[Abdominal aortic aneurysm associated with non-neoplastic abdominal disease. Therapeutic approach]. / Aneurismi dell'aorta addominale associati a patologia addominale non neoplastica. Strategia terapeutica.

BACKGROUND: Personal experience concerning the treatment of 8 patients with infrarenal aortic aneurysms associated with extravascular non-neoplastic abdominal diseases is presented. METHODS AND RESULTS: In all 7 cases which underwent combined surgical procedures (aneury-smectomy + cholecystectomy in 4 patients and aneurysmectomy + groin hernia repair in 3 patients) early and late postoperative complications were not recorded. CONCLUSIONS: The main therapeutic guidelines concerning the pathologic association of infrarenal aortic aneurysms associated with extravascular non-neoplastic abdominal diseases are discussed on the basis of a literature review and of personal experience.

Platelet and white blood cell counts during therapy with different types of alpha interferon in patients with chronic viral hepatitis. Investigators of the Alpha Interferon Study Group of Piemonte, Italy.

BACKGROUND: Platelet and white blood cell counts decrease in chronic viral hepatitis patients treated with alpha interferon. AIM: To analyse whether delta negative variations in platelets and white blood cells are influenced by type, dose and duration of alpha interferon treatment, we studied 340 consecutive patients (mean treatment 8 months, range 4-18 months). PATIENTS AND METHODS: A total of 204 (60%) patients were treated with recombinant alpha interferons (30% alpha-2a and 30% alpha-2b), 64 (19%) with N3.leukocytic and 72 (21%) N1.lymphoblastoid natural interferons. Median age and male/female ratios were comparable in the 3 groups (41, 41 and 43 years and 2.3, 2.6 and 2.5, respectively). The lowest platelets and white blood cells counts were observed between the 2nd and the 4th month of therapy in all patients. Age, sex, aetiology and duration of interferon therapy did nor influence the platelets and white blood cells reduction rates. The decrease was lower for patients treated with N3.leukocytic interferon than for the other interferons. A significant difference was observed between interferon doses when the groups treated with 3 or 9-10 MIU were compared. However, dose or cirrhosis-related bias are ruled out by similar proportions of cirrhosis and patients treated with 3 MIU in the 3 groups of patients treated with different types of interferon. CONCLUSIONS: The type of interferon appears to represent a major cause of the different haemopoietic toxicity. The lowest toxicity of N3.leukocytic interferon may have clinical implications for the choice of interferon in patients with low baseline platelets and white blood cells counts. These findings prompt prospective studies on larger series of patients.

Adrenal location of the echinococcus. Considerations on a clinical case.

Adrenal location of a hydatic cyst is a clinical occurrence of exceptional rarity, especially in its primitive form and it could be evaluated, on the operative and autoptic comparison, not to exceed overall 0.5% of all the possible locations. Moreover, among all the cystic formations of the adrenal glands, parasitic ones are only 7%. Our observation of a case of adrenal hydatidosis, initially suspected as hepatic mass, was casually discovered by means of abdominal ultrasonography and later confirmed with the operation. This work contributes to the knowledge of this pathology, emphasizing diagnostic difficulties, and, considering the exiguous literature, helping us in supplying real indications to the surgical treatment.

Reduced fibrinolytic potential one year after kidney transplantation. Relationship to long-term steroid treatment.

Thromboembolic complications constitute an important risk in renal transplant patients, in whom a hypercoagulable state is associated with immunosuppressive treatment, and the presence of hypercoagulability and hypofibrinolysis specifically with cyclosporine. Hypercorticism secondary to steroid treatment has been associated with a thrombophilic state and the presence of a reduced fibrinolytic potential in particular. The aims of this study were to first evaluate the fibrinolytic potential by the venous occlusion (VO) test in 19 renal transplant (RT) patients, and then compare these findings with those obtained in similar groups of normal subjects and patients with Cushing's disease. The following tests were carried out before and after the VO test: euglobulin lysis time and t-PA and PAI-1 activities and antigen. Compared with normal controls, RT and Cushing's patients both showed a similar significant increase in PAI-1 activity and concentration. The VO test revealed a similar impairment in fibrinolytic potential in both the RT and Cushing groups. High and pathological PAI-1 levels before and after the VO test were consistent with a defective fibrinolytic potential due to the inhibitory effect of PAI-1 on plasminogen activation. A hypofibrinolytic state was found in 68.4% of RT patients. Our results suggest that an imbalance in the fibrinolytic system is a typical feature of RT patients one year after transplantation. Steroids appear to be the immunosuppressive drug mainly involved in determining thromboembolic risk after renal transplantation.

