Serum Levels of Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) in a Group of Patients with Systemic Sclerosis

In this report we investigate the behaviour of the serum levels of Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) in the course of Systemic Sclerosis (SS). This cytokine is produced mainly by T and NK cells, and its possible role in the pathogenesis of SS has not been previously described in the literature. Serum GM-CSF levels were assayed in 10 female patients, ageing from 35 to 70, affected by SS. These patients were not suffering from other disorders and were not being treated with steroids or immunosuppressive drug. A solid phase immunoenzymatic method was used to assess the serum levels of GM-CSF. Reference values were previously determined in a control group of 36 healthy women blood donors (19 premenopausal and 17 postmenopausal) (x̄=20.1 ±12.3 pg/ml). All the patients but one showed significantly increased serum levels of GM-CSF (x̄= 120.9 ±125.5 pg/ml). The highest levels were found in the two oldest patients, who also had the longest clinical history of SS, but a clear correlation with age, disease duration or clinical manifestations was not evident, even if the postmenopausal age group patients showed a higher mean value of GM-CSF (x̄= 148.0±144.1 pg/ml) than that found in the premenopausal age group (x̄= 57.7±1.4 pg/ml) (in contrast with the findings in the control group). The absence of other pathogenic conditions in our patients suggests that the increase in serum levels of GM-CSF might be linked to the fibroblast proliferation which is typical of SS. However, our results do not explain the role played by this factor in the fibroblastic proliferation process and an in vitro study is necessary to clarify this aspect.

Spin-torque resonant expulsion of the vortex core for an efficient radiofrequency detection scheme

It has been proposed that high-frequency detectors based on the so-called spin-torque diode effect in spin transfer oscillators could eventually replace conventional Schottky diodes due to their nanoscale size, frequency tunability and large output sensitivity. Although a promising candidate for information and communications technology applications, the output voltage generated from this effect has still to be improved and, more pertinently, reduces drastically with decreasing radiofrequency (RF) current. Here we present a scheme for a new type of spintronics-based high-frequency detector based on the expulsion of the vortex core in a magnetic tunnel junction (MTJ). The resonant expulsion of the core leads to a large and sharp change in resistance associated with the difference in magnetoresistance between the vortex ground state and the final C-state configuration. Interestingly, this reversible effect is independent of the incoming RF current amplitude, offering a fast real-time RF threshold detector.

Understanding of Phase Noise Squeezing Under Fractional Synchronization of a Nonlinear Spin Transfer Vortex Oscillator

We investigate experimentally the synchronization of vortex based spin transfer nano-oscillators to an external rf current whose frequency is at multiple integers, as well as at an integer fraction, of the oscillator frequency. Through a theoretical study of the locking mechanism, we highlight the crucial role of both the symmetries of the spin torques and the nonlinear properties of the oscillator in understanding the phase locking mechanism. In the locking regime, we report a phase noise reduction down to -90  dBc/Hz at 1 kHz offset frequency. Our demonstration that the phase noise of these nanoscale nonlinear oscillators can be tuned and eventually lessened, represents a key achievement for targeted radio frequency applications using spin torque devices.

Assessment of host defence mechanisms induced by Candida species

Some species of Candida are opportunistic pathogens that can cause disease in a host immunocompromised by underlying local or systemic pathological processes. C. albicans is the species most often associated with oral lesions, but other species of Candida, including C. glabrata, C. tropicalis and C. parapsilosis, have also been isolated in the saliva of subjects with and without candidiasis. In the present study we evaluated the host defence mechanisms induced by Candida albicans and other Candida species in monocytes and oral epithelial cells in order to establish the existence of a species-specific cellular response. Our results indicated that, during Candida species infection, the epithelial cells actively participate in the host defence by producing antimicrobial peptides and proinflammatory cytokines. Moreover, in infections caused by Candida tropicalis and Candida glabrata, the host defence may be strengthened by the release of perforin and granzyme by polymorphonuclear leukocytes recruited at the site of infection.

In-vitro Analysis of Antifungal Activity of Epigallocatechin-Gallate: Preliminary Study

Oral candisosis is an heterogeneous group of diseases, caused by different species of Candida fungus. The incidence of drug-resistant species is increasing dramatically; furthermore, in recent years higher incidences of non-albicans and antimycotic-resistant species of Candida have been reported, thus increasing necessity of a non-antibiotic agent, which should be both highly effective and safe. It has been showed that the main polyphenols component of green tea, epigallocatechin-gallate (EGCG), has antibacterial activity; recently, it has been reported its antifungal activity too. We tested the effectiveness of a 0.20% EGCG (TEAVIGO®) gel, a non-pharmaceutical product suitable for oral in vivo use, on four species of Candida yeast (C.albicans, Cparapsilosis, C.tropicalis, C.glabrata), evaluating its antifungal activity and its capacity to inhibit biofilm formation. The EGCG gel showed a remarkable activity against C. parapsilosis and C. tropicalis. This preliminary study confirms EGCG effectiveness on fungi; for this reason, a product with such a low concentration of EGCG could be used with no side-effect for every-day oral hygiene. Anyway, mechanisms of antifungal activity of EGCG are not comprehended and need further studies to better understand the reasons of some Candida species' resistance.

