[Instrument applications of three new Bio-Rad kits for HIV, HCV, HBSAG screening: Combo Genscreen Plus HIV 1/2 AG-AB, Monolisa anti HCV Plus V2, Monolisa HBSAG Plus, with the fully authomatic system Plato 3300]. / Applicazioni strumentali di tre nuovi kit bio-rad per lo screening dell'HIV, HCV, HBSAG: Combo Genscreen Plus HIV 1/2 Ag-Ab, Monolisa anti HCV Plus V2, Monolisa HBSAG Plus, con il sistema automatico Plato 3300.

One of the most common technical problems of the virological laboratories is the tests applications on the open microplates systems. Immunoenzymatic methods can present difficulties in terms of results when are apply on several instruments. We have evaluated three different new virological kits from Bio-Rad: Genscreen Plus HIV 1/2 AG-AB, Monolisa anti HCV Plus V.2 and Monolisa AgHBs Plus on the automatic system Plato 3300. The purpose of this article was to present and summarize some data on these new Bio-Rad kits designed for the screening in the Blood Banks and Virological laboratories. We followed a protocol studied for working on automatic machine with different steps using negative fresh donors sera for: - study of edge effect, - study of specificity, and using also positive high value sera and seroconversion Bio-Rad panels for: - study of contamination, - study of sensitivity. The studies showed that the Bio-Rad kits and instrument were releable, flexible, easy to use and ready for each kind of routine in Blood Banks and Virological-Microbiological centres.

Do varicose veins affect quality of life? Results of an international population-based study.

PURPOSE: This study assessed the impact of varicose veins (VV) on quality of life (QOL) and patient-reported symptoms. METHODS: A cross-sectional population-based study was held in 166 general practices and 116 specialist clinics for venous disorders of the leg in Belgium, Canada (Quebec), France, and Italy. Study subjects included a sample of 259 reference patients without VV (CEAP class 0 or 1) and 1054 patients with VV who were classified as having VV alone (367; 34.8%), VV with edema (125; 11.9%), VV with skin changes (431; 40.9%), VV with healed ulcer (100; 9.5%), and VV with active ulcer (31; 2.9%). The main outcome measure was generic and disease-specific QOL, as measured by means of the Short-Form Health Survey-36 (SF-36) and the VEINES-QOL scale, and patient-reported symptoms as measured by the VEINES-SYM scale. RESULTS: In patients with VV, age-standardized mean SF-36 physical (PCS) and mental (MCS) scores were 45.6 and 46.1 in men and 44.2 and 43.2 in women, respectively, compared with population norms of 50. PCS scores decreased according to increasing severity of concomitant venous disease, with the lowest mean scores of 37.3 and 35.5 found in patients with VV and active ulcer. However, adjusted analyses showed no statistically significant differences between patients with VV alone and patients without VV for PCS (0.0), MCS (1.0), VEINES-QOL (-0.1), or VEINES-SYM (0.0) scores. In comparison with patients without VV, the largest differences were seen in patients with VV and edema (PCS, VEINES-QOL, and VEINES-SYM score differences of -1.8, -2.5, and -2.9, respectively) and in patients with VV and ulceration (differences of -3.3, -3.4, and -2.7, respectively). The high prevalence of major symptoms of venous disorders in patients in CEAP class 0 or 1 being treated for venous disorders (76.1% of patients had heaviness, aching legs, or swelling) might have contributed to the impairment of QOL in the reference group. CONCLUSION: Results indicate that impairment in physical QOL in patients with VV is associated with concomitant venous disease, rather than the presence of VV per se. Findings concerning QOL in patients with VV can only be reliably interpreted when concomitant venous disease is taken into account. In patients with VV alone, the objectives of cosmetic improvement and the improvement of QOL should be considered separately.

Efficacy of a biological response modifier in preventing Staphylococcus aureus intramammary infections after calving.

