The prognostic value, in active ulcerative colitis, of an increased intensity of colonic perivisceral fat signal on magnetic resonance imaging with ferumoxil.

OBJECTIVE: In active ulcerative colitis (UC), magnetic resonance imaging (MRI) with ferumoxil, a superparamagnetic oral contrast agent, accurately evaluates, in our experience, the increased wall thickness and frequently shows a stronger perivisceral fat signal intensity (PFSI). The aim of our study was to evaluate the clinical significance of these MRI findings in active UC. METHODS: Twenty-four consecutive patients affected by moderate pancolitis were enrolled. At entry, each patient underwent MRI with ferumoxil to evaluate wall thickness and PFSI. Two groups of patients were individuated: group A (increased PFSI) and group B (normal PFSI). After obtaining remission, the number of relapses and, at each flare-up, the clinical activity index (CAI) were evaluated in all patients in a 2-yr follow-up period. The mean CAI was calculated at the end of the follow-up in each patient. Where there was colectomy, a complete histological examination of the colon was performed. RESULTS: PFSI was increased in 16 patients (group A) and was normal in the remainder (group B). There was a significant difference of wall thickness, number of relapses/yr, and mean CAI between the two groups of patients. No difference was observed with regard the duration of disease. Six patients of group A and no patient of group B underwent colectomy. The histological evaluation showed an increased thickness of the entire colonic wall with significant changes of the perivisceral fat structures. CONCLUSIONS: An increased

Allergy and mucosal eosinophil infiltrate in ulcerative colitis.

BACKGROUND: Data on allergy in ulcerative colitis (UC) have led to conflicting conclusions without proving any causal association. In this report we have investigated the presence of allergy and its possible relation with chronic colonic inflammation in patients with UC. METHODS: Fifty UC patients underwent clinical, endoscopic, and histologic evaluations. The allergologic study included family/personal history; prick/patch exposition to airborne, food, and contact allergens; total serum IgE; and quantification of eosinophils in peripheral blood and intestinal mucosa. Diagnosis of rhinitis, conjunctivitis, and asthma was confirmed by specific provocation tests. Fifty healthy subjects were studied as control group. RESULTS: A higher prevalence of allergic symptoms was found in patients (56%) and their first-degree relatives (52%) than in controls (18% and 26%) (P < 0.0001; P = 0.008). In patients skin tests showed increased rates of immediate (54%) and delayed-type (20%) hypersensitivity compared with controls (30% and 6%) (P= 0.01; P= 0.03). Diagnosis of allergic IgE-mediated disease was made in 19 cases and 6 controls (P= 0.01), and allergic contact dermatitis in 10 and 3, respectively (P= 0.03). IgE levels were higher in UC patients than in controls (P=0.02). No dose-response relationship was found between degree of colonic tissue eosinophilia and clinical. endoscopic, and histologic disease severity. The degree of colonic tissue eosinophilia was higher in the presence of skin reactivity to food allergens. CONCLUSIONS: UC patients frequently show several markers of allergy. In particular, our data suggest an association between ulcerative colitis, tissue eosinophilia, and type-I allergy.

Magnetic resonance imaging with ferumoxil, a negative superparamagnetic oral contrast agent, in the evaluation of ulcerative colitis.

OBJECTIVE: The introduction of new oral contrast agents that enhance image quality has increased the importance of magnetic resonance imaging (MRI) in the management of ulcerative colitis. The aim of our study was to investigate the usefulness of a new negative superparamagnetic oral contrast (ferumoxil) alone or in association with gadolinium i.v. in the assessment of the disease. METHODS: Twenty-eight patients with clinically active ulcerative colitis and 10 control subjects entered the study. In each patient a clinical, endoscopic, histological, and MRI evaluation was performed. In particular, in 14 patients affected by ulcerative colitis (group A) and in five controls, magnetic resonance images were acquired 1 h after the oral administration of 900 ml of ferumoxil, while the remaining 14 patients (group B) and five controls were submitted to double-contrast MRI (ferumoxil and gadolinium). In both groups, wall thickness, length of affected bowel segments, and, in group B, also percent contrast enhancement were calculated. RESULTS: The comparison of endoscopic and MRI extent of disease was statistically significant. Wall thickness and, in group B, also percent contrast enhancement were significantly correlated with clinical and endoscopic activities. In each group wall thickness was significantly different in the activity phases of the disease. CONCLUSIONS: MRI with negative superparamagnetic oral contrast is comparable to endoscopy in the assessment of ulcerative colitis. The double-contrast imaging does not provide more information than single oral contrast, so we concluded that the latter is preferable in the follow-up of the disease and in patients unable or with a poor compliance to undergo endoscopy.

