[Pulmonary re-expansion edema. Description of two cases and observations about its management]

Two cases of Reexpansion pulmonary edema (RPE), an uncommon complication of the treatment of chronic lung collapse secondary to pneumothorax or pleural effusion, are described. RPE is generally unilateral and occurs when the lung is rapidly reexpanded by active evacuation of large amounts of air or fluid. Nevertheless, both cases observed confirm that RPE can be seen when the pulmonary collapse is of short duration and the lung is reexpanded without suction. The pathogenesis of RPE is still unclear and is probably multifactorial. Implicated in the etiological process of RPE are chronicity of collapse, technique of reexpansion, increased pulmonary vascular permeability, airway obstruction, loss of surfactant, and pulmonary artery pressure changes. In the observed cases RPE appeared unexpectedly and dramatically, which is typical of the condition. The edema progressed for 24-48 hours, although it may persist for 4-5 days. Therapy was supportive and proportional to the severity of the clinical picture. Both needed mechanical ventilation, while only in case 1 was a hemodynamic support applied. Since the outcome is still fatal in 20% of cases, physicians treating chronic lung collapse must be aware of the possible causes and try to prevent the occurrence of this complication.

Presurgical integrated MRI/SPECT localization of the sensorimotor cortex in a patient with a low-grade astrocytoma in the rolandic area

We describe the case of a young man who, despite the presence of a tumour in the left sensorimotor cortex, exhibited no motor deficit. Integrated MRI/SPECT-CBF study during motor activation was aimed at determining which cerebral areas were involved in movement execution in this patient and their relationship with the tumour. CBF changes during motor activation were located in two motor areas: anteriorly and medially to the tumour in the left frontal lobe (+29%) and in the right medial frontal cortex (+43%). Integrated MRI/SPECT images provided both an anatomical and functional definition of the motor areas in a patient with a rolandic tumour and could prove useful in determining preoperatively an appropriate surgical strategy.

Delusions in Alzheimer's disease and multi-infarct dementia

Neuropsychiatric symptoms such as delusions and misidentifications have been reported in dementia ranging from 10% to 73% in Alzheimer's disease (AD) patients and up to 40% in multi-infarct dementia (MID) patients. The aim of this study was to investigate in 61 AD and 31 MID patients both the frequency and the content of delusions during the course of illness and to evaluate the relationship between these and both functional and mental decline. The results indicated that delusion experiences had occurred in 45% of AD patients and in 38% of MID patients, occurring most frequently during the first year of illness. Patients who experienced psychiatric symptoms showed higher mini mental state examination scores and were less impaired in functional disability measures. With regard to the content, no significant differences were observed between AD and MID patients; 53% of psychotic symptoms were found to be paranoid delusions while 47% were misidentification delusions.

DHPR activity decrease in dried blood spots stored at 4 degrees C

Dihydropteridine reductase (DHPR) activity has been measured in dried blood spots by the Arai method in 286 subjects divided into 4 groups: 45 newborns aged between 4 and 7 days; 40 subjects with hyperphenylalainaemia; 199 apparently normal subjects, and 2 patients with DHPR deficiency. Furthermore, a study of the persistence of enzymatic activity on the spots stored at 4 degrees C revealed that after 1 year it decreased to one third of the original value, corresponding to the mean value of controls minus 2 SD.

Free tryptophan decrease in jaundiced newborn infants during phototherapy

Tryptophan and nonesterified fatty acids (NEFA) are bound to serum albumin. NEFA displace tryptophan from their binding sites. Since NEFA decrease during phototherapy, we examined reciprocal variations of NEFA, total and free tryptophan in jaundiced newborn infants during phototherapy. After 24 h of phototherapy, we noticed a significant decrease of both NEFA and free tryptophan (p less than 0.001). Free tryptophan variations might affect the synthesis of cerebral neutrotransmitter 5-hydroxytryptamine, which depends on the passing of free tryptophan through the blood-brain barrier.

