AFB staining were both positive, the sensitivity and specificity were 89.3% and 96.9%, respectively. When AMTDT and AFB staining were in disagreement, the sensitivity and specificity of AMTDT were 81.8% and 18.1%, respectively. CONCLUSION: We conclude that when AMTDT is used to predict culture outcome, the results should be evaluated in conjunction with AFB staining results before making decisions about TB management.

Plasma levels of E-selectin in normolipemic and hyperlipemic arteriopathic patients after vasoactive and lipid-lowering treatment.

BACKGROUND: The authors studied the plasma levels of E-selectin in a group of arteriopathic patients, before and after vasoactive and lipid-lowering treatment. METHODS: The series consisted of 73 subjects (53 males, 20 females, aged 54 +/- 9 suffering from occlusive peripheral arteriopathy; 21 subjects with total cholesterol (TC) below 200 mg/dl were considered as normolipemics (group A); 24 subjects with TC between 200 and 240 mg/dl, mild hypercholesterolemics (group B); 18 with TC above 240 mg/dl, severe hypercholesterolemic (group C); 10 subjects who had high triglyceride values (above 200 mg/dl), (group D); 12 normal controls were also considered. All patients underwent a vasoactive treatment for 15 days; group B also underwent a standard hypolipidic diet (phase I NCEP, lipid 30% die) groups C and D underwent the same diet associated respectively with simvastatin (200 mg/die) and bezafibrate (400 mg/die). For each sample of plasma before and after treatment the determination of levels of E-selectin was carried out by an immunoenzymatic method (kit ELISA Amersham). RESULTS: In groups A-B-C-D a reduction of the plasma levels of E-selectin was found, which was significant (p < 0.05), for group C and D, compared to controls. In groups A-B-D significant changes of E-selectin were not found after treatment; in group C the difference between the values after treatment and at baseline was significant (p < 0.05). CONCLUSIONS: The reduction of the E-selectin plasma levels was proportional to the values of total cholesterol and triglycerides; the chronicity and the dyslipidemia may be responsible for the basal diminished biosynthetic endothelial function; in the severe hypercholesterolemics the lipid-lowering treatment caused a significant decrease of E-selectin, due to a probable reduced endothelial irritation dependent on the hyperlipemic stress.

Nitrite, endothelin and E-selectin plasma levels after arginine infusion in normal, obese and type 2 diabetic subjects.

BACKGROUND: The authors studied the behaviour of nitrites (specific end-products of nitric oxide), endothelin and E-selectin after arginine infusion (biosynthetic precursor of nitric oxide). METHODS: The series consisted of 28 female subjects (mean age 59 +/- 8) of whom: 12 normal controls; 12 suffering from essential obesity (BMI 31.4 +/- 0.7); 14 suffering from uncomplicated type 2 diabetes mellitus. Each subject received intravenous arginine (20 g in two hours); before the infusion and after 1 hour and 2 hours venous blood withdrawal was performed. For each plasma sample the levels of nitrites (colorimetric reaction), endothelin (ELISA method) and E-selectin (ELISA method) were determined. RESULTS: In the controls plasma nitrites decreased significantly (p < 0.05), more evidently at the second hour. In the obese subjects a sharp significant (p < 0.05) fall of nitrites was observed, more evidently at the second hour. In the diabetics nitrite values were reduced (p < 0.05) compared to the baseline. Endothelin levels after arginine were almost unchanged in normal and obese subjects, while in diabetics a significant (p < 0.05) reduction was observed. In the three groups of subjects E-selectin values were not modified by arginine. CONCLUSIONS: This study demonstrates that arginine infusion increase NO biosynthesis in normal, obese and diabetic subjects, inducing a significant reduction of nitrites for an early process of organic reconversion; endothelin showed a reductive trend, mainly in diabetics, probably due to an antagonistic balanced response towards an overproduction of nitric oxide. E-selectin did not change, without correlation with the nitrite and endothelin values, because of an independence from the production of the two "hemodynamic markers".

The modified Lapidus arthrodesis: a retrospective analysis.

