[Cryptococcus neoformans meningoencephalitis among apparently immunocompetent patients: description of two cases]. / Meningoencefalite da Cryptococcus neoformans in pazienti apparentement immunocompetenti: descrizione di due casi.

Cryptococcus neoformans is a ubiquitous fungal pathogen which causes human disease ranging from asymptomatic colonization of the lungs, to severe pneumonia, mediastinitis, meningitis or generalized infection. Although cryptococcal infection shows notably opportunistic features, it is sometimes also found among apparently immunocompetent individuals, with an extremely adverse outcome in the case of SNC involvement. Therefore, when faced with a presumed healthy person with anamnestic, clinical, CSF and instrumental findings consistent with chronic meningitis/meningoencephalitis, we must also consider cryptococcosis as a possible cause of disease. This may be rapidly achieved by resorting to quite a simple serological test, namely cryptococcal antigen detection. We describe two cases of cryptococcal meningoencephalitis occurring among apparently immunocompetent subjects (both HIV-negative, not under corticosteroid or immunosuppressive regimen, nor undergoing chemotherapy or radiotherapy. Laboratory diagnostics revealed the existence of reasonable immunological deficit for both subjects. Unfortunately, we were unable to establish whether the alterations in question were preexisting or concomitant with fungal infection. Our patients' course was somewhat problematic, according to findings observed in broader-based studies: this could mostly be explained by the considerable diagnostic delay which often marks cryptococcal infections of immunocompetent individuals. Nevertheless, neither of these two cases were complicated by intracranial pressure increase, leading us to speculate whether this disease may occur less frequently under conditions of substantial immunological integrity.

Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient.

Cytomegalovirus (CMV)-associated transverse myelitis is rare in immunocompetent patients. The case of a 54-year-old man is reported here who developed acute transverse myelitis with cerebrospinal fluid (CSF) alterations, suggesting a central nervous system infection. CMV-IgM positivity in serum and CMV isolated from blood, positive CMV PCR and positivity for pp65 antigen in blood, without viral antigens in the CSF and a positive response to therapy with ganciclovir (followed by progressive improvement) supported the diagnosis.

Primary dorsal localization of invertebrate hydatidosis.

We describe patient with Echinococcus granulosus disease primary localized on the back. This case is uncommon because of the lack of risk exposure history and the sole muscular localization. The patient received several surgical operations on the back, without eradication of the infestation. At the end we discuss the clinical considerations that induced the choice of the usual medical therapy

Comparison of technetium-99m-MDP, technetium-99m-WBC and technetium-99m-HIG in musculoskeletal inflammation.

UNLABELLED: This study compared three radionuclide techniques in distinguishing musculoskeletal infection from noninfectious inflammation. METHODS: Thirty-five orthopedic patients with suspected musculoskeletal infection were examined using three radionuclide techniques in sequence: triphasic bone scintigraphy, 99mTc radioleukocytes (99mTc-WBC) scintigraphy and 99mTc human immunoglobulin (99mTc-Hig) scintigraphy. Two "early" and "late" acquisitions were performed, at 4-6 hr and 20-24 hr postinjection, respectively. Patients who were diagnosed as suffering from noninflammatory lesions became the controls. We calcu"late"d for all studies one index of inflammation (Infl) as the ratio between counts in the uptake area and counts in an equal area of normal tissue. RESULTS: The "early" radiolabeled leukocytes and "late" Hig scintigraphy allowed the greatest ability to distinguish between infections and noninfectious inflammations (p < 0.011 and p < 0.016) with a sensitivity of 96.6% and 96.5% and specificity of 71% and 100%, respectively. Hig and radioleukocytes allowed distinguishing infections from noninflammatory diseases at both examinations. CONCLUSION: The "early" radioleukocyte scintigraphy allowed us to separate infections from noninfectious inflammations. In contrast, the same result can be obtained only with the "late" scan in the Hig study, but Hig mapped the spread of the inflammation into soft tissues better. Hig might be an alternative to radioleukocytes because of its simple preparation, similar accuracy and safety.

[Disulfiram-induced hepatitis] / Epatite indotta da disulfiram.

Overt disulfiram-induced hepatitis is rare; it has a high mortality rate, especially when the etiology is non suspected and when the treatment is not promptly discontinued. The Authors describe a case of disulfiram-induced acute hepatitis and emphasize close clinical and biochemical monitoring.

Hepatitis-like syndrome induced by nimesulide?

The authors describe a case report of a 17 years old woman, complaining of weakness and malaise, associated with a significant increase of serum transaminases, that occurred twice in a month soon after the administration of Nimesulide per o.s.

