Differential health effects of written processing of the experience of a surgical operation in high- and low-risk conditions

The aim of this study was to assess the effects of the writing technique on postoperative course in interaction with different levels of risk. Participants were 40 urologic inpatients waiting to undergo transurethral resection of the prostate, with different levels of surgical risk as assessed with the Goldman Preoperative Risk Index (L. Goldman et al., 1978). Only 20 participants wrote for 3 days about the experience of being in the hospital. Measures were days of stay in the hospital after the operation, the Symptom Check List (SCL-90; L. R. Derogatis, 1977; Italian version: G. Magni, C. Messina, D. De Leo, A. Mosconi, & M. Carli, 1983) scores, and a medical evaluation of postoperative course. A significant positive effect of writing on all three dependent variables emerged only in low-risk participants. High-risk writing participants showed a nonsignificantly worse postoperative course on all parameters than did high-risk nonwriting participants. In highly stressful conditions, writing therefore should be employed only with caution.     

High levels of circulating N‐terminal pro‐brain natriuretic peptide in patients with hepatitis C

Summary. Many patients chronically infected by hepatitis C virus (HCV) experience symptoms like fatigue, dyspnea and reduced physical activity. However, in many patients, these symptoms are not proportional to the liver involvement and could resemble symptoms of chronic heart failure. To our knowledge, no study evaluated serum levels of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in a large series of patients with HCV chronic infection (HCV+). Serum NT‐proBNP was assayed in 50 patients HCV+ and in 50 sex‐ and age‐matched controls. HCV+ patients showed significantly higher mean NT‐proBNP level than controls (P = 0.001). By defining high NT‐proBNP level as a value higher than 125 pg/mL (the single cut‐off point for patient under 75 years of age), 34% HCV+ and 6% controls had high NT‐proBNP (Fisher exact test; P < 0.001). With a cut‐off point of 300 pg/mL (used to rule out chronic heart failure in patients under 75 years of age) 10% HCV+ and 0 controls had high NT‐proBNP (Fisher exact test; P = 0.056). With a cut‐off point of 900 pg/mL (used for ruling in chronic heart failure in patients with age 50–75) 8% HCV+ patients and 0 controls had high NT‐proBNP (Fisher exact test; P = 0.12). The study demonstrates high levels of circulating NT‐proBNP in HCV+ patients compared to healthy controls. The increase of NT‐proBNP may indicate the presence of a sub‐clinical cardiac dysfunction. Further prospective studies quantifying these symptoms in correlation with echocardiography are needed to confirm this association.     

Transcatheter aortic valve implantation in a 54-year-old patient with aggressive HIV

We report a case of a 54-year-old patient who was denied surgical replacement for severe aortic stenosis because of complicated acquired immunodeficiency syndrome and who successfully underwent transcatheter aortic valve implantation at our institution.     

Osteomyelitis complicating scleroderma digital ulcers

Skin ulcers are very frequent in scleroderma (SSc), often complicated by local infection; the latter may be responsible for osteomyelitis (OM) of underlying bone. We retrospectively investigate the prevalence of OM in our SSc patients. The study included 248 SSc patients (M/F 21/227, mean age 61?±?13.5 SD years) followed at our Rheumatology Unit for a mean time period of 60.8?±?20.9 SD months. Patients with infected skin ulcers were carefully evaluated for complicating OM, which was diagnosed on the basis of typical clinical symptoms, laboratory, and radiological alterations. Skin ulcers were observed in 119/248 (48 %) SSc patients, more frequently digital ulcers (110/119, 92 %). These patients presented a significantly lower mean age (59?±?14.5 SD vs. 64?±?12.2 SD years; p?=?0.005) and a lower percentage of anticentromere antibodies (40/119, 33.6 %, vs. 66/129, 51.2 %; p?=?0.007) compared with those without ulcers. The prevalence of OM in the entire SSc patients’ series was 7.7 % (19/248); it was invariably found in the setting of patients with infected digital ulcers, showing a surprisingly high percentage of underlying bone involvement (19/45, 42 %). The OM was localized at the hands in 14 patients and feet in 5; moreover, the most frequently isolated pathogens from infected digital ulcers were Staphylococcus aureus and Escherichia coli. Finally, patients with OM presented a significantly lower mean age (p?<?0.016) and higher percentage of anti-Scl70 autoantibodies (p?<?0.0128) compared to those without. We firstly demonstrated, in a large cohort of SSc patients, high prevalence of OM, invariably associated to infected digital ulcers, which represent the main predisposing condition for the development of such a harmful complication.     

