Evaluation of a score system for the severity and outcome of cytomegalovirus interstitial pneumonia in allogeneic bone marrow recipients

We verified whether a clinical score system developed for renal transplant patients predicts the severity and outcome of cytomegalovirus interstitial pneumonia (CMV IP) in allogeneic bone marrow (BMT) recipients. The score system was retrospectively applied to 20 patients at the estimated date of onset of IP and 10-14 days later. Seven patients received ganciclovir (GCV), seven received GCV plus intravenous immunoglobulin (i.v. Ig), and six received only supportive care. Nine out of 14 patients who received GCV with or without i.v. Ig survived the episode of IP (the median score of these patients at diagnosis of CMV IP was 5 (range 3-8)), while the remaining five patients died of respiratory failure during IP and at the diagnosis had a median score of 10 (range 9-11) (P=0.01). The six patients who received only supportive care survived for a median time of 21 days (range 10-24 days) from the estimated onset of CMV IP, and the median score at the diagnosis of IP was 10 (range 8-12). The overall survival correlates strongly with low initial severity of IP as measured by this score system: 11 out of 20 patients who died of respiratory failure during IP had at the estimated onset of IP a score >8, while of the nine patients who survived IP, eight had at the onset a score <7 and the remaining one a score of 8 (P=0.0007). The sensibility, specificity, predictive positive value and predictive negative value of the score system (with a threshold value of 8) to identify patients who survived IP was: 100%, 88%, 91% and 100%, respectively. The use of ganciclovir alone or in combination was the most important determinant of outcome. These data support the relevance of this score system with a threshold value of 8; if prospective and controlled studies confirm our observations, it would help physicians to identify BMT recipients during CMV IP with high vs. low risk of poor outcome.

Transcription of latent and replicative Epstein-Barr-virus genes in bone-marrow and peripheral-blood mononuclear cells of healthy donors

Reverse-transcriptase polymerase chain reaction has been used to analyze the expression of 2 latent genes (EBNA-1 and LMP-1) and one replicative gene (BZLF-1) of Epstein-Barr virus in mononuclear cells from bone marrow and peripheral blood of healthy donors. EBV-gene transcription was detected in 8 out of 15 bone-marrow samples. Among these, 5 allowed the detection of latency-associated transcripts in the absence of BZLF-1 expression. Only one sample showed positivity for expression of both latent and lytic genes. In 2 cases, BZLF-1 was the only transcript detected. In peripheral blood, 4 out of 7 samples showed evidence of EBNA-1 transcription; LMP-1 was expressed in 5 samples, and in 2 cases concomitant expression of EBNA-1 and BZLF-1 was detected. These results provide a direct demonstration by RT-PCR of EBV-gene transcription in bone-marrow-resident viral infected cells and suggest, in contrast to previous studies on peripheral blood, that LMP-1 and BZLF-1 are frequently transcribed also in absence of EBV-related disease. The heterogeneous viral gene expression found makes it difficult to define a pattern of viral latency in vivo which coincides with that described for lymphoblastoid or Burkitt's-lymphoma cell lines at different stages of differentiation.

Does creatinine adjustment of urinary pregnanediol glucuronide reduce or introduce measurement error?

Correlation between urinary pregnanediol and serum progesterone measurements and the influence of age, race, smoking and urinary creatinine adjustment was determined during the luteal phase of the menstrual cycle in 175 volunteers. A decline in serum progesterone was observed with increasing age. Mean baseline urinary creatinine declined with increasing age in non-smokers and was not affected by race or baseline weight. An excellent correlation between urinary pregnanediol glucuronide and serum progesterone levels existed except when urinary pregnanediol concentrations were adjusted using creatinine measurements in older individuals. Adjustment of urinary pregnanediol glucuronide concentration using creatinine measurement is therefore discouraged.

Potential role of growth factors in ovarian cancer

As with many other tumors, the origin and development of ovarian cancer is constituted by several molecular mechanisms, many of which are still unknown. Furthermore, data in the literature are incomplete and often contradictory, and they are mainly founded on results obtained on cell lines and not on observations based on the in vivo study of ovarian cancer. Despite this situation, the study of control mechanisms of proliferation and differentiation in normal ovarian functioning has enabled clinicians to identify certain growth factors and oncogenes which seem to have an important role in the neoplastic transformation of ovarian tissue. In this review, our aim is to summarise the most important data regarding function of growth factors and oncogene in normal and neoplastic epithelial ovarian cells.

