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Biomedical subjects

E Bottone

Publications and source records attributed to E Bottone.

At least 19 recordsLinked to original sources

Peptostreptococcus asaccharolyticus renal abscess: a rare cause of fever of unknown origin.

Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. We recently cared for a patient who presented with a 3-week history of fever. An indium scan ultimately led to the diagnosis of a renal abscess. Aspiration yielded Peptostreptococcus asaccharolyticus. This unusual case prompted a review of the clinical and microbiologic features of renal abscess in pediatric patients at our hospital over the past 10 years. Seven additional patients with a discharge diagnosis of renal abscess were identified. Only 2 of the patients had identifiable risk factors (diabetes mellitus and polycystic kidneys). Staphylococcus aureus or Enterobacteriaceae were responsible for most infections, consistent with hematogenous and urinary tract sources, respectively. No other cases of anaerobic abscess were identified. This case highlights the importance of considering a renal abscess in the differential diagnosis of fever of unknown origin and of processing specimens for both aerobic and anaerobic organisms.

Abscess↗

Clinical evaluation of Purilens, an ultraviolet light contact lens care system.

Purilens is a new contact lens care system that uses ultraviolet light and subsonic turbulence for lens cleaning and disinfection. In a single hands-off process using only preservative-free sterile saline, the lenses are ready to wear after a 15-minute cycle. This study was designed to test the safety of this contact lens care system. A total of 84 contact lens wearers from six centers were enrolled in the 3-month study, which comprised an initial visit and follow-up visits at 1, 2, 4, 8, and 12 weeks. At the end of the study, lenses and units were collected and a questionnaire was completed. Seventy-six of the 84 subjects (168 eyes) completed the study. No severe eye complications were reported, and no patients were removed from the study because of ocular problems or complications associated with the device or its use. Four patients were removed from the study for noncompliance with follow-up. Another four patients were active for 2 months, but were requested by the sponsor to complete the study 1 month early to complete data collection. Patient satisfaction was high. The study suggests that Purilens may be considered as an alternative for contact lens cleaning and disinfection.

Adolescent↗

Thymic dysfunction in histiocytosis-X.

In some patients with histiocytosis-X there is a deficiency of suppressor T cells, which is corrected in vitro by incubation with either crude calf thymic extract or thymostimulin. This finding suggests that a thymus deficiency could be involved in this disease. Low levels of serum thymic factor (FTS) are found in patients with histiocytosis-X. Their plasma contain factors capable of inhibiting biological activity of FTS in vitro. Elucidation of the mechanism by which FTS is inhibited would be helpful in understanding the immunological defect in histiocytosis-X. The presence of evidence of thymic dysfunction and the fact that patients respond to thymic hormone therapy suggest that histiocytosis-X could be due to a primary immunodeficiency syndrome. Thymulin, which stimulates the generation of suppressor T cells, could be of benefit in therapy.

Adolescent↗

Physiological assessment of growth hormone secretion in the diagnosis of children with short stature.

Many advances characterize the research into the diagnosis of short stature in children. Increasing evidence shows a continuous spectrum of growth hormone (GH) output among GH-deficient patients and short normal children. Although biosynthetic human GH could theoretically offer the chance of treating most slowly growing children, it is not certain that all short normal children with a poor height velocity could benefit from therapy. Indeed, besides auxological findings, the assessment of GH secretion remains essential in selecting candidates for therapy. In this respect the evaluation of GH secretion by means of tests that can explore the physiological pathways involved in the hormone output appears important. Moreover some clinical evidence suggests that pharmacological stimuli cause the pituitary release of stored GH perhaps unavailable in physiological conditions. Among the classical physiological tests, the exercise test, the standardization of which has been debated, is commonly used in clinical practice. The sleep test, i.e. the evaluation of sleep-associated GH secretion, is the most important. It has no side effects and does not require the administration of exogenous stimuli. Several studies have demonstrated its reliability in diagnosing growth disorders in childhood, mainly if performed with EEG monitoring. Among the new physiological diagnostic approaches the most reliable test is the evaluation of 24-hour GH secretion. Knowledge of the integrated hormone concentrations appears particularly important in studying children who may have more subtle disturbances in GH secretion. These cases show normal GH response to provocative stimuli but show a reduced hormone output over 24 h. Indeed they respond well to human GH treatment.

