Investigation in Central Italy of the possible association between Cryptococcus neoformans var. Gattii and Eucalyptus camaldulensis.

The authors present a worldwide review of isolations of Cryptococcus neoformans, var. neoformans and C. neoformans var. gattii from animals and vegetation, referring in particular to the already well-known association of the former variety with Eucalyptus camaldulensis. They then review the Italian situation relative to this association and their studies carried out in Central Italy: in Latina (Lazio), Pisa, Viareggio and Lake Massaciuccoli (Tuscany). From the 256 E. camaldulensis trees examined C. neoformans var. gattii was not isolated. An E. camaldulensis tree situated in the nature reserve on Lake Massaciuccoli proved to be positive for C. neoformans var. neoformans. This variety was isolated from the leaves, flowers, bark and the debris at the foot of the tree, suggesting that it had colonized the entire tree and that it was capable of developing not only on its usual habitat (bird guano, soil rich with guano) but also on Eucalyptus trees. The identity of the isolates was confirmed by their genomic profiles obtained by random amplification polymorphic DNA (RAPD) with the primer (GACA)4. The presence of a single genotype indicates a sole source of contamination, perhaps brought by a bird coming from a contaminated environment.

[Transmissible spongiform encephalopathies. History, epidemiology, etiological, hyphotheses]. / Le encefalopatie spongiformi trasmissibili. Storia, epidemiologia, ipotesi eziologiche.

The history of transmissible spongiform encephalopathies is shortly reviewed beginning with the Westminster parliament act in the year 1755 up to the description in 1996 of the variant of the Creutzfeldt-Jakob disease, transmitted from cattle to man by alimentary route. The epidemiological patterns of encephalopathies of the various animal species and of the four encephalopathies up to date reported in man are shortly described: Creutzfeldt-Jakob disease, Kuru, Gerstmann-Straussler-Scheinker disease, Fatal Familial Insomnia. Etiological hypotheses are discussed until the identification of Prions: PrPcell, on the surface of normal cells, PrPscr in the brain of humans and animals dead for these diseases. The strains of the PrPscr are described on the basis of some characters observed through the passages in rodents and of molecular pattern. The possible future epidemiological evolution of the vCJD is also discussed.

Anti-Malassezia furfur antibodies in the population.

The authors carried out research into anti-Malassezia precipitating antibodies in the population, specifying the distribution by age and sex. A total of 868 serum specimens from subjects of both sexes, aged between 0 and 80 years, were studied. An immunoelectroprecipitation reaction was used using a M. furfur culture filtrate as antigen. No antibodies were found in children under 11 years, whereas they were present after that age and reached maximum frequency in subjects between 31 and 40 years of age. In subjects up to 50 years of age they were more frequent in women, but in subjects over the age of 50 years they were more frequent in men. Globally, antibodies were found in 31% (270/868) of the subjects examined. The presence of antibodies correlates with data from the literature regarding the isolation of this yeast in relation to age.

Cryptococcosis in domestic mammals.

After a brief review of cryptococcosis in dogs and cats from the literature from 1980 to 92, three cases in dogs (two epidemiologically strictly connected) and two in cats are reported. In the three dogs and in one of the two cats lesions were seen in many sites, but only one dog and one cat had a central nervous system localization. The cutis was affected in the three dogs and in one cat; in two of the dogs it was probably the primary lesion, and in the cat it was the only lesion. An unidentified genetic defect was probably the predisposing factor in two of the dogs of the same litter, exposed to soil cryptococcal contamination (from pigeon guano); a third dog, of different breeding, was not infected. Steroid treatment was predisposing in one cat. Flucytosine treatment was initially successful in two dogs, but in both relapses were reported; in one dog fluconazole treatment was successful. The isolates, before and after treatment, demonstrated a large increase in flucytosine MIC, strictly connected with the relapse.

Subperiosteal lateral browlift and its relationship to upper blepharoplasty.

Skin redundancy of the upper eyelid is often associated with a variable degree of ptosis of the lateral third of the eyebrow, which increases the extent of the defect. Correcting this condition implies a combination of a temporal lift with a standard upper blepharoplasty. In the temporal lift it is possible to perform an easy subaponeurotic and subperiosteal dissection of the soft tissues of the temporal area through an incision behind the hairline with pleasing and long-lasting results. The brow ptosis is corrected without noticeable scars and with inconspicuous damage to scalp follicles of the temporal region.

Polyurethane-covered mammary implants: a 12-year experience.

Polyurethane-covered mammary implants are the implants of choice in aesthetic and reconstructive mammary surgery. These implants give very good results in regard to breast contour and consistency, and have a very low complication rate. We present our 12-year experience using polyurethane-covered prostheses. We place the implant mostly in the subglandular or subcutaneous site, and their capsular contracture rate is extremely low (3.3%). Based on our experience, we also review the other complications and side effects occurring with polyurethane prostheses and discuss them in detail.

