Morphological and molecular characterization of adults and larvae of Crassicauda spp. (Nematoda: Spirurida) from Mediterranean fin whales Balaenoptera physalus (Linnaeus, 1758).

Crassicauda boopis is known to infect the kidneys and vascular system of mysticetes included Balaenoptera physalus and has been recently reported in Mediterranean waters. Identification at the species level relies on the observation of morphological features of the adult parasites, but field conditions during necropsy and the massive reaction of the host's immune system often prevent optimal conservation of the extremities. Moreover, larval stages of Crassicauda have never been described and no sequences are available in public databases to help such identification. Adult and larvae of Crassicauda were isolated from four specimens of B. physalus and studied with morphological and molecular techniques. Specimens of C. anthonyi, C. grampicola and Crassicauda sp. isolated from Ziphius cavirostris, Grampus griseus, Stenella coeruleoalba and Tursiops truncatus respectively were studied as well. Sequences of nuclear markers 18S and ITS-2 and of mitochondrial gene cox1 were obtained and phylogenetic relationships within the genus Crassicauda were analysed. Analysis of the ITS2 grouped the different species in accordance with morphological identification, as already evidenced in literature for other Spirurida. A higher intra-specific variability was observed for the cox1 gene, for which two species (C. grampicola and C. anthonyi) did not appear as monophyletic in the tree. Well-developed non-attached larval specimens in the intestinal lumen of a whale calf were molecularly identified as C. boopis, allowing new insights on the life cycle of this species. This work broadens the genetic database on cetaceans parasites, allowing species identification even in challenging field conditions or in poor conservation of the samples; moreover, the first morphological description of C. boopis larvae is provided.

[Gadolinium for DSA in two patients with azotemia: Images of suitable quality and risk of acute renal failure]. / Angiografia con Gadolinio in due pazienti azotemici: la qualita' diagnostica ed il rischio d'insufficienza renale acuta.

BACKGROUND: Gadolinium is an alternative angiographic contrast agent in patients with impaired renal function and high risk for iodinated contrast adverse reaction. We report two cases of acute renal failure caused by gadolinium (0.6 and 0.9 mmol/kg of body weight) after the execution of digital subtraction angiography (DSA) to produce diagnostic-quality images in two elderly diabetic patients with pre-existing renal insufficiency. Both patients needed dialysis treatments for as long as a few weeks until their renal function improved. In our opinion, and according to the guidelines of European Society of Urogenital Radiology, gadolinium has not been assessed as less nephrotoxic than iodinated contrast agents. In fact, 1.8 to 4.8 g of iodine, equally attenuated with a relatively high dose (0.2 to 0.4 mmol) of a gadolinium chelate, is a low iodine dose and could hardly have any important nephrotoxic effects. CONCLUSIONS: The maximum dose of gadolinium-based contrast agents should never exceed 0.2 to 0.4 mmol/kg in azotemic patients who are undergoing DSA, even though these doses of gadolinium may not provide images of suitable quality for diagnosis and intervention.

Aedes albopictus is a natural vector of Dirofilaria immitis in Italy.

Investigations were carried out in Padova town (Veneto region, NE Italy) to define the actual role of Aedes albopictus in the natural transmission of Dirofilaria nematodes, and to assess the risk that its presence might represent for veterinary and medical health. During summer 2000-2002 daytime captures of human-attracted mosquitoes were carried out in three areas of the town. The presence of filarial parasites in mosquitoes was evaluated by PCR, and sequencing confirmed species assessment. DNA extraction was performed separately on pools of the insect abdomen and thorax-head, to discriminate between Dirofilaria infected/infective specimens. A total of 2721 mosquitoes were caught and A. albopictus was the most abundant species (2534). Filarial DNA was found in 27.5% (19/69) of the abdomen pools formed with mosquitoes collected in summer 2000, and in 11.1% (16/144) and 4.9% (6/123) thorax-head pools coming from samplings 2001 and 2002, respectively. Filarial DNA was belonging to D. immitis and all studied areas harboured infective specimens. These results prove A. albopictus as natural vector of D. immitis in Italy. Moreover, they support the hypothesis that the presence of the mosquito could affect the transmission pattern of canine heartworm disease in urban environment and, considering the aggressive anthropophylic behaviour of the species (30-48 bites/h) proven in Padova town, could enhance the circulation of filarial nematodes from animals to humans.

[Local therapy with platelet-derived growth factors for chronic diabetic ulcers in haemodialysis patients]. / Terapia locale con fattori di crescita piastrinici nelle ulcere croniche diabetiche in emodializzati.

BACKGROUND: The increasing number of diabetic patients who need dialysis treatment is the cause for the growing interest of nephrologists in ulcers of the lower limbs. It has been reported that platelet-derived growth factors, such as PDGF and TGF beta 1, are able to heal skin lesions due to diabetes. Therefore, a platelet gel (PG) has been developed to locally treat foot ulcers with a limited number of applications (3+/-1.7). METHOLOGY AND PATIENTS: The PG is a mix of concentrated platelets and cryoprecipitate activated by batroxobin in the presence of calcium chloride (or gluconate) that must be applied to the wound for three days. The surgeon and the dermatologist should then plan successive treatments because the necrotic tissue needs to be removed. We treated a 62-year-old diabetic man, who has been under treatment with insulin since the age of 36 and has been dialysed for three years. His right lower leg was amputated and he developed a chronic left foot ulcer that resulted in many septic episodes. His ulcer recovered in two months after 8 PG applications. CONCLUSIONS: Conventional therapy is not successful in 15-20% of diabetic feet. Uraemia and malnutrition may represent important risk factors for foot ulcers in diabetic patients who need advanced technology to stimulate tissue repair. The use of platelet growth factor may ameliorate ulcer healing thus reducing disease-associated morbidity and lowering health care costs.