Rising incidence of Candida parapsilosis fungemia in patients with hematologic malignancies: clinical aspects, predisposing factors, and differential pathogenicity of the causative strains

Over the years 1983-1994, Candida parapsilosis causes 35 or 138 fungemic episodes (24 of 69 candidemias in the last quadriennium) in patients with hematologic malignancies who were being treated at a large university hospital in Italy. The central venous catheter was usually the source of bloodstream invasion; in most cases, the resolution of fungemia in patients receiving antifungal therapy required catheter removal. In seven cases, C. parapsilosis fungemia evolved to five proven (two cases with endocarditis) and two probable deep-seated infections; three of these seven patients died of deep-seated infections. Deep seated infection was associated with the detection of a circulating mannoprotein antigen of C. parapsilosis but not with in vitro resistance to antifungal agents. Almost all fungal isolates produced slime in vitro, but only 34% were pathogenic in a model of bloodstream infection in neutropenic mice. The four isolates associated with endocarditis or persistent fungemia with multiorgan failure were among the most virulent in the model of infection. Overall, our findings highlight the role of C. parapsilosis as an agent of fungemia in patients with malignant hemopathies.

Predictors of ovarian steroid secretion in reproductive-age women

During the baseline period (1985-1988) of a prospective study, midcycle and luteal-phase estrogens and progestins were measured in 175 healthy women aged 21-36 years with spontaneous, cyclic menses in Brooklyn, New York. Subjects contributed daily first-morning urine specimens and three blood specimens during a single menstrual cycle monitored by basal body temperature. Hormone levels were compared according to age, race, and levels of known or suspected breast cancer risk factors. Late age at menarche was associated with increased urinary and serum progestin levels. Increased body weight was associated with decreased progestin levels, even in ovulatory women. Neither weight nor age at menarche was related to estrogen levels. Cigarette smoking was associated with decreased midcycle and luteal-phase estradiol levels. No other factors were associated with differences in any of the hormones measured either midcycle or during the luteal phase, despite good statistical power to detect moderate differences. Sources of individual variability in ovarian steroid levels remain unexplained. These data do not support hypotheses that breast cancer risk factors act through an effect on ovarian hormones during the middle reproductive years.

Rapid liver failure related to chronic C hepatitis in an HIV seropositive hemophilic patient with severe immunodepression

We report the case of a young HIV seropositive patient with severe hemophilia A who presented rapid liver failure related to his chronic C hepatitis. The patient had been receiving factor VIII:C clotting factor concentrates (mean 60,000 U/year) since 1975. In 1984 alanine aminotransferase presented abnormal levels. The CD4 lymphocyte count in 1991 was normal and ultrasonographic scan showed normal liver morphology. In 1991 the patient were found to be seropositive for HCV antibodies as detected by the ELISA method and confirmed by the RIBA method. One year later, a progressive increase in policlonal gamma-globulin and a decrease in the CD4+ lymphocyte count to below 500/muL were detected in concomitance with ultrasonographic evidence of a progressive increase in the longitudinal diameters of the liver and spleen and signs of liver inhomogeneity. A significant inverse correlation was observed between the increase in the longitudinal diameter of the liver and the decline in albumin levels, and between the increase in the longitudinal diameter of the liver and the drop in platelet count. Elevated levels of ammonemia, gamma-glutamyl transpeptidase, alkaline phosphatase and IgA were detected. Moreover, decreased levels of the C4 and C3 complement fractions were documented. At this time (1994), esophagogram and esophagogastroscopy evidenced varicosities in the lower esophageal section (stage F1). The patient died in 1995 March at the age of 29 years of sudden septic shock related to Pseudomonas aeruginosa infection.

[Clinico-diagnostic considerations on various cases of lymphogranuloma venereum]

The authors report some recently observed cases of lymphogranuloma venereum and focus their attention on the complex approach to clinical and laboratory diagnosis. Furthermore they underline the importance and the spread of this disease in new geographical area, such as Europe.

Risk factors for essential thrombocythemia: A case-control study. Italian Leukemia Study Group

BACKGROUND

Very little information is presently available regarding risk factors for essential thrombocythemia (ET).

METHODS

A case-control study was performed to study the possible association between ET and selected behavioral, occupational, and environmental exposures.

RESULTS

Thirty-nine patients aged 20 years or older and 156 controls were enrolled in 2 Italian Hematology Departments located in Rome and Pavia. Controls were recruited among outpatients seen in the same hospitals and matched 4:1 to the patients after stratification by age and sex. Odds ratio (OR) estimates suggest an association between ET and hair dye use (in particular the use of dark hair dye for periods longer than 10 years: OR - 5.3; 95% confidence interval [CI], 1.4-19.9), living in houses built with tuff (a material with a high concentration of gamma-emitting radionuclides and radon) for longer than 9 years (OR = 5.1; 95% CI, 1.2-22.1), and selected occupations (electrical worker and shoemaker, OR +infinity and 2.7; 95% CI, 0.5-16 respectively).

CONCLUSION

Behavioral exposures such as hair dyes, living in a tuff house, and working as an electrician are significantly associated with ET development. The data are consistent with those observed in acute leukemias.