Treatment of chronic anti-HBe-positive hepatitis B with interferon-alpha.

We studied the prevalence of long-term responders to interferon-alpha (IFN-alpha) treatment (undetectable levels of serum IgM anti-HBc, HBV-DNA and normal ALT values for 3 years) in 53 anti-HBe-positive chronic hepatitis B patients. Forty-two of them were treated with (6-18 MU) alpha-2a-recombinant-IFN t.w. for 4-6 months, and the remaining 11 with 10 MU of lymphoblastoid-IFN thrice weekly for 6 months. At the end of treatment, HBV-DNA levels were undetectable and ALT values within the normal range in 34 of 53 patients (60%); IgM anti-HBc levels decreased in all the 34 patients, falling below 10 PEI U in 2/34 (6%). Response to treatment was maintained throughout the follow-up (mean 3 years, range 2-7 years) in five patients (9.4%). The remaining 29 patients experienced HBV reactivation within median follow-up of 6 months (range 1-22 months; 90% of cases within 12 months). Overall 4/9 long-term responders (44.4%) cleared serum HBsAg. In conclusion, chronic anti-HBe-positive hepatitis B has a lower IFN treatment response rate than the HBeAg-positive form; however, among long-term responders, the incidence of serum HBsAg clearance is comparable in the two forms. Because of the high rate of relapses, stringent monitoring criteria (HBV-DNA, IgM anti-HBc and ALT monthly tested for at least 12 months) are mandatory.

[Intrabiliary rupture of hydatid cysts of the liver. A clinical case]. / Rottura intrabiliare di cisti idatidea del fegato. Considerazioni su un caso clinico.

The authors report a case of intrabiliary rupture of some recurrent hepatic hydatid cysts. The biliary drainage was performed endoscopically during ERCP. The results of treatment were satisfactory. The value of total cystopericystectomy and external biliary drainage on prevention of cyst-biliary fistulas is underlined.

Intramuscular natural beta interferon in the treatment of chronic hepatitis B: a multicentre trial. Italian Hepatitis B Study Group.

A randomized controlled multicentre trial was undertaken to assess the effectiveness of natural IFN beta (Frone) administered by intramuscular injection to chronic hepatitis B patients. Sixty-five HBsAg and HBeAg carriers with chronic hepatitis and intrahepatic HBcAg histologically proven by immunohistochemistry were included in the study. Fifty-nine patients completed the study: 30 of them (mean age 27 years, range 14-55 years, 16M/14F) were treated with 5 Million Units (MU)/m2 of Frone three times weekly for six months and 29 (mean age 28 years, range 14-59 years, 18M/11F) were not treated. The 2 groups of patients were similar in their clinical and histological (CAH/CPH ratio 25/5 and 20/9) characteristics. In the treated patients, a significant reduction in viremia was observed starting from the 6th month of the follow-up (p < 0.01), accompanied by a significant reduction of serum aminotransferase levels (p < 0.005). At the end of therapy serum HBeAg was undetectable in 7 of 30 (23%) treated patients and in 1 of 29 (3%) controls. Six months after the end of treatment 8 of 30 (26%) treated patients and 5 of 29 (17%) controls were HBeAg negative. A significant difference (p < 0.05) was observed in the rate of anti-HBe seroconversion between the 2 groups starting from the 8th month of follow-up. Mild side effects, namely fever < 38 degrees C and asthenia were observed in 20% and 37% of treated patients. In conclusion natural beta interferon given intramuscularly is effective in HBeAg positive patients suffering from chronic hepatitis B with optimal compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Indications for reimplantation of the inferior mesenteric artery in the course of prosthetic substitution for the subrenal aorta]. / Le indicazioni al reimpianto dell'arteria mesenterica inferiore in corso di sostituzione protesica dell'aorta sottorenale.

