Role of chest radiography in the diagnosis of allergic bronchopulmonary aspergillosis in adult patients with cystic fibrosis.

PURPOSE: This study aimed to verify the usefulness of chest radiography in the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in adult patients with cystic fibrosis. MATERIALS AND METHODS: Eleven patients (with a total of 14 episodes) affected by ABPA were selected from among subjects attending a Regional Cystic Fibrosis Centre. For each episode, we retrospectively reviewed the baseline chest radiographs obtained before the diagnosis of ABPA, those obtained during the course of ABPA and those obtained during follow-up. Radiographs were assessed for the presence of bronchial wall thickening, bronchiectasis, infiltrates, atelectasis, mucoid impaction, lymphadenopathy, pleural effusion and fluid levels. Radiographic findings that had appeared at the time of ABPA diagnosis and disappeared after treatment were considered related to ABPA and thus useful for a correct diagnosis of the disease. Chest radiograph abnormalities were compared with changes on the respiratory function tests [forced expiratory volume in 1 s (FEV1)] during the different stages of the disease. RESULTS: Radiographic findings at the time of ABPA diagnosis appeared to have deteriorated in 8/14 cases when compared with the baseline films; after treatment, the radiographic findings deteriorated in 6/14 cases and improved in 6/14. The most significant among the radiographic signs considered (infiltrates and mucoid impaction) appeared at the time of ABPA diagnosis in 7/14 and 4/14 cases, respectively, and in some patients, they were also present at baseline and persisted during follow-up. FEV1 values were significantly decreased (>10%) in 9/14 cases at the time of ABPA diagnosis. CONCLUSIONS: Our results demonstrate the limited usefulness of chest radiography in the diagnosis of ABPA in patients with cystic fibrosis. The most significant abnormalities are nonspecific and commonly seen on baseline films in cystic fibrosis without ABPA and persist after treatment in most cases.

Acute disseminated encephalomyelitis as manifestation of primary HIV infection.

The authors report a 27-year-old woman with clinical, MRI, virologic, and CSF findings consistent with acute disseminated encephalomyelitis as a manifestation of primary HIV infection. Improvements in the clinical and MRI findings and a reduction in HIV RNA levels, both in plasma and in the CSF, were observed during highly active antiretroviral therapy.

[Usefulness of chest X-ray during cystic fibrosis exacerbation in adult patients]. / Utilità del radiogramma del torace negli episodi di riacutizzazione della fibrosi cistica nel paziente adulto.

PURPOSE: Verify the real usefulness of chest X-ray during clinical exacerbation of cystic fibrosis (FC). MATERIAL AND METHODS: The study was based on a group of 46 adult patients affected by FC. For every subject we selected one or more pair of chest films, of which the first was used as reference image (To), whereas the second (T1) was selected among the following controls, either in course of clinical obvious exacerbation, or during another routine control. The 64 pairs of chest films (32 representing phases of clinical stability, 32 documenting evolution towards clinical deterioration) were subjected to evaluation by two radiologists, who were first asked to judge if stability, improvement or worsening of the overall radiographic picture could be observed; then to estimate the improvement, worsening, stability or absence of the 12 radiographic signs, selected among those more frequently correlating with the acute phase of disease. RESULTS: The comprehensive radiological evaluation, which shows a statistically significant difference (p=0.012) between the two groups considered, weakly correlates with the patient clinical status. Among the patients with exacerbation, the radiographic picture appeared worsened in only 18/32 cases (sensibility 56%, specificity 78%), while on the contrary 7/32 clinically stable patients exhibited a radiographic deterioration. Among the considered radiographic-sings, some were exclusively observed during exacerbation (specificity 100%), but with low sensitivity (pneumothorax: 6%, increment of bronchiectasis: 9%, air space disease 22%); the most common alterations (mucoid impactions and bronchial wall thickening) were observed in both groups of patients. DISCUSSION AND CONCLUSIONS: Our results demonstrate that there is not a precise correlation between the radiographic picture and the clinical manifestations of exacerbation and confirm the poor usefulness of chest X-ray in such a phase of disease. Chest X-ray is needed to exclude pnemothorax or extensive air space disease, rather then to accurately diagnose exacerbation.

