Primary antiphospholipid syndrome.
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Biomedical subjects
Publications and source records attributed to L Tarenzi.
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Mucormycosis is a very serious fungal infection caused by habitual saprophytes of the human organism, in many cases concomitant with various pathological conditions marked by immunodepression. The rhinocerebral variant habitually accompanies ketoacidotic diabetes. We report a case of rhinocerebral mucormycosis in a subject free from immunodepression and non-diabetic, in apparently normal health. Following treatment with amphotericin B combined with 5-fluorocytosine and surgery, remission of the disease was finally secured and about one year after the last operation there are no sign of resumption.
Cerebrospinal fluid (CSF) levels of the anxiogenic neuropeptide diazepam binding inhibitor (DBI) were determined by radioimmunoassay in 281 patients who underwent evaluation for neurological problems. Serial dilution curves and reverse-phase high pressure liquid chromatography showed that the immunoreactive material in CSF behaved just as authentic DBI extracted from human brain. Furthermore in the assay there was no evidence of interference from CSF samples deprived of DBI by immunoaffinity. In 82 patients with no evidence of major lesions in the central nervous system, who acted as controls, the CSF DBI content was shown to be age- and sex-related. No correlation was observed with the CSF protein concentration. In patients with different types of dementia, the levels of CSF DBI were significantly increased in a group with normal pressure hydrocephalus. No significant differences were found between Alzheimer's disease, multi-infarct dementia, or dementia with Parkinson's disease and controls. In non-demented patients with Parkinson's disease the levels of DBI were increased in a subgroup with depressive disturbances whereas no differences was observed in the non-depressed cases. The content of DBI was markedly reduced in 5 cases with olivopontocerebellar atrophy and in 4 with spinocerebellar ataxia. In all the other disorders studied the levels of DBI were similar to or slightly lower (multiple sclerosis) than those of the controls. The origin of DBI in cerebrospinal fluid is uncertain; a number of various possibilities are discussed concerning the proposed role of DBI as modulator of brain GABAergic transmission.
Functional residual capacity (FRC) was measured before and after induction of anaesthesia for jejunoileal bypass surgery in 30 morbidly obese patients. The onset of anaesthesia was associated with a 51% reduction in FRC from 2.2 litre to 1.0 litre. Eighteen of the patients were investigated more extensively; in these subjects FRC was reduced below the control values of residual volume (RV) with the onset of anaesthesia, but recovered towards baseline after laparotomy incision. Reduction in FRC is related to baseline vital capacity (VC) and FRC and is much greater than that reported for patients of normal weight.
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We report a case of cortical blindness occurring 7 days after acute CO poisoning with no other neurological or psychic deficits apart from denial of the blindness with visual confabulation and slight loss of retentive memory. There was scant correlation between the course of the clinical pattern, which cleared completely within 6 days, and the electroencephalographic pattern with marked and diffuse slowing, which did not recede completely during 3 months observation. CT scanning of the skull, initially within normal limits, displayed 2 weeks later a faint but diffuse hypodensity of the white substance, more marked in the occipital region, which was no longer present 80 days after the first scan.
One of the major technical obstacles to liver transplantation in children is to find a liver of appropriate size because of the rarity of child donors. To overcome this difficulty an experimental study was carried out using only a portion of the donor liver (right liver) transplanted orthotopically in pigs. A group of 15 allotransplants were performed. A left hepatectomy of the liver graft was performed ex situ and the right liver amounted to 55% of the whole liver. A total of 13 animals survived for more than 5 days (5 to 30 days, with an average of 16). Upon killing, the liver weight was considerably more than that of the part transplanted. The absence of technical complications suggests that this procedure is safe and feasible.
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An epidemiological survey of primary dementia syndromes was conducted in the city of Bra (26287 residents) in the Piedmont region. All the patients for whom a diagnosis of senile dementia had already been recorded together with the cases coming to light as a result of a questionary circulated to general practitioners and neuropsychiatrists were subjected to a broad battery of neuropsychological tests. The prevalence rate proved to be 255 (+/- 61) per 100 000 of the population and 2028 (+/- 476) per 100 000 of the over 65s. Close attention was paid to dements living in nursing facilities. Factors favoring institutionalisation were: advanced age, severe motor impairment and female sex. No correlation between severity or dementia and institutionalisation was found.
