Malabsorption in psoriatic patients: cause or consequence?

OBJECTIVE: The etiopathogenesis of psoriasis is still unclear. Associations between gut and skin diseases are well known, since psoriatic patients show a high prevalence of coeliac disease. Small-bowel abnormalities can cause clinical or, more frequently, laboratory alterations that give rise to malabsorption. The aim of the study was to evaluate the prevalence of malabsorption in psoriatic patients. MATERIAL AND METHODS: Fifty-five (29 M, 26 F, mean age 51+/-8 years) psoriatic patients in the Dermatology Centre of our hospital and 65 healthy controls (36 M, 29 F, mean age 47+/-9 years) were screened for malabsorption using a D-xylose test. Psoriatic subjects who resulted positive were further investigated in order to reach a better characterization of the malabsorption using serum antigliadin, anti-endomysium and anti-transglutaminase antibodies, H2 lactulose breath test, the parasitological faecal test and colonoscopy with retrograde ileoscopy. RESULTS: Altered D-xylose absorption was found in 60% (33/55) of psoriatic patients and in 3% (2/65) of controls. Of the former, 6% had coeliac disease, 21% had bacterial overgrowth, 3% had parasitic infections and 1 patient presented eosinophilic gastroenteritis. CONCLUSIONS: Malabsorption was more prevalent among psoriatic patients than among controls. Coeliac disease, bacterial overgrowth, parasitic infestations and eosinophilic gastroenteritis could be possible causes of malabsorption in these patients. Further studies are needed to clarify the pathogenesis and possible causative associations between gut and skin diseases.     

Mixed cryoglobulinemia: demographic, clinical, and serologic features and survival in 231 patients

BACKGROUND: Mixed cryoglobulinemia (MC) is a systemic vasculitis secondary to circulating immune complex deposition in the small vessels. In the overwhelming majority of patients, hepatitis C virus (HCV) infection represents the triggering factor of the disease. MC is characterized by multiple organ involvement, mainly skin, liver, renal, peripheral nerves, and less frequently by widespread vasculitis and cancer. OBJECTIVES: To investigate the demographic, clinical, serologic features, and survival in a large series of MC patients. METHODS: The study included 231 MC patients recruited between 1972 and 2001 at the Rheumatology Unit of the University of Pisa. All patients underwent wide clinicoserologic and virologic assessment. Cumulative survival rates were computed by the Kaplan-Meier method; moreover, the prognostic relevance of the main variables was investigated by Cox model analysis. RESULTS: In 92% of cases, the presence of HCV infection was demonstrated (anti-HCV antibody, 92%; HCV RNA, 90%), whereas hepatitis B virus (HBV) represented the possible causative agent in only 1.8% of patients (HBV DNA). Clinically, the MC syndrome followed a relatively benign clinical course in over 50% of cases, whereas a moderate-severe clinical course was observed in one third of patients whose prognosis was severely affected by renal and/or liver failure. In a limited, but significant, percentage (15%) of individuals, the disease was complicated by a malignancy, ie, B-cell lymphoma, and less frequently by hepatocellular carcinoma, or thyroid cancer. The survival study by the Kaplan-Meier method revealed a significantly lower cumulative 10th-year survival, calculated from time of diagnosis, in MC patients compared with expected death in the age- and sex-matched general population. Moreover, significantly lower survival rates were observed in males and in subjects with renal involvement. The multivariate analysis by the Cox proportional hazard regression model further supported the above findings: an increased mortality risk of 98% was observed for male gender (male/female hazard ratio, 1.978) and of 197% in patients with, compared with those without, renal involvement (hazard ratio, 2.967). At the end of the follow-up, 97 patients were deceased, and in 79 of 97 patients, the causes of death were ascertained: nephropathy (33%), malignancies (23%), liver involvement (13%), and diffuse vasculitis (13%) were the most frequent causes of death. CONCLUSIONS: Careful patient monitoring is recommended for a timely diagnosis of life-threatening MC complications, mainly nephropathy, widespread vasculitis, and B-cell lymphoma or other malignancies.     

