An unique case of dyspareunia leading to the diagnosis of urachal cyst in a nulliparous 28-year-old woman

Urachal cysts are usually asymptomatic. Symptoms, when present, are usually acute abdominal pain, fever, midline hypogastric tenderness, palpable mass, evidence of urinary infection or haematuria due to infection of the cyst. We report an unique case of dyspareunia and "abdominal fluid flowing feeling" caused by an urachal cyst in a 28 year-old nulliparous woman. Diagnosis was achieved by US and MRI. Cystography excluded any cyst-bladder communication. Laparoscopic surgery was performed without perioperative complications. Patient obtained immediate relief of symptoms still continuing at a 24 months follow up.

Gallbladder metastases of breast cancer: from clinical-pathological patterns to diagnostic and therapeutic strategy

Gallbladder metastasis of breast cancer are rare, particularly linked to lobular histotype and synchronous just in 1/4 cases. A review of the literature has been performed aimed to evidence the patterns of gallbladder metastases of breast cancer finding 15 cases to whom we added a 48 years old post-menopausal woman. 3 weeks after surgery for mixed ductal-lobular breast carcinoma she showed at the abdominal ultrasound, performed for staging, diffuse thickening of the gallbladder wall , coherent with a chronic cholecystitis and with the mild right-upper-abdominal pain that the patient complained in the last months. After laparoscopic cholecystectomy, the pathology report showed a metastatic lobular carcinoma of the breast. Two years later she presented with SNC metastases and died four months later. Lobular histotype is the most frequent breast neoplasm associated with gallbladder metastases. Usually metachronous, these metastases are sinchronous in 28% of cases. Symptoms are usually linked to coexisting acute or cronic cholecystitis. Rarely massive invasions lead to acute abdomen or jaundice. Imaging is rarely diagnostic for neoplasm. Our experience and data from literature lead to careful evaluate every anomaly observed in breast cancer patients. A careful evaluation of abdominal symptoms and of routine imaging examinations performed for staging and for treatment planning, could consent to detect and radically treat the metastases and appropriately assign the chemotherapy. Such approach can lead to discrete survival even in these unfortunate patients. Surgeons and gastroenterologists should be aware of the risk hidden behind apparently benign, mild diseases in such patients.

Four novel cases of periaxin-related neuropathy and review of the literature

OBJECTIVE

To report 4 cases of autosomal recessive hereditary neuropathy associated with novel mutations in the periaxin gene (PRX) with a review of the literature. Periaxin protein is required for the maintenance of peripheral nerve myelin. Patients with PRX mutations have early-onset autosomal recessive demyelinating Charcot-Marie-Tooth disease (CMT4F) or Déjèrine-Sottas neuropathy (DSN). Only 12 different mutations have been described thus far.

METHODS

Case reports and literature review.

RESULTS

Four patients from 3 unrelated families (2 siblings and 2 unrelated patients) were affected by an early-onset, slowly progressive demyelinating neuropathy with relevant sensory involvement. All carried novel frameshift or nonsense mutations in the PRX gene. The 2 siblings were compound heterozygotes for 2 PRX null mutations (p.Q547X and p.K808SfsX2), the third patient harbored a homozygous nonsense mutation (p.E682X), and the last patient had a homozygous 2-nt insertion predicting a premature protein truncation (p.S259PfsX55). Electrophysiologic analysis showed a severe slowing of motor nerve conduction velocities (MNCVs, between 3 and 15.3 m/s) with undetectable sensory nerve action potentials (SNAPs). Sural nerve biopsy, performed in 2 patients, demonstrated a severe demyelinating neuropathy and onion bulb formations. Interestingly, we observed some variability of disease severity within the same family.

CONCLUSIONS

These cases and review of the literature indicate that PRX-related neuropathies have early onset but overall slow progression. Typical features are prominent sensory involvement, often with sensory ataxia; a moderate-to-dramatic reduction of MNCVs and almost invariable absence of SNAPs; and pathologic demyelination with classic onion bulbs, and less commonly myelin folding and basal lamina onion bulbs.

Evaluation of a real-time polymerase chain reaction assay for the detection of Dientamoeba fragilis

The diagnostic value of a real-time polymerase chain reaction (PCR) assay targeting the 5.8S rDNA of Dientamoeba fragilis was investigated as compared with conventional parasitologic methods including cultivation testing 959 fecal samples from 491 patients attending a tertiary-care hospital and suspected of having an intestinal parasitosis. The real-time PCR assay revealed 117 additional D. fragilis-positive samples as compared with conventional methods, showing 100% sensitivity and specificity in our experience. On the whole, D. fragilis infection was detected in 186 samples from 105 patients (21.4%, third in frequency among the diagnosed intestinal parasitoses). The evaluated real-time PCR assay represents an effective tool to obtain both an accurate diagnosis and a reliable epidemiologic picture of dientamoebiasis.

