Characteristics of patients with allergic polysensitization: the POLISMAIL study.

BACKGROUND: The natural history of respiratory allergy is commonly characterized by a worsening of symptom severity, frequent comorbidity of rhinitis and asthma, and polysensitization to aeroallergens. The polysensitization phenomenon starts since childhood and is rare to find monosensitized adult patients. However, there are few studies investigating the characteristics of polysensitized patients. METHODS: This study was performed on a large cohort of patients with allergic rhinitis (assessed by ARIA criteria) and/or mild to moderate asthma (assessed by GINA). The kind and the number of sensitizations, their patterns, and the relation with quality of life (QoL) measured by the Juniper's RQLQ guestionnaire, were evaluated. RESULTS: Globally 418 patients (50.2% males, 49.8% females, mean age 26.4 years, range 3.5-65 years, 64 smokers, 371 non-smokers) were enrolled: 220 had allergic rhinitis alone, and 198 allergic rhinitis and asthma. The mean number ofsensitizations was 2.6. Three hundred-five patients (73%) had persistent rhinitis (PER), 220 of them with moderate-severe form. There was no significant derence in rate of rhinitis and asthma in monosensitized or polysensitized patients. Most patients were sensitized to pollens, whereas only 24.2% of them were sensitized to perennial allergens. Polysensitization was significantly associated with some issues of QoL, confirming previous findings, but not with number ofsensitizations. CONCLUSIONS: This study provides data confirming for poly-sensitized patients the relevance of ARIA classification of AR. PER is the most common form of AR in this cohort, symptoms are frequently moderate-severe, and asthma is present in about the half of patients with AR.

S-adenosil-L-methionine is able to reverse the immunosuppressive effects of chenodeoxycholic acid in vitro.

The study was conceived to evaluate if S-adenosil-L-methionine, a substance commonly used in the treatment of cholestasis in patients with cirrhosis and chronic hepatitis, exerts any immunological effect and of it is able to counterbalance bile acid-mediated immunosuppression. Proliferation and interleukin 2 and interferon-gamma secretion of human lymphocytes, collected from healthy subjects and exposed to mitogenic stimuli (phytohemagglutinin, pokeweed and anti-CD3 monoclonal antibodies), were analysed in the basal condition or after exposure to S-adenosil-L-methionine and/or chenodeoxycholic acid. Chenodeoxycholic acid inhibited phytohemagglutinin-induced lymphocyte proliferation and interferon-gamma secretion, and phytohemagglutinin and pokeweed-mediated interleukin 2 secretion. S-adenosil-L-methionine did not affect lymphocyte proliferation while it reduced interleukin 2 secretion upon phytohemagglutinin and pokeweed stimulation and interferon-gamma secretion upon all stimuli tested. Moreover, S-adenosil-L-methionine counteracted chenodeoxycholic acid-mediated inhibition of lymphocyte proliferation and interleukin 2 secretion. The results of our study confirm the immunosuppressive role of chenodeoxycholic acid on both secretive and proliferative lymphocyte functions and provide evidence of immunomodulatory activities of S-adenosil-L-methionine and its capacity to antagonize chenodeoxycholic acid-mediated inhibition of lymphocyte proliferation and interleukin 2 secretion.

Cardiac and carotid structure in arterial hypertension and in hypertrophic cardiomyopathy.

The aim of this study was to measure intima-media thickness (IMT) of the common carotid artery (CCA) in patients with hypertrophic cardiomyopathy (HCM) and in hypertensive patients with left ventricular hypertrophy (LVH). We studied 73 subjects: 20 normotensive healthy subjects as control group (I); 20 patients with essential hypertension without LVH (II); 20 hypertensives with LVH (III), and 13 normotensive patients with HCM (IV). Each subject underwent a complete echocardiographic and vascular ultrasonographic study in order to assess left ventricular parameters and the IMT at the level of the CCA. Left ventricular mass index (LVMI) was significantly higher in groups III and IV than in groups I and II (156 +/- 18 and 157 +/- 31 vs. 94 +/- 14 and 98 +/- 10 g/m2, respectively, p < 0.01), while IMT was significantly greater in group III but not in the others [0.88 +/- 0.04 vs. 0.61 +/- 0.03 (I), 0.64 +/- 0.03 (II) and 0.61 +/- 0.04 (IV) mm, p < 0.01]. The correlation between LVMI and IMT was statistically significant within all the hypertensive patients (r = 0.48, p < 0.01) but not in the HCM group (r = 0.17, p = NS). The hypertensive patients with LVH showed structural alterations (related to hemodynamic and humoral factors) both at cardiac and vascular level while in patients with HCM the cardiac alterations (due to a genetic disorder) were not associated with changes at the level of the large arteries.

