Biomedical subjects
Publications and source records attributed to L Lupetti.
A 25-month-old girl is described who experienced three successive attacks of purulent meningitis due to Proteus mirabilis. Third generation cephalosporins were employed as treatment. Cranial radiography and computed tomography revealed a malformation, in the form of an epidermoid cyst, in a central occipital position; small cerebellar abscesses were also present. The lesion was removed by surgery which led to a complete recovery.
The usefulness of measuring xylosaemia, carotenaemia and the antigliadin antibodies in the diagnosis and monitoring of coeliac diseases has been examined, 89 children, 57 with aspecific chronic diarrhoea and 32 with coeliachia were examined. The xylose proved less sensitive (80%) and less specific (84.2%) than carotenaemia (respectively: sensitivity 86.6% and specificity 87.7%). Nevertheless, considering the by no means negligible percentage of false positives and false negatives encountered with both techniques, it should be reiterated that these tests have a purely orientative value, whereas measurement of serum AGA may be considered a highly reliable investigation for selective children to be submitted to biopsy, considering the high sensitivity (AGA IgG 100%; AGA IgA 90.9%) and specificity (AGA IgG 85%; AGA IgA 100%) observed in the present series.
In describing one case of congenital fructose 1,6-diphosphatase deficiency the Authors review the several clinical conditions giving problems of differential diagnosis. For certain diagnosis they underline the importance of liver biopsy, to dose the deficient enzyme directly in the liver tissue.
A deficiency of exogenous and endogenous carnitine is present in those pathologies in which the most important clinical sign is represented by weakness and steatosis. We have studied the serum levels of carnitine in 14 children with hepatic disease (8 with acute HAV hepatitis, 2 with acute HBV hepatitis, 2 with toxic hepatitis, 2 with chronic hepatitis). In patients with acute, infective and toxic hepatitis we have found levels of carnitine (25.71 +/- 2.14 nM/ml) below normal (50.87 +/- 1.46 nM/ml). In 5 cases we have performed two blood tests, at admittance to the hospital and at the end of the illness. The variability in carnitine levels in these two blood exams shows a clear correlation with clinical improvement, decrease in aminotransferase and increase in serum carnitine. In chronic hepatitis we have found normal levels of carnitine. Probably it is correlated with the absence of steatosis seen at hepatic biopsy.
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The clinical aspects of coeliac disease before and after anti-gliadin antibodies (AGA) assessment in clinical practice, referring to personal experience (107 cases in the period 1976-1988) are described. AGA determination has executed by two different ELISA methods. The diagnosis of coeliac disease in the period 1976-1986 has been made according to ESPGAN criteria, while in the last two years following the recent SIP advice. After 1987 with the introduction of AGA assay, the number of diagnosis/year of coeliac disease has increased three times in respect of the period 1976-1986. We have observed a more marked increase of the late beginning forms (from 2.8 to 10 diagnosis/year) in respect of the early beginning ones (from 3.7 to 7.5 diagnosis/year) and of the atypical forms (from 0.7 to 9 diagnosis/year) in respect of the typical ones (from 5.8 to 8.5 diagnosis/year). According to these data we think that prevalence of coeliac disease in our country is probably underestimated. AGA determination is at time most effective mean to make a screening of coeliac disease in the population. According to us the largest employment of this method in the next years could take a most exact estimate of the coeliac disease prevalence in our country.
In this study the Authors examine the usefulness in determining Fecal Chymotrypsin (FC) as a screening test for pancreatic exocrine insufficiency. The FC was measured in 503 children (337 control subjects and 166 with various intestinal and hepatobiliary diseases). The results demonstrate that FC is usefull as a screening test for pancreatic insufficiency. However, in certain cases, this should be supplemented by the more discriminant analysis of function provided by duodenal studies.
The Authors demonstrate the successful therapeutic results obtained in two cases of Guillain-Barré-Strohl syndrome treated intravenously with high dosages of intact immunoglobulins. The possible immunological mechanisms behind this therapy are then discussed. The Authors believe that this treatment could very positively influence the prognosis of this disease.