Background: Pneumatic lithotripsy (PL) and Holmium:YAG laser lithotripsy (LL) are two valid mini-invasive approaches in the treatment of urologic stones disease. The aim of this study was to compare stone free rates between these two treatment options.
Material and methods: From January 2010 to January 2011, 120 consecutive patients with single and primary ureteral stones were prospectively enrolled in this prospective study. The study was single-blinded and none of the patients knew which approach for stone fragmentation would be used.
Results: The ureteral stone-free rate (SFRs) in the PL group was 80.7% and 86.1 % in the LL group (p=0.002). The mean operating time was 60 (± 25) minutes in the LL group and 61 (± 21) minutes in the PL group, without significant differences (p=0.68). Multivariate logistic analysis revealed that stone location was not significantly predictive of SFRs (p=0.47). None of the patients had blood transfusions and no other severe complications appeared in either group.
Conclusions: In our study LL was significantly associated with a stone 80.7% in the PL group and 86.1% in the LL group (p<0.05). Also, Holmium:YAG laser lithotripsy was dem-onstrated to be the more efficacious endoscopic procedure for the treatment of ureteral stones, allowing stones to be successfully fragmented, with few complications.
This case report deals with a 30-year-old Brazilian woman who became anxious and de-pressed after her migration to Italy and two years of living there. At psychiatric assess-ment, she presented with mood deflection, difficulties in sleeping, sadness, anxiety and many somatic symptoms that began after her arrival in Italy and progressively worsened, eventually requiring psychiatric intervention.Today an increased number of mental disor-ders and somatisation symptoms tend to be observed among migrants, which are often related to stressful pre-migratory life events and Post-Migration Living Difficulties (PMLD). Management of these kinds of patients should be part of a program for Transcultural Psy-chiatry that integrates both medical treatment (pharmacological and non-pharmacological) and addresses cultural differences to improve individual conditions of the patients.
Gratification is one of the functions necessary for the satisfaction of basic needs geared towards welfare and reproduction, which evolved in higher animal species. Over the years, several studies on the mechanisms through which gratification exerts its effects on the nervous system and is associated with feelings of pleasure have shown that the dopa-minergic system is the most important circuit acting as a biological basis for gratification. This article will review the current knowledge on the response of the midbrain dopa-minergic system to appetitive and aversive stimuli, as well as the role played within this context by the Lateral Habenula, a structure that has attracted great interest among re-searchers in the recent years.
Frequent antibiotic prescriptions for urinary infections (UI) promote the development and spread of antibiotic resistance. In order to identify effective antibiotics for the first line treatment of UI at the Galaţi Infectious Diseases Hospital, we performed a retrospective study based on disk diffusion antibiotic sensitivity testing on bacterial strains from urine cultures. Urine samples were collected from hospitalized patients admitted with symptomatic UI during 2010. In total, 659 records were found of certified bacteriological UI, of which 82% were caused by Enterobacteriacea. Escherichia coli isolates were the most commonly encountered species of Enterobacteriaceae (83%). The median age of the patients with urinary E. coli was 48 [3; 87], sex ratio M/F= 56/399 and 9.8% of patients were HIV positive. Using the Carmeli scoring system for antibiotic resistance risk, we found that 86% of the E. coli isolates were community acquired infections. High level of resistance was evident for Ampiciline at 85%, Neoxazole at 54,6%, TMP-SMX at 45,6% and AmoxiClavulanate at 40,2%. The best sensitivity was obtained with 3rd generation cephalosporins and carbapenemes. The incidence of ESBL-positive strains was 7.4% (34/421). No ESBLpositive strain was identified in community acquired UI (Carmeli score 1). In conclusion, it is strongly recommended that the first line of antibiotic therapy at the Gala ţi Infectious Diseases Hospital should involve 3rd generation cephalosporins, while carbapenems should be reserved to patients with a Carmeli score of 2 or 3.
Nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels present in many regions of the central nervous system (CNS) and the peripheral nervous system. The neuronal nicotinic acetylcholine receptors, being situated at the level of different neurotransmission pathways, participate in the function of many cerebral activities.
Consequently, qualitative or quantitative deficits of nicotinic receptors are responsible for dysfunctions of these brain activities; such dysfunctions can occur at different stages of life due to brain aging or numerous neurological and psychiatric diseases of the developmental age, adulthood and old age. Modifications of specific nAChR subtypes have been found localized in specific brain regions in each such disorder.
In this review, we will discuss some of the above-mentioned brain disorders, reporting the relevant nAChR changes discovered to date, and summarize the therapeutic prospects currently under development.
Palliative procedures are those usually used in the treatment of metastatic limb sarcoma. However given the impressive results obtained with hyperthermic isolated limb perfusion (ILP), we tested the feasibility of isolated lung perfusion (ILuP), using the same regimen. Three patients with multiple metastases from limb sarcoma were included in this study.
ILP was applied in one patient resulting in limb preservation. Patients underwent 90minute ILuP, and subsequent metastasectomy. In all cases the procedure was completed without complications. No systemic toxicity developed. The only postoperative complication was one case of reversible interstitial and alveolar lung edema. The three patients are still alive and two of them were disease-free at a mean follow-up of 19 months. ILuP, with TNF and Melphaln, proved to be feasible and safe. This technique, in association with ILP, might improve long-term survival and quality of life in patients with multiple metastases from limb sarcoma.
