Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients

Ascites is a complication of chronic liver disease that is associated with decreased survival. The purpose of the present study was to identify some prognostic factors easily obtainable by the clinician in a large group of cirrhotic patients with ascites, possibly useful for first screening of outpatients as candidates for liver transplantation. We studied 134 ambulatory patients with cirrhosis who came to our outpatient clinic between July 1983 and March 1989 because of an episode of ascites. These patients were then followed up for an average period of 31 +/- 23 months and survival was determined. Thirty-one variables determined at the time of inclusion were analyzed with a Cox proportional hazards model to identify predictors of mortality. Cumulative mortality as of June 30, 1991, was 59%. Factors independently correlated with death were: refractory ascites (relative risk, 4.78), low albumin levels (3.77), high Child-Pugh score (3.31), encephalopathy (2.71), high bilirubin levels (2.03), high gamma-glutamyl-transferase levels (1.87), and old age (1.57). The results show that 1) the occurrence of refractory ascites has a prognostic value superior to those of other variables, and 2) simple clinical and biochemical parameters, most of them components of the Child-Pugh score, are useful for a first screening of ascitic cirrhotic patients as candidates for liver transplantation.

Bullous lesions in acrodermatitis enteropathica. Histopathologic findings regarding two patients

Acrodermatitis enteropathica (AE) is an autosomic recessive disorder affecting early infancy. Two cases of infantile AE with low plasma zinc levels are reported in which unusually prominent bullous and vesicobullous lesions were seen on the hands and feet, in addition to the more typical erythematous and scaly patches. Both psoriasiform and bullous lesions responded dramatically to oral zinc-sulfate supplementation. The histopathologic features of the bullous lesions of AE have not previously been fully examined. Histologically, the bullous lesions were characterized by intraepidermal vacuolar changes with massive ballooning, leading to intraepidermal vesiculation and blistering, with prominent epidermal necrosis and with no acantholysis. The bullous lesions did not arise on erythematous patchy lesions, but developed ex novo on unaffected skin. The histopathologic differential diagnosis with other bullous conditions is discussed.

Renal effects in cirrhotic patients with avid sodium retention of atrial natriuretic factor injection during norepinephrine infusion

The administration of atrial natriuretic factor to patients with cirrhosis, and avid sodium retention causes marked hypotension and blunted kidney responses. To evaluate whether the unresponsiveness of the kidney is caused by a fall in mean blood pressure below a critical value for the renal blood perfusion pressure (80 mm Hg), we studied nine such patients and compared the effects of synthetic atrial natriuretic factor alone (1 micrograms/kg as a bolus) with those of an atrial natriuretic factor combination with infused norepinephrine titrated to raise baseline blood pressure by 15 to 20 mm Hg (182 to 625 ng/kg/min). The administration of atrial natriuretic factor during norepinephrine infusion caused a fall in mean blood pressure to values not less than 80 mm Hg in eight of nine patients, with a slight natriuresis (greater than 5 mumol/min) in five patients but no changes in the other four. The mean urinary sodium output was markedly lower than that previously observed after atrial natriuretic factor injection into normal subjects and into cirrhotic patients without avid sodium retention. Unlike sodium excretion, urine flow rate and free water clearance (which were not affected by atrial natriuretic factor alone) were markedly improved by the coadministration of norepinephrine and atrial natriuretic factor. In four additional patients we studied the urinary electrolyte excretion during a low-dose infusion of atrial natriuretic factor (20 ng/kg/min) to which an infusion of norepinephrine titrated to maintain blood pressure over 80 mm Hg was added. In only one of these four patients urinary sodium output consistently increased during atrial natriuretic factor infusion, and the output increased even more when norepinephrine was added.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of the intercellular matrix in dermal calcinosis of the CRST syndrome. An electron-microscopic study

We performed an electron-microscopic study on calcium deposits in two patients with calcifying scleroderma (CRST syndrome). Calcium deposits were detected both intracellularly in the mitochondria of phagocytic cells and extracellularly. Needle-like crystals measuring up to 4,500 A in length and approximately 60 A in width were present in both the Von Kossa-positive regions and the apparently normal dermal areas around the calcification sites. Although the fibrillar matrix's ultrastructure was normal, hollow oxytalan fibrils were detected. Slightly electron-opaque, star-shaped material was observed among the fibrillar component of the matrix (matrix granules), which is the ultrastructural expression of some types of proteoglycans containing keratan sulphate and chondroitin sulphate. These granules cannot be detected in normal dermis. The extrafibrillary calcium deposits on these mucopolysaccharide structures may represent an early event in the complex pathogenesis of calcification in the CRST syndrome.

