We investigated the incidence of HBsAg carriers among blood donors from 107 Italian blood banks during 1986. The overall prevalence of HBsAg carriers was 1.98%. This percentage was higher in Southern (2.69%) than in Northern (1.78%) or Central Italy (0.83%). Notable differences were found in the various regions and in single centres belonging to the same region. In some small areas a prevalence of carriers as high as 10% was recorded. Most carriers had normal aminotransferase values, HBeAg was detected in 8.8% of the carriers and anti-delta in 2.9% of them. The figures from this study still suggest a persistence of an intermediate endemicity level of HBV infection in Italy, with some hyperendemic niches.

Adolescent↗

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Epidemiology of chronic viral hepatitis in the Mediterranean area: present status and trends.

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Chronic Disease↗

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Prevalence of anti-HCV antibodies in patients with chronic liver disease and its relationship to HBV and HDV infections.

The prevalence of anti-HCV, anti-HDV and of HBV markers has been investigated in a series of 209 consecutive patients (age 18-74 years) with chronic liver disease. Among 155 HBsAg negative patients (53 chronic hepatitis cases and 102 cirrhosis cases), anti-HCV were found in 69% of the cases. 67% of the 155 patients also carried anti-HBc, with no difference between patients positive or negative for anti-HCV. Among the 54 HBsAg positive patients, 10 (18.5%) also had anti-HCV, 22 (40.7%) were anti-HDV positive and 12 (22.2%) had serum HBV-DNA. One patient had concomitant anti-HDV and anti-HCV and another presented anti-HCV and serum HBV-DNA. 21/54 patients had liver cirrhosis on presentation and among these 17 (81%) were anti-HCV and/or anti-HDV positive. On the whole, 123/209 patients had liver cirrhosis on presentation and in 107 of them HCV infection may have played a role.

Adult↗

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Etiological, clinical and laboratory data of post-transfusion hepatitis: a retrospective study of 379 cases from 53 Italian hospitals.

Among the 8,604 cases of acute viral hepatitis hospitalized during 1982 in 53 Italian hospitals, we studied 379 cases of post-transfusion hepatitis, 262 cases which occurred after surgery and 4,576 cases with no history of parenteral exposure. The etiological agents of post-transfusion hepatitis were NANB viruses in 57.8%, HBV in 39.0% and HAV in 3.2% of the cases. CMV and EBV accounted for less than 1.5% of the post-transfusion hepatitis cases. HBV was the main etiological agent (62.2% of the cases) in the post-surgical hepatitis group, where HAV accounted for only 6.1% of the cases. In contrast, in the group with no history of parenteral exposure, hepatitis A was most frequent. Percentages of patients with history of transfusion or surgery were always higher in type B and NANB hepatitis than in type A, suggesting that surgery without transfusion also represents a risk of acquiring type B and NANB hepatitis. No regional differences were observed in the etiological patterns of post-transfusion hepatitis and post-surgical hepatitis. The acute phase of type B post-transfusion hepatitis was more severe than that of NANB post-transfusion hepatitis, as shown by higher serum bilirubin and ALT levels and by a higher case fatality rate.

Adolescent↗

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Mucocutaneous diseases in drug addicts with or without HIV infection. A case-control study.

A case-control study was performed to evaluate the prevalence of mucocutaneous diseases in 106 male drug addicts (age 21-38 years) with or without HIV infection. A mucocutaneous disease was recorded in ten out of 64 HIV-negative and in 20 of 42 HIV-positive patients (OR = 4.9; p < 0.01). Some mucocutaneous diseases were present in similar proportions in both groups (i.e. fungal skin lesions), while others were typically present only in HIV-positive patients. Stratification for possible confounding factors, such as years of drug addiction and number of sexual partners, confirmed that HIV infection is the main risk factor for mucocutaneous disease. Stratification according to the number of CD4-positive cells showed that the more advanced the HIV disease, the more frequently mucocutaneous disease was present (p = 0.02). The study demonstrates that many, but not all, mucocutaneous diseases are associated with HIV infection.

