[Two cases of pulmonary melanoma metastasis treated with radiofrequency: An alternative to surgical excision]. / Deux cas de métastases pulmonaires de mélanome traitées par radiofréquence : une alternative à la chirurgie.

BACKGROUND: based on consensual recommendations, surgery remains the standard treatment for curable lung metastases. In this setting, radiofrequency ablation of limited metastases has been described in numerous studies in recent years. We report herein two patients presenting with low-burden lung metastases from malignant melanoma treated by radiofrequency. PATIENTS AND METHODS: two patients presented with one to two limited burden lung metastases from malignant melanoma, respectively. Both patients received neoadjuvant chemotherapy leading to disease stabilization, after which the lung metastases were treated by radiofrequency. Both patients had complete remission following radiofrequency, with 12 and 21 months follow-up respectively. DISCUSSION: surgical treatment of solitary or scant pulmonary metastases from melanoma has proved its efficacy with a gain in overall and disease-free survival. Nevertheless, this treatment cannot be proposed in patients with contraindications for anaesthesia or compromised pulmonary function. In this population, radiofrequency ablation appears to offer a potentially valuable alternative to surgery. Additionally, the related morbidity and duration of hospitalisation associated with radiofrequency seemed to be improved. As seen in these two cases, the efficacy and increased survival achieved with radiofrequency appears comparable to those obtained through surgery.

[Bacterial meningitis in adults: a retrospective multicentric study in Tuscany (Italy)]. / Le meningiti batteriche dell'adulto: studio retrospettivo multicentrico della Toscana.

The Infectious Diseases Unit of Lucca Hospital conducted a multicentric retrospective study to evaluate the epidemiological and clinical features of adult patients affected by bacterial meningitis attending all the Infectious Diseases Units of Tuscany (Italy) from July 1999 to June 2004. A specific questionnaire was sent to all the units to collect information about each case of bacterial meningitis occurring in patients older than sixteen. Patients with meningitis by Mycobacterium tuberculosis were excluded from the analysis. Nine out of 12 Infectious Diseases Units of Tuscany took part in the study and 197 cases were identified. Most cases of meningitis occurred during 2002 with a slight reduction in cases in subsequent years. Streptococcus pneumoniae and Neisseria meningitidis were the most frequently isolated pathogens with an increase in diagnosis from 1999 to 2004; in 23.8% of patients no pathogens were isolated, with a reduction in meningitis from unknown aetiology from 1999 to 2004. Most patients were treated with a combination of two antibiotics, and corticosteroid drugs were added to the therapy; in the group of patients treated with corticosteroid drugs invalidating complications occurred in 23% of cases and 5% of patients died. In all, 27 out of 197 subjects (13.7%) developed invalidating complications and 20 out of 197 patients (10.2%) died.

Diagnosis and clinical use of bromperidol in HIV-related psychoses in a sample of seropositive patients with brain damage.

We evaluated in an open trial the safety and effectiveness of a high-potency neuroleptic (bromperidol) for the treatment of AIDS-related organic mental syndromes. Eleven (nine men and two women) seropositive patients with psychotic features were included; six were intravenous drug users (IVDU) and five were not IVDU (NON-IVDU). On the basis of the achievement of a CGI score of 1 or 2 (much improved or very much improved) at the fourth week, nine patients were considered responders, one was a partial responder and one was a non-responder. From a clinical point of view, "positive" psychotic symptoms had a significant remission, while the "negative" ones seemed to be less sensitive or insensitive to bromperidol treatment.

Cytologic and differential diagnosis of rhinosporidiosis.

Rhinosporidiosis is a mycotic infection caused by Rhinosporidium seeberi. The fungus occurs in tissues as spherules measuring 0.25-3 mm. The spherules contain endospores. Diagnosis is usually made histologically on biopsy specimens from polypoid lesions on the mucous membranes of the nasopharynx, larynx, trachea, bronchus and conjunctiva. In our experience two cases of rhinosporidiosis were diagnosed by cytology. The cytologic features are typical. On direct examination the spherules are well-circumscribed, globular structures with several endospores within. The spherules show great variability in size, up to 10-fold. The diameter ranges from 30 to 300 microns. Permanent stains for detecting R seeberi are Giemsa, Gridley and toluidine blue. Numerous mycotic infections (Coccidioides immitis, Histoplasma capsulatum, Mucor, Aspergillus, Blastoschizomya capitatus, Paracoccidioides brasilienses, Cryptococcus neoformans) can be definitively diagnosed or strongly suspected on cytology. In immunocompromised patients it is important to commence the diagnostic study on unstained material. By direct examination R seeberi organisms are identified readily by their brown color. Much more information can be gained from material stained with special stains, especially periodic acid-Schiff, in differentiating R seeberi from Coccidioides immitis.

Cytology in the percutaneous treatment of hydatid cysts. A report of four cases.

Four cases of percutaneous treatment of hydatid cysts are reported. Cytologic examination of the cyst fluid is important to confirm the diagnosis in patients who did not develop antibodies. Gomori stain gives the best results in identifying the three elements of a hydatid cyst: scolices, hooklets and laminated membranes. Moreover, staining for viability assessment gives information about the success of drug treatment.

[Neurological disorder associated to EBV: three case reports]. / Interessamento del sistema nervoso e infezione da EBV: casi clinici.

