Persistence of human T cell lymphotropic virus type 1 (HTLV-1) sequences in peripheral blood mononuclear cells from patients with mycosis fungoides.

Mycosis fungoides (MF) is a rare form of cutaneous T cell lymphoma suspected of having a viral etiology. As in adult T cell leukemia, the virus involved may be human T lymphotropic virus type 1 (HTLV-1). We cultured the peripheral blood mononuclear cells (PBMC) of 29 patients with MF HTLV-1 seronegative by enzyme-linked immunosorbent assay and Western blot. The presence of reverse transcriptase (RT) and p24 antigen was investigated in the concentrate supernatant of the culture. The DNA of all studied patients was submitted to polymerase chain reaction and Southern blot analysis using primers and probes recognizing the tax region of HTLV-1/2 and the pol region of HTLV-1. 10 of 29 patients were found positive to HTLV-1, whereas they were always negative to RT and p24. The same results were confirmed in double blind after 6 mo. Our findings suggest HTLV-1 may be involved in the etiology of MF, at least in certain cases.

Antinuclear antibodies in psoriatic arthritis and its subgroups.

We tested serum samples from 48 patients with Psoriatic Arthritis (PA) for Antinuclear Antibodies (ANA) using a highly sensitive substrate (Hep-2 cells). We obtained the following results: 1) in PA patients ANA positivity (16.6%) was significantly higher than in age-and sex-matched groups of healthy controls (4.1%; p less than 0.05) and uncomplicated psoriasis (2%; p less than 0.025). 2) ANA were more common in Symmetrical Polyarthritis (37.5%) and Arthritis Mutilans (25%) than in Asymmetrical Oligoarthritis and Spondarthritis (11.8%) and 'Classical' PA (0%). 3) We did not find any positivity for anti-DNA and anti-ENA antibodies among PA patients.

Model-based dialysis adequacy prediction by continuous dialysate urea monitoring.

A modeling approach for on-line estimation of urea kinetics from continuous measurement of urea concentration in the effluent dialysate stream (DUN) is presented. On-line identification of urea kinetics response parameters is used to predict and update dialysis adequacy during the treatment. Dialysis adequacy can be quantified in several ways, but its strict dependence on final urea concentration is a major fact. For this reason, a good predictive skill on the time course of DUN may enable better performances in the control of dialysis outcome by treatment parameters adjustment. A post-filter enzymatic sensor performs continuous measurement of DUN on patients undergoing standard haemodialysis. To get an early prediction of the end dialysis urea level, the solution of a variable volume double-pool (VVDP) model is used, whose parameters are identified at each time on the basis of the past DUN history Unlike the variable volume single-pool (VVSP) model, this enables a prompt and accurate estimation of the final DUN. In fact, after 75 min the estimates always differ by less than 10% from the values measured by the sensor at the end of the treatment. Moreover, values predicted by the model in the last hour always lie within 1% of measured final values. Real-time knowledge of an analytic expression for whole DUN time course also enables the accurate prediction of total removed urea, with no need of cumbersome dialysate collection techniques.

A new biosensor for continuous monitoring of the spent dialysate urea level in standard hemodialysis.

This study gives the results in terms of precision and repeatability of a new on-line urea monitoring system (Ureascan P2 Hospal) capable of measuring the urea concentrations in the spent dialysate. The Ureascan P2 Hospal (UP2H), fitted on single-pass dialysis machines (Integra-Hospal), functions by the presence of a disposable mini-reactor containing urease. The passage through the reactor of a minimum quantity of spent dialysate from the filter diluted with a pH 7 buffer solution (1 ml/min) increases its ionic strength, which is detected by a differential measurement of conductivity in proportion to the urea concentration in the dialysis liquid. We studied 13 dialysis sessions, with bicarbonate buffer, in 8 anuric patients. From 4 to 7 dialysate samples were taken during each treatment to determine the urea and 65 samples were analysed overall. Urea values from the UP2H were compared with those measured on the Dimension Du Pont analyser. Simple linear regression analysis showed an excellent correlation between the 2 measuring methods (r=0.987; p<0.001). The Bland-Altman test gave an average difference between the urea values measured with the UP2H and in the laboratory of 1.3+/-1.2 mg/dl. The agreement limits between 2 SD were -1.2 mg/dl and +3.8 mg/dl respectively. In conclusion, the UP2H we have developed has proved to be a reliable and very useful instrument for adapting, through the urea kinetic mathematical models, the dialysis dose for individual patients.