Adult↗

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Hepatitis C virus infection in households of anti-HCV chronic carriers in Italy: a multicentre case-control study.

To test the hypothesis that households of anti-HCV positive subjects might be at increased risk of HCV infection, a case-control study was carried out comparing 518 family members of 205 anti-HCV positive subjects (index carriers) with 281 family members of 100 anti-HCV negative subjects (index controls), consecutively observed in ten gastroenterology units in different Italian regions. The index carriers were age and sex matched to the index controls and their households were similar with respect to the main sociodemographic characteristics. Anti-HCV antibodies were found in 6.9% (36/518) of household members of index carriers and in 3.2% (9/281) of household members of index controls (p < 0.05). The results of multiple logistic regression analysis showed that being over 50 years of age was the sole independent predictor for a household contact of the likelihood of being anti-HCV positive (O.R. 3.6; C.I. 95% = 1.5-8.2). Being in the household of an anti-HCV index carrier was marginally associated to anti-HCV positivity (O.R. 2.0; C.I. 95% = 0.9-4.6). No association was found for sex, area of residence, family size, lowest level of schooling, or any type of family relationship. These findings are not in compliance with the statement that household contacts of HCV carriers are at increased risk of HCV infection. The 3.2% anti-HCV prevalence rate observed among household contacts of anti-HCV negative index controls may suggest that the true anti-HCV prevalence in the general population in Italy is nearly 2.5 times as high as the 1.3% found in Italian blood donors.

Adolescent↗

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Hormonal studies in a male with a 47,XXX chromosome constitution: comparison with the hormonal pattern of a 46,XX male and patients with Klinefelter's syndrome.

Chromosome analysis in peripheral blood lymphocytes and skin fibroblasts of a 18 year old chromatin-positive man showed a 47,XXX karyotype. The following hormonal studies were performed: 1) FSH and LH response to GnRH; 2) hypothalamic-pituitary responsiveness to short-term testosterone administration; 3) plasma levels of testosterone, dihydrotestosterone, 17-hydroxyprogesterone, estradiol before and after hCG stimulation. Results were compared with similar studies performed in a 46,XX male and in a group of patients with Klinefelter's syndrome. Our data support the hypothesis that this rare cytogenetical disorder can be considered, from the endocrine point of view, as a variant of the Klinefelter's syndrome.

Adolescent↗

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A study on human adrenal secretion. Measurement of epinephrine, norepinephrine, dopamine and cortisol in peripheral and adrenal venous blood under surgical stress.

Epinephrine (E), norepinephrine (NE), dopamine (DA) and cortisol (F) were measured in samples drawn simultaneously by direct venepuncture from the brachial and the adrenal vein of 12 patients undergoing surgery for left kidney diseases. In 7 patients the influence of anesthesia on peripheral plasma levels was also assessed. Catecholamines were measured by a radioenzymatic assay and F by radioimmunoassay. Compared to basal values (mean +/- SE) (E: 53.6 +/- 6.2 pg/ml; NE: 209.4 +/- 24.4 pg/ml; DA: 24.5 +/- 3.3 pg/ml; F: 12.9 +/- 1.2 micrograms/dl) only NE peripheral levels were significantly modified by anesthesia (NE: 343.7 +/- 67.4 pg/ml p less than 0.05), whereas under surgery a significant increase in the peripheral levels was found for every substance measured (mean +/- SE) (E: 332.5 +/- 46.6 pg/ml p less than 0.001; NE: 633.6 +/- 114.2 pg/ml p less than 0.005; DA: 85.8 +/- 15.7 pg/ml p less than 0.005; F: 21.3 +/- 1.9 micrograms/dl p less than 0.01). Catecholamine and F levels in adrenal vein showed a high variability suggesting an intermittent secretion. In the adrenal venous blood E levels were, in the mean, 381 times higher, NE levels 45 times, DA levels 27 times and F levels 23 times higher than in peripheral blood. E, NE and DA concentrations in the adrenal vein were all significantly correlated to the others but not to cortisol, suggesting that the medulla secrets E, NE and DA in rather constant ratios and that the cortex and the medulla respond differently to surgical stress.