Hepatitis B and C viruses, human T-cell lymphotropic virus types I and II, and leukemias: a case-control study. The Italian Leukemia Study Group

The relationship between acute myeloid leukemia (AML), acute lymphocytic leukemia, chronic myeloid leukemia (CML), and refractory anemia with excess of blasts (RAEB) and antibodies to human T-cell lymphotropic virus types I and II (HTLV-I and HTLV-II), and hepatitis B virus and hepatitis C virus (HCV) was investigated in a multicenter case-control study. There were 431 cases enrolled in the study at the time of diagnosis of hematological malignancies, and 862 controls ages 15 years or older were recruited in three hospitals. Antibodies to HTLV-I and HTLV-II, antibody to HCV, hepatitis B surface antigen, and antibody to hepatitis B core antigen were assayed. All cases and controls were negative for HTLV-1 antibodies; one case (1 of 431; 0.2%), and one control (1 of 862; 0.1%) were found positive for HTLV-II antibodies. A nonsignificant excess of risk for hepatitis B surface antigen was present among RAEB cases (odds ratio, 2.40; 95% confidence interval, 0.46--12) CML, (odds ratio, 2.70; 95% CI, 0.86--8.43), and between antibody of hepatitis B core antigen and AML (odds ratio, 1.40; 95% CI, 0.93-2.10). A weak, nonsignificant association was present between AML, acute lymphocytic leukemia, RAEB, and antibody to HCV. These preliminary results suggest a possible association (elevated odds ratios) between hepatitis B virus, AML, RAEB, and CML. However, because all confidence intervals overlapped the null value, these findings need to be confirmed in larger case-control studies.

Effects of teicoplanin and those of vancomycin in initial empirical antibiotic regimen for febrile, neutropenic patients with hematologic malignancies. Gimema Infection Program

The efficacy and toxicity of teicoplanin and vancomycin in the initial empirical antibiotic regimen in febrile, neutropenic patients with hematologic malignancies were compared in a prospective, randomized, unblinded, multicenter trial in the setting of 29 hematologic units in tertiary-care or university hospitals. A total of 635 consecutive febrile patients with hematologic malignancies and chemotherapy-induced neutropenia were randomly assigned to receive intravenously amikacin plus ceftazidime plus either teicoplanin at 6 mg/kg of body weight once daily or vancomycin at 1 g twice daily. An efficacy analysis was done for 527 evaluable patients: 275 treated with teicoplanin and 252 treated with vancomycin. Overall, successful outcomes were recorded for 78% of patients who received teicoplanin and 75% of those who were randomized to vancomycin (difference, 3%; 95% confidence interval [CI], -10 to 4%; P = 0.33). A total of 102 patients presented with primary, single-agent, gram-positive bacteremia. Coagulase-negative staphylococci accounted for 42%, Staphylococcus aureus accounted for 27%, and streptococci accounted for 21% of all gram-positive blood isolates. The overall responses to therapy of gram-positive bacteremias were 92 and 87% for teicoplanin and vancomycin, respectively (difference, 5%; CI, -17 to 6%; P = 0.22). Side effects, mainly represented by skin rash, occurred in 3.2 and 8% of teicoplanin- and vancomycin-treated patients, respectively (difference, -4.8%; CI, 0.7 to 8%; P = 0.03); the rate of nephrotoxicity was 1.4 and 0.8% for the teicoplanin and vancomycin groups, respectively (difference, 0.6%; CI, -2 to 1%; P = 0.68). Further infections were caused by gram-positive organisms in two patients (0.7%) treated with teicoplanin and one patient (0.4%) who received vancomycin (difference, 0.3%; CI, -0.9 to 1.0%; P = 0.53). Overall mortalities were 8.5 and 11% for teicoplanin- and vancomycin-treated patients, respectively (difference, -2.5%; CI, - 2 to 7%; P = 0.43); death was caused by primary gram-positive infections in three patients (1%) in each treatment group. When used for initial empirical antibiotic therapy in febrile, neutropenic patients, teicoplanin was at least as efficacious as vancomycin, but it was associated with fewer side effects.

HHV-6 infection in Italy: characterization of an endemic isolate and seroepidemiologic analysis

A biologic, immunologic and molecular characterization of an HHV-6 isolate (BA92) rescued by the peripheral blood mononuclear cells of a child affected by Exanthem subitum is reported. The comparison with the known HHV-6 prototype strains showed that BA92 is indistinguishable from the Z29 isolate, and can be included in the variant B group of HHV-6. A seroepidemiologic analysis of the antibody response to BA92 of normal individuals as well as patients affected by diseases potentially associated to HHV-6 infection has shown an overall seroprevalence of 81%, and that no variations in seroprevalence or in antibody geometric mean titer are observed assaying the sera also against G.S., U1102, or Z29 infected cells, respectively. These findings indicate: (1) HHV-6 infection is widely diffuse in Italy; (2) it is not possible to discriminate between the viral variants by the currently available IF assays, and (3) no conclusions can be drawn on the potential association of HHV-6 with any of the diseases examined.

