Pulmonary hypertension secondary to thrombosis of the pulmonary vessels in a patient with the primary antiphospholipid syndrome

Recurrent pulmonary emboli or microthromboses are hypothesized as possible causes of pulmonary hypertension in the antiphospholipid syndrome (APS), but thrombosis of the pulmonary vessels has been rarely documented. We describe the case of a 45-year-old Caucasian man affected by thrombocytopenia, recurrent deep venous thrombosis, recurrent pulmonary embolism and fatal chronic pulmonary hypertension (systolic pressure: 85 mm Hg). Anticardiolipin antibodies were highly positive, and the lupus anticoagulant was present. At autopsy, recent thromboses of small vessels were observed in the lung, with organized clots and recanalized channels. Furthermore, friable and firm vegetations and nodules were observed on the cusps of the mitral and tricuspid valves, intermingled with recent surface fibrinous thrombi. In the adrenals we found vascular thrombotic lesions similar to those in the lungs. The pathological lesions suggest pulmonary hypertension secondary to pulmonary arterial microthromboses. Moreover, this is the first documentation of tricuspid valve pathology in a patient with APS.

Induction of experimental SLE in naive mice by immunization with human polyclonal anti-DNA antibody carrying the 16/6 idiotype

Recently, the induction of SLE in naive mice employing monoclonal anti-DNA antibodies (anti-DNA Ab) carrying the pathogenic idiotype 16/6 (16/6 Id) has been reported. In the current study we report on the induction of experimental SLE by polyclonal IgG anti-DNA Ab derived from a patient with active SLE and carrying the 16/6 Id. Two different experiments were conducted in which BALB/c mice were immunized in the footpads with 1 microgram/ml or 5 micrograms/ml of anti-DNA Ab. The first experiment showed the appearance in the immunized mice of high titre anti-DNA Ab together with antinuclear antibodies, alopecia and proteinuria. In the second experiment we compared, as immunizing agents, 16/6 positive anti-DNA Ab and 16/6 negative anti-tetanus toxoid antibodies (anti-TT Ab) obtained from the serum of the same patients. Our results show that only mice immunized with 16/6 positive antibodies produced anti-DNA Ab, while mice immunized with anti-TT Ab did not show any DNA-binding activity but, surprisingly, developed high titre anti-cardiolipin antibodies.

[Torsional defects of the lower limb: an evaluation of the reliability of the results obtained by CT]

The torsional angle was calculated goniometrically of 9 femurs and 2 tibio-peroneal groups, and then compared to the values obtained from CT scans of the corresponding bones. The results show how the methods adopted up to now have been inaccurate and have yielded only gross definitions of the axis of the femoral neck. As far as this feature is concerned, an error of +/- 6.5 degrees can be estimated, with limits of confidence of 95%, after applying a more accurate system of measurement to the images and considering statistical interferences. After pointing out the advantages of this method, we suggest that the test performed in vivo be systematically proposed to all those patients in whom a more accurate diagnosis would lead to a different medical/surgical therapy considering that: 1) the inevitable error such a measurement bears can be contained between acceptable limits; 2) the radiation dose sufficient to distinguish the bone from the other surrounding tissues is much reduced with respect to the dosage necessary to perform a common CT of the inferior limbs. It comprises one topogram and four tomograms, with a total dose to the patient of approximately 10-20 mGy.

[Dynamics of food transit in gastrectomized patients with and without dumping syndrome studied with the gamma camera and a marked meal]

Scintigraphy was performed on a group of patients following the administration of a solid radiolabelled meal. As a tracer, human albumin microspheres were used with 99mTc, mixed with fresh scrambled eggs, eaten as a sandwich in two slices of white bread. The analysis of transit and emptying-rate of the radiolabelled meal in the gastric or derivative loop areas was performed by means of a medium field (300 mm) gamma camera interfaced with a digital computer; the data were collected at 15" frames for 90'-120'. Twenty-nine patients were examined who had undergone sub-total gastrectomy: 11 of them were "dumpers" and 18 "non-dumpers"; moreover, 9 volunteers without any history of gastrointestinal diseases and 11 patients with different gastric disorders were checked. In the first group of gastrectomized patients the half-emptying time (T50) was significantly shorter than in the 11 people being checked (Md = 27.5 +/- 10.8 versus 69.6 +/- 19 minutes); in "non-dumpers" T50 was even shorter (Md = 24.2 +/- 13 min). There was no significant statistical difference between the two classes of gastroresected patients in both T50 and emptying-rate of the radioactive solid food, which excludes the accelerated transit as a factor in the functional post-prandial symptoms of the dumping syndrome. On the contrary, the dynamic selective analysis of the radiolabelled food transit through derivative afferent and efferent loops showed different patterns in the two groups of gastroresected patients: the progression of the propulsive wave was very irregular and constantly hyperperistaltic only in the dumpers.

