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Background: The aim of this study is to evaluate the feasibility and the safety of hernioplasty under local anaesthesia in elderly patients with significant comorbidity., Methods: A total of 218 patients underwent inguinal hernia repair with mesh between June 2009 and July 2012. Presence of comorbid conditions and complications were compared between patients younger and older than 70 years., Results: Hernia repair in older patients were more likely associated with comorbid conditions than in their younger counterparts ( hypertension: 25% vs 8.16%; cardiovascular diseases: 50% vs 22%; benign prostatic hypertrophy 60% vs 30%). The most common postoperative complications in both groups were recurrence, wound infection, urinary retention. There was a slightly higher rate of complication in elderly group., Conclusions: Inguinal hernia repair with local anaesthesia is quite safe and results in a good success rate in elderly patients despite a higher rate of comorbidity typical of this kind of patient.

Background: Substantial progresses in the management of peripheral arterial disease (PAD) have been made in the past two decades. Progress in the understanding of the endothelial-platelet interaction during health and disease state has resulted in better antiplatelet drugs that can prevent platelet aggregation, activation and thrombosis during angioplasty and stenting. A role in physiological and pathological angiogenesis in adults has been recently shown in bone marrow-derived circulating endothelial progenitors (BM-DCEPs) identified in the peripheral blood. These findings have paved the way for the development of therapeutic neovascularization techniques using endothelial progenitors., Methods: This pilot study includes five patients, aged 60 to 75, with a history of claudication and recruited from September 2010 to February 2011 at the A.O.U. Federico II of Naples.PBMNCs have been implanted three times in the limb with the worst ABI value in all the patients included in the study.The clinical follow up was performed during the subsequent 12 months from the beginning of the treatment., Results: In four patients there was a regression of ulcerative lesions.One patient's condition improved after the first implantation but later did not respond to the further treatments.All patients achieved a pain relief as judged by the numeric pain scale. Pain relief remained satisfactory in three patients for one year. Pain gradually returned to the pre-treatment level in two patients.All patients referred an ameliorating in their quality of life expressed even by an improvement in claudication free walking distance.These improvements are reflected also by intra-arterial digital subtraction angiography (IADSA) that shows an improvement of arterial vascularization., Conclusions: The data from this study suggest an efficacy of BM-DCEPs implantation in terms of improvement of the vascularization and quality of life in patients affected by Peripheral Arterial Disease. Nevertheless a double-blind placebo-controlled study is needed to confirm our findings.

Background: Differences in health-related quality of life perception in patients with chronic disease may depend on pre-existing differences in personality profile. The purpose of the study was to investigate in a cohort of female patients with chronic diseases the relationship between the Quality of Life perception and the potential presence of depressive symptoms., Patients and Methods: Female patients with chronic diseases were enrolled in the study. Exclusion criteria were diagnosis of psychopathological condition, treatment with psychoactive substances.Methodological approach was based on administration of the following test. Short Form health survey SF-36, Symptom Check List SCL-90-R, Satisfaction Profile test (SAT-P) and Beck Depression Inventory-II (BDI-II). The Pearson correlation coefficient was used to evaluate the relationship between depressive symptoms and Quality of life as assessed by psychometric test., Results: 57 patients, aged 52(± 3,4), responded to inclusion criteria. 57% of patients had a diagnosis of functional dyspepsia or gastro-oesophageal reflux not complicated, and the remaining 43% musculoskeletal diseases. The statistical analysis showed an inverse correlation between the variable Bodily Pain of the SF-36 and the variable Depression scales of the SCL-90-R.In a second phase another sample of female patients was enrolled in the study. 64 patients, aged 49(± 3,2), responded to inclusion criteria.Another significant negative correlation was found between the Somatic-Affective factor of the BDI-II and the scale Physical Functioning of the SAT-P., Discussions: In female patients with chronic disease depressive symptoms resulted influenced by pain and vice versa. The treatment of depressive symptoms could improve the quality of life of patients.

