Low-dose unenhanced CT protocols according to individual body size for evaluating suspected renal colic: cumulative radiation exposures.

PURPOSE: The aim of this study was to assess the radiation dose of dose-reduced unenhanced abdominal multidetector computed tomography (MDCT) scan protocols for suspected renal colic in patients within normal weight range and overweight-obese patients and to record the cumulative dose of repeated examinations. MATERIALS AND METHODS: Over a 2-year period, we performed 1,026 unenhanced CT examinations for urolithiasis; among these, 675 were performed on 636 patients referred from the emergency department. Patients were divided into two groups on the basis of body mass index (BMI): normal weight (BMI <25 kg/m(2) group 1); overweight and obese (BMI >25 kg/m(2) group 2). For patients in group 1 and group 2, the protocols of our 64-row scanner prescribe tube current settings at 70 mAs and 150 mAs, respectively. The dose-length product (DLP) estimated by using the manufacturer's software was converted into effective dose (ED). RESULTS: Mean DLP and ED were 177 and 345 mGy/cm and 2.4 and 4.8 mSv for group 1 and group 2, respectively. A subset of 25 patients (3.7%) underwent two or more examinations, with estimated ED ranging from 4.8 to 19.2 mSv. CONCLUSIONS: Although radiation dose is nearly double in overweight-obese patients undergoing MDCT, it remains lower than that delivered by a standard-dose protocol. Patients with flank pain, who are often young, are at increased risk for serial CT examinations. Use of a low-dose protocol is mandatory in both normal-weight and obese patients to minimise radiation exposure.

Nonrandom chromosome changes in Kaposi sarcoma: cytogenetic and FISH results in a new cell line (KS-IMM) and literature review.

The karyotype of a new tumorigenic Kaposi sarcoma (KS)-derived cell line, as defined by cytogenetic and fluorescence in situ hybridization (FISH) analysis is 49,XY,i(1)(q10),i(7)(p10),+i(7) (q10),+der(8)t(8;13)(p11;q11),-13,+del(14)(q22),+der(17)t(1;17)(p13;p13). Our aim was to point out some characteristics and recurrent chromosome changes probably playing a relevant role in the malignant progression of KS, by a comparison of the cytogenetic results obtained in the present study with data from the literature. The interpretation of the cytogenetic results is that KS development occurs by multiple steps: an initial reactive polyclonal cell proliferation is associated with chromosome instability; the cells in a later stage acquire clonal chromosome changes. If many chromosome changes are present, particularly 8q and 1q trisomy, 3p14-->pter deletion, 1p13, 13p14.3, 7q22, 8p11, 13q11, and 19q13 band rearrangements, KS acquires a neoplastic aggressive state.

Cerebral germ cell tumor and XXY karyotype.

Metaphases from a cultured cerebral germ cell tumor (CGCT) in a boy with a 46,XY constitutional karyotype had 47 chromosomes with an additional X chromosome and a translocation (1;21)(q11;p11). CGCT appear to be nonrandomly associated with Klinefelter syndrome, and a supernumerary X chromosome and trisomy of the 1q21-->1qter region may be clonal abnormalities in these tumors. The predisposition of Klinefelter patients to develop CGCT may be due to the pathogenetic relevance of the extra X chromosome both as an acquired and a constitutional abnormality.

Cytogenetic and interphase FISH analyses of 73 basal cell and three squamous cell carcinomas: different findings in direct preparations and short-term cell cultures.

