Development of a hamster model of Chlamydophila pneumoniae infection

The aim of this study was to develop a new experimental model of Chlamydophila pneumoniae infection in the hamster. Intraperitoneal injection of C. pneumoniae purified elementary bodies (EBs) in the hamsters caused a systemic infection, since it was possible to isolate viable chlamydiae from several organs up to 14 days after infection. In particular, spleen infection was detectable up to 7 days post infection in 100% of animals. In contrast, cultures of the organs obtained from intranasally infected animals were far less frequently positive. Systemic infection probably occurred via macrophages, as demonstrated by the presence of intracellular chlamydial inclusions in peritoneal macrophages of peritoneally inoculated animals four days after infection. Furthermore, by infecting LLC-MK2 cells with supernatant preparations obtained from these macrophages, it was possible to observe the development of chlamydial intra-cytoplasmic inclusions after 96 h. Immunization of 18 hamsters with heat-inactivated purified EBs completely protected 16 animals and substantially reduced infection levels in the remaining two. Sera obtained from immunized hamsters prior to challenge reacted mainly against two C. pneumoniae proteins of about 60 kDa, when tested by immunoblot.

Use of IgG Avidity test in case definitions of toxoplasmosis in pregnancy

A survey network for congenital toxoplasmosis (TOXO-NET) was set up in December 1996 in Piedmont (Italy). Participants were asked to classify the infections in pregnant mothers and newborns by the criteria of the European Network on Congenital Toxoplasmosis published by Lebech in 1996. Because the IgG Avidity test is largely employed as a 2nd level test in toxoplasmosis diagnosis and it could be helpful to date infection, the co-ordinators of TOXO-NET suggested including it in the "case definition" of "probable" infection and "unlikely" infection. 117 cases of toxoplasmosis in pregnancy divided into the risk categories under Lebech's criteria were re-examined using the "new" case definitions. 77 out of 117 (65.8%) Toxoplasma gondii infections during pregnancy could be defined with only one serum sample using the IgG Avidity test. The IgG Avidity test proved a useful method to classify the Toxoplasma gondii infections in pregnancy, especially when we had only one serum sample.

[Endometriosis of the abdominal wall (authors' experience)]

Endometriosis is a very common gynecological disease, although the abdominal wall localization is a rare clinical problem in the everyday practice and this explains the incomplete reports in literature and the difficulty of a standard treatment. The authors report four cases of abdominal wall endometriosis, underlining how the surgical therapy represents the golden standard of decisive treatment, thanks also to prosthetic reconstruction techniques who allow more radical demolitions. On the contrary, the medical treatment should be reserved to selected cases such as especially the less symptomatic umbilical primitive diseases.

Plug-technique for small incisional hernia

OBJECTIVE

The authors report their experience with a new prosthetic technique for the repair of incisional hernia defects smaller than 3 cm.

METHODS

From January 1995 to September 2002, 16 operations for small incisional hernias have been performed. Local anaesthesia was used in 12 out of 16 patients (75%). The repair was achieved by insertion of a polypropylene plug sutured to the margins of the hernial defect.

RESULTS

All patients were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in 25% of cases. Back at home analgesia was needed in only 1 patient. During a follow-up ranging 3 to 91 months (mean 46), no recurrence has been recorded.

CONCLUSION

The proposed technique allows a sound repair of small incisional hernias with minimal pain, quick rehabilitation and early return to unrestricted work.

[Bilateral breast cancer]

Bilateral breast cancer has a cumulative incidence of 3-13% in patients with primary breast cancer, and the majority of these lesions are metachronous. The synchronous and metachronous bilateral breast cancer have at greater risk for distant metastasis than unilateral breast cancer. There was no difference in overall survival when comparing metachronous and synchronous bilateral patients to those with unilateral disease.

[Surgical tactics in abdominal wall neoplasia]

Abdominal wall neoplasms represent more or less 1% of human neoplasms in the adult. The authors reports their own experience based on 9 cases during over 20 years. The prognosis of these tumors is almost influenced from a lot of factors such as: histology, localization, staging, grading, sex, surgical margins, number of local recurrences. Abdominal wall neoplasm are less aggressive for compartmentalization of muscle layer and with a better prognosis because of their localization, and surgical opportunities of extensive resection (not less of 2 cm from tumor's macroscopic limits) allowed by modern prosthetic reconstruction techniques. Polipropilene seems to be the ideal material for such kind of reconstruction even if also mersilene, PTFEe and others were employed. PTFEe and Dual-meshes could be useful in those malignant tumors in which peritoneum resection is necessary.

