Light chain deposition disease neuropathy resembling amyloid neuropathy in a multiple myeloma patient.

A 65-year-old man with IgG lambda multiple myeloma developed severe polyneuropathy with prominent thermal-pain sensory impairment and autonomic failure. Although the clinical presentation suggested amyloid neuropathy, nerve biopsy showed the immunohistochemical and ultrastructural features typical of light chain deposition disease (LCDD). A precise morphologic and clinical description of LCDD neuropathy is given for the first time in the present report.

[Prokinetic activity and antral inflammation. Usefulness of cisapride combined with H2 antagonists in gastritis]. / Attività procinetica e flogosi antrale. Utilità della cisapride associata ad H2 antagonista nella gastrite.

In order to evaluate the symptomatic efficacy of cisapride on motility disorders often associated with mild inflammatory changes of the upper gastrointestinal tract, the authors carried out a comparison between two groups of patients (15 patients in each group, 10 males and 5 females) with histologic antral gastritis, treated respectively with famotidine 40 mg/day per os plus cisapride 10 mg ter/die per os, and famotidine alone. While the endoscopic evaluation performed four weeks later did not show a significant difference between the two groups, both macroscopically and microscopically, cisapride was able to ameliorate all those symptoms presumably provoked by delayed gastric emptying.

[Peptic ulcer and Helicobacter pylori. Comments on the authors' cases]. / Ulcera peptica ed Helicobacter pylori. Considerazioni su casistica personale.

The presence of Helicobacter was tested on a group with antral or duodenal ulcer with or without gastritis, versus a group without gastric or duodenal pathology. Furthermore an open trial was performed between omeprazole and colloidal bismuth subcitrate (CBS) on patients similarly affected by peptic disease. Although CBS did eliminate Helicobacter in more than a half of patients, what was not obtained by omeprazole, this result did not mean a better control of peptic disease: in fact the omeprazole was remarkably more active in our series on clinical and endoscopic ground, whether the Helicobacter was present or not, and further studies are required to assess the real significance of Helicobacter pylori in the above conditions.

[The efficacy of the omeprazole-levosulpiride combination in the therapy of distal reflux esophagitis]. / Efficacia della associazione omeprazolo-levosulpiride nella terapia dell'esofagopatia distale da reflusso.

The therapeutic effectiveness of levosulpiride associated with omeprazole versus omeprazole alone in the reflux esophagitis has been evaluated. Two groups, each of 9 patients, were investigated before and after therapy on a clinical ground and endoscopically. While no difference was shown in terms of macro and microscopic resolution, a better subjective relief was obtained in the group treated with the association levosulpiride-omeprazole.

[Churg-Strauss vasculitis in a 53-year-old man]. / Vasculite di Churg-Strauss in un uomo di 53 anni.

The Authors describe a 53 year old patient, who, after suffering from asthma over the past 10 years, presented with abdominal pain, diarrhoea, dyspnea, petechias on lower limbs, and subsequently developed fever, polyneuritis, pericardial effusion and renal failure. Laboratory showed elevated IgE, presence of antinuclear antibodies to DNA, serum rheumatoid factor and peripheral eosinophilia. The clinical course was suggestive for systemic vasculitis; lung, skin biopsies and renal angiography confirmed this diagnosis: the association with asthma and eosinophilia fulfill the diagnosis of allergic angiitis and granulomatosis (Churg-Strauss syndrome).

[Drugs affecting upper respiratory tract motility: cisapride]. / Farmaci attivi sulla motilità delle prime vie digestive: cisapride.

The article is a short review of older and more recent drugs aimed to modify the gastrointestinal motility. Cisapride the newer one is considered with particular attention.

[Constipation. A critical review]. / La stipsi. Revisione critica.

The paper reviews the current knowledge about constipation, a widespread although often overlooked medical problem. Correct management entails a thorough clinical, diagnostic and therapeutic assessment.

[Influence of smoking on healing in patients with NSAID-induced peptic ulcer]. / Influenza del fumo sulla guarigione di pazienti con malattia peptica da FANS.

The influence of smoking on the cure of patients with peptic disease under non-steroidal antiphlogistic drugs. Observation over a 2-month period of 35 patients with peptic ulcer or erosive duodenitis related to the use of non-steroidal antiphlogistic drugs shows a significant delay in endoscopic cure in smokers, whether or not they have stopped smoking.

Reevaluation of prognostic significance of symptoms in Hodgkin's disease.

The prognostic value--at diagnosis--of fever, sweating and weight loss, which enter the Ann Arbor B category, and of pruritus, whose influence on survival is still debated, were systematically reevaluated in 635 patients with Hodgkin's disease, observed between 1972 and 1982. By means of multivariate analysis an intrinsic, more negative prognostic value was demonstrated for each of the following symptoms: fever over 38 degrees C, weight loss more than 10% of body weight in the 6 months before admission, and severe pruritus, which is defined as being generalized, causing multiple excoriations and resisting local and systemic antipruritics. Patients with the mild counterparts of these symptoms, as well as sweats, were found to have a survival rate quite comparable with that of fully asymptomatic patients. A rearrangement of the Ann Arbor B constitutional symptoms which would replace sweats with severe pruritus might be more correct and more suitable for better selecting the patients who require more aggressive therapy.

Serum albumin in Hodgkin's disease.

Serum albumin levels were measured by electrophoresis in 552 evaluable patients with Hodgkin's disease. Determinations were made on all patients at onset, on 224 after induction therapy and on 78 in relapse after remissions of variable length. At onset a discrete hypoalbuminemia was evident, inversely related to stage and more marked in symptomatic cases and elder patients. Little or no differences in albumin levels were found with relation to histologic subtypes, sex and presence of weight loss or hepatic damage. Posttherapeutic normalization of serum albumin occurred only after achievement of complete remission and failed after partial remission, while a new clear decrease became evident in relapse. On the basis of 799 albumin measurements during active disease and in remission, the albumin/alpha 2-globulin ratio demonstrated a clear and useful clinical advantage over either albumin or alpha 2-globulin fractions alone as indicator of active disease and relapse. If defective synthesis is the most accepted mechanism for hypoalbuminemia in Hodgkin's disease, these results suggest a casual factor somehow related to the tumoral mass.

Prognostic factors in non-Hodgkin's lymphomas.

Prognostic factors were investigated in 67 patients with non-Hodgkin's lymphomas, homogeneously staged and treated (COP or CHOP according to low or high malignant histotype). A large number of parameters were scrutinized in order to recognize those exhibiting a prognostic value regarding length of survival. All the parameters that singly appeared to influence survival were entered into a multiple regression factor analysis. The erythrocyte sedimentation rate (ESR), higher or lower than 35 mm at the 1st h, better discriminated the groups of patients surviving or not at a given time. The histologic type, according to the Kiel classification of malignancy, was the second best prognosticator when a short-term prediction was requested (survival or death after no more than 2.5 years), but showed insufficient statistical weight for predicting longer survivals (greater than 4 years). Stage seemed to be the third best prognosticator for the first years of survival, but only the second best for longer survivals. Other parameters had very low prognostic importance when compared with those above. The results were substantially confirmed by 28 other patients, taken as controls. The importance that such a simple and easy test as ESR may be adequate with regard to prognosis is emphasized.