Cytogenetic analysis performed on 73 sporadic basal cell carcinomas (BCCs) and three squamous cell carcinomas (SCCs) showed different findings in direct preparations (24 hours) and in short-term cell cultures. Except for loss of the Y chromosome, not one of the other clonal (+6, +16, add(2)(q37), del(3)(q13), add(1)(p31), and near triploidy) or sporadic changes found in direct preparations was found in cell cultures and vice versa. Clonal trisomy 6 found in two BCC direct preparations and demonstrated by interphase fluorescence in situ hybridization in 8 other cases seems to be a nonrandom change in basal cell carcinoma. Immunohistochemistry showed that the cell type investigated was different in the two methods of analysis used: epithelial in direct preparations and fibroblastic in cell cultures. Thus, the results obtained in direct preparations indicate the BCC or SCC epithelial karyotype, whereas the aberrations found in cell cultures indicate the presence of chromosome instability in the fibroblastic stroma. The apparent lack of correspondence between direct and indirect preparations and the presence of clonal chromosome changes in both epithelial and stromal cells suggest tumor cell heterogeneity of BCC. The fibroblastic stroma seems to be implicated in the neoplastic process. This is not evident in SCC, in which clonal changes are present only in direct preparations. The chromosomal distribution of the breakpoints involved in structural changes in direct and cell culture preparations is random; together with those reported in the literature, the breakpoints found in BCC cultures show, however, a cluster to 1p36, 3q13, 9q22, 14p11, 15p11, and Xp11 bands. We did not find any significant correlations between BCC cytogenetic results and the clinical data (site, age, sex, recurrence). The incidence of cases of BCC (38%) and of SCC (100%) showing clonal chromosome changes agree with their benign and malignant nature, respectively. Finally, a significantly high incidence of constitutional inv(9) and dup(9)(q11q21) was found in the group of patients with BCC.

Chromosome changes in benign prostatic hyperplasia and their significance in the origin of prostatic carcinoma.

Cytogenetic studies of benign prostatic hyperplasia (BHP) are scarce. We analyzed primary cell cultures obtained from biopsies of prostatic tissues from 10 patients (mean age: 60.7 years) with histologic diagnosis of BHP to compare the eventual chromosome changes with those reported in prostatic adenocarcinoma. Clonal chromosome abnormalities were noted in five of the 10 cases, with loss of Y chromosome in all. In one case, a clonal t(1;20) was observed with a -Y clone. Different numerical and structural sporadic abnormalities were evident in eight. Chromosome 1 was the chromosome most frequently involved in sporadic rearrangements. We concluded that -Y is a frequent nonrandom chromosome abnormality in BHP in this sample of patients. Immunohistochemical studies showed that loss of Y occurs in fibroblasts and not in epithelial cells; therefore, this anomaly is not related to cancer development.

Clonal chromosome changes in renal carcinoma do not correlate with clinical stages and histopathologic grades.

We analyzed the correlations between chromosome abnormalities and clinical and histopathologic characteristics in 77 cases of renal cell carcinoma (RCC). Chromosome changes such as +5,+7,+8,+10,+18,+X,+Y, and -Y have been excluded from the analysis because they also occur in nonneoplastic kidney tissue and cytogenetic analysis indicates that these anomalies are not involved in tumor progression. The most frequent specific chromosome abnormalities in this sample were 3p rearrangements, trisomy 17, and hyperdiploidy and were not related to tumor stage or grade or to development of distant metastases.

Clonal chromosome changes in non-neoplastic ureters.

Cytogenetic analysis was performed on 23 samples from non-neoplastic ureters. Clonal chromosome abnormalities were found in eight. They were: loss of Y chromosome, as a single abnormality (five cases) or associated with trisomy 10 and 20 (one case) or with trisomy 2 (one case); and duplication of Y chromosome (one case). Different numerical and structural sporadic abnormalities were found in nine cases. Immunohistochemical analysis and direct observation using the inverted microscope showed that the cells were mainly of the fibroblastic type. FISH analysis with chromosome 7 alpha-satellite probes failed to detect the presence of trisomy 7 in three epithelial cases tested.

Cytogenetic and interphase cytogenetic analyses reveal chromosome instability but no clonal trisomy 8 in Dupuytren contracture.

The results of cytogenetic and FISH analysis performed in 26 cases of Dupuytren contracture are reported. Clonal or sporadic chromosome changes were found in 18 cases (69%). Clonal changes consisted of: +2, +16, -10, -Y, add(1)(p23), del(2)(q21), t(3;16)(p21;q24), add (3)(p24), del(18)(q21), t(Y;14)(p12;q24), +mar. The results differ from those obtained in normal palmar fascia used as control, in which -Y and +Y were the only clonal changes found in 2 of 11 analyzed cases (18%). No clonal trisomy 8 was found. FISH analysis performed in 11 cases (centromeric probe specific for chromosome 8) failed to show the presence of a cell population with +8. Clonal and sporadic structural changes were different from case to case and no clustering breakpoint was observed. The significance of the chromosome instability leading to clonal and sporadic chromosome changes not specific to Dupuytren contracture are discussed.