Background: Chronic liver disease secondary to hepatitis C virus (HCV) infection is a common clinical problem. HCV is likely to adversely affect the quality of life (QoL) of the patient. This effect is said to be disproportionate to the severity of the disease. The aim of our study was to evaluate QoL in HCV-positive patients focusing both on health status and subjective satisfaction., Methods: Twenty-four patients with combined HCV and alcoholic liver disease (ETOH-HCV) were enrolled in the study. We adopted two generic tools: SF-36 (a health status questionnaire) and SAT-P (a satisfaction profile) for psychological assessment of the patients. SF-36 and SAT-P scores of ETOH-HCV patients were compared with scores of 23 patients with alcoholic liver disease (ETOH). The scores obtained from the study groups were also compared with the reference scores of the healthy Italian population., Results: Both the groups were comparable with respect to age, histological and clinical severity of liver disease (as assessed by MELD and Child Pugh scores). Patients with ETOH-HCV scored less in the vitality and role emotional status domains of the SF-36 scores and the psychological function, social function and free time domains of the satisfaction profile., Conclusions: These results show a significant impact of HCV infection on health status and subjective satisfaction., (Copyright © 2011 S. Karger AG, Basel.)

The trypanocidal activity of racemic mixtures of cis- and trans-methylpluviatolides was evaluated in vitro against trypomastigote forms of two strains of Trypanosoma cruzi, and in the enzymatic assay of T. cruzi gGAPDH. The cytotoxicity of the compounds was assessed by the MTT method using LLC-MK2 cells. The effect of the compounds on peroxide and NO production were also investigated. The mixture of the trans stereoisomers displayed trypanocidal activity (IC50 approximately 89.3 microM). Therefore, it was separated by chiral HPLC, furnishing the (+) and (-)-enantiomers. Only the (-)-enantiomer was active against the parasite (IC50 approximately 18.7 microM). Despite being inactive, the (+)-enantiomer acted as an antagonistic competitor. Trans-methylpluviatolide displayed low toxicity for LLC-MK2 cells, with an IC50 of 6.53 mM. Furthermore, methylpluviatolide neither inhibited gGAPDH activity nor hindered peroxide and NO production at the evaluated concentrations.

Methylation-sensitive single-strand conformation analysis (MS-SSCA) is a method of screening for methylation changes at CpG sites in a region of DNA. After bisulfite modification, the region of interest is amplified using primers specific for bisulfite-modified sequences. The amplified products are denatured and run on a nondenaturing polyacrylamide gel. The sequence differences caused by methylation lead to the formation of different secondary structures (conformers) with different mobilities. MS-SSCA is a convenient and rapid method for screening large numbers of samples for methylation. Individual bands can readily be isolated and sequenced allowing more detailed analysis of methylation changes. In this article, we present a protocol for MS-SSCA and outline strategies for the design of primers for amplifying bisulfite-modified DNA sequences., ((c) 2002 Elsevier Science (USA).)

A total of 64 patients surgically treated for vertebral fractures were evaluated clinically and radiographically after a mean time of 49.55 months (from 1 to 124). There were 50 males and 14 females. Mean age at the time of surgery was 40.67 years (from 17 to 71). Fractures were divided based on the Denis classification system: comminuted fractures: 45; fractures caused by flexion-distraction: 2; fracture-dislocation: 17; 31 of the fractures were localized at the lumbar level, 30 in the dorsal region, 3 at the dorsolumbar passage. Neurologic evaluation was carried out on admission and at follow-up using the Frankel classification system: type A: 22; type B: 13; type C: 7; type D: 6; type E: 16. 56.25% of the patients (36 cases) were classified as having multiple trauma. Of the 64 patients, 38 had reduction and stabilization within 6 hours of trauma, 26 were treated after a mean time of 2.7 days (from 1 to 6). Harrington-Luque stabilization was carried out in 5 patients, using the Hartshill rectangle in 59. The mean time for hospitalization was 27.68 days (from 9 to 91). Follow-up showed neurologic recovery in all of the patients operated on, with the exclusion of those classified as Frankel A, without sacral sparing. Despite the residual kyphosis and the final anatomic findings which were not always satisfactory, the methods used allowed us to obtain results that could be compared to those obtained by other means of fixation and more complex techniques.

