Quantitative Assessment of Asbestos Fibers in Normal and Pathological Peritoneal Tissue-A Scoping Review.

Peritoneal tissue is the second most affected site by malignant mesothelioma linked to asbestos exposure. This scoping review aims to summarize the findings of the studies in which asbestos fibers in the peritoneum were quantified by electron microscopy, occasionally associated with spectroscopy, both in neoplastic and non-neoplastic tissue. The 9 studies selected comprised 62 cases, out of whom 100 samples were analyzed. Asbestos fibers were detected in 58 samples (58%). In addition, 28 cases had diagnosis of peritoneal mesothelioma. For 32 cases, a lung tumor sample was available: 28/32 samples analyzed presented asbestos fibers; 18/32 reported amphiboles with a range from not detected to 14.2 million fibers per gram of dry tissue (mfgdt); 18/32 reported chrysotile, with a range of 0 to 90 mfgdt. The studies were heterogeneous for type of samples, analytical technology, and circumstances of exposure to asbestos. To evaluate asbestos fibers in the peritoneum and to better understand the association between asbestos exposure and malignant peritoneal mesothelioma, it is desirable that the search for asbestos fibers becomes a routine process every time peritoneal tissue is accessible.

Thirty-six cases of epidemic infections due to Trichophyton violaceum in Siena, Italy.

Trichophyton violaceum is an anthropophilous dermatophyte endemic to parts of Africa and Asia, sporadic in Europe. It is an emerging pathogen in Italy due to immigration. We report 36 cases of infections due to T. violaceum, diagnosed in the last 5 years by mycological examination. The source of contagion was 13 children adopted from orphanages.

Identification of Malassezia species isolated from patients with extensive forms of pityriasis versicolor in Siena, Italy

Background. Pityriasis versicolor (PV) is an infection caused by various species of Malassezia yeast. There is no agreement in the literature concerning the species of Malassezia and the demographic, clinical, and mycological data. Aims. To prospectively identify Malassezia species isolated from lesions of patients with extensive, long standing and recurrent forms of PV and to estimate the relationship between Malassezia species and the demographic and clinical data of the patients. Methods. All patients with PV were enrolled over a four-year period. Malassezia species were isolated in cultures and identified by morphological features and physiological tests. In the last 2 years a PCR-based technique was used to confirm the species’ identification. Results. A total of 74 patients (43 males and 31 females, mean age 39.5 years) were enrolled. Only one species was isolated in 45 patients, and more than one species were identified in the remaining 28 patients (38%). M. globosa was the most frequently isolated (60.3%) species. There was a significant association between the isolation of 2 or more species and the presence of at least one predisposing factor. In the last 29 cases, which were subjected to PCR, there were no differences in the identification of isolated species as compared to traditional methods. Conclusions. The isolation of more than one species in a single lesion is not infrequent in PV and is related to the presence of one predisposing factor. The isolated species isolated were not influenced by demographic and clinical features. The traditional and more recent (PCR) procedures gave the same results in the isolated species (AU)

Identification of Malassezia species isolated from patients with extensive forms of pityriasis versicolor in Siena, Italy.

BACKGROUND: Pityriasis versicolor (PV) is an infection caused by various species of Malassezia yeast. There is no agreement in the literature concerning the species of Malassezia and the demographic, clinical, and mycological data. AIMS: To prospectively identify Malassezia species isolated from lesions of patients with extensive, long standing and recurrent forms of PV and to estimate the relationship between Malassezia species and the demographic and clinical data of the patients. METHODS: All patients with PV were enrolled over a four-year period. Malassezia species were isolated in cultures and identified by morphological features and physiological tests. In the last 2 years a PCR-based technique was used to confirm the species' identification. RESULTS: A total of 74 patients (43 males and 31 females, mean age 39.5 years) were enrolled. Only one species was isolated in 45 patients, and more than one species were identified in the remaining 28 patients (38%). M. globosa was the most frequently isolated (60.3%) species. There was a significant association between the isolation of 2 or more species and the presence of at least one predisposing factor. In the last 29 cases, which were subjected to PCR, there were no differences in the identification of isolated species as compared to traditional methods. CONCLUSIONS: The isolation of more than one species in a single lesion is not infrequent in PV and is related to the presence of one predisposing factor. The isolated species isolated were not influenced by demographic and clinical features. The traditional and more recent (PCR) procedures gave the same results in the isolated species.

