Role of HRCT in the identification of atypical pulmonary mycobacteriosis.

AIM: 1) To identify the principal radiological signs of atypical pulmonary mycobacteriosis by means of X-rays and CT/HRCT; 2) to compare the two methods in order to evaluate their reliability with particular interest for the diagnostic role of HRCT in the identification of the disease; 3) to establish any significant differences in the pathology between AIDS and immunocompetent patients. MATERIAL AND METHODS: The chest X-rays and CT/HRCT of 28 atypical pulmonary mycobacteriosis patients (16 with AIDS and 12 immunocompetent) have been studied. The subjects were examined during the period of October 1993 to May 2000 and were found to be positive for atypical mycobacterium and consequently underwent a standard chest X-ray. Twenty cases were followed-up with a chest CT/HRCT; of these only 17 were performed within 30 days of the traditional chest X-ray which was considered to be the time limit in order to validate the comparison between the two methods. RESULTS: The significant semeiotical findings were the parenchymal consolidations observed in 25 patients (89%) by standard chest X-rays; the CT/HRCT confirmed the findings in 4 cases while in 13 it enhanced the evaluation of their extensions. In 9 cases the standard chest X-ray established the presence of cavitations which were confirmed by the CT/HRCT in only 7 cases. Lymphadenopathy was observed in 3/28 patients (10.7%) through standard X-rays and in 15/17 cases (82%) through CT/HRCT. The latter method revealed to be extremely useful in the identification of this pathology. Nodules and micronodules were seen in 5 patients with traditional X-rays and in 9 cases with CT/HRCT. Bronchogenic spread signs of disease became visible only with CT and in particular with HRCT (11/17 patients = 65%). Comparing the two groups (AIDS and immunocompetent) taken into consideration, the most frequent lesion present in both was parenchymal consolidation resulting more bilateral in the AIDS subjects. Cavitation and pleural edema were seen more often in the AIDS group while bronchiectasia, bronchogenic spread and signs of previous pleuro-parenchymal suffering were more frequent in the immunocompetent patients. Lymphadenopathy was frequently found in the total study population but appeared slightly prevalent for the group not afflicted with AIDS. CONCLUSION: Radiological study of the chest permitted the identification of signs useful in the diagnosis of mycobacteriosis in all the patients studied. The application of CT/HRCT added helpful elements in almost all of the cases examined demonstrating to be more effective than the standard chest X-ray not only in terms of improved evaluation of known lesions but also in the identification of lesions which are difficult to determine by means of traditional radiology.

Perception of methacholine-induced airway obstruction in asthmatics.

The main objective of this study was to examine the perception of the first symptom during methacholine bronchoconstriction as soon as it occurred, and in the second instance to quantify the intensity of the breathlessness by means of the Borg Scale performed at the end of challenge so to not determine any difficulties for identification of the first symptom. A methacholine challenge test was carried out in 139 symptom-free asthmatics with a normal pulmonary function. When the first symptom was reported by the subject, the forced expiratory volume in one second (FEV1) was measured immediately. FEV1 was expressed as a percentage of the best personal value (FEV1%BPV). The intensity of the breathlessness was rated using a modified Borg Scale at the end of the challenge test so as not to confuse the patient. Seven subjects felt nothing during challenge. The first symptoms varied: constriction behind the breastbone (49%), inspiratory shortness (16.5%), coughing (10%), wheezing, throat constriction, general chest tightness, pain behind the sternum, and a sensation of rheum behind the sternum. FEV1%BPV at the first symptom was 80.5 +/- 10 (range 41-99). No symptom was perceived by 42% of the subjects within the 80-100 range of FEV1%BPV. FEV1%BPV at the first symptom was related to the log of the provocative dose causing a 20% fall in FEV1 (r = 0.2, p < 0.05). An inverse correlation between Borg Score and final FEV1%BPV (r = -0.25, p < 0.01) was found at the end of challenge. A subgroup of 39 subjects with similar final FEV1%BPV values (68-72) showed a correlation between the Borg Score at end of challenge and FEV1%BPV at the first symptom (r = 0.59, p < 0.001). The first symptom of the methacholine-induced bronchoconstriction varies in asthmatics and may be atypical, the bronchoconstriction level at which it is felt also varies among individuals, highly methacholine-responsive subjects perceive the bronchoconstriction later, while late perceivers of the first symptom show less intense breathlessness at the end of challenge. The measurement of the patient's ability to perceive asthmatic symptoms during the methacholine challenge test could be used to single out poor perceivers.

