Pulmonary mucosa-associated lymphoid tissue lymphoma and myasthenia gravis. A case report.

We describe a low-grade, MALT-lymphoma with multiple, unusually large opacities involving both the lungs in a woman suffering from myasthenia gravis. Unlike other autoimmune diseases, myasthenia gravis has never been associated with MALT-lymphoma thus far. After cyclophosphamide treatment, a complete detersion of the pulmonary opacities was obtained.

[Pulmonary mucosa-associated lymphoid tissue lymphoma in a patient with myasthenia gravis]. / Linfoma polmonare del tessuto linfoide associato alla mucosa in una paziente affetta da miastenia grave.

Mucosa-associated lymphoid tissue lymphomas are a subgroup of non-Hodgkin's lymphoma. The lung is the most frequent non-gastrointestinal organ they affect. Pulmonary mucosa-associated lymphoid tissue lymphoma usually appears as a solitary mass often accidentally discovered on chest radiography. Diffuse, bilateral involvement is rare. The association of mucosa-associated lymphoid tissue lymphoma with autoimmune diseases has been reported, and a pathogenetic role has been suggested for the autoimmune process in its development. Optimum management has not yet been standardized. The case described here is a mucosa-associated lymphoid tissue lymphoma with multiple, unusually large opacities involving both lungs. The patient, a 55-year-old woman, also suffered from myasthenia gravis, an autoimmune disease characterized by an autoaggressive process against the acetylcholine receptors. Whereas other autoimmune diseases such as rheumatoid arthritis, polymyositis, and fibrosing alveolitis have been correlated with mucosa-associated lymphoid tissue lymphoma, an association between this lymphoma and myasthenia gravis has not yet been reported. Complete resolution of the pulmonary opacities was obtained with cyclophosphamide treatment. It continues at 15 months after the suspension of therapy.

Effects of five-day versus one-day infusion of iloprost on the peripheral microcirculation in patients with systemic sclerosis.

OBJECTIVE: To evaluate the effects of iloprost infusion on the microcirculation in patients suffering from severe Raynaud's phenomenon secondary to systemic sclerosis. METHODS: Eight patients received a 7-hour infusion of iloprost for five consecutive days and then for one day 3 months later. The effects on vascular distensibility were evaluated by piezoelectric plethysmography before and after the treatment and at 2, 4 and 6 weeks. RESULTS: The beneficial effects on the peripheral microcirculation were statistically significant after five days of infusion (distensibility index: 0.18 +/- 0.01 vs 0.23 +/- 0.01, p < 0.002) and lasted for less than four weeks, whereas no difference (0.22 +/- 0.04 vs 0.24 +/- 0.02, p: ns) was seen after one day of treatment. One patient suffered from typical angina pectoris with electrocardiographic changes of the ST wave detected during the infusion. CONCLUSION: Our results show that a five-day infusion of iloprost has an effect which lasts from two to four weeks; after four weeks the distensibility index returned to the baseline value. The one-day infusion had no effect on the vascular bed, studied by the piezoelectric pletysmographic method. Treatment with five consecutive days of infusion every four weeks is an impracticable scheme to adopt, however. We have therefore instituted a treatment schedule of a single daily infusion every four weeks with the aim of maintaining the effects induced by the initial five-day infusion. The preliminary results obtained with this schedule are reported.

Seronegative spondyloarthropathy associated with megarectum.

In this report we describe a case of a 19-year-old man with a two-year history of polyarthritis affecting the lower limbs and dactylitis of the toes. His clinical picture fulfilled the new European diagnostic criteria for spondyloarthropathies. Systemic examination revealed a big mass in the left iliac fossa that was found to be due to an acquired functional megacolon. Complete remission of the joint involvement was obtained by treating the bowel disease.

[Methotrexate in the therapy of rheumatoid arthritis. Results in 30 patients]. / Il methotrexate nella terapia dell'artrite reumatoide. Risultati ottenuti in 30 pazienti.

30 patients affected by Rheumatoid Arthritis were treated with Methotrexate (5-7.5 mg/weekly) per os and followed up for at least 12 months; 10 patients had a further control at 24 months. 27 subjects were also on corticosteroid and 2 patients did not stop the therapy with second line drugs. Sulindac was allowed. 3 months later it was observed a significant reduction in the number of affected joints, in the duration of morning stiffness, in the dose of steroid and an improvement of the laboratory investigations indicating the activity of the disease. In the following 12 months, in the 25 subjects still in the study, there was a further clinical improvement. In 24-months follow-up, side effects were present in 17 patients (56.7%); only in 4 cases it was necessary to stop therapy with Methotrexate (3 cases for hepatotoxicity, 1 case for leukocytopenia and stomatitis). 3 subjects did not respond to therapy and 3 patients interrupted for psychological distress. This study confirms the efficacy of Methotrexate at low doses in the treatment of Rheumatoid Arthritis and the modest incidence of severe side effects.

Use of computerized digital thermometry for diagnosis of Raynaud's phenomenon.

The authors have used computerized digital thermometry for the instrumental diagnosis of Raynaud's phenomenon; such a technique enables them to evaluate the temperature of the ten fingers of the hands separately in baseline conditions, during and after the "cold test." In baseline conditions the mean digital skin temperature was 31.2 degrees C (SD 1.67) in control subjects and 26.8 degrees C (SD 2.84) in patients suffering from Raynaud's phenomenon (p less than 0.001). During the cold test the mean skin temperature decreased to 12.7 degrees C (SD 1.94) in control subjects and to 13.0 degrees C (SD 1.67) in patients (p = n.s.). The mean final skin temperature, at the end of the recovery period after the cold test, was 31.1 degrees C (SD 1.76) in controls and 21.9 degrees C (SD 2.78) in patients (p less than 0.001). The sensitivity of the computerized digital thermometry was high (63.6% and 92.7% for basal and final temperature, respectively), while the specificity was 100% for both values. In conclusion, computerized digital thermometry is a useful technique for the diagnosing and quantifying the extent of Raynaud's phenomenon.

Controlled comparison of ketanserin and nifedipine in Raynaud's phenomenon.

Twenty-eight patients suffering from either primary or secondary Raynaud's phenomenon were treated with nifedipine and ketanserin. Each patient was treated with one of the two drugs administered after an adequate washout period. Furthermore each patient was submitted before and after treatment with each drug to computerized digital thermometry to evaluate the therapeutic response. The data obtained during the intake of the two drugs at zero, five, and twenty-three minutes were compared with thermometry-relevant baseline data at the same periods. Ketanserin proved to be useful in the treatment of Raynaud's phenomenon and statistically significantly superior (alpha less than 0.05) with respect to nifedipine in the thermometric controls and also in the subjective evaluation of the patients (p less than 0.02). In this study nifedipine did not show particular efficacy. Furthermore only 2 patients had to discontinue treatment with ketanserin, whereas 8 had to discontinue treatment with nifedipine (p less than 0.001).