The authors report their experience relative to 8 patients who underwent IMA revascularization during infrarenal AAA repair. The Carrel patch technique was employed in all cases operated. With this procedure no ischemic intestinal complication occurred. Two cases of ischemic colitis were observed in a second group of 40 patients operated for AAA in whom the IMA wasn't reimplanted into the aortic graft. The overall incidence of acute intestinal ischemia was 4%.

Hepatitis B virus unable to secrete e antigen and response to interferon in chronic hepatitis B.

BACKGROUND: Anti-hepatitis e antigen-positive chronic hepatitis B is a progressive liver disease associated with precore mutant hepatitis B virus (HBV) and poor response to interferon. Therefore, precore mutant HBV may behave as an interferon-resistant virus. The relations between the prevalences of wild-type and precore mutant HBVs in baseline viremias and response to interferon were analyzed. METHODS: Sera from 115 patients (59 treated and 56 untreated, followed up for 30 months) were tested using a quantitative oligonucleotide hybridization assay. RESULTS: Spontaneous or interferon-induced recoveries were observed in 28.5% (6 of 21) and 47.3% (18 of 38) or in 0% (0 of 35) and 19% (4 of 21) of the patients with wild-type prevalent or mutant prevalent HBVs, respectively. Relapses occurred in 85.7% (12 of 14) and 19.4% (4 of 21) of treated patients with prevalent precore mutant and prevalent wild-type HBV, respectively (P = 0.0001). High precore mutant HBV levels (> 20% of total viremia) were associated with the lack of permanent response to interferon (P = 0.01). CONCLUSIONS: Precore mutant HBV can influence the response to interferon when it reaches significant serum levels (> 20% of total viremia). Therefore, chronic hepatitis B should be treated as early as possible in its natural history before precore mutant HBV is selected as a prevalent virus.

Transplantation of warm ischemia damaged kidneys: an experimental study in pigs.

This study evaluated renal function and histological and oxidative injury in transplanted kidneys harvested after prolonged warm ischemia in pigs. In 8 donor pigs, kidneys were perfused in situ 120 min after cardiac arrest. One of each pair of kidneys was used for histological and biochemical studies while the other was transplanted into a recipient undergoing bilateral nephrectomy. In 6 cases, renal function was satisfactory 14 days after transplantation. Histologically, a reversible acute tubular necrosis was observed with partial recovery at the 14th postoperative day. A moderate oxidation was revealed by decreased glutathione and increased malondialdehyde levels. In spite of this ischemic injury, these findings suggest that kidneys harvested after prolonged warm ischemia can still recover after transplantation, and that non-heart-beating donors may be considered as an alternative organ source for kidney transplantation.

[Predictive value of the echo-Doppler test in relation to the development of carotid arteriosclerotic plaques]. / Predittività dell'esame eco-Doppler in rapporto all'evoluzione della placca aterosclerotica carotidea.

The authors report their experience relative to 102 patients evaluated with carotid duplex-scanner. Ultrasonographic data of atherosclerotic carotid changes have been correlated with the outcome of the tested series. In fact, echographic images of vascular changes with high thromboembolic risk (ulcerated plaque) have been associated with cerebrovascular injuries in 25% of the cases. Furthermore, the duplex-scanner showed the need for surgical treatment (TEA) in 32 patients with asymptomatic carotid stenosis. Therefore, this noninvasive diagnostic tool seems to play an essential role in the prevention of cerebrovascular ischemia.

Treatment of chronic hepatitis B with beta interferon given intramuscularly: a pilot study.

In a pilot study aimed to test the therapeutic potential of beta interferon (IFN) given intramuscularly we treated 4 patients with HBeAg positive chronic hepatitis B with a progressively increased dosage of beta IFN (from 5 to 9 million units daily) for 1 month and with 9 million units for 5 additional months, thrice weekly. In 3 of the 4 patients, serum HBV-DNA decreased during therapy and remained undetectable in 2 who seroconverted from HBeAg to anti-HBe while in 1 patient viraemia rebounded to pretreatment levels during the follow-up. In the remaining patient serum HBV-DNA fluctuated during treatment. These results suggest that beta IFN given intramuscularly has a potential therapeutic efficacy in patients with chronic hepatitis B and prompt further clinical trials in a larger number of patients.