Thyroid involvement in patients with overt HCV-related mixed cryoglobulinaemia.

BACKGROUND: Mixed cryoglobulinaemia (MC), a systemic vasculitis associated with hepatitis C virus (HCV) infection in >90% of cases, is frequently complicated by multiple organ involvement. The prevalence of thyroid disorders in MC has not yet been studied. AIM: To investigate the prevalence and clinical features of thyroid involvement in patients with HCV-associated MC (HCV + MC). DESIGN: Case-control study. METHODS: HCV + MC patients (n = 93, 17 men and 76 women, mean +/- SD age 63 +/- 10 years, mean disease duration 14 +/- 7 years) consecutively referred to the Rheumatology Unit were matched by sex and age (+/- 2 years) to (i) 93 patients with chronic C hepatitis (CH) without MC and (ii) 93 healthy (HCV-negative) controls from the local population. Measurements included prevalence of hypo- or hyperthyroidism, thyroid autoantibodies, thyroid nodules and thyroid cancer. RESULTS: By McNemar's chi(2) test, the following thyroid abnormalities were significantly more frequent in HCV + MC patients than in HCV-negative controls: serum anti-thyroperoxidase autoantibody (AbTPO) (28% vs. 9%, p = 0.001); serum AbTPO and/or anti-thyroglobulin autoantibody (31% vs. 12%, p = 0.004); subclinical hypothyroidism (11% vs. 2%, p = 0.038); thyroid autoimmunity (35% vs. 16%, p = 0.006). Serum AbTPO were also significantly more frequent in HCV + MC patients than in CH controls (28% vs. 14%, p = 0.035). DISCUSSION: The prevalence of thyroid disorders is increased in patients with HCV-related mixed cryoglobulinaemia. We suggest careful monitoring of thyroid function in these patients.

[Lung infections in children. IV. Pneumonia due to Chlamydia pneumoniae]. / Infezioni polmonari emergenti nel bambino. IV. Polmoniti da Chlamydia pneumoniae.

Chlamydia pneumoniae is the third strain of Chlamydia and transmission is presumed to be by droplet spread from symptomatic patients. The authors show a literature scientific review on subject-matter emphasizing several sporadic and epidemic case of illness in every age, first months excepted. The described cases are few and therefore clinical characteristics are shadowy. Certain clinical features are suggesting of severe pneumonia with fever and pharyngitis without exudate. In the childhood and in the adolescence the clinical evolution is favourable. Tetracyclines or erythromycin is recommended for therapy.

[Pulmonary infections in children. III. Pneumonia due to Chlamydia trachomatis]. / Infezioni polmonari emergenti nel bambino. III--Polmoniti da Chlamydia trachomatis.

The authors show a scientific literary review on Ch. trachomatis pneumonia. A distinctive syndrome pneumonia has been reported in infants infected by Chlamydia (at 2-3 months of age) in genital-urinary infected mothers. The infection may be preceded by conjunctivitis, in apyrexia followed by attacks of coughing pertussis-like. Blood eosinophilia is present. Although favorable prognosis in infancy, erythromycin is the drug of choice shortening the clinical course erythromycin is also recommended in woman infected prevention.

[Pulmonary infections in children. II - Mycoplasma pneumonia]. / Infezioni polmonari emergenti nel bambino. II--Polmoniti da micoplasmi.

The authors show a literary review on Mycoplasma pneumonia which represents a fifth of human pneumonia. M. pneumoniae is the major cause of illness in school-age children (5-9 years) and young adults and the peak incidence of illness occurs in this age. The infection appears mainly as an interstitial pneumonitis and the onset of illness is gradual, influence-like with few clinical symptoms and typical roentgenographic and bronchoscopic findings. Cold hemagglutinins appear in approximately 50% of patients. A severe prognosis can be associated with extrarespiratory symptoms; Erythromycin (as others macrolides) is the drug of choice.

[Pulmonary infections in children. I -- pneumonia due to Legionella pneumophila]. / Infezioni polmonari emergenti nel bambino. I--Polmoniti da Legionelle.

Pneumonia due to L. pneumophila occurs frequently in children even though "legionnaires' disease" in adults in usual. The authors show a literary scientific review of almost one hundred cases, sporadic generally, in childhood. In children legionnaires' disease remembers the adults infection, beginning with bronchiolitis. The extrarespiratory symptoms appears more frequently in adults. Chest roentgenograms obtained early reveal patchy infiltrates that become nodular areas of consolidation bilateral also, with pleural effusion. In children prognosis is poor (exitus in 15 about 97 described cases). The infection responds to erythromycin; it is administered intravenously, but oral treatment may also be used.

[Food contamination: a problem of pediatric interest]. / Contaminanti alimentari: un problema di interesse pediatrico.

The application of technology in the production, processing, preservation and transport of food has led to a well known consequence: the presence in the foods of undesirable substances and chemicals, that is to say "the contaminants of feeding". In this study the authors report the main groups of contaminants as the mycotoxins, nitrates, pesticides, methylmercury, lead, cadmium etc., relating for everyone of them the harmful effects for the health of human being, of which they have come to know mostly for some episodes of acute poisoning occurred in several countries in the world. They relate also the hypothetical effects of a chronic exposure to low levels of contamination, mostly if the fetuses and infants come to be exposed to these contaminants for the peculiar embryo genetic and evolutive situation that characterizes them.