Fungemia in patients with leukemia

A nine-year retrospective study on fungemia in patients with leukemia was conducted. A total of 79 episodes of fungemia in 77 patients with leukemia were documented. Candida parapsilosis fungemia was associated more frequently with the presence of a central venous line and to the use of parenteral nutrition than the other fungal species (p = 0.00026 and p = 0.01, respectively). The same fungus was isolated from both blood and surveillance cultures in 95% of Candida albicans and in 89% of Candida tropicalis fungemia (p < 0.01 and p = 0.02, respectively). The neutropenia and fungus colonization that resulted was associated significantly with the presence of invasive disease (p = 0.0024 and p = 0.0028, respectively). Conversely, central venous catheterization and parenteral nutrition appeared to be associated with episodes without deep tissue invasion (p = 0.000037 and p = 0.001, respectively). Invasive mycosis due to the fungus isolated from blood was documented in 51 patients with a mortality rate of 69%, whereas in 20 patients without invasive mycosis, mortality rate was 21% (p = 0.000059). In patients with fungemia, related or unrelated to the presence of a central venous catheter, mortality was 24% and 64%, respectively (p = 0.00042). Mortality was highest with C. tropicalis (p = 0.0017) and lowest with C. parapsilosis (p = 0.057). Severe neutropenia (polymorphonuclears < 100/mmc) appeared associated with a higher mortality rate (p = 0.012), whereas the recovery of neutropenia was related adversely to a fatal outcome (p < 0.01). With antifungal therapy, there was no statistically significant difference whether antifungal therapy was given or not.(ABSTRACT TRUNCATED AT 250 WORDS)

Pneumonia in allogenic and autologous bone marrow recipients. A retrospective study

Pulmonary infections, which frequently occur during the early and late period following bone marrow transplantation for hematologic malignancies, are associated with significant morbidity and mortality. In this study the incidence, the infectious causes of pneumonia and the mortality related to pneumonia in 130 allogeneic and 290 autologous bone marrow recipients are reviewed. Both the incidence and the mortality by pneumonia were far lower in autologous than in allogeneic bone marrow recipients.

Enterococcal septicemia in patients with hematological malignancies

Thirty-six cases of enterococcal septicemia in patients with hematological malignancies were reviewed retrospectively and categorized according to their clinical significance using strict previously described definitions. Overall, most of the infected patients were males (77%), had acute leukemia (64%), had recently received cytotoxic drug therapy (86%), were granulocytopenic at the onset of septicemia (77%), and acquired the infection during hospitalization (77%). The source of septicemia was unknown in 18 (50%) patients, intestinal in 15 (42%) and intravascular in three (8%). Mortality was 19% among 21 inpatients who had clinically significant septicemia and 30% among patients with septicemia of uncertain clinical significance. The fatal outcome could be definitively attributed to enterococcal septicemia in only one of the nine inpatients who died. Clinically significant septicemia appeared somewhat more frequently to be polymicrobial (p = 0.06), whereas septicemia of unknown significance presented more frequently as breakthrough septicemia (p = 0.013). Unless associated with intravascular infection, enterococcal septicemia in patients with hematological malignancies seems to represent a marker of cytotoxic drug damage of the intestinal mucosa rather than a truly invasive infection.

Piperacillin/tazobactam/amikacin versus piperacillin/amikacin/teicoplanin in the empirical treatment of neutropenic patients

A prospective randomized trial was performed to compare the efficacy of a regimen containing a glycopeptide versus one containing a beta-lactamase inhibitor in the treatment of febrile episodes in neutropenic patients. Fifty-eight patients received piperacillin/amikacin/teicoplanin (group 1) and 56 received piperacillin/amikacin/tazobactam (group 2). In the case of persistence of fever without microbiological documentation of the cause, teicoplanin was also given empirically in group 2 on day 4, and amphotericin B in both groups on day 6. In 114 evaluable febrile episodes, the rate of success without modification of therapy was 60% in patients on piperacillin/amikacin/teicoplanin and 41% in patients on piperacillin/amikacin/tazobactam (p < 0.03). Eleven of 34 patients in the latter group who failed to improve eventually responded upon addition of teicoplanin. Ten and nine patients in group 1 and group 2 respectively required the addition of amphotericin B for definite improvement. There were 14 episodes of gram-positive septicemia in each group: the response rate was 100% in group 1 and 43% in group 2. Three episodes of gram-negative breakthrough septicemia occurred in group 1 versus no cases in group 2 (p = 0.1). Three deaths occurred in each group. Piperacillin/amikacin/tazobactam may be as efficacious as piperacillin/amikacin/teicoplanin in the treatment of febrile neutropenic patients provided the regimen is modified (usually by addition of teicoplanin) in unresponsive cases.

