[Problems of differential diagnosis of lymphoma and celiac disease. A case report]. / Problemi di diagnostica differenziale fra linfoma e celiachia. Descrizione di un caso clinico.

An association between celiac disease and non-Hodgkin's lymphoma of the small intestine has been recognized for many years. Coeliac disease is characterized by an enteropathy sensitive to gluten, malabsorption of food and partial or total villous atrophy. Also malignant lymphoma may present with malabsorption and mucosal lesion similar to that found in coeliac patients. The diagnosis of lymphoma in coeliac patients can be extremely difficult because the presenting symptoms and histological lesion are similar, but the presence of a cluster of symptoms such as abdominal pain malabsorption, weight loss in patients older than 40 years with a history of poorly responsive coeliac disease should raise a suspicion of malignancy. We present a case of 55 year-old man with malignant lymphoma and coeliac disease surgically treated in our Institute for intestinal obstruction.

[Hypopituitarism in the elderly at an internal medicine department]. / Ipopituitarismo in età geriatrica in un Reparto di Medicina interna.

We describe three cases of hypopituitarism with empty sella in elderly patients. Hypopituitarism in geriatric population is not uncommon, but is oftern underestimated and confused with more frequent diseases. It can sometimes determine severe clinical picture, above all for the consequences of adronocortical insufficiency. We emphasize that empty sella is not always an asymptomatic radiological finding.

[Lithium poisoning and the use of nimesulide]. / Intossicazione da litio e uso di nimesulide.

We describe a case of lithium intoxication, complicated by renal failure in a lithium treated women. She would take nimesulide, a selective cyclo-oxygenase-2 inhibitor, used in a variety of inflammatory, pain and fever states. This is the first report of the accumulation of lithium caused by nimesulide.

Intestinal tuberculosis: a diagnostically-challenging case misdiagnosed as Crohn's disease at colorectal biopsy.

The clinical presentation of two different digestive diseases such as Crohn's disease and intestinal tuberculosis may be so similar to induce a delay in correct diagnosis and appropriate treatment (immune suppression versus antibiotic therapy). Herein, we describe the case of a young man from Eastern Europe who came to our observation complaining of clinical symptoms initially misdiagnosed as an inflammatory bowel disease. It is important to keep in mind the possibility of an active tubercular disease, particularly in patients coming from countries endemic for the disease. Morphological findings of sarcoid-like granulomas at biopsy is not enough for a conclusive diagnosis of Crohn's disease, and tuberculosis should be ruled out on the basis of clinical information, laboratory tests and radiological imaging.

Programmable large area digital microfluidic array with integrated droplet sensing for bioassays.

We describe a new device concept for digital microfluidics, based on an active matrix electrowetting on dielectric (AM-EWOD) device. A conventional EWOD device is limited by the number of electrical connections that can be made practically, which restricts the number and type of droplet operations. In an AM-EWOD, the patterned electrodes of a conventional EWOD device are replaced by a thin film transistor (TFT) array, as found in a liquid crystal display (LCD), facilitating independent control of each electrode. The arrays can have many thousand individually addressable electrodes, are fully reconfigurable and can be programmed to support multiple simultaneous operations. Each element is 210 µm × 210 µm in size and contains a circuit that measures the electrical impedance of the liquid above it. This is used to determine the presence and size of a droplet, a method that can improve assay reliability and accuracy. This sensor provides feedback, error detection and closed loop control of an assay sequence. We describe the design, fabrication and testing of a 64 × 64 format AM-EWOD device with impedance sensor functionality. A colorimetric assay is implemented on the device and used to measure glucose in human blood serum. Results are compared with the same assay performed on a microtitre plate.

Need for follow up in coeliac disease.

The use of follow up studies was evaluated in 128 patients with coeliac disease during their first visit to a department for adults. The original diagnosis had been made in childhood in all patients. Fifty eight (45%) of the subjects were following a gluten free diet, 23 (18%) were following a gluten free diet but with occasional gluten consumption, and 47 (37%) had adopted an unrestricted, gluten containing diet for a mean of 11.2 years. There was no correlation in individual subjects between the presence of symptoms, biochemical and immunological abnormalities, severity of histological findings, and the amount of dietary gluten, despite the greater frequency of symptoms in the group following an unrestricted diet than in the other two groups. Short stature and epilepsy with cerebral calcifications only occurred in patients following an unrestricted diet. As only diagnosis based on two or three biopsy samples and regular follow up correlated positively with dietary compliance, it is suggested that a histologically confirmed diagnosis of coeliac disease and regular lifelong follow up are essential in the management of these patients.

HBV infection in Italian family groups.

Intrafamilial spread of HBV infection was evaluated in 85 Italian family groups. Secondary infected cases were observed in 43% of these families, of which 73% showed clusters of HBs positive members, with a prevalence among the family members (children-siblings) of the mother/wife index cases, and no strict relation to their "e" system. The presence of the delta agent in the index case was correlated to a higher percentage of secondary HBs-positive cases, but the intrafamilial spread of delta agent was a rare event. A similar higher incidence of HBV markers was observed among the relatives of the index cases positive for auto-antibodies. The evidence presented suggests the importance of genetic factors in the acquisition and clearance of HBV and delta infections.