Redilation of e‐PTFE covered CP stents

Objectives: To evaluate the possibility to redilate covered Cheatham‐Platinum stents during follow‐up, in particular in growing children with aortic coarctation. Background: There are no data in the literature about the redilation of ePTFE covered CP stents. Methods: Sixty covered CP stents were implanted in patients with aortic coarctation or recoarctation between January 2004 and October 2007. Seven patients (mean age 14.2 ± 3.7 years) needed to repeat the hemodynamic study due to somatic growth and increase of aortic gradient with the occurrence of systemic hypertension. Two had near‐atretic aortic coarctation, three had postsurgical recoarctation and aneurysm formation, one had native aortic coarctation associated with aneurysm of the arterial wall, and one had severe native aortic coarctation. Results: Procedures were performed a mean of 20 ± 5 months (range, 12–24 months) after the primary stent implantation. Fluoroscopy time ranged between 7 and 15 min (median, 10 min) whereas procedure time ranged between 60 and 75 min (median, 65 min). After redilation the gradient across the stenosis decreased from a median value of 35 mm Hg to a median value of 5 mm Hg. The stent diameter increased of 20–50% the predilation value. No complications occurred and angiographic controls showed that the stenoses have been relieved. Follow‐up: During a median follow‐up of 12 months (6–30 months) the results were stable without complications. Conclusion: Covered Cheatham‐Platinum stents can be easily redilated © 2008 Wiley‐Liss, Inc.     

Efficacy of postprocedure administration of gabexate mesylate in the prevention of post-ERCP pancreatitis: a randomized, controlled, multicenter study

BACKGROUND AND OBJECTIVE: Gabexate mesylate reduces the incidence of post-ERCP pancreatitis. Patient-related risk factors associated with pancreatitis can be identified before ERCP, but the procedure-related factors are recognized only at the end of the procedure. This study's aim was to evaluate whether gabexate mesylate administered after ERCP reduces the incidence of pancreatitis. DESIGN: Randomized, prospective, double-blind, multicenter trial. SETTING: Tertiary care centers. PATIENTS AND INTERVENTION: A total of 608 patients undergoing ERCP were treated with gabexate mesylate 500 mg within 1 hour before ERCP (group A, 203 patients) or within 1 hour after ERCP (group B, 203), or with saline solution (group C, 202). MAIN OUTCOME MEASUREMENTS: The incidence and severity of pancreatitis and hyperamylasemia, as well as factors associated with the development of pancreatitis. RESULTS: The groups were similar for demographic characteristics, indications to ERCP, risk factors for pancreatitis, and therapeutic procedures. The incidence of pancreatitis was 3.9% in group A, 3.4% in group B, and 9.4% in group C (P<.01). Two patients (in groups A and C) developed necrotizing pancreatitis, and 1 died. Hyperamylasemia occurred in 23.6% in groups A and B, and in 24.7% in group C. Levels of amylase, the incidence of abdominal pain, and other complications occurred similarly. Female sex (odds ratios [OR] 2.7, 95% CI 1.2-5.9) and difficult cannulation (OR 5.6, 95% CI 2.6-12.3) were independently associated with pancreatitis. CONCLUSIONS: The administration of gabexate mesylate after ERCP protects against the development of pancreatitis similarly to the preprocedure administration. Factors associated with pancreatitis were mainly recognized after ERCP. We suggest administering gabexate mesylate after ERCP only in those patients recognized to be at risk of developing pancreatitis.     

Timely HAART initiation may pave the way for a better viral control

Background  

When to initiate antiretroviral therapy in HIV infected patients is a diffcult clinical decision. Actually, it is still a matter of discussion whether early highly active antiretroviral therapy (HAART) during primary HIV infection may influence the dynamics of the viral rebound, in case of therapy interruption, and overall the main disease course.     

The expression of the multidrug resistance-associated glycoprotein in B-cell chronic lymphocytic leukaemia

S ummary . The expression of the multidrug resistance (MDR)-associated 170 kDa glycoprotein (p170) was investigated in 63 cases of B-cell chronic lymphocytic leukaemia (CLL), with two monoclonal antibodies (MRK-16 and C-219). By immunocytochemistry with MRK-16 (63 cases), the great majority of the cells was positive, with a weak reaction in 61% of cases and a strong reaction in 39% of cases. By flow cytometry, the proportion of positive cells was 39±25% with MRK–16 (63 cases), and 23±22% with C–219 (36 cases). The expression of pl70 in leukaemic B-lymphocytes suggests that also in B-CLL the development of MDR can have some therapeutic relevance. By either method the proportion of positive cells was not related to prior treatment, time from diagnosis, absolute lymphocyte count, and clinical stage (Rai's and workshop classifications), but 12 patients who were under treatment with α-interferon had more positive cells than the other ones.     