Tratamiento conservador de la estenosis cáustica del píloro: resultados alejados / Conservative treatment of the corrosive pyloric stenosis: later results

El tratamiento de elección de las estenosis esofágicas secundarias a la ingesta de cáusticos es la dilatación, en cambio, las del píloro son solucionadas habitualmente mediante una derivación gastroyeyunal o una antrectomía. Publicaciones recientes sugieren que algunas estenosis pilóricas de origen cáustico pueden ser tratadas exitosamente mediante dilatación endoscópica, utilizando balones hidrostáticos. Lamentablemente, este instrumental es caro y no está disponible en nuestro medio. El objetivo de este trabajo es presentar dos casos de estenosis cáustica del píloro tratadas mediante dilatación mecánica a través de una gastromía. El tratamiento conservador de la estenosis pilórica de origen cáustica mediante dilatación mecánica, puede ser considerada como una alternativa terapéutica que permite mantener el estómago intacto y un tránsito digestivo fisiológico

[Cytokines and asthma]. / Citochine ed asma.

Asthma is a chronic inflammatory lung disease in which eosinophils are one of the most important involved cells. These cells accumulate in the lung because of cytokines, which are able to regulate cellular responses. The role of cytokines is well known in allergic asthma: IL4, IL5, IL3, GMCSF are the principally cytokine involved. IL4 regulate IgE synthesis while IL5, (and IL3) cause the activation and accumulation of eosinophils. In non allergic asthma, whilst only IL5 seemed to be important recent data, shows that also IL4 plays an important role. Therefore nowadays no relevant difference seems to exist between allergic and non allergic asthma; instead the primer is different: the allergen in allergic asthma and often an unknown factor in the non allergic asthma. Recently other cytokines have been proved to play a role in the pathogenesis of asthma. IL8 is chemotactic not only for neutrophils but also for eosinophils and might cause chronic inflammation in severe asthma. IL13 works like IL4, while RANTES seems to be a more important chemotactic agent than IL5. Finally IL10, which immunoregulates T lymphocyte responses, may reduce asthma inflammation. In conclusion cytokine made us to learn more about the pathogenesis of asthma even if we do not yet know when and how asthma inflammation develops.

Circulating adhesion molecules in cystic fibrosis.

A marked influx of inflammatory cells occurs into the airways of patients with cystic fibrosis (CF), which may contribute to the development of lung injury. Leukocyte-endothelial adhesion molecules play a crucial role in the recruitment of inflammatory cells, and soluble forms of these molecules have been shown to increase in several inflammatory diseases. By using a capture ELISA, we determined serum levels of soluble ICAM-1 (sICAM-1), E-selectin (sE-selectin), and VCAM-1 (sVCAM-1) in patients with CF, in stable clinical conditions (n = 29, mean age: 25.8+/-1.5 yr), and healthy control subjects (n = 12, mean age: 27.6+/-1.5 yr). Clinical, spirometric, microbiological, and hematological assessments were made in all subjects. sICAM-1 and sE-selectin concentrations, but not sVCAM-1 levels were significantly increased in CF patients as compared with normal subjects (both p < 0.001). sICAM-1 levels were inversely related to FEV1 values (r = -0.519, p = 0.004) and Schwachman score (r = -0.405, p = 0.03) in CF patients. In 7 of 29 CF patients, soluble adhesion molecule levels were determined not only at the time of stable clinical conditions, but also before and after antibiotic treatment for a pulmonary exacerbation. sICAM-1 and sE-selectin levels increased in all patients at the time of the exacerbation, compared with levels at the time of stable conditions (p < 0.02 for both comparisons); antibiotic treatment induced a significant decrease of both circulating adhesion molecules (p < 0.02). The elevated serum levels of sICAM-1 and sE-selectin in CF patients, even when they are clinically stable, may reflect the marked and persistent inflammatory process in the disease.

[Clarithromycin in pediatric age. Personal experience]. / La claritromicina nell'età pediatrica. Esperienza personale.

