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Biomedical subjects

E Schiaffino

Publications and source records attributed to E Schiaffino.

At least 19 recordsLinked to original sources

[Acute myocardial damage from a pheochromocytoma].

Cardiac involvement in pheochromocytoma is rare but may be associated with serious clinical deterioration. A 70-year-old woman arrived at our Emergency Department because of chest discomfort, blood pressure lability, mild dyspnea and electrocardiographic signs suggesting an acute myocardial infarction. However two-dimensional echocardiogram did not show any segmental wall motion abnormalities but diffuse and severe left ventricular hypokinesia. The patient was treated with ACE-inhibitors and diuretics and did not receive thrombolytics or beta blocking agents. Creatine kinase-MB and troponin I were normal. Electrocardiogram and echocardiogram completely returned to normal within 1 week and a coronary angiography demonstrated normal coronary arteries. An increase in the catecholamine concentration in a 24-hour urinary sample suggested a pheochromocytoma that was confirmed by abdominal computerized tomography. During surgery, marked hypertension developed treated with sodium nitroprusside and labetalol, and after removal of the tumor severe hypotension required infusion of norepinephrine for several days.

Acute Disease↗

[Benign hemangiopericytoma of the bladder: description of a case and review of the literature].

Hemangiopericytoma (HPC) of the viscera is very rare and only six of these tumors arising in the urinary bladder have been previously reported. The differentiation of HPC from other neoplasms with prominent vascular pattern may be a diagnostic problem. The difficulty is further enhanced by the lack of distinctive immunohistochemical features of this tumor. Here is presented a case of benign HPC occurring in the right lateral wall of the bladder of a 37-year-old woman. The mass is completely transurethrally resected. Histologically, the tumor is characterized by a monomorphic population of polygonal or spindle-shaped cells packed around branching vascular channels, with "staghorn" configuration. There are no foci of necrosis or hemorrhage. The mitotic count is 2 per 10 HPF. Immunohistochemically, the tumor cells react with anti-bodies against Vimentin. Cytokeratin, Actin HHF35, S-100, CD 34, Factor VIII-related antigen are not expressed within the lesion. Ultrastructurally, the tumor cells surround endothelium-lined vascular channels. There are pinocytotic vesicles on the cell borders. The cells are separated from one another by deposits of basal lamina-like material and collagen. On the basis of clinical, histological, immunohistochemical and ultrastructural observations, we believe that the case reported is a primary benign HPC of the bladder. There is no evidence of recurrence or metastasis 32 months later.

Adult↗

Fibrillary and immunotactoid glomerulopathies.

There is sufficient clinical and morphological evidence to suggest that Fibrillary Glomerulonephritis (FGN) and Immunotactoid (IT) Glomerulopathy are two different diseases. Is still open to debate if IT glomerulopathy is a distinct entity or is strictly associated with a spectrum of systemic syndromes ("forme fruste" of Cryoglobulin and paraprotein associated diseases). Further studies about pathogenetic mechanisms of fibril or microtubule formation may allow a better understanding of these diseases.

Glomerulonephritis↗

Primary malignant mesothelioma of the tunica vaginalis of the testis. Immunohistochemistry and electron microscopy.

A case of primary malignant mesothelioma of the tunica vaginalis of the testis in a 75 year old man is here presented. Anamnesis for asbestos exposure was negative. Recurrent left hydrocele was the main symptom. Echography revealed a nodular mass in the caudal aspect of the epididymis and papillary projection on the surface of the tunica vaginalis of the testis. An inguinal left orchiectomy was performed. The tumor both in the solid area and in the papillary projections was identified as a malignant mesothelioma of epithelial type. The role of immunohistochemistry and ultrastructure for a correct definition of the tumor is underlined.

Aged↗

Minimal change nephrotic syndrome with cecum adenocarcinoma.

Membranous glomerulonephritis is the most common glomerular disease associated with malignancy, the association of minimal change glomerulopathy with solid tumor is still uncommon. We report a 72-year-old man with nephrotic syndrome due to minimal change glomerular disease; an accurate seek of underlying malignancy revealed a cecum adenocarcinoma. We had a complete remission of nephrotic syndrome after surgery of carcinoma.