Intercellular communication via gap junctions is a mechanism for tumor suppression. Connexin 26 (Cx26) is a structural component of gap junctions expressed by breast epithelial cells. Expression levels of Cx26 are reduced in many breast tumors. Methylation-sensitive single-stranded conformation analysis showed variable methylation in the promoter region CpG island in 11 out of 20 (55%) breast cancer patients. Heterogeneity in methylation patterns was observed both between and within tumors. The degree of methylation ranged from a few CpG dinucleotides to almost all the CpG dinucleotides in the analyzed region. The most frequently methylated CpG was in an Sp1 site known to be important for Cx26 gene expression. One of eight breast cancer cell lines (MD-MBA-453) was methylated in the promoter region and did not express Cx26. Treatment of MDA-MB-453 with 5-aza-2'-deoxycytidine resulted in the re-expression of Cx26 mRNA. Methylation of the promoter region is likely to be an important mechanism in modulating the expression of Cx26 in breast cancer.

Research suggests that social support can be an important coping resource for athletes recovering from sport injury. Few studies have investigated this claim, however. To address this gap in the literature, 10 elite downhill skiers who had recovered from serious sport injuries were interviewed about the sources of stress associated with injury and the role of social support in recovery from sport injury. This paper presents the social supportfindings that emergedfrom this research'. Content analyses of the social support data revealed that the skiers needed various types of emotional, informational, and tangible support from the occurrence of injury through the return to full activity. Members of the treatment team, the ski team, and the skiers' home support net works provided social support throughout these phases. In general, the skiers were satisfied with the support received, indicating that it reduced distress and kept them motivated throughout recovery. The findings from this research have implications for the design of sport injury interventions.

Loss of A, B, and H antigens from the surface of red blood cells has been a recurrent observation in patients with hematologic malignancy, particularly those malignancies in which the myeloid lineage is involved. To better understand this phenomenon, a 2-color flow cytometric method was developed to determine quantitative and qualitative alterations of A, B, and H antigens in patients with myeloid malignancies. Characteristic patterns, dependent on the genotype, were seen for healthy individuals from each of the blood groups. Fifty-five percent (16/29) of patients of blood group A, B, or AB had a proportion of red cells with decreased expression of A or B antigens compared with no changes in 127 healthy A, B, and AB individuals. In most cases, the changes were not detected by routine serologic typing. The loss of A or B antigens was the primary change in 28% (8/29) of patients. In 17% (5/29) of patients, loss of A or B antigens was an indirect consequence of loss of the precursor H antigen. Alterations involving both the H and the A or B antigens were seen in 10% (3/29) of patients. Loss of H was also detected in 21% (6/28) of group O patients whereas none of 51 healthy O individuals showed changes. Alterations of ABO antigens can now be considered a common event in myeloid malignancy. (Blood. 2001;97:3633-3639)

Objective: To investigate the incidence and define the diagnostic aspects of intraepithelial squamous cell carcinoma of the oesophagus and to show the trend in its natural history., Design: Analysis of records of more than 31000 upper gastrointestinal endoscopies in a secondary referral centre., Setting: Gastroenterology unit, Italy., Subjects: 23 men and 2 women with endoscopic and histological diagnoses of intraepithelial squamous cell carcinoma of the oesophagus., Results: The incidence was 0.8/1000 patients/year. There was a coexisting oropharyngeal or laryngeal cancer in 17 patients. The endoscopic appearance was of a more or less well-defined hyperaemic area. Lesions progressed to infiltrating carcinoma in a mean of 18.3 months range 11-32)., Conclusions: Intraepithelial squamous cell carcinoma is rare in this population. Endoscopy and histology are essential for diagnosis and staging.

Injury and illness pose significant physical and psychological challenges for competitive athletes. The present study examined the psychological processes associated with injury and illness among elite skiers. Twelve members of the Canadian Alpine Ski Team who had recovered from a serious sport injury or debilitating illness were interviewed for the study. Inductive analyses of interview transcripts revealed that the experience of sport injury and athlete illness spanned three distinct phases, namely, the injury-illness phase, the rehabilitation-recovery phase, and the return to full activity phase. In addition, it was found that each phase was marked by a series of events that caused the skiers varying degrees of distress. This article traces the skiers' psychological journey from injury and illness through recovery, with an emphasis on factors contributing to stress and the strategies used to manage stress.