The authors report their experience on the use of oral suspension of Clarithromycin in respiratory infections in the pediatric age. Thirty-three patients affected by various infectious pathologies of the respiratory tract, treated with oral Clarithromycin at the dosage of 15 mg/kg/day, were studied. The therapeutic outcome was very encouraging, the drug well tolerated and without side effects.

[Clinical-therapeutic considerations in pertussis]. / Considerazioni clinico-terapeutiche sulla pertosse.

One-hundred and seventy-one cases of pertussis were observed at the Institute of Infections Diseases and at the 2nd Division of Infectious Diseases of the Policlinico Umberto I in Rome from January 1, 1987 to June 30, 1991. All subjects were treated according to a therapeutic protocol consisting of macrolides (erythromycin or myocamicin) at doses of 40-50 mg/die, betamethasone 0.1 mg/kg/die, specific immunoglobulin G at doses of 0.5 ml/kg repeated after 24 hours (new born babies and babies still unweaned) and oxygen therapy during the paroxystic fits. In 20 patients who were over the first year of life and who had serious asphyxiated fits, bronchodilators (trimetochinol or salbutamol) were added to the previous therapeutic scheme. Our data show both efficacy of therapeutic protocol and importance of early starting the treatment to shorten the length of disease, the strength of asphyxiated fits, and the risk of contagion.

Polyclonal lymphadenopathy presenting as plasma cell leukemia with reversible renal insufficiency.

A case is reported of an elderly patient with generalized lymphadenopathy who, at presentation, showed a blood and bone marrow picture suggestive of plasma cell leukemia, polyclonal hypergammaglobulinemia restricted almost exclusively to IgA, and severe renal insufficiency. Treatment with melphalan and prednisone produced a complete remission that lasted only 1 month. A second partial remission was obtained, but the patient eventually died of heart failure. The pathological picture of the lymph nodes and spleen was intermediate between that of angioimmunoblastic lymphadenopathy (AIL) and of the plasma cell type of giant lymph node hyperplasia (Castleman's disease). The hypothesis is presented that AIL, Castleman's disease and many other polyclonal lymphadenopathies recently described in immunodeficient or elderly patients, including the present case, represent a continuous spectrum of lymphoproliferative disorders due to abnormal responses to various stimuli.

Inferior venacavography for the staging of lymphomas.

Inferior venacavography was used for revealing enlarged retro- or paracaval lymph nodes, some of which are not visualized by lymphography as they lay above L 2. As criteria for involvement of lymph nodes the dislocation or narrowing of the vena cava and the reflux of contrast medium in the lumbar veins were studied. Venacavography was carried out in 48 consecutive patients with lymphomas: 23 Hodgkin's disease and 25 non-Hodgkin's lymphoma. Signs of enlargement of paracaval lymph nodes were seen in 52% of patients with Hodgkin's disease and in 80% of the cases of non-Hodgkin's lymphoma. A fairly good agreement was found to between lymphograms and cavograms. Cavography proved to be an easy, inexpensive and minimally invasive technique that can be repeated several times without inconveniencing the patients too much, thus enabling restaging of patients after therapy; moreover, it produced fairly good urograms as the contrast medium is promptly eliminated through the kidney, thus eliminating the need for intravenous pyelography.

[Immunity and neoplasms. Behavior of E rosette-forming lymphocytes in patients with malignant neoplasms]. / Immunità e neoplasie. Comportamento delle rosette E linfocitarie in pazienti con neoplasie maligne.

The per cent and absolute figures of E rosette forming lymphocytes have been evaluated in the blood of normal subject and of patients with non-neoplastic diseases and with epithelial and lymphoreticular tumours. The percentage of rosetting lymphocytes was not affected by non-neoplastic diseases, whilst it was by tumours, especially by lymphoreticular ones. However differences were not statistically significant in view of the large dispersion of values. Absolute counts of rosetting lymphocytes displayed lesser variations. These findings are better explained by Schwartz's concept of immunoregulation than by Burnet's theory of immunosurveillance.