Efficacy and safety of the intravitreal treatment of diabetic macular edema with pegaptanib: a 12-month follow-up.

AIM: This observational study was performed to evaluate the efficacy and safety of intra-vitreal injections of pegaptanib during a 12-month follow-up period. PATIENTS AND METHODS: Forty eyes (20 patients) affected by diabetic macular edema were monitored. Twenty were subjected to treatment, and 20 were controls. The treatment involved a cycle of three intravitreal injections of pegaptanib (0.3 mg every 6 weeks), at the end of which treated patients were submitted to a monthly follow-up for a period of 12 months. The aim was to evaluate the clinical condition of the eye after therapy and gauge the efficacy of the long-term use of this drug. Specific criteria were used to measure the efficacy and safety of pegaptanib. Regarding efficacy, we considered the following: an average improvement in the power of vision, or visual acuity, of →10 letters (2 lines), equivalent to an average logMAR score of →0.2, and a reduction in the central macular thickness of →250 µm. Regarding safety, we considered the occurrence of undesired eye and systemic side effects correlated to either the drug itself or the injection procedure. RESULTS: The logMAR score for the measurement of visual acuity at T3 (third intra-vitreal injection at week 13) with respect to T0 decreased from 0.7 ± 0.277 to 0.445 ± 0.216, suggesting an improvement, while the mean Early Treatment Diabetic Retinopathy Study (ETDRS) score increased from 25.75 ± 13.046 to 34.300 ± 11.770 letters. The central macular thickness was reduced from the initial value of 746.95 ± 293.601 to 334.050 ± 93.997 µm. In seven controls, we registered a worsening both in terms of visual acuity and macular thickness in some eyes, justifying a continuation of therapy in eight eyes of the control group. CONCLUSIONS: Pegaptanib proved to be efficacious and safe for the treatment of diabetic macular edema throughout the 12-month followup. To evaluate its long-term efficacy, further studies are required with larger numbers of patients and longer observational follow-up periods.

[Epidemiology of syphilis: new cases of neurosyphilis]. / Epidemiologia della sifilide: nuovi casi di neurolue.

The Authors report three cases of ophthalmic neurosyphilis in patients who complained a visual decrease monocular. The diagnosis was performed with physical and fundus examination, electrophysiological, hemato-chemical and microbiological tests, fluorangiografy and RMN. The physical examination provided standard results about eyes interested while the fundus examination, as well as the electrofunctional and fuorangiografy examinations, showed some alterations. The sockets and encephalon RMN were normal. Moreover; the patients were submitted to specific haematic and microbiological laboratory tests which showed positivity for syphilis. To sum up all patients received an incidental diagnosis of syphilis. This trend could be attributable to an extensive use of antibiotics that changing the natural course of disease, mask clinical evidences and make them harder to diagnose.

A pilot clinical study on the effectiveness of mesoglycan against diabetic retinopathy.

PURPOSE: A double-blind placebo-controlled study on 68 patients suffering by Diabetic Retinopathy was aimed in order to evaluate the effectiveness of Mesoglycan in this pathology. This drug is particularly interested in treatment of disorders of microcirculation. MATERIALS AND METHODS: The two treatments were randomly assigned to each patient, using a 100 mg/day dosage of Mesoglycan, and both treatments were prescribed for 6 months. The efficacy of both treatments was based on clinical and instrumental check. RESULTS: The clinical results that emerged in the group treated with Mesoglycan were excellent, although observations are on a limited number of patients appears a direct action of Mesoglycan on the endothelium retinal blood vessels and circulation. Indeed, in the observed patients, was detected a significant reduction of microhemorrhages, microaneurysms and exudates. The same cannot be said of the placebo group; none of patients of that group showed signs of clinical improvement at the end of the study. CONCLUSION: Data emerging from our study show a direct action of Mesoglycan on endothelium retinal blood vessels and circulation, as we observed in patients we found a significant reduction in the number of microhemorrhages, microaneurysms and exudates. This action can be explained by the characteristics of drug as antithrombotic profibrinolytic and anti-edema, already found in vitro and experimentally. We conclude that our preliminary study showed an encouraging clinical efficacy, together with excellent tolerability, and therefore our objective has been met, which was to verify the existence of the prerequisites for a larger clinical study.

Testing the effectiveness of intravitreal ranibizumab during 12 months of follow-up in venous occlusion treatment.

AIMS: To determine the effectiveness and safety of treatment of intravitreal Ranibizumab for Central Retinal Vein Occlusion. PATIENTS AND METHODS: This non-randomized observational clinical study was comprised of a round of therapy with three IVI. Twenty eyes affected by CRVO were recruited. The average age was 65.06 +/- 15 years and criterion for inclusion: age >18 years, best Corrected Visual Acuity (BCVA) from 5 to 40 letters and macular edema with thickness greater than 275 micrometer. The criteria used for reinjection were: CMT> 150 micrometer, ETDRS <10 letters and LogMAR <0.2. The statistical analysis for continuous variables (ETDRS, logMar and CMT) was conducted calculating median and range (min-max), since these variables, due to sample size, were not normally distributed.Time trends of these variables were plotted with boxplot and differences. Events between T0 and T12 were assessed using the analysis of variance (ANOVA) for repeated measurements and the F test (Pillai's trace). The statistical significance was set at p <=0.05. RESULTS: All of the patients showed improvement. In fact, the ETDRS went from a median of 20.00 to 28.50, LogMAR went from a median of 0.75 to 0.55 and the values for CMT went from a median of 556.00 micrometer to 390.00 micrometer. The drug reaches maximum effectiveness after two months of therapy, with T2 remaining constant from the third injection at T3 until the end of 12 months at T12. CONCLUSIONS: The results produced by our study indicate that Ranibizumab is a valid treatment for CRVO.

