Biomedical subjects
Publications and source records attributed to G Croce.
A case presenting with clinical features of ocular myasthenia and a false-positive edrophonium test is reported. Brain CT and MRI scan revealed a pineal region tumor histologically verified as germinoma. We recommend evaluating patients with clinical features of myasthenia gravis (MG) confined to the ocular muscles for intracranial mass lesions.
Since January 1988 is taking place a multicentre experience on pharmaco-epidemiology named ARIES (Adverse Reaction Identification Evaluation System), with two primary aims: surveillance of drug adverse reactions and monitoring of medical prescriptions. At present 5 departments of internal medicine are involved in the study. The factual cooperation of the departmental doctors depends on the evaluation of benefits and costs of the study. The benefits for doctor are: (a) the possibility of contributing to the research in a field which has not been systematically investigated in a hospital setting; b) the acquisition of skill in monitoring adverse reactions: to facilitate doctors cooperation an algorithm has been developed to select the events to be entered into the system; c) the possibility of evaluating and improving the prescription habits. At present, data on 9,000 patients and 60,000 prescriptions are available. As an example of utilization study, we report a research on antibiotics prescribed for bronchopneumonia in two departments involved in the ARIES project. The remarkable differences in the prescription settings lead to some rethinking on the strategies of such different prescription choices. In each department, the contribution of doctors is integrated by a monitor, entering additional information on drugs and patients into the system. Thanks to the cooperation of doctors and contribution of monitors, the pharmaco-epidemiology research may become a "normal" component of the hospital activities, thus allowing to systematically retrieve and process some basic knowledges, which are not routinely used, derived from the daily activity of the departmental doctor.
The Authors describe a scrub typhus case imported from Indo-China and observed in Milan, which is probably the first case reported in Italy. The patient, on holiday journey, exposed herself unwisely to the danger of catching the infection. The diagnosis was based on clinical grounds and Weil-Felix reaction. The problems of the diagnosis reliability and of the imported diseases are briefly discussed as well.
A study was carried out to confirm the pathogenetic role of ethanol in the development of chronic active hepatitis (CAH) and to assess if previous or current superimposed hepatitis B virus (HBV) infection could be relevant to the course of alcoholic liver disease (ALD). We examined clinical and laboratory reports of 57 alcoholics with biopsy-proven CAH. Serum and/or tissue HBV markers and the presence or absence of cirrhosis were investigated. Alcohol was the only aetiological factor present in a small group of CAH, with or without histological findings suggestive of alcoholic damage. Age, sex and survival were similar among the subgroups of CAH with and without previous or current HBV infection and among the subgroups of CAH with and without associated histological alcoholic features. Among the laboratory data, the AST/ALT ratio was higher in CAH without previous or current HBV infection. The mean age was comparable in CAH patients with and without cirrhosis, whereas the cumulative 5-year survival was worse in CAH with cirrhosis (87% vs. 49%). These data suggest a difference in alcohol susceptibility in our subjects.
The prevalence of serum antibody to hepatitis B virus antigen (anti-HBs and anti-HBc) were determined in biopsy proven alcoholic liver disease (n = 60), compared with: an age and sex-matched hospital control population (n = 60), HBsAg-negative chronic liver disease (n = 27), renal unit patients (n = 32) and volunteer blood donors (n = 286). All sera were HBsAg negative (RIA). The prevalence of total hepatitis B virus antibody was significantly increased (p less than 0,001) in alcoholic liver disease (71%), as well as in renal unit patients (65%) and non-alcoholic liver disease (66%), versus hospital controls (35%) and blood donors (43%). These data suggest that hepatitis B virus infection might be a factor in selecting which alcoholic patients go to develop hepatic damage.
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The correlation between serum immunoglobulin levels and "helper/suppressor" (T4/T8) ratio has been investigated in 45 patients with biopsy proven liver diseases (22 with ALD, 16 with CAH and 7 with VHR). In the ALD and CAH groups the T4/T8 ratio was significantly higher than in normal controls and a strong correlation was noticed with IgA, but not IgG and IgM levels. The same correlation was found in the VHR group as well, even if the mean value for the T4/T8 ratio in these patients was not significantly above that of normal controls. The pathogenetic significance of these findings is discussed.
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