H1N1 pneumonia: our experience in 50 patients with a severe clinical course of novel swine-origin influenza A (H1N1) virus (S-OIV).

PURPOSE: The authors reviewed chest radiographs (CXR) and thin-section computed tomography (CT) findings of pulmonary complications in a selected population of 50 consecutive patients with severe novel swine-origin influenza A (H1N1) virus (S-OIV) pneumonia who were seen at the Subintensive Respiratory Unit (UTSIR) and at the Intensive Care Unit (ICU) at Monaldi Hospital, Naples, Italy. MATERIALS AND METHODS: CXR and CT findings of 50 patients who fulfilled the World Health Organisation (WHO) criteria for S-OIV infection were reviewed by four radiologists. The final study group of 50 patients was divided into two subgroups on the basis of clinical course: group 1 consisted of 42 patients requiring noninvasive mechanical ventilation and admitted to the UTSIR; group 2 consisted of eight patients who required ICU admission and extracorporeal membrane oxygenation or advanced mechanical ventilation from October 2009 to December 2009. All patients underwent CXR and thin-section multidetector CT (MDCT) scan; the initial and follow-up radiographs and CT scans were evaluated for the presentation and follow-up pattern (consolidation, ground-glass opacities, nodules, reticulation), distribution and extent of abnormality. RESULTS: All patients had radiological signs of pulmonary involvement. Ground-glass opacity and consolidation, which was mainly peripheral, was the most frequent finding. In three patients, we report for the first time in viral pneumonia the reversed halo sign. Lesion extent was related to aggressiveness of the illness. More often, both lungs were involved (82%). Thoracic comorbidity was present in 18% of patients; 22% of patients was obese, and in this group, the clinical course was more aggressive than in the others with the same lesion extent at imaging. Furthermore, superinfection led to worsening of the clinical conditions. CONCLUSIONS: The most common CXR and CT findings in patients with S-OIV infection were unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. On MDCT, ground-glass opacities and areas of consolidation had a predominant peribronchovascular and subpleural distribution, resembling organising pneumonia; they progressed to bilateral extensive airspace disease in severely ill patients.

Immunopharmacology of human mast cells and basophils.

Human mast cells and basophils play a key role in the pathogenesis of several immunological and inflammatory disorders, not only by producing inflammatory and fibrogenic mediators, but also by directly (CD40 ligand) and indirectly secreting various cytokines and chemokines. Studies carried out to evaluate the effects of drugs that modulate the release of mediators and cytokines from these cells have contributed to clarifying the biochemical mechanism by which immunological and non-immunological stimuli activate these cells. Significant differences have been documented between human mast cells and basophils as regard the pharmacological agents that modulate the release of mediators, between mast cells isolated from different anatomical sites, and between compounds of the same class of drugs. Efforts to gain insight into the biochemical events occurring during immunological activation of mast cells and basophils could lead to the identification of new biochemical targets for therapeutic interventions in several immunological disorders.

[Double cardiac fibroma in a newborn infant]. / Fibroma cardiaco doppio in neonato.

The authors describe the autopsy finding of two fibromas within the left ventricular wall of a five-day-old newborn. Histochemistry and immunohistochemistry showed the lesion as a purely fibroblastic proliferation, with intense elastic fibers formation and secondary morphological alteration and biological damage of the pre-existing muscular fibers. The authors, on the basis of the phases of the cardiac metamers development and of myocardial tissue differentiation, exclude any relationship with disembryogenetic factors, and hence the hamartomatous origin of the lesion, despite their onset in the first months of intrauterine growth.

[Pulmonary malformations associated with congenital cardiopathy]. / Malformazioni polmonari associate a cardiopatie congenite.

The authors describe, in a series of 132 pediatric autopsies in the period January 1979-December 1994, the associations between congenital cardiopathies and pulmonary malformations. These latter were present in 13 of 46 cases (34.8%) in which cardiopathy was associated to a malformation of other discricts. In 9 of cases was exclusively interested the lung, while in the remaining 4 cases also other organs presented anomalies. The lung malformations observed were represented in 12 cases by supernumerary scissures with conjuncted cardiac septal system defects; in one case an alveolar dysplasia was associated to a previous Botallus duct. None of the 8 malformative syndromes, due to chromosomopathies, showed lung malformations. Examining the sequential chronological phases of the development of the two apparatus, the Authors hypothesize a common etiopathogenesis in both malformations, due to the isochronous action of the same intra-uterine pathogenic noxa, favoured by the topographic relationships of the two systems. Conversely, seems unlike the action of genetic damages, although either in genetically determined, or intra-uterine acquired, malformative syndromes, the pulmonary defects are almost exclusively represented by anomalies in the scissures formation.

[Ventricular hypoplasia in congenital heart diseases]. / Le ipoplasie ventricolari nelle cardiopatie congenite.

Twenty-seven cases of autopsy showing hypoplasia of one of the ventricular cavities, prevalently the left, were selected from a series of 103 congenital cardiopathies (1979-1990). In 9 cases ventricular hypoplasia formed part of complex malformative syndromes with a well-known physiognomy: a further 18 cases showed a complete (9 cases) or incomplete (9 cases) hypoplastic heart syndrome. Subjects were prevalently female and the presence of other malformations indicating a genetic dysfunction was less evident than in other cardiopathies. The different pathogenetic hypotheses are discussed in the light of macro- and microscopic morphological factors, of which the most plausible is that involving an anomalous position or orientation of the musculo-membranous folds which give rise to the septation system of the various metamers of the cardiac tube.

[Cardiac malformations with septal defects. Apropos of a case of biloculate heart with transposition and aortic atresia]. / Le malformazioni cardiache con difetti settali. A proposito di un caso di cuore biloculato con trasposizione ed atresia aortica.

The Authors describe a case of uniatrial univentricular heart with a right transposition and atresia of the aorta. This case forms part of an autoptic series of 74 congenital cardiopathies with defects of the septal system: monometameric (52 cases), polymetameric (22 cases), and limited (66 cases) or broad DIA, DIV or FAP types (8 cases). Having outlined the correlations between the type of defect and the complex morphogenetic events, whose close integration leads to a continuous septal system, the Authors focus their attention on the common associations between septal defects and other cardio-vascular anomalies (66 cases). The analysis of findings supports hypothesis that many of these are due to alterations in the position and direction of individual septal buds are should be seen against the overall background of septal pathology. Under these circumstances the pathogenetic importance of alterations of the complex movements presented by the cardiac type during the course of septal development and, to an event greater extent, possible alterations of the embryonal hematic flow are underlined.

[Roundish opacity of the right lung (a clinical case)]. / Opacità rotondeggiante del polmone destro (caso clinico).

The authors describe a rare case of pulmonary hamartomyxoma observed by them as a secluded roundish opacity (coin lesion) in the middle right thoracic region. After reporting an accurate anatomic-radiology can description of the lesion, they expose the histogenesis and the classification attempts concerning the chapter about "hamartomas" through an ample revision of the cases reported in the last years.