Biomedical subjects
Publications and source records attributed to F Pellegrino.
Two cases of infected aneurysms of the subrenal abdominal aorta observed in the last year are reported. In this study some specific aspects of this unusual pathology are analyzed: the high mortality rate, the difficulties involved in the diagnosis and the surgical solutions.
Cardiac involvement in peripheral vascular diseases can present interesting patho-physiological aspects and can influence the prognosis. The authors evaluated the cardiac condition of patients with asymptomatic aortic abdominal aneurysm (AAAA) by using clinical, electrocardiographic, and echocardiographic techniques. Seventy-eight patients were studied, 74 men and 4 women, with ages ranging from fifty-five to eighty-one years (mean 69.5 +/- 6.4). All patients were submitted to a complete clinical examination, usual blood tests, a 12-lead resting electrocardiogram, and an echo-Doppler evaluation. Forty-eight subjects (61.5%) were affected by hypertension, 53 (67.9%) were smokers, 25 (32.1%) were alcohol abusers, 39 (50%) had a history of angina pectoris, 20 (25.6%) had had previous myocardial infarction, and 30 (38.5%) were receiving active cardiovascular treatment. All patients except 2, who had chronic atrial fibrillation, manifested sinus rhythm. Electrocardiographic signs of left ventricular (LV) hypertrophy were present in 20 cases (25.6%), intraventricular conduction disturbances in 19 (24.4%), pathological Q waves in 20 (25.6%), and primary repolarization abnormalities in 25 (32.1%). Echocardiography showed a slight increase in left atrial diameter and intraventricular septum thickness (41.5 +/- 4.3 and 12.3 +/- 2 mm respectively). A clearer increase was found in LV mass index (159 +/- 44 g/m2). In 31 patients one or more LV asynergic segments were found. In our patients with AAAA the prevalence of major risk factors for atherosclerosis and ischemic heart disease including previous myocardial infarction was high. Echo-derived LV myocardial mass index was higher than normal even though electrocardiographic criteria for LV hypertrophy did not match echocardiographic data in all subjects. Finally a moderate prevalence of intraventricular conduction disturbances was recorded.
Hairy leukoplakia is a specific oral lesion associated with the opportunistic development of Epstein-Barr virus in the oral epithelium. It is now considered to be an early sign of HIV-induced immunosuppression. Four cases of oral hairy leukoplakia (OHL) from the lateral borders of the tongue of male AIDS patients were investigated by transmission electron microscopy. At the ultrastructural level, herpes-like viral particles were detected in the oral lesions of all cases. Indirect immunofluorescence performed on two cases showed the presence of EBV antigens in the nuclei and the cytoplasm of the infected epithelial cells. None of the specimens contained ultrastructural evidence of human papillomaviruses.
The transmission of the human immunodeficiency virus (HIV) was studied in 647 subjects who presented no apparent risk factors for the infection other than having had promiscuous heterosexual relations, heterosexual relations with people with an elevated risk of infection, or heterosexual relations with people infected by human immunodeficiency virus. Thirty subjects were found to be seropositive for anti-human immunodeficiency virus antibodies. The elevated risk factors included being the habitual partner of a person at risk of infection or of a person who was infected by human immunodeficiency virus, or being the partner of a patient with acquired immunodeficiency syndrome. The transmission of the virus was verified in 13 of 284 subjects (4.57%) who had had heterosexual intercourse three or more times with persons at risk and in 16 of 101 subjects (15.84%) who had had heterosexual intercourse three or more times with persons who were seropositive for human immunodeficiency virus antibodies. No significant correlation between human immunodeficiency virus infection and a history of sexually transmitted infections, nor between human immunodeficiency virus infection and female subjects was found. These data suggest that the epidemic of acquired immunodeficiency syndrome can also spread through heterosexual relations, even if the possibility of becoming infected in this way seems at the moment limited to particular risk behaviors.
Author's report a case of visceral amebiasis in a 26 year old woman, clinically characterized by pericarditis, without any other symptoms related to organs usually interested in such disease. It was possible to reach an etiological diagnosis by indirect hemagglutination assay. The successful treatment with metronidazole confirmed the etiology "ex adjuvantibus".
