Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with Pycnogenol.

In a previous, double-blind, placebo-controlled study we evaluated the efficacy of a 3-month treatment with Pycnogenol for 156 patients with osteoarthritis of the knee. Pycnogenol significantly decreased joint pain and improved joint function as evaluated using the WOMAC score and walking performance of patients on a treadmill. In this study, we further investigated the anti-inflammatory and antioxidant activity of Pycnogenol in a subset of the osteoarthritis patients presenting with elevated C-reactive protein (CRP) and plasma-free radicals. Elevated CRP levels have been suggested to be associated with disease progression in osteoarthritis. In our study, 29 subjects of the Pycnogenol group and 26 patients in the placebo group showed CRP levels higher than 3 mg/l at baseline. Comparison of blood specimens drawn at baseline and after 3-month treatment showed that Pycnogenol significantly decreased plasma free radicals to 70.1% of baseline values. Plasma CRP levels decreased from baseline 3.9 mg/l to 1.1 mg/l in the Pycnogenol group whereas the control group had initial values of 3.9 mg/l which decreased to 3.6 mg/l. The CRP decrease in the Pycnogenol was statistical significant as compared to the control group (P < 0.05). Fibrinogen levels were found to be lowered to 62.8% of initial values (P < 0.05) in response to Pycnogenol. No significant changes for plasma free radicals, CRP and fibrinogen were found in the placebo-treated group. The decrease of systemic inflammatory markers suggests that Pycnogenol may exert anti-inflammatory activity in osteoarthritic joints and patients did not present with other ailments or infections. The nature of the anti-inflammatory effects of Pycnogenol with regard to CRP warrants further investigation.

Treatment of osteoarthritis with Pycnogenol. The SVOS (San Valentino Osteo-arthrosis Study). Evaluation of signs, symptoms, physical performance and vascular aspects.

The aim of this double-blind, placebo-controlled study was to evaluate the efficacy of 100 mg Pycnogenol daily (oral capsules) in a 3 month study in patients with osteoarthritis (OA). OA symptoms were evaluated by WOMAC scores, mobility by recording their walking performance (treadmill). Treatment (77 patients) and placebo group (79) were comparable for age, sex distribution, WOMAC scores, walking distances and use of antiinflammatory drugs. The global WOMAC score decreased by 56% (p < 0.05) in the treatment group versus 9.6% in the placebo group. Walking distance in the treadmill test was prolonged from 68 m at the start to 198 m after 3 months treatment (p < 0.05), under placebo, from 65 m to 88 m (NS). The use of drugs decreased by 58% in the treatment group (p < 0.05) versus 1% under placebo. Gastrointestinal complications decreased by 63% in the treatment group, but only 3% under placebo. Overall, treatment costs were reduced significantly compared with placebo. Foot edema was present in 76% of the patients of the treatment group at inclusion and in 79% of the controls. After 3 months edema decreased in 79% of Pycnogenol patients (p < 0.05) vs 1% in controls. In conclusion, Pycnogenol offers an option for reduction of treatment costs and side effects by sparing antiinflammatory drugs.

Management of superficial vein thrombosis and thrombophlebitis: status and expert opinion document.

Superficial vein thrombosis is characterized by clotting of superficial veins (ie, following direct trauma) with minimal inflammatory components. Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection. Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise and ambulation, and, in some cases, local or systemic anticoagulants. It is better to avoid bed rest and reduced mobility. Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the superficial vein thrombosis/superficial thrombophlebitis area controls symptoms. Hirudoid cream (heparinoid) shortens the duration of signs/symptoms. Locally acting anticoagulants/antithrombotics (Viatromb, Lipohep, spray Na-heparin) have positive effects on pain and on the reduction in thrombus size. Intravenous catheters should be changed every 24 to 48 hours (depending on venous flow and clinical parameters) to prevent superficial vein thrombosis/superficial thrombophlebitis and removed in case of events. Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters. In case of superficial vein thrombosis/superficial thrombophlebitis, vein lines should be removed. In neoplastic diseases and hematological disorders, anticoagulants may be necessary. Exercise reduces pain and the possibility of deep vein thrombosis. Only in cases in which pain is very severe is bed rest necessary. Deep vein thrombosis prophylaxis should be established in patients with reduced mobility. Antibiotics usually do not have a place in superficial vein thrombosis/superficial thrombophlebitis unless there are documented infections. Prevention of superficial vein thrombosis should be considered on the basis of patient's history and clinical evaluation.