[Extraskeletal myxoid chondrosarcoma of the abdominal wall. A clinical, histological, ultrastructural and cytofluorimetric case study]

The authors present a case of extraskeletal myxoid chondrosarcoma of the abdominal wall, an unusual localization and specific presentation. According to the literature, the clinical characters of this kind of tumor, the diagnostic iter and the therapeutic indications are being examined. The actual anatomopathological patterns used for the diagnosis of this neoplasm are being underlined.

Piperacillin plus amikacin vs. piperacillin plus amikacin plus teicoplanin for empirical treatment of febrile episodes in neutropenic patients receiving quinolone prophylaxis

A prospective, randomized trial was initiated to evaluate the efficacy of two antibiotic regimens, differing in the agent included with activity against gram-positive bacteria, for the empirical treatment of febrile episodes in neutropenic patients with hematologic malignancies (group 1, piperacillin plus amikacin; group 2, piperacillin plus amikacin plus teicoplanin). After 72 hours of therapy, patients in group 1 who were still febrile were administered teicoplanin and those in group 2 were administered amphotericin B. A total of 158 evaluable episodes were observed within 8 months. The success rate was 50.6% in group 1 and 60% in group 2. The response rate among patients who did not respond to the original regimen increased to 86.7% with the addition of teicoplanin (group 1) and to 90% with the addition of amphotericin B (group 2). There were 86 unexplained febrile episodes and 56 documented episodes of bacteremia (34 caused by gram-positive organisms). Our results indicate that teicoplanin is safe, well tolerated, and effective for the treatment of documented episodes of gram-positive bacteremia and as an empirical agent. The inclusion of teicoplanin in the initial empirical regimen appears unnecessary if a combination of antibiotics active against gram-positive organisms is used, unless infections are due to oxacillin-resistant staphylococci.

[Polycystic retroperitoneal leiomyosarcoma. A clinical and anatomo-pathological contribution]

The Authors report an unusual case of retroperitoneal leiomyosarcoma, multicystic, resembling an ovarian cystoma in a patient with simultaneous subclavian-axillary thrombosis. They analyze anatomo-pathological and clinical aspects of this kind of tumor and underline the possible errors they themselves faced. To they come to the conclusion that a careful diagnostic iter of this kind of tumor must be carried out and that the surgical approach must be radical.

Ki-67 antigen expression in lymphocytes of cattle infected with bovine leukemia virus (BLV)

The Ki-67 monoclonal antibody, which recognizes an antigen present on the nuclear membrane surface of mammalian cells in the replication phase, has been used for the determination of the cellular cycle of peripheral blood lymphocytes on a group of cattle positive for bovine leukemia virus (BLV) and with blood values showing a persistent lymphocytosis. The results obtained have shown that: 1. Both of the techniques used (immunofluorescence and immunoperoxidase) are easily applicable and give uniform results; 2. Cattle with a persistent lymphocytosis show an absolute number of cells in cycle significantly more elevated compared with cattle positive for BLV with normal blood values.

[Viral infections in children with kidney or heart transplants]

The introduction of new protocols of immune suppression and especially the use of cyclosporine have led to a marked reduction of infective pathology in children receiving transplants. Nevertheless, infections still represent a major factor of morbidity and mortality in these patients. The above study lists the main viral infections, according to apparatus involved, that may arise, also with reference to the time elapsed since transplantation. The most up-to-date diagnostic possibilities for each infection are reviewed together with some indications on therapy which may subsequently be examined in greater detail.

Single daily dose ceftriaxone plus amikacin treatment of febrile episodes in neutropenic patients attending day hospital for hematologic malignancies

Once-a-day ceftriaxone and amikacin was administered in case of fever to 46 neutropenic patients attending day hospital for hematologic malignancies. All patients were admitted to a short-term ward for infective complications, but were discharged in the event of prompt disappearance of fever and of clinical signs of infection continuing their therapy either by daily reporting to the hospital, or at home. Response to the initial empiric therapy was obtained in 37 cases (76%). Twenty-four patients who promptly responded to therapy completed their treatment on an outpatient basis, their mean number of days of hospitalization being reduced to 4.6 versus a mean of 9.6 days in the overall patient population being considered. Since the outpatient treatment accounted for 21% of the antibiotic therapy administered, the above treatment may result in cost containment and better quality of life for patients, provided that these data are confirmed by prospective randomized studies.

