Paraneoplastic dermatopolymyositis

In a retrospective study covering 11 years, 59 adult cases of dermatomyositis or polymyositis were reviewed. The disease was of paraneoplastic origin in 9 cases (15,25 p. 100), the same proportion as that found in the literature (14,6 p.100). The striking female predominance (8/9 cases) and the patients' mean age (61.11 years) were higher than those noted in non-paraneoplastic dermato- and polymyositis in adults (female predominance 34/50, mean age 52.9 years). Clinically, out of 9 patients 7 had dermatomyositis and 2 had polymyositis. The disease was discovered at the same time as the neoplasia in 7 of the 9 cases. Muscle histology showed that in contrast with non-paraneoplastic cases of dermatomyositis-polymyositis those of paraneoplastic origin had moderate lesions without fibrosis.     

Alteration of Elastin, Collagen and their Cross-links in Abdominal Aortic Aneurysms

OBJECTIVES: although the mechanism of arterial dilation and aneurysm development has not been clarified, the degradation of elastin and collagen plays undoubtedly a critical role. We evaluated the elastin and collagen content through the detection of their cross-links in aneurysmal and non-aneurysmal abdominal aortic walls. MATERIALS AND METHODS: in 26 human abdominal aortic aneurysm specimens obtained during surgery and in 24 autopsy control samples of non-aneurysmal abdominal aorta the tissue content of elastin and collagen cross-links were measured by HPLC. Collagen was also detected by evaluating two characteristic amino acids, 4-hydroxyproline (4-hypro) with a colorimetric method and 5-hydroxylysine (5-hylys) by gas chromatography. RESULTS: significantly fewer elastin cross-links were found in aneurysm samples compared to controls (desmosines and isodesmosines: 90% reduction; p<0.01). The opposite was true for pyridinoline collagen cross-links (350% increase) and deoxypyridinolines (100% increase, p=0.01). Tissue content of 5-hylys, 4-hypro and total amino acids were reduced significantly by 50% in aneurysmal samples. CONCLUSIONS: beside confirming decreased elastin content in aneurysmal walls, these results show a concurrent increase of collagen cross-links. Since total collagen markers were decreased (decreased 4-hypro and 5-hylys) it is reasonable to suggest that in aneurysmal aortic walls old collagen accumulates cross-links while new collagen biosynthesis is somehow defective.     

Non invasive estimation of mean right atrial pressure utilizing the 2D-Echo transverse diameter of the left hepatic vein

Aim of our study was to assess if the 2D-Echo transverse diameter of the left hepatic vein (LHV) obtained from the subcostal approach is correlated with invasive mean right atrial pressure (RAP). Thirty-two consecutive patients with acute myocardial infarction were studied by simultaneous 2D-Echo and right heart catheterization. LHV could be adequately imaged in 90% of patients. Mean RAP values at catheterization ranged from 0 to 15mmHg (mean 6±3.5 mmHg). A correlation was found between mean RAP and LHV diameter calculated after inspiration (r=0.81, SEE=1.54 mm, slope=0.71,p< 0.001) as well as after expiration (r=0.82, SEE=1.32mm, slope=0.62,p< 0.001) or during post-expiratory apnoea (r=0.85, SEE=1.3 mm, slope=0.71,p< 0.001). Moreover, percent increments of LHV diameter correlated well with percent changes of mean RAP during rapid infusion of 250–500 cc of saline in 4 patients (r=0.98,p< 0.001). Thus, the 2D-Echo LHV diameter is a feasible measurement that seems to correlate well with invasive mean RAP over a wide range of mean RAP values in patients with myocardial infarction; the changes in LHV diameter correlate well with the percent increase in central venous pressure obtained with saline infusion. Underestimation of invasive RAP occurs when mean RAP value exceeds 12 mmHg and can be explained by limited venous compliance. However these preliminary results suggest that this method may represent a valid alternative to obtain a non invasive estimate of mean RAP with 2D-Echocardiography.     

