Hierarchy of baby-linked immunogenetic risk factors in the vertical transmission of hepatitis C virus.

Mother-to-infant transmission of Hepatitis C Virus (HCV) represents the major cause of pediatric HCV infection today. Immunogenetic influence has been poorly investigated and mainly confined to HLA-class II serological polymorphisms. Among 290 parities, 135 from Pavia and 155 from Bergamo, of HCV-RNA-infected Italian women, 21 babies (7.24%) were HCV-RNA positive at birth and steadily positive over 20 months of life. All the 21 infected babies and 44 randomly selected uninfected ones, born to HCV-RNA+ mothers but steadily negative for HCV-RNA during a follow-up of 2 years, and their mothers were investigated for HLA-G, -C, -DRB1, -DQA1 and -DQB1 genomic polymorphisms. Among the different covariates, HLA-Cw*07, -G*010401, -DRB1*0701, -DRB1*1401 and homozygosity for HLA-G 14bp deletion can be considered as risk factors for HCV vertical transmission. On the contrary, protection was conferred by the HLA-DQB1*06, -G*0105N, -Cw*0602, DRB1*1104 and -DRB1*1302 alleles. Our initial question was: has the immunogenetic profile any role in the protection of the fetus growing in an infected milieu and, if so, is it independent from the other non-immunogenetic parameters? The answer to both questions should be yes.

In vitro human osteoblast and extracellular matrix changes after transforming growth factor beta 1 treatment.

AIMS: Normal bone tissue is characterised by a balancing of osteoblast and osteoclast activity. The activity and differentiation of these cells are regulated by vitamins, hormones and cytokines. The action of these factors on bone tissue cells depends on the composition and mineralisation of extracellular bone matrix. In particular, transforming growth factor beta 1 (TGFbeta1) acts on collagen fibres, glycosaminoglycan secretion and on the enzymes correlated to the turnover of glycosaminoglycans. The normal functions of bone tissue also depend on its mineralisation, which is highly altered in the process of uraemia. METHODS: In this study, we analysed in vitro the effect of transforming growth factor beta on osteoblast proliferation, collagen synthesis and glycosaminoglycan secretion with 3H-thymidine, 3H-proline or 3H-glucosamine incorporation, and on enzymes, such as beta-N-acetyl-D-glucosaminidase and beta-glucuronidase, involved in extracellular matrix turnover. Moreover, phosphatase alkaline activity and osteocalcin related to mineralisation of extracellular matrix were determined. RESULTS: Our data show that TGFbeta1 significantly decreases 3H-thymidine and 3H-proline incorporation and increases (p < or = 0.01) extracellular sulphated glycosaminoglycan synthesis. It also increases osteocalcin levels, phosphatase alkaline, beta-N-acetyl-D-glucosaminidase and beta-glucoronidase activities. CONCLUSION: TGFbeta1 changes the synthesis of extracellular matrix components by osteoblasts. These variations favour the action of cytokine and osteoclasts. Since the TGFbeta1 accumulates in bone tissue and increases during uraemia, with due limitations this action leads to an imbalance between synthesis and degradation and could explain bone alterations in uraemic patients.

Chronic hepatitis in hypereosinophilic syndrome: report of an unusual case.

Hypereosinophilic syndrome has been reported to be associated with hepatic dysfunction; liver histology is mainly characterized by a diffuse eosinophilic inflammatory infiltrate. A 28-yr-old woman, affected by idiopathic hypereosinophilic syndrome with bone marrow and pulmonary eosinophilic infiltrates associated with peripheral eosinophilia, developed features of chronic hepatitis without a significant eosinophil component. She responded favourably to systemic glucocorticoid therapy with normalization of liver function tests within a few weeks. This observation could support the hypothesis that liver damage in idiopathic hypereosinophilic syndrome may be due to circulating substances produced by eosinophils rather than direct infiltration of liver by these inflammatory cells.

Parathyroid glands in primary hyperparathyroidism: an ultrastructural study of 50 cases.

Parathyroid glands from 50 cases of primary hyperparathyroidism were examined by light and electron microscopy in an attempt to elucidate the diagnostic role of electron microscopy in this disease. In the cases in which only one gland was removed at surgery, a final diagnosis by light microscopy was not possible. The electron microscopic findings for some of these single glands (e.g., ribosomal-lamellar complexes and groups of centrioles) suggested that they were adenomas. In cases in which two or more enlarged glands were removed, a correct final diagnosis could be made on the basis of the light microscopic findings alone, and electron microscopy provided no further significant information. Where one enlarged gland and one normally sized gland were removed, electron microscopy disclosed important findings in the normally sized glands. Specifically, light microscopic examination of normally sized glands suggested endocrine suppression, while electron microscopy showed chief cell activity, thereby changing the final diagnosis from adenoma to hyperplasia. The clinical follow-up assessment in some of these patients confirmed the electron microscopic findings. Therefore, the incidence of adenoma in patients with primary hyperparathyroidism should be critically re-evaluated by ultrastructural studies of the normal glands that should be removed with the enlarged ones.