Tinea corporis purpurica and onychomycosis caused by Trichophyton violaceum.

We report two cases of tinea corporis purpurica of the legs, presumably caused by self-inoculation of the mycete from the toenails, in two elderly women (80 and 78 years). Trichophyton violaceum was isolated from the skin and nails. Histological examination of a biopsy specimen from the leg lesions confirmed the diagnosis. The source of infection was an Ethiopian carer who had tinea capitis in the first case, and was undiagnosed in the second patient. Cases of purpuric variants of tinea corporis are rare and this is the first report of probable self-inoculation of T. violaceum from onychomycosis.

Sympathetic skin response in primary Raynaud's phenomenon.

OBJECTIVES: The pathogenetic hypotheses of Raynaud's phenomenon include increased activation of sympathetic noradrenergic nerves controlling muscle tone of digit arteriolar walls. Because acral sympathetic fibres contain vasoactive adrenergic and cholinergic fibres for sweat glands, we tested cholinergic sympathetic fibre function in primary Raynaud's phenomenon (PRP) patients by sympathetic skin response (SSR). METHODS: Twenty-six consecutive patients (19 women, 7 men, mean age 37.8 years) with PRP were enroled prospectively. SSR was obtained by random electrical stimulation of the left ulnar nerve at the wrist recording from the palm (PSSR), third (M3SSR) and fifth fingers (U5SSR) on the right side. For each subject latency of shortest response, area of largest response and grand mean latencies and areas of 12 consecutive responses were calculated. The differences between patients and a control group (15 women, 6 men, mean age 38.9 years) were calculated. SSR habituation was also compared between patients and controls. RESULTS: PSSRs were recorded in all patients and no difference in any PSSR parameter was found between patients and controls. U5SSRs and M3SSRs were absent in two patients. Grand mean area and mean of largest M3SSRs and U5SSRs were significantly lower in patients than in controls. Grand mean latency and mean of shortest M3SSRs and U5SSRs were significantly slower in patients than in controls. M3 and U5SSRs habituated less in patients than in controls. INTERPRETATION: Dysregulation of cholinergic sympathetic fibres innervating the fingers was found in PRP. Abnormal peripheral mechanisms may be the cause. Since SSR habituation was also not normal, even central mechanisms may be implicated.

Prospective study of positive factors for improvement of carpal tunnel syndrome in pregnant women.

The aims of this study were to evaluate differences between women with carpal tunnel syndrome (CTS) and symptom onset in pregnancy (pregnancy cohort) and women with idiopathic CTS (control cohort) and to report changes in symptoms assessed by the Levine Boston Questionnaire (BQ) administered by phone 3 years after diagnosis. Forty-five pregnant women with CTS (mean age 32 +/- 3.9 years) and 90 age-matched women with idiopathic CTS were consecutively enrolled. Diagnosis was based on clinical findings and abnormal transcarpal median nerve conduction. Univariate analysis showed that the pregnancy cohort had a shorter duration of symptoms, higher frequency of bilateral symptoms and non-blue-collar workers, and lower clinical and electrophysiological severity evaluated by ordinal scales and BQ scores. Multivariate analysis showed that the pregnancy cohort had a probability of improvement of symptoms 3-4 times greater than the control cohort. The need for further treatment depended on BQ functional score; 50% of pregnant women had tolerable CTS symptoms and 85% did not require further treatment 3 years after diagnosis, whereas 72% of women in the control cohort did not require long-term therapy. The probability of need for CTS treatment did not depend on the cohort, but only on the severity of hand disability.

Nine male cases of tinea genitalis.

Nine cases of tinea genitalis observed in Siena and Terni (Italy) between 1988 and 2003 are reported because of their infrequency. The patients were males ranging in age from 23 to 45 years. The lesions, situated on the penis, glans and scrotum, were preceded by dermatophytosis in other sites (groin five cases; feet two cases; toenails two cases; hands in one; beard in another). Mycological examination consisting of direct microscopy and culture led to isolation of Trichophyton rubrum in five cases, Epidermophyton floccosum in two and T. mentagrophytes var. interdigitalis in the others. Clinical diagnosis is not always easy. In three cases the lesions had been misdiagnosed as eczema.

Retrospective study of onychomycosis in Italy: 1985-2000.

