[Two case reports of cerebral autosomal dominant arteriophaty with subcortical infarctions and leukoencephalopathy (CADASIL)]. / Arteriopatia cerebrale autosomica dominante con infarti sottocorticali e leucoencefalopatia (CADASIL).

Cerebral autosomal dominant arteriopathy with subcortical infarctions and leukoencephalopathy (CADASIL) was first reported in European families and since 1993 it has been observed in America, Africa and Asia, suggesting that today the disease probably still remains largely underdiagnosed. CADASIL appears to be essentially a disorder of the arteries linked to single missense mutations in the Notch3 gene locus on chromosome 19; the aberrant dimerisation of Notch3, due to abnormal disulphide bridging with another Notch3 molecule or with another protein, may be involved in the pathogenesis of the disorder. It is characterized by recurrent stroke episodes and focal neurologic deficits progressing to pseudobulbar palsy and dementia, caused by multiple lacunar infarctions with ischemic and diffuse white matter abnormalities on neuroimaging. Migraine with aura, epileptic seizures and affective disorders are frequent additional symptoms of CADASIL. It is usually observed in the 3rd decade, but some individuals remain asymptomatic close to the age of 60. MRI displays a marked leukoencephalopathy in affected individuals as early as in the age of 20. The authors emphasize the role of a direct DNA test for gene mutation to make a differential diagnosis between CADASIL and other forms of vascular leukoencephalopathy as Alzheimer's dementia, multiple sclerosis and Binswanger's subcortical arteriopathic encephalopathy where CADASIL's arteriopathy is characterized by major alterations of vascular smooth muscle cells and the presence of specific granular osmiophilic deposits.

[Splenic artery aneurysm and portal hypertension. Report of a case]. / Aneurisma dell'arteria splenica ed ipertensione portale. Descrizione di un caso.

Visceral arteries aneurysms are an uncommon pathology. Lienal artery (60%), hepatic (20%), superior mesenteric (5.9%) and tripod celiac (4%) are the most involved. Female predominance, portal hypertension, arteriosclerosis, pregnancy, traumatic and infective factors are the most remarkable etiopathogenetic factors. Portal hypertension with splenomegaly might be an important factor in the pathogenesis of intra- and extraparenchimal splenic artery aneurysms. Stress is laid on the importance of arteriography during portal hypertension in pregnancy as a preventive measure because the rupture of aneurysm of the splenic artery, despite laparotomy in emergency is often fatal, and of coeliac angiography prior to liver transplantation; if splenic artery aneurysm is found, ligation of the splenic artery should be performed at the time of transplantation to prevent possible rupture. The different roles of the imaging techniques used are examined.

[Laboratory diagnosis of intestinal micro-parasitosis in AIDS patients: state of the art]. / Diagnosi di laboratorio delle microparassitosi intestinali in pazienti affetti da AIDS: stato dell'arte.

BACKGROUND: The diarrhea, often associated with growing thin and weight loss, is important for nutritional state and quality of life in AIDS patients. It was demonstrated that patients with AIDS who present diarrhea have a greater degree of immunosuppression than those without diarrhea, predisposing the gastrointestinal tract to the action of protozoa, bacterial, viral, fungal pathogens which may cause morbidity and death. HIV-patients are particularly susceptible to protozoa infections. Cryptosporidium infection is among the most common causes of enteric disease but Microsporidium (Enterocytozon bieneusi) and Cyclospora are emerging as potentially important enteric pathogens in AIDS patients. In spite of frequent interest of gastrointestinal tract the knowledge of diarrhea syndromes AIDS-related are often greatly limited by diagnostic difficulties. OBJECTIVE: A review is made of the different laboratory methods employed in intestinal microparasitosis in the light of considerable dangerousness and aggressiveness of some protozoa on HIV-patients. METHODS: The methods for the diagnosis of intestinal microparasitosis are based particularly on direct diagnosis (macroscopic or microscopic examination at fresh or after concentration) or an immunological diagnosis. RESULTS: The laboratory methods available at present permit to evidence different protozoa not evidenced in the past and without invasive techniques. CONCLUSIONS: The etiological diagnosis of diarrhea in AIDS-patients is often difficult and/or disappointing. Epidemiological knowledge on protozoa pathology has been limited by diagnostic difficulties but their identification is important particularly because an increasing therapeutic regimens are now available to treat these infections.