Adrenal Glands↗

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Immunosuppressive therapy of HBsAg-positive chronic active hepatitis in childhood: a multicentric retrospective study on 139 patients.

We analyzed retrospectively the effect of immunosuppressive therapy in 139 children with HBsAG-positive chronic active hepatitis (CAH) observed in four liver units in Italy from 1974 to 1982. All children had been observed for at least 12 months. Of these 139 patients, 38 were treated with steroids (prednisolone or prednisone from 1 to 2 mg/kg daily), 78 with combination therapy (prednisolone or prednisone 1 mg/kg daily in combination with azathioprine, 2 mg/kg daily) and 23 were not treated. The outcome of the disease was assessed by evaluating clinical, biochemical, and histological parameters on the basis of preselected criteria. Untreated patients deteriorated more frequently than those treated with steroids (34.8% versus 13.2%, p less than 0.05) or those receiving combination therapy (34.8% versus 10.3%, p less than 0.01). Remission or improvement was observed more frequently in steroid-treated and combination-treated patients than in the untreated ones (p less than 0.001 and p less than 0.01, respectively). At the end of the study, only one untreated patient had died of liver failure. Remission was observed in about 10% of patients in the two groups of treatment, but in the untreated one, this event never occurred. Although this study is retrospective and presents some shortcomings, the data clearly indicate that steroid and combination therapy are not deleterious, and are possibly helpful, to children with HBsAg-positive CAH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗

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Scanning electron microscopy of vas deferens epithelium after temporary alteration caused by radiopaque medium.

Nine male rats (Rattus norvegicus albinus) weighing approximately 300 g were divided into 3 groups: a control group (CG), an experimental group of 7 days (EG-7), and an experimental group of 35 days (EG-35). All rats except those in the control group underwent a left vasography. The EG-7 and EG-35 rats were killed on the 7th and 35th days, respectively, after vasography; CG rats were killed on a randomly chosen day. The histological sections and scanning electromicrographs showed that the temporary alterations caused by radiopaque medium on vas deferens mucosa seen on the 7th day after vasography were completely repaired on the 35th day of recovery and either apical secretion or stereocilia of principal cells were reestablished.

Animals↗

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[Distribution of HBs-(Australia) antigen in progressive systemic scleroderma and other connective tissue disorders].

Of 173 patients, mostly suffering from collagen diseases and rheumatoid disease, the HBs antigen (HBsAg) was present in 1.73%. This figure is no higher than that observed among blood donors from the same area (Naples and surroundings). One HBsAg positive patient suffered from chronic active hepatitis and rheumatoid arthritis; another from chronic active hepatitis and a secondary type of reticuloendotheliosis; the third was one of seven patients with psoriatic arthritis. HBsAg was not found in any of 48 patients with other collagen diseases, including 22 patients with Progressive Systemic Sclerosis. These data do not support the hypothesis based on observations of polyarteritis nodosa that HBsAg plays an ethiopathogenetic role in collagen diseases with serious vasculitis.

Arthritis, Rheumatoid↗

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The spread of viral hepatitis in Italian dialysis units.

In order to evaluate the spread of viral hepatitis to dialysis patients and staff, 83 out of the 134 dialysis units operating in Italy at present were surveyed. The results were statistically evaluated. Of the 81 Italian centres surveyed, 66 were affected by viral hepatitis. There were 450 cases of infection among patients on regular dialysis treatment (9.7% of all dialysed patients). Of these 450, 163 had icteric viral hepatitis (116 HBsAg positive), 145 has non icteric hepatitis (100 HBsAg positive) and 142 were HBsAg carriers. The mortality rate among the dialysis patients with hepatitis was 9.1% with death occurring most frequently in icteric cases. Of the 133 cases of viral hepatitis observed among medical and nursing staff, 103 of these were HBsAg positive. Moreover, there was a higher risk of hepatitis infection observed in patients on regular dialysis treatment by multi-patient central system plate dialysers, in carriers of exteriorized arteriovenus shunt in patients who were submitted to frequent dialysis sessions and haemotransfusions.

Cholestasis↗