Alterations in erythrocyte morphology induced by blood pumps.

A scanning electron microscopy was used after in vitro and in vivo tests to investigate any alterations caused by the peristaltic roller pump in erythrocyte morphology. The electron micrographs of samples were examined as follows: 1) by image analyser; 2) by applying Bessis's classification for the qualitative study of crenated red blood cells (RBCs). The in vitro test was repeated four times using blood from healthy donors. Each basal blood sample was divided into 250 ml portions, each of which was recirculated for 12 minutes at different flow rates. In order to verify any persistent erythrocyte damage caused by the peristaltic pump, 15 minutes after recirculation at 450 ml/min, another sample was prepared using the blood remaining from the last test. A statistically significant direct correlation was found between blood flow (Qb) increase and the percentage of morphologically altered RBCs, when either using an image analyser (r = 0.97; p < 0.05) or Bessis's classification (r = 0.95; p < 0.05). However, neither method showed any statistically significant difference between the percentage of deformed RBCs, determined in the basal sample, or in the percentage found at the end of the 450 ml/min test after standing 15 minutes at room temperature. The in vivo test was carried out on 6 patients over 2 dialysis sessions, which differed only for the Qb: 250 versus 400 ml/min. The two dialysis sessions gave comparable results when using both study methods regarding the presence of deformed RBCs.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison between three mathematical models of KT/V.

In thirty anuric patients undergoing chronic hemodialysis the KT/V values obtained with the formula: (formula; see text) were compared with the values obtained with the following two formulae: (formula; see text) The results given by formulae B and C differed from those with formula A respectively by 12.81 +/- 11.98% and 10.38 +/- 3.64%. For routine determination of KT/V we suggest the use of formulae A and C as a means of establishing rapidly, in one step, whether the hemodialytic treatment examined is adequate.

[Mass transfer of magnesium in hemodialysis]. / Mass-transfer del magnesio in emodialisi.

The rate of mass-transfer (MT) of magnesium during hemodialysis was studied in thirty-five patients with hypermagnesemia (Mg = 3.75 +/- 0.72 mg/dl) undergoing chronic hemodialysis. The aim of the study was to verify which is the best dialytical approach to remove the excess of magnesium. The concentration of Mg in the dialysate was of 1.82 mg/dl for all patients. MT was -0.51 +/- 0.36 g and no statistical difference was found between patients treated with cuprophan hollow fibers dialyzers, PAN and cuprophan plates. Mg MT is not correlated with dialysis duration (r = -0.23; p:ns), urea clearance (r = -0.08; p:ns), KT/V index (r = -0.03; p:ns), blood flow (r = -0.15; p:ns). In conclusion from our data, in agreement with other Authors, reduction of serum Mg levels is more convenient by obtained by a decrease in Mg concentration in the dialysate under 1.82 mg/dl, in order to increase the blood-dialysate concentration gradient.

Generalized melanosis associated with malignant melanoma: unusual histologic appearance.

A case of generalized melanosis associated with malignant melanoma, characterized by up-to-date, previously undescribed histologic findings, is reported. Markedly dilated dermal lymphatics with features resembling secondary lymphangioma were found. We speculate that a further mechanism, as well as those previously reported in the literature, could be operative in the pathogenesis of this disorder of altered pigmentation.

Low sodium concentration solution in normohydrated CAPD patients.

