In order to evaluate the usefulness of Ca 72.4 tumor associated antigen assay in gastrointestinal diseases, we have studied 751 patients suffering from benign (376) and neoplastic (375) digestive diseases and 305 normal controls. The cut-off point was fixed at 6 U/ml. The Ca 72.4 assay, with the proposed method, provides additional information only in gastric cancers; the positivity of the marker in gastric neoplasms is 38.4% and the specificity vs gastric ulcers and atrophic gastritis is 99%. In six patients with gastric cancer, the Ca 72.4 is the only positive test. The most striking observation to be made from the current study is a no good sensitivity of the marker for gastrointestinal cancers (29.6% vs 35.7 and 37.6% for CEA and Ca 19-9 respectively), but rather the excellent specificity of the Ca 72.4 immunoassay with respect to being gastrointestinal diseases (98.7%), vs values of specificity for CEA and Ca 19-9 of 94 and 92%. In conclusion, the high specificity of this marker for gastrointestinal neoplasms may be very interesting in follow-up studies. In fact, an elevation of serum levels of Ca 72.4 should always be taken seriously.
Summary. Eleven cases of chronic haemolytic jaundice treated with phenobarbitone are reported. In all patients, except one, the drug caused a significant reduction of hyperbilirubinaemia in spite of the persistence of an increased haemolysis. Radioactive bilirubin (3H) kinetic studies demonstrated a bilirubin transfer defect from plasma to liver in seven patients which improved after phenobarbitone therapy along with the reduction of bilirubinaemia. It is concluded that a phenobarbitone‐sensitive hepatic mechanism frequently operates in producing jaundice in chronic haemolytic syndromes.
Introduction: It is known that the metabolic syndrome (MS), i.e. a condition characterised by a cluster of alterations in glucose metabolism, lipid metabolism and blood pressure, is more common in subjects with HIV infection than in HIV negative individuals This has been ascribed to use of anti-retroviral therapy. Methods: To compare the prevalence of MS in HIV patients with that from a sample of a general Italian population. 1263 HIV patients aged more than 18 were recruited in 18 centres for Infectious Diseases in Northern and Central Italy. Controls were 2051 subjects aged 25 to 74 years representative of a town in the Milan province. MS was diagnosed by the ATP criteria, i.e. at least 3 out of 5 abnormalities among a fasting glucose (>110 mg/dl), a low HDL cholesterol (< 40 mg/dl) a high plasma triglycerides level (>150 mg/dl) an increased waist circumference 88 cm) and a blood pressure > 130/85 mmHg. Results: Prevalence of MS in HIV group was 20.8% whereas in the control group it was only 15.8% (P<0,05) HIV patients was accounted for by a much more common occurrence of an impaired fasting glucose, increased plasma triglycerides and reduced HDL-cholesterol whereas the blood pressure and abdominal obesity components of MS were similar or lower in HIV patients than in controls. MS prevalence was similar in HIV patients treated with anti-retroviral drugs and in those never treated.
Conclusions:The prevalence of MS is greater in HIV patients compared to general population, due to a greater prevalence of lipid and glucose abnormalities. Prevalence of MS and its components is similar in treated and untreated HIV patients.
Macroangiopathy is multifactorial. It is more severe and frequent in association with nephropathy in diabetes mellitus (DM), being the first cause of mortality in both types of DM. Nevertheless, it is poorly understood in young patients. We report on 2 young diabetic patients with early-onset coronary disease. Case 1, 40 yo, Caucasian, female, type 2 DM for 21 y: treated with sulphonylureas until 25 y, she was switched to insulin upon becoming pregnant. Preeclampsia ensued, but no premature delivery occurred. Macroproteinuria remained (0.99 g/24 h), and she progressed to renal failure (clearance 52.7 mg/min) (conservative treatment). At age 36, she had an acute myocardial infarction. Severe tri-arterial disease was diagnosed, and coronary bypass grafting (CABG) performed. Case 2, 34 yo, black, female, type 1 DM for 24 y: diagnosed by diabetic ketoacidosis. Due to poor metabolic control (HbA1c chronically above 4 points beyond upper limit for normal) she progressed to microalbuminuria (0.26 g/24 h) at age 22, after pregnancy. Macroproteinuria (1.7 g/24 h) ensued after a second pregnancy. At 31 y, she presented with stable angina. After coronary angiography, CABG was indicated. These two cases of macroangiopathy in patients diagnosed with DM at an early age show acceleration in the development of coronary disease, suggesting aggressive multifactorial approach of related risk factors from the beginning, regardless of its etiology.
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