Adolescent↗

Circulating thymic hormone activity in young cancer patients.

We measured serum levels of Facteur Thymique Sérique (FTS) in 56 young cancer patients compared to normal controls. All patients who received immunosuppressive therapy had low age-corrected titres of FTS. Low levels were also found at diagnosis and off therapy. Plasma from 22 patients contained factors capable of inhibiting biological activity of FTS in vitro. The nature of this inhibitor has not been elucidated. No zinc deficiency was found in the patients studied, suggesting that FTS is secreted in its active form. Our study points out the importance of monitoring FTS activity in young cancer patients for its implications on immunological surveillance. The practical applications of thymic hormone therapy in cancer patients are discussed.

Adolescent↗

The incidence and outcome of asymptomatic herpes simplex genitalis in an obstetric population.

In a prospective study of an obstetric population, 28 of 488 (4%) routine asymptomatic patients had positive cultures for herpes simplex virus from their genital tract. Cesarean section was carried out if the virus was present in the genital tract at the time of delivery. In one instance, a culture which had reverted to negative became positive again. No cases of neonatal herpes were reported in the time of the study. As yet, the infectivity of these subclinical cases is unclear, and the incidence of neonatal herpes is not as high as would be expected from the study. Further studies need to be carried out to evaluate the exact risk of the asymptomatic herpesvirus shedder to the infant at birth.

Adult↗

Evaluation of the clinical efficacy of erythromycin, amoxicillin and co-trimoxazole in the treatment of acute respiratory tract infections in paediatric patients.

An open comparative study was carried out in 56 paediatric patients with acute upper and lower respiratory tract infections to assess the efficacy and tolerance of treatment with erythromycin, amoxicillin or co-trimoxazole. Patients were treated with the standard recommended doses for 7 to 10 days. Diagnoses included otitis, tonsillitis, pharyngitis, epiglottiditis, pertussis, scarlet fever and bronchitis and, when possible, pathogens were isolated and identified at the initial visit. The clinical findings showed that all three treatment resulted in statistically significant decreases in final mean values for temperature, pulse rate and respiration rate. Twenty of the patients with positive cultures on entry became negative by the end of treatment. No clinical side-effects, were reported with any of the treatments. Overall assessment of response and acceptability of treatment by physician and patient/parent indicated that erythromycin was at least equally as effective as the other two drugs in treating common respiratory diseases found in paediatric practice.

Acute Disease↗

Occurrence of Clostridium difficile toxin during the course of inflammatory bowel disease.

Clostridium difficile toxin, the presumed mechanism of antibiotic-associated pseudomembranous colitis, has been suggested as a contributory factor to mucosal injury in inflammatory bowel disease. We evaluated its incidence and apparent role in 65 consecutive patients with diarrheal and inflammatory bowel diseases. Toxin was demonstrated in 3 of 18 patients with ulcerative colitis (17%), 1 of 26 with Crohn's colitis (4%), and 5 of 21 with a variety of diarrheal illnesses (24%). Toxin appeared only in those who had been exposed to antimicrobials within 2 mo. In inflammatory bowel disease, presence of toxin was not correlated with disease severity. We conclude that Clostridium difficile toxin appears only in patients exposed to antimicrobials and is unlikely to be a significant contributory factor in inflammatory bowel disease.

Anti-Bacterial Agents↗

Circadian rhythm in gonadotropin secretion in children with constitutional stature delay.

Plasma levels of luteinizing and follicle-stimulating hormones were measured for 24 hours in six subjects affected by constitutional stature delay associated with sexual maturation delay. The children in pubertal stage exhibited fluctuating plasma concentrations of these hormones which significantly increased during sleep, as in healthy pubertal subjects. Thus in this type of delayed puberty, the synchronization of augmented gonadotropin secretion with sleep develops later in chronologic age but it is strongly related to bone age.

Adolescent↗