Are hepatic steatosis and carotid intima media thickness associated in obese patients with normal or slightly elevated gamma-glutamyl-transferase?

BACKGROUND

Hepatic steatosis (HS) has been associated with obesity and metabolic syndrome (MS), conditions carrying a high risk of coronary artery disease. We aimed to determine whether HS was an independent factor of atherogenic risk beyond its association with MS and its components.

METHODS

We assessed the circulating levels of the heat shock protein-70 (HSP-70), a chaperone involved in inflammation, endoplasmic reticulum stress and apoptosis at liver and endothelial level and the gamma-glutamyl transferase activity (γ-GT) correlating them to carotid intima-media thickness (IMT), along with lipid profile, HOMA, C-reactive protein, fibrinogen, ferritin, adiposity type as well as spleen volume in 52 obese pts with grade 1, 128 with grade 2, and 20 with grade 3 of HS evaluated by sonography.

RESULTS

Patients with different grade of HS demonstrated overlapping HSP-70 levels; similarly performed obese subjects regarding IMT. Using multiple regression analysis, IMT was predicted by age, visceral adiposity and by HOMA (β = 0.50, p < 0.0001, β = 0.30, p = 0.01 and β = 0.18, p = 0.048 respectively, while the severity of HS was predicted by visceral and subcutaneous adiposity and HOMA (β = 0.50, p < 0.0001 and β = 0.27, p = 0.001 and β = 0.18, p = 0.024, respectively).

CONCLUSION

In our series of patients with normal or mild elevation of γ-GT, the severity of HS does not entail higher IMT, which may be linked to MS stigmata.

Serum Bcl-2 concentrations in overweight-obese subjects with nonalcoholic fatty liver disease

AIM: To shed some light on the relationship between anti-apoptotic serum Bcl-2 concentrations and metabolic status, anthropometric parameters, inflammation indices, and non-alcoholic fatty liver disease severity were investigated in 43 young individuals with fatty liver (FL) and 41 with nonalcoholic steatohepatitis (NASH).

METHODS: Circulating levels of Bcl-2 were detected in 84 patients with ultrasonographic findings of “bright liver” and/or hyper-transaminasemia of unknown origin and/or increase in γ-glutamyl-transpeptidase (γ-GT) strictly in the absence of other acute or chronic liver disease, whose age was not advanced, who gave consent to liver biopsy and were then divided on the basis of the histological results into two groups (43 with FL and 41 with NASH). Twenty lean subjects, apparently healthy and young, were chosen as controls.

RESULTS: Serum Bcl-2 concentrations were significantly higher in the FL group than in the NASH group. Insulin resistance and γ-GT activity were significantly higher in NASH subjects. Apoptotic hepatocytes were significantly more numerous in NASH patients. NASH patients presented with larger spleens and augmented C-reactive protein (CRP) concentrations than healthy subjects. Steatosis grade at histology was similar in both NASH and FL populations. The number of apoptotic cells was significantly related to anti-apoptotic Bcl-2 protein values in FL patients. Bcl-2 serum levels positively correlated to body mass index (BMI) values (P≤ 0.0001) but not to age of the population. Triglycerides/HDL ratio correlated well to waist circumference in males (P = 0.0008). γ-GT activity was associated with homeostatic metabolic assessment (HOMA) (P = 0.0003) and with serum ferritin (P = 0.02). Bcl-2 concentrations were not related to either spleen size or CRP values. NASH patients presented a weak negative correlation between lobular inflammation and Bcl-2 levels. A prediction by low values of serum Bcl-2 towards a greater presence of metabolically unhealthy overweight/obese patients (MUOs) was evidenced. HOMA, BMI and uric acid, in that sequence, best predicted serum Bcl-2 concentrations.

CONCLUSION: MUOs could be detected by Bcl-2 levels. By favoring the life span of hepatocytes, and enhancing triglyceride formation, the anti-apoptotic process inhibits free fatty acids toxicity in FL.

Circulating levels of cytochrome C, gamma-glutamyl transferase, triglycerides and unconjugated bilirubin in overweight/obese patients with non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease, characterized by hepatocyte apoptosis, is distinct in fatty liver and non-alcoholic steatohepatitis, the more severe form. Apoptotic cell death is caspase-dependent and associated with mitochondrial membrane depolarization and cytochrome c release. Adhering to the hypothesis that the exposure of hepatocytes to free fatty acids, resulting in increased ROS production and mitochondrial damage, is balanced by the presence of antioxidant substances, circulating levels of gamma-glutamyl transferase, cytochrome c, triglycerides and unconjugated bilirubin were explored in patients suffering from non-alcoholic fatty liver disease with different severity. One hundred and eighty-six consecutive patients who presented recent ultrasound feature of bright liver without any liver disease of known origin were enrolled, eighty-nine of whom underwent liver biopsy. Forty-five subjects were allocated on the basis of histology in fatty liver group while 44 patients formed the group with non-alcoholic steatohepatitis. A cohort of 27 young, lean, apparently healthy individuals was selected as control group. The levels of gamma-glutamyl transferase were normal or slightly increased, while unconjugated bilirubin concentrations were elevated in all the spectra of non-alcoholic fatty liver disease. Comparing the present results with relevant findings from other studies dealing with diseases characterized by apoptosis, we did not find high circulating levels of cytochrome c in non-alcoholic fatty liver disease. What is more, our patients, categorized as suffering from simple fatty liver or from the more severe non-alcoholic steatohepatitis, had similar levels of cytochrome c and gamma-glutamyl transferase, p=0.19 and 0.11. Serum triglycerides were higher in patients with non-alcoholic fatty liver disease than in the healthy group, p=0.001. These findings likely reflect a balance between oxidative stress and anti-oxidant response rather than a lack of reliability of cytochrome c as a reliable biomarker of mitochondrial damage.