Intramuscular calcitriol for uraemic children with severe hyperparathyroidism and hypercalcaemia.

The effect of intramuscular calcitriol was evaluated in five children (aged 1-16 years) with severe chronic renal failure and hyperparathyroidism [range of intact parathyroid hormone (PTH) 400-1,200 pg/ml]. All five children had been on oral calcitriol or 1 alpha-hydroxyvitamin D3 treatment (5-20 ng/kg per day), but an adequate, efficacious dosage could not be achieved since any attempt of increasing the dosage resulted in severe hypercalcaemia (> 2.9 mmol/l). Intramuscular calcitriol was given three times weekly for 5 months at an initial dosage of 65-70 ng/kg to all but one patient who received 100 ng/kg. In the first three patients, treatment resulted in an 86%-98% fall in serum PTH compared with baseline levels and serum calcium never exceeded 2.65 mmol/l, except for one episode of hypercalcaemia in one patient. In the last two patients, serum calcium rose above normal limits, thus calcitriol had to be discontinued several times and then restarted at a lower dosage (40 ng/kg); PTH fell by 61% and 73%, respectively, compared with basal values. All patients had very low pre-treatment levels of serum 1,25-dihydroxyvitamin D3 (5-15 pg/ml) which were normalized (35-56 pg/ml) by the intramuscular calcitriol-treatment. Serum phosphorus and magnesium did not vary in any of the five patients. No side effects were observed at the injection site. Intramuscular calcitriol seems a useful therapeutic option for patients with severe hyperparathyroidism associated with a high serum calcium level when treated with conventional oral calcitriol.

[Giant-cell arteritis. Comments on the case histories of 30 patients]. / Arterite a cellule giganti. Riflessioni su una casistica di 30 pazienti.

This survey deals with the main clinical aspects at the diagnosis and during the follow-up of thirty consecutive patients with giant-cell arteritis (temporal arteritis and rheumatic polymyalgia), controlled over a period of 15 years. The work aimed at verifying the diagnostic accuracy with regard to a more underestimated than rare disease. We believe that such a consideration is a useful introduction to a wider research into the epidemiological and biological aspects of the disease which are still to be determined.

Results of routine patch testing of 834 patients in Turin.

834 consecutive patients (630 female), aged between 26 and 46 years, who were suspected of having allergic contact dermatitis were patch tested with the GIRDCA standard series during 1989-1990. The most frequent sensitizers observed included nickel sulphate, cobalt, Kathon CG, perfumes, potassium dichromate and balsam of Peru. We have evaluated the influence of individual factors such as sex, age and occupation on the patch test results, and the coexistence of 2 or more unrelated but statistically significant sensitivities.

Microbiological study of Enterococcus faecium SF68: post-antibiotic effect and growth curves.

We studied the microbiological characteristics of Enterococcus faecium SF 68 (an oral vaccine) assessing post-antibiotic effect of ampicillin and growth curves in different media. Results showed a good resistance of the microorganism tested which has important implications in clinical practice. The growth ability of Enterococcus faecium SF 68 was similar on all media tested.

[Role of Enterococcus faecium SF 68 in experimental infection in mice]. / Ruolo dell'Enterococcus faecium SF 68 nell'infezione sperimentale del topo.

The normal intestinal flora is an important defence against various infectious agents. It also allows important metabolic stages in the host. The Authors studied the ability of Enterococcus faecium SF 68 to protect the mice (Swiss strain) from infection by Salmonella typhi and its role when used with penicillin in infection by Staphylococcus aureus. Our results showed that SF 68, determined a good protection against infection. Moreover the association E. faecium SF 68-antibiotic lowers the mortality rate in the infected mice compared with the control group.

