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We describe a case of brainstem infection by Listeria monocytogenes with right oculomotor palsy and lip drop, facial hypoesthesia, left arm paresthesia, positive blood culture, and sterile liquor in a 63-year-old man. Magnetic resonance imaging revealed an isolated mesencephalic lesion. Localization of this kind accounted for 3% of 111 cases reviewed.

Objective: In this study, we sought to appreciate the role of adenosine in the regulation of pulmonary vascular tone, especially in the case of clinical pulmonary hypertension, by investigating the relationship between endogenous plasma adenosine levels and pulmonary artery vasoconstriction. Methods: Adenosine plasma concentrations, were measured simultaneously in the distal right pulmonary artery and in the femoral artery, both at steady state (room air) and during pure oxygen inhalation. Three clinical situations were considered: (1) normal hemodynamics [7 control subjects, mean pulmonary artery pressure (MPAP)=18.5±1 mm Hg], (2) moderate pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD), (8 patients, MPAP=31±3 mm Hg), (3) severe primary pulmonary hypertension (PPH), (8 patients, MPAP=70±5 mm Hg). Results: In every instance, adenosine evaluated by HPLC was higher in the pulmonary than in the systemic circulation. For room air, adenosine plasma concentrations were significantly lower in COPD (0.49±0.16 μmol l−1) and PPH patients (0.45±0.14 μmol l−1) than in controls (1.26±0.12 μmol l−1). During O2 administration, adenosine plasma concentrations all decreased but more so in COPD and PPH patients. The significant correlations between adenosine plasma concentrations and both pulmonary vascular resistance and P vO2, in controls, were not found in COPD or PPH patients. Conclusion: The adenosine plasma concentrations in the pulmonary circulation of PPH and COPD patients are low, and may contribute to pulmonary artery hypertension.

We describe long-term therapy for paracoccidioidomycosis occurring in a 61-year-old housepainter from Venezuela. The diagnostic examinations made in South America had shown pulmonary granulomatous lesions and an osteolytic pattern of the left knee that had been considered suspect of malignant disease with an indication for limb amputation. With the aid of fine needle aspiration biopsy (FNAB) and culture examination we diagnosed an osteomyelitis by Paracoccidioides brasiliensis and initiated therapy with itraconazole, 400 mg per day, reduced to 200 mg per day after 2 months. At the end of 2 years of drug therapy, we observed complete regression of the pulmonary lesions a nd of the osteolytic a rea of the left knee. Moreover, we have periodically observed our patient to verify his clinical development and he is still in good health. We suggest that this pathology be considered in differential diagnosis of leprosy, tuberculosis, leishmaniasis, and systemic mycoses, even in non-endemic areas.

We describe the case of a 56-year-old man who had high aminotransferase levels and anti-hepatitis C virus (HCV) antibodies. He underwent liver biopsy and biochemical screening to evaluate whether he would benefit from interferon (IFN) treatment. The patient was discharged with a diagnosis of HCV-related active chronic hepatitis, skin porphyria, and type 2 diabetes. On December 5, 1995, he began therapy with recombinant IFN-alpha at a dose of 3 MIU three times a week. He stopped this therapy in February 1996 because of asthenia, diplopia, headache, and anxiety. During IFN therapy, he had normal aminotransferase levels and no detectable HCV RNA, a condition that persists to the present. Between March and May 1996, the patient was admitted several times to a neurology clinic, where myasthenia gravis was diagnosed and treatment with pyridostigmine and cyclosporine was initiated. This case and others indicate that caution should be exercised in administering IFN because low doses can be correlated with myasthenia gravis in patients without malignancies.

The aim of this study was to evaluate the incidence of postoperative lymphocytotoxic antibodies (LA) formation and to assess their potential utility in immunologic monitoring after lung transplantation. We determined prospectively the percentage LA against a reference panel reactive antibody in a complement-dependent microlymphocytotoxicity test in 137 sequential serum samples obtained from 14 consecutive lung transplant recipients who survived over the first postoperative year. Four patients developed high titers of LA (greater than 10% panel reactive antibody reactivity in at least 3 consecutive samples) by 2 to 24 months after surgery. Antibodies were mostly immunoglobulin M isotype, without any specificity against the donor's human leukocyte antigen and were correlated with the development of bronchiolitis obliterans syndrome (p=.01) and with chronic bronchial infectious colonization (p=.03). In conclusion, a polyclonal immunoglobulin M antibody production can be detected in serum samples from lung transplant recipients and seems to be involved in the progression of chronic rejection process. These preliminary results incline to carry on the cytotoxicity screening of a panel of lymphocytes to better understand the significance of such reactivity.

