A case of infectious esophagitis caused by human papilloma virus.

Esophageal infections may be caused by diverse pathogens that alter the mucosal lining and produce mild symptoms or sometimes critical clinical diseases with a high risk of mortality, particularly among the immunocompromised. The most common causes of infectious esophagitis are: herpes virus, candida, cytomegalovirus (CMV), and human immunodeficiency virus (HIV); human papilloma virus (HPV) infections are rare in Western countries. Endoscopic features of infectious esophagitis are specific for different agents; nonetheless, differential diagnosis is difficult and requires biopsy, cultures and brushing. We present the clinical case of a young woman admitted to the Department of General Surgery of A.O.U. Federico II, Naples, for a large, deep ulcerative lesion of the esophagus caused by HPV infection.

Combination of all-trans-retinoic acid and gemtuzumab ozogamicin in an elderly patient with acute promyelocytic leukemia and severe cardiac failure.

All-trans-retinoic acid (ATRA) combined with anthracyclines is currently the standard treatment for acute promyelocytic leukemia (APL). In elderly patients the presence of comorbidities, such as cardiomyopathy or different organ failures, often represents an absolute contraindication to standard chemotherapy. In this particular setting of patients, alternative front-line approaches are needed. Here we report the use of gemtuzumab ozogamicin as consolidation therapy in a 68-year-old patient not eligible for standard dose anthracycline due to severe cardiac failure and chronic anticoagulant therapy, affected by low-risk APL. Induction therapy was started with ATRA alone, at a dose of 45 mg/m2 for 80 days. The patient obtained a complete hematological and molecular remission. At day +170 the patient was treated with 6 mg/m2 gemtuzumab ozogamicin monthly for two months (2 total doses) as a consolidation therapy and then started a maintenance program with ATRA 45 mg/m2 for 15 days every three months, for a total time of two years. No adverse events were observed in every phase of treatment and the patient is still in complete continuous hematological and molecular remission 29 months from diagnosis. This approach represents an intriguing therapeutic option to be investigated in randomized studies in low- and intermediate-risk elderly patients (older than 65 years), aiming to minimize or to eliminate standard chemotherapy in advantage of new non-conventional agents, including ATO.

Retinal degeneration associated with ectopia lentis.

Two brothers had retinal degeneration, lens subluxation, and myopia since early life. There was no evidence of Marfan syndrome, homocystinuria, or other systemic disease. They had nystagmus, myopia, inferior dislocation of the lens, and posterior subcapsular opacities in both eyes. Fundus examination showed attenuated retinal vessels, macular atrophy with occasional pigment accumulation as clumps, and perivascular sleeves. Electroretinography revealed decreased photopic and scotopic responses. The visual fields were constricted. We believe this to be the first report of retinal degeneration with bilateral lens subluxation in a family. It appears to be inherited in an autosomal recessive fashion.

Autosomal recessive familial exudative vitreoretinopathy: evidence for genetic heterogeneity.

Two unrelated families with familial exudative vitreoretinopathy (FEVR) show apparent autosomal recessive inheritance rather than the previously reported autosomal dominant or X-linked recessive mode of inheritance. Compared with the other modes of inheritance, the inherited clinical features here include earlier onset (at birth) and a more severe progressive course.

Evaluation of fatty acids in membrane phospholipids of erythrocytes in retinitis pigmentosa patients.

Several investigators have observed abnormalities of plasma DHA in various common forms of retinitis pigmentosa. Erythrocyte membranes are an accessible tissue which may more closely reflect neural membrane fatty acid levels, but little data is yet available on their fatty acid composition in retinitis pigmentosa patients. We have evaluated the DHA levels in red blood cells membrane phospholipids in various genetic forms of retinitis pigmentosa and relative controls. The results obtained indicate significantly lower DHA levels in red blood cell membrane phospholipids in retinitis pigmentosa patients with respect to controls (p < 0.01). This data is significant for autosomal dominant forms only (p < 0.01). Fatty acid content alterations in membrane phospholipids of red blood cells may be considered as markers for abnormalities in the lipid metabolism which disturb the retina integrity.

Fatty acid composition of membrane phospholipids of cataractous human lenses.

The effect of lipid peroxidation on fatty acid composition in membrane phospholipids of transparent and cataractous lens nuclei was investigated. The preliminary results demonstrate a trend toward an increase in the content of palmitic acid with a decrease in the content of oleic acid, linolenic acid and docosahexaenoic acid in the opaque nuclei as compared to the transparent ones of senile cataractous lenses.

[The clinico-instrumental evaluation of the efficacy of picotamide in treating chronic obstructive arteriopathies of the lower extremities]. / Valutazione clinico-strumentale della efficacia della picotamide nel trattamento delle arteriopatie croniche ostruttive degli arti inferiori.

In 25 patients (19 males and 6 females) suffering from chronic arteriopathy of lower extremities at Fontaine stage II, the clinical efficacy of picotamide was investigated in double blind, cross over placebo-controlled study. Patients were assigned randomly to the treatment with placebo or picotamide (900 mg/die) for three months and, after 15 days of wash-out, to the treatment with picotamide or placebo for the same period. Painfree walking distance and ankle/arm systolic pressure ratio improved significantly only during picotamide treatment. Laboratory monitoring revealed a significant decrease in platelet aggregation and an increase of fibrinogen degradation products only during picotamide treatment. Three patients during picotamide treatment referred transient gastrointestinal discomfort (nausea, vomiting and diarrhoea); however in no case the treatment was suspended because of the appearance of these symptoms. These results indicate that picotamide is an effective drug in the management of chronic arteriopathy of lower extremities.

[Elastoviscosimetry in maxillo-facial pathology]. / L'elastoviscosimetria nella patologia maxillo-facciale.

In the oro-maxillo-facial pathology it may be useful to perform hematochimical and saliva tests which can clarify the kind of the pathology and which can be used in the post-surgical follow-up because of incidental modifications. Saliva compliance and viscosity and blood hemorrheology variations always result lower than in normal population. The Authors are going to value which kind of oro-maxillo-facial pathologies shows a significant reduction of saliva elastoviscosity and blood hemorrheology. Yet, in a further study, they will try to explain that reduction and the connection with the specific pathology and the medical and/or surgical treatment.

Epidemiology of diabetes mellitus in an Italian rural community.

To evaluate the prevalence of diabetes in a rural community, 589 subjects in Laurino, Southern Italy, were submitted to a 50 g oral glucose tolerance test. Two hours later, blood glucose levels revealed 453 normal subjects, 36 diabetics and 100 borderline subjects. The borderline subjects were re-examined with 75 g OGTT and, according to criteria recommended by the National Diabetes Data Groups (NDDG), 29 subjects were found normal, 35 with impaired glucose tolerance (IGT) and 36 with diabetes. Final figures showed 72 diabetics (12.2%) and 35 IGT cases (5.9%). Obesity appeared strongly related to diabetes (p less than 0.05 in males and p less than 0.01 in females 40 years old and over). Diabetes was more prevalent in subjects with a positive family history (p less than 0.01). No significant difference in number was observed between male and female diabetics, nor between big babies delivered by normal women and big babies by diabetic women. The high diabetes prevalence might be partly explained by the changes created by an industrially-established dietetic influence on the rural communities in Southern Italy.