Evidence for CD8+ cell increase in long-term PUVA-treated psoriatic patients after PUVA discontinuation

Long-term PUVA-treated psoriatic patients given maintenance therapy (UVA doses greater than 1,000 J/cm2) have been demonstrated to undergo lymphopenia and a decrease in the total number of circulating CD3+ and CD4+ T cells. The aim of this study was to assess whether the impairment of T cells is detectable also in psoriatic patients after long-lasting PUVA discontinuation. A group of 34 psoriatic patients (25 males, 9 females; mean age 52.7 +/- 12.82 years), who had previously been treated by PUVA therapy (average cumulative dose 1,898.48 +/- 1,207.12 J/cm2), was studied 1 year or more after discontinuation of PUVA therapy. The patients studied failed to show any impairment in CD3+ and CD4+ cells. Nevertheless, a significant increase (p less than 0.05) in circulating CD8+ cells (both in the percentage and the total number) was detectable in PUVA patients as compared to appropriate controls. The significance and implications of this finding are not known and need further investigations.

Paederus fuscipes dermatitis. A histopathological study

Paederus fuscipes (PF) dermatitis is a self-healing blistering disorder of the skin caused by a small insect belonging to genus Paederus, family Staphylinidae, order Coleoptera. Crushing PF on the skin causes acute dermatitis within 24 hours, corresponding in shape and dimensions to the area affected by the substance released (pederin). The acute vesicular lesions become crusted and scaly within a few days and heal completely in 10-12 days, with a transitory postinflammatory hypercromic patch. Twenty consecutive cases of PF dermatitis at different stages were studied histologically by routine light microscopy. The pederin causes a spectrum of histopathologic changes ranging from acute epidermal necrosis and blistering in acute stages, to marked acanthosis with mitotic figures in the late stages. PF dermatitis is an entomological model of irritant contact dermatitis, having histopathologic features of intraepidermal and subepidermal blistering, epidermal necrosis and acantholysis. The presence of some acantholytic foci, relatively far from the foci of clinically involved skin, in four of the cases considered suggests a possible role of pederin in inducing acantholysis indirectly. Acantholysis is probably caused by the release of epidermal proteases.

Lymphopenia and decrease in the total number of circulating CD3+ and CD4+ T cells during 'long-term' PUVA treatment for psoriasis

The relationship between high-dose PUVA treatment in psoriatic patients and peripheral T lymphocyte subsets (total number and percentage) has been studied. Of the two groups of patients considered, the first included 19 patients, all affected by chronic, progressively worsening psoriasis; they had never been previously treated by photochemotherapy. The second group included 13 psoriatic patients, who had received an average cumulative dose of 2,007.69 +/- 1,191.05 J/cm2. The 'long-term' PUVA-treated group was assessed while undergoing maintenance therapy. No significant differences were found between untreated patients and healthy controls for any of the parameters considered. A significant reduction (p less than 0.05) in the total number of lymphocytes in long-term PUVA-treated patients both versus untreated patients and controls was found. Furthermore, long-term PUVA-treated patients showed a significant reduction (p less than 0.05) in the percentage of lymphocytes as compared with controls. The reduction in the total number of CD3+ and CD4+ T cells was, moreover, significant (p less than 0.05) as compared with untreated patients. The impairment of circulating CD3+ and CD4+ T cells (total number) was only on the borderline of statistical significance vis-à-vis controls. These findings suggest the usefulness of a careful assessment of circulating T lymphocyte subsets in patients who undergo long-term PUVA therapy.

The language of dermatology and dermatopathology from Robert Willan to A. Bernard Ackerman

Contemporary dermatologists often use sophisticated, striking forms of communication in the exposition of their ideas. Among their innovative techniques is the pseudodialogue, which permits them to summarize and attack the arguments of other researchers while at the same time asserting their own views. Earlier generations of dermatologists were well aware of the need for appropriate and even unconventional linguistic techniques. We contend that the current notion on the part of linguists that scientific language rigidly conforms to certain patterns-for example, the idea that scientific style is essentially impersonal-is much in need of revision. Indeed the conventions have been broken for centuries by leading dermatologists, often deliberately and consciously.