We have developed methylation-sensitive, single-strand conformation analysis (MS-SSCA) as a method of screening for methylation changes. Bisulfite modification converts cytosines to thymines, but methylated cytosines remain unchanged. This modification creates sequence differences between methylated and unmethylated samples, which can be resolved by SSCA. SSCA is 70-95% efficient at detecting single base changes in a fragment. As bisulfite modification of methylated DNA would typically involve several base changes in a fragment, the efficiency of detecting methylation using MS-SSCA could approach 100%. We applied this method to analyze the BRCA1 promoter CpG island in breast cancer samples. About 20% of sporadic breast cancers are hypermethylated at the BRCA1 promoter CpG island. MS-SSCA rapidly detected those tumors that had previously been shown to be methylated by Southern blotting. The variant bands detected by SSCA were analyzed by sequencing and shown to be methylated. MS-SSCA is a simple method for screening large numbers of samples for methylation and can accelerate genomic sequencing, as all bands can be isolated and sequenced directly., (Copyright 1999 Wiley-Liss, Inc.)

Study Objective: To compare prothrombin time measurements by fingerstick and routine laboratory methods., Design: Prospective cohort study., Setting: University-affiliated anticoagulation clinic., Patients: Thirty-three patients receiving warfarin with stable anticoagulation for 3 months preceding the two studies., Interventions: Groups 1 (17 patients) and 2 (16 patients) provided 150 and 125 paired samples, respectively, for fingerstick and routine laboratory analysis. The fact that no patient required a dosage change allowed for a clinical assessment., Measurements and Main Results: Correlation and agreement between methods were good in group 1 but poor in group 2. Fingerstick results were less variable (smaller standard deviation and smaller coefficient of repeatability) in both groups. By analysis of discrepant pairs (25 in group 1, 63 in group 2), the routine laboratory results indicated dosage changes erroneously more often than did the fingerstick method., Conclusions: In these two trials, the fingerstick system was superior to the routine laboratory method in that it was more reliable (less variability and more repeatable) and less likely to indicate dosage changes erroneously.

Risk factors of slow healing were previously researched in a large sample of duodenal (DU) and gastric ulcer (GU) patients over 65 years of age; persistence of ulcer symptoms was proven the most reliable factor in predicting nonhealing ulcer, while ulcer size was of importance only for DU. We aimed to complete the analysis, with a more careful evaluation of concomitant diseases and therapies. Ranitidine 300 mg daily was given for four to eight weeks to 310 GU and 699 DU patients. Ninety-three patients dropped out of the study; 79/294 gastric ulcers and 138/635 duodenal ulcers were unhealed after four weeks. Cardiovascular, gastrointestinal, and pulmonary disorders were the most frequent concomitant diseases; NSAIDs, cardiovascular drugs, and antihypertensives were the most frequent concomitant therapies. Esophagitis was diagnosed in 15.5% of patients. Ulcer healing was the major determinant of persistence of ulcer symptoms; esophagitis emerged as an important adjunctive and independent factor. Use of hypoglycemic agents in the whole sample and smoking habit (in GU) may have also a role. With persistence of ulcer symptoms removed from the analysis, ulcer size was the most constant factor affecting ulcer healing. NSAID use, cardiovascular disorders, esophagitis (in GU), and concomitant therapy with cardiovascular drugs (in DU) also play a role. In conclusion, persistence of ulcer symptoms, the major indicator of slow ulcer healing in the elderly, is independently affected also by the presence of esophagitis. Use of hypoglycemic agents and smoking habit may also have a role in persistence of ulcer symptoms. NSAIDs, cardiovascular disorders, cardiovascular drugs, and esophagitis affect ulcer healing, for which the most constant indicators remained persistence of ulcer symptoms and ulcer size.

The authors evaluated several immunological parameters in patients with loosened hip arthroplasty in order to determine the state of sensitization with regard to the metallic constituents of the prosthesis. The results obtained by in vivo epicutaneous testing did not reveal a correlation between loosening and sensitization, as the patch test was positive in only 1 out of 16 cases examined. An evaluation of the lymphocyte subpopulation on peripheral blood demonstrated that patients with prostheses in Cr, Co, Mo, Ni alloy present significant lymphopenia, with a reduction in subpopulations CD4 and CD8 and a decrease in in vitro cytotoxic activity. The meaning of these modifications could be interpreted to be either a toxic effect products released from the implant, or as the recruitment of lymphocytes in the site of loosening, due to lymphocyte sequestration phenomena consequent to a cell-mediated hypersensitivity reaction.