[The 'dreams' of Cesare Augusto Levi: a pre-Freud interpretation]. / "i sogni" di Cesare Augusto Levi: un' interpretazione preFreudiana.

On 25th February, 1887 Cesare Augusto Levi, a poet and archaeologist born in Venice in 1856, held a conference on dreams at the "Ateneo di Venezia". The conference deals with the nature of dreams, with the unconscious, with hypnosis and magnetism. Levi advocates a socially oriented version of psychiatry and he may be considered as a forerunner of Freud's theories.

[The effects of the carbocalcitonin + arginine-lysine-lactose combination in senile involutional osteoporosis]. / Effetti della associazione carbocalcitonina + arginina-lisina-lattosio nell'osteoporosi involutiva senile.

Numerous osteometabolic factors are implicated in the bone mass loss which occurs with ageing. Among these a significant role is played by the impairment of intestinal calcium absorption which may be attributed in the elderly to various factors such as the reduction of chlorhydro-peptic secretion, the correlated deficiency of vitamin D and their relative duodenal receptors. In order to evaluate the clinical efficacy of an arginine-lysine-lactose preparation a group of 40 subjects with senile involutional osteoporosis was studied. The subjects were divided into two groups using random criteria and were treated with carbocalcitonin alone (40 UMRC day i.m. on alternative days) or carbocalcitonin association complex. The following parameters were evaluated in basal conditions and after six months of treatment: bone mass density (BMD) using computerised bone mineralometry, bone pain, intake of analgesics, serum levels of calcium, phosphorus, alkaline phosphatase, osteocalcin, parathormone, as well as calciuria and hydroxyprolinuria. The comparison between the two groups shows a more marked increment in BMD in subjects treated with arginine-lysine-lactose, a greater reduction in painful symptoms, and a more evident and significant reduction of parathormone and hydroxyprolinuria levels. These effects appear to be due to a distinct improvement in intestinal calcium absorption mediated by lysine and lactose, and probably to a positive action played by the amino acid at the level of support structures.

Plasma predeposit: the role of productive plasmapheresis.

At the Rizzoli Orthopaedic Institute, as part of our autotransfusion program, we have recently had the possibility to introduce plasma predeposit by means of productive plasmapheresis in patients undergoing major orthopaedic surgery, in which bleeding more than 50-60% of circulating blood mass was expected and so a greater quantity of plasma compared to red blood cells was considered necessary. Red cells and fresh frozen plasma predeposits and perioperative blood recovery was sufficient to cover transfusional needs. In our opinion, plasma predepositing by plasmapheresis is indicated in patients with anaemia, cardiopathy and/or vasculopathy, minute constitution.

[Comparative study of ASA and heparan sulfate in the secondary prevention of cerebrovascular disorders]. / Studio di confronto tra ASA ed eparansolfato nella prevenzione secondaria delle vasculopatie cerebrali.

Aim of our study was to compare heparan sulphate and acetylsalicylic acid (ASA) in the secondary prevention of cerebrovascular events. Eighty patients with recent episodes of RIA or minor stroke of atherothrombotic origin were randomized in two groups of 40, one treated with heparan sulphate and the other with ASA. The two groups were homogeneous for age, sex, clinical history and type of events qualifying for enrollment. After a 6-month follow-up no difference was found in fatal or non fatal vascular events. The incidence of adverse reactions was significantly lower in the heparan sulphate group. All the patients showed a trend towards improvement in cognitive functioning, but a significant improvement in attentional functions was observed only in the heparan sulphate group. As hypothesis, it may be supposed that such clinical results depend on a better perfusion of inner watershed cerebral areas.

Seckel's syndrome: presentation of one case associated with Legg-Calvé-Perthes disease.

The authors present the case of one patient affected with Seckel's syndrome which came to their observation as a result of pain in the hip with limping, diagnosed after Legg-Calvé-Perthes disease. There seems to be an accidental relationship between the two diseases, although Legg-Calvé-Perthes disease is frequently described in all cases of endocrinous dwarfism.

[Anthropologic and ethnic psychology]. / La psicologia antropologica ed etnica.

In the second half of the 19th century and up to the first two decades of the 20th century a new school of thought about two fundamental trends began and gradually developed; firstly anthropology and secondly the findings of Linneo and Buffon in the 18th century. Consequently, in the field of anthropology and the science of human constitutions, one notes the importance of a chapter which hitherto has remained rather unclear; anthropologic and ethnic psychology which made use of certain experimental data which were increasingly available in various research laboratories. The Italian Giuseppe Sergi, the Frenchman Giuseppe Arturo Visconte di Govineau, the German Guglielmo Wundt and others added their remarkable contributions to this new field of study.

[Rheumatoid serology: insufficient using a single test]. / Sierologia reumatoide: insufficiente un solo test.

The rheumatoid factor research restricted to only a test finds evident limitation not only in clinical field, but also on epidemiological investigations. The problem may find a solution by contemporary employment of a tests pool both in epidemiology and in the different physiopathological conditions present in rheumatology. Such kind of proposal has been verified on rheumatic diseases (rheumatoid arthritis classic or probable, polyarthritic syndrome, polyarthritis, spondylitis, psoriatic arthritis) and not rheumatic ones and in control group population (2901 subjects controlled). The results obtained emphasize the eventual presence of rheumatoid factor in the control group population, usually documented by the isolate positivity of three or more tests is preponderant for the same occurrence. By the statistical analysis applied to the conditions with equivalent number in the positive tests, is resulted that the possibility to discriminate the population, apparently health from the sick one is realized in a significative way of the positive tests, and starting from the positivity of two or more tests at least. It can be concluded confirming the already historical datum that the rheumatoid factor research with a test only has a limited orientation power to the diagnosis purpose.