[Amiodarone-induced pigmentation. A histological, ultrastructural study and review of the literature]

Amiodarone is an iodinated cardiac antiarrhythmic drug that causes a slate- gray discoloration of sun-exposed skin. Histopathologically, biopsy specimens of two patients affected by amiodarone pigmentations reveal yellow-brown granules in the reticular dermis, both in the cytoplasm of macrophages and between the collagen bundles. The histochemical stainings of the granules suggest that a lipofuscin pigment rather than melanin is present in the granules. Electron microscopy displays distinctive intracytoplasmic inclusions in many dermal cell types. Six morphologic types can be seen: 1) electron-lucent, membrane bound granules, 2) granules with electron dense nucleus, 3) lamellar "myelin-like" granules, 4) granules with a combination of electron-dense and electron-lucent areas, 5) electron-dense membrane-bound granules, 6) electron-dense no-membrane granules. The different dimensions, structure and shape are related to the structural and aggregational phases of the granules. In particular their pathogenesis may be related to the action of the drug on cell membranes with thesaurismosis, local metabolic damage, accumulation of the drug in the lysosomes and acceleration of the physiological ageing cell process.

Serological determination of rabies antibodies in vaccinated subjects

This study reports the immunological response in subjects vaccinated against rabies. Four serological methods were compared: the immunoenzymatic test with HDCV virus vaccine (EIA-V) and with purified viral glycoprotein (EIA-P), the neutralizing in vitro rapid fluorescent focus inhibition test (RFFIT) and the indirect immunofluorescent test (IFI). A concordance of 93.3% was found with RFFIT and EIA-V, 86.8% with RFFIT and EIA-P and 80.5% with RFFIT and IFI. The RFFIT is the most sensitive and specific method for rabies antibodies but more expensive and difficult. IFI recognizes late nucleocapsid antibodies but reports more false positive and negative results. The EIA-V and EIA-P methods are efficient, sensitive, specific and inexpensive for routine use to detect protective titres of antibodies above 0.5 IU/ml fifteen days after the inoculation of HDCV vaccine.

[Early and late histologic aspects of atrophodermia vermiculata. A case study]

Atrophoderma Vermiculatum (AV) is a rare disease characterized by the occurrence on the face and the cheeks in particular, of fine, atrophic pits, with a bilateral distribution, producing a honeycomb, reticulate appearance. All the cases reported in the literature focus on the atrophic changes of the disease while no attention has been paid to the condition which causes atrophy. The early stages are not usually reported. MC is a girl aged 13. She had multiple, fine, pale-brown papules (1-2 mm in diameter) on her right cheek. The histopathological findings of these lesions predominantly showed lymphocytic perifolliculitis with perifollicular fibrosis. The epidermis was normal. No specific diagnosis other than perifolliculitis was possible. Eight months later the patient showed tiny, atrophic depressions and follicular plugs with reticulate teleangectases in the same area of the right cheek (with disappearance of the tiny papules). A clinical diagnosis of AV was done. The histological findings of a further biopsy showed atrophy of the epidermis, less severe perifollicular inflammation and decrease in number of the follicles. The hair follicles were widely dilated and were either empty or contained keratinous materials. Dermal atrophy and disappearance of elastic fibers was noticeable. In conclusion the late clinical features of the lesions, through unusual (asymmetry of the lesion, small and superficial atrophic scars), make the diagnosis of the early clinical and histological features of papules and perifolliculitis possible and suggest a specific name: early stages of AV.

[Necrobiosis lipoidica diabeticorum in children. Description of a case]

A case of necrobiosis lipoidica diabeticorum (NLD) in a 12-year-old male patient is described. Diabetes mellitus (DM) was diagnosed at the age of 1.5 years. The onset of the first NLD lesion had been previously observed at the age of 7, on the back of the left foot. Three new lesions appeared at the age of 8, one on the left leg, the others on the thighs. At the age of 12, four infiltrated, reddish patches, with slight central atrophy were evident on his lower extremities. Histopathological features showed foci of collagen degeneration with sclerosis, surrounded by a chronic, mainly perivascular, granulomatous infiltrate, made up of lymphocytes and histiocytes. The patient is now 19-year old, with no eye or kidney failure, owing to a constant metabolic control of DM. A constant follow-up of the patient demonstrated a self-resolution of NLD plaques, with no evidence of further lesions.

