[Diagnostic pathway in a case with severe degree of hypertension]. / Iter diagnostico di un caso di ipertensione arteriosa di grado severo.

A 29- year-old male was admitted because of exertion dyspnea and intense headache. These symptoms were associated with severe hypertension, small multiple areas of cerebral ischemia, thrombocytopenia, prolonged aPTT and renal failure. The diagnostic tests performed during hospitalization resulted in a diagnosis of Primary Antiphospholipids Syndrome. The renal biopsy sample suggested histopathological features of uncommon simultaneous occurrence of antiphospholipids nephropathy and a "collapsing variant" of segmental focal glomerulosclerosis. It is fundamental to be aware that this syndrome is very likely to occur, and therefore to perform antiphospholipids antibodies assessment, since only an anticoagulant therapy proves effective; nevertheless, in view of the pathological renal findings, other therapies such as steroids might be added.

[Renal biopsy: outpatient procedure?]. / Biopsia renale: possibile procedura ambulatoriale?

BACKGROUND: The renal biopsy is usually performed as an in-patient procedure, with patients admitted to hospital for at least 24 hours. We have carried out renal biopsies on two groups of patients. In the first group, patients rest in the hospital for 8 hours following the procedure. They are discharged after undergoing ultrasonography and a TC scan. These patients return to the hospital after 24 hours to verify possible post-biopsy complications. In the comparison group, patients remain in hospital for 24 hours. RESULTS: In both groups, the only observed complication was asymptomatic postbiopsy hematoma. No major complications were present in either group. CONCLUSIONS: In selected cases, renal biopsy performed by an expert practitioner as an outpatient procedure is safe and does not require 24-hour observation.

Juvenile hyaline fibromatosis: a case report.

The authors present a 9-year-old girl with a juvenile hyaline fibromatosis observed before any treatment and after surgical releases. The disorder showed impressive clinical features both concerning the size of the dermal nodules and the degree of limitation of involved joints. Although the follow-up was short, we emphasize the great role surgery can play in reaching very satisfying results, both aesthetically and functionally.

Resistance to alpha interferon therapy in HCV chronic liver disease: role of hepatic fibrosis.

The response rate to interferon in HCV chronic liver disease is insufficient to date and the causes of this failure are not fully understood. Hepatic fibrosis hinders the blood-hepatocyte exchange of substances and we hypothesized that this process may also reduce the efficacy of interferon. Serum levels of connective tissue metabolites are related, to some extent, to the amount of extracellular matrix in the liver. Therefore, the usefulness was evaluated of serum tests of connective tissue metabolism compared to standard biochemical and histological parameters in predicting the probability of primary response to interferon. Sixty-eight patients with HCV chronic liver disease were treated with alpha-interferon for 1 year. At multivariate analysis time 0, the serum level of the P1 fragment of laminin was found to be the only factor independently associated with the response to treatment. As is well known, higher serum concentrations of the P1 fragment of laminin are associated with active basement membrane turnover and derangement of the hepatic structure. Therefore, this process seems to reduce the probability of response to interferon and, if confirmed, evaluation of serum the P1 fragment of laminin may be a useful test to predict the response to interferon and to define the therapeutic strategy, especially as far as the dose of interferon is concerned.

[Lupus glomerulonephritis. Study of 21 cases: clinico-morphological correlations]. / Glomerulonefrite lupica. Studio di 21 casi: correlazioni clinico-morfologiche.

The authors report their experience, based on 21 cases, on lupus glomerulonephritis with clinic-morphological correlation and follow-up. They classified renal biopsies utilizing WHO classification and applying a numerical score system proposed by Austin. This system considers the morphological characters referable to duration (chronicity index: C.I.) and activity (activity index: A.I.) of renal disease. Histological data have been connected with clinical evolution of renal disease. Patients have been followed for periods varying from 8 months to 8 years. From data obtained we can see that there is not a constant relation between a high chronicity index or activity index and unfavorable evolution of disease. Besides the authors report a revision of literature considering the possibility of connection between morphological data and the prognosis of lupus glomerulonephritis. They refer contrasting judgements about this.

[Agnathia, microstomia, synotia]. / Agnatia, microstomia, sinotia.

The authors describe a case of plurimalformative syndrome, characterized by agnathia, microstomia, synotia and by cardiac and pulmonary maldevelopment. The case peculiarity consist in the rarity of this malformative occurrence; moreover, the authors underline the occurrence of familiarity with Seckel's Syndrome.

[Mid-term natural course in Naples of chronic HBeAg positive infection caused by the HB-virus. Prospective study, preliminary to antiviral treatment]. / L'andamento naturale a medio termine a Napoli della infezione cronica da HB-virus HBeAg positiva. Studio prospettivo, preliminare al trattamento antivirale.

41 consecutively observed patients with chronic HB virus infection in replication phase (HBeAG positive) were followed up for an average period of 60 months with a view to evaluating the frequency of spontaneous HBeAg/anti-HBe seroconversion and the influence of the event on the clinical course of the liver disease. The 41 patients, of mean age 22 years, suffered from: 26 ECP, 7 ECA, 8 CIRR. 18 patients (41%) presented HBeAg/anti-HBe seroconversion with an annual percentage of 12%, all with stable normalisation of hepatic cytolysis tests. Factors related to HBeAg/anti-HBe seroconversion were: female sex, higher mean starting values of transaminase, positive history for EVA, absence of Virus Delta superinfection. The effectiveness of antiviral treatments will only be demonstrated when seroconversion (inhibition of viral replication) is produced much more frequently than that which occurs spontaneously. Candidates for current antiviral treatment are indicated.

Reactive glioma in intracranial sarcoma ('sarcoglioma'). Histology, electron microscopy and immunohistochemistry of two additional cases.

The clinicopathologic features of 2 cases of sarcoglioma are described. This rare type of mixed brain tumor is composed of a central core of sarcoma with peripheral distribution of gliomatous elements with gradual transition from reactive to neoplastic astrocytes. The immunohistochemical features showed a strict positivity to glial fibrillary acidic protein only in glial cells, a positivity to vimentin prevalently in sarcomatous cells, whereas the factor VIII-related antigen was negative in astrocytes as well as in sarcomatous cells. The different origin of two neoplastic components is demonstrated well by an ultrastructural study. The morphological observations together with an adequate clinical setting contribute to separate this specific entity from other mixed brain tumors.

[Ischemic stenosis of the ileum with reactive parietal and lymph-nodal angioendotheliomatous hyperplasia]. / Stenosi ischemica dell'ileo con iperplasia reattiva angioendoteliomatosa parietale e linfonodale.

Ischemic stenosis of ileum with reactive parietal and lymph node angioendotheliomatous hyperplasia. The case subject of this study represents a form of segmentary chronic ischemic enteritis with intramural haematoma, intestinal stenosis and neighbouring mesenteric venous thrombosis. In the histopathologic picture it is of great interest a peculiar lesion of the intestinal wall which has been interpreted like reactive nodular angioendotheliomatous hyperplasia, associated to diffuse parietal granulation tissue formation and marked transmural neoangiogenesis. This lesion also interests a small locoregional mesenteric lymph node, where it appears to be included in a morphological picture of nodal angiomatosis (also known as vascular transformation of lymph node sinus). The last pathological entity has been thought to take rise from a local perinodal venous obstruction. This aetiopathogenetic interpretation has been also referred to the lesion of the intestinal wall which for the Author's knowledge is not accompanied by similar examples in the literature. The patient is a 28 years old man who after a six years follow up presents perfect health.