Characterization of Vaccine Breakthrough Cases during Measles Outbreaks in Milan and Surrounding Areas,Italy, 2017–2021

Despite the existence of an effective live-attenuated vaccine, measles can appear in vaccinated individuals. We investigated breakthrough measles cases identified during our surveillance activities within the measles/rubella surveillance network (MoRoNet) in Milan and surrounding areas (Northern Italy). Between 2017 and 2021, we confirmed measles virus (genotypes B3 or D8) infections in 653 patients and 51 of these (7.8%) were vaccinees. Among vaccinated individuals whose serum was available, a secondary failure was evidenced in 69.4% (25/36) of cases while 11 patients (30.6%) were non-responders. Non-responders were more frequently hospitalized and had significantly lower Ct values in both respiratory and urine samples. Median age and time since the last immunization were similar in the two groups. Importantly, we identified onward transmissions from vaccine failure cases. Vaccinees were involved in 20 outbreaks, in 10 of them they were able to transmit the virus, and in 8 of them, they were the index case. Comparing viral hemagglutinin sequences from vaccinated and non-vaccinated subjects did not show a specific mutation pattern. These results suggest that vaccination failure was likely due to the poor immune response of single individuals and highlights the importance of identifying breakthrough cases and characterizing their clinical and virologic profiles.     

Liquid-crystalline epoxy resins: a glycidyl-terminated benzaldehyde azine cured in the nematic phase

A novel glycidyl-terminated benzaldehyde azine was synthesized and subsequently cured with an aromatic diamine. The resulting liquid-crystalline network was characterized by means of optical microscopy, X-ray analysis and dynamic-mechanical analysis. The influence of the curing temperature on the nematic textures is pointed out. The curing reaction was followed by means of differential scanning calorimetry and dielectric analysis.     

Hepatic abscesses in the immunocompromised patient: role of CT in detection, diagnosis, management, and follow-up

Newer cytotoxic and immunosuppressive agents and more aggressive oncologic treatment protocols have resulted in an increased incidence of opportunistic infections in the immunocompromised host. Clinical symptoms and laboratory data are often nonspecific and definitive diagnosis may be difficult to establish. The role of CT in the detection, diagnosis, management, and follow-up of various hepatic opportunistic infections in 9 immunocompromised hosts is presented. In 5 of 6 patients, CT-guided needle aspiration resulted in definitive diagnosis. In 3 patients, surgical intervention was obviated by abscess drainage using CT guidance. There is clearly a role for CT not only in the detection but also in the definitive diagnosis, treatment, and follow-up of abscesses in the immunocompromised host.     

Primary large-cell lymphoma of the central nervous system

Primary non-Hodgkin's lymphoma of the central nervous system (CNS) is a rare disease. Seven patients were seen and treated at the University of Michigan Medical Center between January 1969 and December 1983. All patients had histologically proven diagnoses of large cell lymphoma with clinical and radiologic evidence of involvement limited to the CNS. Five of seven patients received postoperative radiation therapy, two of whom have had apparent local control at 1- and 2-year follow-up. The two patients without postoperative radiation died of local recurrence 2 and 3 months following subtotal resection. These poor results suggest that adjuvant therapy may be required for improved control of this type of extranodal lymphoma.     

Radiation-Induced Malignant Fibrous Histiocytoma: A Report of Five Cases Including Two Occurring Post Whole Brain Irradiation

Five patients who were successfully treated with external radiation therapy for a variety of histologically unrelated tumors subsequently developed malignant fibrous histiocytoma (MFH) within the irradiated field. It is suggested that therapeutic irradiation was a causative factor in the development of these tumors with latent periods ranging between 3 and 17 years. A review of the pertinent literature is presented. It is apparent that postradiation MFH is being recognized with increasing frequency and at an earlier age than when it appears de novo.     