Improvement of diabetic microangiopathy with pycnogenol: A prospective, controlled study.

The aim of this study was to investigate the clinical efficacy of oral Pycnogenol (Horphag Research Ltd, United Kingdom) in patients with diabetic microangiopathy. Patients without a history of diabetic ulcerations were treated with Pycnogenol. Patients received oral Pycnogenol (50 mg capsules, 3 times daily for a total of 150 mg daily for 4 weeks). A group of 30 patients was included (severe microangiopathy); 30 comparable patients were observed as controls (no treatment during the observation period). All patients (age, 59 years; range, 55-68 years; male:female = 18:12) included in the treatment group completed the 4-week study. Also, all controls completed the follow-up period. There were no drop-outs. All included subjects had signs and symptoms of diabetic microangiopathy. The duration of diabetes-from the first signs/symptoms--was on average 7.5 years (SD = 3). After 4 weeks, microcirculatory and clinical evaluations showed a progressive decrease in skin flux at rest in the foot (indicating an improvement in the level of microangiopathy), a significant decrease in capillary filtration, and a significant improvement in the venoarteriolar response in all treated subjects. There were no visible effects in controls except a slight reduction in skin flux at rest in the foot. Treatment was well tolerated in both groups. In conclusion, this study confirms the clinical efficacy of Pycnogenol in patients with diabetic microangiopathy. The study indicates the clinical role of Pycnogenol in the management, treatment, and control of this common clinical problem. The treatment may be also useful to prevent diabetic ulcerations by controlling the level of microangiopathy.

Diabetic ulcers: microcirculatory improvement and faster healing with pycnogenol.

Diabetic microangiopathy leads to lower limb ulcers that are very slow to heal. Pycnogenol was evaluated on diabetic ulcers in a controlled trial. Ulcer medications were used in 4 groups (30 patients): (1) systemic Pycnogenol and local application; (2) local Pycnogenol only; (3) oral Pycnogenol; and (4) medications only (control group). Ulcerated areas and symptom scores were more reduced with the combined oral and local treatment (P < .05). Oral and local treatment were less effective, but still improved compared with the controls. Combined treatment produced 89% complete healing at 6 weeks versus 84% with local treatment and 85% with oral treatment; healing in controls was 61%. The combined treatment group and oral only group had better microcirculation after the combined treatment. Combined local and systemic application of Pycnogenol may offer a new treatment of diabetic ulcers. Local treatment also speeds ulcer healing.

[The treatment of thoracic empyema by video-assisted thoracic surgery (VATS)]. / Il trattamento dell'empiema pleurico per VATS.

Despite various treatment options, empyema thoracis remains associated with important morbility and mortality. Diffused or loculated empyema developed through exudative, purulent and organized phases. Clinically, these phases corresponding to the evolution of the disease: acute and chronic one. The treatment of empyema thoracis is also correlated with the general condition of the patient and even if the drainage is satisfactory in the exudative form, these surgical procedure may be not curative in the purulent and chronic phase. In these cases empyemectomy and pleural decortication are treatment of choice. Recently, Video Assisted Thoracic Surgery has assumed greater importance in the management of this pathology. In our Department of General and Thoracic Surgery, on 178 patients with chronic empyema thoracis, 26 were underwent VATS. During the follow-up there was no mortality or recurrence of empyema. The results indicate VATS because of higher efficacy, shorter hospital stay and less cost, is the primary surgical treatment of chronic empyema thoracis.

[Hemoperitoneum secondary to aneurysm of the pancreatico-duodenal artery: report of a clinical case]. / Emoperitoneo da rottura di un aneurisma dell'arteria pancreatico--duodenale: a proposito di un caso clinico.