Cases of onychomycosis diagnosed by mycological examination in three mycology units (Florence, Siena and Milan) of central and northern Italy over the 15-year period, 1985-2000, were studied retrospectively. The number of cases was 4046 (1952 women, 2094 men). Dermatophytes were isolated in 2859, yeasts in 655 and moulds in 532 cases. The most frequent dermatophyte was Trichophyton rubrum (87%), followed by T. mentagrophytes var. interdigitale (10%). Candida albicans (93.2%) was the prevalent yeast. Moulds were mainly Scopulariopsis brevicaulis (48.6%) and Aspergillus spp. (25.2%). Dermatophytes and moulds most commonly infected the toenails, yeasts the fingernails.

Clinical and histological aspects of toenail onychomycosis caused by Aspergillus spp.: 34 cases treated with weekly intermittent terbinafine.

BACKGROUND: Non-dermatophytic onychomycoses represent 1.45-17.6% of all fungal nail infections. Epidemiological studies have shown that Aspergillus spp. are emerging fungal agents of toenail onychomycosis. Indeed, after Scopulariopsis spp. the genus Aspergillus is the second most common agent of non-dermatophytic onychomycosis. The diagnosis and treatment of toenail onychomycosis caused by non-dermatophyte moulds are not always straightforward. OBJECTIVES: The aims of this study were to describe the clinical appearance of toenail onychomycosis due to Aspergillus spp., to investigate the pathogenetic role of these agents and to evaluate the efficacy and safety of weekly intermittent terbinafine (500 mg/day for 1 week each month for 3 months) in the treatment of these patients. PATIENTS AND METHODS: Mycological study of 2,154 patients with onychodystrophy revealed 1,228 onychomycoses (57%) including 71 cases due to non-dermatophytic fungi (5.6%). Non-dermatophytic onychomycosis caused by Aspergillus spp. represented 2.6% of all onychomycoses. The subjects were 34 patients (22 females, 12 males, age range 30-82 years) observed between September 1999 and December 2001, with toenail onychomycosis caused by Aspergillus spp. confirmed by standard techniques (microscopic examination and culture according to the criteria of English), histological examination of nail clippings and scanning electron microscope examination of the cultures whenever necessary. RESULTS: The clinical features suggesting onychomycosis due to Aspergillus spp. are chalky deep white nail, rapid involvement of lamina and painful perionyxis without pus. Standard mycological tests (direct microscopy and fungal culture) and histological examination confirmed the pathogenetic role of Aspergillus spp. in onychomycoses. In particular, the histological examination was positive in 28 cases (82%) and useful in identifying typical aspects of Aspergillus spp. nail infections. At the follow-up, 12 months after the start of therapy with pulsed terbinafine, clinical and mycological recovery was confirmed in 30 of the 34 patients (88%). CONCLUSIONS: Treatment of non-dermatophytic onychomycosis with terbinafine usually requires at least 3 months of continuous systemic therapy. Our study of 34 patients confirms that terbinafine is particularly effective in the treatment of Aspergillus spp. nail infections and that a pulsed regimen is more economical and less demanding.

Outcome of surgical release among diabetics with carpal tunnel syndrome.

OBJECTIVE: To compare the results of surgical decompression of carpal tunnel syndrome (CTS) in patients with diabetes with those of patients with idiopathic CTS. DESIGN: Prospective case series. SETTING: Ambulatory care in Italy. PARTICIPANTS: Twenty-four consecutive patients with diabetes type 1 or 2 and CTS (mean age, 66.7 y) were matched for age and sex with 72 patients (mean age, 66.2 y) with idiopathic CTS. INTERVENTIONS: All patients underwent surgical release of CTS by the mini-incision of palm technique. MAIN OUTCOME MEASURES: Clinical and electrophysiologic evaluation and patient self-administered Boston Questionnaire (BQ) for the assessment of severity of CTS symptoms and hand functional status before and 1 and 6 months after surgery. RESULTS: After surgical release, almost all patients of both groups reported an absence of pain, disappearance or reduction of paresthesia, and improvement in hand function. One month after surgery, there was a significant improvement in clinical status, BQ scores, and distal conduction velocities of the median nerve. A further improvement was evident at 6-month follow-up. There were no differences between the 2 groups in the number of surgical complications, in clinical and electrophysiologic status, or in BQ scores before and after surgery. The improvement in distal conduction velocities of the median nerve, BQ scores, and clinical and electrophysiologic status were similar in the 2 groups after surgery. CONCLUSION: Diabetes is not a risk factor for poor outcome of surgical decompression of CTS. Patients with diabetes have the same probability of positive surgical outcome as patients with idiopathic CTS.