Does spleen volume play a role in patients with HCV-related chronic hepatitis?

As the lymphotropism of hepatitis C virus (HCV) has already been ascertained, and in the light of the fact that the immune defense system is an organized network composed of functionally interrelated tissues, this study was carried out to verify the possible involvement of spleen in HCV-related chronic hepatitis. In this cross-sectional study we measured spleen longitudinal diameter by ultrasound, beta2-microglobulin serum levels and splenic artery resistivity index (SARI) by Doppler in 51 patients treated with standard combined (Peg-Interferon plus Ribavirin) antiviral therapy. Thirty-three patients (17 females) completed the regimen and were compared to 31 controls (16 females). The mean basal values of spleen longitudinal diameter were higher in patients with chronic hepatitis than in controls, i.e., 116 mm (9.4) versus 102.7 mm (9.3), P = 0.0001. In the same patients a significant trend towards increased spleen longitudinal diameter was found after antiviral therapy, independently of the stage of HCV-related chronic hepatitis. The median values of the beta2-microglobulin concentrations were not significantly higher in the patients with HCV-related chronic hepatitis compared to controls, i.e., 1.3 (0.5-2.6) versus 1 (0.6-1.4), P = 0.16, although during the course of therapy they were significantly increased. SARI values of HCV-related chronic hepatitis patients were different from those of controls, but were unvaried compared to values at the end of treatment. Neither spleen measurements nor serum beta2-microglobulin levels were able to predict therapeutic response to antiviral therapy. A stimulation/expansion of lymphoid tissue was found in patients with HCV-related chronic hepatitis. Such evidence raises the question whether physicians should continue to prescribe antiviral therapy in non-responders and supports the use of a new scheme (SLD plus beta2-MG) to diagnose this ongoing, apparently reversible, but nevertheless dangerous immunologic process.

The contribution of omental adipose tissue to adipokine concentrations in patients with the metabolic syndrome

PURPOSE

To examine differences in peripheral vascular endothelial growth factor (VEGF), interleukin-6 (IL6) and cortisol concentrations between patients with both visceral obesity and metabolic syndrome, and lean controls. In a subsample of metabolic patients underwent abdominal surgery, the adipokine concentrations were measured in venous blood from the omentum to determine information on some processes of synthesis.

METHODS

Forty-two healthy lean controls and 46 overweight-obese patients with central adiposity and stigmata of metabolic syndrome were studied. In a subsample of 11 metabolic patients undergoing non-bariatric surgery, blood samples from omental and peripheral veins were taken intraoperatively to determine VEGF, IL6 and cortisol concentrations.

RESULTS

Median levels (range) of peripheral VEGF and IL6 were higher in patients than in controls [31.5 (3-112) pg/mL vs 21.35 (9-41.9) pg/mL (P < 0.05) and 5.50 (1.40-13) pg/mL vs 1.15 (0.3-1) pg/mL (P < 0.0001)]. On the other hand, concentrations of VEGF and IL6 from the omental and peripheral veins were similar in the surgery sub-group. Peripheral cortisol concentrations were not higher in patients than in controls, nor were omental concentrations different from the peripheral. Omental and peripheral VEGF and cortisol values were correlated, whereas no association was found between omental and peripheral IL6.

CONCLUSIONS

In the presence of abdominal obesity, VEGF and IL6 concentrations are increased in the systemic circulation. The contribution of visceral adipose tissue to circulating levels of VEGF and IL6 was modest.

The soluble transferrin receptor (sTfR)-ferritin index is a potential predictor of celiac disease in children with refractory iron deficiency anemia

The soluble transferrin receptor (sTfR) distinguishes iron deficiency anemia from other types of anemia. Refractory iron deficiency anemia is often the onset symptom in malabsorption-induced celiac disease. We evaluated whether sTfR levels distinguish celiac disease-associated iron deficiency anemia from iron deficiency anemia of other origin. To this aim we measured sTfR and ferritin levels and their ratio (the sTfR/ferritin index) and other hematological parameters in 42 anemic children (20 with and 22 without celiac disease) vs. 22 non-anemic children with celiac disease and 31 healthy controls (age range 4-12 years). Hemoglobin parameters, mean cell volume, and serum iron and ferritin levels were decreased to a similar extent in the anemic patients (celiac and non-celiac). The sTfR level in non-anemic celiac patients was similar to that of normal controls (1.7+/-0.35 mg/L), whereas it was significantly increased in non-celiac and celiac anemic patients (2.2+/-0.5 mg/L, p<0.05 and 2.7+/-1.2 mg/L, p<0.001, respectively). The sTfR/ferritin index was also increased more in the anemic celiac patients (mean 4.4, range 1.5-12.0) than in anemic non-celiac children (mean 2.6, range 1.4-4.0) compared with non-anemic children (mean 1.2, range 0.7-2.0). Differences were more pronounced when ferritin was <5 ng/mL. Thus, the sTfR/ferritin index may be a predictive measure in discriminating anemic patients with celiac disease from those without celiac disease.