Evaluation of a rapid immunochromatographic test for the serologic diagnosis of tuberculosis in Italy.

OBJECTIVE: To determine specificity, sensitivity and predictive values of a rapid immunochromatographic assay (ICT tuberculosis) for the diagnosis of tuberculosis (TB) in an Italian clinical setting, and to identify tentative new guidance for the interpretation of test results. METHODS: The ICT tuberculosis test is an immunochromatographic test based on the detection of IgG antibodies directed against five highly purified antigens secreted by Mycobacterium tuberculosis during active growth. Sera from 60 patients with active pulmonary (48 sputum smear-positive and six sputum smear-negative cases) and extrapulmonary (six cases) TB were obtained. Personal, anamnestic and clinical data were investigated and recorded for each patient. The control groups comprised 156 subjects: 40 healthy individuals, half of them Mycobacterium bovis BCG-vaccinated, and 116 patients with mycobacterial diseases other than TB (five cases), with nonmycobacterial lung diseases (30 cases), with nonmycobacterial nonlung diseases (30 cases), with nonmycobacterial diseases and rheumatoid factors positivity (30 cases), and with asymptomatic HIV infection (21 cases). For 21 individuals the test was simultaneously performed with both serum and whole blood sample. Each positive result of the ICT test was reported with regard to the number (1-4), position (A, B, C, D) and color intensity (+ to ++++) of the evidenced lines in order to assess the quality of the antibody response. RESULTS: The overall sensitivity and specificity were 56.7% and 90.4%, respectively. The sensitivity for pulmonary TB patients was 61.1% (66.7% for smear-positive and 16.7% for smear-negative cases) and 16.7% for extrapulmonary TB patients. The difference between ICT results in pulmonary TB patients and control subjects was statistically significant (P < 0.0001). The analysis of the positive ICT tests revealed that samples with strong color intensity (>/=++) and specific antibodies bound to antigens immobilized on line D were significantly more frequent in TB patients than in controls (P = 0.001 and P= 0.027, respectively). ICT test results with the presence of at least three visible lines were more often observed in the TB patients than in controls, although not reaching statistical significance (P = 0.052). No difference was observed between the results of the ICT test performed both on serum and whole blood sample. CONCLUSIONS: The ICT tuberculosis test was confirmed to be rapid and easy to perform without requiring special equipment, both on serum and whole blood sample. Our data, in accordance with those obtained in a previous study conducted in extra-European countries, confirmed higher sensitivities for the smear-positive TB patients than for the smear-negative TB patients, and for pulmonary TB patients than for the extrapulmonary TB patients. Data obtained on the quality of antibody response in the ICT positive samples, might be used to improve the performance of the test.

Long-term treatment of asthmatic patients with salmeterol vs slow-release theophylline.

The aim of the present multicentre, open, randomized, parallel group study was to evaluate the efficacy and safety of salmeterol versus theophylline in asthmatic patients. A total of 112 patients were randomized: 56 received inhaled salmeterol (50 micrograms twice daily) and 50 oral dose titrated theophylline twice daily. The study lasted 12 months. The efficacy of both drugs was evaluated for the first 3 months of the study and the safety for a further 9 months. Spirometric measurements were carried out for the total duration of the study. Salmeterol showed a greater and more significant efficacy than theophylline in reducing both day- and night-time symptoms (P < 0.001) and in reducing additional salbutamol requirement (P < 0.001). The subjective assessment of efficacy by physicians and patients was in favour of salmeterol from the first month of treatment (P < 0.001). Both drugs improved the quality of life as measured by the specific questionnaire 'Living with Asthma' with no significant differences. The total number of adverse events was slightly higher in the theophylline group compared with salmeterol (18 vs 9; P n.s.). Both salmeterol and theophylline increased morning and evening PEFR with no significant difference. FEV1 and FVC increased in both groups of patients; the difference between the effects of the two treatment was not statistically significant at 12 months. Our study suggests that salmeterol has higher efficacy and safety than theophylline in long-term treatment of asthmatic patients.

Carboplatin and vinorelbine in the treatment of advanced non-small-cell lung cancer: a multicenter phase II study.

