Recurrent pulmonary embolism secondary to popliteal vein aneurysm with intraluminal wall ulcer.

The popliteal vein is the most frequent site of venous aneurysm. Surgical treatment is indicated above a 2.5 cm diameter to prevent complications, notably deep venous thrombosis and pulmonary embolism (PE). Here we report a case of recurrent episodes of severe PE, leading to cardio-circulatory shock caused by a popliteal vein aneurysm (PVA) despite oral anticoagulant therapy. When surgical correction of the aneurysm was performed, we found an ulcerative lesion in the inner aspect of the vein that was acting as a 'thrombogenic focus' inside the aneurysm. An accurate inspection of the intimal wall is always important during surgery of PVA, particularly when tangential resection is performed.

Imported occupational lead poisoning: report of four cases.

BACKGROUND: In most industrialized countries, occupational lead poisoning has become increasingly rare, however this metal remains a serious health hazard in the rest of the world. REPORT OF CASES: We observedfour male patients (aged 35 / 54 years) who had suffered recurrent abdominal pain due to recent lead exposure (for 7 to 13 months) in two Chinese battery recycling plants. On their return to Italy, three of them presented normocytic, normochromic anaemia. The diagnosis was confirmed by high lead levels in the blood and urine, decreased erythrocyte delta-aminolevulinic acid dehydratase (ALA-D), raised erythrocyte zinc protoporphyrin (ZP), and elevated urinary excretion of b-aminolevulinic acid (ALA-U) and porphyrins. Chelation with EDTA resulted in increased urinary lead excretion, improvement of the clinical picture, decreased ZP, and progressive normalization of the other lead biomarkers (Pb-B, ALA-D, ALA-U, urinary porphyrins). CONCLUSIONS: Temporary work in developing countries may result in imported lead poisoning. Differential diagnosis of this unusual condition requires careful medical history collection and specific toxicological analysis. Preventive measures for workers going abroad are needed.

[ANCA-associated vasculitis]. / Vasculiti anca-associate.

ANCA-associated vasculitis. The term "antineutrophil cytoplasm antibody (ANCA)- associated vasculitis" (AASV) ihighers generally used to include primary vasculitis syndromes in which circulating ANCA against proteinase 3 (PR3) and myeloperoxidase (MPO) are commonly found. AASV syndromes include Wegener's granulomatosis, microscopic polyangiitis, idiopathic pauci- immune necrotizing crescentic glomerulonephritis and Churg-Strauss syndrome (CSS). AASV syndromes share some general clinical-histological manifestations, such as rapidly progressive renal failure and focal necrotizing glomerulonephritis with extracapillary proliferation in the absence (or in the presence of modest) immunoglobulins deposits (pauci- immune). Untreated AASV follow a progressive course with a fatal outcome due to vital organ failure. The combination of cyclophosphamide and prednisone is now established as the treatment of choice for patients with AASV, but there is considerable debate over the duration of therapy and the best way to administer cyclophosphamide. Treatment of AASV can be divided into two phases: an induction of remission and a maintenance of remission phase. Patients with AASV and renal involvement (serum creatinine less than 500 ml/L or 5.6 mg/dl) should be treated with a combination of oral prednisone with gradual tapering and cyclophosphamide. Once remission is achieved, usually after 3-6 months, azathioprine should replace cyclophosphamide. It is not known for how long treatment should be continued but at least one year of treatment after remission is warranted. When serum creatinine is than 500 ml/L (5.6 mg/dl) and/or oliguria is present, the addition of methylprednisolone pulses and/or plasma exchange should be considered.

Fibrillary and immunotactoid glomerulopathies.

There is sufficient clinical and morphological evidence to suggest that Fibrillary Glomerulonephritis (FGN) and Immunotactoid (IT) Glomerulopathy are two different diseases. Is still open to debate if IT glomerulopathy is a distinct entity or is strictly associated with a spectrum of systemic syndromes ("forme fruste" of Cryoglobulin and paraprotein associated diseases). Further studies about pathogenetic mechanisms of fibril or microtubule formation may allow a better understanding of these diseases.

Cytologic detection of metastatic malignant melanoma in urine. A report of three cases.