Evaluation of the monocyte counting by two automated haematology analysers compared with flow cytometry

The aim is to determine the monocyte count performance of the Bayer Diagnostics ADVIA120 and Coulter LH 750 automated haematology analysers and the results obtained by these two instruments were compared with those provided by Becton Dickinson FACScan flow cytometer using the combination of CD45/CD14 MoAb. Linearity and imprecision were also evaluated. The linearity of both instruments was good. Coulter LH 750 showed better precision (4.3%) than ADVIA 120 (9.0%) both within and between batch. A significant correlation (r = 0.973) was found between the LH 750 and the flow cytometry method, while a modest one was observed between the latter and the ADVIA 120 (r = 0.880). When comparing the percentage of monocytes by means of one-way anova and Tukey test, it was found that the LH 750 provided the closest results in comparison with flow cytometry, with no statistical difference between the means (mean difference MO% = 0.6); however the difference was statistically different between the ADVIA 120 and flow cytometry (mean difference MO% = -4.06). These data were confirmed by Altman-Bland and Deming regression analyses.

[Postpartum perineal assessment]

BACKGROUND

To evaluate the incidence of urogenital and anorectal dysfunctions during puerperium, verify the correlation between obstetric perineal damage observed during labour and puerperal symptoms, test the efficacy of tests to evaluate perineal function in pelvic floor dysfunctions consequent to vaginal birth.

METHODS

A total of 693 consecutive puerperae were recruited two months after birth. All completed a clinical and anamnestic questionnaire and underwent clinical urogynecological examination, digital test, vaginal manometry and uroflowmetric evaluation of the voluntary capacity to interrupt micturition. From a statistical point of view, persistent urinary incontinence was identified by graphic representation on frequency tables and predictive tests, and statistical "kappa" was used to evaluate the correlation between perineal function tests.

RESULTS

Stress urinary incontinence (15.1%) represents the most widespread symptom, a postpartum perineal inspection provides a sufficiently accurate estimate of posterior damage, but does not identify those puerperae who will develop urinary incontinence. None of the tests used was able to predict persistant urinary incontinence.

CONCLUSIONS

Postpartum perineal inspection seems to be effective in predicting anorectal dysfunctions, but is not so useful for urethro-vesical disorders. None of the diagnostic methods examined allowed a sufficiently accurate selection of those puerperae at risk.

The urine stream interruption test and pelvic muscle function in the puerperium

OBJECTIVES

This study assesses the role of the uroflowmetric urine stream interruption test (UST) in the evaluation of postpartum pelvic floor muscle function.

METHOD

Two months after vaginal delivery, 492 women who underwent a digital test, vaginal manometry, and a UST were divided into two groups: continent and incontinent. Variables were subjected to the Student's t-test and to Fisher's exact test to verify the difference between the two groups.

RESULTS

Digital test and vaginal manometry results were higher in the continent group, but only the UST showed significantly different values (P=0.001). All test results of incontinent puerperae who underwent rehabilitation were significantly improved after treatment.

CONCLUSIONS

UST is low cost, non-invasive, and can give objective information about pelvic floor performance after a vaginal delivery. It can be used for both routine clinical use and an outcome measure for women who undergo rehabilitation treatment.

Effect of paraformaldehyde on platelet size and on measurement of surface IgG

In many platelet assays, as in measurement of platelet-adherent IgG (PAIgG), platelets are fixed in paraformaldehyde (PFA). To better clarify the effect of PFA on platelet size and on PAIgG measurement we compared PAIgG levels in a series of 40 samples, with or without PFA fixing. We used an ELISA which was set up on unfixed platelets and gave excellent results in terms of linearity (r = 0.923), precision (mean CV = 5%) and correlation with a platelet suspension immunofluorescence test. We found PAIgG values in unfixed platelets were about 10-fold higher than in PFA-fixed (0.411 +/- 0.172 fg/platelet vs. 0.035 +/- 0.019 fg/platelet). This discrepancy could be a consequence of the smaller mean platelet volume (MPV) of washed platelets when fixed in PFA (8.0 +/- 0.8 fl as compared to 10.1 +/- 1.07). This effect of PFA could decrease the amount of binding sites for IgG exposed on the platelet membrane and hence explain the significantly lower PAIgG values observed in fixed platelets. The PAIgG measurements on unfixed platelets from 200 healthy subjects displayed a Gaussian distribution with a mean +/- SD of 0.32 +/- 0.13 fg/platelet, i.e., 1200 +/- 500 molecules/platelet.

[Magnetic resonance (MR) in endometrial carcinoma preoperative evaluation]

BACKGROUND

Myometrial invasion of endometrial carcinoma is an important prognostic factor because the degree of myometrial invasion is correlated with the rate of lymphnode metastases and of recurrences. The aim of the study was a preoperative evaluation of endometrial carcinoma by Magnetic Resonance (MR).