Pancreaticoduodenal artery (PD A) aneurysms are rare, with a reported incidence of 2% among all splanchnic artery aneurysms. Most of these lesions are undetectable until symptoms of rupture occur. In similar cases (65%), PDA rupture is usually associated with a high mortality rate, with fatal bleeding into the retroperitoneal space, intraperitoneal cavity or gastrointestinal tract. Clinical picture without rupture also has been reported (35%) and is often associated with atypic abdominal signs and symptoms or diagnosed incidentally on radiology studies. The Authors report a case of octogenarian patient with ruptured PDA aneurysm and bleeding into the retroperitoneal space presenting with stable clinical condition. Surgical treatment was performed successfully after radiological diagnosis of retroperitoneal haematoma with good outcome. Patients presenting catastrophic clinical condition need rapid resuscitation and emergency laparotomy: control of the bleeding site may be successful and aetiologycal diagnosis delayed after perioperative angiography. Further laparotomy is mandatory for a definitive treatment such as PDA obliteration or resection. An alternative therapy is the transcatheter embolization. In patients with relatively stable condition, radiological study is stressed. Anyway, the aneurysm should be obliterated whenever possible to avoid rebleeding or local complications such as erosion of the neighboring structure. In conclusion, an appropriate and early treatment lead to a good outcomes.

Nomograms used to define the short-term treatment with PGE(1) in patients with intermittent claudication and critical ischemia. The ORACL.E (Occlusion Revascularization in the Atherosclerotic Critical Limb) Study Group. The European Study.

Infusional, cyclic PGE1 treatment is effective in patients with intermittent claudication and critical limb ischemia (CLI). One of the problems related to chronic PGE1 treatment in vascular diseases due to atherosclerosis is to evaluate the variations of clinical conditions due to treatment in order to establish the number of cycles per year or per period (in severe vascular disease reevaluation of patients should be more frequent) needed to achieve clinical improvement. In a preliminary pilot study a group of 150 patients (mean age 67+/-12 years) with intermittent claudication (walking range from 0 to 500 m) and a group of 100 patients with CLI (45% with rest pain, and 55% gangrene; mean age 68 +/-11 years) the number of PGE1 cycles according to the short-term protocol (STP) needed to produce significant clinical improvement was preliminarily evaluated. Considering these preliminary observations, the investigators established a research plan useful to produce nomograms indicating the number of cycles of PGE1-STP per year needed to improve the clinical condition (both in intermittent claudication and CLI). A significant clinical improvement was arbitrarily defined as the increase of at least 35% in walking distance (on treadmill) and/or the disappearance of signs and symptoms of critical ischemia in 6 months of treatment in at least 75% of the treated patients. With consideration of the results obtained with the preliminary nomograms a larger validation of the nomograms is now advisable. A cost-effectiveness analysis is also useful to define the efficacy of treatment on the basis of its costs. The publication of this report in two angiological journals (Angeiologie and Angiology) will open the research on nomograms to all centers willing to collaborate to the study. The data are being collected in the ORACL.E database and will be analyzed within 12 months after the publication of this report.

[Betamethasone versus placebo in Peyronie's disease]. / Betametasone versus placebo nella malattia di la Peyronie.

The Peyronie's disease or Induratio Penis Plastica, represents one of the most controversial and uncertain points of the modern andrology, since its real etiology is still disputable. Consequently also the non-surgical therapy results as still confused and variable as shown in the considerable number of drugs utilized till now. Our study takes into consideration the injection therapy, by the use of the Betamethasone (corticosteroid), and it tries to explain, how it is possible, the real efficacy of drug versus placebo. The randomized study includes 30 patients. The valuation of the results has been effected in reference to three parameters: disappearance of pain, decrease of plaque volume and consistency of 50%, decrease subjective penile curvature. The data obtained show no significant differences between group A (treated with Betamethasone) and group B (treated with placebo). At twelve months of mean follow-up the pain at erection disappeared in 66.6% of the patients of group A, in 53.3% of the patients of group B. The curvature diminished in 20% of the patients of group A and in 26.6% of the patients of group B. A decrease in plaque volume and consistency was noted in 40% of the patients of group A and in 40% of the patients of group B. The data show that probably the clinical results of the therapy is to refer to a mechanical effect of injected volume and not to the drug action itself.

[Role of MCP-1 chemokine in the response of monocytes of patients with superficial tumors of the bladder treated with BCG immunotherapy]. / Ruolo delle chemiochine MCP-1 nella risposta dei monociti di pazienti affetti da tumore superficiale della vescica sottoposti ad immunoterapia con BCG.