A change in the epidemiology of mastitis in recent years has emphasized the role of the udder immune system in the pathogenesis of Staphylococcus aureus. Therefore, if the bovine or udder immune capability could be enhanced, susceptibility to Staph. aureus could be reduced and antibiotic efficacy could be increased. Immune system defense mechanisms could be enhanced by vaccination and by biological response modifiers. Within this latter group, a biological response modifier obtained from Parapox ovis that was attenuated over 200 tissue culture passages was recently developed and commercialized in some European countries. This study reports the results of a field trial on the efficacy of this biological response modifier in reducing Staph. aureus intramammary infection (IMI) after calving in primiparous and pluriparous cows. The trial included 106 cows sampled six times (55 cows from herd A and 51 from herd B) for a total of 2544 quarter milk samples. The analysis of IMI prevalence showed that 25.09% of samples were bacteriologically positive in the placebo group, and 23.17% of the positive samples were observed in the biological response modifier group. Staphylococcus aureus IMI had a frequency of 11.44% in the placebo group and 6.00% in the biological response modifier group. The dynamic of the hazards showed significantly lower rates in the biological response modifier group than in the placebo group (risk ratio = 0.47). Treatment with the parapox-containing biological response modifier showed significant reduction of Staph. aureus IMI around calving, and this reduction was attributed to an increase in immune defenses.

Occult sporadic medullary microcarcinoma with lymph node metastases.

A sporadic form of medullary occult microcarcinoma was cytologically diagnosed, by fine-needle aspiration biopsy (FNAB), on metastatic cervical lymph nodes. The cytologic specimens were partially smeared and partially zinc-formalin-fixed, so that a microinclusion clot for immunohistochemical studies would be possible. The reactivity to calcitonin of neoplastic cells obtained from metastatic cervical lymph nodes supported the search for a thyroid tumor, which only a careful echographic study revealed. Under sonographic guidance, FNAB on a 0.5-cm hypoechoid nodule was performed. The smears were diagnostic of medullary carcinoma. A total thyroidectomy with node dissection was made. Diagn. Cytopathol. 1999;21:203-206.

Multivariate analysis of patients with medullary thyroid carcinoma. Prognostic significance and impact on treatment of clinical and pathologic variables.

BACKGROUND: The prognostic significance of the histologic and clinical features of medullary thyroid cancer (MTC) and their impact on therapy and outcome have been evaluated infrequently in the same series. METHODS: Fifty-tree patients with MTC (32 females, 21 males; 44 sporadic, 9 familial MTC [4 families]; mean age: 46.11 +/- 14.04 years) who were operated on consecutively between 1970 and 1992 were studied. All pathology slides were reviewed. Patients were followed with clinical examination, serum calcitonin (CT), and carcinoembryonic antigen (CEA) assay, and imaging procedures (median follow-up: 4 years; mean: 5.66 +/- 4.85 years; range: 0-19 years). Impact on survival was evaluated with Kaplan-Meier survival curves compared with the log rank test for these variables: familiarity, sex, age, pT, N, M, stage, histotype, necrosis, calcitonin, gene-related peptide (CGRP), CT, CEA, thyroglobulin, chromogranin A, chromogranin A PHE5, neuron-specific enolase, amyloid, argyrophilia, synaptophysin Y38, external radiotherapy, chemotherapy, 131I therapy, postsurgical serum CT, and postsurgical serum CEA, Multivariate analysis was performed using Cox's proportional hazards model for statistically significant factors (P < 0.05). RESULTS: Ten- and 15-year cause-specific survival were 71% and 54%. Nineteen patients (35.8%) appeared to be cured and 8 (15.1%) were alive with high serum CT levels but no proven metastases. Eight recurrences as distant sites and four at the cervical region were diagnosed. Stage M, N, necrosis, and postsurgical CT and CGRP were significant prognostic factors for survival by univariate analysis, but only the stage was significant by multivariate analysis. CONCLUSIONS: Stage and postsurgical serum CT level are the most powerful and the most useful prognostic factors for MTC, while survival did not correlated significantly with the majority of available immunohistochemical markers.

Outpatient surgery of varices of the lower limbs: experience of 2,568 cases at four universities.

