Clinical and therapeutic aspects of allergic asthma in adolescents

Little is known about the management of asthma in adolescents. We aimed at evaluating these aspects, through a specific questionnaire, in the real life of adolescents with allergic asthma.The questionnaire was administered to a group of adolescents after a diagnosis of allergic asthma. The diagnosis was based on history, clinical examination, pulmonary function tests and allergy tests. One hundred and fifteen adolescents (65 males, mean age 16.5 years) fulfilled the criteria for allergic asthma. The questionnaire explored demography, family history, clinical history, previous diagnosis, therapy, attitude towards therapy and social aspects. The mean actual FEV ₁ was 87 ± 10%. Methacholine challenge was carried out in 79 patients and was always positive (PD20 < 1200  μ g), whereas 36 patients underwent reversibility test. According to GINA guidelines, severity of asthma resulted intermittent in 62, mild persistent in 31, moderate in 19 and severe in three patients. In 61% of cases teachers were not aware of the disease. Asthma was managed by general practitioners, allergists and pulmonologists, but PFT/allergy tests had never been performed in 14% of patients. Forty-two per cent of the adolescents received no therapy at all, and only 15% of those with persistent asthma were receiving a stable treatment. Seventy-four per cent of adolescents preferred the inhaled, as against the oral, route. From a clinical and functional point of view, asthma in adolescents did not differ from other age ranges. Nevertheless, the management (diagnosis and therapy) emerged to be unsatisfactory from many points of view.     

The significance of the tuberculin test using bioequivalent PPD.

The biological reactivity of two commercially available tuberculin preparations was measured in 168 subjects (9 with active tuberculosis; 98 with inactive tuberculosis; and 61 general population). One tuberculin had 5 tuberculin units (TU) per 0-1 ml dose relative to a stabilized solution of PPD-S, whereas the other preparation was bioequivalent to 5 TU per 0-1 ml dose of unstabilized PPD-S, and was therefore of lower potency. Differences between the tuberculins were more evident when an induration of larger than or equal to 10 mm was considered as positive. Using a criterion of larger than or equal to 5 mm the differences were smaller, but the frequency of non-tuberculous responders was increased using this criterion. The average difference between the tuberculins was of the order of 5 mm regardless of the criterion of postivity. The use of chemoprophylaxis based on reaction size necessitates that the physician should know which of these two commercially available tuberculins is being used.     

Bilateral TIAs and unilateral seizures due to orthostatic hypotension. A case report

After a reversible right hemispheric stroke, a patient with bilateral carotid occlusion developed left motor seizures and bilateral TIAs, both triggered by orthostatic hypotension. A CT-scan showed a right frontal hypodense area. Hemodynamic factors may cause focal seizures in patients with cortical lesions.

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Riassunto Dopo un attacco ischemico reversibile in emisfero destro, un paziente con occlusione carotidea bilaterale presentò crisi epilettiche focali motorie agli arti di sinistra e TIA bilaterali, entrambi scatenati da ipotensione ortostatica. Una TAC dimostrò un 'area ipodensa frontale destra. Fattori emodinamici possono provocare crisi epilettiche focali in pazienti con lesioni corticali.

     

Oxidative enzyme metabolism in rabbit intrasynovial flexor tendons. II. Studies of nutritional pathways

The nutritional pathways of intrasynovial tendons have been investigated by transplantation of a free tendon graft to the knee joint. These grafts developed adhesions to host tissues as early as 2 days after operation. Central necrosis was apparent after 1 week. By 3 weeks postoperation, metabolically active infiltrating cells from the synovial layer of the tendon removed necrotic material, and began the process of partial regeneration of the tendon. This was clearly apparent at 9 weeks. At this stage, the new tenocytes had assumed the metabolic pattern of normal adult tendon cells. It is concluded that the vascularised synovial layer of the tendon is of paramount importance in the remodeling process.     

Non-steroidal anti-inflammatory drug (NSAID) use and Alzheimer disease in community-dwelling elderly patients.

OBJECTIVE: Recently, greater attention has been paid to the role of inflammatory processes in the pathophysiology of Alzheimer disease (AD). However, the mechanism by which anti-inflammatory agents (NSAIDs) might slow the progression of AD is not completely known. The aim of the present study was to examine the relationship between NSAIDs use and AD in a large sample of community-dwelling elderly people. METHODS: In a cross-sectional retrospective study, the authors analyzed data on patients admitted to home care programs. A total of 12 home health agencies participated in the project, with a total of 2,708 patients enrolled in the present study. The main outcome measures were the prevalence of AD and use of NSAIDs treatment. RESULTS: Compared with all non-users, NSAID users had a nearly 50% lower risk of being affected by AD. Separate multivariate analyses of subjects receiving different types of NSAIDs found a significantly decreased risk of cognitive impairment associated with non-aspirin NSAID use, whereas, among subjects taking aspirin, the difference in estimated risk did not reach statistical significance. CONCLUSION: The results of this population-based cross-sectional study are consistent with the notion that long-term NSAIDs use has a protective effect against AD. However, after possible confounding effects of age and several other variables potentially associated with cognitive impairment were controlled, this association was statistically significant only for non-aspirin NSAIDs use.