Subdermal liposuction.

Liposuction is a widely used technique today and indications are that it is becoming even more popular due to new technical refinements. The use of cannulae with a smaller diameter allows suction of the fat immediately under the dermis. The cannula we use to perform this new kind of fat suction is straight and has an external diameter of less than 2 mm. This cannula, the so-called Mercedes cannula, has a bullet tip and a three-hole head. Moreover, the holes are not round but are slit-shaped and oriented in the same plane at 120 degrees. This cannula is specifically designed to produce less trauma. The cannula with one downward-facing orifice is not suitable for suction of the subdermal layer and an upward-facing orifice would be too traumatic. The advantage of this new technique, apart from the possibility of treating patients with very slight adiposity, is to allow an effective skin retraction. When a large amount of fat has already been aspirated, residual deformities can occur. These skin irregularities represent the lack of an effective cutaneous retraction mostly due to the permanence of the subdermal fat. In fact, the presence of a thick subdermal adipose layer decreases the possibility of skin retraction. Therefore, indications for liposuction of the subdermal fat are mainly the slight adiposities and the remnant deformities of a previous liposuction operation. Moreover, this technique is applied to every lipoplasty whenever better skin retraction is needed.

Scanning electron microscopic pattern of recurrent vaginitis by Candida albicans in the mouse.

The scanning electron microscopic pattern of the development of yeasts of Candida albicans on the vaginal mucosa of mice in oestral phase, was studied in four consecutive infections performed at 30 d intervals. The findings were practically identical following the 1st and 2nd infections, evidencing a progressive mycelial development starting from 12 to 72 h after inoculation with C. albicans yeasts. In the 3rd and 4th infections the mycelial tufts appeared extremely reduced in number and size, although there was an acceleration in the early evolutive phases and the filamentation process had already started 6 h after infection. It can be concluded that, after successive infections with C. albicans, mouse vaginal mucous membrane develops a local state of resistance evidenced by the decrease in mycelial tufts. The possible causes of the early onset of the filamentation process are discussed.

Experience and technical refinements in the "donut" mastopexy with augmentation mammaplasty.

Minor ptosis and pseudoptosis of the breast may be corrected by a "donut" mastopexy. This technique offers the opportunity to reach a good aesthetic result with minimal scarring. A prosthesis is inserted at the time of the mastopexy and the skin is reduced in an elliptical way to achieve a good balance between the breast volume and the skin envelope.

Emerging microorganisms in cystic fibrosis.

Pseudomonas aeruginosa is the most common bacterial isolate obtained from patients with cystic fibrosis of the lungs. Recently, however, new multiresistant organisms have emerged, whose identification may be difficult and whose pathogenic role proves hard to define. Of the 71 strains isolated from 24 patients with cystic fibrosis during acute flareups of pulmonary symptoms, 48 turned out to be Pseudomonas aeruginosa (67.6%); 11 were Pseudomonas non-aeruginosa (15.5%); and 12 were Achromobacter xylosoxidans (16.9%). Each bacterial isolate was tested for sensitivity to nine antibiotics (ceftazidime, azlocillin, piperacillin, aztreonam, cefsulodin, cefoperazone, amikacin, tobramycin, and sisomycin) in terms of minimum inhibitory concentration and minimum bactericidal concentration values. In this series, Achromobacter xylosoxidans proved the species least responsive to treatment, and ceftazidime the most active antibiotic both against Achromobacter and against strains of the genus Pseudomonas. Twenty-three different associations of ceftazidime with aminoglycosides, tested for activity on the multiresistant strains, failed to show synergism of action.

Antigenic differences between Brucella abortus and Brucella melitensis recognized by a monoclonal antibody.

By means of somatic hybridization of spleen cells from BALB/c mice inoculated with Brucella abortus and of a line of murine myeloma, a monoclone was obtained producing an antibody which specifically recognizes an epitope of Brucella abortus by means of the agglutination reaction. This epitope is not only on the surface of the homologous strains but on all the Brucella abortus biotype I, on the Brucella melitensis biotype II and on the Brucella suis biotype II tested. On the contrary it is not present on the Brucella melitensis biotype I and in just one of six Brucella melitensis biotype III. Very few strains of the other biotypes of Brucella suis were tested: the results are often negative.

Brucella phagotypes: their relation to the spread of infection in Italy.