Prognostic value of progressive decrease in serum cholesterol in predicting survival in Child-Pugh C viral cirrhosis.

BACKGROUND: The identification of cirrhotic patients with low life expectancy is an open clinical problem. Hypocholesterolemia is frequently found in severe chronic hepatic insufficiency because the liver is the most active site of cholesterol metabolism, but poor information is available on its precise prognostic value. We evaluated the prognostic role of hypocholesterolemia in patients with advanced liver cirrhosis. METHODS: Serial serum cholesterol concentrations of 34 patients with virus-induced cirrhosis, from the first appearance of Child-Pugh class C to death, were considered. To compare survival functions, we established three base-line cholesterol cut-off points (150, 125, and 100 mg/dl) and stratified patients into groups A and B, with base-line cholesterol levels lower and higher than each cut-off value, respectively. RESULTS: Cholesterolemia decreased progressively in all patients. At the 100 mg/dl cut-off point all group-A patients died within 17 months, whereas 75% of group-B patients were alive at 24 months (P < 0.0001). Moreover, cholesterolemia was significantly correlated with cholinesterase, indirect bilirubin, and total bilirubin at entry time and immediately before death. No correlation was observed between cholesterol and these variables when stratified for the Child-Pugh score. CONCLUSIONS: Base-line serum cholesterol levels lower than 100 mg/dl identify a subgroup of Child-C cirrhotic patients with high mortality risk within a 2-year follow-up. The prognostic importance of cholesterolemia may also be deduced by the significant correlation with other well-established indicators of survival.

Beclomethasone dipropionate (3 mg) enemas combined with oral 5-ASA (2.4 g) in the treatment of ulcerative colitis not responsive to oral 5-ASA alone.

BACKGROUND/AIMS: Beclomethasone dipropionate is one of the topical corticosteroids which appear to have minimal systemic effects. We evaluated whether combined therapy with Beclomethasone dipropionate enemas and oral 5-aminosalicylic acid could be effective in patients suffering from ulcerative colitis not responsive to oral 5-aminosalicylic acid as monotherapy. PATIENTS: In twenty patients, non responders to 5-aminosalicylic acid treatment (2.4-3.6 g/day) given for at least 6 weeks, Beclomethasone dipropionate enemas (3 mg/60 ml/day) were added for 4 weeks. METHODS: Efficacy of the combination was evaluated before and at the end of the treatment using a clinical, endoscopic and histological score. RESULTS: After a four-week treatment period, a significant clinical improvement in stool frequency (p < 0.01), stool consistency (p < 0.001), blood (p < 0.001) and mucus in stools (p < 0.05), was observed. Endoscopy and biopsy confirmed an improvement in the activity score at the end of the treatment (p < 0.001). Six patients (30%) achieved remission, ten patients showed an improvement (50%) and four (20%) showed no benefits. No adverse event was observed. CONCLUSIONS: Beclomethasone dipropionate enemas combined with oral 5-aminosalicylic acid may be a safe and useful therapeutic approach in the treatment of ulcerative colitis not responsive to oral 5-aminosalicylic acid alone.

[Authors' experience with medical therapy of herpes genitalis in pregnancy]. / Nostra esperienza nella terapia medica dell'Herpes genitalis in gravidanza.

BACKGROUND: Neonatal risk in herpes infections is very high: in the USA it is 1:2,000, in Japan 1:15,000 and in England 1:65,000. These differences seem to be due mostly to the different risk factors associated to the mother infection. The best strategy to cure herpes infection is to examine every patient during pregnancy and to identify the high risk ones. METHODS: In this study, 1,860 pregnant women have been submitted to a colposcopic and cytologic screening for the research of HSV. RESULTS: HSV was found in twenty (1.07%) women. Two groups have been made: the first with 14 HSV positive women at 3-6 months of pregnancy and second with 6 HSV positive women at eight months of pregnancy. Both groups were treated with acyclovir per os. The 14 women of the first group underwent vaginal delivery. The women of the second group underwent cesarean section. Only in 1 case a neonatal infection has been observed.

