D-dimer assays in patients with carotid atherosclerosis in clinical practice.

BACKGROUND: Correlate D-dimer plasma values with the presence and degree of severity of atherosclerotic carotid lesions in consecutive outpatient and hospitalized patients without cardiovascular symptoms, checking to see if such correlation, if any, may be of help in daily clinical practice. METHODS: 113 consecutive outpatient and hospitalized patients (M/F 69/44; mean age +/- SD 66 +/- 11 years). EXCLUSION CRITERIA: acute arterial and venous thrombo-embolism, chronic venous insufficiency of lower limbs, active infections or inflammatory conditions, neoplasms, recent trauma or surgery. Ultrasonography of epiaortic vessels and quantitative assay of D-dimer using the ELFA method (Enzyme-Linked Fluorescent Assay) were carried out. RESULTS: The patients with carotid lesions at high thrombo-embolic risk had significantly higher D-dimer concentrations than those with normal IMT or with carotid presentation at low risk (1155 +/- 1099 ng/ml vs 359 +/- 121 ng/ml and 638 +/- 468 ng/ml; ANOVA p < 0.001). Among the patients at high thrombo-embolic risk, 85% had values higher than cut-off (vs 11.5% of patients with normal IMT and vs 45.5% of patients at low thromboembolic risk). CONCLUSIONS: D-dimer assay is a sound means for the study of angiology patients; normal D-dimer concentrations combined with modest lesions in the arterial wall are typical of patients at low thromboembolic risk. Monitoring this parameter may be useful between ultrasound tests. Significant increases over baseline values would prompt clinical intervention and justify additional diagnostic tests.

[Oral contraceptives and activated protein C resistance: a paradigmatic example of genotype and environment interaction in the development of deep venous thrombosis]. / Anticoncezionali orali e resistenza alla proteina C attivata: esempio paradigmatico delle interazioni tra genotipo e ambiente nello sviluppo della trombosi venosa profonda.

A young woman, carrying factor V Leiden, developed a deep venous thrombosis after the use of oral contraceptives. This suggests that it is appropriate to study the most frequent causes of primary thrombophilia in all of the women beginning a treatment with estrogens.

Relationships between serum hyperhomocysteinemia and carotid atherosclerosis in geriatric patients.

BACKGROUND: Evaluate the relationships between serum total hyperhomocysteinemia and carotid atherosclerosis. METHODS: The 102 consecutive patients over the age of 65 epiaortic vessels were examined by means of a high-resolution echo-Doppler and Doppler cw. Depending on the size of the atherosclerotic plaques in the carotid the patients were divided into two groups: a) patients with lesions at high thromboembolic risk (heterogeneous and/or ulcerated plaques, hemodynamically significant stenoses > 70%); b) individuals with low risk carotid involvement (IMT normal and/or thickened by > 0.8 mm and/or lumen stenosed by homogeneous plaques < 70%). The quantitative assay of serum total homocysteinemia (tHCY) was carried out by means of an immunofluorescent method (FPIA). Depending on their tHCY values, the patients were broken down into those with normal tHCY (cut-off 14 mumol/l for the women and 16 mumol/l for the men; 62 patients, M/F = 34/28, mean age 71 +/- 4); patients with mild hyperhomocysteinemia (tHCY 14-18 mumol/l for the women; 16-20 mumol/l for the men; 19 patients, M/F = 11/8; mean age 74 +/- 7); patients with moderate hyperhomocysteinemia tHCY 18 mumol/l for the women; > 20 mumol/l for the men; 21 patients, M/F = 18/3; mean age 74 +/- 7). RESULTS: As against the individuals with normal serum concentrations of HCY (Fig. 2; chi 2: p < 0.05), the patients with mild hyperhomocysteinemia (Odds ratio: OR = 1.48) and, above all, patients with moderate hyperhomocysteinemia (OR = 4.6) were found to have a greater prevalence of carotid lesions at high thromboembolic risk. No significant differences within the three groups were found with regard to distribution by age, gender and the prevalence of the more common cardiovascular risk factors (smoking, diabetes mellitus, arterial hypertension, hyperdyslipidemia). CONCLUSIONS: Hyperhomocysteinemia is associated with highly severe carotid lesions at higher risk for cerebrovascular events.

[Epstein-Barr virus meningoencephalitis. Considerations on a very unusual clinical manifestation in adults]. / La meningo-encefalite da virus di Epstein-Barr. Considerazioni su una rarissima manifestazione clinica nel soggetto adulto.

The authors report a case of meningoencephalitis occurring as a complication in an adult suffering from infective mononucleosis. As well as the clinical and serological aspects of the pathology, the authors analyse the main and most recent etiopathogenetic hypotheses responsible for neurological symptoms, and pay special attention to the indirect namely immunomediated action of the virus.

