[Early recognition of twin-to-twin transfusion syndrome. Differential diagnosis and therapeutic hypothesis].
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Biomedical subjects
Publications and source records attributed to G Cornaglia.
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The effect of minimal (MIC) and sub-minimal (sub-MIC) inhibitory concentrations of penicillin on Staphylococcus aureus and Streptococcus faecium were compared. It was found that similar alterations in both cell shape and ultrastructure were found in the presence of penicillin MIC and sub-MICs, the only difference being that while in the presence of penicillin MIC all individual cells were altered, in the presence of sub-MICs the damaged portion was smaller the lower the penicillin concentration and the longer the incubation time. By testing the effect of inoculum size on the penicillin MIC, it was found that penicillin concentrations, which were sub-MICs for rather dense population, turned out to be the MICs for lower density populations. These findings do not support the view that sub-MICs of antibiotics can cause specific damage to bacterial cells which, although not leading to growth inhibition, lowers their virulence. On the contrary, it is suggested that penicillin sub-MICs have no specific effect on Staphylococcus aureus and Streptococcus faecium cells, but simply differ from MIC in that they do not inhibit all cells.
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A survey of antibiotic resistance in Streptococcus pyogenes in Italy showed a sharp increase in erythromycin resistance. In 1993, the incidence of erythromycin-resistant strains was on average 5.1%, with marked variations by geographic area. Two years later, the incidence of these strains had registered a 1.5- to roughly 20-fold increase, with a mean value of 25.9%, exceeding 40% in three centers out of 13 and 30% in another four. For all the strains studied, normal levels of susceptibility to penicillin were reported.
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The first clinical studies on hydroxy-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors reported a low incidence of liver toxicity. The personal observation of a case of simvastatin-induced acute cholestatic hepatitis prompted us to evaluate the true incidence of hepatic side effects of these drugs in a large Italian population. One hundred patients taking simvastatin and ninety patients treated with pravastatin were followed-up six months with periodical evaluation of serum lipid levels and liver function test. In 5% of simvastatin-treated patients and 4.5% of pravastatin-treated patients significant liver toxicity was observed, which required drug discontinuation. The mechanism of liver damage was direct, idiosyncratic, but immunological features of drug toxicity could be hypothesized in one patient.