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Il volume raccoglie i contributi di ricerca dell'International call for paper Community/Architecture promosso dal Festival dell'Architettura nell'Edizione 2009-2010. Cinquantasette eterogenei contributi provenienti da diversi paesi del mondo sul tema generale del Festival e suddivisi sulla base di tre focus tematici: Città e quartiere, Il congegno tipologico e le forme di aggregazione, Composizione architettonica e nuove tecnologie: architetture eco-virtuose.

Although high-grade non-Hodgkin's lymphoma (NHL) and an unusually aggressive form of Kaposi's sarcoma (KS) remain the most common malignancies seen in AIDS patients, other tumors such as cervical cancer, Hodgkin's disease and others, have been increasingly observed, probably because these patients now live longer. We report the imaging findings of 80 AIDS patients with pathologically confirmed neoplasms from a series of 340 AIDS patients examined 1986-1994. Twenty-four of 80 patients had NHL, 4 Hodgkin's disease, 31 KS, 4 cervical cancer, 2 leukemia, 2 testicular, 1 larynx, 2 lung, 2 breast, 1 esophagus, 1 stomach, 1 liver, 2 kidney and 3 adrenal carcinomas. Twenty of 24 NHLs exhibited extranodal involvement--to the liver (13/24), brain (9/24), lung (7/24) and gastrointestinal tract (6/24). Visceral KS involved the gastrointestinal tract (6/32), lung (4/32) and liver (2/32). The most accredited pathogenetic theories concerning the role of HIV infection in oncogenesis advocate the effect of multiple growth factors produced by HIV-infected lymphocytes (KS) or the disregulation of B-cells caused by T-cell destruction (NHL). The atypical morphostructural features of AIDS-related tumors are discussed--e.g., atypical presentation, occurrence in younger individuals, aggressive clinical course and poor response to conventional therapy--together with the differential diagnostic problems, especially vs. opportunistic infections.

The effects of long-term therapy (70 days) with torasemide (20 mg/day), a new loop diuretic, were compared with those of furosemide (50 mg/day) in a randomized double-blind trial. Both drugs were administered in association with spironolactone (200 mg/day) in 28 nonazotemic cirrhotic patients with controlled ascites. The treatments did not modify creatinine clearance and exhibited a similar effect on body weight, urinary volume, and fractional excretion of uric acid, sodium, and chloride. The effect of torasemide on fractional potassium excretion was lower than that of furosemide. Torasemide showed higher sparing effect than furosemide on calcium, inorganic phosphate, and magnesium excretion and stronger action on free water clearance. No changes in serum parameters were induced by either treatment. Two episodes of hepatic encephalopathy occurred in the torasemide group. In view of its effects on sodium and water excretion and on other urinary parameters, torasemide can represent an alternative tool for the long-term treatment of ascites.

We screened 74 patients with nonA nonB acute hepatitis (37 of post-transfusion PTH, and 37 of non-post-transfusion, NPTH, origin) for the presence of anti-HCV by tests detecting either C100–3 antibodies alone (ELISA I) or C100–3 plus C33c plus C22–3 antibodies (ELISA II). Samples were taken at the onset of disease and then serially for a period of time ranging from 12 to 60 months. An increased number of anti-HCV positive cases (86% vs 69%) and an earlier seroconversion were observed with the second compared to the first generation ELISA. Positive samples were confirmed by recombinant immunoblot assay (RIBA), which was also used to study the kinetics of the antibody response to individual HCV antigens. Anti-C33c and anti-C22–3 antibodies were the first detectable markers of HCV infection in 80% and 20% of the patients, respectively. Thirty-two percent of the patients studied showed complete and persistent biochemical recovery, whereas 68% maintained a chronic elevation of the transaminase values. Among the 20 patients who showed early and persistent normalization of the transaminase values, complete disappearance of all antibody reactivities was limited to five of them, whereas in four cases only anti-C100–3 and anti-5–1-1 became negative.

In a group of 55 patients with NANBH, 81% were found to be reactive for HCV antibodies. In addition, many patients who had not been subject to parenteral risk of infection were also found to be reactive. Statistically, HCV positive patients have an increased tendency to develop chronic hepatitis.

In a group of 55 patients with NANBH, 81% were found to be reactive for HCV antibodies. In addition, many patients who had not been subject to parenteral risk of infection were also found to be reactive. Statistically, HCV positive patients have an increased tendency to develop chronic hepatitis.

In a group of 110 dialysis patients, 21% had anti-HCV antibodies. Statistical differences were noted according to method and duration of dialysis as well as the presence of further risk factors.

In a group of 110 dialysis patients, 21% had anti-HCV antibodies. Statistical differences were noted according to method and duration of dialysis as well as the presence of further risk factors.

The behavior of insulin and glucagon and related metabolic substrates was assayed in plasma of patients with fulminant hepatic failure. All 12 subjects were provided the same nutritional support. High levels of insulin and glucagon were present at all times and no difference was observed between surviving patients (four) and those who died (8). Elevated values for branched-chain and aromatic amino acids as well as alanine were present. Statistically significant lower levels of aromatic amino acids and consequently a greater branched chain-aromatic amino acid ratio was found in surviving vs nonsurviving patients. A significantly greater level of alpha-fetoprotein was found in patients who survived as compared to those who died.