The self-locating catheter: clinical evaluation and comparison with the Tenckhoff catheter.

BACKGROUND: Peritoneal catheter displacement appears to be related to various causes including omental attachment, bowel contractions, peritoneal adhesions, and the catheter floating in the dialysis fluid. In order to prevent this complication, which can impair peritoneal dialysis efficacy, Di Paolo et al. designed a "self-locating catheter" (SLC) that is similar to the Tenckhoff catheter (TC) and includes a small tungsten cylinder (weight 12 g) at the distal end (Di Paolo N, et al. The self positioning catheter. Proceedings of the VII Italian Congress on Peritoneal Dialysis. Milan: Wichtig Editore, 1993:539-42). The weight of the tip prevents the catheter from floating and migrating by gravitation toward the Douglas cavity. OBJECTIVE: Starting in 1996, we implanted SLC in 15 continuous ambulatory peritoneal dialysis patients. The aim of our study was to compare the ratio of migration and other catheter-related complications between patients with SLC (196 patient-months) and 13 patients with conventional straight TC (295 patient-months). RESULTS: Peritonitis ratio, catheter complication rate, dialysate inflow and outflow, and weekly creatinine clearance were similar in the two groups of patients. The incidence of catheter displacement was significantly higher (p = 0.0349) in theTC group than in the SLC group (4 vs 0). CONCLUSION: In our experience, the SLC seems to be useful in preventing catheter migration by continuous gravitation of its extremity toward the pelvic cavity.

Effect of okadaic acid on membrane protein phosphorylation in human erythrocytes.

Okadaic acid, penetrating the human erythrocytes, almost completely inhibits P-Ser-protein phosphatase activity, whereas it unaffects Ser/Thr-protein kinase activity (casein kinases CKI and CKII), thus promoting a marked increase of the endogenous Ser-phosphorylation level of membrane proteins, such as cytoskeletal spectrin beta-subunit (band 2) and transmembrane band 3 protein. By contrast, the Tyr-phosphorylation state of band 3 protein is practically unaffected by okadaic acid, being unaffected both Tyr-protein kinase and P-Tyr-protein phosphatase activities.

Risk factors of ischemic cardiac disease in patients on continuous ambulatory peritoneal dialysis.

Elevated plasma levels of fibrinogen, factor VII coagulant activity (F VIIc), and plasminogen activator inhibitor (PAI-1) have been reported to be strictly associated with thrombotic events and are considered to be important risk markers of atherothrombotic cardiovascular disease. Therefore, we evaluated in 15 patients on continuous ambulatory peritoneal dialysis (CAPD) the plasma levels of these coagulation factors, basal insulin values, and the lipid pattern in comparison with 33 hemodialysis (HD) patients and 59 healthy subjects. In CAPD the total cholesterol and triglyceride results were significantly increased, but no difference was found in HDL cholesterol. Fibrinogen and F VIIc results were significantly higher in CAPD and HD than in the control group, probably due to an increased hepatic synthesis as a nonspecific response to the peritoneal protein loss. Elevated F VIIc activity may be caused by the presence of large negatively charged lipoproteins, in vivo thrombin formation, or reduced hepatic clearance. Both PAI 1 and t-PA results were higher in CAPD, probably due to an increased synthesis by endothelial cells activated by glucose peritoneal absorption and hypertonic dialysis solutions. The contemporary elevation of fibrinogen, F VIIc, PAI-1, and t-PA suggests that CAPD patients present a hypercoagulability and hypofibrinolysis condition, which may promote the development of atherothrombotic events.

Long-term monitoring of renal transplant patients by a CUSUM test on serum creatinine.

A retrospective clinical assessment of kidney function change was performed on 38 kidney transplant patients over a median follow-up period of 128 weeks. Full records of the patients' course were available to the clinician, while only the serum creatinine series of each patient was supplied to the computer on which a bilateral CUSUM test was implemented. The frequency of change assessed by the clinician was 146 out of 2,688 patient-weeks. The computer identified the function changes with 84.9% sensitivity and 94.3% specificity and the function deteriorations attributed to rejection with 88.9% sensitivity and 97.2% specificity. Thus we suggest an efficient long-term monitoring of the graft function with this simple and reliable statistical technique.

Granulomatous involvement of the liver in anthracosilicosis.

The authors reexamined 300 autopsies which were carried out from 1965 to 1983, on male subjects affected by pulmonary anthracosilicosis already diagnosed in vita and holders of pensions for invalidity allocated to them by the Istituto Nazionale Assicurazione Infortuni sul Lavoro. Their livers were reexamined and the specimens which contained agglomerates of at least 5 macrophages in phagocytic activity with dust particles and birefringent silica crystals were considered positive for a silicotic interstitial type involvement of the organ. Larger accumulations of macrophages in fibroelastic activity, including those with fibrohyaline evolution, were considered as silicotic granulomas. Only the incidence of the hepatic granulomatous types was analyzed and related to the severity of the disease, classified according to four types of increasing gravity: interstitial, nodular, confluent and massive. The statistical analysis of the data demonstrates that there is a close correlation between the gravity of pulmonary anthracosilicosis and hepatic involvement, less in interstitial and more in massive types; thus, it is dependent on the amount of silica. On the other hand, the granulomatous evolution following hepatic involvement is not correlated with the gravity of pulmonary anthracosilicosis; therefore, it is not dependent on the amount of silica but is an individual cellular response.