Therapeutic protocol of vulvar and cervical HPV-infection.

BACKGROUND: The stages of HPV (Human Papilloma Virus) infection are under the control of the immune system, which is inhibited by the virus itself. Thus, at present the treatment of condyloma acuminata is based on the use of interferon (IFN). The aim of the present study was to evaluate immune system activation and clinical response to IFN therapy. In addition, in the most serious cases, medical treatment with IFN was associated with diathermocoagulation (DTC) of persistent warts. The effectiveness of the combined therapy was also assessed. METHODS: 7 women (age range: 16-52) suffering from cervix condylomata were selected for our study. All of them were injected intramuscularly with doses of 3 million UI of IFN-alpha leucocytar every three days for six weeks together with daily applications of alpha-IFN for six weeks. The women that were still ill three months after IFN therapy, were treated with DTC. In one case, another cycle of IFN treatment was necessary. RESULTS: Clinical response to IFN treatment was complete in 46 cases, partial in 20 cases and unsuccessful in 4 cases. After three months of medical therapy, 30 women were treated with DTC. After this therapy, in 21 cases, the warts were resolved. After 24 months the percentage of relapse was 37.9% when only IFN was used, and 4.51% when IFN was combined with DTC. CONCLUSIONS: These data suggest that a successful protocol for the treatment of condyloma acuminata consist of IFN therapy associated with DTC when warts persisted.

A case of failure of tubal sterilization using Pomeroy's technique.

With reference to a case of pregnancy of a patient formerly subjected to tubal sterilization using Pomeroy's technique, the authors define the possibility for tubal stumps to recanalise. Despite the low percentage of failure in tubal sterilization using Pomeroy's technique, the authors conclude that it is advisable to make the earliest possible diagnosis of both intrauterine and extrauterine pregnancy on the basis of suspected symptoms in order to, especially for tubal pregnancies, avoid any tubal sterilization.

PIP: The Pomeroy technique of tubal sterilization is widely used and considered highly effective. Reported in this paper is a case of a pregnancy in a woman from Naples, Italy, who underwent this procedure. The patient requested sterilization during her third cesarean section delivery in 1992 and tubal occlusion was confirmed by a hysterosalpingograph conducted 3 months later. When the patient presented 19 months later with a missed period, an intrauterine pregnancy was found. During the subsequent cesarean section delivery, bilateral tubal exploration revealed that some tubal residual products from the sterilization were still bound by the thread and the stumps graphing. It was assumed that recanalization of the two stumps below the tubal binding was responsible for the conception. A new sterilization was performed after removal of the stumps by the Pomeroy technique 0.5 cm below the canalization.

[Folic acid and cervix dysplasia]. / Acido folico e displasia cervicale.

The localized folate deficiency, which is sometimes misdiagnosed as cervical dysplasia, because of morphological similarities between the cytologic features of megaloblastosis seen with folate deficiency and the changes associated with dysplasia, could be a component of the dysplastic process. In this study we attempted the effect of oral folic in women with cervical dysplasia. A total of 154 subjects with grade 1 or 2 CIN were randomly assigned either 10 mg of folic acid or a placebo daily for 6 months. Clinical status, human papillomavirus type 16 infection and blood folate levels were monitored at 2 month intervals. After 6-months no significant differences were observed between supplemented and unsupplemented subjects regarding dysplasia status, biopsy results, or prevalence of human papillomavirus type 16 infection. Folate deficiency the initiation of cervical dysplasia, but folic acid supplements do not alter the course of established disease.

[Drug treatment in vulvar lichen sclerosus]. / Il trattamento medico nel lichen scleroso vulvare.

