[Cryptococcus neoformans meningoencephalitis among apparently immunocompetent patients: description of two cases]. / Meningoencefalite da Cryptococcus neoformans in pazienti apparentement immunocompetenti: descrizione di due casi.

Cryptococcus neoformans is a ubiquitous fungal pathogen which causes human disease ranging from asymptomatic colonization of the lungs, to severe pneumonia, mediastinitis, meningitis or generalized infection. Although cryptococcal infection shows notably opportunistic features, it is sometimes also found among apparently immunocompetent individuals, with an extremely adverse outcome in the case of SNC involvement. Therefore, when faced with a presumed healthy person with anamnestic, clinical, CSF and instrumental findings consistent with chronic meningitis/meningoencephalitis, we must also consider cryptococcosis as a possible cause of disease. This may be rapidly achieved by resorting to quite a simple serological test, namely cryptococcal antigen detection. We describe two cases of cryptococcal meningoencephalitis occurring among apparently immunocompetent subjects (both HIV-negative, not under corticosteroid or immunosuppressive regimen, nor undergoing chemotherapy or radiotherapy. Laboratory diagnostics revealed the existence of reasonable immunological deficit for both subjects. Unfortunately, we were unable to establish whether the alterations in question were preexisting or concomitant with fungal infection. Our patients' course was somewhat problematic, according to findings observed in broader-based studies: this could mostly be explained by the considerable diagnostic delay which often marks cryptococcal infections of immunocompetent individuals. Nevertheless, neither of these two cases were complicated by intracranial pressure increase, leading us to speculate whether this disease may occur less frequently under conditions of substantial immunological integrity.

Use of vascularized iliac crest with internal oblique muscle flap for mandible reconstruction.

In the last decade, immediate reconstruction of maxillary bones following extensive trauma, large oncological defects, or late effects of radiation therapy has proved to be a reliable morpho-functional reconstruction technique. Use of the vascularized iliac crest with an internal oblique flap has become our flap of choice for mandible reconstruction when there is no need for overlying facial skin or oral sphincter reconstruction, and for bone segments within 6-15 cm of length. The advantages of this composite bone flap are the large and resizable bone stock available, the quality of bone transferred with an optimal height, depth, and contour of bone to maintain a good facial profile, and the possibility to reconstruct properly the oral lining, with a portion of the internal oblique muscle flap raised with the same pedicle that epithelializes during the healing stages. We present the experience of the Department of Maxillofacial Surgery of "S. Maria della Misericordia" Regional Hospital in Udine, Italy.

[Hepatic abscesses caused by Streptococcus intermedius]. / Ascesso epatico da Streptococcus intermedius.

Pyogenic abscess of the liver is uncommon child's pathology. The authors briefly describe a clinical picture characterized by beginning of an hepatic abscess dues to a germ that is not usually pathogen for men. It is often a mouth saprophyte.

Mild sialoadenitis: a common finding in patients with hepatitis C virus infection.

BACKGROUND: Sjögren's syndrome (SS) is an autoimmune disease of presumed viral origin; sialoadenitis has been reported to occur in hepatitis C virus (HCV) infection. METHODS: Lip biopsy specimens were graded in 32 consecutive patients with either HCV-related chronic liver disease or SS. RESULTS: Seventeen of 22 HCV-positive patients had sialoadenitis, although generally mild (15 of 17, grades I-II). Severe inflammation (grades III-IV) was observed in 8 of 10 patients with SS (chi-square = 12.6; P < 0.0005). Moreover, HCV-positive patients with sialoadenitis differed from patients with SS in female sex prevalence (6 of 17 versus 10 of 10; chi-square = 10.9; P = 0.0001) and presence of serum antinuclear autoantibodies (0 of 17 versus 9 of 10; chi-square = 23.0; P < 0.0001). Five of 13 HCV-positive patients and 7 of 8 patients with SS were HLA-DR3-positive (chi-square = 4.9; P < 0.05). CONCLUSIONS: Sialoadenitis of HCV-related liver disease is common but differs from SS with regard to predisposing genetic factors, expression of autoimmune markers, and histopathologic severity.

[Anti-endomysium antibodies: a new marker for the diagnosis and treatment of celiac disease]. / Gli anticorpi antiendomisio: un nuovo marker per la diagnosi ed il trattamento della malattia celiaca.

Coeliac disease is the most frequent cause of chronic diarrhea (1:1000 children) in Italy. It often has atypical symptoms, so a sensitive and specific test is needed that can both simplify the ESPGAM criteria and monitor compliance of patients to their gluten free diet. The AEmA (anti endomysium antibody), found by Chorzelsky in 1984, appears to be a very sensitive and specific screening test in the diagnosis of coeliac disease (CD). Sera from 150 children, mean age 4 years (range 6 months to 20 years) were tested for endomysium antibodies (IgA class) and anti gliadin antibodies (IgG class). From our preliminary study IgA-AEmA seem to be more specific for CD than IgG class anti-gliaadin antibodies.

Mandibular prognathism: a cineradiographic analysis of mandibular and hyoid bone movements before and after surgical correction.

A study was undertaken to investigate the effect of surgical treatment of mandibular prognathism on mandibular and hyoid movements during speech and swallowing in fourteen individuals. The material consisted of cineradiographic records of adult prognathic patients before and after the surgical correction. The records were obtained with a 16 mm, cinecamera at a speed of thirty-two frames per second. Image intensification was used, and the head of the patient was positioned in a cephalostat during the recording. Postoperative recordings were taken at about 1 month after the removal of intermaxillary fixation. To improve the accuracy of the analysis, templates of the skeletal structures were prepared. The following cephalometric landmarks were located and marked on the template: the tip of the upper central incisor, the occlusal plane, pogonion, and hyoid point. The coordinates of the cephalometric points were recorded by means of a Lysta dental digitizer linked to a Hewlett-Packard 9815A desk-top computer. The significance of the difference between the pre- and postoperative values was determined by the Student's test. The results were examined for variations in the vertical and horizontal ranges of movement and in the surface areas covered by pogonion and hyoid during movement. Correlation between several pairs of variants was tested. Large individual variations were found in the pattern and range of movement of the mandible and hyoid both pre- and postoperatively. The coefficients of correlation between several parameters showed some significant correlation, which disappeared after surgical correction. A general trend for a reduction in most parameters studied was shown. Some correlation between the amount of setback and the mandibular movement was also found. The hyoid and mandibular movements in tongue-reduction cases do not differ significantly. Lines of further investigation are suggested, with larger and possible more homogeneous samples.