Experimental pharmacological Parkinsonism (preliminary report)

The purpose of our project was to analyse membrane-bound proteins in Haloperidol-treated rats with clear Parkinson type motor inhibitions. Membrane bound protein was chosen because the main sites of functional changes in the Parkinson syndrome may be the plasma membrane and postsynaptic membranes of nerve cells. Twenty male Sprague-Dawley rats were treated with Haloperidol for 67 days. The areas analyzed were the hippocampus and the caudate nucleus. The electrophoretic analyses were done by the method of Ballou (1974) as further elaborated by Booth (1977). Double-labeling analysis of 7 protein fractions after gel electrophoresis showed the presence of a 50 000-dalton protein infraction 3 of the caudate nucleus (see block diagrams) in the haloperidol-treated animals but not in the hippocampus material.

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Sommario La presente nota riguarda i risultati di analisi delle proteine legate alla membrana cellulare di neuroni in ratti trattat i con Haloperidol fino alla comparsa di chiari segni di inibizione motoria di tipo parkinsoniana. Il motivo per il quale sono state scelle le proteine della membrana cellulare è che le alterazioni funzionali nella sindrome di Parkinson possono maggiormente localizzarsi nella membrana plasmatica e postsinaptica della cellula nervosa. Sono stati trattati 20 ratti per 67 giorni con Haloperidol. Le aree analizzate sono state l'ippocampo e il nucleo caudato. Le analisi elettroforetiche sono state eseguite secondo il metodo sviluppato da Ballon (1974) e successivamente da Booth (1977). I risultati di queste analisi (nucleo caudato) e del tessuto di controllo (ippocampo) di 7 frazioni proteiniche dopo gel elettroforesi hanno dimostrato la presenza di 50,000-dalton proteina nella frazione 3 del nucleo caudato (vedi grafico) nel materiale trattato con Haloperidol. Tale valore non è présente nell'ippocampo.

     

Role of bile acids and metabolic activity of colonic bacteria in increased risk of colon cancer after cholecystectomy

Since the metabolic activity of the colonic flora plays a definite role in colon cancer and an increased incidence of this disease is reported after cholecystectomy, we studied the metabolic activity of the colonic flora in a group of postcholecystectomy patients and matched controls by measuring, as representative end products of the bacterial metabolism, their fecal bile acids (BA), fecal 3-methylindole (SK) and indole (IN), and respiratory methane and hydrogen. Patients had significantly higher SK and lower IN, and, among BA, higher lithocholic (LCA) and chenodeoxycholic acid concentrations and LCA/deoxycholic acid ratio in the stools than controls. Similar differences from controls were reported for colon cancer. Comparable bacterial metabolic activities are thus operative in the large bowel of postcholecystectomized and colon cancer patients. This supports the biological plausibility of the association of cholecystectomy and colon cancer.     

Ceftolozane/tazobactam for the treatment of serious Pseudomonas aeruginosa infections: a multicentre nationwide clinical experience

This study describes the largest clinical experience using ceftolozane/tazobactam (C/T) for different Pseudomonas aeruginosa infections. A retrospective study was performed at 22 hospitals in Italy (June 2016–March 2018). All adult patients treated with ≥4 days of C/T were enrolled. Successful clinical outcome was defined as complete resolution of clinical signs/symptoms related to P. aeruginosa infection and lack of microbiological evidence of infection. C/T treatment was documented in 101 patients with diverse infections, including nosocomial pneumonia (31.7%), acute bacterial skin and skin-structure infection (20.8%), complicated UTI (13.9%), complicated IAI (12.9%), bone infection (8.9%) and primary bacteraemia (5.9%). Over one-half of P. aeruginosa strains were XDR (50.5%), with 78.2% of isolates resistant to at least one carbapenem. C/T was used as first-line therapy in 39 patients (38.6%). When used as second-line or later, the most common reasons for discontinuation of previous antibiotics were in vitro resistance of P. aeruginosa and clinical failure of previous therapy. Concomitant antibiotics were reported in 35.6% of patients. C/T doses were 1.5 g q8h in 70 patients (69.3%) and 3 g q8h in 31 patients (30.7%); median duration of C/T therapy was 14 days. Overall clinical success was 83.2%. Significant lower success rates were observed in patients with sepsis or receiving continuous renal replacement therapy (CRRT). Mild adverse events were reported in only three patients. C/T demonstrated a favourable safety and tolerability profile regardless of the infection type. Clinicians should be aware of the risk of clinical failure with C/T therapy in septic patients receiving CRRT.