Adenocarcinoma↗

[Microcystic adenoma of the pancreas. Immunohistochemical and ultrastructural study of 7 cases].

Microcystic cystadenoma of pancreas is a rare benign neoplasm with peculiar pathologic characteristics. It is more frequent in women and in elderly age. Macroscopically it is composed of a spongy, microcystic mass with a starry central fibrous core. Histologically serous cysts are lined by cuboidal or flattened epithelium without nuclear atypias and with PAS positive cytoplasms. A surgical conservative approach is the treatment of choice. Seven cases of microcystic cystoadenomas of the pancreas observed within ten years at Osp. San Carlo Borromeo-Milano and Osp. Santa Maria degli Angeli-Pordenone from 6 women and 1 man aged 54-87 years are described. The preoperative and intraoperative investigations that have been necessary for reaching its diagnosis are discussed.

Aged↗

[Fibrous hamartoma in childhood].

Is a rare soft tissue benign tumor usually appearing during the first two years of life, often occurring in axillary or upper arm region subcutaneous tissue. Surgery is the treatment of choice. The lesion histologically consists of three different tissue elements: dense mature fibrocollagenous, loose immature myxoid mesenchymal and mature adipose tissue. A case of fibrous hamartoma of infancy with the usual clinical characteristics, but with particular microscopic features due to the abundance in fibrocollagenous and scarcity of myxoid tissue, is described. The results of the immunohistochemical and ultrastructural study on the same patient are reported. The differential diagnostic problems are discussed.

Axilla↗

[Pancreatic endocrine F-cell tumor].

Two cases of pancreatic F-cell malignant tumors, producing only pancreatic polypeptide (PP) with clinical, biochemical and immunohistochemical features are described. No PP-associated endocrine symptoms were present. In both tumors, definitive diagnosis was immunohistochemical, and surgical treatment was carried out. Clinical evolution in the two patients was different: one of them died within the postoperative period with upper gastrointestinal bleeding by multiple duodenal ulcers, whereas the other--with lymph node metastasis at intraoperative diagnosis--is alive six years after treatment. F-cell tumors can be classified among the group of silent endocrine tumors of the pancreas. The reason for their discrepancy in the clinical behavior is unknown.

Aged↗

[Microcystic serous cystadenoma of the pancreas. Enucleation or regulated pancreatic resection?].

Cystic benign tumors of the pancreas are rare lesions: they represent less than 10% of all pancreatic neoplasms. We studied two cases of microcystic adenoma, one of the less common varieties, that only in the last few years has been morphologically recognized as a distinct pathological entity. Our clinical experience--though limited--made us remark some interesting features: 1) preoperative diagnostic procedures (ultrasonography and CT) may present great interpretative difficulties: in one of the cases observed, radiographic imaging demonstrated an unresectable pancreatic tumor. On the contrary, in both cases surgical radicality has been achieved; 2) preoperative needle aspiration cytology (FNAB) does not always provide diagnostic material, as happened in both case observed; 3) the diagnosis of a benign tumor may result from surgical exploration and multiple biopsies with intraoperative frozen sections. Further and more complex histological investigations will definitively diagnose a microcystic adenoma; 4) in disagreement with some authors' results, we observed that microcystic adenoma may grow rapidly: one of our patients, after an incomplete tumor enucleation, developed a local relapse in a few months, needing a subtotal distal pancreatectomy, followed by complete recovery; 5) surgical radicality is mandatory. This result can be achieved through a simple, but complete, tumor enucleation or through a pancreatic resection; 6) our immunohistochemical and ultrastructural studies on microcystic adenoma exhibited no cells with endocrine activity, supporting the hypothesis that this tumor may originate from ductal or centroacinar cells.

Aged↗

Glomerulonephritis induced by human IgMK-IgG cryoglobulins in mice.