Total clearance and extracellular volume with 125I-iothalamate in peritoneal dialysis.

To assess treatment adequacy by calculating total clearance (CL) in patients on peritoneal dialysis (PD), fluids must be collected over 24 hours, a laborious procedure and prone to inaccuracy. CL calculation from the plasma disappearance curve of an injected tracer has none of the above inconveniences. We therefore compared creatinine clearance CR-CL with CL calculated from the plasma disappearance curve of 125I-iothalamate (IO) injected in a single intravenous bolus. Twelve patients aged 63 (44-80) years and on PD for four (1-44) months were studied in hospital. Nine plasma samples were taken for IO-CL after a bolus of 21 kBq/kg of tracer. The least-squares biexponential fitting according to Gauss-Newton-Raphson was then carried out: [Aexp(-at) + Bexp(-bt)], and clearance was calculated by the formula, IO-CL = dose/AUC, where AUC = A/a + B/b. Both CLs were normalized for 1.73 m2 of body surface. Agreement (r = 0.746, p = 0.005) for the CR-CL (6.8 +/- 1.9 mL/min) and IO-CL (7.6 +/- 1.9 mL/min) was good, with a difference of 0.9 +/- 1.4 mL/min (t = 2.182, p = 0.052). Extracellular volume (ECV), calculated from the IO plasma disappearance curve with the formula, ECV = dose/ bAUC, and including the endoperitoneal fluid, was 19.8 +/- 2.9 L (29.5 +/- 6.2% body weight).

The CSF myelin basic protein: a reliable marker of actual cerebral damage in hydrocephalus.

Raised ventricular CSF myelin basic protein (MBP) concentration has been evidenced in 17 shunted hydrocephalic patients. Contemporary evaluation both from ventricular and lumbar CSF samples showed a concentration ratio of 20:1. In all cases the raised values of ventricular CSF concentration of MBP demonstrated a significant decrease after shunt operation. This preliminary report suggests that this marker is an important index of actual brain damage in hydrocephalus and could be taken in account for the indication of shunt operation.

Serum SCC-Ag in head and neck squamous cell carcinoma.

We estimated the serum levels of SCC-Ag, CEA and TPA in 69 patients with head or neck neoplasia and 31 healthy patients using a radioimmunometric method (double antibody). SCC-Ag concentrations were significantly increased in 43.4% cancer patients with respect to the cut-off point value (1.7 ng/ml) of the control group, and the specificity was 96.7%. The data varied according to the evolutive phase of disease. Since the combined evaluation of SCC-Ag, TPA and CEA serum levels increased the sensitivity, that was 71.0%, we thought it opportune to use all these markers in the tumoral pathology taken into consideration.

Serum immunoreactive calcitonin in lung cancer.

Serum immunoreactive calcitonin (iCT) assay was performed in 92 patients suffering from different kinds of cancer of the lung and in 42 healthy control subjects. Gel filtration of serum of patients suffering from microcytoma was carried out on Sephadex G75 to study the forms of circulating iCT. The obtained results (pg/ml M +/- SE) were: 1) normal subjects, 73 +/- 3; 2) epidermoidal cancer, 105 +/- 19; 3) adenocarcinoma, 116 +/- 47; 4) anaplastic carcinoma with large cells, 156 +/- 74; 5) microcytoma , 354 +/- 74; 6) chronic obstructive bronchitis, 38 +/- 6. Gel filtration of serum of patients with microcytoma demonstrated the same behavior as in normal subjects. We can conclude that iCT increases significantly in microcytoma with extensive disease (84% of cases): in this condition, the iCT assay can be useful as a marker in follow-up of disease.

[Study of a family with a slow type of bisalbuminemia and of 2 other familial cases]. / Studio di una famiglia portatrice di bisalbuminemia di tipo lento, e di altri due casi familiari.

The AA. illustrate cases of slow type bisalbuminaemia that they happen to observe on three different family one of which, on a family of north italian origin, has been particularly developed. The cases have been studied on the various components of each family living and to be found, on serum and urine, using electrophoretic methods on cellulose acetate and acrylamide gel and also using the immunoelectrophoretic and cromatographic method on serum after hydrolysis. Cases taken in account, together with results of investigation, add up to those already given to the litterature.

[Relations between serum apha-antitrypsin level and neoplasms]. / Correlazione tra tasso sierico di "alfa1-antitripsina" e neoplasie

Alpha1-antitrypsin levels were determined in patients with bronchopneumopathies and in others with various forms of neoplasia. No relationship between levels and disease was noted in the first group, whereas a marked increase in values was observed in the second, particularly in the case of subjects with lung cancer. The interestiang aspects of this finding are discussed.