Prolonged effect of two combined methods for Legionella disinfection in a hospital water system.

This study was conducted in our 650 bed general hospital, which is situated on the southern outskirts of Milan (Italy). After a first nosocomial case of pneumonia (caused by Legionella pneumophila serogroup 1), we first used a conventional method (heat shock) without success. To solve the problem we then tried a copper-silver ionization system combined with a chlorine dioxide device. During the four years after the installation of these two systems we recorded a significant (p < or = 0.05) reduction in Legionella colonization, and no new cases of Legionnaires' disease were observed. Our results suggest that the Cu-Ag ionization system, combined with a chlorine dioxide device, is a highly promising method for the control of Legionella pneumophila in a hospital water distribution system.

[Antibodies anti granulocytic antigens in IBD: from microscopic morphology to antigenic specificity]. / Anticorpi contro gli antigeni granulocitari nelle IBD: dalla morfologia microscopica alla specificità antigenica.

OBJECTIVE: ANCA (p-ANCA and x-ANCA) have been documented to occur in many inflammatory disorders. The specific ANCA antigens and the clinical correlation of a positive ANCA test in these disorders are still for the most part obscure. The aim of the present study was to investigate the prevalence of and the target antigens for ANCA in patients with IBD. METHODS: 104 patients (67 age between 3-18 years, mean age 8+/-3 and 37 age between 25-70 years, mean age 48+/-15) clinically and hystopathologically diagnosed as: 67 ulcerative colitis, 16 Crohn' disease, 21 other colitis (7 indeterminate colitis) were enrolled in our study. ANCA were determined by ELISA and IIF methods. RESULTS: We observed a good performance in terms of sensibility and specificity of ANCA, and a good correlation between the two methods used; as regard ELISA determination the antigen frequently found in our cases was lactoferrin (60%). CONCLUSIONS: Is still unclear the role of these "minor antigens" in the diagnosis and pathogenesis of IBD, but is clear that only morphologic evaluation is no more sufficient.

Immunological markers anti-saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) in inflammatory bowel disease: a helpful diagnostic tool.

AIM: Nowadays the diagnosis of inflammatory bowel disease (IBD) and the differentiation between Crohn disease (CD) and ulcerative colitis (UC) is still based on morphological changes identified at endoscopy, radiology, and histopathology. In 5-15% of cases this differentiation is not possible (diagnosed with indeterminate colitis). METHODS: We evaluated if recently developed commercial kits for the determination of anti-Saccharomyces Cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) are useful in differentiating cases of UC from CD diseases with a consequent reduced number of undefined colitis and improved clinical management. Sera from 56 consecutive patients with a clinical diagnoses of IBD were evaluated in a blinded fashion for the presence of ASCA IgA and IgG and ANCA IgG with 2 different diagnostic methods: indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA). RESULTS: In our cases we observed good agreement between histopathological examination and laboratory results and the combined use of ASCA and ANCA yielded a correct diagnosis in 93% of patients with CD and in 97% of the UC patients. CONCLUSIONS: We confirm the value of the test for the diagnosis of CD and UC and the differentiation from other forms of colitis.

The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects.

BACKGROUND: Recent studies suggest that coeliac disease (CD) is one of the commonest, life-long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy. PATIENTS AND METHODS: Fifteen centres screened 17,201 students aged 6-15 years (68.6% of the eligible population) by the combined determination of serum IgG- and IgA-antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA-AGA positive and were recalled for the second-level investigation; 111 of them met the criteria for the intestinal biopsy: IgA-AGA positivity and/or AEA positivity or IgG-AGA positivity plus serum IgA deficiency. RESULTS: Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening-detected coeliac patients showed low-grade intensity illness often associated with decreased psychophysical well-being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 x 1000 (95% CI 3.79-5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 x 1000 (95% CI 4.57-6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7. CONCLUSIONS: These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.

[Alpha 1-antitrypsin deficiency: the Brescia clinical study]. / Il deficit di alpha 1-antitripsina: lo studio clinico di Brescia.

In a longitudinal clinical study, two hundred subjects have been evaluated in order to identify alpha 1-antitrypsin deficiency patients. According to their serum alpha 1-antitrypsin levels, they have been divided into three groups: 25 patients with severe deficiency (with both pathological alleles--ZZ, SZ or Z and rare deficiency allele--and, if clinically suggested, to be treated with augmentation therapy), 92 patients with intermediate deficiency (with one pathological allele, to be followed up in order to evaluate the risk to develop deficiency related disease) and 63 healthy subjects (normal alleles MM). They performed lung function test (including cardiopulmonary exercise test and methacholine bronchial challenge) chest X-ray and high resolution computed tomography, blood tests. Severe deficiency patients also performed perfusional lung scan to detect early disorders of blood flow, evaluation of arterial blood gases and liver echotomography. Expiratory flow limitation, the prevalence of vascular disease, the amount of urine elastin products and correlations between the amount of nitric oxide exhaled and bronchial hyperresponsiveness have been also investigated. The study showed that in Brescia county the deficiency is more common than expected and that evaluation of liver and vessels might be as useful as lung function tests. In addition, beneficial effect on local system has been observed. The longitudinal study might permit to detect early organ damage and to eliminate additive risk factors.

[Heat exposure differentiates 2 electrophoretically equal allo-albumins]. / L'esposizione al calore differenzia due alloalbumine elettroforeticamente uguali.

An alloalbumin characterized by thermolability at 56 degrees C of its slow migration band is described in this paper. The comparison between this new variant and correspondent standard of the "Comitato Italiano per la Standardizzazione dei Metodi Ematologici e di Laboratorio" (CISMEL) allow some remarks upon classification of variants based on the electrophoretic mobility.

Interaction between a serum factor and T lymphocytes in Gaucher disease.

A defective formation of E rosette from peripheral lymphocytes was observed in five patients with Gaucher disease. Evidence is shown that the reduction of E rosetting capacity is due to serum factors since it was induced in normal lymphocytes incubated with patients' sera. It is likely that ferritin, found elevated in the patients, might be involved in this inhibitory phenomenon. This disfunction might play a role in the high incidence of cancer in Gaucher patients.

Thermolabile alloalbumin of slow type: a new variant?

A new variant of Alloalbumin, with electrophoretic mobility identical to CISMEL standard SO/BS, characterized by thermolability at 56 degrees C of its slow migration band is described in this paper. This thermolabile Alloalbumin was present in 5 out of 10 family members of the original propositus. The new Alloalbumin has been indicated BS/BG according to the CISMEL recommendations. Our observations indicates that Alloalbumins with the same electrophoretic mobility may differ in structural composition as evidentiated by the different behaviour of these Alloalbumins with respect to their thermostability.

Alpha-1-antitrypsin deficiency and nephropathy.

Glomerulonephritis occurring in association with alpha(1)-antitrypsin deficiency has been sporadically reported in the literature but it is assumed to be a rare and poorly investigated disease. The complete pathologic pattern of glomerular lesions has not yet been established. The aim of our work was to investigate the correlation between the extent of antiprotease deficiency and the expression of nephropathy evaluated in two groups of patients (47 heterozygotic subjects with the PiMZ phenotype and 12 homozygotic subjects with the PiZZ phenotype) by a noninvasive approach with urinalyses and proteinuria measurement. No statistical differences between proteinuria in the two groups were observed suggesting that nephropathy is not a direct and single expression of the protein deficiency.