METHODS

The authors present a prospective study performed on 54 cases of endometrial carcinoma collected at the Department of Gynecology and Obstetrics of the University of Trieste (Italy). All the patients were considered as Stage I after hysteroscopy and endocervical curettage. Prior to surgery all the patients underwent MR at the Department of Radiology of the University of Trieste (Italy) in order to evaluate the depth of myometrial invasion. The surgical procedure included total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and lomboaortic lymphadenectomy in high risk cases. Statistical evaluation was performed by Fischer's exact test.

RESULTS

Statistically significant positive correlation was found (p<0.001) between MR staging and surgical staging. The sensitivity reported in our series for distinguishing between superficial disease (Stage IA and IB) and deep myometrial invasion (Stage IC) was 92%.

CONCLUSIONS

Preoperative MR is helpful in selecting patients at high risk of nodal involvement and it is suggested that, although MR is considered an expensive examination, its use should be always considered before surgical treatment of patients with high surgical risk.

[Typification of HPV in clinical practice]

OBJECTIVE

To improve the sensitivity of cervical carcinoma screening and to determine the optimal management with an ASCUS Pap result we evaluated the effectiveness of combining thin layer cytologic slides (ThinPrep) and HPV DNA testing.

METHODS

A total of 170 women were studied with conventional Pap smears, liquid based cytology, HPV testing and colposcopy with eventual histologic evaluation.

RESULTS

The ThinPrep method yielded 12.5% more high grade lesions than did the conventional smears (and more severe diagnoses as compared to the conventional smears). HPV prevalence was significantly associated with disease status. Of 30 patients with ASCUS, HPV testing detected 100% of high grade lesions and 67% of low grade. If colposcopy had been limited to HPV+ women, 47% of case would have been spared.

CONCLUSIONS

Liquid based cell collection improves sensitivity for the detection of disease. For women with ASCUS cytology, HPV DNA testing of residual specimen can identify the majority of high risk cases using a single sample.

[Sexually transmitted diseases in adolescence]

BACKGROUND

Sexually transmitted diseases (STD) have their most incidence in adolescence. We conducted an observational study on the symptomatic patients of our STD's office to evaluate epidemiological distribution, behavioral patterns and diffusion of genital infections in teen-agers in respect of the adult population.

METHODS

From april 1996 to april 1999 we studied two groups of patients: 54 teen-agers (13-19 years) and 917 women in fertile age (20-40 years). All the patients underwent to a clinical and microbiological examination of vaginal secretions (Gram slide, wet mount, cultures for bacteria, yeasts, eventually Chlamydia trachomatis, Mycoplasma spp, Neisseria gonorrhoeae, Herpes simplex virus--HSV--) and to an anamnestic and socio-epidemiological questionnaire.

RESULTS

The more frequent genital infections among adolescents was vulvovaginal candidiasis (35% vs. 23.9% of adult people). HSV was found in 1.8% of teen-agers (vs. 0.6%) and when requested, Chlamydia trachomatis and mycoplasmas was found respectively in 16.6% (vs. 1.1%) and 50% (vs. 28%) in adolescents. We observed a high percentage of pregnancy (22.2%) of voluntary pregnancy interruption (41.6%) and a specific sexual behavior among teenagers.

CONCLUSIONS

Our data show a particular behavioral risk pattern in the adolescence population and indicate the necessity of a serious program of prevention and sexual education that allow young people to live with more consciousness and safety their sexuality.

[Gynecologic infections in adolescence]

BACKGROUND

Adolescence in the age bracket with the highest incidence of sexually transmitted diseases (STDs). An observational study was performed in symptomatic patients attending our Outpatient Clinic for STDs in order to evaluate the diffusion of genital infections in the adolescent population and the different epidemiological distribution compared to adults.

METHODS

The incidence of these infections was compared in two groups of patients attending the clinic between April 1995 and April 1999. The first consisted of 54 teenagers (13-19 years-old) and the second, used as a control, consisted of 917 women of child-bearing age (20-40 years). All patients underwent clinical examinations and microbiological tests of vaginal secretions (bacterioscopic test on coloured plates using the Gram method, cold tests, cultural assay of bacteria and fungi, assay for (Chlamydia trachomatis, Mycoplasma spp., Neisseria gonorrhoeae, Herpes simplex virus).

RESULTS

The most common genital infection in teenagers was candidosis (35% vs 23.9%), followed by bacterial vaginosis (31.9% vs 25.8%) and mixed flora vaginitis (25.9% vs 22.6%). HSV was found in 1.8% of adolescents (vs 0.6%), in selected cases, Chlamydia and Mycoplasma were present in 16.6% (vs 1.1%) and 50% (vs 28%) of teenagers respectively.

CONCLUSIONS

All genital infections were more frequent in the study population of adolescents compared to the control group. The adolescent population should be the target of a serious and systematic programme of prevention in order to ward off the sequelae of early and often irresponsible sexual activity.