Evaluation of a real-time polymerase chain reaction assay for the laboratory diagnosis of giardiasis

A real-time polymerase chain reaction (PCR) assay was evaluated in comparison with the combination of conventional methods (microscopic examination and antigen detection assay) during the period 2006 to 2008 on 771 fecal samples belonging to 386 patients to assess its usefulness for an accurate laboratory diagnosis of giardiasis. The real-time PCR assay detected Giardia intestinalis DNA in 195 samples (106 patients), including 26 samples (21 patients) negative by the conventional assays. Among the 21 patients, in 8 cases, giardiasis was previously diagnosed also by conventional methods in additional samples of the same patients, whereas in 13, it would have been undiagnosed if real-time PCR assay was not used. The real-time PCR assay demonstrated a detection limit of 2 cysts per reaction and 100% specificity and sensitivity compared to conventional methods. A genotype analysis targeting the beta-giardin gene allowed to identify 53 samples (23 patients) containing genotype A and 59 samples (45 patients) containing genotype B.

Prediction of rabbit caecal fermentation characteristics from faeces by in vitro gas production technique: roughages

To find equations able to estimate the fermentation characteristics of the caecum from that of faeces, caecal content and faeces of 10 hybrid Hyla rabbits were used as inocula for an in vitro gas production trial. About 1 g of 12 roughages, 11 hays (ryegrass, alfalfa, sulla, oat, vetch, sulla-lolium, vetch-oat, sulla-oat, clover, ryegrass-clover, sulla-vetch-oat) and a wheat straw, was weighed, in triplicate per inoculum, in 120-ml flasks; 75 ml of anaerobic medium and 4 ml of reducing solution were added and the flasks were placed at 39 degrees C. Caecal content and faeces were diluted respectively 1:2 (CI) and 1:8 (FI) with anaerobic medium and were introduced into their respective flasks (10 ml). Gas production was recorded 20 times at 2-24 h intervals throughout fermentation (120 h). The fermentation characteristics (i.e. degraded organic matter, OMd; potential gas production, A; maximum fermentation rate, R(max); volatile fatty acid, VFA; ammonia, NH(3)) were studied by inocula and substrates. The two inocula did not differ in OMd but CI produced significantly higher gas (A, 213.1 vs. 199.4 ml/g, respectively, for CI and FI, p < 0.01) in less time (R(max), 3.08 vs. 2.24 ml/h, respectively, for CI and FI, p < 0.01). CI also produced higher levels of total VFA (57.86 vs. 46.70 mmol/g OM, respectively, for CI and FI, p < 0.01) and showed a higher branched chain proportion (0.023 vs. 0.018, respectively, for CI and FI, p < 0.01). For some parameters (as OMd pH and propionate) the equations for the estimation of caecal fermentation characteristics from that of faeces were accurate (R(2) > 0.8828) and reliable (CV < 10.78%) suggesting that faeces can be successfully used for the estimation of these parameters.

An 8-year survey on the occurrence of imported malaria in a nonendemic area by microscopy and molecular assays

Our study aimed to describe the occurrence of imported malaria in a nonendemic area (Parma, Italy) during the period 2000 to 2007, comparing the data obtained by microscopy and molecular assays targeting plasmodial 18S subunit rRNA gene. The prevalence of imported malaria in Parma was 21.8% by microscopy and 22.7% by polymerase chain reaction (PCR). Plasmodium falciparum accounted for 81.1% of the cases, followed by Plasmodium ovale (8.8%), Plasmodium vivax (3.8%), and Plasmodium malariae (1.9%). Mixed infections accounted for 4.4% of the cases. In this study, PCRs proved to be more sensitive and specific than microscopy and changed the picture of malaria epidemiology in Parma, detecting additional cases of malaria undiagnosed by microscopy and allowing speciation of plasmodia in cases misidentified by microscopy. Generally, imported malaria cases reflect the number of immigrants who visit their native countries, in particular, West Africa, explaining the increased prevalence of P. ovale cases among non-P. falciparum infections in Parma.

Myiasis of the scalp due to Dermatobia hominis in a traveler returning from Brazil

This article describes a case of myiasis by Dermatobia hominis diagnosed in a young Italian man returning from a vacation through Brazil. Considering the increasing number of travels to tropical and subtropical areas, clinicians in nonendemic areas must think about the possibility of imported unusual infestations during their daily practice.