BACKGROUND: The presence of melanoma cells in urinary specimens is a rare event in either primary or metastatic melanoma of the genitourinary tract. CASES: Melanoma cells were observed in urinary specimens from three white males aged 50, 67 and 51 years, with a previous history of cutaneous melanoma in the first two cases; in the last one autopsy showed a primary melanoma of the gallbladder. The first patient, treated with palliative therapy, survived 10 months, the second died a few days after the cytologic diagnosis, while the third survived 1 month. All patients had widespread metastases at the time of cytologic diagnosis. CONCLUSION: The presence of melanoma cells in urinary specimens may be an important marker for assessing the spread of metastatic disease. When the cytologic diagnosis is made, widespread dissemination is present, and only palliative treatment is suggested.

Solid and cystic tumor of the pancreas--case report.

Pancreatic tumors are rarely present in childhood. The authors present a case of papillary-cystic tumor in a 13-year-old girl, treated by partial pancreatoduodenectomy, with preservation of the pylorus. The histologic pattern was of a papillary cystic tumor without evident atypical nuclei. One year after operation, the girl is well without any finding of disease.

Toxicity evaluation of trap and skeet shooting targets to aquatic test species.

: Large quantities of trap and skeet clay targets are used in shooting activities around the United States. For example, the number of targets used since 1970 has averaged approximately 560 million a year. A number of acute and chronic tests were performed to determine the toxicity of Remington Arms Company Blue Rock(®) trap and skeet target fragments upon selected freshwater and marine organisms. These studies were undertaken in support of an environmental impact study of trap and skeet shooting activities at a major gun club in the northeast United States. Targets were composed of approximately 67% dolomitic limestone, 32% petroleum pitch and 1% fluorescent aqueous paint (painted targets only). The majority of samples were painted, new targets obtained from the manufacturer and painted and aged targets collected around a shooting range. Additional tests were conducted using non-painted, new targets and leachates prepared from both painted, new and aged targets. Targets were crushed to small fragments and were either directly added to the test vessels at extremely high concentrations ranging from 670 to 600 000 mgl(-1) or used in leachate tests. In direct tests all target materials were essentially non-toxic to marine and freshwater organisms, except for the non-painted new targets which exhibited minimal acute toxicity to Daphnia magna (48 h EC 50=2200 mgl(-1)). In leachate tests, the leachate was not-toxic to mysid shrimp, the only organism tested. Additional samples of crushed targets were analysed for the presence of selected priority pollutants (EP toxicity test) and polycyclic aromatic hydrocarbons (PAHs). The targets did not exhibit the characteristics of toxicity as determined by the EP toxicity test but did contain substantial amounts of PAHs. However, results from new and aged targets suggest that PAH are tightly bound in the petroleum pitch and limestone matrix and are unlikely to be readily available in the environment. The potential impact of targets on the environment is further discussed.

Histologic patterns of primary malignant tumors of the fallopian tube.

From 1978 through 1993 four patients underwent surgical treatment of primary fallopian tube rumors. Mean age was 62.5 years. A different histologic pattern was found in each cases: transitional, endometrioid, serous papillary and malignant mixed mesodermal tumor. Prognostic significance of histologic patterns is underlined together with grade and stage; all our cases were included in stage IA. Surgical treatment was, in all cases, hysterectomy with bilateral salpingo-oophorectomy; in two cases an adjunctive chemotherapy followed. A second look was performed in two cases. All patients are alive and free of disease with a follow-up varying from 15 to 84 months.

[Pseudoaneurysm of the right ventricle and rupture of the interventricular septum during the acute phase of myocardial infarct: diagnosis by color Doppler echocardiography]. / Pseudoaneurisma del ventricolo destro e rottura del setto interventricolare nella fase acuta di un infarto miocardico: diagnosi con eco color-Doppler.

The authors describe the association of a right ventricular pseudoaneurysm and ventricular septal rupture at the onset of an acute inferior and right myocardial infarction. The patient, a 84-year-old man, presented with cardiogenic shock and died within a few hours with electromechanical dissociation. The diagnosis was made by Echo-color flow mapping and confirmed at autopsy. The authors point out the singleness of such association and the diagnostic value of Echo-Doppler in the early assessment of the mechanical complications of myocardial infarction.

Strategies employed to determine the acute aquatic toxicity of ethyl benzene, a highly volatile, poorly water-soluble chemical.