The spread of Brucella infection in man in Italy during the last three years is briefly reviewed with reference to the Brucella strains collected and typed. The strains were tested by H2S production, dye-inhibition, agglutination by monospecific sera, and sensitivity to a phage set. From 108 tested strains, 91 have been identified by means of the traditional tests as Br. melitensis, sometimes with some irregularities, 10 as Br. abortus, while 7 were not typable. It was possible to recommend some phage sensitivity patterns of Br. melitensis for epidemiological purposes: one phagotype is much more frequent in the north, another in the south of Italy. However, the currently recommended phagotypes must be considered provisional and will be modified in the light of more extensive studies.

Sensitivity of 115 strains of the genus Brucella to some antibiotics (cephalosporins, ureidopenicillins and aminoglycosides).

The Authors tested piperacillin, azlocillin, aztreonam, cefotaxime, ceftizoxime, ceftriaxone, cefotetan, moxalactam, gentamicin, sisomicin and dibekacin, on about 120 strains of the genus Brucella, using as control drugs tetracycline, streptomycin and rifampicin. Cefotaxime, ceftizoxime, gentamicin, and sisomicin exhibited antibrucella activity comparable to that of tetracycline and just a little superior to that of rifampicin. Among the aminoglycosides tested, gentamicin, sisomicin and dibekacin were, in decreasing order, more active than streptomycin. For all the other drugs tested there was a large variability among the brucella strains, with roughly a peak of activity on the strains which have a history of repeated in vitro passages.

Evaluation of ceftazidime in the treatment of 80 infectious episodes in compromised children.

The efficacy of ceftazidime in the treatment of infections in compromised children was evaluated in 80 such episodes occurring in 64 patients with various underlying diseases. Among the patients treated, 9 were newborns with severe neonatal distress, 21 were children with cancer and neutropenia, 8 were surgical patients, 22 had cystic fibrosis and 4 were suffering from meningitis. The following types of infections were treated: 19 bacteriologically documented and 8 possible septicemias (the latter only in newborns and neutropenic cancer patients); 2 severe upper respiratory tract infections in cancer patients; 8 soft tissue or skin infections; 1 cholangitis; 1 pneumonia; 1 osteomyelitis; 1 mediastinitis; 35 infectious exacerbations of underlying pulmonary disease in cystic fibrosis patients; and 4 meningitides. In almost all cases ceftazidime was administered intravenously in combination with an aminoglycoside. In 2 cases it was also given intrathecally or intraventricularly. Bacteriological documentation was achieved in 70 out of 80 episodes. A successful outcome was obtained in 79% of the cases with slight and statistically nonsignificant differences between groups of patients with different etiological patterns in terms of prevalence of gram-positive microorganisms. Tolerance of the treatment was uniformly good, only one patient showing a mild, transient transaminase elevation.

In vivo tests for antimycotic drugs.

Authors emphasize the pathogenetic importance of fungous dimorphism and its consequence in the usefulness of antimycotic drugs. For the study of drugs' activity on C. albicans, two models for the evaluation on yeast or mycelial form were developed. The first model is of candida growth on an animal cell culture, where a good mycelial form develops during the first 24 hours: authors demonstrated a synergism of the amphotericin B-rifampin combination, which is less evident in the traditional in vitro tests, and some activity of tolcyclate. The second model is an intracutaneous injection in the guinea pig of C. albicans, which quickly develops in the mycelial form, infiltrating the skin layers. Some interesting differences were recorded, comparing amphotericin B and ketoconazole. Moreover the authors used a therapy test in mice, based mainly on examination of the kidney.

Abnormal length of cilia as a possible cause of defective mucociliary clearance.

A 12-year-old girl with obstructive lung disease was examined with respect to the ultrastructure of her nasal mucociliate epithelium. She had the characteristics of the immotile-cilia syndrome: chronic rhinitis, sinusitis, and bronchitis, a severely decreased mucociliary clearance of the lungs, and nasal polyps. The nasal cilia showed a normal cross-sectional appearance but were found to have twice the normal length: 12 micron rather than 6 micron. We conclude that the patient represents a new subgroup of the immotile-cilia syndrome and that her cilia are unable to perform their normal tasks.

Fungal infections in hematological neoplastic disease: the possibility of chemoprophylaxis.

Immunoelectrosmophoresis (IEOP) was used to detect antigens of Candida albicans in the sera of 90 patients with hemolymphoblastosis. A higher percentage of sensitive results occurred in patients with acute myeloid leukemia; moreover, most of the serologically positive patients showed severe leukopenia and neutropenia (WBC less than 1000/microliter; neutrophils less than 200/microliter). According to the results of IEOP assays, a prophylactic treatment with standard dosages of amphotericin B or myconazole was instituted in positive cases. Treatment schedules were randomized in order to assess the effect of each drug. The therapy resulted in serological negativity in 60% of the patients treated with amphotericin B and 57% of those who were given myconazole.