This article presents the case of a 26 year old male heroin addict and chronic user of high doses of citalopram, who was found dead at his home. Toxicological analysis showed that the young man was in a state of chronic citalopram intoxication. The low opioid concen-tration detected excluded heroin overdose as the cause of death.
The heroin used by the man was characterized by a low percentage of opiates (heroin 0.1%, acetylcodeine 0.8%; 6-MAM 1.19%, codeine 0.2%) and a high percentage of cutting substances (caffeine 38%, acetaminophen 29%).
The pathogenetic mechanism underlying the man’s death was reconstructed through the integrated evaluation of analytical and pathological data together with consideration of the toxic effects of intravenous injection of heroin cut with a significant amount of caf-feine (although non-lethal) in the presence of high citalopram concentrations.
This study is a retrospective work of ambulatorial injections in patients suffering from Class II osteoarthritis (OA) of the knee. The research was conducted from January 2012 to July 2012 in a private clinic in Benevento, Hospital Val D'Elsa, Poggibonsi, Siena. A total of 60 patients were treated with intraarticular knee injections. Group A, composed of 30 patients (15 male and 15 female), was treated with injections of low molecular weight Hyaluronic Acid and Group B, composed of 30 patients (15 male and 15 female) was treated with injections of Ploynucleotide. At the six month follow-up, Group B showed a statistically significant difference (p<0.05) of the Visual Analogue Scale (VAS); the Knee injury and Osteoarthritis Outcome Score for Group B also showed a statistically significant difference (p<0.05). The results obtained suggest that polynucleotides can be considered as a valid alternative to hyaluronic acid for the treatment of symptomatic osteoarthritis of the knee.
The purpose of this study was to evaluate the different behaviors of the femoral bone in patients after anterior cruciate ligament reconstruction. Twenty-two patients undergoing ACL reconstruction either by double semitendinosus and gracilis tendon graft (DTSG), or ligament advanced reinforcement system (LARS) fixed at the femur with two biodegrad-able pins (RIGID FIX), were evaluated.
In all patients a physical examination was performed and functional outcome scores were obtained at follow up. Instrumental evaluation was performed by multislice CT. The CT scan, which mainly focused on the area of the femoral tunnel, showed an increase in spongy bone out of the socket in the surgery performed with LARS, while in patients treated with DTSG, the bone retained the normal structural characteristics of density of the femoral meta-epiphysis. The CT scan also documented a higher rate of pin biodegra-dation in reconstruction with LARS. The results analysis showed different patterns of re-sponse based on the type of ligament. A bone reaction for mainly mechanical purposes, evidenced by a circumferential fibrous ring, was observed in all patients. Additionally, a bone reaction for biological purposes, characterized by an increase in the spongy tissue associated with a reduction in bone density and a faster reabsorption of pins, was found in patients treated with LARS.
Efforts in developing guidelines have to be supported by investments on their application. Medical software may have a role in these initiatives. Two computer programs have been developed: one regarding chronic kidney disease and one about chronic pain management. For six months their use by 104 general practitioners was monitored. At study conclusion, a questionnaire of 13 multiple choice questions was emailed to all participating doctors. To evaluate the clinical benefits for the patients, a GP regularly used the CKD program and provided patients’ outcomes and clinical data. The application recorded 108 accesses during 66 work sessions. In the clinical outcomes section of this study, 7 patients out of 21 were diagnosed with CKD. Our study shows a need for programs of the “expert systems” kind: sources devoted to a narrow field of competence, accessed only when needed, in a way that resembles traditional specialist consultation.
In the contemporary society an International Health Elective (IHE) represents a strategic tool in order to implement future medical doctor’s education. In Italy, in the last decade, an increasing interest of trainees and residents to IHE and opportunities was documented and supported by the reorganization of the Italian residency programs, provided by the Ministry for Education, University and Research (MIUR). Aim of the present study was to collect data on perceived need of medical residents for an IHE.
A structured questionnaire was developed and administered to medical residents of Palermo’s University who underwent their annual visit to the Occupational Health Physician Ambulatory (OHPA) of Palermo’s University Hospital, in the period between March and October 2011.
Medical residents more prone to undergo an IHE were, younger than 29 years old (p <0.01), attending the new educational system (p 0.02) and surgical residents (p= 0.0001). A negative opinion about the formative quality performances of the residency program was significantly associated with surgical residencies (p= 0.002). Future Italian surgeons are more prone to undergo an IHE and this statement is probably related to the not satisfying residency program. Residents attending the old educational system consider the IHE as a way to implement their professional perspectives possibly for their more realistic professional perspective facing an approaching future full of work uncertainties.
Considering the future competition between medical professionals working in different EU contexts, the Italian Government should implement future medical education policy in order to provide for a Healthcare “without Border” in the EU.
Many peptides are present in the nasal mucosa, but few studies have investigated the presence or absence of the oxytocin and vasopressin peptides. This immunohistochemical study on the inferior turbinates of patients affected by chronic sinusitis shows, for the first time, that these peptides are present in the epithelium of both nasal mucosa and glands. Their presence could be related to the presence of atrial natriuretic peptide (ANP), like previously demonstrated in other organs such as heart and prostate, since in some circumstances they play in antagonism.