Species identification and detection of oxacillin resistance in coagulase-negative Staphylococcus blood isolates from neutropenic patients

One hundred coagulase-negative staphylococcal isolates from septicemic neutropenic patients with hematologic malignancies were identified to a species level by means of the French API STAPH strip system and by the Automicrobic VITEK system. According to these two methods, which concurred in 95% of cases, S. epidermidis (80-82% of the isolates) was the most frequently identified species, followed by S. haemolyticus (6-7% of the isolates). The susceptibility to oxacillin was also evaluated by macrodilution MIC, Automicrobic VITEK system and agar screen, and 76, 78 and 79 of the 100 isolates, respectively, were found resistant to this antibiotic. All oxacillin-resistant isolates according to Automicrobic VITEK were confirmed resistant by agar screen. A 48h incubation was required to determine oxacillin resistance in 11 of 79 isolates with agar screen and in 10 of 76 isolates with macrodilution MIC. Automicrobic VITEK system may represent a useful method for rapid identification to a species level and early recognition of oxacillin resistance in coagulase-negative staphylococci.

Cryptosporidiosis in patients with hematologic malignancies

The clinical features of cryptosporidial infection in 20 patients with hematologic malignancies were assessed. Five patients had severe diarrhea, 10 had moderate diarrhea, and five were asymptomatic carriers of Cryptosporidium. Extraintestinal cryptosporidiosis with pulmonary involvement was observed in one case and relapse of cryptosporidiosis in four. All but one patient recovered from cryptosporidiosis whether or not spiramycin was administered. Cryptosporidiosis in T cell-depleted recipients of allogeneic bone marrow transplants did not appear more severe than that in patients undergoing autologous bone marrow transplantation or conventional chemotherapy.

[A mucinous cystadenocarcinoma of the pancreas. A clinical and histopathological contribution]

Two cases of pancreatic cystadenocarcinoma, a very rare pathology, are reported. The authors treat the anatomopathological classification and they underline the diagnosis especially with reference to the new methods of cytologic study. Finally they consider the surgical approach that must be radical because of the potential malignancy of this kind of tumor whose prognosis is quite good with a lasting long-term survival.

A modelistic approach to evaluate the factors affecting the 137Cs transfer from mother to fetus in cattle

The authors have analysed the relationship between 137Cs radioactivity and pregnancy in cattle with radiometric analysis of muscle, kidney and liver of 24 cattle at various stages of pregnancy, fed with fodder exposed to radioactive fall-out. Also the relative fetal muscle, kidney, liver and myocardium have been analysed. The automatic spectra analysis and the statistical one have given the following results: there is no correlation between 137Cs retention and the pregnancy stage in the cattle sampled; the absolute 137Cs concentration is always larger in the kidney than in the muscle (Km/Mm = 1.7), while it is just minor in minor in the liver (Lm/Mm = 0.8). The fetal concentration in muscle, kidney and liver is generally homogeneous, whereas the myocardium tends to retain more 137Cs in the first stages of the pregnancy as against the other tissues. In the last stage of pregnancy it presents a lower concentration. The authors have included the fetal body weight growth to get a more realistic description of the 137Cs transfer in the mother-fetus system; this approach enables to evaluate the kinetic constants so introduced.

Ganciclovir and standard high-dose immunoglobulins for the treatment of cytomegalovirus interstitial pneumonia in a bone marrow recipient

A 47-year-old woman received an allogeneic bone marrow infusion because of chronic myeloid leukemia. Two months after the transplant she developed an interstitial pneumonia: bronchoalveolar lavage yielded cytomegalic cells with intranuclear bodies, and cytomegalovirus DNA was detected by in situ hybridization techniques. Ganciclovir and standard high-dose immunoglobulins were administered to the patient with resolution of the pneumonia. No relapse of pneumonia was observed after a 4-month follow-up. It seems that the favorable outcome of the potentially fatal pneumonia observed in this patient might be related to early diagnosis, and prompt administration of ganciclovir and standard high-dose immunoglobulins.

Spontaneous pneumothorax complicating pulmonary mycetoma in patients with acute leukemia

Pneumothorax caused by the rupture of a mycetoma into the pleural space is rarely reported in patients undergoing intensive cytotoxic therapy for hematologic malignancies. We reviewed 46 episodes of mycetoma that developed in 43 patients undergoing antineoplastic therapy; six (13%) of these episodes were further complicated by the occurrence of pneumothorax that developed after bone marrow recovery with return to normal granulocyte count. Etiologic agents included Aspergillus fumigatus, Aspergillus fumigatus plus Blastoschizomyces capitatus, and Mucor (one case each). No pathogen was detected in the remaining three cases of pneumothorax. Four of the six patients died (7, 10, 27, and 50 days after the onset of pneumothorax). Two of the six patients with pneumothorax died of massive hemoptysis, whereas only one of the 40 patients who did not develop pneumothorax died of hemoptysis. This suggests that both pneumothorax and hemoptysis may represent the clinical expression of a more destructive course of invasive fungal diseases.

[Aneurysm of the left gastric artery. Clinical contribution and review of the literature]

The extra-visceral aneurysms of the gastric arteries are very rare and their diagnosis occurs mostly in the presence of haemoperitoneum and shock due to their rupture. Through echography and selective arteriography a right diagnosis can be made before a rupture. The treatment is surgical with good results but treatment with embolisation through arteriography is preconized. Two cases treated in emergency are reported.

