[MIPS: multicenter Italian pneumonia study. Results of an observational, prospective and multicenter study on the clinical approach to community-acquired pneumonia]. / MIPS: multicenter Italian pneumonia study. Risultati di uno studio osservazionale, prospettico e multicentrico sulla gestione clinica delle polmoniti acquisite in comunita.

In a survey of 25 Divisions of Internal Medicine and Pneumology throughout Italy, our study aimed to ascertain the diagnostic and therapeutic pathway, the gravity in accordance with Fine's score (PSI), the median hospital length of stay and mortality rate among patients consecutively hospitalized for community-acquired pneumonia (CAP), from January 1 to March 31, 2002. Overall 407 patients were evaluated, with a mean age of 69 years; the following Fine's scores: 28% less than 70, 21.4% between 71 and 90, 31.25% between 91 and 130, 19.4% more than130. A single chest radiography was performed in 27.2% of the patients, two chest radiographs in 55.2% of the patients, more than two chest radiographs in 13.2% of the patients. A CT scan of the thorax was performed in 20.1% of the patients; arterial blood gas tensions were measured in 73.4% of the patients. Antibiotics were used as follows: beta-lactams in 46.5% of the patients, fluoroquinolones in 30% of the patients, macrolides in 13.2% of the patients, glycopeptides in 2.2% of the patients, others in 2.9% of the patients. Mean hospital stay was 11 days; the 30-day in-hospital mortality was 9.6%. This study showed that a large number of patients with low-risk CAP were unnecessarily hospitalized.

Dorfman-Chanarin syndrome: a case with prevalent hepatic involvement.

BACKGROUND/AIMS: Dorfman-Chanarin syndrome is a very rare condition determined by an autosomal recessive inherited disorder of neutral lipid metabolism. The syndrome is defined by the association of ichthyosiform nonbullous erythroderma, vacuoles in the leukocytes and variable involvement of liver, muscle and central nervous system. Only 19 cases have been described worldwide. METHODS: We studied a 16-year-old patient with congenital ichthyosis, liver and spleen enlargement and abnormal gamma-glutamyltransferase. Liver biopsy, skin biopsy and blood smear showed abnormal intracellular neutral lipid storage. RESULTS/CONCLUSION: On the basis of clinical and histological findings, the patient was diagnosed as having Dorfman-Chanarin syndrome. This is the fourth reported Italian case, with a prominent skin and hepatic involvement. Liver biopsy, performed in the first instance, was of great importance in reaching a diagnosis.

[Toxic shock syndrome due to Streptococcus pyogenes: a case report]. / Sindrome da shock tossico da Streptococco pyogenes: descrizione di un caso clinico e revisione della letteratura.

An increasing number of severe invasive Group A streptococcal infections have recently been reported. A new syndrome similar to the staphylococcal toxic shock syndrome, defined "streptococcal toxic shock-like syndrome" is also described. We report a case of streptococcal toxic shock-like syndrome with atypical clinical onset. A 67 years old man was admitted on the emergency department because of pain in the scapular area without fever. The patient developed irreversible shock and died after 36 hours. Diagnosis was made with autopsy. We stress the possibility of infectious cause in presence of severe multi organ failure with rapid clinical exacerbation.

[Importance of the determination of blood pressure profile in the diagnosis of atherosclerotic cardiovascular disease]. / Importanza della determinazione del profilo pressorio nella diagnostica del danno cardiovascolare aterosclerotico.

The nocturnal decline of blood pressure (BP) is not observed in autonomic dysfunction (after cardiac transplantation and in patients with diabetic neuropathy) or in patients with atherosclerotic cardiovascular disease. This study evaluated if smoking prematurely alters the blood pressure during the night and if the cumulative risk of hypertension and smoking may additionally alter this nocturnal profile. Three different groups of subjects were studied. In each subject systolic and diastolic BP was recorded, for 24 hours at 15 min intervals, by automatic non-invasive monitoring. Group 1 consisted of 14 normotensive nonsmokers (with a mean age 50, range 38 to 54 years); Group 2 consisted of 14 normotensive heavy smokers (with a mean age 48, range 37 to 52); Group 3 consisted of 14 heavy smokers with mild or moderate hypertension and with left ventricular hypertrophy (with a mean age 51, range 39 to 54 years). We have evaluated particularly the average systolic and diastolic BP during 3 hours of the day and 3 hours of the night, the latter selected from midnight to 3.00 am, when the patients were asleep, and the former selected from 3.00 pm to 6.00 pm when they were engaged in social activities in the hospital. The statistical analysis showed that in normotensive heavy smokers (and in hypertensive smokers) the normal nocturnal decline of BP is not present. This physiologic fall in arterial pressure was normally observed in the group of normotensive nonsmokers. The absence of nocturnal decline of BP may be related to the reduced arterial distensibility secondary to smoking damage and may represent an important and early marker of this vascular alteration.

[Evaluation of blood ferritin in sideropenic anemia and its modifications in the course of divided-dose parenteral iron therapy]. / Valutazione della ferritinemia nell'anemia sideropenica e sue modificazioni in corso di terapia marziale parenterale refratta.

Changes in blood ferritin during divided dose parenteral iron therapy and the importance of ferritin evaluation in iron-deficiency anaemia were investigated in 20 women and 10 men with this diagnosis through withdrawals before and after treatment. In 6 subjects, blood ferritin values enabled the presence of iron deficiency to be ruled out, since they were high at the first control (in agreement with the histological examination of the marrow in the search for iron deposits). In sideropenic males, the difference between values at the time of diagnosis and those of normal controls was significant (p less than 0.001). The absence of this finding in the females may have been due to over-low values in the normal controls. Blood ferritin values during therapy gradually rose until its termination. The conclusion is drawn that at any rate in males the determination of blood ferritin can be a useful aid in the diagnosis of iron-deficiency anaemia, and in the demonstration of normal reserves after treatment.

[The importance of thyroid hormone determination in the course of acute and chronic liver diseases]. / Importanza del dosaggio degli ormoni tiroidei in corso di epatopatie acute e croniche.

The RIA values of thyroid hormones in the course of acute and chronic liver disease were studied to see whether they were related to the severity of the picture in a series of 50 healthy subjects and 133 with various hepatopathies: 26 with acute viral hepatitis, 18 with alcoholic liver disease, 16 with alcoholic cirrhosis without ascites and 33 with ascites, 14 non-alcoholic cirrhosis without ascites and 24 with ascites. A reduction in T3 proportional to the seriousness of the clinical and laboratory findings was noted in chronic forms, whereas both T3 and T4 were high in acute viral hepatitis. There was no difference in T3 values in alcoholic and non-alcoholic cirrhosis of similar gravity, showing that the fall in serum T3 is not a specific alcohol-induced lesion. T3 less than 25 ng/100 ml proved the best index in the prediction of mortality (chi 2 = 20,5; p less than 0,0005).