Biomedical subjects
Publications and source records attributed to G Paladini.
A patient suffering from an acute myocardial infarction presented on the seventh and eighth days of hospitalization recurrent episodes of ventricular fibrillation refractory to antiarrhythmic treatment. The life-threatening ventricular fibrillation was suppressed by percutaneous pharmacological block of the left stellate ganglion.
We present a case of multiple myeloma in which pulmonary calcification was clinically shown by bone scintigraphy and subsequently confirmed at autopsy. It is suggested that, in patients with myeloma, radionuclide bone scanning may be of value for differentiating deposits in the lung due to calcification from those due to other types of pulmonary infiltration revealed by chest X-rays. A thorough review of the relevant literature is presented.
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Carbamazepine is one of the drugs most widely prescribed for the treatment of trigeminal neuralgia and psychomotor seizures. Coincidentally with its use, hypersensitivity reactions to this agent have ben reported with increasing frequency. This report documents our recent encounter with 2 patients who developed hepatitis within one month of beginning carbamazepine therapy for temporal-lobe epilepsy. The occurrence of fever, skin rash and arthralgias suggest immunologic hypersensitivity as does eosinophilia and raised level of IgE, as seen in our patients. After withdrawal of the drug, symptoms and signs disappeared rapidly. We also describe a patient with psychomotor seizures who had ingested carbamazepine for less than 2 months before presenting with a febrile illness characterized by rash, arthritis, lymphadenopathy, epatosplenomegaly and diffuse pulmonary infiltrates with eosinophilia. The reaction cleared on cessation of the drug. Besides showing antinuclear antibody without DNA-precipitating antibody, this patient had an increased helper-T-cell count as well as a decreased number of T lymphocytes with suppressor activity. Taken together, these observations make it reasonable to speculate that carbamazepine may have interfered with lymphocyte triggering, thereby favouring the emergence of B cells with autoimmune propensities.
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3 patients with multiple myeloma developed hyperkalemic hypoaldosteronism and renal insufficiency while receiving indomethacin for bone pain. Claims are made that indomethacin has been responsible for these complications, possibly by inhibiting prostaglandin biosynthesis. Careful observation of myeloma patients during administration of this agent and perhaps other prostaglandin inhibitors appears warranted.
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The clinical course of a 54-year-old man with generalized lymphadenopathy bearing all physical, laboratory and histologic characteristics of angioimmunoblastic lymphadenopathy with dysproteinemia is described. Morphologic and laboratory features of a hyperimmune state with autoimmune hemolytic anemia, elevated cold agglutinin levels and polyclonal gammopathy, but with paradoxical cutaneous anergy and decrease in blood T-lymphocytes, were found. Therapy with levamisole was without significant benefit and the patient died 2 months after initial diagnosis. Our findings give further support to the contention that this disease is an abnormal, but non-neoplastic, immune reaction resulting from a loss of suppressor T cells with hyperfunction of the B lymphocyte system.
In 12 myeloma patients responding to chemotherapy (7 IgG and 5 IgA), we studied the effect on the anion gap of a 50% reduction in the serum paraprotein concentration. In contrast to the pretreatment anion gap which was decreased in IgG myeloma and increased in IgA myeloma, the value calculated when the paraprotein spike was halved showed a tendency towards normalization in the former type of myeloma, whereas it appeared as quite normalized in the latter. Our results lend further support to the conceptions that IgG and IgA paraproteins behave in the serum as cations and anions, respectively, and that serial determinations of the anion gap may be of value for monitoring the response to treatment in patients with multiple myeloma.
Peyronie's disease (induratio penis plastica) and a syndrome resembling systemic lupus erythematosus (S.L.E.) contemporaneously developed in a 50-year-old man six months after initiation of treatment with metoprolol. In view of the improvement in symptoms and signs on withdrawal of metoprolol, it seems likely that the drug was responsible for both these conditions. Peyronie's disease has been observed in relation to treatment with other adrenergic blocking agents, including practolol, and the S.L.E. syndrome is thought to be a possible untoward effect of practolol therapy. The relationship between practolol and sclerosing conditions elsewhere in the body is well recognized and an immunological basis for the fibrosis has been suggested. Similarly, the possibility is raised that Peyronie's disease may be in this case a particular expression of the auto immune disorder induced by metoprolol administration.
