Fatal case of human rabies imported to Italy from India highlights the importance of adequate post-exposure prophylaxis, October 2011.

In October 2011, an Indian man resident in Italy was admitted to a hospital in Mantua, Italy with symptoms of acute encephalitis. Due to a recent history of bite by a suspected rabid dog in India, where he had received incomplete post-exposure treatment, rabies was suspected. The patient died after 22 days of intensive care treatment and rabies was confirmed post mortem. This report stresses the need of appropriate post-exposure prophylaxis in rabies-endemic countries.

[Type 2 diabetic nephropathy: clinical course and prevention proposals 2004]. / Diabete di 2 tipo e nefropatie: storia naturale e proposte di prevenzione 2004.

The first clinical evidence of nephropathy is the appearance of low, but abnormal, albumin levels in the urine (>30 mg/day or 20 mg/min), microalbuminuria. Without specific interventions, approximately 80% of type 1 diabetics have their urinary albumin excretion increase at a rate of 10-20%/yr to the stage of overt nephropathy or clinical albuminuria (>300 mg/24h or >200 mg/min) over 10-15 yrs, developing hypertension along the way. Approximately 30% of individuals with type 2 diabetes are found to have microalbuminuria or overt nephropathy shortly after the diagnosis of their illness, because diabetes is actually present for many years previously and because the presence of albuminuria can depend on other concomitant nephropathies, as shown by biopsy studies. Without specific intervention, 20-40% of type 2 diabetic patients with microalbuminuria progress to overt nephropathy, but 20 yrs after onset only 20% progress to end-stage renal failure (ESRD). The rates of decline in glomerular filtration rate (GFR) are highly variable from one individual to another, but they may not be substantially different between patients with type 1 and type 2 diabetes. As therapies and interventions for coronary artery disease continue to improve, more elderly type 2 diabetes patients can be expected to survive long enough to develop renal failure. The recently published Italian Society of Nephrology (SIN) guidelines for diagnosis and therapy of diabetic nephropathy present the route for the best strategies in prevention and therapy, from earlier onset to advanced ESRD.

[Acute renal failure caused by VIP-secreting tumor]. / Una causa rara di insufficienza renale acuta: il VIPoma.

A 74-year-old woman had secretory diarrhea, severe metabolic acidosis, hypokalemia, hypovolemia, and acute renal failure caused by a pancreatic vasoactive intestinal polypeptide (VIP)-secreting tumor. Vipoma is a rare neuroendocrine tumor. Morbidity and mortality are related to long-standing dehydration and electrolyte and acid-base disturbance resulting in acute renal failure. Diagnosis requires the documentation of large volumes of secretory diarrhea, elevated VIP plasma levels, and the localization of the VIP-secreting tumor. Metastases are present in 50% of patients at the time of diagnosis. Treatment includes correction of volume, electrolyte, and metabolic abnormalities; CVVH during ARF; pharmacotherapy to decrease gastrointestinal secretion; and surgical resection of the vipoma.

Delayed spongiform leukoencephalopathy after heroin abuse.

Here we report the clinical and pathological findings in a 30-year-old drug addict in whom an intravenous injection of heroin led to reversible coma with respiratory depression and heart failure. On regaining consciousness, the patient was found to have rhabdomyolysis with renal failure requiring dialysis and peripheral neuropathy. Three weeks later his neurological condition suddenly deteriorated and delayed encephalopathy developed, leading to death 20 days later. The neuropathological study of the brain disclosed pale, spongy myelin with diffuse reactive astrogliosis and microglial proliferation, without hypoxic necrotic lesions. The cerebral and cerebellar cortices were unchanged. The absence of typical hypoxic lesions and the presence of spongiosis with massive astrocytosis distinguished this case from the previously reported cases of delayed leukoencephalopathy following severe hypoxia. An immunocytochemical study designed to exclude an underlying alteration of the metabolic oxidative pathway detected normal expression of the respiratory chain complexes IV, III and V. Despite the absence of an oxidative chain alteration in our patient, we cannot exclude the possibility that an individual predisposition played a pathogenetic role in this delayed leukoencephalopathy.

[Cytodiagnosis by fine-needle aspiration (FNAB) in thyroid dysplasias and neoplasms observed in 1983-1987]. / Citodiagnostica per agoaspirazione con ago sottile (F.N.A.B.) in displasie e neoplasie tiroidee osservate nel periodo 1983-1987.

Cytology using fine needle aspiration biopsy has been widely used in dysplastic and neoplastic thyroid lesions as it is free of complications and very accurate. Personal experience with 2212 thyroid fine needle aspiration biopsies (1564 patients) performed in the period 1983-1987 is reported. Cytologic and histologic diagnoses are compared with respect to 139 patients. Diagnostic accuracy was 85.61%, with 9 false negatives (6.45%) and 11 false positives (7.51%). Sensitivity was higher in papillary thyroid carcinomas and Hürthle cell neoplasias than in follicular neoplasias and nodular goitres (89.66% and 90% versus 79.47% and 87.03% respectively). The false positives observed in follicular neoplasias depend on the limitations of cytologic and histologic analyses. Fine needle aspiration biopsy makes it possible to select candidates for thyroidectomy although in some cases surgical exploration is required for diagnosis.

Melanotic neuroectodermal tumour of infancy (MNTI). Immunohistochemical and ultrastructural study of a case.

A case of melanotic neuroectodermal tumour of infancy (MNTI) which occurred in the left lower jaw of a 15-months old child was studied by electron microscopy and immunohistochemical methods to verify the neural crest origin of this tumour. Two cell population were observed: pigment melanocyte-like cells and non-pigmented nerve-like cells. Immunohistochemical analysis with neuron-specific enolase (NSE) and S-100 protein visualized two cell subtypes in the non-pigmented cell population. The combined ultrastructural findings and immunohistochemical data confirm the neural crest origin of MNTI.