Takayasu's arteritis: a review of the literature

Takayasu's arteritis is a rare, idiopathic, chronic inflammatory disease with cell-mediated inflammation, involving mainly the aorta and its major branches. It leads to stenosis, occlusion or aneurysmal degeneration of large arteries. The clinical presentation is characterised by an acute phase with constitutional symptoms, followed, months or years later, by a chronic phase in which symptoms relate to fibrosis or occlusion of vessels. Angiography is the gold standard for diagnosis and for topographical classification and it correlates with symptoms and prognosis. Here we focus on the pathophysiology, clinical and angiographical classification, diagnostic assessment and therapeutic approach of Takayasu's arteritis.     

Transmembrane adaptor molecules: a new category of lymphoid-cell markers

Transmembrane adaptor proteins (of which 7 have been identified so far) are involved in receptor signaling in immune cells. They have only a short extracellular region, with most of the molecule comprising a substantial intracytoplasmic region carrying multiple tyrosine residues that can be phosphorylated by Src- or Syk-family kinases. In this paper, we report an immunohistologic study of 6 of these molecules in normal and neoplastic human tissue sections and show that they are restricted to subpopulations of lymphoid cells, being present in either T cells (LAT, LIME, and TRIM), B cells (NTAL), or subsets of both cell types (PAG and SIT). Their expression in neoplastic lymphoid cells broadly reflects that of normal lymphoid tissue, including the positivity of plasma cells and myeloma/plasmacytoma for LIME, NTAL, PAG, and SIT. However, this study also revealed some reactions that may be of diagnostic/prognostic value. For example, lymphocytic lymphoma and mantle-cell lymphoma showed similar profiles but differed clearly from follicle-center lymphoma, whereas PAG tended to be selectively expressed in germinal center-derived subsets of diffuse large B-cell lymphoma. These molecules represent a potentially important addition to the panel of immunophenotypic markers detectable in routine biopsies that can be used in hematopathologic studies.     

Effect on survival of the development of late-onset non-infectious pulmonary complications after stem cell transplantation

We evaluated the incidence, risk factors, and clinical outcome of late-onset non-infectious pulmonary complications (LONIPC) in 599 patients who underwent hematopoietic allogeneic stem cell transplantation (HSCT). The 2-year cumulative incidence of LONIPC was 10% among the 438 patients surviving more than 3 months after HSCT. Transplants from an unrelated donor and occurrence of extensive chronic graft-versus-host disease were the variables significantly associated with the development of LONIPC. The 5-year overall survival was significantly worse among patients with LONIPC than among those without (34% vs 65%, p=0.009). Causes of death were respiratory failure and infections. The relapse rate was similar in the two groups.     

Lead extraction: a new effective tool to overcome fibrous binding sites

We report the case of a 50 year-old woman referred for extraction of an infected biventricular implantable cardioverter defibrillator (ICD) who underwent device and leads extraction. Due to adhesions at the level of the subclavian–innominate vein angle, manual traction with locking stylet was ineffective. A new mechanical sheath provided with a stainless steel bladed tip, the Evolution™ Mechanical Dilator Sheath (Cook Medical), was successfully used to complete lead extraction. As far as we know, this is the first report on the use of this new tool; its safety should be ascertained by increasing the number of cases but its simple use and its low cost make the Evolution™ Mechanical Dilator Sheath a new interesting tool that can be added to the instruments available for lead extraction. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

The metabolic syndrome (MS) in the elderly: considerations on the diagnostic criteria of the International Diabetes Federation (IDF) and some proposed modifications

This study aimed at verifying the International Diabetes Federation (IDF)-indicated criteria in the elderly, characterized by a decrease of several normal values, the neglected evaluation of those values with aging, and an eventual decision of an obligatory consideration of the visceral obesity as a sign of the metabolic syndrome (MS), the relative prevalence of Acute Myocardial Infarction (AMI) and stroke. The study involved 3038 elderly persons (65-84 years), covered by the Italian Longitudinal Study on Aging (ILSA): they were investigated for the diagnosis of MS, for the prevalence of AMI and stroke at the baseline, and after 3 years. We applied both the IDF-criteria and a new concept considering the age-dependent increase of several parameters in older subjects, the previous cardio-cerebrovascular complications, as well as the presence of other diseases being independent of those complications. The prevalence of AMI and stroke determined according to the IDF-criteria is not different significantly from the results obtained in either the elderly population with "normal" or increased waist circumference (WC), nor in subjects with MS or without MS. After a 3-year-follow-up quite similar results were found. From these results one can conclude that the diagnostic criteria of the IDF for the MS are not valid for the elderly population. We propose some criteria on the basis of which one can reveal systematically significant differences between the MS and the cardiovascular complications. Our conclusion is that it seems to be necessary to verify the validity of our proposed criteria on wider long-term epidemiological studies.     

Medication adherence in schizophrenia: exploring patients', carers' and professionals' views

One of the major clinical problems in the treatment of people with schizophrenia is suboptimal medication adherence. Most research focusing on determinants of nonadherence use quantitative research methods. These studies have some important limitations in exploring the decision-making process of patients concerning medication. In this study we explore factors influencing medication adherence behavior in people with schizophrenia using concept mapping. Concept mapping is a structured qualitative method and was performed in 4 European countries. Participants were 27 patients with schizophrenia, 29 carers, and 28 professionals of patients with schizophrenia. Five clinically relevant themes were identified that affect adherence: medication efficacy, external factors (such as patient support and therapeutic alliance), insight, side effects, and attitudes toward medication. Importance ratings of these factors differed significantly between professionals and carers and patients. Professionals, carers, and patients do not have a shared understanding of which factors are important in patients' medication adherence behavior. Adherence may be positively influenced if professionals focus on the positive aspects of medication, on enhancing insight, and on fostering a positive therapeutic relationship with patients and carers.