Prevalence of imported malaria in Parma during 2005-2006

BACKGROUND AND AIM OF THE WORK

Malaria is a protozoan infection caused by parasites of the genus Plasmodium (P. falciparum, P. ovale, P. vivax, P. malariae) that is transmitted from one human to another by female Anopheles mosquitoes. It can be considered a reemerging imported disease in our area because of increasing of movements from endemic countries, and nowadays it is the most common imported infection in Italy. This study describes the occurrence of imported malaria in our area between January 2005 and May 2006.

METHODS

During 17 months we analysed 170 blood samples belonging to 139 patients (95 foreigners and 44 Italians) with the clinical suspect of malaria. Samples were used to prepare orange acridine and Giemsa stained thin blood films for microscopic observation and to perform an immunochromatographic assay for the detection of specific plasmodia antigens. Molecular assays (nested-PCR and Real-time PCR) were also performed in order to confirm the diagnosis.

RESULTS

Thirty-six cases of malaria were diagnosed: 35 in foreigners coming from Africa and only one in an Italian who lived in Chad. Thirty-three patients were infected by P. falciparum, 1 by P. ovale, 1 by P. vivax, and a mixed infection by P. falciparum, P. ovale and P. malariae was also found.

CONCLUSIONS

Malaria is usually associated with travels within areas where the infection is endemic and our data demonstrated that imported malaria in our area has a prevalence of 25.89%.

Infective colitis associated with human intestinal spirochetosis

AIM

Our study reports the detection and identification of intestinal spirochetosis in patients with colonic diseases in a tertiary-care hospital over a 12-year period, and includes a description of all cases we diagnosed.

METHODS

Our patients (8323) underwent colonoscopy and histopathological examinations including transmission electron microscopy (TEM) and light microscopy. Specimens from patients suspected of intestinal spirochetosis at histopathology (17 patients) underwent microbiological investigation performed by culture and molecular methods (16S restriction fragment length polymorphism-polymerase chain reaction [RFLP-PCR], nox RFLP-PCR assays).

RESULTS

Seventeen cases were diagnosed: seven patients were infected by B. aalborgi, one by B. pilosicoli, two by both species and four by Brachyspira spp. diagnosed both histopathology and microbiology (culture and molecular methods: 16S RFLP-PCR and nox RFLP-PCR assays). Three cases were referred to as Brachyspira spp. infections using only histopathology, including TEM.

CONCLUSIONS

Our results demonstrated that intestinal spirochetosis, although rarely occurring, might play a role in chronic diarrhea and suggested a pathogenetic mechanism of intestinal spirochetosis based on the destruction of colonic microvilli and colitis histologically documented, providing additional clinical and pathological information on this entity. This study suggests that metronidazole seems to be the drug of choice for the eradication of intestinal spirochetosis.

Occurrence of human intestinal spirochetosis in comparison with infections by other enteropathogenic agents in an area of the Northern Italy

The aim of this study was to investigate the occurrence of human intestinal spirochetosis (IS) by a 16S rRNA restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR) in a selected group (234) of patients with gastrointestinal complaints and/or potential risk factors for IS in comparison with the occurrence of infections by other enteropathogenic agents. By using 16S rRNA RFLP-PCR, 16 patients (6.8%) with IS were found (11 infected by Brachyspira aalborgi, 3 by Brachyspira pilosicoli, and 2 by both species); moreover, 10 patients with gastroenteric viruses (4.2%), 13 with enteropathogenic bacteria other than intestinal spirochetes (5.5%), and 24 with intestinal parasites (10.2%) were found. This study provides an enhancement of the knowledge about the distribution of IS, suggesting that it may be more frequent than suspected and that clinicians should consider IS when patients present with long-standing diarrhea. Moreover, 16S rRNA RFLP-PCR might be a powerful tool not only for diagnostic purpose but also to investigate the occurrence of IS just on fecal samples, not requiring invasive diagnostic techniques.