BACKGROUND: Human cryoglobulinemia is sometimes associated with glomerulonephritis (GN) due to deposition of cryoglobulins (cryos). To see whether human cryos can induce GN in mice and to study time-related changes of glomerular lesions and possible factors of cryos' nephritogenicity, we developed an experimental passive model of cryoglobulinemic GN. EXPERIMENTAL DESIGN: Two cryos IgMk-IgG from 2 patients with active GN (OLD and SOR), 2 cryos IgMk-IgG (TAC and GRO) and 1 IgM lambda (CHI) from 3 patients without GN were purified, solubilized at 37 degrees C and injected intravenously into BALB/c mice, 4 mg, twice a day. To study the possible factors of cryo nephritogenicity, we analyzed: (a) the presence, amount, and size of complexed IgMk-IgG at 37 degrees C by fast flow liquid chromatography; (b) the Cc1 or Lc1 subclass of rheumatoid factors; (c) the isoelectric points of the IgMks; (d) The proportion of IgG subclasses in cryos. RESULTS: On day 1 from the beginning of intravenous injections, cryos OLD had induced mesangial deposits of human IgM, human IgG, mouse C3 and mesangial hypercellularity. On day 2, phagocytizing cells were found along with massive endoluminal and subendothelial deposits of IgM, IgG, and C3. On day 6, perivascular infiltrates of mononuclear cells were also seen. Cryos SOR induced a similar but milder form of GN. After administration of purified OLD IgMk, OLD IgG, GRO IgMk or GRO IgG, only OLD IgMk was deposited in the mesangium. Analysis of all the cryos revealed that: the amount of complexed IgMk-IgG at 37 degrees C was always less than 1% of cryos; Cc1 and Lc1 idiotypes were not related to the nephritogenicity of cryos, the isoelectric points of IgMks were 4.5 to 5.5 and IgG1 was the prevalent subclass. CONCLUSIONS: Data demonstrate that human cryos from patients with GN can induce GN in mice that resembles the corresponding human pathology. The affinity of IgMk for glomeruli and the unexpectedly small amounts of IgMk-IgG complexes at 37 degrees C suggest that there is a role of in situ binding in nephritogenicity which is independent of the isoelectric point, rheumatoid factor idiotype, or IgG subclass.

Aged↗

Ganglioneuroblastoma and urticaria by physical agents.

A case is reported of ganglioneuroblastoma in a 5-year-old boy, who had urticaria syndrome by physical agents (water, light, cold) in the last 2 years, associated with an apparent splenomegaly. A sonography and a CT scan showed a large cystic mass with calcification near the left kidney. After surgery, it was possible to diagnose left adrenal ganglioneuroblastoma (Evans's first stage). Complete regression of urticaria syndrome was obtained after mass removal.

Adrenal Gland Neoplasms↗

Detection of the early steps of cadmium nephropathy--comparison of light- and electron-microscopical patterns with the urinary enzymes excretion. An experimental study.

Few data are yet available comparing the histological patterns of cadmium nephropathy with the values of urinary enzyme excretions, useful indexes of renal tubular damage. 40 Wistar rats, divided into four groups (A-D), were intoxicated with cadmium chloride (CdCl2) at 16 ppm in drinking water for 4, 16, 40 and 60 weeks, respectively. At the end of each period all the intoxicated rats and 5 controls were assessed for creatinine clearance, fractional excretion of gamma-glutamyltransferase (UfrGGT) and alpha-glucosidase (UfrAGL), indexes of anatomical tubular damage, and for fractional clearance of lysozyme (CfrLys), index of functional tubular damage. Thereafter, the rats were sacrificed and their kidneys examined with light and electron microscopy. Control rats and group A and B rats did not show any histological impairment. A widespread vesiculation of proximal tubular cells with mitochondrial and lysosomal alterations was found in the group C rats and was more evident in group D. The brush border never showed any damage in all groups in accordance with the finding of a normal excretion pattern of UfrGGT, an enzyme situated in this structure. The UfrAGL was increased only in group D rats (p less than 0.025), who showed the most severe anatomical damages. The CfrLys, an index of tubular function, was elevated in group C and D rats (p less than 0.02 and p less than 0.002, respectively). It was possible to detect the initial renal tubular damage.

Animals↗

Pulmonary lymphangiomyomatosis. Report of a case with immunohistochemical and ultrastructural findings.

