[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.

Use of vascularized iliac crest with internal oblique muscle flap for mandible reconstruction.

In the last decade, immediate reconstruction of maxillary bones following extensive trauma, large oncological defects, or late effects of radiation therapy has proved to be a reliable morpho-functional reconstruction technique. Use of the vascularized iliac crest with an internal oblique flap has become our flap of choice for mandible reconstruction when there is no need for overlying facial skin or oral sphincter reconstruction, and for bone segments within 6-15 cm of length. The advantages of this composite bone flap are the large and resizable bone stock available, the quality of bone transferred with an optimal height, depth, and contour of bone to maintain a good facial profile, and the possibility to reconstruct properly the oral lining, with a portion of the internal oblique muscle flap raised with the same pedicle that epithelializes during the healing stages. We present the experience of the Department of Maxillofacial Surgery of "S. Maria della Misericordia" Regional Hospital in Udine, Italy.

A study of adult T-cell leukemia/lymphoma incidence in central Brooklyn.

Adult T-cell leukemia/lymphoma (ATL), a rare outcome of infection with human T-lymphotropic virus (HTLV-I), is endemic in central Brooklyn, which has a large Caribbean migrant population. Previous studies have suggested that HTLV-I prevalence in central Brooklyn may be similar to that recorded in the Caribbean islands. We established a pilot 1-year surveillance program to identify cases of ATL in 7 of 10 hospitals serving the residents of 18 zip codes of central Brooklyn with a combined population of 1,184,670. Of the 6,198 in-patient beds in the catchment area, approximately 83% were covered. Twelve incident cases of ATL were ascertained, all among persons of Afro-Caribbean descent, indicating an annual incidence in African-Americans in this community of approximately 3.2/100,000 person-years. Unexplained hypercalcemia was the most useful screening method, identifying 3 of 5 patients not referred for possible ATL by a local hematologist. The female:male ratio was 3:1. The age pattern was different from that reported in the Caribbean Basin and closer to the pattern seen in Japan. Our study supports evidence that HTLV-I infection and ATL are endemic in central Brooklyn and suggests that a more intensive surveillance program for this disease coupled with intervention efforts to reduce HTLV-I transmission are warranted.

[Hepatic abscesses caused by Streptococcus intermedius]. / Ascesso epatico da Streptococcus intermedius.

Pyogenic abscess of the liver is uncommon child's pathology. The authors briefly describe a clinical picture characterized by beginning of an hepatic abscess dues to a germ that is not usually pathogen for men. It is often a mouth saprophyte.

[A statistical epidemiological study of cranio-maxillofacial trauma in the Friuli Venezia Giulia region]. / Studio statistico-epidemiologico dei traumi cranio-maxillo-facciali nella regione Friuli Venezia Giulia.

Data corresponding to 17,247 subjects, admitted in Hospital of Friuli Venezia Giulia region, were analyzed in the period between 1984/2/28 and 1993/2/27. All data were selected for for diagnosis, sex, aetiology, age, diagnosis's priority, days of stay in Hospital and locality where the patients live. The results showed 69.31% of the patients were male (range 0-80 years) of 15-19 years (2,605 cases corresponding to 15.1%) and 20-24 years (2,448 patients, 14.2%). More frequently the traumatic pathology was related to injuries of the facial bones (72.22%) and of these 62.13% were fractures of the nasal bones. The major incidence of injuries was caused from unspecified nature's incidents (47.5%), followed by road accidents (31.2%), violence, work accidents and others. The evaluation of single years showed a decrease of traumas from 2,019 cases (1984-85) to 1,759 cases (1992-93), probably caused by traffic regulations. Variables and incidence of cranial-maxillofacial traumas were also examined.

Mild sialoadenitis: a common finding in patients with hepatitis C virus infection.

BACKGROUND: Sjögren's syndrome (SS) is an autoimmune disease of presumed viral origin; sialoadenitis has been reported to occur in hepatitis C virus (HCV) infection. METHODS: Lip biopsy specimens were graded in 32 consecutive patients with either HCV-related chronic liver disease or SS. RESULTS: Seventeen of 22 HCV-positive patients had sialoadenitis, although generally mild (15 of 17, grades I-II). Severe inflammation (grades III-IV) was observed in 8 of 10 patients with SS (chi-square = 12.6; P < 0.0005). Moreover, HCV-positive patients with sialoadenitis differed from patients with SS in female sex prevalence (6 of 17 versus 10 of 10; chi-square = 10.9; P = 0.0001) and presence of serum antinuclear autoantibodies (0 of 17 versus 9 of 10; chi-square = 23.0; P < 0.0001). Five of 13 HCV-positive patients and 7 of 8 patients with SS were HLA-DR3-positive (chi-square = 4.9; P < 0.05). CONCLUSIONS: Sialoadenitis of HCV-related liver disease is common but differs from SS with regard to predisposing genetic factors, expression of autoimmune markers, and histopathologic severity.