Abomasal nematodes of the red deer Cervus elaphus in north-eastern Italy

The composition of the abomasal helminth fauna and parasite diversity were studied in 298 red deer collected during 1997–2000 from three different sectors (Bolzano, Trento and Sondrio provinces) of the Stelvio National Park, one of the main protected areas of north-eastern Italy. The association between parasite burdens and geographical areas of the hosts was assessed using the negative binomial regression. A variety of abomasal helminths, both host specific and generalist, was found in all sectors. The most commonly observed parasites were the Spiculopteragia spiculoptera morph spiculoptera and Ostertagia leptospicularis morph leptospicularis, with prevalences of 79.5% and 40.9%, respectively. The minor morphs S. spiculoptera morph mathevossiani (prevalence 31.9%) and O. leptospicularis morph kolchida (18.8%) occurred at lower prevalences. Teladorsagia circumcincta morph circumcincta, Marshallagia marshalli morph marshalli and Haemonchus contortus were rarer, at prevalences of 1, 1.3 and 1.3%, respectively. Deviance analysis of the negative binomial regression model shows that the geographical area is significantly related to parasite burdens (P = 0.001). Prevalences of hosts with parasites were greater in the Sondrio (odds ratio = 1.31; 95% confidence interval: 0.16–10.85) and smaller in the Trento (odds ratio = 0.62; 95% confidence interval: 0.20–1.96) sectors with respect to Bolzano, but these differences were not statistically significant. Possible cross-infections by more generalist parasites between wild and domestic animals were also suggested, as deer and domestic ruminants (Bovinae, Caprinae and Ovinae) used the same feeding areas of the park sectors.

Human intestinal spirochaetosis in Parma: a focus on a selected population during 2002-2005

BACKGROUND AND AIM OF THE WORK

Human intestinal spirochaetosis (HIS) is a large bowel infection characterised by the colonization of the intestinal mucosa by spirochaetes belonging to the genus Brachyspira. The causative agents of HIS are Brachyspira aalborgi and Brachyspirapilosicoli. Symptoms of the infection, even if not specific, are long standing diarrhoea, abdominal pain, meteorism and rectal bleeding and sometimes they can suggest the clinical suspect of inflammatory bowel diseases or rectal carcinoma. Since poor data were available on the prevalence of this infection, the aim of our study was to describe the occurrence of this infection in our area in the period 2002-2005.

METHODS

During a period of 4 years we analysed 297 faecal samples from 99 patients selected by potential risk factors and symptomatology suspected for HIS. The diagnosis of HIS was performed by isolation and a molecular assay based on 16S rDNA restriction fragment length polymorphism (RFLP)-polymerase chain reaction (PCR).

RESULTS

From 2002 to 2005 we detected 12 cases of intestinal spirochaetosis, 7 caused by Brachyspira aalborgi, 4 by Brachyspirapilosicoli and one by both spirochaetes, which represented the first case of a mixed infection by 2 intestinal spirochaetes in our area.

CONCLUSIONS

Despite the fact that HIS seems to be a low prevalence infection in our area, in a strongly selected population we found 12 cases of this infection (12.12%). These results stimulate us to extend the research of intestinal spirochaetosis in the general population, when long standing gastrointestinal disorders and potential risk factors are present.

Use of two different dietary energy and protein contents to define nutritive requirements of lactating buffalo cows

Two total mixed rations, differing in energy and protein concentrations (diet A: 6.1 MJ/kg DM of NE(l), 112.5 g/kg DM of metabolizable protein, MP, and 101.7 g of protein digestible at the intestinal level, PDI, vs. diet B: 6.4 MJ, 95.1 g of MP, 78.9 g of PDI) were administered ad libitum for 1 year to two groups of 12 buffaloes in which the partial monthly turnover of animals allowed the lactation stage to be maintained close to 160 days. The diets were formulated to obtain, with a daily intake of about 15.5 kg of DM, a balanced energy supply but an excess of protein (diet A); the opposite occurred with diet B. The average dry matter intake recorded during the trial was 14.5 kg for diet A and 15.0 kg for diet B. Milk production was similar for both groups (7.94 kg vs. 7.95 kg). The diet with a higher protein concentration brought about a significant increase in protein, casein and non-protein nitrogen contents in the milk. A significant increase in milk fat percentage was observed when the animals were fed the diet with a higher energy concentration. The serum urea concentration (8.62 mm/l) of buffaloes fed diet A was outside the physiological range for lactating buffaloes. The energy and protein conversion efficiencies for milk production were more favourable when their supplies were balanced: 3.58 MJ of NE(l)/kg of FPCM for diet A; 2.50 g of MP or 2.07 g of PDI/g of protein milk for diet B. Moreover, when the requirements were satisfied, greater energy or protein supplies failed to induce significant changes in milk yield and quality. Finally, regarding the great differences between estimated MP requirements and those recorded during the trial, the authors suggest that the equations used in the CPM-Dairy software, formulated for dairy cows, are not applicable in buffaloes.

Genetic polymorphisms influence Plasmodium ovale PCR detection accuracy

Detection of Plasmodium ovale by use of a nested PCR assay with a novel Plasmodium ovale primer set was superior to detection of Plasmodium ovale by real-time PCR assays. Nested PCR was also better at detecting P. malariae. The detection of P. ovale in many patients first admitted >2 months following their return to Italy indicated that P. ovale relapses are common.