Biomedical subjects
Publications and source records attributed to M Piazza.
A young patient developed Hodgkin's disease 11 years after surgical, chemotherapeutic and radiation treatment for stage IIIA embryonal carcinoma of the testis. The importance is stressed of establishing a tissue diagnosis when there is an unexpected course of the disease.
A hepatitis B vaccination campaign was carried out in a town of 60,000 inhabitants, Afragola, Campania, Italy, a hyperendemic area for hepatitis B where HBsAg prevalence was 13.4% and anti-HBc prevalence was 64.7%. This experimental pilot project aimed to reduce the incidence of both acute and asymptomatic viral hepatitis B and of related chronic liver complications. From 1983-1989, 8,400 subjects were vaccinated: 6,900 children up to 10 years of age and 1,500 subjects from 11-60 years of age. High seroconversion rates were observed: 99.0% in all children under one year of age, 96.0% in the older children, and 86.7% in adults. The rate of infection in Afragola has diminished from 63/100,000 in 1983 to 10/100,000 in 1989. Carriers of HBsAg decreased in the general population (7.3% compared to 13.4%), especially in children up to 10 years of age (1.0% compared to 9.0%). In babies who received hepatitis B vaccine at the same time as compulsory vaccinations compliance was 98% while it was 80% in babies who were vaccinated separately. In June 1991 the Italian Parliament promulgated a decree which imposes hepatitis B vaccination for all newborn babies at 3, 5, and 11 months of age, at the same times as the mandatory childhood vaccinations (diphtheria, tetanus, and polio) according to a new protocol (Piazza scheme) which has been in use since January 1987 in our pilot vaccination campaign in Afragola.
In order to understand the significance of presence of HIV-1 in saliva, we searched for by PCR HIV-1 proviral sequences in the saliva cells of 49 HIV-1 infected patients. Seven out 49 specimens resulted positive, 4 of which were from patients with PGL, 1 with ARC and 2 with AIDS. Four patients had a CD4+ lymphocyte counts < 200/cmm and in 3 patients the CD4+ lymphocyte count ranged from 200 to 400/cmm. Two patients were treated with AZT, 1 with DDI and 4 had no antiretroviral treatment. In conclusion, although HIV-1 proviral sequences have been found in saliva of HIV-1 infected patients, a larger group of patients should be investigated to define more precisely the role of HIV-1 in saliva.
27 healthy babies born to HBsAg, antiHBs and antiHBc negative mothers were given three doses of hepatitis B vaccine "Recombivax HB" (5 micrograms/dose/0.5 ml) at 3, 5 and 11 months of age (Piazza's protocol). AntiHBs response was highly satisfactory. Since both in terms of seroconversion rate and of mean antiHBs titre immunogenicity of other hepatitis B vaccines given at 3, 5 and 11 months of age was already demonstrated, it is possible to conclude that Piazza's protocol is valid for all hepatitis B vaccines available in Italy and will certainly facilitate the compulsory hepatitis B vaccination in infants in Italy.
From 1977 to 1990, 37 patients with Stage III or IV invasive thymoma (20 men and 17 women; median age, 40 years of age) were referred for chemotherapy to the Padova Medical Oncology Department. All patients initially received the same regimen (50 mg/m2 of cisplatin and 40 mg/m2 of doxorubicin intravenously (IV) on day 1, 0.6 mg/m2 of vincristine IV on day 3, and 700 mg/m2 of cyclophosphamide IV on day 4 [ADOC]), recycling at monthly intervals. No life-threatening side effects were noted. The overall clinical response rate (complete response plus partial response) was 91.8%, with 43% complete remissions. Median duration of response and survival were 12 months (range, 2 to 96+ months) and 15 months (range, 5 to 96+ months), respectively. Seven of the 16 complete remissions were pathologically confirmed at subsequent thoracotomy. Other chemotherapy combinations and radiation therapy have been applied as second-line treatment, achieving only minimal responses. In the opinion of the authors, such chemotherapy deserves evaluation for adjuvant and neo-adjuvant treatment of invasive (and/or inoperable) thymoma due to the high complete response rate and overall response rate.
This paper presents a case of pleomorphic adenoma from an abnormal site in the right upper neck in a patient surgically treated 4 years previously for pleomorphic adenoma of the right parotid gland. The lack of normal salivary tissue in the neck growth oriented us towards a diagnosis of implantation tumor, resulting from surgery of the parotid mass, rather than towards one of heterotopic tumor. The literature concerning salivary heterotopias and salivary tumors arising from heterotopic foci is also reviewed.
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Following the demonstration of a fully satisfactory immunogenic activity of a hepatitis B vaccination protocol consisting of three doses of Hevac B Pasteur vaccine given at 3,5 and 11 months of age, it was possible to administer this vaccine at the same times as the vaccinations for diphtheria, tetanus and polio which are mandatory in Italy at those ages. We have also shown that both another plasma-derived vaccine, H-B-VAX (MSD), as well as the DNA-recombinant Engerix B (SK&F) are highly immunogenic when given at the same times as the mandatory childhood vaccinations. In this paper we demonstrate that the same schedule can be used for another hepatitis B vaccine prepared by a DNA-recombinant technique, Recombivax HB (MSD) recently introduced in Italy. In fact two doses of this vaccine, the first given at three months of age and the second two months later, resulted in a 100% seroconversion rate and a mean anti-HBs titre of 440 mUI/ml. Although the date are incomplete since the third dose will be given at 11 months of age, we conclude that this hepatitis B vaccine can also be used in the mass vaccination campaigns of infants in Italy, the first of which was initiated in January 1987 in an hyperendemic area near Naples (HBsAg prevalence about 14%). We underline that this mass vaccination campaign is the first in Europe.
