[Spontaneous perirenal hemorrhage in patients with polyarteritis nodosa]. / Emorragia perirenale spontanea in paziente con poliarterite nodosa.

Polyarteritis nodosa is a necrotising vasculitis of small and medium-sized arteries. All coats of these vessels are involved easily resulting in aneurysm formations. It is an immunologic disease owing to immune complexes deposits. Kidney affection is over 80%. Polyarteritis nodosa may be complicated by perirenal hematoma, hemobilia, intrahepatic hemorrhage, epidural hematoma. Spontaneous perirenal hematoma can be the initial manifestation of this disease. Abdominal ultrasonography can provide a quick diagnosis of complicating disease and embolization by interventional radiology may be considered a therapeutic alternative to surgery.

[Methimazole-induced aplastic anemia]. / Anemia aplastica indotta da metimazolo.

The aplastic anemia methimazole induced is a rare event. We describe a case of a woman, affected by hyperthyroidism, who suffers from bone marrow aplasia during Tapazole treatment, and literature has been reviewed. Stopping methimazole and beginning a therapy with methylprednisolone in high dosage, intravenous IgG in high dosage, filgastrin and danatrol, medullary recover after 11 days of treatment is obtained. By analyzing our case and the 12 further cases described, we find that the prognosis of aplastic anemia during the treatment of antithyroid therapy, is rather good. Even if the pathogenetic mechanism of Tapazole induced bone marrow aplasia, it seems to be immuno-mediated in most cases, a direct toxicity in bone marrow cannot be excluded. In examined cases the antithyroid dosage was medium high (mean 40 mg/die). Therefore the use of Tapazole in low doses (15 mg/die) effective in almost all hyperthyroid patient must be considered, when possible, the best therapeutic choice, since it is safer in the incidence of important side effects such as bone marrow aplasia, especially in elderly patients or in patients with chronic renal failure.

[Chronic erythremic myelosis (or the chronic form of Di Guglielmo's disease). A case report]. / Mielosi eritremica cronica (o forma cronica della malattia di Di Guglielmo). Descrizione di un caso.

The chronic erythromyelosis (or chronic type of Di Guglielmo's disease) is a rare illness of uncertain classification. This illness shows characteristics that remember on the one hand the myeloproliferative and on the other hand the myelodysplastic diseases. The therapy is quite unsatisfactory. As a presence of erythrocytic antibodies has been detected, a therapy with steroids, danazol, splenectomy, immunosuppressive agents, plasmapheresis is advised. We have tried a cycle of therapy with high doses of intravenous gammaglobulin (0.4 g/kg/day for 4 days) also in the attempt of reduce, even if temporarily, the hemolytic component due to the reticuloendothelial system's hyperplasia. We conclude that this therapy, in our patient, has not yielded good outcomes immediately but carried out settled levels of haemoglobin as well as reduction of bilirubin and LDH after a month.