Mechanism by which intravesical BCG treatment mediates antitumor activity are currently poorly understood. We initiated studies to determine the sequence and the factors that produce the immunological events. During the inflammatory answer a lot of molecules are produced. Chemokines MCP-1 and RANTES induces the mast-cell recruitment, that begins the "immunological fall". In our study 5 patients with superficial bladder cancer treated with BCG present an improvement of this cytokines correlated with a tumor-free status.

[Half-life of blood PSA after radical prostatectomy. Correlations with pathological stage and clinical course of the disease]. / Vita media del PSA sierico dopo prostatectomia radicale. Correlazione con lo stadio patologico e l'evoluzione clinica della malattia.

PSA half-life was calculated in 37 patients after radical prostatectomy to identify earlier patients with residual disease. The half-life calculated in patients potentially "cured" with absolute PSA values inferior to 0.5 ng/ml after 28 days, was significantly different (P = 0.0008) from the group of patients "uncured" (PSA > 1.0 ng/ml) and from those ones that, despite of detectable PSA level, had evidence of recurrence in the following follow-up. In comparison with the absolute value, the PSA half-life is able to define in the group of patients potentially "cured" those who could have a recurrence in the future.

[Orthotopic continent urinary diversion according to Hautmann: 1989-1995. Physiopathologic, morphologic and urodynamic, metabolic considerations and follow-up]. / Derivazione urinaria continente ortotopica sec. Hautmann: 1989-1995. Considerazioni fisiopatologiche, morfologiche ed urodinamiche, metaboliche e follow up.

The orthotopic ileal neobladder is a completely detubularized, low pressure, high capacity reservoir created from the ileum without any valve. After cystoprostatectomy, a bowel segment of 40-60 cms is dissected free at a distance of 15 cms from the ileo-cecal valve. The bowel is detubularized and configurated in a cylinder. Then the neobladder is anatomized to the urethra and ureters. From 1989 to 1995 20 patients underwent ileal orthotopic urinary diversion according to Hautmann. Two patients died, the others are still disease free (mean follow up 36 months). The high capacity and low pressure allow a good continence control, while among metabolic alterations the most frequent is metabolic acidosis. The ileal neobladder represents a valid alternative to any form of cutaneous urinary diversion and is associated to a low incidence of complications.

[The bronchogenic carcinoma-laryngeal cancer association: the experience of our school]. / L'associazione carcinoma broncogeno-cancro del laringe: esperienza di Scuola.

In a 20 year period (1974-1995), 3451 patients with bronchogenic carcinoma were observed. Retrospective analysis of these cases allowed to study the relationship between primary pulmonary malignancies and laryngeal tumours. In 32 patients synchronous or metachronous carcinoma of the larynx and lung were found. All laryngeal tumours were curable but only fifteen of these second primary lung tumours were successfully treated. None of unresected patients survived beyond 2 years.

[Hemospermia: role of transrectal echography]. / Emospermia: ruolo dell'ecografia transrettale.

Hemospermia is a common benign condition, but is prevalence remains unknown, and can result from several causes. The etiology is idiopathic in about 50% of cases. The advent of transrectal ultrasonography has afforded the opportunity to best evaluate patients with hemospermia. Eighty patients affected by hemospermia were studied with Stamey test, semen analysis and culture, and transrectal ultrasonography (TRUS). Infection was detected in 16/80 of the cases (20%), while in 11/80 patients (14%) was present only excessive white blood cells in expressed prostatic secretions. TRUS showed abnormalities in 70/80 of patients (88%), including periurethral and ejaculatory calculi (42/70 pt., 60%), dilated seminal vesicles (22/70 pt., 31.4%) and müllerian duct cyst (6/70 pt., 8.6%). Stamey test and TRUS are the more usefulness investigations in hemospermia, since they can demonstrate the pathologic causes in about 90% of the cases.

[Complications in a patient with a jejuno-peritoneal shunt by the Le Veen technique]. / Complicanza in un paziente portatore di shunt peritoneo-giugulare secondo Le Veen.

The case of a patient, who, 3 months after application of a Le Veen shunt for a refractory ascites, underwent the pleural effusion of ascitic fluid is reported. The adoption of a scintigraphic diagnostic technique allowed the demonstration of a direct ascitic fluid passage from the peritoneal to the pleural cavity and the subsequent successful pleurodesis, performed using an application of local tetracycline.