[Sexual behavior and adolescence]

BACKGROUND

Adolescence represents the period with the highest frequency of negative consequences associated with sexual activities (sexually transmitted diseases and unwanted pregnancies). An epidemiological study was carried out in symptomatic patients attending our Outpatient Clinic for Sexually Transmitted Diseases between April 1995 and April 1999 in order to evaluate the behaviour pattern of the adolescent population and identify the differences compared to the adult population.

METHODS

A questionnaire was used to assess the characteristics of two groups of patients: the first consisted of 54 teenagers (13-19 years-old) and the second, the control group, consisted of 917 women aged between 20 and 40 years old.

RESULTS

A high percentage of pregnancies (22.2%) and voluntary abortions (41.6%) was observed in teenagers, associated with different sexual behaviours. The age of sexual intercourse was below 15 in 44.4% of adolescents (vs 7.7% of controls), whereas 61.1% had more than one sexual partner and 20.4% had changed partners in the last 6 months (vs 7.4%). 50% of teenagers did not use any method of contraception (vs 44.2%) and barrier methods were only used by 20.4% (vs 18.4%).

CONCLUSIONS

Our study confirms the existence of a high-risk behavioural pattern in the adolescent population and draws attention yet again to the need for a serious programme of prevention and sexual education which will allow adolescents to experience the discovery of their own sexuality with greater awareness and safety.

Evaluation of the Abbott CELL-DYN 4000 hematology analyzer

A new generation hematology analyzer, Abbott CELL-DYN 4000 (CD 4000), capable of providing 26 parameters, including fully automated reticulocyte, nucleated RBC, blast, band, and immature granulocyte, and variant lymphocyte counts, was evaluated by using the National Committee for Clinical Laboratory Standards H20-A protocol and compared with the Bayer-Technicon H-2 analyzer, which is used routinely in our laboratory. A lipid interference experiment and a sample aging study also were performed. Linearity, carryover, and precision were within the limits established by the manufacturer, and satisfactory agreement was found with the H-2 analyzer. The evaluation of leukocyte differential counts indicated an excellent correlation with the manual reference method for neutrophils and lymphocytes, a good correlation for monocytes and eosinophils, and a poor correlation for basophils in samples with low counts; for basophil counts of 2% or higher, we found an improvement of the correlation coefficient. In the lipid interference experiment, only hemoglobin determination was influenced significantly on the CD 4000, but by using a new Abbott hemoglobin reagent, the interference was eliminated. The CBC and differential counts were stable and reportable up to at least 24 hours. Intrasample viability information on leukocytes provided a quality check on each individual specimen.

[Pregnancy cholestasis. Clinical aspects and neonatal outcome]

AIM

Gravidic cholestasis is a syndrome that is usually manifested during the third trimester of pregnancy and regresses in puerperium. It is characterized by the onset of itch, with or without associated jaundice and alterations of hepatic functional parameters. Its incidence varies according to geographical area.

METHODS

A retrospective analysis was made regarding the frequency of this pathology in pregnant patients attending the Gynecology and Obstetrics Clinic of Trieste from 1-1-1980 to 31-7-1997. The epidemiological and clinical characteristics were studied relating to the course of pregnancy and neonatal outcome. Patients were identified on the basis of diagnosis on admittance and anamnestic and laboratory data, generalised itch and increased transaminase, biliary salts and alkaline phosphatase. Patients suffering form active-phase viral hepatitis were excluded, as were those in whom symptoms appeared after the start of alpha methyldopa administration.

RESULTS

The frequency of gravidic cholestasis in this series was 0.36%. No significant differences were recorded in terms of age, parity and weight increase in these patients compared to the general population of pregnant women. Birth was spontaneous in 66% and by cesarean section in 34%. The frequency of premature births was 12%. The Apgar score at 5 min was satisfactory in all neonates.

CONCLUSIONS

Careful monitoring of pregnancy associated with suitable obstetric care enabled a zero rate neonatal and maternal mortality to be achieved.

Essential mixed type II cryoglobulinemia in a HCV positive pregnant woman: case report

Cryoglobulins are a group of proteins with the common property of precipitating from cooled serum. Cooled cryoglobulinemia is a classic disease caused by immune complexes which subside on vessel walls and produce a clinical picture represented by recurrent purpura, asthenia, arthralgias, Raynaud's phenomenon, glomerulonephritis and sensorimotor neuropathy. The authors describe a case of a patient C.M., 37 years old, with cryoglobulinemia, chronic hepatitis C and gravidic cholestasis at 28 weeks' gestation. The clinical picture worsened with the appearance of mild hypertension with proteinuria and hypochromic anaemia. At 31 weeks' the arthralgic symptomatology and pruritus revealed degeneration with an alteration of glycemic profile values and treatment with rapid human insuline was started. The cardiotocography began to be pathologic and a cesarean section was performed; the newborn weighted 1570 g. Cooled cryoglobulinemia is a pathology which worsens in a gravidic state and can impair the outcome of pregnancy.

[Percutaneous mechanical revascularization of chronic iliac artery occlusion with "first intention" stent placement]

INTRODUCTION

Percutaneous treatment of chronic iliac artery occlusion has not yet gained complete acceptance as the method of choice. The reason of this widespread skepticism are the poor results achieved with angioplasty and/or lysis therapy. The introduction of stents seems to open new perspectives to percutaneous treatment and the latest follow-up studies report encouraging results.