Catheter-related right-sided endocarditis in bone marrow transplant recipients

Bone marrow transplant recipients are at increased risk of severe central venous catheter-related septicemias that may be complicated by endocardial infection. In view of this, we prospectively evaluated 141 consecutive patients receiving allogeneic or autologous bone marrow infusion. Seven (5%) of 141 patients developed eight episodes of a clinical syndrome compatible with catheter-related right-sided infective endocarditis; this diagnosis was confirmed at autopsy in two patients who died. Staphylococcus epidermidis was the most frequent isolate (four cases). Other offending pathogens were, in one case each, Enterococcus faecalis, Corynebacterium jeikeium, Pseudomonas alcaligenes, and Achromobacter xylosoxidans plus Candida species. Three- to 7-week courses of antibacterial therapy were associated with a favorable outcome in six of the seven cases. Infective endocarditis may be a complication of the use of central venous catheters and should be actively sought in septicemic bone marrow transplant recipients.

[Acute and long-term effects of captopril in patients with left ventricular dysfunction and dilatation: evaluation of function and work capacity]

To assess acute hemodynamic effects and exercise capacity of an intravenously administered single dose of captopril and to compare the acute response with chronic variation in hemodynamic and functional parameters after long-term oral administration, (in order to determine the profile of responders and non-responders) we studied 12 patients with chronic congestive heart failure due to primary dilated cardiomyopathy (11 pts) and ischemic heart disease (1 pt). Hemodynamic response was assessed using transthoracic electric impedance with cardiac output measurement. The exercise capacity was determined using multistage bicycle ergometer symptoms limited stress test. The hemodynamic and functional evaluation--resting cardiac output, exercise capacity (Ex. Dur.) and cardiac output rise at maximum workload (% CO)--were investigated at first as a control; after i.v. captopril administered in 10 min (25 mg) (acute); after captopril per os (25-75 mg for 30 days) (chronic) and after 5 days of withdrawal (wash out). (Table: see text). Improvement of left ventricular performance mainly during exercise after acute and chronic administration of captopril occurred, as evidenced from cardiac output increase at maximum work load, and rise of exercise duration. Moreover, our data suggest that captopril may have a sustained beneficial effect, for a few days, even after drug withdrawal. Nevertheless, the lack of correlation in single cases between acute and chronic response, also indicates that captopril deserves further study to determine its role in acute and/or chronic management of congestive heart failure in order to choose the ideal strategy.

S-phase evaluation with bromodeoxyuridine in lymphocytes from cattle infected with bovine leukemia virus (BLV)

Bromodeoxyuridine (BrdUrd), an analogue of thymidine, can be detected by means of monoclonal antibodies and utilized as a marker of the S-phase. In this paper a determination of the S-phase in BLV+ cattle with lymphocytosis has been performed by incorporating bromodeoxyuridine in the DNA. This evaluation was compared to the DNA content, demonstrating that i) bromodeoxyuridine incorporation is a reliable marker of S-phase in BLV+ cattle with lymphocytosis and ii) cytofluorimetry is the method of choice, together with immunocytochemistry, to demonstrate bromodeoxyuridine incorporation.

Pefloxacin in the treatment of gram-negative infections in patients with hematologic diseases

Quinolones are active against gram-negative strains. They are commonly used for selective intestinal decontamination in patients with hematologic malignancies and prolonged neutropenia due to chemotherapy. In our open study we used pefloxacin, a new fluoroquinolone, for the treatment of fifteen documented gram-negative infections in hematologic patients. Thirteen patients were mildly neutropenic, and in nine cases they received oral treatment as non-hospitalized patients. Cure was achieved in fourteen cases, with microbiological eradication of the offending pathogen.

Effects on oral and intestinal microfloras of norfloxacin and pefloxacin for selective decontamination in bone marrow transplant patients

We monitored the modifications of oral and intestinal microfloras of 10 allogeneic bone marrow recipients who received randomly either norfloxacin or pefloxacin (400 mg three times a day) as selective decontamination for infection prevention. After 1 week of treatment, in all patients members of the family Enterobacteriaceae were no longer detectable and in all but one pefloxacin-treated patient enterococci were also eliminated in the intestine. The anaerobic flora was not affected, with the exception of Bacteroides spp., markedly reduced after treatment with pefloxacin. In most patients the most striking effect was the increase in staphylococcal counts. These strains were found to be resistant to both quinolones in the study. Less consistent changes were observed in oral flora. No relevant difference could be demonstrated between the two regimens on bacterial counts either in feces or in saliva. This study shows the efficacy of both quinolones in eradicating gram-negative bacilli in the alimentary tract of bone marrow transplant patients; however, the finding of the overgrowth of resistant gram-positive organisms during treatment with these agents deserves further evaluation.