The authors present a review of 47 modified Lapidus arthrodesis procedures performed between 1985 and 1995. There were 29 females and 10 males. Eight patients underwent bilateral procedures. The average follow-up was 6.3 years (range, 1.5-10.6 years). The patients were evaluated preoperatively and postoperatively using standard weightbearing radiographs, clinical examination, and chart review. The average preoperative intermetatarsal angle was 13.8 degrees degrees, and the average postoperative intermetatarsal angle measured 2.1 degrees degrees, with a mean improvement of 10.8 degrees. The average effective shortening of the first metatarsal was 4.7 mm in those patients without bone graft. In patients whom bone graft was utilized, an average effective increase in first metatarsal length of 2.6 mm was identified. Complications included delayed union (n = 2), nonunion (n = 3), postoperative development of hyperkeratosis beneath the second metatarsal head (n = 4), elevation of the first ray (n = 3), and hallux varus (n = 2). There were no recurrences of hallux abducto valgus at follow-up. The average return to preoperative activity level was 13 weeks. Forty-two of the 47 procedures healed uneventfully. Of the remaining five feet, two required the use of a bone growth stimulator, and three required revisional surgery with autogenous bone graft to promote arthrodesis and restore alignment. In conclusion, the modified Lapidus arthrodesis is both a predictable and durable procedure for the correction of hallux abducto valgus.

Nitrite plasma levels after an oral fat meal in normolipemic subjects.

BACKGROUND: The authors, investigating the effects of an oral triglyceride-rich fatty load upon the endothelial function as regards the production of nitric oxide, performed the determination of plasma nitrites, which are stable, specific and irreversible end-products of nitric oxide. METHODS: The series consists of 13 metabolically normal female subjects (mean age 55 +/- 7 years); after an overnight fasting each subject undertook an oral fat load (butter 1 g/kg); a venous blood withdrawal was carried out before oral fat meal and after two and four hours. For each plasma sample total cholesterol, HDL-cholesterol and triglyceride plasma levels were determined by enzymatic methods; LDL-cholesterol was calculated by Friedwald's formula; the nitrite plasma levels were obtained by the Gutman and Hollywood colorimetric method. RESULTS: Total cholesterol, HDL-cholesterol, LDL-cholesterol did not show significant changes after the oral fat load; triglycerides rose significantly (p < 0.05) after 4 hours as compared to the basal value (226 +/- 12 vs 175 +/- 12 mg/dl, +30%). The nitrite plasma levels were almost unchanged before oral fat load and after 2 and 4 hours. CONCLUSIONS: The results suggest that the acute biochemical stress consisting of increased triglyceride-rich very low density lipoproteins was not able to stimulate the endothelial production of nitric oxide.

Nitrite plasma levels in normolipemic and hypercholesterolemic arteriopathics after vasoactive and lipid-lowering treatment.

BACKGROUND: The authors studied the plasmatic levels of nitrites, stable end-products of nitric oxide in arteriopathic patients before and after vasoactive and lipid-lowering treatment. METHODS: The series consisted of 63 subjects (mean age 64 +/- 9) suffering from peripheral arterial occlusive disease; 21 subjects with total cholesterol (TC) lower than 200 mg/dl were considered as normolipemic (group A); 24 subjects with TC ranging between 200 and 240 mg/dl were considered as mild hypercholesterolemic (group B); 18 subjects with TC higher than 240 mg/dl were consider as severe hypercholesterolemic (group C). All the patients were examined before and after 15 and 30 days of a vasoactive treatment (calciparine, aspirin, buflomedil and pentoxiphylline); group B after vasoactive and diet (NCEP phase 1) treatment and group C after vasoactive, diet and drug (simvastatin) treatment. Nitrite plasma levels were determined by the Gutman and Hollywood colorimetric method. RESULTS: In group A the basal value of nitrites was sharply (p < 0.05) lower than controls; after vasoactive treatment a significant increase (p < 0.05), was observed after 15 and 30 days; in group B the basal value was higher than controls; after 15 days a significant increase (p < 0.5) was noted, but a regression was found after 30 days. Also in group C the basal value of nitrites was higher (p < 0.05) than controls; after treatment significant changes were not found. CONCLUSIONS: The increase of nitrites in group A may be due to an improved endothelial function; this phenomenon, less appreciable in group B and no longer evident in group C may depend on the lipid-lowering treatment.