Pulmonary function abnormalities in children with Henoch-Schönlein purpura.

Henoch-Schönlein purpura (HSP) is a widespread necrotizing vasculitis affecting small vessels characterized by nonthrombocytopenic purpura. Pulmonary involvement is a rare fatal complication with diffuse alveolar haemorrhage. The objective of this study was to evaluate possible early lung function abnormalities and to establish any relationship with the clinical activity of the disease. Fifteen children with HSP and without clinical or radiological evidence of lung involvement underwent pulmonary function study at the onset of the disease. A sample of 28 subjects matched by age, height, and weight was chosen as a control group. After a mean of 21 months (range 12-43) lung function tests were repeated in 10 of the previously studied children. During the acute phase of the disease the transfer factor for carbon monoxide, measured by steady-state (TL,COss) and single-breath (TL,COsb) methods, was found to be significantly lower in children with HSP than control subjects. There was no significant relationship between pulmonary function tests with symptoms and signs at onset, nor was there any correlation between variables and serum immunoglobulin A (IgA) concentration. In all but two patients, clinical recovery was observed within 6 weeks from the onset of the disease. In one case relapses of purpuric skin lesions were observed during the first 3 months of follow-up. The second case had relapses of purpuric skin lesions and microscopical haematuria during the 12 months following the onset of the disease with characteristic IgA mesangial deposition on renal biopsy. Although the overall mean value of TL,COsb improved from baseline to the second investigation, in both patients the recurrences of clinical signs were associated with a slight impairment of TL,COsb at the second evaluation. These data suggest an early subclinical lung impairment in children with Henoch-Schönlein purpura during the active phase of the disease. The presence of isolated pulmonary function abnormalities was not associated with the subsequent development of lung disease.

Pulmonary tumourlets and microcarcinoids in bronchiectasis.

A 66 year old woman underwent a left lower lobectomy for bronchiectasis. Histology revealed the presence of multiple endocrine lesions, such as neuroendocrine cell hyperplasia, tumourlets and microcarcinoids, which were widespread in bronchi, bronchioles and alveolar tissue. This case confirms the occurrence of neuroendocrine proliferations, in the setting of bronchiectasis, ranging from neuroendocrine cell hyperplasia to carcinoids, and suggests tumourlets as an appropriate model for neuroendocrine lung tumour genesis.

[The surgical treatment of a rare primary cardiac tumor: hemangioma. A report of 2 cases]. / Trattamento chirurgico di un raro tumore primitivo cardiaco: l'emangioma. Osservazione di due casi.

Primary benign tumors of the heart are particularly rare; cardiac hemangioma is one of the most rare primary benign cardiac tumors. Natural history, symptoms and prognosis of the disease depend on the potential complications due to the location and diffusion of the mass. We report on 2 cases of cardiac hemangioma, diagnosed occasionally in the first patient or due to gastroenteric symptoms in the second patient. The diagnosis was obtained by 2-D-echo and magnetic resonance imaging. In both cases the hemangioma was located on the right ventricle. Both patients underwent tumor resection in hypothermic cardiopulmonary bypass. In one case, a graft to the right coronary artery was associated; in the other case, the right ventricular outflow tract was reconstructed with an infundibular patch. Histology showed mixed hemangioma in one case and cavernous hemangioma in the other. The postoperative course was uneventful. At a follow-up of 8 years and 1 year, respectively, both patients are classified as NYHA 1 and both 2-D-echo and magnetic resonance imaging did not show any residual tumoral mass. This experience demonstrates that, depending on their location, benign neoplastic masses may be radically resected with acceptable operatory risks and excellent long-term results.