Analogic evaluation of pain during inguinal hernioplasty under local anaesthesia

OBJECTIVE

The authors evaluate intraoperative pain in patients undergoing tension-free inguinal hernioplasty under local anaesthesia.

MATERIAL AND METHODS

One hundred and fourteen primary inguinal hernia repairs were carried out at the Department of General Surgery I of Catania University Polyclinic from January to September 2002. 2% Mepivacaine cloridrate was the local anesthetic of choice. Intraoperative pain was measured by a visual analog scale.

RESULTS

A mean analogic score of 1.9 (range 0-2.9) was obtained. Intraoperative complications were recorded only in 2 patients (1.7%). There was no operative mortality. All patients were up and about straightaway after surgery, had a light meal two hours later and were discharged within one day of operation.

CONCLUSIONS

Inguinal hernia repair under local anaesthesia is well tolerated and is associated with a low risk of complications.

[Undifferentiated carcinoma of the thyroid]

Anaplastic thyroid carcinoma is a rare and highly lethal cancer. Between 1969 and 2002, 9 cases with anaplastic carcinoma were reviewed. Surgical treatment with radiotherapy and chemotherapy were performed in all cases. All patients died of their disease within 5 years. The mean survival was 10 months. There is still controversy as to what constitutes adequate treatment for anaplastic thyroid carcinoma, and combined multimodal therapy seems to be the most common management strategy for this aggressive disease.

Comparative in vitro activity of garenoxacin against Chlamydia spp

The in vitro susceptibilities of 33 isolates of Chlamydia trachomatis, Chlamydia pneumoniae and Chlamydia psittaci to a new quinolone drug, garenoxacin (BMS-284756), in comparison with levofloxacin, ciprofloxacin, doxycycline, erythromycin and roxithromycin, were determined. Garenoxacin was the most active of the quinolone drugs tested, with identical MIC and MBC, which ranged from 0.007 to 0.03 mg/L. The MIC and MBC of the other two quinolones tested, levofloxacin and ciprofloxacin, were also identical, ranging from 0.25 to 2 mg/L. The MICs and MBCs of doxycycline, erythromycin and roxithromycin were also determined.

[Tension-free prosthetic repair in the surgical treatment of epigastric hernia]

From November 1994 to June 2001, the authors have performed 16 operations for epigastric hernia. Local anaesthesia was used in 8 patients with small hernias, in the remaining 8 general anaesthesia was preferred. In defects smaller than 4 cm, the repair was achieved by insertion of a polypropylene dart plug sutured to the margins of the hernial defect. In larger defects a double layer mesh placed in the pre-peritoneum was used. All patients were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in 25% of cases and domiciliary analgesia in 1 patient only. During a follow-up ranging 3 to 79 months (mean 31.2), no recurrence has been recorded. The proposed technique is simple, safe and absolutely effective, allows immediate rehabilitation with a low risk of complications.

[Plug-technique for umbilical hernia repair in the adult]

BACKGROUND

Umbilical hernia represents 6% of all abdominal wall hernias in the adult. Surgical repair should always be carried out due to possible occurrence of complications. Aim of this paper is to evaluate the efficacy of the plug-technique.

METHODS

From October 1995 to April 2000, the authors performed 21 operations for acquired umbilical hernia with a defect smaller than 4 cm. Local anesthesia was used and a light intravenous sedation added in particularly anxious patients. The repair was achieved by insertion of a polypropylene dart plug sutured to the margins of the hernial defect.

RESULTS

All patients were up and about straightaway and were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in only 19% of cases and domiciliary analgesia in 24%. During a follow-up ranging from 6 to 60 months (mean 30), only one recurrence has been recorded.

CONCLUSIONS

This tension-free technique allows immediate rehabilitation, with few complications and a low recurrence rate.

[Current approach in the treatment of desmoid tumors of the abdominal wall]

Desmoids of the abdominal wall are rare tumours with an incidence of 2-4 cases per million. From our experience which is reported here in detail (5 cases observed over the past 20 years), we draw the conclusion that the only completely reliable diagnosis is still histological, in spite of the use of ultrasound, CT scans and the new imaging possibilities afforded by NMR. After comprehensive excision of at least 2 cm of macroscopically healthy tissue from the tumour margins, reconstruction using prosthetic materials, such as Mersilene, PTFE or Prolene was performed. Neither radiotherapy nor chemotherapy were used, since there were doubts as to their usefulness. The functional and cosmetic results were satisfactory in all cases. Over follow-up periods ranging from 3 to 13 years, none of the patients has presented recurrences or incisional hernias.