Outpatient surgery of varices of the lower limbs is currently considered a viable alternative to traditional surgery with hospitalization. This paper reports the experience of 4 university groups (Padua, Modena, Verona, Milan), where outpatient treatment has been used since 1987. From June 1987 to June 1992, 2,568 lower limb varices were treated in this way. Different techniques of anaesthesia were used (local infiltration, combined local and general, general, subarachnoid). In all cases, crossectomy was combined with short or long saphenous stripping. There were no intra- or perioperative deaths, and only limited morbidity. Postoperative hospitalization was required in only 2 cases: for hemorrhaging of the inguinal wound in one case, and headache 2 days after spinal anaesthesia in the other. In 2 separate samples of 100 patients, 88 and 89 indicated satisfaction with the surgical treatment. In conclusion, outpatient surgery of varices can be based on the same techniques as in-patients treatment. The risks of surgery and anaesthesia in specialised centres are very limited, with scope for a variety of anaesthetic techniques according to facilities available. Patients satisfaction is high.

[Iopentol in varix radiography. Double blind comparison with iohexol]. / Iopentolo nella varicosografia. Confronto in doppio cieco con Iohexolo.

This trial was aimed at comparing the tolerance and the safety of Iopentol, a new nonionic monomeric contrast agent, with Iohexol, a reference compound already on the market and commonly used in similar trials. Sixty adult patients (41 women and 19 men, aged 23 to 76 years, mean age: 51.4 years) referred to our Department of Radiology for varicography 24 hours before surgery were examined; the trial was designed as a double-blind, parallel two-group comparison of Iopentol 300 mg/ml and Iohexol 300 mg/ml with 30 patients in each treatment group. No adverse reactions were observed in our series of patients. Only slight and not clinically significant changes were observed in heart rate and blood pressure values. The immunohistochemical parameters were studied for postvaricography anatomopathologic complications of the injected veins (A-Actin ML, Vimentin, Factor VIII, CD31, CD68, CK, Ulex Europaeus I, Lecitin, Desmin, Laminin) and no statistically significant differences were observed between the two groups. The histologic specimens showed only venous wall changes, as diagnosed on admission. All radiographs were classified as technically adequate and contrastographic efficacy was defined as "good" in all patients by two independent radiologists. To conclude, our trial on the efficacy and safety of the two nonionic monomeric radiographic contrast agents Iopentol and Iohexol proved the two contrast agents to be equally effective and well tolerated, which makes Iopentol a good alternative to Iohexol in varicography.

[Echo-sclerotherapy in the management of varices of the lower extremities]. / La sclerosi ecoguidata nel trattamento delle varici degli arti inferiori.

Sclerotherapy has been used with satisfactory results, for several years in the treatment of varicose veins. Nevertheless sometimes sclerosis can be incomplete because of the morphology of lower limbs or because the varicose disease is not clinically evident. In addition, sclerotherapy can give rise to severe complications due to intrarterial or extraluminal injections. In order to exceed this limits, some authors suggested to use a new technique, the echosclerotherapy, which was presented for the first time in Strasburg 1989 by Knight and Vin. Echosclerotherapy is a good help for traditional sclerotherapy, especially when it is applied in the sclerosis of the short saphenous veins, of perforating veins or in unfavourable anatomical situations. From May to November 1993 at the Second Surgical Department of Padua University, 31 patients, 29 women and 3 men, have been treated by echosclerotherapy. 25 patients had great saphenous varicose veins; 3 patients had varices due to perforating veins of the popliteal fossa and 3 patients varices due to Hunter perforating veins. In 48.4% of cases we obtained a complete sclerosis of the vessel; in 38.7% a stump remained near the sapheno-femoral junction of about two centimeters; in one case the treatment was not completed and in one case remained a stump of ten centimeters. Only in two cases Echosclerotherapy was not able to obtain sclerosis. None of the patients had major complications and nobody had deep vein thrombosis. If we consider our results altogether we can say that in 87% of cases we had good results.(ABSTRACT TRUNCATED AT 250 WORDS)

[Color Doppler and phlebography in the Paget-Schroetter syndrome]. / Color Doppler e flebografia nella sindrome di Paget-Schroetter.