[Cutaneous extramedullary hematopoiesis in idiopathic myelofibrosis. Description of a case]

The Authors present a case of cutaneous extramedullary hematopoiesis in a 63-year-old male patient with agnogenic myeloid metaplasia. The skin lesions appeared before splenectomy as multiple papules and nodules on the trunk. Histologic examination of a lesion showed all the tree components of the hematopoietic tissue, i.e. myeloid, erythroid and megakaryocytic series. A review of the literature revealed 18 previously reported cases, with polymorphous clinical manifestations of skin involvement. The possibility of extramedullary hematopoiesis should be considered in a patient with agnogenic myeloid metaplasia who shows cutaneous eruptions.

In vivo tretinoin-induced changes in skin mechanical properties

Topical tretinoin has been reported as having anti-aging effects on photodamaged skin. The purpose of this study was to evaluate tretinoin-induced changes in the mechanical properties of the skin of 18 patients (aged 39 +/- 8 years) after 4 months of treatment with topical 0.05% tretinoin on one forearm and a placebo base cream on the other. The biomechanical skin parameters investigated were elasticity, extensibility and hysteresis and data were normalized for skin thickness. A slight but non-significant increase of skin elasticity was detected in the tretinoin-treated sites using low-stressing forces (1.2 X 10(4) Nm-2) and at higher loads (3.8 X 10(4) Nm-2), the increase in skin elasticity was significant (P less than 0.01). This improved skin elasticity was dependent on the increased collagen resulting from topical tretinoin and the replacement of elastotic material. However, topical tretinoin treatment did not improve the responses mediated by elastic fibres.

Relapsing eruptive psoriasis and immunological changes triggered by growth hormone therapy in a growth hormone-deficient girl

A 9.8-year-old girl with growth hormone (GH) deficiency and concomitant chronic and localized psoriasis of the groins and axillae showed repeated and sudden relapse of eruptive psoriasis after GH treatment. The aggravating effect of GH and the improvement of the skin condition after withdrawal suggests, at least in this case, that GH plays a significant role in the pathogenesis of psoriasis.

Familial steatocystoma multiplex: HLA, Gm, Km genotyping and chromosomal analysis in two unrelated families

Steatocystoma Multiplex (S.M.) is an inherited condition characterized by the appearance of cysts during the first or second decade of life. Familial cases have occasionally been reported. We studied 13 patients affected by S.M. from two unrelated families, focusing our attention on HLA, Gm and Km genotypes and on chromosomal analyses. Although we failed to correlate the syndrome with a particular HLA, Gm or Km haplotype, we report some peculiarities and differences between these two families and the healthy Italian population.

[Erythema pernio of the face: clinical and histopathological aspects]

A case of chilblains on the face of a man is described. An acute episode of chilblains occurred after a long period of exposure to cold. The unusual site and unusual clinical aspect raised problems of differential clinical diagnosis. Moreover histological diagnosis is easy to perform only after a correct clinical diagnosis has been carried out. For these reasons the literature on chilblains needs to be updated, even though, thanks to impaired living and working conditions, this disease is becoming uncommon.

[Changes in the biomechanic property of the skin after hemodialysis treatment]

Skin extensibility in 21 subjects (belonging to two different age groups) undergoing hemodialysis has been investigated. Measurements have been performed on the forearm before and after two hours of dialytic treatment. A significant decrease of skin extensibility (P less than 0.02) has been recorded in the elderly prior to the dialytic procedure; the data is consistent with an increased dermal water content. Water removal during treatment led to normalization of extensometric levels (P less than 0.05). However, improvement of skin extensibility is not directly related to the amount of water withdrawn. The study support the importance of water in determining skin viscoelastic responses; hemodialysis is a useful model to monitor the effects of water on skin biomechanics.

[Werner's syndrome and intracranial meningioma]

A case of Werner's Syndrome in a 47-year-old man, with typical features of progeria associated with intracranial meningioma is described. A revision of the literature showed that meningioma is the most frequent benign neoplasm in Werner's Syndrome. Meningioma is a peculiar model of neoplasm, because of the frequency of cytogenetical aberrations concerning chromosome n. 22. Either chromosome n. 22 and other chromosomal alterations could be detected in peripheral blood lymphocytes of our patient. These findings suggest a correlation between chromosomal instability and the onset of neoplasms in Werner's Syndrome. Furthermore, the possibility of detecting chromosome n. 22 aberrations in peripheral blood lymphocytes of Werner's Syndrome patients could provide a clue to the presence of a meningioma at a preclinical stage.