Chemotherapy of primary and secondary liver cancer: is it useful?

The therapeutic efficacy of three different antiblastic regimens was tested in patients affected by primary or secondary liver cancer. The association of cyclophosphamide and adriamycin gave the best results, despite no partial remission observed with any treatment. As regards the efficacy of antiblastic therapy in this type of tumor, we must conclude that the only detectable effect is a transient improvement of the course of the disease.

Vasoactive factors in the mechanism of renal sodium handling in cirrhotics: the effect of acute plasma expansion.

Twenty cirrhotic patients with ascites, divided into two groups of 10 each, according to their daily urinary sodium excretion (sodium retainers and sodium excretors) and given a diet of 75 mEq of sodium daily, underwent acute plasma volume expansion with 1,000 ml of 10% dextran in saline, infused through a catheter located in the right atrium. Even if a significant increase in sodium excretion was observed in both groups (p less than 0.001 in sodium excretors and p less than 0.05 in sodium retainers), plasma expansion did not reverse sodium retention in sodium retainers. A significant increase in creatinine clearance was found only in sodium retainers (p less than 0.02). Basal plasma renin activity and plasma aldosterone were elevated only in a few patients of both groups. The renin-angiotensin-aldosterone system was highly responsive to plasma expansion. Sodium retainers, who showed an ineffective natriuretic response after expansion, were able to suppress both plasma renin activity and plasma aldosterone in an analogous manner to the sodium-excreting group. This result lends strong support to the concept that the elevated aldosterone level in cirrhosis is not the major determinant of sodium retention. The kallikrein-kinin system was responsive to volume stimulus, since a decrease in kallikrein excretion was noted. It was significant in sodium retainers (p less than 0.05). Plasma PGE1,2 levels were significantly higher in sodium retainers than in controls. This may suggest that there is an activation of the intrarenal prostaglandin system, which could play a protective role against renal ischaemia. After volume expansion, PGE1,2 increased, but not significantly. Octopamine appeared unrelated to sodium excretion and unresponsive to volume stimulus. Endotoxins did not seem to be involved in renal sodium handling. Plasma volume expansion seemed effective in inducing a reduction of vasoconstrictor and sodium-retaining factors, such as the renin-angiotensin-aldosterone system. It is possible to suggest that volume expansion could increase PGE1,2. Plasma volume expansion produced different rates of sodium excretion in the two groups of patients and this suggests that impaired sodium handling in cirrhosis could, to some extent, be independent of effective plasma volume.

Vasoactive factors in decompensated cirrhosis. Effect of acute plasma expansion.

Plasma volume expansion was performed in 16 cirrhotic patients with ascites, 8 with avid sodium retention (sodium retainers) and 8 with normal sodium balance (sodium excretors). No natriuretic response was observed in sodium retainers (daily UNa = 7.1 +/- 1.5 mEq before expansion and 20.8 +/- 7.8 after expansion; p = not significant). After expansion plasma renin activity and plasma aldosterone showed a fall in both groups, whereas urinary kallikrein excretion decreased significantly in sodium retainers (27.1 +/- 9.7 before expansion and 7.8 +/- 6.4 after expansion; p less than 0.05). Baseline PGE were higher than normal in sodium retainers (997.0 +/- 134.3; p less than 0.02 vs. controls) and increased after expansion. Plasma octopamine was always within normal range. These results suggest that: a) reduction of effective plasma volume is not the main factor involved in sodium retention; b) the renin-angiotensin-aldosterone system has only a permissive role; c) prostaglandin system is activated and could have a protective role in maintaining renal function in cirrhotic patients.

Systemic hemodynamics and renal function in cirrhotic patients during plasma volume expansion.

Systemic hemodynamic impairment (hepatocirculatory failure) has been suggested as one of the possible factors which may explain the renal hemodynamic alterations found in the late stage of liver cirrhosis, typical of the hepatorenal syndrome. 20 patients, divided into two groups of 10 sodium retainers and 10 sodium excretors, affected by liver cirrhosis with portal hypertension and ascites, were studied. Renal functional parameters (diuresis, urinary and plasma electrolytes, urine to plasma osmolality and creatinine ratios and creatinine clearance) were evaluated before and after acute volume expansion with 1,000 ml of 10% dextran in saline, infused through a catheter located in the right atrium. Hemodynamic tests (cardiac index, systemic vascular resistance, right atrial pressure and capillary wedge pressure) were performed before, during and after expansion. Cardiac index decreased in 6 patients (sodium excretors) after a 500-ml infusion and rose again after 1,000 ml in 5 of them. The remaining 14 patients showed a progressive and significant increase of cardiac index. A strong inverse relationship between cardiac index and systemic vascular resistance was observed (r = -0.87; p less than 0.001). The mean left-ventricular function curve showed a slow response in most sodium excretors and a normal response in the sodium-retaining group, without significant difference between the two groups. Sodium excretion significantly improved after expansion in both groups of patients. No relationship was found between hemodynamic response and renal function. These data show that cardiocirculatory function is normal, even in sodium-retaining cirrhotics.