Epstein-Barr virus (EBV) is associated with a wide range of clinical manifestations. Neurological involvement (NI) during Infectious Mononucleosis occur in 1-5% of the cases, the only NI is more rare. From January 1995 to December 1996 three patients with NI and EBV infection have been observed in our department. The diagnosis were: meningoradiculitis (1 case), meningoencephalitis (1 case), aseptic meningitis (1 case). The diagnosis was based on the results of the lumbar puncture and on the serology: IgM VCA positive at the onset of the symptoms and a significant increase of the IgG VCA after three weeks. No other etiology was apparent. All the patients have been treated with dexamethasone, glycerol and acyclovir obtaining a complete remission of the disease. In these cases the NI has been the only clinical manifestation of the EBV infection. Therefore the authors believe that it is important recognize that EBV can cause a myriad of neurological illness with or without the stigmata of infectious mononucleosis and recommend the need to suspect this infection in any acute neurologic disorder.

[HIV infection and nosocomial risk: experience at the ORL Clinic of Pisa]. / L'infezione da HIV e il rischio nosocomiale: esperienza della clinica ORL di Pisa.

The risk of nosocomial risk of HIV infection and the problem of preventative measures to adopt has been modifying how workers in the health field deal with patients. In fact, the increased spreading of HIV infections within our population has led to the establishment of a national protocol of preventative measures by which no patient can be considered "safe". Consequently, the likelihood that contact with any patient can lead to infection causes the health care worker to look upon the patient as a potentially dangerous enemy, thus leading to a decline in the quality of health care. On the other had, although the risk of a health care worker being infected by HIV during routine work is low, preventative measures must be taken both during examination and during surgery. Unanimous agreement exists in regard to what measures are to be taken to prevent cutaneous and mucosa exposure of workers whenever the risk of accidentally coming into contact with the blood and/or other biological fluids exists. On the other hand, the use of an anti-HIV screening for all patients in order to distinguish between infected and non infected subjects is still subject to debate. Some feel such screening is unacceptable because it would deny sero-positive patients adequate care and could give rise to both false positives and false negatives while others propose routine screening feeling it to be helpful both to those who are sero-positive and to health care workers.(ABSTRACT TRUNCATED AT 250 WORDS)

Mycobacterial infection in HIV+ patients detected with a new immunological method (TB test).

Antibody response to antigen A60 (a mycobacterial antigen) was evaluated in ELISA in 18 HIV+ subjects with clinical and cultural evidences of mycobacterial infections, in 10 HIV+ subjects without Mycobacterial infections and in 22 healthy donors. We found higher levels of specific IgG in the HIV+ patients with Mycobacterial infections (mean 179.2 +/- 83 U) compared to the values of the donors (mean 92.5 +/- 35.5 U: p < 0.01). This test may be useful in the diagnosis of tuberculosis, but it needs clinical validation.

[The cytological picture in pleural pneumocystosis]. / Quadri citologici in corso di pneumocistosi pleurica.

We report a case of a HIV+ patient treated with prophylactic aerosolized pentamidine. The patient showed evidence of tensive right pneumothorax and slight pleural effusion. The pleural fluid was aspired from the drainage and processed in our laboratory. The cytologic examination of aspired fluid revealed abundant Pneumocystis carinii organisms. The cytologic presentation is peculiar in pleural fluid because of the presence of a large amount of trophozoites and a small number of cysts. Direct examination and Giemsa stain are suitable methods to detect trophozoites. The diagnosis can be confirmed by Gomori and Toloidine Blu stains that demonstrate the presence of isolated and scarce cysts. Pneumocystis carinii can also be recognized in Papanicolaou-stained smears as eosinophilic aggregates.

[Laboratory diagnosis of Pneumocystis carinii: comparison of cytological, immunofluorescent and immunocytochemical staining]. / Diagnosi di laboratorio di Pneumocystis carinii: paragone tra colorazioni citologiche, immunofluorescenza e immunocitochimica.

Authors review several methods for diagnosis of Pneumocystis carinii on BAL fluid in AIDS patients aiming to identify ideal routine technic. Giemsa, Gomori and Toluidine Blue staining. Direct and Indirect Immunofluorescence. Immunocytochemical methods were tested and advantages/disadvantages compared on BAL fluid from AIDS patients. Pneumocystis carinii was detected in 7 out 21 cases (33%). Gomori staining and Toluidine Blue staining were chosen for routine Pneumocystis carinii detection while IF technics are deserved as very useful in fields showing high fungal ++ contamination (inducted sputum).

Albendazole treatment of human hydatid tissue.

The effect of albendazole was studied in 12 patients with cystic hydatid disease (CHD) of the liver. Six patients received albendazole continuously for 6 months, while 6 patients received albendazole for 6 courses of 4 weeks with a 2 week drug-free interval between cycles. The continuous therapy proved successful, with stable involution at the follow-up at 24 months, while the patients treated with discontinuous therapy showed improvement or relapse. In our experience, continuous therapy was more effective and can be considered to be a suitable alternative or percutaneous therapy in uncomplicated hydatid liver disease, as an initial treatment.

[The behaviour of plasma triglycerides and cholesterol in HIV positive haemophiliacs] / Il comportamento dei trigliceridi e del colesterolo plasmatici in emofilici HIV positivi.

Hypertriglyceridemia has frequently been found both in subjects with AIDS and in asymptomatic HIV-positive ones. In order to evaluate the importance of hyperlipemia as an index of the clinical evolution of HIV infection, the levels of triglycerides, total cholesterol and CD4 lymphocytes were determined over a period of 2 years in 8 haemophiliacs with AIDS, 13 asymptomatic HIV-positive and 45 HIV-negative haemophiliacs attending the Operative Unit of Coagulation Disorders of the University of Pisa. The mean concentration of triglycerides and incidence of hypertriglyceridemia were significantly higher in haemophiliacs with AIDS, compared with HIV-negative subjects (p<0.0001), while the triglycerides values of asymptomatic HIV-positives fell between those of the other groups. Cholesterol levels were lower in HIV-positive haemophiliacs and in those with AIDS compared with HIV-negatives. No correlation was found between triglyceride levels and those of CD4 lymphocytes.