Chromosome instability in lymphocytes from a patient with Werner's syndrome is not associated with DNA repair defects

Different cellular parameters used to detect genetic instability were analyzed in lymphocytes from a patient affected by Werner's syndrome (WS). Cytogenetic studies indicated the presence of structural and numerical chromosomal abnormalities and the occurrence of variegated translocation mosaicism. The baseline mutation frequency was similar to that observed in normal donor samples. DNA repair investigations showing a normal capability to perform UV-induced DNA repair synthesis and a normal sensitivity to various mutagens (UVC light, mono- and bi-functional alkylating agents) indicate that different DNA repair mechanisms act normally in WS. In this feature, WS appears to differ from the other genetically determined syndromes in which chromosomal instability is associated with a marked hypersensitivity to specific DNA-damaging agents.

[Thallium-induced alopecia]

A case of accidental Thallium intoxication showing, as the only sign, alopecia of the scalp with depigmentation of the hair, is described. A 21 year old woman developed acute loss of hair after ingestion of contaminate tomatoes. No further signs of intoxication were evident. The diagnosis has been made by evidencing Thallium in the urine (colorimetric method) and in the hair (atomic absorption spectrophotometry). Moreover, the clinical and histopathological findings of Thallium alopecia are described.

Relapsing eruptive multiple Spitz nevi or metastatic spitzoid malignant melanoma?

An unusual case of multiple relapsing Spitz nevus (SN) in a patient with pseudohypoparathyroidism is described. It arose initially as a single lesion, and recurred twice as multiple agminated lesions that maintained the same histological pattern as the original SN. Nevertheless, the clinical behavior led to a diagnosis of metastasis from malignant melanoma at another medical institution. This case emphasizes the need for relying on accurate histopathological criteria to distinguish SN from malignant melanoma if inappropriate and detrimental therapeutic procedures are to be avoided.

Immunological alterations in a case of Papillon-Lefèvre syndrome with recurrent cutaneous infections

An immunological study was performed in a 16-year-old boy affected with Papillon-Lefèvre syndrome (PLS) and recurrent staphylococcal cutaneous infections. A defect of neutrophil intracellular killing of Staphylococcus aureus and a decreased lymphocyte proliferative response to phytohaemagglutinin were detected. The possible role of these alterations in promoting recurrent infections in PLS is discussed.

Eosinophilic ulcers of the tongue

A case of eosinophilic ulcer of the tongue is presented. Although the entity is rarely described, the distinctive histopathologic pattern featuring the remarkable presence of eosinophils in the superficial corium and in between muscle bundles, together with the benign clinical course, make a diagnosis possible.

[Experiences with the control of antitetanus immunity at National Health Service units]

The results obtained in the PMIP of Milan for tetanus antitoxin titration in the serum of 772 subjects vaccinated permits a discussion on the problems posed by the antitetanus prophylaxis in the population and on the suitable methods for its control.

IgG rheumatoid factors behaviour in young normal subjects following vaccination

In order to contribute to explain the finding of Rheumatoid Factors of the IgG class in all normal subjects, even at low levels, a study on their behaviour in a group of young subjects serving in the army, at the time of anti-typhoid and antitetanic vaccination, and in the following two months, was conducted. Parallely some aspecific serological parameters of autoimmunity were determined. The results demonstrate, first of all, a good antibody response to the vaccine in all subjects observed. Immunoglobulins of the IgG, IgA, and IgM class were normal in all samples. Complement factors C3 and C4 were slightly decreased after the second dose of vaccine, suggesting a modest consumption probably due to immune complexes formation. Factor C3A showed a slight increase, may be to be considered as its property of an acute phase reactant. Autoantibodies determined by immunofluorescence were constantly negative. IgM rheumatoid factors became transitory positive in a significant proportion. IgG rheumatoid factors demonstrated a two-phase increase, more evident after the second dose of vaccine. We can conclude, mainly for the latest parameter, that these results reveal an autoimmune serological response, even quantitatively modest, concomitant to the specific sensitization resulting from vaccination.

[Organizational and methodologic problems in a human rabies prevention service]

On the basis of attained experiences by Antirabies Centre of Milano are described the organization and structure of the antirabies services, the modality of correct performance of the immune prophylactic treatment, the estimation of the antibodies titre considered protective.