The authors compared the adequacy of phlebography and color-Doppler US in the diagnosis of subclavian-axillary thrombosis, or Paget-Schroetter syndrome. Ten patients with subclavian-axillary thrombosis (8 men and 2 women, aged 16 to 55 years, mean age: 30 years) were examined over a two-year period. All of them underwent color-Doppler US and conventional phlebography in the same session. US findings were in agreement with phlebographic results in all cases as to thrombosis presence and site. The thrombosis involved the subclavian-axillary vein in 8 cases, the subclavian-innominate vein in 1 case and both veins in 1 case. Color-Doppler US, however, yielded no information relative to the superior vena cava; these data were always obtained with phlebography even though in 4 cases that segment had to be studied with phlebographic opacification via contralateral route. Furthermore, US failed to clearly demonstrate the thrombosis involving the last axillary valve; preserving this valve is indeed the main aim of fibrinolysis since its integrity, at this level, prevents venous reflux independent of subclavian-axillary trunk recanalization, thus reducing the severe symptomatologic sequelae following postphlebitic damage. Phlebography showed the valve and its possible involvement in all cases. In 4 cases phlebography also demonstrated compressive thoracic inlet syndrome, which had been missed by US, yielding the main anatomic elements for following surgery. To conclude, the authors suggest noninvasive color-Doppler US as the screening method of choice, while phlebography remains the gold-standard technique to be performed in all Doppler positive cases: in fact, the latter method yields more pieces of information and is more panoramic than the former, besides allowing fibrinolysis effects to be studied and the possible presence of an associated thoracic inlet syndrome to be investigated.

Phagocytic activity of bovine polymorphonuclear neutrophil leucocytes.

Two different investigations were conducted on the chemiluminescent activity of bovine milk polymorphonuclear neutrophil leucocytes (PMN) activated by different stimuli: zymosan, derived from the wall of Saccharomyces cerevisiae (Experiment A), and Streptococcus uberis and Escherichia coli (Experiment B). In Experiment A, a quarter with a phagocytic activity of PMN < 20 mV/1000 PMN following stimulation with zymosan was found to be 23 times more likely to be a clinical mastitis case than a quarter with phagocytic activity above this threshold value. In Experiment B, calculation of the odds ratio showed similar results following stimulation with Str. uberis or Esch. coli. These results provide evidence that immunocompromisation of mammary gland defences could predispose to clinical mastitis. They also support the need to challenge phagocytic cells with appropriate stimuli, and the Esch. coli test seems to be the most sensitive.

[Subpopliteal muscular venous thrombosis in aching calf syndrome]. / Le trombosi venose muscolari sottopoplitee nella sindrome del polpaccio dolente.

The lower limbs of 84 consecutive patients (48 women and 36 men, age range: 16-75 years, average: 38 years) suffering from acute aching calf symptoms were examined with conventional and color Doppler US. Thirteen cases of muscular thrombosis in the calf were observed, together with 19 cases of deep venous thrombosis, 7 post-phlebitic syndromes, 9 lymphatic obstructions, 6 muscular hematomas and 7 popliteal articular cysts. Case history, clinical signs and phlebography do not allow the former condition to be differentiated definitely from the latter ones--especially hematomas and Baker's cysts which require different treatment protocols. The authors stress the value of conventional and color Doppler US imaging in the aching calf syndrome for its differential diagnostic capabilities. The other more complicated and expensive radiologic and laboratory techniques should be used in case of negative US findings only.

[Thallium-dipyridamole in acute myocardial infarction treated by thrombolysis: diagnostic and prognostic value]. / Il tallio-dipiridamolo nell'IMA non complicato trattato con trombolisi: valore diagnostico e prognostico.

