Diffusion-weighted imaging in patients with progressive multifocal leukoencephalopathy.

Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease of the central nervous system due to JC polyoma virus infection of oligodendrocytes. PML develops in patients with impaired T-cell function as occurs in HIV, malignancy or immunosuppressive drugs users. Until now no imaging methods have been reported to correlate with clinical status. Diffusion-weighted imaging (DWI) is a robust MRI tool in investigating white matter architecture and diseases. The aim of our work was to assess diffusion abnormalities in focal white matter lesions in patients with PML and to correlate the lesion load measured with conventional MRI and DWI to clinical variables. We evaluated eight patients with a biopsy or laboratory-supported diagnosis of PML. All patients underwent MRI including conventional sequences (fluid attenuated inversion recovery-FLAIR) and DWI. Mean diffusivity (MD) maps were used to quantify diffusion on white matter lesions. Global lesion load was calculated by manually tracing lesions on FLAIR images, while total, central core and peripheral lesion loads were calculated by manually tracing lesions on DWI images. Lesion load obtained with the conventional or DWI-based methods were correlated with clinical variables such as disease duration, disease severity and survival. White matter focal lesions are characterized by a central core with low signal on DWI images and high MD (1.853 x 10(-3) mm2/s), surrounded by a rim of high signal intensity on DWI and lower MD (1.1 x 10(-3) mm2/s). The MD value of normal-appearing white matter is higher although not statistically significant (0.783 x 10(-3) mm2/s) with respect to control subjects (0.750 x 10(-3) mm2/s). Inter-rater correlations of global lesion load between FLAIR (3.96%) and DWI (3.43%) was excellent (ICC=0.87). Global lesion load on FLAIR and DWI correlates with disease duration and severity (respectively, p=0.037, p=0.0272 with Karnofsky scale and p=0.0338 with EDSS on FLAIR images; p=0.043, p=0.0296 with Karnofsky scale and p=0.0365 with EDSS on DW images). Central core lesion load on DWI correlates with disease duration and severity (respectively p=0.043, p=0.0103 with Karnofsky scale and p=0.0112 with EDSS), while peripheral lesion load does not correlate with any clinical variable. The global lesion load in PML correlates with disease duration and severity. DWI images, which can distinguish within lesions a central core from a peripheral rim, reveal that a larger central core component correlates to a worsened clinical status and longer disease duration. On the other hand the peripheral rim lesion load visualized on DWI images does not correlate with clinical variables and does not achieve obtaining further prognostic information with respect to conventional imaging.

A 59-year-old liver-transplanted woman with fever, dyspnea and pulmonary infiltrates.

A 59-year-old woman was admitted to hospital 10 months after receiving a liver transplant (LT) for hepatitis C virus (HCV) cirrhosis because of fever, dyspnea and basal patchy peripheral infiltrates. Microscopic examinations and blood, sputum and BAL cultures were negative. Empirical anti-infective therapy was ineffective. Thoracoscopic lung biopsy was performed, and histology showed a pattern suggesting bronchiolitis obliterans organizing pneumonia (BOOP). Prednisone led to rapid clinical and radiologic improvement. BOOP has been anecdotally reported in LT cases, and this case was unrelated to any infectious agent. BOOP should be taken into account in the differential diagnosis of pneumonia in LT.

[Neurological disorder associated to EBV: three case reports]. / Interessamento del sistema nervoso e infezione da EBV: casi clinici.

Epstein-Barr virus (EBV) is associated with a wide range of clinical manifestations. Neurological involvement (NI) during Infectious Mononucleosis occur in 1-5% of the cases, the only NI is more rare. From January 1995 to December 1996 three patients with NI and EBV infection have been observed in our department. The diagnosis were: meningoradiculitis (1 case), meningoencephalitis (1 case), aseptic meningitis (1 case). The diagnosis was based on the results of the lumbar puncture and on the serology: IgM VCA positive at the onset of the symptoms and a significant increase of the IgG VCA after three weeks. No other etiology was apparent. All the patients have been treated with dexamethasone, glycerol and acyclovir obtaining a complete remission of the disease. In these cases the NI has been the only clinical manifestation of the EBV infection. Therefore the authors believe that it is important recognize that EBV can cause a myriad of neurological illness with or without the stigmata of infectious mononucleosis and recommend the need to suspect this infection in any acute neurologic disorder.

[Laboratory diagnosis of Pneumocystis carinii: comparison of cytological, immunofluorescent and immunocytochemical staining]. / Diagnosi di laboratorio di Pneumocystis carinii: paragone tra colorazioni citologiche, immunofluorescenza e immunocitochimica.

Authors review several methods for diagnosis of Pneumocystis carinii on BAL fluid in AIDS patients aiming to identify ideal routine technic. Giemsa, Gomori and Toluidine Blue staining. Direct and Indirect Immunofluorescence. Immunocytochemical methods were tested and advantages/disadvantages compared on BAL fluid from AIDS patients. Pneumocystis carinii was detected in 7 out 21 cases (33%). Gomori staining and Toluidine Blue staining were chosen for routine Pneumocystis carinii detection while IF technics are deserved as very useful in fields showing high fungal ++ contamination (inducted sputum).

Cold-air isocapnic hyperventilation test in the study of the effects and duration of action of Duovent. Comparison with fenoterol, salbutamol, disodium cromoglycate and placebo.

The cold-air isocapnic hyperventilation (CAIH) test is a challenge test for non-specific bronchitis which was recently incorporated into the study of bronchial hyperreactivity. As it is easy to perform and to reproduce, the CAIH test is regarded as a valuable examination in clinical pharmacology. We carried out a study using this test in 12 atopic asthmatics in intercritical phase. The patients were treated for a few days before, under double-blind conditions and random order, with Duovent (80 micrograms ipratropium bromide + 200 micrograms fenoterol), fenoterol (400 micrograms), salbutamol (200 micrograms), disodium cromoglycate (DSCG) (10 mg) and placebo. All the drugs were administered by aerosol 30 min before the test which was repeated at intervals of 120, 240 and 360 min after intake of the drug. Certain parameters of respiratory function were measured by dry spirometry (Vicatest 2 C) before administration of the drug as well as before and 0, 3, 5, 15, 30 and 60 min after each test. For the sake of brevity only the FEV1 values are shown in the figures since the other parameters all revealed a similar pattern. After placebo, all the patients reacted to the CAIH test with significant falls after each of the 4 tests, but there was no statistically significant difference between the 4 tests; there were no statistically significant differences between the pretreatment values in FEV1 recorded before each treatment (verum or placebo).(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchodilator effect of tiaramide hydrochloride.

A bioassay with tiaramide hydrochloride (THC) and placebo was performed in 32 non-asthmatic patients suffering from chronic obstructive lung disease. Each patient received one administration of THC (200 mg) and one of placebo according to a double-blind cross-over design. FVC, FEV1, FM25-75, PEF and FEF200-1,200 were measured before and at several intervals until 360 min after treatment. Significant differences were found between drug and placebo which gave no significant variations. It is concluded that THC is an effective and safe bronchodilator. The substained bronchodilator effect shown by THC appears to be a clinical advantage.