The aim of this study was to examine the possibility of increasing sodium and water removal with peritoneal dialysis. Ten patients aged 67.3 +/- 6.2 years, on continuous ambulatory peritoneal dialysis (CAPD) for 28.1 +/- 13.9 months, with no episodes of peritonitis for at least 2 months and clinically normohydrated, gave their informed consent to undergo two consecutive peritoneal equilibration tests (PETs) with dialysis solution at a sodium concentration of 126 mEq/L (low sodium) and 132 mEq/L (normal sodium), both with 2.5% glucose. Net ultrafiltration and sodium mass transfer were 319.4 +/- 178.5 and 443.2 +/- 234.4 mL (p = 0.0346) and 27.7 +/- 24.5 and 28.2 +/- 27.1 mEq (p = NS), respectively. There were no variations in natremia or the transport indices of the studied solutes or in the arterial pressure or heart rate. All patients showed drowsiness or torpor during the low sodium PET and one had cramps. The 126 mEq/L sodium dialysis solution showed no advantages compared to the more common solution, 132 mEq/L. However, further study is necessary to check the potentiality of solutions with different sodium and glucose compositions for both acute and chronic use.

[Comparative clinical study between standard hemodialysis, PHF (HDF on-line) and PHF AF (HDF on-line acetate free)]. / Studio clinico comparativo fra HD standard, PHF (HDF on-line) e PHF AF (HDF on-line acetate free).

PURPOSE AND METHODS: In this study, three different techniques were compared in eight uremic patients on regular dialysis treatment: standard hemodialysis (HD), paired hemodiafiltration (PHF) and PHF acetate free (AF). We evaluated the Kt/V, the percentage reduction in Beta 2-microglobulin, the acid-base balance (blood samples were drawn pre-treatment and after 30, 60, 120 and 180 min, post-treatment and pre-treatment of the following session) and the acetate plasma concentration pre- and post-treatment. RESULTS: Between these treatments there were no significant differences in Kt/V and in urea reduction rate (URR). The percentage reduction in plasma Beta 2-microglobulin levels was significantly higher in PHF and in PHF AF than in standard HD. CONCLUSIONS: The correction of acidosis was not significantly different between standard HD and PHF, while it was significantly less effective in PHF AF. The post-dialysis plasma acetate concentration was significantly lower in PHF AF than in standard HD and in PHF with an improvement in cardiovascular (CV) stability and a reduction in oxidative stress.

[Persistent lymphedema of the penis and scrotum after recurrent episodes of cellulitis and urethritis caused by Chlamydia trachomatis]. / Linfedema persistente del pene e dello scroto successivo ad episodi recidivanti di cellulite ed uretrite da Chlamydia trachomatis.

A 20 year old man affected by a persistent peno-scrotal lymphedema is reported. This condition followed recurrent attacks of cellulitis and a chronic urethritis. From the urethral discharge we isolated Chlamydia trachomatis and, only during the attacks of cellulitis, Group G Streptococcus. This pathogen cannot be isolated from microflora of the normal urethra and rarely cause cellulitis. In our opinion Chlamydial infection favoured the urethral colonization of Group G Streptococci and their passage in the loose connective tissue of the penis and scrotum. Lymphedema, clinically inapparent before the first attack, become progressively more severe and recurrent attacks took place at intervals without obvious re-exposure to an exogenous source of streptococci. The operative treatment of persistent lymphedema is lymphangiectomy and lymphangioplasty.

[Pemphigus and neoplasia. 2 new clinical cases and a review of the literature]. / Pemfigo e neoplasie. Due nuovi casi clinici e revisione della letteratura.

We report two cases of pemphigus vulgaris associated with internal malignancies. The former was a 56 year-old man who developed pemphigus shortly after non-Hodgkin lymphoma has been formed. The latter was a 69 year-old woman who presented pemphigus and gastric carcinoma in the same time. In order to clarify the relationships between all forms of pemphigus and malignancy or thymoma, a search of the world literature was carried out. We found 44 reports of the association of pemphigus with internal malignancy and with benign or malignant thymoma. The key problem that needs to be resolved is whether there is a causal relationship or whether these are only occasional coincidental findings.

[Proposal for a therapeutic protocol in Crosti lymphoma]. / Proposta di protocollo terapeutico nel linfoma di Crosti.

Three patients with Crosti's lymphoma were treated with radiotherapy using electron accelerators. The energy radiations ranged from 5 to 9 Mev. with large fields. The total dose was 40 Gy, delivered in 2 Gy fractions daily. The treatment lasted four weeks. No side effects were reported and no recurrence was remarked after 24 months.