Stroke related to carotid artery dissection in a young patient with Takayasu arteritis, systemic lupus erythematosus and antiphospholipid antibody syndrome.

Autoimmune diseases are rarely the cause of stroke even in the young age group in association with cervical artery dissection and collagen vascular diseases. Takayasu arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its main branches. Takayasu arteritis rarely coexists with systemic lupus erythematosus, and only few cases have been reported in association with the presence of antiphospholipid antibodies. We describe a young patient with right internal carotid artery dissection and subsequent stroke who presented with all three syndromes. Although this patient met the diagnostic criteria for each syndrome, systemic lupus erythematosus, Takayasu arteritis and the antiphospholipid antibody syndrome, it remains unlikely that the three disorders are not related. We suggest a single disimmune disorder may have led to carotid artery dissection.

[Fever caused by penicillin. Description of a clinical case]. / Febbre da penicillamina. Descrizione di un caso clinico.

A case of drug-provoked fever is described in a scleroderma patient on penicillamine. The drug was withdrawn because of the severity and recurrence of the fever. Both our personal experience and a review of the literature, show this side effect to be markedly less frequent than reported by German researchers.

[The non-steroidal anti-inflammatory drugs]. / I farmaci antinfiammatori non steroidei.

The non-steroidal anti-inflammatory drugs (NSAIDs) are a chemically heterogenous group of organic acids which possess analgesic, antipiretic, and anti-inflammatory action. They act by inhibiting the biosynthesis of the ubiquitous chemical mediators prostaglandins, but other mechanism of action are probably important. More than one hundred NSAIDs have been studied and many of them have been marketed worldwide, in many different formulations. Pharmacokinetic characteristics are different with various compounds and some of these differences may be relevant for the efficacy/safety profile of some of these drugs. The range of clinical applications of NSAIDs has been extended remarkably as a result of the recognition of their action on ubiquitous prostaglandins. In general NSAIDs therapeutic efficacy is similar and probably not superior to that of aspirin. Although the risk of serious toxicity from the newer NSAIDs is reasonably low in individual patients, the high prevalence of usage of these drugs, especially in the elderly, gives perception of a high relative risk. A high level of vigilance for toxicity, especially that of the gastrointestinal tract and the kidney, seems wise. The basis for the selection and rational use of NSAIDs is reviewed.

Leukopenia with neutropenia associated with teicoplanin therapy.

The first case report of leukopenia with neutropenia due to the new glycopeptide antibiotic teicoplanin is described. The side effect occurred in a 73-year-old man hospitalized because of subacute bacterial endocarditis caused by Streptococcus faecalis. Leukopenia with neutropenia (white blood cells 2000/mm3, neutrophils 46%) developed after 20 days of teicoplanin therapy. After stopping teicoplanin white blood cell and neutrophil counts reverted to normal, but dropped again on rechallenge. A review of 1500 records of patients treated with teicoplanin alone or in combination with other drugs was also performed. Five cases were found in which leukopenia was possibly (four cases) or probably (one case) related to teicoplanin therapy. From these preliminary data the incidence of leukopenia related to teicoplanin seems to be low.

Oesophageal motor activity in rheumatoid arthritis: a clinical and manometric study.

Oesophageal motor function was clinically and manometrically investigated by means of a low-compliance system in 24 nonselected rheumatoid arthritis (RA) patients and 15 healthy controls. Dysphagia was referred by 37.5% of RA patients. Oesophageal motor abnormalities were discovered to be significantly present in a high percentage (62.5%) of patients with RA. However, there was no correlation between oesophageal motor abnormalities and any disease characteristic. It is concluded that a high percentage of RA patients have an oesophageal motor dysfunction, even in the absence of dysphagic symptoms.