An enhanced surveillance program for adult T-cell leukemia in central Brooklyn.

The Brooklyn Adult T-cell Leukemia/Lymphoma (ATL) study was developed to estimate the incidence of the human T-cell lymphotropic virus type I (HTLV-I)-associated ATL in the Crown Heights/Bedford Stuyvesant community. This central Brooklyn black community is an area which has already been shown in earlier reports to be endemic for HTLV-I-associated ATL. Surveillance has been conducted at seven area hospitals that serve this community, with surveillance already completed at five hospitals. Potential study subjects who are 20 years or older are identified by the review of admission records, discharge summaries, pathology and clinical chemistry reports, or physician referrals. Diagnoses of leukemia or lymphoma, or the presence of leukocytosis or hypercalcemia are used as criteria to identify the subjects. Participating subjects give a sample of blood for the determination of HTLV-I infection by serologic tests. At the time of enrollment, subjects provide demographic information including age, sex and birthplace. After one year of surveillance at five hospitals (39.5% of inpatient beds in the catchment), we have identified 12 cases of HTLV-I-associated ATL. The mean age of the ATL patients was 50 years, with patients being predominantly female (83.3%) and often Caribbean immigrants (83.3%). Interestingly, 42% of our cases were identified solely by findings of hypercalcemia from clinical chemistry reports. The remaining ATL cases were identified by physician referral. This enhanced surveillance program that uses both clinical and laboratory criteria for ATL case ascertainment can serve as a prototype for similar surveillance in other areas endemic for HTLV-I-associated ATL--an important effort because of the strong potential for disease prevention.

[Anti-endomysium antibodies: a new marker for the diagnosis and treatment of celiac disease]. / Gli anticorpi antiendomisio: un nuovo marker per la diagnosi ed il trattamento della malattia celiaca.

Coeliac disease is the most frequent cause of chronic diarrhea (1:1000 children) in Italy. It often has atypical symptoms, so a sensitive and specific test is needed that can both simplify the ESPGAM criteria and monitor compliance of patients to their gluten free diet. The AEmA (anti endomysium antibody), found by Chorzelsky in 1984, appears to be a very sensitive and specific screening test in the diagnosis of coeliac disease (CD). Sera from 150 children, mean age 4 years (range 6 months to 20 years) were tested for endomysium antibodies (IgA class) and anti gliadin antibodies (IgG class). From our preliminary study IgA-AEmA seem to be more specific for CD than IgG class anti-gliaadin antibodies.

[Juvenile osteomyelitis and osteopetrosis. A case report]. / Osteomielite e osteopetrosi infantile. Descrizione di un caso.

A case of mandibular osteomyelitis in a child affected by osteopetrosis is presented. Systemic antibiotic therapy was ineffective and surgery was required to obtain a partial control of infection.

Ultrastructural findings on the interface between hydroxylapatite and oral tissues.

Two patients were treated with surgical implantation of synthetic, granular, nonporous hydroxylapatite to correct bone defects around dental implants. Ultrastructural examination of biopsy specimens taken several months later showed that the hydroxylapatite material was encapsulated mostly by fibrous connective tissue, without any signs of active inflammation. Osteoid and mature bone were also present in many areas. Under the electron microscope, an electron-dense delimiting band was detected at the interface of the tissue and the material. A polygonal, networklike structure, originating from the electron-dense layer and penetrating into the periphery of the hydroxylapatite granules, was also observed. These findings confirm the results of previous studies, in which it was hypothesized that the electron-dense structures were of a mucopolysaccharide nature and might prove the close bond between the hydroxylapatite and the tissues.

[Taste changes in diabetics. Clinico-experimental study]. / Le alterazioni del gusto nel diabete. Studio clinico-sperimentale.

A preliminary research was carried out, comparing taste sensitivity of 33 healthy subjects and 120 diabetics patients, either with complications or not. After this, a further analysis of the results was done, collecting the patients into more numerous groups. A significant decrease of the sensitivity for some tastes in some oral areas was attested, as regards diabetics with vascular and neurologic complications.

[Taste sensitivity in diabetic patients]. / La sensibilita gustativa nel paziente diabetico.

Taste sensitivity of 33 healthy subjects and 120 diabetic patients, either suffering from complication or not, was compared. Diabetic patients showed statistically significative reduction of sensitiveness for some tastes in some oral zones. Taste decrease looks to be related more to vascular of diabetes, than to neurologic ones.