BACKGROUND: The management of patients who received thrombolytic therapy for acute myocardial infarction is still controversial. It is not clear if the strategies usually followed after myocardial infarction for risk stratification have the same value when applied to patients treated with thrombolysis. METHODS: To assess the diagnostic and prognostic value of dipyridamole thallium-201 scintigraphy in the "thrombolytic era", we studied 110 consecutive patients younger than 75 recovering from first uncomplicated acute myocardial infarction treated with thrombolytic agents. Patients with early angina, recurrent acute myocardial infarction, heart failure, life-threatening arrhythmias, non Q wave myocardial infarction were excluded. Ninety patients were treated with streptokinase, 14 with rtPA, 6 with APSAC: All patients underwent dipyridamole thallium scintigraphy with standard dose and coronary angiography before discharge (10-20 days). Ninety-nine patients underwent exercise test. All patients were followed-up for 22 +/- 9 months (range 8-42). Perfusion abnormalities were classified as reversible (totally or partially) defects or persistent defects and within or outside the infarct zone. RESULTS: Fifty-eight patients developed anterior and 52 inferior acute myocardial infarction. Coronary angiography showed single vessel coronary artery disease in 66 patients, multivessel disease in 34, and normal coronary arteries or sub-critical stenosis in 10. No major complications (death, myocardial infarction, threatening arrhythmias, prolonged severe hypotension) occurred after dipyridamole infusion. Sixty-two patients had reversible perfusion defects at thallium scanning (34 within the infarct zone, 21 within and outside the infarct zone, 7 outside); 38 patients had persistent defects; 10 patients had a normal scintigraphic pattern. The diagnostic value of homozonal perfusion reversible defects for identifying a patent infarct-related vessel was poor (sensitivity 69.7%, specificity 64.7%). The diagnostic values of the same scintigraphic pattern improved in detecting patent infarct-related artery with residual critical stenosis (sensibility 75.4%, specificity 77.3%); in all the false positive cases (reversible defects within the infarct zone and occluded infarct-related artery) a good collateral flow was present. The sensitivity of reversible defects outside the infarct zone in detecting multivessel disease was 64.7% vs 56.3% of exercise test; the specificity was 92% vs 64%; the positive predictive value 78.6% vs 44%; the negative predictive value 85.3% vs 74.5%; the diagnostic accuracy 83.6% vs 61.4%. During the follow-up 2 deaths, 7 recurrent myocardial infarction, 1 sustained ventricular tachycardia, 1 heart failure, 13 recurrence of unstable angina and 9 revascularization procedures occurred among patients with reversible defects (either within or outside the infarct zone) at thallium scanning. One recurrent myocardial infarction, 4 recurrence of unstable angina and 2 revascularization procedures were the events among patients with persistent defects or normal scintigraphic pattern (p < 0.001). Ischemic events occurred with similar frequency in patients with reversible perfusion defects within the outside the infarct zone (55% vs 50%, NS). CONCLUSIONS: Dipyridamole thallium-201 scintigraphy performed after uncomplicated myocardial infarction treated with thrombolytic agents is a valuable diagnostic tool in identifying viable jeopardized myocardium within the infarct zone perfused by a patent but critically narrowed vessel; it shows better diagnostic accuracy in detecting multivessel disease than does the exercise test and is able to identify a subset of patients at risk for future ischemic events after thrombolytic therapy.

[Deep venous thrombosis of the legs. Diagnostic results comparing the duplex and the color-Doppler methods]. / Trombosi venosa profonda localizzata agli arti inferiori. Risultati diagnostici a confronto fra sistema duplex e color-Doppler.

Thirty-eight patients (45 limbs on the whole) with clinical suspicion of deep venous thrombosis in the lower limbs were examined with duplex US and color-Doppler flow mapping. The results were compared with those of ascending phlebography used as a reference. Disease sites included distal localizations, limited to the leg, with no involvement of the popliteal vein, and proximal localizations, involving the popliteal vein to the iliac segment. In case of proximal thrombosis, duplex US had 81% sensitivity, 93% specificity, 86% positive and 90% negative predictive values. Color-Doppler flow mapping had 87% sensitivity, 96% specificity, 93% positive and negative predictive values. In case of distal localizations, the results were poorer with both methods; duplex sensitivity decreased to 60% and specificity to 83% with 64% positive and 80% negative predictive values. Color-Doppler results were slightly higher, with 80% sensitivity, 93% specificity, 85% positive and 90% negative predictive values. Thus, the authors believe color-Doppler flow mapping to be adequate as the imaging method of choice when deep venous thrombosis is suspected. Color-Doppler imaging yields better results in distal localizations and makes the examination easier, quicker and more panoramic. Phlebography should be employed in questionable cases and is required for the diagnosis of limited thromboses, which are at risk for embolism, as those we observed in the adductor canal, which are difficult to diagnose with US.

[Duplex study of primary venous insufficiency of the legs. First results and methodologic comparison]. / Studio duplex dell'insufficienza venosa primitiva agli arti inferiori. Primi risultati e confronto metodologico.