[Systemic venous thrombolysis with rt-PA in arterial embolism of the legs in the elderly]. / Trombolisi per via venosa sistemica con rt-PA nell'embolia arteriosa degli arti inferiori nel soggetto anziano.

Lower limb arterial embolism with blockage of a proximal artery is still a significant use of mortality, especially in elderly subjects. The excellent results achieved in acute myocardial infarction by the use of recombinant tissue plasminogen activator (rt-PA) have prompted us to apply this agent systemically i.v. in elderly patients with probably cardiogenic arterial embolism of the lower limbs. Out of 14 patients in our care, 9 have been submitted to this treatment after careful selection, and in 7 total or partial recanalization of the vessel has been achieved thus saving the limb involved. It can therefore be concluded, even on the basis of the small number of cases, that in selected cases thrombolytic management is possible, while avoiding the hemorrhagic complications attending arterial thrombolysis. This treatment can be applied in hospitals lacking the resources of angiographic diagnostics. The mechanism of action of rt-PA is such that at the doses administered critical changes of blood clotting parameters are not to be feared. Venous systemic thrombolysis can be performed mainly in elderly subjects whose precarious conditions may be upset by manoeuvres involving bleeding, sophisticated diagnostic or surgery.

[Treatment of chronic atherosclerotic obliterative arteriopathy in the II and IV Fontaine stage. Personal observations using iloprost]. / Il trattamento delle arteriopatie obliteranti croniche aterosclerotiche al III e IV stadio di Fontaine. Osservazioni personali con impiego di iloprost.

The traditional medical treatment of atherosclerotic artery disease of the lower limbs with vasodilators, antiplatelet agents, hemorheologic agents and heparin has so far yielded only partly satisfactory results. In view of this, we have treated ten patients with lower limb arterial disease, Fontain stages III and IV, with a stable prostacyclin analogue, iloprost, with antiaggregant, vasodilating, and cytoprotective activity. Patients' mean age 73.6 +/- 9.9 yrs., M/F ratio 9/1. The drug was infused by peristaltic pump at dosages varying from 1.5 to 2 ng/kg body weight/min for 6 hours daily and for an average of 25 days. Our observations, albeit on a limited number of subjects, appear to confirm the good tolerability, and above all the efficacy of iloprost (relative number of patients improved: 0.70). Nevertheless, in our view, a hypertensive diabetic woman who under treatment developed a lower myocardial infarction deserves special attention. Data found in the literature do not allow us to hold iloprost responsible for this effect with any degree of certainty. However, the doubt remains that as a result of its vasodilating action the drug may have caused steal phenomena from the subendocardial to subepicardial districts, thus provoking the ischemic event.

Recurrence of Hodgkin's disease after 10 years: observation of 5 cases.

Five patients whose Hodgkin's disease recurred 10 years or more after the achievement of complete remission are reported. Four out of 5 patients had shown an advanced stage at the onset of disease and therefore had received combination chemotherapy (ABVD or MOPP-like) as primary treatment. Involved-field irradiation was delivered as consolidation therapy in 1 patient only. All pathologically proven relapses occurred in a previously affected area and the histologic subtype differed from the primary subtype. The time interval between the achievement of the first complete remission and the relapse was 120, 170 and 190 months in 3, 1, and 1 patient, respectively. All 5 patients are alive in second complete remission. This paper emphasizes the risk of late relapse even after a prolonged disease-free interval for patients with Hodgkin's disease. Close follow-up is therefore recommended also in this clinical setting.

Immunophenotyping of acute myeloid leukaemia: relevance of analysing different lineage-associated markers.

The immunophenotype of 135 previously untreated patients with FAB defined acute myeloid leukaemia (AML) was studied at diagnosis. The panel of reagents included monoclonal antibodies (MoAb) recognising myeloid-associated determinants (CD11, CD13, CD14, CD33 and others) as well as MoAb directed towards lymphoid antigens (CD7, CD10, CD19) and TdT. The results indicate that CD13 and/or CD33 are consistently expressed in AML and only rarely in ALL blasts (131/135 + ve cases, versus 4/130 in ALL). Lymphoid antigen expression was rarely detected when CD10 and CD19 were investigated in AML (0.9% and 2% + ve cases, respectively), whereas significant positivities were found for TdT and CD7 (20% and 10% respectively). Concerning FAB subtypes, two new MoAb (LAM3 and LAM7) proved very useful in the specific recognition of AML with monocytic features. The phenotype CD13+ and/or CD33+, CD9+, HLA-DR- was found to be almost exclusive for M3 AML. The response to induction chemotherapy was analysed in CD7+ and in TdT+ patients. In the latter group a statistically significant lower response rate was found with respect to TdT-ve-AML patients.