U Baicchi

High prevalence of G1 and G2 TT-virus infection in subjects with high and low blood exposure risk: identification of G4 isolates in Italy

BACKGROUND/AIMS A non-enveloped single-stranded DNA virus (TTV) was detected in Japanese patients with fulminant hepatitis (47%) and chronic liver disease of unknown etiology (46%) more frequently than in blood donors (12%). Subsequent studies, however, questioned the association of TTV with liver disease. We further investigated the role of this novel virus in liver diseases. METHODS We tested 106 patients and 102 blood donors for TTV by polymerase chain reaction using conserved region primers. RESULTS TTV DNA was found in 19 of 102 volunteer blood donors (18.6%) and in 27 of 106 patients with liver disease (25.5%): 10 of 28 chronic hepatitis B (35.7%), 9 of 28 chronic hepatitis C (32.1%) and 8 of 50 (16%) cryptogenic liver disease patients. Previous interferon treatment was not associated with a significantly lower prevalence of TTV infection. TTV prevalence was higher in patients with blood exposure (42.8%, 6/14) than in patients without risk factors (21.4%, 18/84). Four of five patients (80%) with HBV familial infection and without blood exposure were also TTV positive. Partial nucleotide sequences from 3 Italian isolates diverged more than 30% from the 2 prototype genotypes G1 and G2 and were 88% homologous to the recently described genotype G4. CONCLUSIONS G1 and G2 TTV are common in Italy and in the USA in liver disease patients and in blood donors. The prevalence is high in patients with blood exposure but also in subjects without risk factors; other routes of transmission should therefore be considered.

Increased thrombin generation in patients with chronic renal failure

The plasma concentration of prothrombin fragment 1+2 (F1+2) is considered a very sensitive parameter for specific detection of latent hypercoagulability. To evaluate the degree of hypercoagulation associated with chronic uremia, we measured F1+2 by ELISA in the plasma of 51 patients with severe or end-stage chronic renal failure (35 males, 16 females, aged 22–81 years): 24 on dietary treatment, 15 on combined dietary and once a week hemodialysis, and 12 on regular maintenance hemodialysis; 33 healthy subjects served as a control group. Plasma F1+2 showed a significant elevation in the group on dietary treatment; it was further increased in the group on once a week hemodialysis, and even more markedly increased in the group on maintenance hemodialysis. In patients on dietary treatment a positive correlation was found between plasma F1+2 and serum creatinine. In patients on maintenance hemodialysis, no increase in the F1+2 plasma level was found during the course of a single hemodialysis session. Low molecular weight heparin, administered to 7 patients on dietary treatment, caused a marked drop in the F1+2 plasma level, providing evidence that the elevation in F1+2 indicates an accelerated in vivo thrombin generation rather than impaired renal catabolism. The enhanced coagulation activation appears to be related to the reduction of residual renal function, i.e., to the severity of renal failure, and may contribute to the increased risk of vascular events in uremic patients.

Pretreatment plasma levels of fibrinopeptide‐A (FPA), D‐dimer (DD), and von Willebrand Factor (vWF) in patients with operable cervical cancer: Influence of surgical‐pathological stage, tumor size, histologic type, and lymph node status

Pretreatment plasma levels of fibrinopeptide-A (FPA), Ddlmer (DD), and van Willebrand Factor (vWF) in patients with operable cervical cancer: Influence of surgical-pathological stage, tumor she, bistologlc type, aad lymph node status Gadducci A.; Baicchi U.; Marrai R.; Facchini V.; Del Bravo B.; Fosella P.V.; Fioretti P. ITA GYNECOL ONCOL 1993 49/3 (354-358) The preoperative plasma levels of tibrinopeptide A (FPA), D-dimer (DD), and von Willebrand Factor (vWF) were measured in 38 patients with cervical cancer undergoing radical hysterectomy with pelvic lymphadenectomy. The surgicalpathological stage of disease was Ib in 17 patients. Ila in 9 patients, and Ilb in 12 patients. The tumor size was 54 cm in 20 patients and >4 cm in 18 patients. The histologic type was squamous cell carcinoma in 32 patients and adenocarcinoma in 6 patients. Positive pelvic lymph nodes were found in 10 patients. When compared to controls, FPA, DD, and vWF levels were significantly raised in patients with surgical-pathological stage IIb disease but not in patients with stage Ib or Ila disease. The values of FPA, DD, and vWF were related to surgicalpathological stage (stage IIb vs. stage lb-IIa: P < 0.005, P < 0.001, and P < 0.001, respectively) and tumor size (>4 cm vs

In vivo measurements of fibrin formation and degradation in nephrotic patients

4 cm: P < 0.05, P < 0.005, and P < 0.02, respectively), but not to histologic type. vWF values were also related to lymph node status (positive vs negative lymph nodes: P < 0.02). FPA and DD levels were higher in patients with positive lymph nodes than in patients with negative lymph nodes, but the difference did not reach the statistical significance even due to the small number of patients involved. In conclusion, increased fibrin production and degradation seem to occur in patients with stage IIb cervical cancer. The biological meaning of this hemostasis activation deserves further investigation.

Preoperative evaluation of D-Dimer and CA 125 levels in differentiating benign from malignant ovarian masses.

SummaryIntraglomerular fibrin deposition has been implicated as an important pathogenetic mechanism in patients with glomerular diseases and the nephrotic syndrome. To investigate fibrin formation and degradation in nephrosis, we measured fibrinopeptide A by radio-immunoassay and D-dimer by enzyme-linked immunosorbent assay in the plasma of 30 consecutive adult patients with the nephrotic syndrome; in 10 the serum creatinine was more than 2 mg/dl. Both fibrinopeptide A and D-dimer were abnormally elevated in the majority of nephrotics (P<0.001 vs. healthy controls), providing evidence of increased fibrin generation and lysis “in vivo.” A positive correlation was found between fibrinopeptide A and D-dimer (correlation coefficient 0.64,P<0.001), suggesting a close relationship between fibrin formation and degradation. Calcium heparin, administered to 12 nephrotics, caused a marked decrease in plasma fibrinopeptide A, due to a reduction of in vivo thrombin activity. As enhanced thrombin activity can favor fibrin deposition within the renal parenchyma, as well as vascular complications, it is reasonable to assume that an antithrombotic treatment aimed at controlling thrombin generation may ameliorate the natural history of nephrosis.