Plasma levels of tumor necrosis factor-alpha in patients with visceral leishmaniasis (Kala-azar). Association with activity of the disease and clinical remission following antimonial therapy.

Evaluation of TNF-alpha in patients with Kala-azar has drawn increasing interest due to its regulatory role on the immune system, in addition to its cachetizing activity. The objective of this study was to examine the association between plasma levels of TNF-alpha, measured by immunoreactivity (ELISA) and bioactivity (cytotoxicity assay with L-929 cells), and clinical manifestations of visceral leishmaniasis. Plasma samples from 19 patients with Kala-azar were obtained before, during and at the end of antimonial therapy. TNF-alpha determinations was done by using the cytotoxicity assay (all patients) and the enzyme-linked immunoassay (ELISA-14 patients). A discrepancy between results obtained by ELISA and cytotoxicity assay was observed. Levels of circulating TNF-alpha, assessed by ELISA, were higher in patients than in healthy controls, and declined significantly with improvement in clinical and laboratory parameters. Plasma levels before treatment were 124.7 +/- 93.3 pg/ml (mean +/- SD) and were higher than at the end of therapy 13.9 +/- 25.1 pg/ml (mean +/- SD) (p = 0.001). In contrast, plasma levels of TNF-alpha evaluated by cytotoxicity assay did not follow a predicted course during follow-up. Lysis, in this case, might be not totally attributed to TNF-alpha. The discrepancy might be attributed to the presence of factor(s) known to influence the release and activity of TNF-alpha.

[Echography in the follow-up of patients receiving an endoscopic injection of teflon for vesico-renal reflux]. / L'ecografia nel follow up di pazienti sottoposti ad iniezione endoscopica di teflon per reflusso vescico-renale.

The surgical treatment of vesicorenal reflux implies open surgery and consequently an hospitalization. The sub-ureteric injection of poly-tetra-fluoro ethylene (Teflon) for correction of vesicorenal reflux was first utilized in 1981 by Matouschek. We have reviewed our personal experience with endoscopic correction of vesicorenal reflux from 1985 to 1990 and evaluated the importance of ultrasonography especially in the follow up.

[The Nissenkorn endourethral prosthesis: our experience]. / La protesi endouretrale di Nissenkorn: nostra esperienza.

The Authors report their experience about 40 patients who presented urinary retention by cervico-prostatic obstruction with anesthetic counterindications or limited life expectancy, cured with the urethral prosthesis of Nissenkorn (IUC). Our data permit to say that in selected patients IUC may represent an effective treatment with minimal invasiveness, low cost and few side effects.

Acromegalic cardiopathy: a left ventricular scintigraphic study.

In order to study "acromegalic cardiomyopathy", cardiac function was examined, using gated radionuclide ventriculography, in 18 acromegalic patients and 21 control subjects with no clinical evidence of cardiac involvement. In these acromegalic subjects, while the Ejection Fraction (EF) did not appear to be significantly different, the Peak Filling Rate (PFR) was reduced while the Time to Peak Filling Rate (TPFR) resulted significantly greater than in control subjects. These findings indicate that chronic growth hormone (GH) hypersecretion, as observed in acromegaly, deteriorate the cardiac ventricular relaxation (diastolic phase) while it has no influence on contractility (systolic phase).

Usefulness of dynamic reno-scintigraphy in the follow-up of patients treated by surgery or percutaneous transluminal angioplasty for renovascular hypertension.

The aim of this study was to assess the role of dynamic reno-scintigraphy (DRS) in follow-up of 21 hypertensive patients who underwent surgery or percutaneous transluminal angioplasty (PTA) for renal artery stenosis. Dynamic reno-scintigraphy was recorded following injection of 0.12 mCi/kg 99Tcm-glucoheptonate i.v. before and after reconstructive vascular surgery or PTA. Serial images and renal time activity were analysed according to established criteria of interpretation. In terms of blood pressure response, 14 patients were cured or improved after surgery or PTA; DRS normalized or markedly improved in all these cases. Dynamic reno-scintigraphy did not change in seven patients who did not benefit from surgery or PTA. In three of them, repeated angiography showed, respectively, a by-pass occlusion, a renal artery re-occlusion after PTA, and a renoparenchymal disease. Dynamic reno-scintigraphy appears to reflect well the recovery of renal perfusion in patients treated by surgery or PTA for suspected renovascular hypertension.