Evaluation of the surgical risk in cirrhotic patients undergoing emergency operations must take into account potential anesthesia-related problems, the specific type of operation, and altered liver function. Therefore, (a) the generic surgical risk, (b) the specific surgical risk and (c) the anesthetic risk, must be distinguished. The factors which affect the generic risk are the conditions which can worsen pre-existing liver failure (e.g. cardiopulmonary disease, area of surgical intervention, stage of liver cirrhosis). Splanchnic reflexes as well as lower venous return to the heart are the potential factors which may lead to reduced hepatic blood perfusion and, therefore, represent the specific surgical risk. The anesthetic risk is due to negative interference with the splanchnic circulation by both artificial ventilation and direct pharmacologic vasoconstrictor effects. Finally, the possibility that the patient is positive for HBV or HIV markers must be considered in order to carry out the necessary measures to avoid direct contact with the blood.

With the recent advances in treatment of AIDS, we have seen an increase in detection of malignant neoplasms in our patients. While some malignancies have an undoubted relationship with the HIV infection, others represent nothing more than sporadic reports and their relationship with the underlying immunological deficit is all but clear. We report the imaging findings in three patients with AIDS and an adrenal adenocarcinoma. We also discuss the peculiar imaging aspects of these pathological entities and report some pathogenetic theories on the relationship between AIDS and neoplasms.

Malnutrition and nutrient abnormalities are often associated with chronic liver disease, and may contribute to the development of several complications. The liver’s role being central in nitrogen metabolism, hepatic damage frequently causes derangements in protein metabolism (Mezey 1978). In most patients with chronic liver disease, protein requirements for maintenance of nitrogen balance (NB) are no different from those of normal individuals. It follows that the accuracy of either oral or parenteral protein equivalent administration can play a major role in liver disease progress. Besides, one must take into consideration the fact that an increased requirement of protein, in order to repair the hepatic damage, leads to deficiencies in other organs; specifically, it causes muscle wasting, since amino acids are continuously deaminated so as to provide a source of energy (Soeters and Fischer 1976). This picture is characteristic of chronic liver disease, with a trend to: (a) an increase in plasma concentrations of amino acids normally removed by the liver, i. e., essential and nonessential aromatic and sulfurated amino acids; (b) a decrease in the amino acids preferentially taken up by extrahepatic tissues, i.e., essential branched-chain amino acids (BCAA) such as valine, leucine, and isoleucine. Therefore, the most common amino acid pattern observed in chronic liver disease consists of increases in the aromatic amino acids (AAA) tyrosine and phenylalanine, glutamic acid, methionine, and sometimes cystine, and a decrease in the BCAA valine, leucine, and isoleucine (Rosen et al. 1977).

In January 1984 a hepatitis B vaccination campaign was started in health care workers of Hospital of Parma. Within 3 years, of the 953 subjects submitted to serologic screening, 446 were eligible and 409, serum negative for HBV, completed the vaccination. 202 received HB-VAX vaccine (M.S.D.) intramusculary into the buttock at 0.1 and 6 months, and 208 received HEVAC-B vaccine (Pasteur) into deltoid region at 0, 1, 2 and 12 months. After the booster injection, percent of seroconversion (anti-HBs greater than 10 UI/l) and anti-HBs antibody titres were significantly (p less than 0.01) higher in HEVAC-B recipients (95.6%, mean anti-HBs titres = 6400 UI/l), than in the subjects vaccined with HB-VAX (77.1%, mean anti-HBs titres = 2703 UI/l). There was no significative difference in immune response in both groups with respect to age, sex or occupational category. Three hepatitis B infections were identified in HB-VAX recipients, but no one in individuals vaccined with HEVAC-B. No participants had serious adverse effects, minor side effects occurred with equal frequency in both groups. In general, both plasma-derived vaccines have proved to be highly immunogenic, safe and well tolerated in health care workers, however HEVAC-B vaccine, since contains S and pre-S ag, has shown a more satisfactory immunogenic effect.

Thirty members of the staff and fifty-one patients of Parma hemodialysis unit, serum negative for HBV markers, having completed the vaccination (HB-vax vaccine) against hepatitis B, were followed for two years after booster dose. After the third injection, the response to HB vaccine was significantly higher (p less than .0005) in staff members, than in patients. In the staff group, 83.3% were responders at mean titers of anti-HBs of 2703 mUI/ml; only 51% of patients developed anti-HBs at mean titres of 287 mUI/ml. As to either sex or age, no significant differences were observed in the two groups. Among hemodialysis patients the higher response (71.4%) was noted in the less than 40 aged individuals in comparison with those 40-60 (56.9%) or greater than 60 aged (38%). The persistence of the immunisation in both groups appeared to be statistically correlated to the anti-HBs titres after booster injection. At the end of the follow-up, 63.3% of the staff vaccinated members, but only 15.6% of the patients still had protective titre. No ill-effects induced by vaccine developed. Hepatitis B infection was only observed in one non responder member of the staff. The study demonstrates a low response to HB-vaccine and a rapid decrease of anti-HBs titre in the hemodialysis patients, thus leading to the need of frequent revaccination.