[Correlation between arterial pressure at rest and during effort and left ventricular mass in hypertensive patients who were never treated]. / Correlazione tra pressione arteriosa a riposo e sotto sforzo e massa ventricolare sinistra in pazienti ipertsi mai trattati.

A poor correlation has been found between blood pressure at rest and left ventricular mass in the course of several echocardiographic studies on hypertensive patients. The aim of this work was to determine if this finding could be the result of previous antihypertensive therapy, which had been suspended a few weeks previously in most of the studies. In addition, we tested whether blood pressure values during physical exercise correlate with the echocardiographic indices of left ventricular mass better than the values at rest. In our group of 43 patients with mild to moderate essential hypertension who had never been pharmacologically treated, the correlation between both systolic and diastolic blood pressure and left ventricular mass was poor (r = 0.41 and 0.30 respectively). This result suggests that one or more factors other than hypertension may determine the development of left ventricular hypertrophy. However, in 10 patients with left ventricular hypertrophy a more significant correlation was found between cardiac mass and diastolic pressure (r = 0.52), rather than systolic pressure (r = 0.33). This finding supports data indicating that cardiovascular risk is related more to diastolic pressure increments than to systolic pressure. As for blood pressure values during physical exercise, in our study they did not show a better predictivity of ventricular mass than the values at rest.

Calorimetric response to amino acid infusion in sepsis and critical illness.

The effect of the infusion of mixed amino acids with glucose and fat on metabolic rate (MR) in sepsis (S) and in nonseptic trauma (NS) was investigated. The results demonstrated that diet-induced thermogenesis (specific dynamic action) controlled in S and in NS 25% and 18% of the MR variability, respectively (r2 = .25 and .18, p less than .01 for both). Also, diet-induced thermogenesis represented a quantitatively relevant portion of the total MR. There was a larger thermogenic effect of amino acids in S with respect to NS (22.3 vs. 5.7 cal/mg N, p less than .01) with a concomitantly increased thermogenic effect of fat. The results suggest the importance of recognizing the thermogenic effect of administered nutrients as an important determinant of MR during calorimetric measurements. The finding of an enhanced thermogenic effect of amino acids and fat in S also implies the need for more complete investigations of the impact of these substrates in modifying oxidative and energy metabolism in S.

Bladder reconstruction after cystectomy: use of ileocecal segment and three-loop ileal reservoir.

We report on 11 patients who in 1980-1982 had bladder reconstruction, after cystectomy for bladder cancer, utilizing the ileocecal valve as an antireflux mechanism and a direct urethrocecal anastomosis. They received preoperative irradiation (2,000 rad) and had some early complications such as pelvic abscesses and temporary urinary fistulas. We have since omitted preoperative radiation on cases performed in 1984-1987 and they did not have these complications.

Effect on resting blood pressure and blood pressure homeostasis of short-term administration of the alpha 1-adrenergic receptor antagonist, trimazosin, in hypertension.

The effects of trimazosin on blood pressure and cardiovascular homeostasis were studied in 12 subjects with untreated essential hypertension of mild or moderate degree. After a 3-day placebo period, the subjects were given trimazosin at the dose of 50, 100, or 200 mg twice daily (7 am and 7 pm) according to a randomized, double-blind crossover protocol. Each treatment was prolonged for 3 days and separated from the subsequent treatment by a 2-day placebo period. Blood pressure (sphygmomanometry) and heart rate were measured at rest during various laboratory maneuvers on the first and third day of the initial placebo, on the first and third day of the drug periods, and on the second day of the intervening placebo periods. Compared to placebo values, trimazosin caused a reduction in systolic and diastolic blood pressure which was well sustained through the time between the morning and the evening administration of the drug and was accompanied by only a slight tachycardia. the antihypertensive effect was similar in the supine and upright position and in both instances it was greater for the 100 or 200 mg twice daily dose than for the 50-mg twice daily dose. The pressor and tachycardic responses to cold pressor test and to isometric and dynamic exercise were unaffected by the various doses of trimazosin whose antihypertensive effect was therefore similarly evident at rest and during behaviorally occurring blood pressure rises.(ABSTRACT TRUNCATED AT 250 WORDS)