Teicoplanin in the treatment of gram-positive-bacterial endocarditis

Intravenous teicoplanin has been used to treat 23 cases of gram-positive-bacterial endocarditis, usually with 3 to 7 mg/kg every 12 h on the first day, followed by 3 to 7 mg/kg every 24 h. For some cases (staphylococcal and enterococcal endocarditis), the dosage was 8 to 14.4 mg/kg per day and/or other antibiotics were given. The mean duration was 48.2 days (range, 23 to 130 days). Of 23 patients, 21 (91.3%) had negative cultures or were cured. A total of 18 patients were treated with teicoplanin alone; of these, 4 had surgery, and all (except 2 who relapsed) were cured. Teicoplanin was combined with one or more antibiotics in five cases; in all cases appropriate cultures were negative, but three patients died during therapy or follow-up. Mild renal impairment was seen in two patients; both were receiving teicoplanin in combination with an aminoglycoside. We conclude that intravenous teicoplanin administered once a day at doses of 7 to 14 mg/kg per day is well tolerated, easy to administer, and may represent an efficacious therapy for gram-positive-bacterial endocarditis.

Cryptosporidium as a common cause of childhood diarrhoea in Italy

Cryptosporidium oocysts were observed in the stools of 9 (7.2%) of 124 Italian children with diarrhoea, examined during the period 1 January-31 December 1984. In two children, the parasite was associated with other enteric pathogens. The duration of diarrhoea was 2-30 days, with a median of 6 days. In all cases the infection was self limiting. The mean age of the Cryptosporidium-positive children was 34 months, and all cases occurred in the warm season. Cryptosporidium was found to be the third most common enteric pathogen after rotavirus and Salmonella spp.

Aspergillus colonization of the nose and pulmonary aspergillosis in neutropenic patients: a retrospective study

Fungal infections are definitely increasing in neutropenic patients with hematologic malignancies. In view of a previous report on a likely correlation between nose cultures positive for Aspergillus spp. and pulmonary aspergillosis, a retrospective study on 306 consecutive neutropenic patients was performed. Twenty-six patients had one or more nose cultures positive for Aspergillus: thirteen of them developed pulmonary aspergillosis. On the other hand, only twenty out of the remaining 280 patients with negative nose cultures developed this fungal pneumonia (p less than 0.00001). Even if negative results do not obviously exclude the possibility of invasive aspergillosis, nose cultures positive for Aspergillus might prove helpful in predicting this fungal infection in febrile neutropenic patients.

Antimicrobial susceptibilities of Streptococcus species that cause septicemia in neutropenic patients

Sixty-three consecutive streptococcal blood isolates from neutropenic patients, represented mainly by viridans group streptococci, were evaluated in vitro for antibiotic susceptibility. Of these isolates, 79.3% were highly susceptible to penicillin (MIC, less than or equal to 0.12 microgram/ml). Overall, imipenem was the most active agent, followed by teicoplanin and vancomycin. All other agents showed decreased activity against streptococcal isolates that were not highly susceptible to penicillin.

[Pretreatment evaluation of CA 72.4 in patients with carcinoma of the stomach (0-IV stage) versus CEA, TPA, CA 19-9, FER]

Before surgical treatments, sera of 54 pts suffering from gastric cancer, histologically typed and clinically staged (from stage 0 to 4), were assayed to evaluate CEA, TPA, CA 19-9 and Ferritin versus a new tumoral marker called TAG-72, in order to determine the biological behaviour and the relation to the clinical stage of this last one. Starting from their results, Authors say that the new marker TAG 72 has an increasing sensibility according to the clinical stage (4 th more than 1 st), and that the association of the TAG-72 plus CEA and/or TPA is rather significant in order to evaluate the evolution of the gastric cancer than other markers.

Comparative in vitro activities of new fluorinated quinolones and other antibiotics against coagulase-negative Staphylococcus blood isolates from neutropenic patients, and relationship between susceptibility and slime production

We evaluated the in vitro antibiotic susceptibilities of 31 coagulase-negative Staphylococcus isolates causing septicemia in neutropenic patients undergoing norfloxacin prophylaxis. All the strains but one were resistant to 1 microgram of norfloxacin per ml. At the same concentration, ciprofloxacin, ofloxacin, imipenem, and pefloxacin were inhibitory for 19 (61%), 19 (61%), 18 (58%), and 14 (45%) of the evaluated strains, respectively. Imipenem had an MBC/MIC ratio of greater than or equal to 32 against 19 (61%) of the evaluated isolates, and resistant subpopulations were detected at 5 micrograms/ml in 16 of 17 oxacillin-resistant strains and in 3 of 14 oxacillin-susceptible or -tolerant strains. Resistance to gentamicin was seen with increased frequency among slime-producing strains.