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After implementation of programmes for active immunization against Haemophilus influenzae b, Streptococcus pneumoniae and Neisseria meningitidis became the most common agents of bacterial meningitis in childhood. Over a 9-year period, children showing clinical and laboratory findings of meningitis on the basis of their positive cultures of blood or cerebro-spinal fluid (CSF) for S. pneumoniae were enrolled. Predisposing conditions, clinical and laboratory findings, and microbiological and imaging studies were considered. Meningitis-related death or neurological sequelae defined an unfavourable outcome. Sixty-four patients met the inclusion criteria. Thirty-one (48%) children had predisposing conditions to pneumococcal meningitis. Fever and neck stiffness were the main symptoms; 14 patients (22%) reported seizures before admission. Twenty-one patients required treatment in the intensive care unit (ICU). Streptococcus pneumoniae strains were penicillin susceptible in 54 cases (84%). Forty-eight children (75%) showed complete recovery. Two patients (3%) died, and 14 (22%) had sequelae. Patients with a low CSF cell count, low neutrophils, early admission to ICU or infection by penicillin-nonsusceptible strains of S. pneumoniae had an unfavourable outcome more frequently. Low blood neutrophils, low CSF cell count, early admission to ICU and infection by penicillin-nonsusceptible strains are the main factors predicting an unfavourable outcome in children with pneumococcal meningitis.

Invasive aspergillosis is observed mainly in immunodepressed patients. Here we report a case of pulmonary aspergillosis with CNS involvement in a pregnant woman without other known causes of immunodeficiency.A 23-years old pregnant woman underwent a caesarean because of unexplained seizures. During the subsequent days worsening headache and a deteriorating neurological status were reported suggesting meningitis. Stiffness, right sided hemiparesis and cranial nerve palsies were observed at admission. Radiological findings revealed lesions involving the right pulmonary apex, the right cerebellar hemisphere and the Pterygopalatina fossa. Microbiological studies revealed large colonies of Aspergillus fumigatus. A favorable outcome was observed after administration of liposomal amphotericin B and 5-fluorocytosine and, at improved conditions, when oral uptake of itraconazole was given. The authors conclude that risk of infections sustained by fungal opportunistic agents during pregnancy must be considered. Sequential antifungal administration may be an efficient therapy able to shorten hospitalization.

A lot of different implants are available in hip replacement arthroplasty (THA), stems differ mainly by type of fixation, material, length, diameter, shape, surface coating, modularity, etc. The main quality of a non-cemented stem is to pursuit primary and secondary stability, to preserve bone stock, to be adaptable and modular. The literature shows that the most popular non cemented stems used in THA are metaphyseal femoral stem in which the distal portion has only the action to avoid varus stem placement but can also be a source of complications such as stress shielding. The stability of a short stem is closely dependent on material that must allow a high "scratch fit" and facilitate osteointegration with a generous surface of bone-implant contact. From September 2010 we have performed 287 THA using a modular titanium porous short stem. The article shows the preliminary results, which are very encouraging, showing excellent primary and secondary osteointegration, also slightly undersized implants or in elderly porotic patients.

A 37-year-old splenectomized man affected by beta-thalassemia and chronic hepatitis, recently treated with pegylated interferon-alpha (Peg-IFN), was admitted because of elevated fever lasting 3 months and unresponsiveness to broad-spectrum antibiotics. Laboratory studies showed white blood cell and platelet counts within the normal range but lower than observed before Peg-IFN treatment and an elevated erythrocyte sedimentation rate. The blood transfusion rate was reported to be increased compared with the period preceding Peg-IFN treatment. A diagnosis of visceral leishmaniasis (VL) was made after Leishmania amastigotes were identified from Giemsa-stained smears of bone marrow aspirates. Cure occurred after liposomal amphotericin B was administered. Symptoms of VL may be difficult to distinguish from the manifestations of Peg-IFN intolerance. We suggest that VL must be suspected in any immunodepressed patient with an unexplained fever and a history of exposure in an endemic area.

Between 1980 and 1987 we have implanted 46 isoelastic cementless THR in 40 patients affected with rheumatoid arthritis. We have reviewed 38 hips clinically and by X-ray. The mean follow-up was 8,5 years. Harris hip scores ranged from 30.6 preoperatively to 73,4 post-operatively when reviewed. While on the other hand Merle D'Aubigné hip scores ranged from 7,06 pre-operatively to 15,59 post-operatively. All patients have been satisfied, and X-rays showed an improvement for both Charnely and Gruen X-ray score.