This study was made in the Oncologic Gynecology's surgery of the Department of Obstetrics and Gynecology of the University of Naples. We evaluated the efficacy of local therapy with testosterone and progesterone in Vulvar Lichen Sclerosus. We treated 65 women suffering from Vulvar Lichen Sclerosus. In the group of 38 women treated with testosterone, we observed a complete response in 26 cases (68%). In the group of 27 women treated with progesterone we observed a complete response in 18 cases (66.6%). This demonstrates the efficacy of local therapy with testosterone and Progesterone in Vulvar Lichen Sclerosus. The authors believe that medical treatment with topical testosterone and progesterone represents an effective alternative to invasive methods for the care of Vulvar Lichen Sclerosus.

[Drug therapy of condylomata acuminata]. / Trattamento farmacologico dei condilomi acuminati.

This study seeks to evaluate two candidate regimens (5-fluorouracil and interferon) as adjuvants to optimally performed laser surgery in the treatment of condylomata acuminata. Skillful laser ablation can remove any volume of human papillomavirus-associated vulvar disease but cannot prevent reactivation of the surrounding latent viral reservoir during postoperative healing. Conversely, interferon and 5-fluorouracil are relatively ineffective as primary therapies. This study involves 118 evaluable patients: 32 in the laser-CO2 group, 34 in the 5-fluorouracil group and 52 in the interferon group. At assessment of final outcome, it was found that 43 of 52 (82%) assessable patients in the adjuvant interferon arm were controlled by a single laser ablation as compared with only 17 of 34 (50%) in the 5-fluorouracil group and 13 of 32 (40%) in the laser alone group. There was no statistical difference in outcome within the 5-fluorouracil and laser only arms. Conversely, a relatively low dose of recombinant interferon, used in combination with effective surgical deleulking, can markedly reduce the risk of postoperative recurrence.

[Extrauterine pregnancy: epidemiology and etiology]. / Gravidanza extrauterina: epidemiologia ed eziologia.

The aim of the present study is to determine the epidemiological characteristics and etiological factors of ectopic pregnancy. The pool of women at risk is determined by different factors such as contraceptive practices, fertility rate, sterilization, gynecological and pelvic infection. Serological evidence of previous Chlamydia infection was much more common when ectopic pregnancy occurred in abnormal tubes than in normal tubes or compared to intrauterine pregnancies. The influence of endometriosis and ovarian cyst was limited to a very few cases. The analysis of contraceptive habits shows a much higher number of extrauterine pregnancies (45%) when the woman is using progestin-only pill than when she is on combined oral tablets (20%). This higher rate of ectopic gestation can be interpreted to suggest either that the POP might be less effective in preventing ectopic than intrauterine pregnancies or that the POP can delay ovum transport by inhibiting the motility of the fallopian tube.

[Association of interleukin 2 and interferon alpha in the management of cervical condylomatosis]. / Associazione di interleuchina-2 ed interferone-alpha nel trattamento della condilomatosi della cervice uterina.

At present the therapy of cervical condylomatosis is based on the use of interferon because the HPV types responsable for condyloma inhibit the immunitary system. But many A. studying the effects of IFN have found that at high concentration it has an immunosuppressive action. The aim of the present study was to evaluate if interleukin-2 associated with IFN is useful in avoiding this negative effect by improving the efficacy of cervical condylomatosis therapy. We treated 25 women suffering from cervical condyloma with increasing doses of IL-2 injected intralesionally and associated with natural alpha-IFN injected intramuscularly. The duration of the whole therapy was six weeks. We evaluated the percentage of inflammatory cells in peripheral blood before and after treatment. The per-cent number of lymphocytes, eosinophils and lymphoblasts was increased by 27%, 88% and 40%, respectively. The clinical response to the therapy was total in 14 cases, partial in 9 cases and unsuccessful in 2 cases. These data suggested that combination therapy with interleukin-2 and alpha-IFN for the treatment of patients with cervix condylomatous is successful.

Epidermal growth factor receptor expression: is it the same in normal and malignant endometria?

Epidermal growth factor was investigated in normal and malignant tissues in order to detect possible differences in its expression. We used immunohistochemical techniques that employ murine monoclonal antibody 528. Thirty-nine patients (12 with normal endometria and 27 with endometrial adenocarcinomas) were examined. Epidermal growth factor receptor was seen in all normal uteri and in 27 uteri with adenocarcinoma. It was absent in 11 patients with cancer. No correlation was found between the intensity of immunohistochemical staining and histologic grade, depth of myometrial invasion and clinical stage.