The effects of alcoholism pharmacotherapy on immune responses in alcohol-dependent patients.

Chronic alcohol use has profound modulatory effects on the immune system. Both the innate and the acquired immunity are compromised. The use of pharmacotherapy is increasingly applied to enhance the percentage of success in maintaining alcoholic patients in remission. Disulfiram, naltrexone and gamma hydroxybutiric acid are the drugs used for this purpose in Italian Addiction Services. In this study we analyze the effect of pharmacotherapy of alcohol dependence on immune responses in alcoholics. Six groups were studied. Group A included 10 patients who were still using alcohol. Group B consisted of 10 patients abstinent from alcohol in treatment only with group therapy. Groups C, D and E were composed of 10 patients each, treated for at least 6 months with oral doses of gamma hydroxybutiric acid, naltrexone or disulfiram respectively. Ten age- and sex-matched healthy volunteers who never misused alcohol were included as a control group. Lymphoproliferation and peripheral mononuclear cell production of the Th1 cytokines IL-2 and IFN-gamma, the Th2 cytokine IL-4, and of the pro-inflammatory cytokines IL-1 and TNF-alpha were evaluated in all the patients and controls. The level of activity of the hypothalamus pituitary adrenal axis was assessed. Both ACTH and cortisol levels in plasma were elevated in alcoholic patients with no treatment. In this group a significant alteration of cytokine production was observed. TNF and IFN-gamma were lower than controls, while the Th2 cytokine IL-4 was increased. These altered levels state for a Th1/Th2 unbalance characterized by decreased Th1 response in the presence of Th2 predominance. In patients undergoing pharmacological treatment, none of the immune parameters were different from those observed in healthy controls, independently of the type of drug administered. These data indicate that pharmacotherapy more than group therapy treatment is able to ameliorate the immune system functioning in alcoholic patients.

Subacute left ventricular free wall rupture complicating acute myocardial infarction. Successful surgical repair with a sutureless technique.

The high mortality index related to surgical therapy with direct suture of rupture of left ventricular free wall following acute myocardial infarction, suggested we analyze and use alternative techniques. So we applied sutureless technique described by Padro to two patients. We used a Teflon patch fixed to the ventricular wall with a biocompatible synthetic glue, an ethyl-2-cyanoacrylate monomer, without any direct suturing of the infarcted myocardium. The two patients survived the operation and were discharged from the hospital 12 and 14 days after surgery. The sutureless technique allows, in our opinion, a more confident and safe aggressive attitude to subacute left ventricular free wall rupture.

[Invasive cardiological diagnosis in an ambulatory regimen of transported inpatients]. / Diagnostica cardiologica invasiva in regime ambulatoriale protette.

We report our initial experience with 302 consecutive cases of percutaneous cardiac catheterization in in-patients from other hospitals. The patients reached our laboratory immediately before the procedure in an ambulance with an attending physician and were transported back to their hospital soon after completion of the procedure. This accounts for 35% of 864 diagnostic cardiac catheterization procedures in our laboratory in the first 12 months of activity. There were no complications related to this regimen, and a substantial reduction in unnecessary overnight admission to the cardiology ward was achieved. This report confirms the safety and the advantages of this practice. Implications for the organization of the catheterization laboratory are discussed.

Coronary occlusion secondary to blunt chest trauma: a first attempt at balloon angioplasty.

There have been only 58 angiographically documented reports of transmural myocardial infarction due to closed-chest trauma. None of these cases has been treated by percutaneous transluminal coronary angioplasty. We report the case of a 40-year-old man who developed an anterior-wall myocardial infarction secondary to blunt chest trauma suffered in an automobile accident. Angiographic study performed 2 months after the injury revealed an isolated total obstruction of the left anterior descending coronary artery. The patient was judged a good candidate for balloon angioplasty, but total reocclusion occurred within 24 hours of the procedure and a 2nd attempt did not restore patency. Surgical revascularization was performed a week later. A year after his injury, the patient remains asymptomatic and is back at work. Despite the failure of percutaneous transluminal coronary angioplasty in its 1st application to coronary artery repair after blunt chest trauma, we believe it to be the treatment of choice in young patients and in single-vessel disease.

Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures.

From January, 1979, to December, 1984, at the Cardiac Surgery Department of the University of Torino Medical School, major sternal wound infections developed in 48 (1.86%) of 2,579 consecutive patients. These patients underwent open-heart procedures through a midline sternotomy and survived long enough for infection to appear. Possible risk factors were evaluated by means of a multivariate analysis. For the group of patients, we considered age, sex, hospital environment (different locations of our surgical facilities over the years), interval between hospital admission and operation, antibiotic prophylaxis, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, postoperative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of treatment in the intensive care unit. Univariate analysis indicated that age, sex, type and mode of surgical procedure, antibiotic prophylaxis, and duration of mechanical ventilation were not significantly associated with wound infection. For all other predisposing factors, a p value of less than .05 was demonstrated. These variables were entered in a multiple stepwise logistic regression. Six emerged as significant: hospital environment (p = .0001), interval between admission and surgery (p = .041), reoperation (p less than .0001), blood transfusions (p = .031), early chest reexploration (p less than .0001), and sternal rewiring (p less than .0001). Contamination of patients may occur before, during, and after operation, and any kind of reintervention may predispose to wound infection.

Optical determination of coated and uncoated mineral fibers in lungs of subjects without professional exposure.

Coated and uncoated mineral fibers, more than 10 micron long, were counted by light microscopy in digested lung samples from 82 adult subjects without professional exposure. Up to about 150 coated and 12,500 uncoated fibers/g dry weight were found, without any correlation to sex, occupation and smoking habit. An association between counts of more than 1,000 fibers and ages over 50 was observed. The ratio of uncoated to coated fibers was very inconstant. Only the counts of both coated and uncoated fibers seem advisable for an optical evaluation of the possibly pathological mineral fiber burden in the lungs of unexposed persons.

[Septic complications in subclavian vein catheterization]. / Complicanze settiche dell'incannulamento della vena succlavia.

Authors have studied the incidence of septic complications due to subclavian vein catheterization, According to literature, have considered that this is generally connected to the operating ability. Septic contamination, though of high incidence, only exceptionally is reason of a septic clinical condition.

[Lymphoid myelofibrosis or hairy cell leukemia]. / La mielofibrosi linfoide o "hairy cell leukemia".

By lymphoid myelofibrosis or hairy cell leukaemia or tricholeukaemia is meant an unusual haemopathic condition known only for the past few years. It is characterized pathognomonically by the presence of lymphocyte type cells with villous extroflexions, hence the name "hairy cell". Clinically the disease presents as an involutive myelopathy associated with splenomegaly, generally without any particular lymph gland involvement. The attention of students today is concentrated on the nature of the hairy cells; while some are inclined to admit their monocyte or histiocyte derivation, others consider that they derive from B lymphocytes. Therapeutically, almost everybody agrees that splenectomy is the only valid step. A case of H.C.L., which was typical from the clinical and laboratory viewpoints is reported. It is probable that certain haemopathic pictures once classified among atypical leucoses and lymphomas, would today be more correctly classed as hairy cell leukaemia.