MATERIAL AND METHODS

We report our personal experience in percutaneous mechanical revascularization of chronic iliac occlusion with primary stent placement in 29 patients with 2 years' maximum follow-up. Clinically the patients had at least 3 months' claudication and were in Fontaine stages II to IV. The occlusion was passed mechanically using a hydrophilic guide wire, through the contralateral access in 19 cases and ipsilaterally in 10. The stents were primarily implanted in the last 12 patients; in the first 15 patients, after dilatation with undersized balloons, 25 Wallstent and 12 Palmaz stents were implanted. Each patient underwent color Doppler follow-up for 3-24 months. Nine patients underwent angiography too, after one year.

RESULTS

The mechanical passage of the guide-wire through the occluded segment was successful in 27 of 29 (93.1%) patients referred for percutaneous revascularization of a chronic occlusion of the iliac artery. The stent was placed and immediate patency was achieved in 100% of these 27 patients. Clinical improvement was of two stages in 24 patients and of one stage in 3 patients. The follow-up showed neither reocclusions nor critical stenoses of the restored iliac segment. Five embolic complications (5%) occurred after angioplasty, all of them treated percutaneously; surgery was never necessary.

DISCUSSION AND CONCLUSIONS

The follow-up studies published in the literature in the last few years and our personal experience encourage the percutaneous treatment of chronic iliac artery occlusions. Percutaneous mechanical revascularization with primary stent positioning can be proposed because it is a reliable and efficacious tool, particularly in young patients in whom a surgical aortoiliac or aortofemoral bypass might injure the pudendal plexis and cause sexual disturbances.

[Insulinemic response to oral glucose loading tests in screening for diabetes in pregnancy]

BACKGROUND AND AIMS

Given that an increased peripheral insensitivity to insulin represents the primum movens of gestational diabetes, it is reasonable to suppose that the determination and evaluation of the insulinemic response to an oral glucose loading test may represent a simple, effective and low cost screenign test. A method was devised which consisted in performing two assays of insulin and glycemia in venous blood; the first while fasting, the second one hour after the ingestion per os of 50 g glucose.

METHODS

A group of 79 pregnant women, aged between 20 and 41 years old (mean age 30.5), was tested in around the 23rd week of gestation. All women were attending the Obstetric and Gynecological Clinic at Trieste University.

RESULTS

Based on the results obtained, insulinemic parameters appear to be significantly correlated with data for the short glycemic curve according to O'Sullivan-Mahan.

CONCLUSIONS

This study appears to confirm the need to include insulinemic tests as part of the new and more efficacious glucose tolerance tests and to perform prospective studies in order to identify the most reliable screening method in terms of sensitivity and specificity, also in relation to the cost-benefit ratio.

Eligibility criteria for labor induction with prostaglandins

Particular conditions exist at the end of some pregnancies which cause an increase in maternal and fetal risk. A valid alternative for these pregnancies is represented by the administration of prostaglandins, in order to obtain labor induction. The goal of our study was to define the eligibility criteria and the epidemiological characteristics that correlate most with a favorable obstetrical outcome. The study was conducted on 133 informed, consenting patients subjected to labor-induced delivery with prostaglandins E2. The mode of delivery in relationship to parity demonstrated that the pluriparous patients had fewer difficulties in labor and in its induction: of the 43 pluriparous cases, none had a cesarean section for failed induction and 95.3% delivered vaginally. One hundred percent of the patients with a Bishop score of more than 4 went into labor, as opposed to 81% of the patients with a score of less than 4. Therefore, taking into consideration the cost of the method, we retain that choosing an active position is valid, respecting the eligibility criteria for the induction of labor described above.

Monoethylglycinexylidide production as a measure in predicting hepatic histology

To clarify whether monoethylglycinexylidide (MEGX) production can be useful in predicting the severity of chronic liver disease, 51 subjects were enrolled in this study: 13 mild-moderate CAH (group A), 9 severe CAH (group B), 29 cirrhosis, 18 compensated and 11 decompensated disease (group C). The patients were injected with a 1 mg/Kg lidocaine bolus i.v. and serum-sampled for MEGX values (time 15, 30 and 60 minutes), determined by TDX-immunoassay. MEGX formation was significantly different (Mann-Whitney U test) in the three groups at each time interval, especially at 30 min: group A = 70.5 +/- 9.9 ng/ml (mean +/- SD); group B = 49.7 +/- 7.2; group C = 37.2 +/- 19.5 (in A vs B, p = 0.0003; in A vs C, p < 0.0001; in B vs C, p = 0.0237). The difference between compensated and decompensated cirrhosis was always significant (p = 0.0099, 0.0005, 0.0113 respectively) but between severe CAH and compensated cirrhosis it was marginal only at 15min (p = 0.0763) and absent at 30 and 60min. At 30min MEGX values > 60 suggest mild-moderate CAH, < 40 cirrhosis, < 30 decompensated cirrhosis, between 40 and 60 severe CAH or compensated cirrhosis. We are of the opinion that the MEGX test could be utilized to predict hepatic histology.