Effect of solid detergent washing on values of skin electrical impedance

We have studied the electrical behaviour of the skin on 20 volunteers, before and after cleaning with solid detergent. The aim was to study one of the possible variables of the measurements. The results have shown that the cleaning has globally reduced the electrical skin parameters of the forehead, without influencing other parts examined (dorsal and palmar surfaces of the hand). The result has been attributed to the elimination of the hydrolipidic film of the surface and in particular that of the sebum of the forehead. The data give an idea as to how to obtain more homogeneous final results, as well as studying the sebum production function.

[Initial evaluations on the use of passive microhemagglutination test for the verification of antitetanus immunity]

First results obtained in the L.P.I.P. of Milan for tetanus antitoxin titration in the serum of 200 subjects vaccinated, are exposed in this work. A micromethod of passive haemoagglutination against avian erythrocytes was employed. The 26.5% of these subjects presents less than 0.1 Ul/ml. of antitoxin in spite of previous immunization. On the contrary in 33% of cases, high levels of antibodies have been determinated in spite of a not correctly executed vaccination. It seems confirmed the validity of this diagnostic procedure for monitoring the prophylaxis against tetanus among the National Sanitary Service and for its more correct management. The study of the results permits in addition to better determine the cases in which this test is suitable.

High prevalence of Werner's syndrome in Sardinia. Description of six patients and estimate of the gene frequency

Several patients with Werner's syndrome in a large family group in Sardinia were ascertained three years ago and reported briefly by Rabbiosi and Borroni (1979). Since then two sisters from a second family and a single case from a third family were ascertained. The three families originated from the Northern part Sardinia and no connection between them was found. We provide a detailed clinical description of six of these patients and attempt to estimate the prevalence and the gene frequency of Werner's syndrome in Sardinia. The prevalence was calculated as 1:94,914 for the two districts of Sassari and Nuoro and as 1:202,766 for the whole island. This is the highest prevalence thus far ascertained. Using Dahlberg's formula we obtained an estimate of the gene frequency q = 0.003288 and thus a frequency of Werner's syndrome of 1:92,515. A more rigorous estimate gave a gene frequency q = 0.001483 and thus a frequency of Werner's syndrome of 1:454,505, but because of the small sample size this estimate should be taken with caution.

Jaundice, an Early Clinical Manifestation of Secondary Syphilis

Hepatitis is an uncommon manifestation of early acquired syphilis. A case of secondary syphilis presenting with jaundice and papular eruption is reported. The icterus was slight and responded romptly to penicillin therapy, transaminase levels were moderately increased. Alkaline phosphatase was elevated. Jaundice was due to an inc of both conjugated and unconjugated bilirubin; serological reactions for syphilis were positive.

Palmoplantar keratoderma and Charcot-Marie-Tooth disease

A close association was noted between palmoplantar keratoderma (PPK) and Charcot-Marie-Tooth disease (CMT) in nine members of a family in five generations. Clinical, genealogic, electroneurophysiologic, chromosome, urinary amino acid, and histopathologic studies were performed to define the two entities. Charco-Marie-Tooth disease occurred with advancing age in all of the members with PPK, but in none without PPK. Palmoplantar keratoderma and CMT appear to be genetically associated and transmitted as an autosomal dominant trait. This is the first report, to our knowledge, of an association between PPK and CMT.

Werner's syndrome: seven cases in one family

7 cases of Werner's syndrome in one family of northern Sardinia (the female : male ratio being 4:3) are reported. A 9-year-old girl affected with Cooley's anemia is reported too. The typical complete pattern of the syndrome was observed in patients in the fourth decade of their lives, whereas in the two youngest ones, some features were missing. 1 patient died of gastric carcinoma, 1 of cachexia. Consanguinity was established in two generations. The genealogical tree suggests an autosomal recessive mode of inheritance. Genealogical, clinical, biochemical, and histopathological studies were performed. As far as we know, this is the largest number of patients with Werner's syndrome reported in one family.

Scintigraphic evaluation of Kaposi's sarcoma

10 patients with clinical and histopathological evidence of Kaposi's sarcoma were evaluated with 99Tcm-pertechnetate and 67Ga-citrate scintigraphs. Combined studies using these radionuclides are useful aids in investigating, detecting and following-up Kaposi's sarcoma and any associated lymphoma or other malignancies.