An open-label pilot study comparing rivastigmine and low-dose aspirin for the treatment of symptoms specific to patients with subcortical vascular dementia

Background: Patients with vascular dementia (VaD) show cholinergic deficits that may result in characteristic clinical syndromes for different subtypes of the condition. In addition to executive function, subcortical VaD is characterized by behavioral and emotional problems, reflecting deterioration of the frontal lobe.Objective: The purpose of this study was to determine the effect of rivastigmine on the specific symptoms of subcortical VaD.Methods: Patients received rivastigmine 3 to 6 mg/d (n = 8) or low-dose aspirin (cardioaspirin) 100 mg/d (n = 8) for 22 months in an open-label study design. Rivastigmine-treated patients began therapy with the lower dosage of rivastigmine 3 mg/d, which was increased to the higher dosage of 6 mg/d after 4 weeks. Disease severity was assessed using the Clinical Insight Rating Scale. Behavior was assessed using the NeuroPsychiatric Inventory (NPI), the Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) rating scale, and the Cornell Scale for Depression in Dementia (CSDD). The main results of this study, including executive function, NPI, and caregiver stress scores, have been presented elsewhere.Results: Sixteen patients were enrolled. Patients receiving rivastigmine showed statistically significant improvements in their BEHAVE-AD and CSDD scores (P = 0.001 and P = 0.02, respectively, versus cardioaspirin). Comparison of individual items on the BEHAVE-AD scores of the rivastigmine group with the cardioaspirin group indicated statistically significant improvements in activity disturbance, affective disturbance, aggressiveness, anxiety/phobia, hallucinations, and paranoia/delusions (P = 0.007, P = 0.035, P = 0.008, P = 0.003, P = 0.006, and P = 0.001, respectively). Similarly, comparison of the NPI scores of the 2 groups showed that the rivastigmine group experienced significantly greater improvements in anxiety, hallucinations, and wandering (P = 0.001, P = 0.005, and P = 0.014, respectively). Side effects in both groups were tolerable and there were no study withdrawals.Conclusions: In this preliminary study, rivastigmine treatment was well tolerated and effective. Improvements in the symptoms that characterize subcortical VaD were observed, suggesting that rivastigmine may have provided targeted treatment in areas of the brain that are particularly affected in this patient population. A large, double-blind, placebo-controlled study of rivastigmine in patients with VaD is warranted.     

Radiation-induced brain tumours after central nervous system irradiation in childhood: a review

OBJECTS: Radiation-induced cerebral tumours constitute a significant risk for subjects undergoing radiotherapy for the management of cerebral neoplasms. Age-related cerebral vulnerability could be a specific factor in the genesis of these complications. METHODS: The pertinent literature of both paediatric and adult series has been reviewed. Three personal cases were added. RESULTS: One hundred forty-two paediatric second brain tumours were evaluated. Out of them, 69 were malignant gliomas, 33 meningiomas, 8 sarcomatous lesions and 13 low-grade astrocytomas. The average latency period for the appearance of the second tumour was 8 years. Among the second tumours occurring in adults, meningioma is the most common. In this subgroup, the latency period ranged between 16 and 30 years. CONCLUSION: Paediatric radiation-induced brain tumours differ from the adult counterpart for both the histological subtypes. These figures indicate a specific vulnerability of the infantile brain demonstrated by the most frequent occurrence of highly malignant lesions.     

Prevention of corticosteroid-induced osteoporosis with salmon calcitonin in sarcoid patients

Summary The aim of this study was to evaluate the usefulness of salmon calcitonin (sCT) in preventing corticosteroid-induced osteoporosis. Three groups of patients with sarcoidosis requiring long-term steroid therapy were followed for 2 years with yearly evaluations of vertebral cancellous mineral content (VCMC) by quantitative computed tomography. The first group (n=18) was treated with intramuscular (i.m.) sCT for the 2-year study period; the second (n=11) with i.m. sCT for the first 4 months and then with sCT nasal spray for 20 months; the third (n=35) received no sCT. We observed a large mineral loss in the third group but a very slight drop of VCMC in the two groups receiving sCT. SCT nasal spray was better tolerated and as effective as i.m. injections. The action of sCT appeared extremely useful, especially in the first year of steroid therapy when corticosteroid-induced mineral loss was maximal. We conclude that sCT nasal spray is a good tool for preventing corticosteroid-induced osteoporosis.