Haemodynamic effects of short-term nasal continuous positive airway pressure therapy in sleep apnoea syndrome: monitoring by a finger arterial pressure device.

We have evaluated the effects of short-term nasal continuous positive airway pressure (nCPAP) therapy on systemic blood pressure and heart rate in patients with obstructive sleep apnoea syndrome. Twenty five consecutive patients were examined during baseline conditions (No-CPAP) and during one night of nCPAP treatment (CPAP). The mean value and the variation coefficient of cardiovascular variables, examined by a finger arterial pressure device (Finapres), were determined in wakefulness and sleep. Without nCPAP an increase in blood pressure from wakefulness to sleep was observed in all patients from 138 +/- 3 mmHg to 146 +/- 3 and 155 +/- 4 mmHg, and from 80 +/- 1 mmHg to 82 +/- 2 and 84 +/- 2 mmHg, respectively, for systolic and diastolic values in non rapid eye movement (NREM) and rapid eye movement (REM) sleep. Conversely, heart rate decreased from 75 +/- 2 beats.min-1 to 70 +/- 2 and 69 +/- 2 beats.min-1. In addition, variability of heart rate and blood pressure was greatly increased compared with the awake state. Short-term nCPAP therapy significantly reduced systolic pressure from 144 +/- 3 mmHg to 137 +/- 3 and 143 +/- 4 mmHg during NREM and REM sleep, respectively, associated with a decrease in heart rate (from 69 +/- 2 to 65 +/- 2 beat.min-1). In total sleep and in all sleep stages a significantly reduced variability (p less than 0.001) was found. No changes were observed for diastolic pressure during CPAP night compared with baseline conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Reflections on the footprints of the hominids found at Laetoli.

The prints of Laetoli are of considerable interest with respect to the evolutionary development of the foot and of the human mode of progression. The placing of the prints, with one foot behind the other and the absence of an angle of gait may be due to the condition of parallelism of the guides of the astralagus, an archaic characteristic, which, however, also occurs in the Olduvai foot and in other very old human astragali, but which also occurs sporadically in present-day feet. It is also of great relevance that the feet, which left these prints, show a hallux, which is longer than the second digit. This character has either been considered a relatively recent evolutionary development, but the prints at Laetoli demonstrate the contrary.

[Long-term outcome in nonmassive pulmonary embolism. Radiologic, scintigraphic and functional correlation]. / Esiti a distanza dell'embolia polmonare non massiva. Correlazioni radiologiche, scintigrafiche e funzionali.

54 cases of acute pulmonary embolism were followed for 3 to 4 years by serial chest radiography (plain film and tomography) to survey the radiographic outcome of complete and incomplete pulmonary infarcts in man. A perfusion lung scan (99Tcm-MAA), arterial blood gas analysis and spirometric data were recorded at similar time intervals to chest films in 30 patients. Our retrospective study showed that the most common long-term residual radiographic findings were linear pulmonary scars and localized pleural thickening. The analysis of the radiographic abnormalities with the lung scan showed a residual perfusion defect in 29% of cases, with complete clearing of the infarct on chest radiography. Long term impairment of pulmonary function, estimated with arterial blood gas analysis and spirometric tests, was never observed.

Comparison of terbutaline and salebutamol aerosols in patients with bronchial asthma.

The authors have compared the activity of Terbutaline with that of Salbutamol in 14 subjects with partially reversible airways obstruction. In this within patients trial FEV1 resulted significantly increased with both compounds and was still significant 240 minutes after Terbutaline. After Terbutaline there was in addition a better situation in regard to blood gases. Tolerability with both compounds was very good.