Tuberculosis (TB) is an important cause of morbidity and mortality worldwide. Here, we describe our experience of childhood tuberculous meningitis (TBM), focusing on factors influencing presentation and outcome.Children aged 0-14 years, with diagnosis of TBM and 24 months of post-therapy follow-up, were evaluated in this retrospective study.Thirty-two patients with TBM were identified. Fever, nuchal rigidity and vomiting were the main presenting symptoms. Fourteen cases (44%) presented with cranial nerve palsy. Seventeen (53%) patients were in advanced stage of the disease on admission. Cerebrospinal fluid (CSF) examinations showed low glucose, high proteins and pleocytosis. A central nervous system device was placed in 4 cases (13%) because of worsening hydrocephalus. Four (13%) patients died, while 6 (19%) had sequelae. Faster normalization of CSF parameters was associated with better outcome.Early antimycobacterial therapy and close monitoring of TBM in childhood improve the outcome.

This study evaluated the role of linezolid in the treatment of patients suffering from pneumococcal meningitis. Treatment included ceftriaxone (4000 mg every 24 h), linezolid (600 mg every 12 h) and dexamethasone (8 mg every 6 h). Linezolid was withdrawn if a penicillin-susceptible isolate of Streptococcus pneumoniae was identified. Of 16 patients studied, seven were infected with penicillin-non-susceptible isolates of S. pneumoniae, two died, and three reported sequelae. No toxicity was reported. It was concluded that linezolid can be used for the treatment of pneumococcal meningitis, as an alternative to vancomycin or rifampicin, in regimens including a third-generation cephalosporin.

Considerable data have identified tumour necrosis factor α (TNFα) as a pivotal mediator in inflammatory processes, suggesting that it has a role also in the pathogenesis of some autoimmune diseases, such as rheumatoid arthritis (RA).1,2 Currently, two drugs that interfere with TNFα, infliximab and etanercept, have been extensively used for the treatment of patients with RA and other immunological disorders; both have been associated with a higher risk of serious infective complications.3–7 Listeria monocytogenes is a Gram positive intracellular organism seen almost always in neonatal sepsis, elderly meningitis, and in patients with chronic diseases and impairment of cellular immunity, which avoids the host immunity by a mechanism of cell to cell spreading.8 Association between anti-TNFα agents and listeriosis has already been reported in patients …

In this study we reviewed M. tuberculosis meningitis (TBM) cases in childhood at our unit in a five-year period.Included in this retrospective study were children admitted to Cotugno Hospital from 1995 to 1999 who fulfilled criteria for a TBM diagnosis. Medical records were analyzed for epidemiological data, clinical manifestations, laboratory test results, radiological investigations and clinical outcome.We identified 10 children with TBM. Family history of tuberculosis (TB) was observed in 6 patients. Fever preceded hospital admission of 4-60 days (median 8 days); neurological signs were present 1-6 days before admission in 8 patients. All patients showed a predominance of lymphocytes, elevated proteins and reduced glucose concentration in cerebrospinal fluid (CSF). Mycobacterium tuberculosis was either cultured or identified by acid fast stain in 5 patients. Cranial CT-scans and MRI showed hydrocephalus in 8 patients and ring-enhancing lesions in 6. Antituberculous therapy was administered according to current recommendations for at least 12 months, with a 4-6 week steroid therapy course. Two patients had permanent neurological sequelae.Careful evaluation of symptoms and CSF findings is the only way to establish an early diagnosis and reduce sequelae.

In our department, an osteochondroma of the tibia in a young girl with intermittent claudication of the right leg was treated. Many instrumental examinations were performed in order to exclude an arterial disorder. As the patient shows signs of arterial compression, an operative procedure to remove the exostosis was performed.

In a prospective, controlled, single-blind study the efficacy of teicoplanin versus cefamandole in preventing infections in total hip replacement was investigated in 496 consecutive patients. A single intravenous dose of teicoplanin (400 mg) was as effective as two intravenous doses of cefamandole (2 g before and 1 g after surgery). No major complications were observed in either group. Infective wound complications were observed only in the cefamandole group. These infections, although not dangerous for the patients, required supplementary antibiotic treatment in all cases. Teicoplanin is a reasonable choice as a prophylactic agent in orthopaedic surgery when a high risk of infection due to staphylococci is present.

The problem of total hip prosthesis is an immediate and long-term stability. An insufficient bone anchorage of the prosthesis produces a tissue reaction around the implant that causes a loosening. The hight incidence of loosening of cemented total prosthesis has spurred the research into uncemented implants. The experience at the Busto Arsizio Hip Center (Director Prof. R. Bombelli) with more than 2,800 R.M. uncemented isoelastic total hip prostheses was favorable and the study with the cooperation of Pathology Department (Director Prof. P. Lampertico) of the 82 loosening hips has shown: 1) the importance of the elasticity for a stress transmission to the surrounding bone; 2) the pursuit of the most suitable stem calibre and length; 3) the necessity of a stable primary mechanical fixation, waiting for a biological reaction.

