Biomedical subjects
Publications and source records attributed to S Lodrini.
The first known case of association of giant cell arteritis and normal pressure hydrocephalus is described. The arteritis was cured with corticosteroid therapy while hydrocephalus required ventriculo-peritoneal shunt. The high protein content of cerebrospinal fluid of this patient is probably the pathogenetic mechanism of cerebrospinal fluid block, leading to occult obstructive hydrocephalus.
The case of a young boy bearing a pituitary PRL secreting adenoma (20-30,000 ng/ml) with the unusual association of clinical and endocrinological features of Cushing's disease successfully treated with bromocriptine is described. Brain computed tomography evidenced a huge pituitary adenoma leading to visual field defects and raised intracranial pressure. Due to the very large size of the tumor, which rendered the complete neurosurgical removal unlikely, medical treatment with bromocriptine (10 mg/day) was started. Follow-up for more than six months demonstrated an impressive reduction of tumor size, the lowering of prolactin levels into the normal range, the normalization of visual field, and the regression of both clinical and biochemical signs of hypercortisolism.
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Two cases of metastases from carcinoma to intracranial meningioma are presented. In the first case the presence of the malignant tumor was unsuspected at the time of intracranial operation. In the second case, a breast cancer had been previously removed, and unusual cranial computed tomographic findings were noted. The literature on metastases to intracranial tumors is reviewed, and the association of meningioma and carcinoma of the breast is emphasized.
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A case of an intracranial meningioma containing a metastasis from breast cancer is reported. CT demostrated a hypodense area within the meningioma and angiography showed a relatively less evident blush in the same area. The correlation of the neuroradiological with the pathological findings is discussed.
The clinical correlation between the degree of HCV variability and the response to anti-HCV treatment in HIV positive patients infected with HCV genotype 3a is unknown. In this study, 27 HIV positive and 5 HIV negative patients with HCV genotype 3a infection were treated with interferon-alpha-2b with or without ribavirin. Nine patients (5 HIV positive) achieved a sustained virological response (SR) and 23 (only one HIV negative) were non-responders (NR). Sequence analyses of the partial E2 domain and the non-structural 5A protein were performed at baseline in all patients, and before and during treatment in the HIV positive NRs. There was no difference in the mean number of amino acid mutations from HCV 3a prototype, within E2 region, between the HIV positive and HIV negative patients: 17 (range 11-25) vs 16 (range 14-17). The mean baseline number of mutations in E2 region, was similar in HIV positive SRs and NRs: 18 (range 14-25) vs 16 (range 11-19). Phylogenetic analysis of HCV paired serum samples at baseline and during treatment revealed identical E2 sequence in 5/21 HIV positive NR patients, whereas 6 other sequences were strictly related to baseline E2 domain and the remaining 10 were divergent. The mean number of amino acid mutations in the NS5A protein at baseline, was 1 (range 0-3) in HIV negative patients and 2 (range 0-4) in HIV positive ones. This region was highly conserved in all isolates of HIV positive NRs analysed during treatment. These results suggest that genetic variability at baseline within the E2 region and NS5A protein of HCV 3a strain obtained from HIV positive and HIV negative patients is not associated with treatment response. Furthermore, the anti-HCV treatment did not influence HCV heterogeneity within the E2 and NS5A domains in HIV positive patients infected with HCV genotype 3a.
The amino terminal region of the non structural gene 3 (NS3) of hepatitis C virus (HCV) is a chymotripsinlike serine-protease responsible for cleavage of the non structural proteins of Hepatitis C virus (HCV). In order to investigate the genetic variation of this region, we developed a nested PCR to obtain NS3 protease sequences from 54 patients chronically infected with HCV genotypes 1a, 1b and 3, respectively. Comparison of nucleotide and amino acids sequences of NS3 protease domain with consensus sequence obtained within the same genotype, showed 3.73% nucleotide divergence and 1.64% amino acid divergence in isolates of genotype 3a, whereas isolates 1a exhibited 4.45% nucleotide and 4% amino acid change, respectively. Finally, NS3 sequence from 1b isolates revealed 6.47% nucleotide and 3.5 % aa changes. Comparison of consensus amino acid sequences derived from isolates 1a, 1b and 3, with the HCV prototypes showed a low amino acid sequence diversity. However, the consensus sequence of HCV genotype 3 isolates showed an amino acid changed from the prototype, that was located within a region important for enzyme structure and activity. These results indicated that the NS3 protease gene is highly conserved within the same HCV genotype. The domains involved in enzyme function were highly conserved in 1a and 1b strains, whereas consensus sequence of isolates 3a showed that the majority of these strains were not perfectly conserved in one of such regions. These findings altogether suggested that the NS3 protease enzyme of HCV may constitute an important target for antiviral therapy, but the NS3 protease variability of isolates 3 within a region that is a potential target for antiviral therapy could pose a problem for structure based drug development.
A surgical series of 59 patients with cerebellar or spinal cord hemangioblastomas or von Hippel-Lindau's (VHL) syndrome is analyzed. The presence of the tumor is easily detected by Computerized Tomography (CT) and Nuclear Magnetic Resonance (NMR), but angiography is still necessary for a correct surgical planning. The value of a sharp distinction among patients with single hemangioblastomas and the ones with Lindau's disease and VHL syndrome is stressed. In fact patients with single cerebellar or spinal hemangioblastomas have a good prognosis, while patients with disseminated hemangioblastomas have a rather poor outlook. Neuropathological studies with immunohistochemical techniques have been performed to identify the nature of the stromal cells of the hemangioblastomas: their origin from glial, endothelial and monociticphagocitic elements seems excluded.
The clinical, radiological and histological findings of a huge olfactory grooves meningioma in a 14 years-old girl are described. Good result after complete removal is stressed and concerning literature is reviewed.