Plasma levels of E-selectin in normolipemic and hyperlipemic arteriopathic patients.

BACKGROUND: The authors studied the plasmatic levels of E-selectin in a group of normolipemic and hyperlipemic arteriopathic patients. METHODS: The series consisted of 73 subjects (53 male, 20 female, age 54 +/- 9) suffering from occlusive peripheral arteriopathy; 21 subjects with total cholesterol (TC) below 200 mg/dl were considered as normolipemics (group A), 24 subjects with TC between 200 and 240 mg/dl, mild hypercholesterolemics (group B), 18 with TC above 240 mg/dl, severe hypercholesterolemics (group C); 10 subjects had high triglyceride values (above 200 mg/dl), (group D); 12 normal controls were also considered. For each subject the determination of the E-selectin E-plasma levels was performed with an immunoenzymatic method (kit ELISA Amersham). RESULTS: In group A a value of E-s (4.03 +/- 0.37 ng/ml) statistically lower (p < 0.05) compared to normal controls (5.71 +/- 0.61 ng/ml) was found; in group B the E-s value (3.81 +/- 0.31 ng/ml) was slightly lower than that of group A; in group C the value of E-s was 3.53 +/- 0.23 ng/ml, statistically lower compared normal controls (p < 0.01) and to group A (p < 0.05); in group D the E-s value (3.24 +/- 0.23 ng/ml) was sharply reduced compared to controls (p < 0.01) and to groups A-B-C (p < 0.05). CONCLUSIONS: The reduction or E-selectin, was proportional to the magnitude of total cholesterol and triglycerides; the chronicity of the vasculopathy and the dyslipidemia may be responsible for an impaired biosynthetic endothelial function.

Practical applications of monitoring respiratory mechanics in newborn.

The authors evaluate the use of data supplied by common systems used to calculate respiratory mechanics in newborns in order to analyse the impact on the management of patients requiring assisted ventilation. Over the past few years, the sale of respiratory monitors that are easier to use and less complicated to manage, as well as being less expensive, has meant that nearly every Neonatal ICU can now determine, in real time, both the causes of respiratory insufficiency and the conditions of the newborn lung during mechanical ventilation to ensure improved adaptation of ventilatory support. Leaving aside a discussion of respiratory physiopathology and the principles regulating pulmonary ventilation, the authors focus on the practical effect that data normally supplied by this type of apparatus (airway pressure, inspiration and expiration airflow, expiration minute volume calculated for each respiratory act, tidal volume, system leaks and dynamic compliance) have on the ventilatory "setting" chosen by the clinician or on the diagnosis of some commonly found situations during neonatal mechanical ventilation. The experience described concerns the impression of clinicians, skilled in the management of patients receiving conventional artificial ventilation but not so attracted by respiratory physiopathology, regarding the value of such instruments. The unanimous positive opinion confirms the thesis whereby respiratory monitoring can certainly help the neonatologist make a real time evaluation of both the causes leading to respiratory failure and the effect on the lung of any therapeutic decisions.

Nitrite plasma levels in chronic lung disease patients.

BACKGROUND: The authors carried out a study in a group of lung disease patients, about the behaviour of the plasmatic levels of nitrites (stable, specific and irreversible end-products of nitric oxide). METHODS: The series consisted of 13 male patients (mean age 65 +/- 7 years) with chronic obstructive pulmonary disease with type 1 respiratory failure; 33 male subjects (mean age 58 +/- 5 years) without internistic disease were considered as controls. For each subject the determination of nitrite plasma levels by the Gutman and Hollywood method based on the Griess colorimetric reaction was performed. RESULTS: The mean value of the plasmatic nitrites was significantly reduced (p < 0.05) as compared to the controls (11 +/- 0.48 mumol/l vs 21 +/- 0.92 mumol/l). CONCLUSIONS: The authors hypothesized that in chronic lung disease patients there would be a condition of initial pulmonary hypertension; in this condition long-term endothelium-dependent nitric oxide production, aimed at the vasodilating effects with secondary excessive exhaled amount of NO, might cause a reduction in nitrite plasma levels. These levels may represent an early marker of pulmonary hypertension and suggest interesting therapeutic treatments through inhalation of exogenous NO.