We have studied hemoglobin concentration in saliva of anti-HIV positive and anti-HIV negative intravenous drug abusers (IVDA) and normal controls and the relationship between hemoglobin concentration in saliva and number of CD4+ cells and clinical status of AIDS in anti-HIV positive IVDA. 120 anti-HIV positive IVDA, 112 anti-HIV negative IVDA and 116 normal healthy subjects not belonging to any risk group for HIV infection completed the study. Saliva was collected at awakening before brushing teeth and the concentration of hemoglobin was determined. Hemoglobin concentration in saliva in basal conditions is higher in anti-HIV positive IVDA with respect to anti-HIV negative IVDA (p less than 0.05) and controls (p less than 0.01). In anti-HIV positive IVDA hemoglobin concentration in saliva is higher in subjects with CD4+ cells less than 200/10(6) l with respect to subjects with CD4+ greater than 200/10(6) l (p less than 0.05) and in subjects with ARC/AIDS with respect to subjects with PGL or who are asymptomatic (p less than 0.01). Subjects with ARC/AIDS have a mean concentration of hemoglobin of 19 micrograms/0.1 ml saliva (range 0-153) which corresponds to 1.3 microliters of blood/ml saliva. If 10 ml of saliva are exchanged during kissing an average of 13 microliters of blood are transferred (110 microliters of whole blood at extreme range). Blood of symptomatic patients has an HIV titer of 7 TCID/microliters which for 10 ml saliva containing an average of 1.3 microliters blood/ml saliva corresponds to an average of 90 TCID (770 TCID at the extreme range).(ABSTRACT TRUNCATED AT 250 WORDS)
The retrospective analysis of 1876 cases of invasive cervical cancer allows some considerations and conclusions on the clinical management of this neoplasia. Always led by the Gynaecologist, in the aims of prophylaxis and early diagnosis, personalized screening are necessary, with regard to risk factors. Surgical Pathological Staging (SPS) is mandatory for adequate treatment and prognosis. By personalizing surgical radicality and avoiding the application, in all cases, of the routine and standard extended operations of the past, it may be possible to reduce the complication rate with 5 year survival rate unchanged. In early stages personalized radical operations with systemic pelvic lymphadenectomy allow the best results (94% 5 year survival rate). Integrated therapies must be planned only in lymph nodal positive or in vascular space invasion cases. In advanced cases, surgery must be personalized in enlarged operations and integrated with adjuvant treatments on the basis of surgical pathological findings. In very advanced stages, integrated therapies, even without surgery, are justified, due to the poor prognosis of these cases.
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Thirty-two patients with stage III or IV invasive thymoma (14 women and 18 men; median age, 40 years) were treated at the Padua Medical Oncology Department from 1977 to 1988. All patients received the following chemotherapy in 4-day courses: 50 mg/m2 of cisplatin intravenously (IV) and 40 mg/m2 of doxorubicin IV on day 1; 0.6 mg/m2 of vincristine IV on day 3; and 700 mg/m2 of cyclophosphamide IV on day 4 (ADOC). The courses were repeated every 3 weeks, and toxic effects were tolerable. The radiologically defined overall clinical response rate (complete plus partial response) was 91% with 47% clinical complete remissions; median time to progression was 11 months (range, 0 to 96) and the median estimated (Kaplan-Meier) progression-free interval was 22 months. Five of the 15 clinical complete remissions were pathologically confirmed at thoracotomy. We believe the ADOC regimen qualifies for adjuvant and preoperative treatment of invasive thymoma due to the high complete response and overall response rates.
Since hepatitis C is sexually transmitted, this poses the problem of protecting the anti-HCV negative partners of anti-HCV positive subjects. Since no specific prophylaxis exists for hepatitis C, I suggest that 4 ml of normal human gammaglobulin should be given to the anti-HCV negative partners intramuscularly every two months until a vaccine against hepatitis C virus is available.
Isolation of virus-like particles from sera of anti-HCV positive patients and their ultrastructural characterization are reported. Particles were identified in sera of 5 out of 6 patients tested. Immunoelectron microscopy assay revealed small aggregates of viral particles. Size and morphological criteria suggest that these particles can be classified as Togaviridae.
The ultrastructural changes which occur during the mycelium to yeast transition in Histoplasma capsulatum induced by a temperature shift from 25 degrees C to 34 degrees C are described and compared to those observed after a temperature shift from 25 degrees C to 37 degrees C. 24 hours after the temperature shift to 34 degrees C only 8% of the cells are lysed. However, many mitochondria have lost their characteristic elongated form and have become rounded. Vesicular cristae which are no longer oriented parallel to the long axis of the mitochondria are also observed. In contrast a temperature shift from 25 degrees C to 37 degrees C induces lysis of 70% of the cells; mitochondria are rarely observed in the remaining cells. These ultrastructural changes can be correlated with the uncoupling of oxidative phosphorylation and the production of heat shock proteins.
Ultrastructural changes observed during the first 24 hours of mycelium to yeast transition in the dimorphic fungus Histoplasma capsulatum are reported. During this period the plasma membrane becomes undulated and the cell wall loses its characteristic fibrous outer layer. At 8 h the ordered lamellar structure of the mitochondria is no longer apparent. 24 h after the temperature shift 70% of the cells are lysed. The remaining cells contain many cytoplasmic membrane structures; mitochondria are rarely observed. These morphological changes are probably correlated with the physiological events characteristic of mycelial to yeast transition.