The authors attempt to define the role of computed tomography (CT) in the study of loosened hip prosthesis. To this purpose they have studied 30 patients with clinical and/or radiographic findings of loosening, carrying out a conventional radiographic assessment and a CT scan of the hip in question, and then comparing them. They conclude that CT scan when carried out according to the correct procedures described is very useful. Despite the presence of technical artefacts due to the presence of the metal prosthesis, the test makes a considerable contribution, not so much to the diagnosis of loosening in itself, which continues to be a clinical-radiologic diagnosis, rather to the evaluation of the morphostructural states of the acetabular bone for correct planning of surgery.

MCD peptide is a toxic component of bee venom that contains 22 amino acid residues and two disulfide bridges. The peptide was prepared synthetically and purified by HPLC. The proton NMR spectrum of aqueous MCD peptide was assigned at 300 MHz. The NMR and HPLC results showed that the peptide is an approximately 2:1 mixture of two slowly interconverting species, most likely conformers. Proline-12 is proposed as the locus of the conformational equilibrium. Measurements of the proton-proton nuclear Overhauser effect confirmed that the connectivity of the major form is C3-C15 and C5-C19.

The authors retrospectively analyzed 205 patients affected with low back pain and submitted to conventional radiology, CT scan, MR. The purpose of the study was that of gaining a better understanding of the mechanisms caused by the occurrence of spondylosis and its evolution. In light of the most recent literature, the authors conclude: 1) the degenerative process nearly always initiates with laceration of the anulus; 2) dysfunction of the disc then has repercussions on the posterior structures at varying times and with different modalities; 3) symptoms do not always coincide with radiological findings. Thus, the authors believe that for a more complete understanding of the etiopathogenesis and the evolution of spondylosis, further studies involving long-term follow-up of a young population, in relation to clinical and MR findings are needed. MR is the method of choice in determining disc degeneration.

To study the effect of Esaprazole, a new antiulcer drug, on acid, peptic and alkaline secretion a modified gastric acid test was performed in 18 duodenal ulcer patients. Pentagastrin was administered as bolus 30' and 75' after the beginning of the test, followed by Esaprazole 300 mg i.v. at 90'. Gastric juice was collected every 15' for determination of: total volume, volume of non parietal secretion, acid, bicarbonate and pepsin output. Serum pepsinogen group I was determined by radioimmunoassay. Esaprazole had a significant inhibitory effect on the total volume of gastric secretion and on volume of non parietal secretion. Pepsin output and serum pepsinogen group I were not affected by Esaprazole, while bicarbonate secretion was reduced. Antiulcer activity of Esaprazole seems to be due to the reduction of total volume of gastric secretion.

The authors report their experience in the surgical treatment of the sequelae of congenital hip dysplasia, more specifically, 125 arthroplasties performed in 116 patients, with specific reference to the technical difficulties encountered and the various surgical methods used. This review suggests that prosthetization yields a high percentage of good results (77%) and constant remission of pain. Nonetheless, joint function, particularly when motion was severely compromised before surgery, or when dislocation was very severe (Crowe grades III and IV), is not always restored.

Osteosynthesis with a humeral anchor nail may be listed along with other methods of intramedullary fixation for the treatment of diaphyseal fractures. The authors report their experience with 33 cases of humeral fractures treated between July 1987 and July 1991. Results were excellent in 61% of the cases, good in 24%, and fair in 15%; no particular complications were reported. The authors believe that the anchor nail constitutes a system of osteosynthesis involving only a small amount of trauma, and allowing for positive elastic stability for the consolidation of the fracture, as well as being a sufficiently safe system so that immobilization in plaster may be avoided. When compared with other systems of intramedullary fixation, the anchor nail is more effective than the Rush nail from a mechanical point of view, and the Kuntscher nail from a biological one.

Drug-drug interactions are most likely to occur in patients receiving multiple medications and with drugs that have a narrow therapeutic window. The outcome may be harmful or beneficial, but the relative incidence of clinically important adverse drug interactions remains unknown. Many interactions may be minimized or avoided; the prescriber must be aware of this potential in order to take the necessary precautions.