Plasma prolactin concentrations and prolactinaemic response to sulpiride, a prolactin releaser with pituitary dopamine receptor blocking activity, were examined in 16 subjects with mild essential hypertension and in 20 patients with long-sustained essential hypertension. When compared with 16 normotensive controls only the former showed raised plasma renin activity (P < 0.001) and higher plasma prolactin levels either after two-hour ambulation (P < 0.05) or at supine rest (P < 0.05). The average of maximal sulpiride-induced prolactin values was 157 +/- 53 ng/ml (mean +/- SD) in the mild hypertensive, significantly different from 60.2 +/- 21.4 ng/ml (mean +/- SD) as resulted in the controls (P < 0.001). In contrast, patients with sustained hypertension had a mean level of 60.2 +/- 21.4 ng/ml (mean +/- SD), indifferent from the one of the normal volunteers. It is suggested that the excessive prolactinaemic response to sulpiride detected in patients with mild hypertension reflects a reduced hypothalamic dopaminergic activity and that such an alteration may assume some pathogenetic relevance in the natural history of essential hypertension. Further, in the mild hypertensive a positive prolactin-renin correlation was found (r = + 0.76; P < 0.01), so suggesting that in these patients a peripheral sympathetic overactivity is associated to an impaired central dopamine control. The individuation of such cases may be important since they could benefit by dopamine agonists as L-dopa and bromocriptine.
A case of isolated lambda-light chain proteinemia and proteinuria is reported. During a 42-month follow-up, no sign of myelomatosis or amyloidosis developed and Bence Jones proteinuria remained nearly of the same magnitude. This case of apparently idiopathic Bence Jones gammopathy, the first lambda-type so far reported, is added to similar observations to give further support to the contention that a benign counterparty to light-chain myeloma may exist.
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The anion gap was evaluated in 26 consecutive patients with multiple myeloma (15 IgG and 11 IgA). The average union gap was found reduced only in IgG myeloma. Instead, in the subjects with IgA myeloma it resulted as increased. The partial differences between our results and those of other authors are discussed. The finding of correlations between the anion gaps and paraproteinemic concentrations (direct in IgA myeloma, inverse in IgG myeloma) gives further support to the conception that the charge exhibited in the serum by IgG and IgA paraproteins is, respectively, positive and negative. It is suggested that a 'normalization' of the anion gap during chemotherapy may be a useful tool to judge the efficacy of the treatment of multiple myeloma.
The ethiocholanolone test was used to evaluate the granulocyte reserve in 22 patients with Hodgkin's disease before and during polychemical antiblastic and radiation therapy. Under basal conditions, the reserve was normal and its behavior was fairly constantly related to histological type. Stress is laid on the inadequacy of the simple leukocyte count as a guide to the planning of treatment by comparison with the more accurate picture offered by the granulocyte reserve.
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The distribution of intermediate-filament (IF) proteins of the keratin, vimentin and desmin type in breast stromal sarcomas, carcinosarcomas, metaplastic carcinomas and phyllodes tumors has been compared using the avidin-biotin complex immunoperoxidase technique. Keratin reactivity was found in carcinomatous and pseudosarcomatous areas of all metaplastic carcinomas, in the cuboidal epithelial cells of carcinosarcomas and in the epithelial component of phyllodes tumors. Vimentin and desmin were detected in the sarcomatous portion of carcinosarcoma, focally in the stromal component of phyllodes tumors and not always in the stromal sarcomas. These data confirm that combined analysis of IF expression is a reliable and convincing way to differentiate stromal sarcomas, metaplastic carcinomas and carcinosarcomas in breast pathology.