The aim of this study was to identify a chemotherapy combination that would be active and well tolerated for palliative treatment of advanced non-small-cell lung cancer (NSCLC). From February 1992 to December 1994, a total of 77 patients affected by stage-IIIB and stage-IV NSCLC were treated with carboplatin 350 mg/m2 on day 1 and vinorelbine 25 mg/m2 on days 1 and 8 of each cycle, with cycles repeated every 28 days. All patients were evaluable for response and toxicity. A total of 24 patients showed a partial response (31% response rate; 95% CI = 21-41%). The median duration of overall survival was 41 weeks (95% CI = 31-51), and the median time to disease progression was 34 weeks (95% CI = 25-43). The treatment was well tolerated: no grade-4 toxicity was observed. The carboplatin-vinorelbine combination deserves to considered as a valid alternative to regimens that include cisplatin for palliative treatment of advanced NSCLC.

Knowledge about HIV transmission and prevention among Italian patients with psychiatric disorders.

For a study designed to examine the accuracy of information about HIV transmission, risk behavior, and preventive measures among individuals with psychiatric disorders in Italy, 214 psychiatric patients-114 outpatients and 100 inpatients-and 88 nonpsychiatric patients completed the AIDS Risk Behavior Knowledge Test. Levels of knowledge were lower among psychiatric patients than among control subjects. Patients with chronic illness and a diagnosis of schizophrenia were found to have less knowledge than other patients about HIV transmission. These findings confirm the need for HIV-related educational and behavior-modification programs for patients with chronic and severe mental illness in the community in Italy.

[Skin lesions in progressive disseminated histoplasmosis associated with AIDS]. / Lesões cutâneas na histoplasmose disseminada progressiva associada com sida.

The protean manifestations of progressive disseminated histoplasmosis in AIDS patients (PDH/AIDS) specially the cutaneous lesions, may confuse the clinician or the pathologist. A case of PDH/AIDS diagnosed by direct and histologic examination and cultures of subcutaneous nodule aspirate and skin biopsy is reported. The requirement of special histologic and cultures procedures is emphasized. Clinical manifestations of the disease are discussed.

[Profile of self-medication in Brazil]. / Perfil da automedicação no Brasil.

INTRODUCTION: The data presented are part of a World Health Organization (WHO) multicenter study of self-medication in Latin America. Brazilian sites included: Belo Horizonte, Fortaleza, the city of S. Paulo and outlying locations. The objective was to characterize self-medication practices by analyzing drugs sought by consumers in pharmacies without a physician's prescription. MATERIAL AND METHOD: Drugs were classified according to the Anatomic Therapeutic Classification codes, and analyzed with respect to 1) intrinsic value; 2) recognition as an essential drug (by either WHO or Brazil); 3) number of active ingredients; and 4) requirement for prescription. RESULTS: Five thousand, three hundred and thirty-two (5,332) different drugs, with 785 distinct active ingredients were sought. Of these, 49.5% were fixed dose combinations, 53.0% were of little intrinsic value, 44.1% required a physician's prescription, 71.0% were not essential drugs, and 40.0% of requests were based on prior prescriptions from the physician. The drugs most requested were analgesics (17.3%), nasal descongestants (7.0%), antirheumatic anti-inflammatory drugs (5.6%), and systemic anti-infective drugs (5.6%). CONCLUSIONS: Self-medication in Brazil reflects the needs and habits of the population. It is strongly influenced by physician's-prescribing habits and by the inadequate selectivity of the Brazilian pharmaceutical market.

[Trichosporon beigelii peritonitis in a child during treatment by continuous ambulatory peritoneal dialysis]. / Peritonite por Trichosporon beigelii em uma criança durante tratamento por diálise peritoneal ambulatorial continuada.

We report a case of peritonitis caused by Trichosporon beigelii in a 2-year-old child during treatment by continuous ambulatory peritoneal dialysis (CAPD). Diagnosis was established by direct examination and culture of dialysis effluent. Infections caused by Trichosporon beigelii in children are commented.

[Diagnostic imaging of bone metastases]. / Diagnostica per immagini delle metastasi scheletriche.