Use of monoclonal antibodies to identify shared idiotypes on anticardiolipin and anti-DNA antibodies in human sera

Using hybridoma technology we produced monoclonal antibodies (MoAb) to idiotypic determinants on human anti-cardiolipin antibodies purified from a patient with SLE. Hybridomas were screened by inhibition of cardiolipin binding activity of sera from patients with SLE. Seven hybridomas were selected, two of which were studied extensively. Sera from a number of patients with SLE were found to share idiotypic determinants. This cross-reacting idiotype was not detectable on anti-cardiolipin antibodies in syphilis sera. The cross-reacting idiotype was present in sera with anti-ssDNA antibodies even though some of these sera had no anti-cardiolipin antibodies. We propose that these MoAb may recognize a regulatory idiotype.

Bilateral cerebral occipital calcifications and migraine-like headache

Computed tomography scanning in two young patients with recurrent, pulsating, migraine-like headache showed parieto-occipital calcifications. One patient presented with an atypical form of the Sturge-Weber syndrome, and the other with celiac disease and folic acid deficiency. The clinical features were analyzed and compared with those in other cases reported in the recent literature which have shown bioccipital calcifications but no cutaneous angiomas, sometimes associated with visual and/or intelligence deficit and epilepsy. Finally, the possible connection between cerebral calcifications and headache is discussed.

[Standard radiography of the chest in heart transplantation. Our experience]

In the cardiovascular Surgery Department of the University of Padua, where the first heart transplant operation in Italy took place in November, 14, 1985, in a period of six months, nine heart transplants have been performed. The post-operative follow-up of these patients included, among other tests, a chest X-ray, which has given us many morphological and functional data concerning both the circulatory and the pulmonary systems.

[Dermatopathies in those engaged in domestic work and related risks]

The AA., considering the skin diseases in the subjects employed in the domestic work and similar activity, in a more ample table of general medicine, produced a contribution to the study of etiopathogenetic and nosographic problems. They have estimated the role of the individual predisposition and the etiopathogenetic, chemical, physical, biotic, complex factors. They pointed out the various nosographic, skin expressions in range of contact irritant dermatitis, of contact allergic eczema, skin abrasion, of dermatitis by physical agents, of urticaria, of dermal alterations by infectious and parasitic agents and of various dermal, morbid expressions by chemical agents. They reported the direct experience of personal casuistry and called attention on multiple aspects of preventive medicine.

Anti-phospholipid and anti-mitochondrial type M5 antibodies in systemic lupus erythematosus

Fifty-one sera from patients with systemic lupus erythematosus (SLE) were studied in order to evaluate the prevalence of anticardiolipin (ACA) and anti-mitochondrial antibodies (AMA) type M5, and also to explore their relationship with the main serological and clinical features of the disease. A group of 25 (49.0%) patients was found to be ACA positive (IgG or IgG and IgM); in this group we found a significantly higher prevalence of false positive VDRL (p less than 0.01), lupus-like anticoagulant (p less than 0.05), and AMA type M5 (p less than 0.01), but not of anti-ds or ss-DNA antibodies. Three sera positive for ACA, AMA-M5 and anti ss-DNA were absorbed with cardiolipin liposomes. Anti-DNA and AMA-M5 showed only a minimal decrease. Central nervous system involvement and especially seizure syndrome was demonstrated with a higher prevalence in ACA-positive groups (p less than 0.05). Despite the results of absorption experiments, the close relationship between AMA-M5 and ACA, false positive VDRL or lupus-like anticoagulant (LLAC) might justify a speculation on the antiphospholipid nature of this antimitochondrial activity.

On the other side of the reference desk: the patron with a physical disability

In order for reference librarians to overcome feelings of inadequacy which they experience in aiding physically disabled patrons, they must educate themselves about the special needs of these patrons. This article will address the concerns, common mistakes, and difficulties involved in personal interactions with disabled individuals, particularly as they relate to the reference setting. In addition, specific steps will be described to minimize the difficult aspects of these interactions; these will be presented in terms of attitudinal and service activities. An attempt also will be made to describe aspects of these reference interactions which are unique to various health care settings.