Analysis of treatment results in craniopharyngioma

A retrospective study of 30 patients treated primarily with surgery for craniopharyngioma between 1965 and 1980 was conducted. There were 13 children and 17 adults in this series. Apparent total surgical removal was obtained in six children and eight adults; the remaining patients had subtotal resection. Radiation therapy was used for salvage in five patients and after complete cyst removal in one. The ten-year survival rate was 80% in children and 30% in adults. The five-year survival was ten of 11 patients with childhood craniopharyngioma and seven (41%) of 17 patients in the adult group. Seven of 13 patients in the childhood group experienced surgically documented recurrence after first surgery. Seven of 17 patients recurred after first surgery in the adult group. Four died of operative complications. Morbidity demonstrated by quality of survival was high in these patients.     

Staging of renal carcinoma using magnetic resonance imaging at 1.5 Tesla

The preoperative magnetic resonance imaging (MRI) studies of 31 patients with surgically proven renal cell carcinomas obtained with a 1.5 Tesla unit were retrospectively reviewed to assess the accuracy of MRI for staging of tumor. According to the Robson classification 12 patients were found at surgery to have Stage I renal carcinoma, three patients had Stage II, ten had Stage IIIA, one had Stage IIIB, two had Stage IIIC, one had Stage IVA, and two had Stage IVB disease. Twenty-five (81%) of 31 patients were staged correctly by MRI. Clearly MRI showed venous tumor extension without the need for intravenous contrast administration. Also, MRI had a negative predictive value of 95%, and a positive predictive value of 100% for the evaluation of inferior vena cava tumor thrombus. At 1.5 Tesla MRI is an excellent staging modality in the preoperative evaluation of renal carcinoma. It is especially recommended in patients with equivocal computed tomography findings and in all patients with contraindications to the intravenous use of iodinated contrast material.     

Induction of "tissue" transglutaminase in HIV pathogenesis: evidence for high rate of apoptosis of CD4+ T lymphocytes and accessory cells in lymphoid tissues.

Peripheral blood mononuclear cells and lymphoid tissues from HIV-infected individuals display high levels of "tissue" transglutaminase (tTG) with respect to seronegative persons. In asymptomatic individuals, > 80% of the circulating CD4+ T cells synthesize tTG protein and the number of these cells matches the level of apoptosis detected in the peripheral blood mononuclear cells from the same patients. In HIV-infected lymph nodes tTG protein is localized in large number of cells (macrophages, follicular dendritic cells, and endothelial cells), showing distinctive morphological and biochemical features of apoptosis as well as in lymphocytes and syncytia. These findings demonstrate that during the course of HIV infection, high levels of apoptosis also occur in the accessory cells of lymphoid organs. The increased concentration of epsilon(gamma-glutamyl)lysine isodipeptide, the degradation product of tTG cross-linked proteins, observed in the blood of HIV-infected individuals demonstrates that the enzyme accumulated in the dying cells actively cross-links intracellular proteins. The enhanced levels of epsilon(gamma-glutamyl)lysine in the blood parallels the progression of HIV disease, suggesting that the isodipeptide determination might be a useful method to monitor the in vivo rate of apoptosis.     

Tomographic renal cortical scintigraphy: correlation with intravenous urography, computed tomography, ultrasonography, angiography, and nuclear magnetic resonance imaging

This study evaluates single-photon renal tomoscintigraphy (SPECT) in the evaluation of renal masses and correlates this modality, where indicated, with computed tomography (CT), ultrasonography (US), angiography (ANGIO) and nuclear magnetic resonance imaging (NMR). Eight patients with renal cortical lesions detected on intravenous urography (IVP) were evaluated by SPECT and planar nuclear imaging using Tc-99m glucoheptonate (GH). Three of these patients were felt particularly likely to have renal tumors and were additionally evaluated with US, CT, ANGIO and NMR. The five patients with nodules on IVP that were not particularly suggestive of malignancy had functioning, benign, renal tissue accounting for their IVP lesions. Four of five were found by planar-GH nuclear imaging, five/five by SPECT-GH. In addition, SPECT-GH allowed better "confidence" in the normal renal tissue diagnosis in three/five cases. Of the three renal lesions that were highly suggestive of malignancy, two were hypernephromas and one was hypertrophied functioning cortical tissue. All three were correctly identified prospectively on SPECT-GH; however, one hypernephroma was missed on planar-GH. NMR, CT, and ANGIO detected only one of two hypernephromas prospectively (US detected both); all four modalities incorrectly diagnosed the hypertrophied tissue suggestive of malignancy.