Effects of dynorphin on the PHA-induced lymphocyte proliferation in vitro

The effect of the opioid peptide dynorphin (DYN) on PHA-induced lymphocyte proliferation has been evaluated in the present study. A significant increase in PHA-induced lymphocyte activation was observed when DYN was added to cultures 48 hr after the mitogenic stimulation. This effect occurred at suboptimal (3.12 and 6.25 micrograms/ml) PHA concentrations and at DYN doses ranging from 10(-9) to 10(-12) M. Conversely, DYN did not affect the lymphocyte blastogenic process either when added before, or simultaneously or after intense PHA (12.5 micrograms/ml) stimulation. Naloxone preincubation did not modify the above described effects. Results suggest that DYN might play a role in neuroendocrine regulation of the lymphocyte blastogenic process.

[Osteomyelitis caused by atypical mycobacteria in multiple colonies]

The authors describe a seven months and a half little girl, A.B., affected by multiple localization osteomyelitis caused by an Atypical Mycobacterium, with the culture identifies as M. Avium, belonging to the third group of Runjon classification. The radiographic tests show a primary pulmonary complex and some osteolytic areas of the seventh right rib and of the bones of the lower legs (femur and tibia). From the beginning a multiple antituberculous chemotherapy against non tuberculous mycobacterial disease has initiated: Streptomycin (for two months) associated with Rifampicin, Isoniazid and Pyridoxine. The patient responds very slowly to the treatment and only three years later the whole radiologic regression of the lesions occurs. The interest of the case comes from the extreme rarity of disseminated bone localization during an atypical mycobacterial infection, and also from the early beginning of the clinical and radiologic manifestations.

[Hepatitis B and hepatitis A markers in 33 cases of acute hepatitis B surface antigen-negative, hepatitis A virus antibody-positive viral hepatitis. Importance of immune complexes]

The authors have looked for the markers of HBV by R.I.A. method (HBsAg, anti HBsAg, HBeAg, anti HBeAg, anti HBcAg), of HAV (by measurement on two samples of HAVab or by measurement of HAVab IgM), the immune-complexes (I.C.C.) by C1q solid-phase binding assay method with E.L.I.S.A. with determination after division I.C.C. of HBsAg by R.I.A. method in 33 cases of HBsAg negative acute viral hepatitis. The 9% (3 cases) were HAV acute hepatitis, the 42,4% (14 cases) no A no B acute hepatitis, the 36,3% (12 case) were HBV acute hepatitis, in 9 anti HBcAg positive cases the I.C.C. with HBsAg positive after division resulted positive, the 12,3% (4 cases) had a positivity for HAVab by stereoconversion (2 cases) or HAVab IgM (2 cases) with HBsAg positivity after division I.C.C. This result puts a nosologic problem about the 4 cases of acute viral hepatitis, which, from epidemiological and clinical point of the view are HAV acute hepatitis.

[Meaning and development of markers of acute hepatitis]

The Authors analyse the results of their tryls about the markers of HBV and HAV acute hepatitis (HBsAg, anti-HAVAb) by R.I.Z. method. HAVAb was in 75% of the cases, its meaning was of post-contact with HAV. The title of HAVAb was effected in 18 patients with viral acute hepatitis; the results were 3 cases of HAV acute hepatitis and in other 7 cases no Ano B viral acute hepatitis. The 58.3% of acute viral hepatitis was HBsAg positive, the study of other markers of HBV and the title of HAVAb showed a viral acute hepatitis caused by HBV. We were not able to demonstrate the viruses which caused 7 HBsAg negative acute virale hepatitis, anti-HBcAg was in 97.8% of HBV acute hepatitis; its the most sensitive of HAV past-infection. The system c-anti-e was in 78.2% of HBsAg viral acute hepatitis. The persistence after 7th week of illness of HBeAg coincided with the hepatitis cronicity. On the contrary anti-HBeAg has not always a protective meaning.