Normal values of total reticulocytes and reticulocyte subsets in children and young adults.

This work provides the values for percentage and total reticulocyte count, as well as the values of reticulocyte fluorescence intensity ratios as determined by an automated fluorescent technique in a normal pediatric population. The peripheral reticulocyte subsets, as assessed on the basis of their degree of maturation, allow a more accurate evaluation of bone marrow activity than the percentage or total count do. This would result in a more appropriate management of erythropoietic disorders in children.

[Clinico-biological aspects of myositis due to Trichinella T3 with special regard to a rheumatologic study]. / Aspetti clinico-biologici della miosite da Trichinella T3 con particolare riguardo ad uno studio reumatologico.

One hundred and fifty patients living in Salsomaggiore Terme developed signs and symptoms of trichinellosis after eating infected horse meat. The etiological agent was identified as Trichinella T3. This large outbreak gave us the opportunity of studying the rheumatic manifestations during this kind of parasitic disease. Myositis was observed in 62% of the entire series whereas arthralgias were recorded in only 20% of the patients. The muscle pain was described in several ways, but in the majority it appeared during isokinetic movements. The scapular girdle was involved much more than the pelvic girdle. Arthralgias correlated with the degree of myositis, thus allowing us to conclude that the involvement of the muscle groups proximal to the joint clearly determined a painful sensation in the joint itself. Our histopathologic data suggest that the eosinophils may play an important role in the myositis process.

Prospective rheumatological study of muscle and joint symptoms during Trichinella nelsoni infection.

One hundred and fifty patients were assessed during an outbreak of Trichinella infection in Northern Italy. The aetiological agent was proved to be T. nelsoni. A detailed prospective rheumatological study was carried out. Myalgia was observed in 88 per cent, muscle weakness in 60 per cent, myositis in 62 per cent and arthralgia in 20 per cent of the patients. The arthralgia score was strictly related to myalgias-myositis. The degree of myositis correlated with the degree of hypereosinophilia. Muscle damage in tissue samples was often observed in areas where eosinophils were the major cell population infiltrating the tissue. No relationship was seen between IgG antibody titers against Trichinella or IgE levels and clinical manifestations. Steroids, thiabendazole or mebendazole were not administered. We observed no CNS or heart involvement nor did we see vasculitis. After six months 18 patients, with the highest degree of myositis and hypereosinophilia had all improved. None showed abnormalities in laboratory tests and only four were still complaining of muscle aches. T. nelsoni-related infection appears to induce musculoskeletal symptoms in the majority of patients, but the long term course and prognosis is favourable.

[Rheumatic polymyalgia and temporal arteritis. Case contribution and bibliographic review]. / La polimialgia reumatica e l'arterite temporale. Contributo casistico e revisione bibliografica.

Polymyalgia rheumatica (PMR) is a frequent clinical syndrome in the elderly, characterised by morning aching and stiffness in the shoulder and girdle muscles associated with an elevated erythrocyte sedimentation rate and responsive to low-dose corticosteroid therapy. PMR may be associated with temporal arteritis (AT), a systemic granulomatous vasculitis predominantly affecting branches of the carotid artery in patients over the age of 50. Recent studies suggest an immunological pathogenesis for PMR and TA. Personal experience on 56 cases of PMR and TA, and a survey of the literature is reported and the articular manifestations and the differential diagnosis, are underlined. Polymyalgia rheumatica and temporal arteritis. Personal experience and survey of the literature.

Serum IgA levels and ANA behaviour in rheumatoid patients with and without toxicity to remission-inducing drugs.

IgA levels and ANA behaviour were studied in twenty-five patients suffering from toxicity to remission-inducing drugs (Tiopronin or Gold thiosulphate) and in thirty-two without any evidence of toxicity. A comparable number of patients with low IgA levels were found in the two groups. ANA test positivity correlated better with the appearance of toxicity, but the low specificity and predictivity hinder its application as a screening parameter.

Tiopronin-nephropathy: clinical, pathological, immunological and immunogenetic characteristics.

Nine patients who developed proteinuria while on Tiopronin (a D-Penicillamine-like drug) have been studied. Nephrotic syndrome was observed in six cases. Immunologic analysis revealed a high frequency of ANA positivity and RF seronegativity by the time nephropathy appeared. Six patients were biopsied. Immunofluorescence, electron and light microscopy studies showed: glomerulonephritis with segmental deposits in the mesangium and along the capillary walls in one patient, mesangioprolipherative glomerulonephritis in one case and stage 1 membranous glomerulonephritis in four cases. Immunogenetic typing disclosed a strong association with B35-Cw4 class I antigens.

Association between DR3 and thrombocytopenia due to gold or tiopronin. Case reports and review of the literature.

Two patients who developed thrombocytopenia while on Tiopronin and gold salts respectively were HLA typed. Their common haplotype was A25(10), B8, DR3. A survey of the literature showed that the association between DR3 and the sudden onset form of thrombocytopenia is striking. A genetic predisposition, besides other unknown factors, seems to play a crucial role.

[Idiopathic hypereosinophilic syndrome. Current clinico-therapeutic state]. / Sindrome ipereosinofila idiopatica. Attualità clinico-terapeutiche.

Idiopathic hypereosinophilic syndrome is a term labelling clinical illnesses characterized by blood hypereosinophilia and widespread infiltration of organs and tissues by mature eosinophils. Although any tissue can be affected the involvement of the nervous system and of the myocardium usually indicates worse prognosis. Histopathological studies carried out on myocardial tissues of hypereosinophilic patients, suggest that eosinophils are the main inducers of tissue damages. These cells seem to affect first the coronary endothelial cells, so leading to thrombi formation and then fibrosis. Eventually restrictive cardiomyopathy may occur. The pathogenetic events are not fully understood. However several studies have been focused on two eosinophil proteins: the major basic protein (MBP) as possible mediator of tissue damages and the cationic eosinophil protein (ECP) involved in thrombotic events. In the bone marrow a marked hyperplasia of the eosinophil series is usual, while in the blood only mature eosinophils circulate. Non specific abnormalities either of the cellular or humoral immunity have been described. Previous reports of a definitely incurable disease have been improved by modern therapeutic programs.

Indomethacin-related serum sickness-like illness with IgM lambda cryoparaprotein?

A unique association of a transient IgM lambda monoclonal gammopathy and a serum sickness-like illness, appearing after a short course of indomethacin, is described. The IgM lambda monoclone did cryoprecipitate along with fibronectin in hypotonic medium and disappeared with the resolution of the clinical picture. Emphasis is given to the role of some foreign antigens in the induction of benign monoclones.

Clinical features, scintiscan characteristics and X-ray progression of late onset rheumatoid arthritis.

The clinical features, serology behaviour, scintiscan characteristics and the degree of X-ray progression according to the disease duration were compared in two RA groups with a disease onset after 65 years of age (LORA) and before 65 (EORA) respectively. No differences emerged in either the clinical findings or in the scintiscan picture. A sub-group of LORA showed acute flares of the illness presenting with very high ESR values and high fever. The erosive index (EI) evaluated in three areas (carpal-bone and wrist, MCP and PIP joints) revealed an undistinguishable degree of X-ray damage either in seropositive or seronegative patients, whereas seropositive EORA fared clearly worse than seronegative ones. A prospective study in two small sub-groups of LORA and EORA revealed a progression of X-ray erosions despite second line drug treatment in both groups, especially in LORA.