[Tension-free lumbar hernioplasty]

The authors report a case of a 51 year-old woman with spontaneous Grynfeltt's hernia. Computerized tomography accurately displayed the anatomy of the lumbar region, thus aiding diagnosis and treatment. A double layer polypropylene mesh was used for the repair, placed in the pre peritoneum and sutured to the margins of the hernial defect avoiding muscles and fascias. The use of a double layer prosthesis and reduction of tension on the suture line allow a sound repair, with minimal postoperative pain and immediate resumption of daily activities.

Helicobacter pylori infection and gastric function in patients with fundic atrophic gastritis

In the present study we evaluated the relation among histology, H. pylori, IgG to H. pylori, gastric emptying, and acid secretion in 43 patients with fundic atrophic gastritis. On the basis of gastric acid secretion, patients were divided into three subgroups: patients with preserved acid secretion (Group 1), patients with hypochlorhydria (Group 2), and patients with achlorhydria (Group 3). Fundic glandular atrophy was more severe in hypoachlorhydric patients than in those with preserved acid secretion (P < 0.05 vs Group 2, P < 0.005 vs Group 3). H. pylori colonization was found in 94% of patients in Group 1, in 61% of patients in Group 2, and in only 8% of patients in Group 3 (P < 0.001 vs Group 1, P < 0.05 vs Group 2). Conversely, serological positivity to H. pylori was high in all three subgroups of patients (100% in Group 1, 77% in Group 2, 92% in Group 3). Gastric emptying was delayed in atrophic patients, particularly in those with hypoachlorhydria. Our data suggest that fundic atrophic gastritis represents a possible end stage of H. pylori infection, characterized by a progressive disappearance of the bacterium and a progressive deterioration of gastric functions.

Comparative study of the immune response in mice immunized with four live attenuated strains of mumps virus by intranasal or intramuscular route

The observation of many cases of mumps and mumps-associated CNS complications in vaccinees prompted us to perform an evaluation of the efficacy of four attenuated mumps virus (Urabe, Jeryl Lynn, Rubini and S12) vaccines. Two doses of vaccine were necessary to induce a good immunity in animals. The humoral and cell-mediated response induced in mice immunized intramuscularly or intranasally with these vaccines has been evaluated. Although the Urabe and Jeryl Lynn strains appear more immunogenic than the other strains and induce higher levels of IgG when administered intramuscularly, the S-12 strain administered intranasally induces a good IgG response. A marked specific CTL activity against mumps virus was observed in mice immunized intranasally with all the strains and, particularly, with the S12 strain. Thus, the intranasal immunization could be considered a possible alternative and efficient route of vaccination against mumps.

Localization of a new neutralizing epitope on the mumps virus hemagglutinin-neuraminidase protein

Four protein fragments which span the entire hemagglutinin-neuraminidase protein (HN) of mumps virus were expressed in HeLa cells and cell extracts were tested for their capability to induce neutralizing antibodies in mice. Fragment HN3 (aa 213-372) was able to induce the production of hemagglutination-inhibiting and neutralizing antibodies. When a subfragment of HN3, the synthetic peptide NSTLGVKSAREF (aa 329-340 of HN) was used for immunization, hemagglutination-inhibiting and neutralizing antibodies against mumps wild type virus but not against the Urabe Am9 vaccine virus were raised. The peptide could, therefore, contain a new epitope, which may be critical for protective host humoral immune response.

Neutralization of Toscana virus is partially mediated by antibodies to the nucleocapsid protein

The envelope glycoproteins G1/G2 of Toscana virus (TOSV) seem to have the most important protective role in stimulating antibodies against the disease in humans, as well as antibodies against the Nucleoprotein (N), a partial neutralizing activity. Mice immunized with TOSV recombinant Nucleoprotein developed a strong humoral response to the TOSV that revealed the presence of neutralizing antibody than in vitro assay. The neutralizing antibody titre of mice immunized with the whole TOSV was analyzed before and after absorption of the sera with the recombinant N protein. A decrease of the neutralizing activity was observed in the treated sera. Similar results were obtained absorbing human anti-TOSV positive sera with the recombinant N protein. This study was designed to identify the nature of antibodies produced against the N protein of TOSV in mice and to establish correlation with antibodies produced in humans by natural infection.