Giant coronary artery aneurysm in association with systemic arterial ectasia. A case report.

Since the advent of coronary angiography, coronary artery aneurysm has been diagnosed with increased frequency. The etiology of coronary artery aneurysm is atherosclerosis in 50%, followed by other causes. In a 71-year-old man with previously documented abdominal aortic aneurysm of 6 cm diameter and ectasia of both left and right middle cerebral arteries, thoracic magnetic resonance imaging (MRI) demonstrated a large hollow para-cardiac mass (maximum diameter of 7 cm) lying in the anterior-lateral part of the atrio-ventricular sulcus. Coronary arteriography confirmed the aneurysmatic nature of the proximal tract of left anterior descending (LAD) artery lesion. Screening for laboratory signs of vasculitis was negative and other vascular and systemic diseases were excluded, suggesting an atherosclerotic aetiology of the aneurysm. In the absence of current cardiac symptoms, conservative management has been chosen and the patient is still well 2 years after presentation.

Arthropathies and thyroid diseases.

AIM: Improvement of articular symptoms following thyroidectomy has often been observed in patients with an association of thyroid and joint diseases. An assessment has therefore been made of the types of arthropathy thus benefited and the anatomopathological features of the thyroid in patients with concomitant joint diseases. An account is given of the arthropathies associated with nontoxic nodular goitre (NTG). METHODS: Three cell markers are examined to identify immunocytokine elements differentiating thyroid diseases. RESULTS: Immunohistochemical examination shows extravasal lymphocyte infiltrates; thyrocytes were negative for HLA-Cl II, CD38 and IL-6R, and only dim-positive for HLA-Cl I. Endothelial cells were positive for HLA-Cl I and II and CD38, and negative for IL-6R. The lymphocyte were positive for HLA-Cl I, HLA-Cl II and CD38, but negative for IL-6R. The follow-up of 6 thyroidectomised patients disclosed improvement in joint pain and remission of rheumatoid arthritis and spondylarthritis. Association of nodular goitre with arthro-pathies is demonstrated. CONCLUSION: Arthritis and arthralgia are frequent in patients with thyroid diseases, we particularly found the association with MHNG and Hurthle cell adenoma. Arthritis and arthralgia quickly improve after thyroidectomy. Immunohistochemical NTG thyrocytes are still normal cells (HLA-Cl II negative) by contrast with their HLA-Cl II positivity in autoimmune thyroiditis.

[Idiopathic adult pulmonary hemosiderosis: a new etiopathogenetic hypothesis]. / Emosiderosi polmonare idiopatica dell'adulto: una nuova ipotesi eziopatogenetica.

IPH is an uncommon disease affecting mainly children and adults and has usually a poor prognosis. The basic pathogenesis of the disorder is unknown; many theories have been advanced, but none is proved. A case of IPH in a 35 years old male presenting the atypical feature of a myeloperoxidase deficiency is reported. This unusual feature may be compatible with a generalized redox systems deficiency, which leads, via an impaired flow of iron into alveolar macrophages, to the pulmonary fibrosis.

[Active immunoprophylaxis of type B viral hepatitis. Evaluation of the effectiveness of HEVAC-B vaccine in a population at risk]. / Immunoprofilassi attiva dell'epatite virale di tipo B. Valutazione dell'efficacia del vaccino HEVAC-B in una popolazione a rischio.

Hepatitis B virus (HBV) is the commonest cause of liver disease world-wide, with an estimated 200 million chronically infected individuals. The prevalence of HBV is particularly high in parts of Africa, Far East and South-East Asia. The worldwide distribution of HBV infection with the consequence of chronic liver disease and primary hepatocellular carcinoma implies the need for an efficient and safe vaccine. Three vaccines are today available: HB-VAX (M.S.D.), HEVAC-B (Ist. Pasteur, Paris) and Engerix-B (Smith-Kline Biological) and the first international experience proves that they are harmless, immunogenic and protective. The possibility of eliminating hepatitis B depends on mass vaccination in the high carrier areas of the third world and this in turn depends on supplies of inexpensive vaccine. The present work reports results obtained in Italy in 16 volunteers with high risk, who received HEVAC-B vaccine. Blood samples of the subjects were also tested for HBSAg/IgM complexes.

[Rheumatoid arthritis. Considerations on a rational therapeutic strategy]. / Artrite reumatoide. Considerazioni per una razionale strategia terapeutica.

Rheumatoid Arthritis (RA) is a progressive disease of unknown aetiology which may be caused by faulty immune mechanisms. Early diagnosis and correct treatment can be extremely effective. Fast and lasting results can only be obtained by an appropriate combination of NSAID and DMARD drugs which both reduce subjective symptoms and halt the progression of the disease.

[Type B viral hepatitis. Recent findings]. / Epatite virale di tipo B. Recenti acquisizioni.