Massive haemoptysis after living donor liver transplantation.

A 27 year old man with hereditary haemorrhagic telangiectasia who developed progressive liver dysfunction underwent living related right lobe transplantation. Pulmonary arteriography did not reveal arteriovenous malformation or abnormal intrapulmonary venous channels. The postoperative course was characterised by persistent hypoxaemia and respiratory failure developed. On day 6, a massive haemoptysis developed and the patient died shortly thereafter. The native liver showed a nodular pseudocirrhotic transformation, with highly dilated and irregularly interconnected vein-like or arterial-like structures in the fibrous septa. Pathological examination of both lungs showed irregular thickening of the wall of the arteries, secondary to eccentric and/or concentric myointimal hyperplasia. This case suggests that massive haemoptysis can develop even when arteriovenous malformations are undetectable by pulmonary arteriography, and it questions the role and the appropriateness of living donor liver transplantation in high risk patients.

Outcome of liver disease in a large cohort of histologically proven chronic hepatitis C: influence of HCV genotype.

OBJECTIVE: To assess the influence of hepatitis C virus (HCV) genotypes on the clinical outcome of liver disease, we analysed 2,307 patients. RESULTS: The most frequently represented genotypes were 1b (40%) and 2 (28.1%). Patients with these genotypes had a median age higher than patients with other genotypes (P< 0.01). The overall survival of subjects with genotype 1b was poorer than the survival of patients with other genotypes (P< 0.01). Liver cirrhosis was found in 280 patients (12.1%), and type 1b was the most represented isolate among them (P< 0.01). Sixty-two patients (22%) developed hepatocellular carcinoma (HCC) during a follow-up of 1481.8 cumulative years (estimated crude incidence rate, 4.1 cases per 100 person-years for all cirrhotics; 5.9 cases for genotype 1a; 4.5 cases for genotype 1b; and 2.8 cases for genotypes non-1). Considering the whole population of 2,307 patients, only genotype 1b was associated significantly with both cirrhosis and the development of HCC. One hundred and nineteen cirrhotic patients underwent treatment with interferon in uncontrolled studies. Interferon therapy was associated with both better survival (P< 0.01) and a lower cumulative hazard for HCC (P< 0.01). CONCLUSIONS: Genotype 1b was associated with a poorer prognosis, probably because it leads to cirrhosis and consequently to HCC development. However, our data did not confirm genotype 1b as an independent risk factor for HCC in liver cirrhosis, which plays a major role in carcinogenesis. Interferon should be considered as a useful strategy in cirrhosis for improvement of survival and reduction of HCC risk.

Clinical course of pregnant women with chronic hepatitis C virus infection and risk of mother-to-child hepatitis C virus transmission.

As far as concerns chronic hepatitis C virus infection in pregnant women, different points remain to be elucidated, such as the clinical course, the rate of mother-to-child hepatitis C virus transmission and, in particular, its route and the possible risk factors. This review aimed to analyse current data on the prevalence of chronic hepatitis C virus infection in pregnant women and its relationship with risk factors, the rate of mother-to-child hepatitis C virus transmission and the factors possibly involved, particularly the maternal hepatitis C virus viral load and the human immunodeficiency virus coinfection, and the type of delivery and feeding. Finally, the appropriate timing for HCV-RNA testing in newborns has been reviewed.

Short-term antibiotic prophylaxis for the prevention of wound infection and secondary meningitis in acoustic neuroma surgery: a ten-year experience in a regional hospital.

Wound infection and secondary meningitis are important complications for patients undergoing acoustic neuroma surgery. The Authors retrospectively evaluated the efficacy of a short-term protocol utilizing vancomycin and netilmicin. 434 patients underwent acoustic neuroma surgery in the Otorhinolaryngology Division, A.O. Ospedali Riuniti di Bergamo, from February 1987 to February 1997. Perioperative short-term prophylaxis was administered with vancomycin plus netilmicin. The utility of the prophylaxis schedule was evaluated on the basis of the occurrence of infectious episodes during the first 10-day follow-up. Only 2 episodes (0.5%) of bacterial meningitis were observed.

Hemothorax in congenital neuroblastoma.

The authors report a case of massive left hemothorax in a 15-day-old baby girl, caused by the rupture of a thoracic neuroblastoma.

Pancreatic cystadenocarcinoma and pregnancy: a case report.