We reviewed the results of 277 intertrochanteric valgus-extension osteotomies performed between 1973 and 1975 for primary or secondary osteoarthritis. The average age of the patients was 51 years and follow-up varied from 11 to 15 years. At the latest evaluation 67% of the hips were good or excellent on the Merle D'Aubigne scale. Better results were obtained in patients under 40 years of age with unilateral involvement and a mechanical (secondary) aetiology. An elliptical femoral head, minimal subluxation and an adequate pre-operative range of motion were also favourable. There was radiographic evidence of regression of the arthritic changes in 39% of the hips at final review. Valgus-extension osteotomy is effective for secondary osteoarthritis of the hip in selected younger patients, but not for those with primary hip disease or a poor range of movement.

We have reviewed the results of 106 intertrochanteric osteotomies performed for osteonecrosis of the femoral head. The average age at operation was 47.5 years. At two years from operation 71% of the hips had a clinically satisfactory result and at final follow-up, an average of 8.2 years after operation, 58% continued to have excellent or good rating. Twenty-four hips had needed total replacement or arthrodesis because of pain. Patients aged less than 55 did better than those operated on after that age, and hips with an idiopathic or post-traumatic aetiology did considerably better than alcohol-induced or steroid-induced cases. In view of these findings we believe that in the younger adult, in the absence of metabolic bone disease or advanced joint destruction, intertrochanteric osteotomy should be considered for the treatment of osteonecrosis.

Forty-three patients with aseptic mobilization of hip prostheses were submitted to revision surgery using cementless R.M. isoelastic total hip prostheses. The femoral component was substituted in all cases, the acetabular component in 37. Autoplastic bone grafts were required in 27 cases to replace severe bone defects in the acetabulum or femoral diaphysis. All the patients were followed up for an average of 46 months (range 36 to 59 months). The results were good in 38 cases, evaluated both on the Harris scale (average 87 points) and the Charnley method (5.4 points for pain, 5.0 for walking, and 5.2 for movement). There were 2 cases of ankylosis, one case of infection, one paralysis of the peroneal nerve and one proximal migration of the acetabular component. Therefore we believe that the use of cement is contraindicated in revision surgery of the hip, particularly in the presence of severe osteolysis and in younger patients. The isoelastic stem encourages bone reconstruction and cortical thickening in the femoral diaphysis. When there is bone deficiency the cementless acetabulum must always be associated with autoplastic bone grafting.

Effusion recurrence is a major problem in the palliative care of patients with disseminated cancer. Thirty-two patients with recurrent malignant pleural effusions were treated with intracavitary natural beta-interferon at increasing doses (5-20 million units) for a maximum of three administrations. Among 29 evaluable patients, 11 showed complete (27.6%) or partial (10.3%) remission. No difference in response rate was observed according to sex, age, and histological type. All the responses were observed in patients with an effusion volume less than 1,000 ml (11/16; 68.8%). No side effect was observed. In conclusion, intrapleural beta-interferon is promising as a palliative in the treatment of recurrent malignant effusions.

Dealing with emergencies is never an easy task. Coping with the Covid-19 emergency was and still is an incredibly tough and unprecedent challenge for mankind, not only from a healthy point of view, but also from a socio-economic point of view, where a key role will be played by a reliable and sustainable transport of people and goods. Professional and researchers from all disciplines have been required to adapt their models, methods and tools to support decision makers in coronavirus emergency days. This paper reports the experience of the authors for the analysis of the Rome mobility system to estimate the impacts of the progressive lockdown imposed by the government. It focuses on data available for monitoring, which have been used to carry out transport analytics both for private and public transport. Such analytics have been used for planning the reboot of the transport system to be ready for the post Covid-19 era.

L'Università del Salento da lungo tempo conduce attività di ricerca rivolte alla conoscenza e alla tutela della città di Veio e del suo territorio. Questo studio delinea un quadro dello sviluppo urbano e delle vicine necropoli, dalla preistoria alla tarda età imperiale. Tra le principali tecniche di analisi impiegate, il posizionamento cartografico di precisione di tutte le evidenze archeologiche rilevate nelle ricerche pregresse e in quella incorso, la fotointerpretazione e restituzione sistematica di tutte le tracce archeologiche visibili in immagini aerorilevate, la continua integrazione tra gli elementi urbanistici individuati e posizionati e i materiali visibili in connessione insieme ad altre tecniche di analisi hanno consentito una definizione cronologica il più possibile precisa delle singole evidenze.