The discovery of hepatitis B surface antigen by Blumberg in 1965 offered a specific marker that could readily be employed in the clinical, epidemiological and experimental investigation of type B viral hepatitis. It has since been followed by the continuous gathering of further knowledge concerning this disease. The morphology and immunological and biochemical features of virus B, the epidemiology and prevention of hepatitis B, and marker determination techniques are examined in an overview of the present situation.

[Folate and vitamin B12 deficiency. Characterization of parameters for early diagnosis]. / Deficit di folati e vitamina B12. Individuazione di parametri per la diagnosi precoce.

True vitamin B12/folate deficiency is more common than is currently appreciated; it appears in many guises and the classic hematological features of megaloblastic anaemia are often absent. The single most reliable predictor of megaloblastic anaemia is serum vitamin B12/folate concentration, but this determination in a screening program for all patients is difficult in terms of laboratory overload and cost. Early recognition of nutritional anaemias is, however, mandatory and we undertook this study to explore the possibility of identifying, on a demographic basis or because of routine laboratory results, a group of subjects at risk for vitamin B12/folate deficiency. Results obtained in simultaneous radioassay of serum B12 and folate levels and erythrocyte folate concentration in 1.200 hospitalized patients are presented. Coexisting iron deficiency was excluded by ferritin assay. We found no significant difference between males and females and no correlation between serum folate and B12 concentrations and aging. Low serum folic and cobalamin levels were found in 53% of patients with macrocytosis and elevated MCH, even in the absence of anaemia. These observations suggest that increased MCV and MCH may be present before a related anaemia and that serum folate and cobalamin levels must be monitored early in these patients to prevent a deficiency.

Identification and characterization of an active soluble form of human CD38 in normal and pathological fluids.

Human CD38 is a transmembrane glycoprotein involved in lymphocyte activation and adhesion to endothelium. The ectocellular domain of the molecule possesses properties of a bifunctional enzyme catalyzing both the synthesis from NAD+ and the hydrolysis of the calcium-releasing metabolite cyclic ADP-ribose (cADPR). Surface expression of CD38 (mCD38) is rapidly and almost completely down-modulated upon ligation by specific mAb in cells from different lineages. The data presented here also show that, in addition to the existence of a mCD38, a soluble form of CD38 (sCD38) is detectable in the cell culture supernatant of allo-activated T lymphocytes and of several tumor cell lines. sCD38 is also present in vivo and is assayable in normal (fetal serum and amniotic fluid) and pathological (serum and ascites from patients with multiple myeloma, and serum from patients with AIDS) biological fluids. Immunoaffinity chromatography, SDS-PAGE and Western blot analyses with mAb and polyclonal antibodies, along with metabolic labeling, yield a body of data concerning the structure of sCD38, which displays a M(r) of 39 kDa. Native sCD38 maintains the ability to inhibit the binding activity of different anti-CD38 mAb and still catalyzes the synthesis and the hydrolysis of cADPR at the same ratio observed with mCD38. Furthermore, cross-linking experiments indicate that the purified soluble molecule binds a 120 kDa molecule expressed by monocytoid cells and identified as a candidate ligand for human mCD38.

Evidence for a positive correlation between serum cortisol levels and IL-1beta production by peripheral mononuclear cells in anorexia nervosa.

A hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis has been reported in anorexia nervosa (AN), together with some immunological abnormalities, involving citokine - and particularly Tumor Necrosis-Factor-alpha (TNF-alpha) - production by polymorphonuclear cells. The ability of pro-inflammatory cytokines to activate the HPA axis is well known; however, there are no data demonstrating an interdependence between immunological and endocrine response in AN. To investigate the presence of a correlation between immune response and pituitary-adrenal function, plasma ACTH and serum cortisol concentrations were measured in 13 AN patients and in the same number of controls. TNF-alpha and interleukin (IL)-1beta production by ex-vivo unstimulated and LPS-stimulated peripheral mononuclear cells was also assessed. Circulating cortisol concentrations were higher (p<0.01) in AN (156.7 +/- 45.1 microg/l, mean +/- SD) than in controls (105.9 +/- 25.7 microg/l). Unstimulated IL-1beta release in supernatants of mononuclear cell cultures was slightly but not significantly higher in AN than in controls, while TNF-alpha release was similar in the two groups. A positive correlation was found between IL-1beta concentrations in unstimulated culture supranatants and serum cortisol levels in AN (r=0.782, p=0.002), while in normal subjects there was a trend toward a negative correlation; a slight positive correlation, while not significant, between IL-1beta and plasma ACTH, as well as between TNF-alpha and serum cortisol was also found in AN. These data suggest that the normal relationship between pro-inflammatory cytokines release, particularly IL-1beta, and cortisol secretion is deranged in AN.