We report a case of cystadenocarcinoma occurring in a pregnant woman. After child birth, a subtotal pancreatectomy was performed, without rupture of the cyst. The patient is asymptomatic, 24 months after surgery. The presentation of cystadenocarcinoma in pregnancy has been reported in another single case. The possibility of hormonal dependence is discussed.

[Visceral toxocariasis. Description of 3 cases]. / Toxocariasi viscerale. Descrizione di tre casi.

Three cases of visceral toxocariasis in adult patients are here described. Toxocariasis is a not uncommon, probably underestimated infection and the diagnosis should be considered also in adults who present clinical signs and it must be confirmed by serological tests.

[Clinical characteristics of HCV infection in pregnancy: the role of sexual transmission]. / Caratteristiche cliniche dell'infezione da HCV in gravidanza: il ruolo della trasmissione sessuale. Analisi di 178 casi.

BACKGROUND: There is no uniformity of opinions about the possibility of sexual transmission of hepatitis-C-virus infection. Moreover the infection during pregnancy is often underestimated. METHODS: One hundred and seventy-eight anti-HCV-positive pregnant women were investigated to evaluate the incidence of HCV infection and the possibility of sexual transmission of the disease to the partners. RESULTS: 126 patients out of 178 (70.8%) were positive for viral infection at PCR. In 96 patients (53.9%) HCV-positivity was detected for the first time in the actual pregnancy. 147 male partners out of 178 were checked for HCV-positivity and in 31 of them (21.1%) HCV antibodies were found. CONCLUSIONS: The results underline the importance of a screening for HCV-positivity in every pregnant, searching for anti-HCV antibodies also in patients not reporting risk factors. ALT values seem to be of little importance in the monitoring of the pathology. Sexual transmission of HCV virus from woman to man seems to occur rarely.

[Tuberculous peritonitis: extra-community immigrants at risk?]. / La peritonite tubercolare: immigrato extra-comunitario a rischio?

Two cases of tuberculosis peritonitis are here reported. Two young black males, who had recently immigrated from Senegal to Italy, were admitted to the Hospital because of aspecific, acute abdominal pain and underwent exploratory laparotomy. In both cases a flare-up of quiescent, post-primary chronic intestinal tuberculous infection was found at surgery. Extra-European immigrants often live in poor hygienic conditions in our country and are exposed to infectious ailments, which are unusual for the Italian population. In the differential diagnosis of acute abdominal pain in African immigrants, tuberculosis peritonitis should be always considered.

[A case of neonatal listeriosis]. / Su di un caso di listeriosi neonatale.

The AA describe a case of neonatal sepsis caused by Listeria monocytogenes observed in their Intensive Care Unit. The preterm neonate, born at the 30th week of gestational age, died after three days, showing clinical signs of sepsis and severe respiratory distress. Although the anamnesis of the mother revealed an episode of fever one month before delivery, the origin of which was not identified, it was not possible to isolate the Listeria in the mother. The AA discuss some clinical and therapeutical aspects of listeriosis; this infection is not very frequent in Italy, nevertheless it should not be underestimated either in the mother or in the neonate.

Morphometric analysis of primary graft non-function in liver transplantation.

AIMS: Primary graft non-function (PNF) is a life-threatening condition that is thought to be the consequence of microcirculation injury. The aim of the present study was to assess, with a computerized morphometric model, the morphological changes at reperfusion in liver biopsy specimens from patients who developed PNF after liver transplantation. METHODS AND RESULTS: Biopsy specimens were obtained at maximum ischaemia and at the end of reperfusion. Morphology included many stereological parameters, such as volumes of all parenchymal components, surface density, size distribution and mean diameter of hepatocytes. Other variables examined were intensive care unit stay, degree of steatosis, serum liver function tests and ischaemic time. In the postoperative period, the PNF group showed elevated serum levels of alanine transferase, decreased daily rate of bile production and prothrombin activity. Blood lactates were significantly higher in the PNF group than in a control group. When comparing groups, the volumetric parameters related to hepatocytes and sinusoids and the surface densities of the hepatic cells showed an inverse relationship. At the end of reperfusion, in PNF group the volume fraction of hepatocyte cytoplasm was decreased; in contrast, the volume fraction of sinusoidal lumen was markedly increased. The cell profiles showed the same inverse trend: the surface density of the parenchymal border of hepatocytes was decreased in PNF when compared with the control group, while the surface density of the vascular border was increased. In the PNF group, the surface density of the sinusoidal bed was directly correlated with alanine transferase, daily rate of bile production, prothrombin activity and cold ischaemic time. CONCLUSIONS: The alterations in hepatic architecture, as demonstrated by morphometric analysis in liver transplant recipients that developed PNF, provide additional information that may represent useful viability markers of the graft to complement conventional histological analysis.