Pulmonary lymphangiomyomatosis is a rare disease characterized by wide-spread proliferation of smooth muscle cells around lymphatic and blood vessels, smaller airways and in the interstitium. Young women in the fertile status are almost exclusively affected. Spontaneous recurrent pneumothorax is the most important symptom. Chylous effusions are reported in 37.5% of cases. Our observation deals with a woman aged 43. Light- and electron-microscopic findings are described. Estrogen receptors have been detected on smooth muscle cells. Bilateral oophorectomy and treatment with progesterone were successful.

Adult↗

Ultrastructural alterations and virus-like particles in lymph nodes of drug addicts with lymphadenopathy syndrome (LAS).

Lymph node biopsies from 16 cases of intravenous drug addicts with lymphadenopathy syndrome (LAS) have been examined at the electron microscope. The main ultrastructural alterations observed in the lymphocytes, dendritic reticulum cells and endothelial cells were tubulo-reticular structures (TRS), test tube and ring shaped forms (TRF) and nuclear pockets (NP). Images suggesting virus budding from lymphocytes and virus-like particles have also been found in 9 out of the 16 cases. The possibility to correlate the latter findings with a better knowledge of LAS evolution and prognosis is discussed.

AIDS-Related Complex↗

[External post-infarction rupture of the heart. Retrospective anatomo-clinical analysis of 70 cases].

A retrospective comparison was made between the clinical and pathological findings pertaining to: a) 70 cases of rupture of the ventricular free wall following myocardial infarction (RC group), b) 70 cases of acute myocardial infarction (AMI) where death intervened in the absence of cardiac rupture (NR group) and c) 70 cases (clinical findings only) of patients with AMI admitted to the hospital (IM group). The history of the RC group disclosed a considerably lower percentage of previous myocardial infarctions (p less than 0,005) as compared to the control groups. In the same group systemic hypertension after myocardial infarction was more frequent (p less than 0,025) than in the others. Shock, heart failure, bundle branch blocks were significantly less common in the RC group than in the NR group, and severe arrhythmias were found in a significantly lower percentage than in both the control groups. An electrocardiographic pattern of anterior AMI was more frequent in the RC group than in the IM group (p less than 0,05). Death was preceded by sudden loss of consciousness in 83% of the RC cases and in 51% of the NR cases (p less than 0,005), by severe chest pain respectively in 19% and 9% of the two groups (p less than 0,05). More than 25% of the patients of both RC and NR groups died within the first 24 hours, almost half within the third day after the onset of AMI. On autopsy the AMI was anterior and/or lateral in 77% of the cases in the RC group and in 44% of the NR group (p less than 0,005). In all the cases except one rupture had occurred in the area of the infarction. The site of rupture was anterior in 64% of the cases, posterior in 16%, lateral in 11%, and apical in 9%. Scars larger than 5 mm were noted in 17% of the cases in the RC group as compared to 37% in the NR group (p less than 0,01). Left ventricular hypertrophy was present in 16% of the RC cases and in 31% of the NR group (p less than 0,05). Finally the characteristics of patients at risk of cardiac rupture following myocardial infarction seem to be: absence of previous infarctions, anterior localization of AMI, sustained hypertension after myocardial infarction, absence of serious hemodynamic and arrhythmic complications.

Adult↗

Lung calcification in long-term dialysed patients: a light and electronmicroscopic study.

Lung calcification was detected in four out of 29 long-term dialysed patients on whom postmortem examinations were performed between 1967 and 1980. On light microscopy, calcification showed either a finely granular and linear localization along the alveolar septa, or a coarse and widespread parenchymal distribution. Histochemical studies revealed evidence of calcium, magnesium and phosphate ions in the deposits. Ultrastructural examination of the less severely involved alveolar septa showed selective deposition of calcium salts within an increased amount of elastin. The deposits consisted of electron dense roundish granules with a concentric laminar structure. They appeared either single or conglomerated in polycyclic formations, supposedly representing the progressive steps of the mineralization process, at first localized within elastin and progressively spreading outside it. The high magnesium content of the deposits suggests that the serum concentration of this ion may play an important role in visceral calcification of long-term dialysed patients.

Adult↗