PURPOSE: To present an "algorithm" for detection and diagnosis of skeletal metastases, which may be applied differently in symptomatic and asymptomatic cancer patients. MATERIAL AND METHODS: February to March 1999 we randomly selected and retrospectively reviewed the clinical charts of 100 cancer patients (70 women and 30 men; mean age: 63 years, range: 55-87). All the patients had been staged according to TNM criteria and had undergone conventional radiography and bone scan; when findings were equivocal, CT and MRI had been performed too. RESULTS: The primary lesions responsible for bone metastases were sited in the: breast (51 cases), colon (30 cases: 17 men and 13 women), lung (7 cases: 6 men and 1 woman), stomach (4 cases: 2 men and 2 women), skin (4 cases: 3 men and 1 woman), kidney (2 men), pleura (1 woman), and finally liver (1 men). The most frequent radiographic pattern was the lytic type (52%), followed by osteosclerotic, mixed, lytic vs. mixed and osteosclerotic vs lytic patterns. The patients were divided into two groups: group A patients were asymptomatic and group B patients had local symptoms and/or pain. DISCUSSION: Skeletal metastases are the most common malignant bone tumors: the spine and the pelvis are the most frequent sites of metastasis, because of the presence of high amounts of red (hematopoietic active) bone marrow. Pain is the main symptom, even though many bone metastases are asymptomatic. Pathological fractures are the most severe consequences. With the algorithm for detection and diagnosis of skeletal metastases two different diagnostic courses are available for asymptomatic and symptomatic patients. Bone scintigraphy remains the technique of choice in asymptomatic patients in whom skeletal metastases are suspected. However this technique, though very sensitive, is poorly specific, and thus a negative bone scan finding is double-checked with another physical examination: if the findings remain negative, the diagnostic workup is over. On the contrary, in patients with a positive bone scan or with local symptoms and pain, radiography and CT are used for screening of metastatic lesions: results may be negative (for low sensitivity of conventional radiology) or questionable (in which case bone biopsy is necessary), or else symptoms may be due to different causes than metastatic lesions (i.e., osteoarthritis). Before bone biopsy is made, MRI must be performed, because it is the only technique that allows to distinguish between bone marrow components. The limitation of MRI is the poor specificity of its findings, which may provide misleading findings.

Laparoscopic oophoropexy for recurrent adnexal torsion.

Torsion of the adnexa has traditionally been treated by adnexectomy because of the fear of emboli departing from thrombosed ovarian veins. Several recent reports have described successful conservative management with unwinding of the twisted adnexa. As the trend toward conservative management progresses, the incidence of recurrent adnexal torsion may increase. We present a case of a 33 year old gravida 3, para 2 Caucasian female who presented at 7 weeks gestation complaining of symptoms similar to those experienced during an episode of right ovarian torsion treated by laparoscopic unwinding 6 years earlier. Colour Doppler sonography revealed absent flow in the right adnexa. The twisted right adnexa containing the presumed corpus luteum of pregnancy was laparoscopically unwound. Using an extracorporeal suturing technique, a laparoscopic oophoropexy was performed to prevent any further rotatory movement. This appears to be the first reported case of laparoscopic oophoropexy for a recurrent ovarian torsion; we encourage the use of this simple, minimally invasive procedure in cases of recurrent adnexal torsion.

Illness behavior, emotional stress and psychosocial factors among asymptomatic HIV-infected patients.

BACKGROUND: Over the last years the way in which patients with chronic physical illness respond to their illness (illness behavior) has been explored by several studies. This study sought to examine characteristics of illness behavior and to investigate the association between illness behavior and psychosocial and clinical variables among asymptomatic HIV-infected subjects. METHODS: Seventy-three asymptomatic HIV+ outpatients completed self-report questionnaires to evaluate illness behavior (Illness Behavior Questionnaire), psychological stress symptoms (Brief Symptom Inventory), personality variables (External Locus of Control and Courtauld Emotional Control Scales) and social support (Social Provision Scale). RESULTS: Psychological morbidity ('caseness' = 34%) was associated with a pattern of illness behavior characterized by conviction of disease progression, irritability, dysphoria, psychological perception of illness and low denial. Individual capacity to express emotions, adequate levels of social support and low levels of depression, as well as clinical variables (high number of CD4+ cells, recent notification of HIV infection and nonintravenous drug use category) influenced a more adaptive illness behavior. Psychological stress and low CD4+ cell count were the main predictors of the affective dimension of illness behavior. CONCLUSIONS: Psychosocial variables resulted to influence the tendency to interpret illness in a nonadaptive way in asymptomatic HIV-infected subjects. Such variables merit to be routinely examined within the doctor-patient relationship in AIDS clinics.