Fifteen biopsies of malignant gliomas, treated before surgery by radio- and chemotherapy, have been studied. The aim of the study was to ascertain if the tissue changes, which have already been observed in autopsy samples and are related to the above mentioned treatments, occur also in biopsy samples. Even taking into due account the limitations imposed by the small number of cases, a positive correlation was found between macrophages, vessel degenerations, endothelial proliferations and radiation therapy as well as between monster cell increase and chemotherapy. These findings are consistent with those obtained with autopsy material and demonstrate that tumors after radio- and chemotherapy are more quiescent and contained.
35 brains with malignant gliomas treated by surgery, radiotherapy and chemotherapy and processed by means of the "complete study" technique have been studied. The preliminary results are reported. Many types of changes have been observed. Areas of coagulative necrosis with vessel alterations and teleangectasias are present around the tumor in many cases. Different pathologic aspects are observed distant from the tumor. Edema both in the homo - and contralateral hemisphere is constantly present. Severe edema with demyelination, axon disappearance and loss of cells is frequently found associated with prolonged survival. Often it is accompanied by wide or small areas filled with macrophages. Spongio-necrosis in the white matter of contralateral temporal lobe has been observed in two cases and telangiectasias areas have been found in another one. The relation between changes and treatment is discussed.
The pathological effects of radio- and chemotherapy on the normal nervous tissue have been studied in 42 brains with malignant gliomas. The brains have been examined by means of the complete study technique. In seven cases the picture of delayed radionecrosis has been found. Apart from this, many histological features have been related to post-operative survival, radiation dose, interval between radiation and death, chemotherapy, steroids, size and activity of the tumour. Some alterations, such as peritumoural necroses, macrophage areas, vessel wall degenerations etc. result from radiotherapy. The relations and pathogenesis are discussed.
Six lambs were anesthetized and connected venovenous mode to a Membrane Lung for Extracorporeal CO2 removal. The animals underwent several hours periods of continuous positive pressure ventilation (CPPV), at 5 cmH2O positive end expiratory pressure (PEEP), alternated with several hours periods of low frequency positive pressure ventilation (5 cmH2O PEEP, 2 b.p.m.) with extracorporeal CO2 removal (LFPPV-ECCO2R). During LFPPV-ECCO2R compared with CPPV, cardiac output increased by 26%, pulmonary vascular resistances and systemic vascular resistances decreased by 28% and 22% respectively. The renal function improved significantly during LFPPV-ECCO2R compared with CPPV, i.e. urinary flow, creatinine clearance and osmolar clearance increased by 50%, 37% and 52% respectively. In these experiments LFPPV-ECCO2R, a form of completely artificial ventilation, seems to prevent hemodynamic and renal complications of CPPV.
The pathological effects of radio- and chemotherapy have been studied in 31 malignant gliomas. The brains have been examined by means of the complete study technique. Many histological features have been related to surgery, localization, preoperative duration, postoperative survival, irradiation, and chemotherapy. No specific alterations have been found, but some positive correlations have been established: decrease of mitoses, occurrence of macrophages and vessel degeneration after radiation, increase of monstrous cells after chemotherapy.
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Renal damage in acute hepatic failure induced in the pig by means of an hepatic state, temporary or permanent devascularisation Amanita phalloides poisoning or orthotopic liver transplant proved of slight degree, particularly in animals treated with replacement therapy. In the cases of animals that died in acute hepatic coma, on the other hand, renal cortex ischaemia and marked medullary congestion were constant. Histologically, the damage consisted of slight tubular nephrosis; this was more apparent in the proximal tubules. Evaluation of renal damage in 38 patients with acute hepatic failure was more complicated owing to the variety of clinical conditions (level of coma, hypovolaemia, intensive care and hepatic assistance). Nevertheless, a clear relation was established between the degree of liver damage and blood creatinine and creatinine clearance values. All patients who died presented liver cell necrosis of over 75%, blood creatinine values of more than 2 mg/100 ml, and less than 50 ml/min clearance. Tubular nephrosis was the predominant lesion. It appeared that renal damage was primarily pre-renal. No signs of a true hepatorenal syndrome could be made out.
Intensive care was applied in 13 patients with acute liver insufficiency and different degrees of metabolic encephalopathy due to the ingestion of Amanita phalloides. Twelve of them were subjected to hepatic assist with E.T., in three cases this measure was repeated. Ten recoveries were obtained, which denote, on the basis of the necrosis enzymes and the hepatic histo-pathological aspects from bioptic samplings, the use of the E.T. method, when applied within the first 72 hours. In pigs poisoned with Amanita phalloides, the clinico-biochemical pattern and the histopathological findings are comparable to the observations in man. Electron microscopy demonstrates peculiar lesion in the cytoplasm. The anatomo-pathological findings in the three dead patients show a liver necrosis over the 90% and the presence of cerebral edema.