Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain with positive tests for sacroiliac dysfunction: a randomised clinical controlled trial with 1 year follow-up.

AIM: Back pain is a highly frequent condition due to many causes, although most of them cannot be established with certainty. It is also the current clinical and scientific belief that sacroiliac joint syndrome can be a specific low back pain cause. Nonetheless the existence of clinical tests aimed at highlighting the responsibility for lumbar pain secondary to sacroiliac dysfunction, it is not easy to diagnose it with either manual or instrumental means. Moreover, uncertainty is diffuse when facing a correct treatment for patients involved. The aim of this study was to verify, in patients with acute or sub-acute low back pain and positive sacroiliac signs, the efficacy of a stabilising therapy (orthosis and exercises, with previous mesotherapy) directly targeted to sacroiliac dysfunction versus a symptomatic usual care such as He-Ne laser therapy. METHODS: Over a period of 14 months, we recruited 22 patients (10 females, mean age 44+/-11) with acute and sub-acute low back pain and symptoms and signs suggesting a sacroiliac dysfunction. They were randomised in a Group laser (GL), 11 patients treated with He-Ne laser therapy targeting the sacroiliac region, and a Group stabilisation (GS), 11 patients treated with mesotherapy, a specific dynamic sacroiliac support (ILSA) and specific exercises. Outcome criteria included VAS, and Mens and Laslett sacroiliac tests. RESULTS: Out of 449 acute and sub-acute low back pain out-patients, 22 (4.9%) had symptoms and signs suggesting a sacroiliac dysfunction. A reduction of pain was achieved only in the GS. All pain-provocation and stability tests were negative both after the end of treatment and at the follow-up only in the GS. CONCLUSIONS: A targeted approach based on mesotherapy, a specific sacroiliac belt and specific stabilizing exercises proved its efficacy in acute and sub-acute low back pain patients with symptoms and signs suggesting a sacroiliac dysfunction. As soon as it will be possible to identify particular spine syndromes in the universe of non specific low back pain, there will also be the possibility to employ specific therapies.

Interferon-alpha activity in a case of severe autoimmune lymphoproliferative disease.

Autoimmune lymphoproliferative disease (ALD) is a rare familial disorder. Clinical and laboratory features of this disease include a generalized lymphadenopathy, splenomegaly, increased levels of circulating CD3+ with low levels of CD4+, CD8+ T-cells, and autoimmune phenomena, characteristics that the autoimmune lymphoproliferative syndrome (ALPS) have in common. Treatment usually consists of different supportive therapies. We report on the case of a young man affected by ALD who became resistant to steroids and was unresponsive to cyclosporine. Nevertheless, he was successfully treated with interferon (IFN)-alpha, resulting in a long-lasting, clinically complete remission.

Unusual morphology in a case of large granular cell leukemia.

Large granular lymphocyte proliferative status represents a group of clonal and nonclonal lymphoproliferative disorders of natural killer (NK) or T-cell lineages with common morphological features. Cellular differences may sustain the clinical polymorphism observed in these disorders. Here we report a case of large granular lymphocyte disease unusually expressing CD4+CD8+ clonal T cells and atypical cell morphology in bone marrow.

Behçet's disease with gastrointestinal involvement associated with myelodysplasia in a patient with congenital panhypopituitarism.

Myelodysplastic syndromes (MDS) are hematologic disorders characterised by peripheral cytopenias and the hystologic features of hematologic dysplasia. Their association with autoimmune manifestations have been suggested by several authors: recently, the appearance of Behçet's disease during MDS has been reported. We describe the occurrence of MDS in a patient affected by Behçet's syndrome with gastrointestinal involvement and congenital panhypopituitarism.

Hibernoma of the larynx. Review of the literature and a new case.

Hibernoma is a rare, benign, soft-tissue tumour composed of cells similar to those of brown adipose tissue. Only seven cases in the cervical area have been reported and none in the larynx. A case of hibernoma of the pre-epiglottic area is presented and the histological, histogenetical and clinical features are discussed.

Neoadjuvant chemotherapy, surgery, and postoperative radiation therapy for invasive thymoma.

Between January 1988 and June 1990, seven previously untreated patients with histologically confirmed and clinically staged IIIa invasive thymoma (IT) were enrolled in a prospective, single treatment arm study of neoadjuvant chemotherapy (NC) followed by surgery and postoperative radiation therapy (4600 to 6000 cGy). The NC included three cycles of cisplatin (75 mg/m2 on day 1), epirubicin (100 mg/m2 on day 1), and etoposide (120 mg/m2 on days 1, 3, and 5), every 3 weeks. All patients showed a partial response (greater than 50%) and underwent complete (n = 4) or incomplete (gross [n = 1] or microscopic [n = 2] residual tumor) surgical resection. Histologic examination was negative for two completely resected patients. Projected 2-year survival was 80%; all patients but one currently are alive and disease-free. This approach appeared to be feasible and may be a new therapeutic choice in the management of IT, but its use on a regular basis should be reserved until a larger number of patients and longer follow-up are available.

[Diagnostic reflections on lung lymphangioleiomyomatosis]. / Riflessioni di ordine diagnostico sulla linfangioleiomiomatosi polmonare.

Two cases of histologically proven pulmonary lymphangiomyomatosis were studied by means of an adequate combination of the current imaging modalities. After an anatomical survey of the secondary pulmonary lobule, the authors discuss the pathologic appearance, the pathogenetic factors (mainly hormones), and the diagnostic problems concerning this pathologic condition. Finally, the authors emphasize the decisive role of high-resolution CT (HRCT) in the evaluation of pulmonary lymphangioleiomyomatosis.