HCV is ubiquitous. In 50% of all cases it causes chronic hepatitis that often evolves into liver cirrhosis and hepatocellular carcinoma. Recently HCV has been classified in 5 genotypes by Okamoto. The purpose of this study is to evaluate the prevalence of 5 genotypes in Campania, a region of southern Italy, where the prevalence of anti-HCV antibodies ranges from 0.87 to 4%, and to evaluate the correlation between the HCV genotypes and the severity of histological damage. One-hundred- and-thirty-five anti-HCV positive patients were enrolled and tested by PCR to identify HCV-RNA. One-hundred-and-twenty-four patients resulted HCV-RNA positive. Genotyping was performed as described by Okamoto et al. with minor modifications of the specific primer to type III proposed by Silini et al. Eight patients were negative for all genotypes. Eight patients were positive for type I(1a), 61 for type II(1b), 39 for type III(2a), 11 for type IV(2b) and 1 for type V(3a). In 4 cases two different genotypes were present in the same sample [II(1b)-IV(2b), III(2a)-II(1b) twice, III (2a)-IV(2b)]. Histological evaluation of liver damage showed: CPH (22 cases), minimal CAH (56), severe CAH (31) and liver cirrhosis (15). There was no statistically significant correlation between the 5 genotypes and the severity of histological damage. Data on the prevalence of genotype II (1b) in Italy are similar to those reported for other European countries. The prevalence of genotypes in southern Italy is similar to that reported in the population of northern Italy.

An ultrastructural study of the prevalence of electron dense 23-27 nm intranuclear particles was carried out on liver biopsies from patients with NANB chronic active hepatitis (CAH), Delta + CAH, HBsAg + CAH, nonviral liver pathologies and in one healthy volunteer. The particles were classified according to aggregation pattern and were found to be correlated with NANB CAH and Delta + CAH. No particles were observed in nonviral liver pathologies. A close antigenic relationship has been shown between the cytoplasmic alterations observed in NANB and delta hepatitis in chimpanzees. Our data indicate that there is a structural similarity between the intranuclear particles seen in both Delta and NANB hepatitis, thus reinforcing the hypothesis that the NANB and Delta agents are closely related.

Intranuclear particles of 23-27 nm diameter have been repeatedly demonstrated in the nuclei of hepatocytes of patients with non-A, non-B hepatitis and of experimentally infected chimpanzees; however, their specificity has been challenged since they have also been observed in other pathological conditions and in healthy volunteers. We have conducted an ultrastructural study of liver biopsies from 10 patients with chronic active non-A, non-B hepatitis. The intranuclear particles, which were observed in all patients, were classified according to the aggregation patterns described by De Vos. Eight patients (80%) had particles of type 2. A reevaluation our proceeding data on Delta hepatitis demonstrated that no particles of type 2 were present. These results support the hypothesis that only type 2 particles are markers of non-A, non-B hepatitis.

Increased levels of circulating immunecomplexes (CIC) have been demonstrated in the serum of patients with HBV infection and HDV superinfection. This finding appears to be correlated to the disease's activity. In this report serum levels of two fractions of CIC (CIC-Clq and CIC-C3d) were evaluated by ELISA method in a sample of 110 subjects with hepatitis infection (HBV, HCV, HDV). Reference values were obtained in a group of 45 healthy subjects (blood donors). Both the CIC fractions were increased in the patients with HCV infection. The most significant increase for both CIC-C1q and CIC-C3d was found in the cirrhotic patients. The complement fractions C3c and C4 were determined in the serum of these patients to investigate a potential pathogenic role of such immunecomplexes. C3c and C4 fractions showed a significant decrease only in the cirrhotic patients, without correlation with the viral agent. Serum levels of C1q complement fraction were not significantly decreased, thus excluding an impaired synthesis of complement fractions. No significant correlation was found between CIC and C3c and C4 fractions in patients with increased levels of CIC, except a slightly significant correlation between reduction of C3c and increase of CIC-C1q. These data suggest a pathogenic action of immunecomplexes in the course of HCV, particularly in the cirrhotic stage.