Background: The intensity of warfarin anticoagulation in the United States may be inappropriate if the international normalized ratio (INR) is not used, or if the international sensitivity index (ISI) of the thromboplastin is outside the range of 2.2 to 2.6., Methods: Fifty-three hospital laboratories provided data on the sensitivity of their thromboplastin and whether they reported INR values. Additional data on thromboplastin sensitivity were obtained from 140 laboratories involved in the Stroke Prevention in Atrial Fibrillation study. The three major manufacturers of thromboplastin confirmed the range of thromboplastin sensitivity reported by the laboratories., Results: Of 53 laboratories surveyed, 16 (30%) could not provide ISI data and only 11 (21%) reported INR results. Unlabeled thromboplastin was being used by 20% to 24% of laboratories, and only 8% to 20% were using thromboplastins with an ISI of 2.2 to 2.6. At the time the three manufacturers were contacted, they reported marketing thromboplastins with ISI values from 1.2 to 2.8, but none of the thromboplastins at that time had ISI values between 2.2 and 2.6., Conclusion: Warfarin therapy in the United States is managed inappropriately because most laboratories do not report INRs and the variability in thromboplastin sensitivity produces misleading prothrombin time ratio results. Additionally, recent research may require reexamination if INR or ISI data were not provided.

This study prospectively evaluated the potential interaction between the oral anticoagulant warfarin and the quinolone antimicrobial agent ciprofloxacin. After a 10-day placebo lead-in phase, 16 patients stabilized with long-term warfarin therapy were randomized to receive ciprofloxacin 500 mg or a matching placebo twice/day for 10 days. International normalized ratios (INRs) measured by both standard laboratory analysis and by Coumatrak (finger-stick) methods were evaluated at 3- to 5-day intervals. No patient experienced a significant increase in INR. No patient experienced a bleeding event. These data support the fact that a warfarin-ciprofloxacin interaction does not routinely occur at this dosage and duration of ciprofloxacin therapy.

The concentration of 2-(2,3-dihydro-5-acetoxy-4,6,7-trimethylbenzofuranyl) acetic acid (IRFI 016) and its active metabolite 2-(2,3-dihydro-5-hydroxy-4,6,7-trimethylbenzofuranyl) acetic acid (IRFI 005) in bronchial alveolar liquid (BAL) and plasma of mice were studied. IRFI 016 and its active metabolite IRFI 005 are both present in BAL and plasma after oral administration of IRFI 016. In BAL no delay times were noted, in comparison with plasma, regarding Cmax time nor significant variation of t1/2 and the elimination constant (Kel). IRFI 016, orally administered, is very rapidly absorbed and, both in unaltered form and as its active metabolite, reaches the anatomic site where it carries out its principal pharmacological activity, according to the same kinetic course observed in plasma.

The authors analyzed the results obtained in 10 fractures of the posterior arch of the atlas treated nonsurgically. There was consolidation in all of the cases at the end of treatment. According to the authors the element which most characterizes this fracture is constituted by its radiological diagnosis which principally makes use of lateral projection. In particular cases, when patients are characterized by multiple trauma, the fracture may go unrecognized.

Surgical treatment of vertebral deformity due to myelomeningocele has always presented important technical problems. Many complications, the foremost of which pseudarthrosis and infection, are reported in the literature. The authors discuss 14 patients with vertebral deformity from myelomeningocele who were treated with different surgical methods and reviewed after an average of eight years. The only conclusion that can be drawn on the basis of both the literature and the present study is that posterior surgery alone is incapable of guaranteeing stable correction over time for severe deformity. Combined anterior and posterior surgery with spinal fusion up to the sacrum yields better results, and the patient is not required to wear a corset afterward.

The authors examined 25 fractures of the dens epistrophei treated conservatively by several methods in order to evaluate the most suitable treatment for this lesion. A Minerva plaster cast proved to be effective in the treatment of type III fractures, while the halo plaster system obtained the best results in type II fractures.

We studied hepatitis B virus surface antigen (HBsAg), surface antibody (HBsAb) and "core" antibody (HBcAb) prevalence in 166 among hospital personell and patients with and without liver disease. Results show there is a very high prevalence of hepatitis B virus markers in such populations and the presence of HBcAb in absence of the other markers varies from 6% in "high risk" subjects to 30.3% in cirrhotic patients. We conclude that HBcAb seems to be, at moment, the most sensitive serological marker either for epidemiological studies or diagnosis and, in some instances, for prognosis of hepatitis B virus liver diseases.