[Peritoneal mesothelioma as a rare case of acute abdomen. Review of the literature]. / Il mesotelioma peritoneale come raro caso di addome acuto. Revisione della letteratura.

Peritoneal mesothelioma is a rare neoplasm with generic and non-specific symptoms. In some cases it is associated with various and particular clinical syndromes. These findings make it so insidious that the diagnosis is rarely make the preoperative course. Usually, there has been previous exposure to asbestos, during even if other causes are reported. Rarely, a peritoneal mesothelioma appears with signs and symptoms suggestive of acute abdomen, such as the present case. On admission the patient presented clinical features apparently requiring emergency surgery. In fact, at laparotomy, the tumour, arising from the mesenterium, had perforated the peritoneal cavity and communicated with the digiunal lumen, causing a septic hemoperitoneum. A radical resection was performed and the continuity of the intestinal tract was restored through an end-to-end entero-anastomosis. The patient, with a history of exposure to asbestos, was alive four years later. But over the last twelve months diffuse metastasis has occurred in the lung and liver, and there was no response to systemic chemotherapy. This case may be considered singular of the clinical syndrome, the long-term survival and the circumscribed aspect of the tumour. Through a review of the literature, the features of the present diagnostic procedure are underlined and the importance of multidisciplinary treatment as the best approach to peritoneal mesothelioma is emphasized.

[Spontaneous perforations of the large intestine]. / Le perforazioni spontanee del grosso intestino.

Spontaneous perforation of colon is a rare disease and physiopathologic basis are actually unknown. Surgical treatment is standardized and post-operative survival is over 60%, morbidity and mortality rate depends on peritoneal contamination. In 1984 J.A. Berry classified spontaneous perforations into "stercoral" and "idiopathic" perforations on the basis of etiopathogenetical causes of lesions. Anatomopathologically stercoral and idiopathic perforations present different characteristics. Macroscopically stercoral perforation origines from an ulcerative lesion often situated on the sigmoid colon or rectum. Microscopical characteristic is represented by a superficial ischemic necrosis of mucosa (caused by fecalomas) followed by an extension to sub-mucosa and muscular tissues of the colonic wall. On the contrary, "idiopathic perforation", frequently situated on the sigma, is a linear laceration of anti-mesenteric side of the colon without pathologic modifications of the colon. Physiopathologic basis of spontaneous perforations of the colon were also discussed. Stercoral perforation is often a consequence of chronic constipation. Instead, two hypoteses are advanced as regards idiopathic perforations. S.V. Kessing e coll. (1962) hypotized a parietal suffering caused by ischemia of anti-mesenteric side of the colon, depending on ipoperfusion of colonic tissues; they also hypotized a constitutional weakness of colonic wall as a cause of idiopathic perforation. Others hypotized an intraluminal hypertension caused by intestinal hernias (J.W. Eadie, 1955; K. Cronin, 1959), rectal prolapse or abnormal depth of Douglas cavity (D.C. Lyon, 1969). In these cases, lesion is caused by contraction of abdominal muscles during defecation, which presses colonic wall during distension.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of color duplex and phlebography in the diagnosis of deep venous thrombosis of the legs]. / Confronto fra color-duplex e flebografia nella diagnostica della trombosi venosa profonda degli arti inferiori.

The aim of this prospective study was to evaluate the efficacy of color duplex scanning in comparison with plebography in patients with clinically suspected deep vein thrombosis of the legs. The group was of sixty patients. The tests were both positive in 51 limbs and negative in 8 limbs. In a case of below-knee thrombosis, color-duplex was negative while phlebography was able to show small localized thrombosis. The sensitivity of color-duplex was 98%, its specificity and positive predictive value 100% and its negative predictive value 88.8%. In conclusion, color-duplex is as effective as phlebography in detecting deep vein thrombosis above knee.

[Bronchoesophageal fistulae: apropos a case rarely seen]. / Le fistole bronco-esofagee: a proposito di un caso di rara osservazione.

One case of acquired oesophago-bronchial fistula is reported. Diagnostic images are presented. Pathogenesis, clinical and therapeutics features are discussed.