Primary venous insufficiency is a pathologic condition characterized by reflux in the deep venous system not secondary to phlebothrombosis. The authors compare the diagnostic capabilities of duplex and Doppler US in the evaluation of this condition. At present, Doppler US has a more widespread use than the duplex method. Both lower limbs were examined in 46 patients known to be affected with mono/bilateral primary venous insufficiency thanks to previous retrograde phlebography. Ten patients with different phlebopathies and 10 healthy volunteers were also studied as a control group, duplex US had 92% sensitivity and 90% specificity, while Doppler had 86% and 75%, respectively. Duplex US appeared to be more accurate than Doppler in locating and quantifying the reflux. Finally, the authors draw attention to the segmentary reflux phenomenon they observed in asymptomatic patients and suggest the possibility of recognizing the preclinic stage of this condition by duplex US, which is a non-invasive and relatively inexpensive method. The latter could become, thanks to its intrinsic characteristics, the method of choice for monitoring.

[The Duplex system in the follow-up of sclerosing therapy of the greater saphenous vein. First results and considerations]. / Il sistema Duplex nel follow-up della terapia sclerosante della vena grande safena. Primi risultati e considerazioni.

The authors evaluated the long-term results of sclerosing therapy as an alternative to surgery by means of high-resolution US and Doppler dynamic fluximetry (duplex system). Seventy patients (53 females and 17 males) were examined, all of whom fulfilled the clinical criteria of recovery and efficacy of sclerosing therapy. Average follow up was 20 months (range: 6-26). The results, compared with duplex findings before sclerosing therapy, demonstrated: a) persistence of reflux and absence of US signs of sclerosis (9/70 patients); b) evident sclerosis with persistent residual lumen and reflux of variable entity at the thigh (33/70) cases; c) incomplete sclerosis sparing the crosse, with physiological flow and disappearance of reflux (8/70 patients); d) nearly complete sclerosis with vasal lumen obliteration (20/70 cases). No changes were observed in the deep venous system after sclerosing therapy. The authors stress the advantages of the duplex system they employed as an instrumental support to clinics for a complete monitoring of sclerosing therapy.

[Duplex-sonography in the preoperative evaluation of the small saphenous vein]. / L'indagine duplex nello studio preoperatorio della vena piccola safena.

The authors analyze the results obtained by means of Doppler US, duplex examination and venography in the preoperative evaluation of venous vascular anatomy and flow dynamics in the popliteal fossa for short saphenous vein surgery. As a whole, 50 legs were examined in 34 patients who subsequently underwent surgery. The confluence of the short saphenous vein in the deep system proved to be very variable. Doppler results were compared with contrastographic ones: Doppler US had 10% accuracy in locating the confluence of the short saphenous vein and the figure rose to 62% with a +/- 2 cm tolerance. Duplex US had 30% and 98%, respectively. The latter always correctly demonstrated the reflux, while Doppler US in 5 cases (10%) ascribed gastrocnemius vein incompetence (4 cases) and Giacomini vein incompetence (1 case) to the short saphenous vein. The above findings demonstrate the total reliability of duplex US versus Doppler US and venography in recognizing the anatomic confluence and in allowing the fluximetric evaluation in a noninvasive, riskless and inexpensive way.

[First experience with the combination of ultrasonics and pulsed Doppler (Duplex system) in the study of venous pathologies of the legs]. / Prime esperienze di associazione ecotomografia-Doppler pulsato (sistema Duplex) nello studio della patologia venosa negli arti inferiori.

Over a 2-year period the authors examined 400 patients affected with different types of phlebopathies with combined real-time US and pulsed Doppler (Duplex system). Ninety-eight patients had deep phlebothrombosis, 45 had superficial phlebothrombosis, and 110 primitive or secondary vein insufficiency. The obtained data, supported in 171 cases by contrastographic findings, allowed both the semeiological study and the evaluation of the indications for Duplex US in the various phlebopathies. The combination of high-resolution US morphological data, dynamic tests, and the functional data from pulsed Doppler have particular interest in the study of: a) the diagnostics of superficial or deep thrombosis and adhesive or floating thrombi; b) post-thrombotic syndrome; c) primitive or secondary vein insufficiency; d) the ostium of the superficial venous system (location, morphology, functionality). Duplex US is a non-invasive technique for the examination of the superficial and the deep venous systems, which reduces the indications for phlebography, an exam which requires radiation exposure, and is not always safe or possible. Duplex US is however limited by the difficult assessment of the venous system below the knee, because of too many trunks and variants.