Studies are described in which ethyl benzene (EB) was tested to determine its acute toxicity to three marine organisms, Atlantic silversides (Menidia menidia), mysid shrimp (Mysidopsis bahia), and diatoms (Skeletonema costatum), and to one freshwater algae (Selenastrum capricornutum). The respective 96-hr median lethal concentration (LC50) values and 95% confidence intervals for EB in the flow-through studies with fish and mysid shrimp were 5.1 (4.4-5.7) mg/liter and 2.6 (2.0-3.3) mg/liter. While the 96-hr median effective concentrations (EC50's) for growth inhibition and 95% confidence intervals for the static studies with diatoms and algae were 7.7 (5.9-10.0) mg/liter and 3.6 (1.7-7.6) mg/liter, respectively. Problems were encountered in all four studies as a result of the high volatility and poor water solubility of EB in water and an apparent "salting out" effect noted in seawater. This effect was found particularly true in the diatom and algae studies where the salinity was increased with the addition of culture medium. Measures are described which were used to overcome this stability problem with EB. These included sealing the test systems tight without any air spaces to prevent the collection of EB vapors. Also, increased mixing of EB in the test solutions was found to be essential in the flow-through studies to maintain stable levels. In the case of the diatom and algal studies, since current EPA test guidelines were judged to be inadequate to overcome EB volatility from the test medium, a new closed test system had to be developed and employed, after validation with a nonvolatile reference toxicant in the new and conventional static test systems. The results of these studies indicate that previous reports underestimated the potential acute aquatic toxicity of EB by at least one order of magnitude. The implications of these findings are discussed in relation to the potential environmental impact of EB and the resultant regulatory actions.

The pseudotumor cerebri.

Pseudotumor cerebri is the most appropriate term yet devised for classifying clinical patterns marked by papillary edema, uni- or bilateral, without major clinical signs and with normally sized cerebral ventricles, in which clinical or radiological investigations have ruled out the presence of a space occupying lesion of infective process. Because pseudotumor cerebri is a syndrome and its etiologies are many and varied, it is still difficult to make a diagnosis other than by exclusion. However, the knowledge that has accumulated as a result of epidemiological, clinical, neuroradiological, and experimental research enables us to say that the explanation of pseudotumor cerebri lies, on the one hand, in a sluggishness of the intracranial venous circulation with a consequent increase in cerebral blood volume and slowing of cerebrospinal fluid absorption and, on the other, in the onset of cerebral edema, either hypo-osmolar or vasogenic. The differing extent to which these three components participate in the clinical pattern depends on the etiology, but the resulting syndrome is always the same, though varying in clinical expression and pathogenesis.

[Well's syndrome with eosinophilic vasculitis, coronary aneurysms and myocardial infarction]. / Sindrome di Wells con vasculite eosinofila, aneurismi coronarici e infarto miocardico.

This report describes a 40-year-old man suffering from Well's syndrome (recurrent granulomatous dermatitis with eosinophilia) who presented an anterior myocardial infarction complicated by shock and 3rd degree A-V block. The patient died within 12 hours of admission to the hospital. At autopsy, both main coronary arteries showed proximal aneurysms occluded by thrombi. On light microscopy, the aneurysmatic coronary walls were infiltrated by numerous eosinophils, lymphocytes and plasma cells. Similar cellulitis, mainly perivascular, was found in kidneys and anterior mediastinum. Because the patient had been treated with large doses of diclofenac and piroxicam owing to painful arthralgias, the Authors discuss the possible allergic pathogenesis of the vasculitis.

Immunohistochemical evaluation of a panel of monoclonal antibodies for the diagnosis of small cell lung cancer.

Monoclonal antibodies (mAbs) with a high sensitivity and specificity for small cell lung cancer (SCLC) may be of potential diagnostic and therapeutic use. We selected five different mAbs generated against SCLC cell lines and tested them on paraffin-embedded SCLC and non SCLC (NSCLC) clinical samples in a retrospective study using immunohistochemical techniques. The results showed that the contemporary use of mAbs that react with different antigens allowed all the examined SCLC to be detected indicating that this panel of mAbs was extremely sensitive. Analysis of the reactivity of these mAbs with NSCLC showed that 4 of the 5 antibodies reacted also with a few NSCLC. Using higher dilutions of these mAbs their specificity improved substantially. The 5 different mAbs presented marked heterogeneity of antigenic expression within and between SCLC. This panel of antibodies may be very useful in the diagnosis of SCLC whereas their application, in vivo, in therapeutic trials, is limited by the heterogeneity of antigenic expression.