Emerging imported parasitoses in Italy.

In the period 1987-2001, 111 cases of imported parasitoses were diag- nosed in three Italian dermatology departments (Monza, Milan and Siena): 22 cases of tungiasis, 11 of furuncular myiasis and 78 of creeping eruption. The patients were 73 males and 38 women, who had been on trips abroad. All underwent appropriate treatment and recovered. Here we describe the geographic location of the parasites, the clinical features of the skin manifestations and differential diagnoses. Autochthonous cases of these infections, which are increasingly frequent as Europeans travel to endemic areas, have been described. Detailed knowledge of these parasitoses is necessary to enable prompt diagnosis and treatment.

Skin infection due to Geomyces pannorum var. pannorum.

Geomyces pannorum var. pannorum is an ubiquitous saprophytic fungus frequently isolated from the soil and from air samples. It has rarely been reported as an animal or plant pathogen and it is an occasional aetiological agent of superficial infection of skin and nails in humans. Here, we report a case of superficial infection of the skin due to this fungus in a healthy man. The patient was treated orally with terbinafine 250 mg daily and topic bifonazole with complete resolution in 2 months.

Primary cutaneous aspergillosis in an immunocompetent patient.

A case of primary cutaneous aspergillosis in a 39-year-old woman with apparently normal immune status is reported. The woman had an occasionally suppurating nodular lesion which developed in the site of a trauma on the back of the right wrist. Diagnosis was based on histological and mycological examination. Systemic involvement was not found. Surgical excision led to clinical and mycological recovery, confirmed at follow-up 18 months later.

An unusual case of tinea capitis due to Trichophyton soudanense.

A case of tinea capitis due to Trichophyton soudanense observed in a 4-year-old African girl is described. The infection manifested with diffuse pustular lesions of the scalp. Diagnosis was based on culture. Genome study by single primer PCR fingerprinting was also performed. A younger sister, aged 10 months, was the healthy carrier of the mycete.

Case Reports. Tinea capitis due to Trichophyton soudanense and Trichophyton schoenleinii.

Four cases of tinea capitis, two due to Trichophyton soudanense in Italian children who had had contact with Africans, and two due to Trichophyton schoenleinii in an African and an Italian child, respectively, are reported. Infections caused by anthropophilic dermatophytes are rare in Italy and are related to immigration. The most frequent agents of tinea capitis in Italy are zoophilic dermatophytes.

Herpes zoster of the head and limbs: electroneuromyographic and clinical findings in 158 consecutive cases.

OBJECTIVES: To quantify electromyographic and neurographic changes and to correlate them with the clinical data of outpatients with herpes zoster. DESIGN: Prospective case series. SETTING: Outpatient department. PATIENTS: A consecutive, unselected series of 158 outpatient cases (88 women, 70 men; mean age, 64y) of herpes zoster of the head and limbs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Blink reflex and electromyography and motor and sensory nerve conduction velocities of nerves and muscles corresponding to affected dermatomes. RESULTS: Postherpetic neuralgia (PHN), segmental zoster paresis, and polyneuropathy were found in 31%, 19%, and 2.5% of cases, respectively. Absence or reduction of sensory action potential amplitudes, blink reflex areas, and compound muscle action potential amplitudes were found in 60%, 31%, and 18% of cases, respectively. Sensory and motor conduction velocities and motor and blink reflex latencies were nearly always normal or only slightly slowed. Electromyographic signs of abnormal spontaneous activity were found in 36% of the cases. Electrophysiologic alterations were correlated among themselves, with age, with presence of segmental zoster paresis, and with absence of antiviral therapy. The extent of the skin rash (number of dermatomes affected by herpes zoster) was the only variable predictive of disappearance or improvement of PHN. CONCLUSIONS: Sensory axonal neuropathy, often associated with similar motor involvement, can be shown by classical electrophysiologic methods in herpes zoster. The severity of damage to motor fibers was related to damage to sensory fibers, but no relation was found between peripheral axon damage and PHN. The site of motor system damage may be the ventral roots, plexus, or peripheral nerve. The probability of complications and the severity of sensory and motor peripheral axonal damage were increased in older patients. Appropriate antiviral therapy seems to reduce the incidence of segmental zoster paresis and the severity of damage to the peripheral fibers. A reduced extent of herpetic rash was the only factor to correlate with a good outcome of PHN.