[Imported myiasis. Report of a case and prevention measures]. / Miasi d'importazione. Descrizione di un caso e misure di prevenzione.

Myiasis is the invasion of tissue by larvae of flies. They parasitize living tissues (specific myiasis) or cavity of warm blood animals compulsorily, optional (hemispecific myiasis) or accidentally (accident myiasis). It is frequent in sub-saharian Africa, while in European countries only imported cases are described. A case personally observed and some measures for prevention are described.

Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases.

PURPOSE: To assess the effect of intraparenchymal saline injection on the results of radio-frequency (RF) tissue ablation. MATERIALS AND METHODS: Ex vivo and in vivo animal RF ablation was performed with and without intraparenchymal saline injection. Initially, saline was injected as a bolus (1-20 mL) before RF application. For subsequent in vivo studies, saline was injected as a bolus before RF application or continuously (1 mL/min) during RF application. Finally, 14 patients with liver metastases and one patient with primary cholangiocarcinoma were treated with the continuous infusion technique. A single RF electrode (tip exposure, 1-3 cm) was used with various ablation parameters. RESULTS: With pretreatment bolus injection of saline, lesions measured 1.4 cm +/- 0.1, 1.6 cm +/- 0.2, and 1.2 cm +/- 0.1 in ex vivo liver, in vivo animal muscle, and in vivo animal liver, respectively. Without saline enhancement, lesion sizes were 1.0 +/- 0.2, 1.2 +/- 0.2, and 0.8 +/- 0.1 cm, respectively. With continuous saline injection in in vivo pig liver, lesion size was 1.8 - 4.1 cm in diameter. In human tumors, necrosis volume was variable, but complete necrosis was seen in 13 of 25 lesions (diameter, 1.2-3.9 cm). Partial necrosis greater than 50% was seen in 12 lesions (diameter, 1.5-4.5 cm). CONCLUSION: Saline-enhanced RF ablation might permit percutaneous destruction of large liver lesions.

[Aplastic anemia in acute viral hepatitis type A. Our experience]. / Anemia aplastica in corso di epatite virale acuta tipo A. Nostra esperienza.

A case of posthepatitis A aplastic anemia is described. The pathogenesis of this rare complication of viral hepatitis type A infection is underlined.

[Tropical pyomyositis. A case report]. / Piomiosite tropicale. Descrizione di un caso.

Tropical pyomyositis is an infection of large muscle groups that can lead to sepsis and death. The most common etiologic agent is Staphylococcus aureus. It usually occurs in patients living in the tropics but is seen with increasing frequency in temperate climates, particularly in immunosuppressed patients, where it may be misdiagnosed and may cause severe morbidity and mortality. Diagnosis is based on the examination of pus from a muscle aspirate and treatment consists of surgical incision, drainage and appropriate antibiotic therapy. It is stressed to take into account pyomyositis in the differential diagnosis of immunocompromised patients with "cryptic" myalgia.

[Cytomegalovirus pneumonia in patients with AIDS treated foscarnet. Our experience]. / Polmonite da citomegalovirus in paziente affetta da AIDS trattata con foscarnet. Nostra esperienza.

A case of cytomegalovirus pneumonia occurring in a patient affected with AIDS is reported. The treatment of this disease is still difficult and remission of CHV-pneumonia after therapy with foscarnet is emphasized.

[Norwegian scabies in immunosuppressed patients. Report of a case]. / Scabbia norvegese in paziente immunodepresso. Descrizione di un caso.

A case of Norwegian scabies in an immuno-suppressed patient is reported. This skin ectoparasite, rarely described in healthy individuals, varies from common scabies for clinical presentation, appearance and distribution of skin lesions. Norwegian scabies should be suspected in any atypical itching, or non, rash in immunosuppressed patient. Attention is also drawn to the importance of early diagnosis to precede familiar and hospital epidemics.

[Visceral leishmaniasis in patients with HIV infection. Our experience]. / Leishmaniosi viscerale in paziente con infezione da HIV. Nostra esperienza.