Determination of the kinetics of Na+/H+ exchange in platelets using the Coulter S-plus cell counter

Cell swelling, as measured by electronic cell sizing, is a good indicator of the Na+/H+ exchange activation. In this study the kinetic properties of the Na+/H+ exchanger were determined with the aid of the Coulter S-Plus VI D haematological cell counter. Cell swelling was measured in platelets suspended in Na-propionate medium. The rapid entry and intracellular dissociation of propionic acid induces activation of the exchanger, and in turn the uptake of water by osmosis. The fractional volume increase measured by the Coulter S-Plus was dependent on the external Na-concentration, with Km = 86 mmol/l. Saturation was reached at a propionate concentration of 140 mmol/l. Inhibition by amiloride was dose-dependent with Ki = 24 mumol/l. The activity of the exchanger was not modified by ouabain. These data are generally consistent with those published in previous reports, and indicate that automated haematological analysers are appropriate for the study of this aspect of platelet function.

Evidence of a cold immunoglobulin M autoantibody against 78-kD platelet glycoprotein in a case of EDTA-dependent pseudothrombocytopenia

Pseudothrombocytopenia is a phenomenon in which the electronic count shows spuriously low platelet counts in subjects with normal platelet levels. The mechanism of anticoagulant-dependent pseudothrombocytopenia appears to involve cold reactive agglutinins against platelet antigens. The authors report a case of EDTA-dependent pseudothrombocytopenia with evidence of a cold immunoglobulin M antibody against 78-kD platelet membrane glycoprotein (GP). Cell counts were performed by Coulter Counter S-Plus VI (Coulter, Hialeah, FL) in the following anticoagulants: EDTA, Na-citrate, and citrate-theophylline-adenosine-dipyridamole. Anti-platelet antibodies and platelet membrane GP antigens were assayed by an immunofluorescence technique as described by Van dem Borne in 1978. An immunoglobulin M/lambda anti-platelet antibody was found to react in serum as well as in plasma EDTA at room temperature, but not at 37 degrees C. This antibody appeared to be directed against GP78 membrane antigen because this antigen was not detectable by immunofluorescence in platelets collected in EDTA and Na-citrate anticoagulant, whereas a fluorescence signal was revealed in platelets collected in citrate-theophylline-adenosine-dipyridamole. This evidence was confirmed by platelet clumping inhibition tests in which target platelets were pretreated with anti-GP monoclonal antibodies. Clumping in the presence of pseudothrombocytopenia serum was inhibited by anti-GP78kD and anti-GPIIb/IIIa but not by anti-Ib. In this case, GP78 appears to be involved in platelet clumping, together with IIb/IIIa complex. The partial inhibition of the phenomenon observed in citrate-theophylline-adenosine-dipyridamole is probably related to a lower expression of the membrane antigens in platelets collected in this anticoagulant.

Characterization of Hemoglobin Lepore Variants by Advanced Mass-Spectrometric Procedures

We describe an analytical protocol for characterizing the molecular structure of hemoglobin (Hb) Lepore variants by using two different mass-spectrometric approaches. The first method consists of direct examination of the chromatographically separated hybrid globins by electro-spray mass spectrometry; the variant Lepore globin is identified through the accurate determination of its molecular mass. Alternatively, the anomalous globins are digested with trypsin and their structures are determined by fast atom bombardment mass-spectrometric analysis of the peptide mixture. The application of this procedure to the identification of Hb Lepore Boston and Hb Lepore Baltimore is described.

Characterization of hemoglobin lepore variants by advanced mass-spectrometric procedures

We describe an analytical protocol for characterizing the molecular structure of hemoglobin (Hb) Lepore variants by using two different mass-spectrometric approaches. The first method consists of direct examination of the chromatographically separated hybrid globins by electro-spray mass spectrometry; the variant Lepore globin is identified through the accurate determination of its molecular mass. Alternatively, the anomalous globins are digested with trypsin and their structures are determined by fast atom bombardment mass-spectrometric analysis of the peptide mixture. The application of this procedure to the identification of Hb Lepore Boston and Hb Lepore Baltimore is described.

[Evaluation of the Coulter T-660 hematologic analyzer compared with the Hemalog 8/90]

The authors evaluated technical performance of two automated haematological counters, the Coulter T-660 in comparison to Hemalog 8/90. Both systems showed a good correlation and a good precision. The Coulter T-660 revealed to be a high standard analyzer, that can adequately support more complex haematological analyzers in laboratory routine.

Investigation of Aeromonas isolated from water; a serological study using Ouchterlony and immunoelectrophoresis techniques

We have shown that immunoelectrophoresis and the Ouchterlony double diffusion technique are valuable assays for the identification of Aeromonas species. Serological correlations have been found between the antigenic extracts originated from a collection reference strains of Aeromonas hydrophila subsp. hydrophila and those originated from wild type water isolated.

Tuberculosis in marine tropical fishes in an aquarium

Skin, gill and visceral tubercle lesions were detected in marine tropical fish in an aquarium. Ninety-seven fish of 17 different genera were affected. The tubercles consisted of a wall of densely packed epithelioid cells and necrotic center packed with acid-fast bacilli identified as Mycobacterium marinum.