The safety of iloprost in systemic sclerosis in a real-life experience

Iloprost (ILO) is employed intravenously for the treatment of severe Raynaud phenomenon (RP) and digital ulcers (DU) in systemic sclerosis (SSc). The aim of this study was to evaluate the safety and tolerability of the intravenous treatment with ILO in different phases of SSc. Eighty-one consecutive non-selected SSc patients, all on nifedipine, with moderate RP, treated with ILO infusion, were retrospectively evaluated. Patients were sub classified according to the edematous or fibrotic/atrophic cutaneous phase of the disease. ILO was infused with a progressive increase of the dosage up to the achievement of patient’s tolerance, 1 day/week. In cases of slower infusion regimen due to adverse events (AE) at the beginning of the administration, patients received a lower dose of the drug (not possible to quantify precisely the final cumulative dosage). 16/81 SSc patients presented digital edema, 5 developed diarrhea, and 9 developed transient hypotension during the infusion at 20 ml/h that ameliorated when the drug was withdrawn. Moreover, 10/16 edematous patients experienced significant and painful digital swelling, unlike patients in the fibrotic group (p?<?0.0001); 11/16 patients reported flushing and 7/16 headache, always controlled with dose tapering below 10 ml/h. In the atrophic/fibrotic phase patients (65/81), 10 developed diarrhea and 24 hypotension at infusion rate of 20 ml/h that led to temporary withdrawal of the drug. When ILO was restarted and kept below 10 ml/h, no side effects were experienced. 23/65 patients experienced flushing and 8/65 headache, all controlled with infusion reduction below 10 ml/h. In these patients, adverse events were significantly less frequent than in the edematous group (p?=?0.023 and p?=?0.008, respectively). Our data suggest that calcium channel blockers should be transitorily stopped while using ILO and that a pre-treatment approach might reduce or control adverse events. In patients with digital edema, ILO infusion should be carefully employed after the evaluation of patient’s drug tolerance.     

Treatment of severe scleroderma skin ulcers with recombinant human erythropoietin

Systemic sclerosis (SSc) is frequently complicated by skin ulcers, often unresponsive to traditional treatments. A preliminary evaluation of the effects of recombinant human erythropoietin (rHuEPO) was carried out in 14 patients with SSc with nonhealing, severe cutaneous ulcers. Patients received rHuEPO subcutaneously at a dosage of 150 IU/kg 3 times weekly for 2 weeks, twice weekly for the next 2 weeks, and then once weekly for 1 month. At follow-up 3-6 months from the beginning of the treatment, six patients showed complete resolution of the skin ulcers, while a significant reduction (> 60%) in lesional areas was obtained in the other eight patients (mean +/- SD ulcer area reduced from 27.6 +/- 28 to 5.3 +/- 7.8 cm(2); P<0.005). Moreover, patients' quality of life significantly improved (pain, as measured on visual analogue scale reduced from 96 +/- 5 to 46 +/- 17 points; P=0.0001; disability as measured by the Health Assessment Questionnaire-Disability Index reduced from 1.6 +/- 0.5 to 0.9 +/- 0.4 points; P=0.0001). The rHuEPO may represent a novel treatment of nonhealing scleroderma skin ulcers, suggesting some important aetiopathological implications.