A commercial enzyme immunoassay was utilized for the detection of the human immunodeficiency virus antigen (p24) in serum samples from persons at risk for AIDS. The test demonstrated sensitivity to 20 pg/ml of serum antigen. The results obtained showed 14.63% of the subjects (Ss) with persistent generalized lymphadenopathy or asymptomatic Ss, and 69.23% of the Ss with AIDS related complex (ARC) or AIDS to be positive for HIV-Ag. In addition, there were no false-positives in the control serum samples collected from seronegative individual. The close correlation observed between HIV-Ag presence and advanced stages of the disease, stresses the diagnostic importance of this viral marker and its usefulness in the follow-up of Ss with HIV infection.
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A rapid, sensitive indirect immunofluorescence assay based on the use of acetone-fixed virus producing MOLT T4/LAV cells was adapted for the detection of anti-HIV antibodies. At the same time, 1486 serum samples, collected by the AIDS Surveillance and Study Centre of Modena, were tested by ELISA and IFA: the percentage of agreement of both assays was of 99.66%. Such datum suggested that IFA could be used as a serological assay for screening and confirmatory purposes.
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A case of primary hepatic actinomycosis is reported. Multiple liver abscesses were diagnosed in a febrile 60-year-old-man by means of non-invasive techniques such as ultrasonography, CT and radioisotope scans. The aetiology was confirmed by the unusual finding of Actinomyces israelii in anaerobic blood cultures. Other sites were not involved. Early penicillin therapy enabled surgery to be avoided.
An account is offered of the haemodynamic and neurological questions posed by the relation between reconstructive aortoiliac surgery and sexual function. Attention is drawn to the anatomical and surgical features of the preaortic sympathetic structures. In the light of experience gained in pelvic haemodynamic evaluation with the Doppler penile pressure index, a method that has proved very useful in the study of pre- and postoperative impotence in the arteriopathic subject, stress is laid on three conclusions: a) the high frequency of impotence in aortoiliac arteriopathy (65% in a personal series); b) the beneficial effect on penile circulation of revascularisation of the hypogastric artery (increase in pressure index in 70% of cases); c) the relatively high incidence of postoperative sexual disturbances (30% in the personal series) due to lesion of the preaortic sympathetic structures, the risk being greater with techniques requiring wide exposure of the aorta. This danger is foreseeable in all sexually potent patients and should determine the indication for surgery, the method chosen (extra-peritoneal route, extra-anatomical by-pass), and the technique (in an aorto-femoral by-pass, the aorta should be prepared in accordance with carefully followed rules of surgical anatomy, and confined wherever possible to a short infrarenal segment).
The authors report the first documented italian case of type E botulism. The initial symptoms were typical permitting prompt diagnosis; the symptoms became severe and the patient had to be moved to intensive care. Biological tests on guinea-pigs showed the presence of type E botulin toxin in the tuna (stored in oil) which the patient had eaten 24 hours prior to admission. This tuna had been caught near the mediterranean coast of Spain several months earlier and canned at home. The authors emphasize that, even though this fish was imported, there is a danger that this intoxication could, in the future, be more widely observed.
The case is presented of a young Somali with acute lymphadenitis. Whereas histological examination indicated abscessing granulomatous lymphadenitis, bacteriological studies revealed the presence of M. tuberculosis in the pus taken from the lymph node. Hence the aetiological diagnosis contradicted the morphological picture.
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Mortality and amputations after limb ischemia following thromboembolic obstruction show no significant improvements despite the technical progressions based on the use of Fogarty catheter. The Author analizes 98 patients surgically treated, to point out the reasons of failures: 14,5% mortality and 11% amputations in embolic ischemia and 11% and respectively 16% in acute thrombosis; the age resulted over 70 in 70% of patients; in the 75% embolic origin was determined by a atherosclerotic senile cardiopathy. In case of embolic ischemia, highly significantly from a statistical point of view worse results were observed for proximal obstructions. In overall patients must be noted a mortality of 6% under the age of 60 and 22% over this age. Finally, once again considering the embolic obstruction, the length of ischemic time was observed directly correlated with functional results.
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