The authors describe a case of visceral leishmaniasis in an intravenous drug abuser, HIV seropositive patient. Visceral leishmaniasis was the first opportunist infection and diagnosis was based on smear from bone marrow. A treatment with N-methylglucamine and allopurinol was successful. The authors stress to take into account visceral leishmaniasis in HIV-infected patient in act resident or in past lived in endemic for Leishmania areas even in presence of atypical clinical features and propose to include visceral leishmaniasis as an opportunist infection in the IVC-2 group of clinical classification of HIV infection.

Percutaneous ethanol injection of hepatic tumors: single-session therapy with general anesthesia.

OBJECTIVE: We studied the feasibility and the effectiveness of percutaneous ethanol injection, performed with general anesthesia in a single session, for treating malignant hepatic lesions. SUBJECTS AND METHODS: We treated 30 patients with sonographically guided percutaneous injection of ethanol. Twenty had hepatocellular carcinoma and cirrhosis, and 10 had hepatic metastases, principally from colon cancer. The mean volume of ethanol injected was 57 ml (range, 6-165 ml). RESULTS: CT showed complete necrosis (up to 8.2 cm) in seven of 10 patients with encapsulated hepatocellular carcinoma and about 90% necrosis in the remaining three patients. In four of these patients, the alpha-fetoprotein level fell from more than 200 ng/ml to less than 20 ng/ml during treatment. In 10 patients with infiltrating hepatocellular carcinoma, about 70-90% necrosis was achieved; in six of these patients, the alpha-fetoprotein level, which had been more than 200 ng/ml, decreased during treatment. In the 10 patients with metastases, more than 50% necrosis was always achieved. Levels of carcinoembryonic antigen decreased after treatment in all patients. In three patients who had cirrhosis with superficial hepatocellular carcinoma, peritoneal hemorrhage occurred but did not require transfusion. CONCLUSION: Our results show that percutaneous injection of ethanol in a single session with general anesthesia is feasible and effective and has several advantages over multisession therapy. These include shorter treatment time and the ability to treat larger and more numerous lesions.

[The epidemiology of non-A, non-B hepatitis (NANB). A review of the literature]. / Epidemiologia dell'epatite non-A, non-B (NANB). Revisione della letteratura.

Non-A, non-B hepatitis (NANB) is, after type B hepatitis, the most frequently encountered form of hepatitis. Parenteral transmission and apparently nonparenteral or "sporadic" forms are described. The epidemiology of this new form of hepatitis is examined in the light of personal experience and of reported data.

[Clinico-epidemiologic considerations in cases of acute viral non-A, non-B hepatitis (NANB)]. / Considerazioni clinico-epidemiologiche su una casistica di epatite virale acuta non-A, non-B (NANB).

Personal experience with a series of 69 cases of non-A, non-B viral hepatitis out of 164 cases of acute viral hepatitis observed at hospital admission between January 1985 and June 1988 is reported. Agreement is expressed with other Italian series as regards the incidence of sex, of the most involved age classes, of the most affected professional categories and of the incubation period of posttransfusional forms. The prevalence of sporadic forms over those transmitted intraparenterally and more prolonged course in icterus patients and in parenteral forms is pointed out.

[Induced pemphigus and brucellosis]. / Pemfigo indotto e brucellosi.

A case of induced pemphigus occurring in a patient affected with a brucellosis is reported with emphasis on the definitive remission of the pemphigus after antibiotic therapy against brucellosis and in the absence of corticosteroid treatment. Attention is also drawn to a possible autoimmune mechanism of the pemphigus triggered by brucellosis.

[Visceral leishmaniasis as an opportunistic infection. Our experience]. / La leishmaniosi viscerale come infezione opportunista. Nostra esperienza.

A case of visceral leishmaniasis in a female patient suffering from acute nonlymphoid leukaemia is reported. Stress is laid on the atypical nature of the clinical picture, falsified by the underlying disease, and attention is called to the behaviour of Leishmania as an opportunistic agent in the immunodepressed host.

[Pneumocystis carinii: laboratory diagnosis. State of the art]. / Pneumocystis carinii: diagnosi di laboratorio. Stato dell'arte.

In the light of the international literature and personal observation, the diagnostic techniques employed in Pneumocystis Carinii Pneumonia (PCP), a major opportunistic infection of acquired immunodeficiency syndrome (AIDS) are reviewed.