Prurigo nodularis (Hyde's prurigo) disclosing celiac disease.

A case of prurigo nodularis (Hyde's prurigo) preceding by 15 years the diagnosis of celiac disease is presented. In particular, the association between the clinical course of prurigo nodularis and the compliance with gluten-free diet is reported and discussed.

Different efficacy of alcohol education tools among trainee nurses.

BACKGROUND/AIMS: The evaluation of the efficacy of two different forms of scientific information concerning alcohol-related problems (ARP), among Italian trainee nurses. METHODOLOGY: A specific questionnaire, investigating the awareness of ARP, was distributed to 193 trainee nurses, 158 enrolled in the Italian Red Cross School for Professional Nurses at S. Orsola-Malpighi Hospital in Bologna and 35 enrolled in the Professional Nursing School at the Social Security Institute in the Republic of San Marino, who had attended a scientific meeting on ARP in the last year. Eighty-one nurses (62 belonging to the Red Cross School of Bologna and 19 to the Professional Nursing School of San Marino), had previously been given an information package on ARP (Group A). One hundred twelve subjects (96 belonging to the Red Cross School of Bologna and 16 to the Professional Nursing School of San Marino) did not read the specialized material (Group B). RESULTS: The results showed a statistically significant difference in the percentage of correct answers between Group A (25.98%) and Group B (21.80%). The percentage of correct answers among the Bologna trainee nurses were always significantly lower than that of the San Marino nurses. CONCLUSIONS: These results suggest a scant awareness and interest in ARP among trainee nurses and show that courses and lectures are more effective than scientific printed material.

Anxiety and depression: a common feature of health care seeking patients with irritable bowel syndrome and food allergy.

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a chronic disorder of the gastrointestinal tract. The etiology of IBS is still unclear and the relationship between foods and IBS is controversial; psychological factors have always been considered as a major cause of IBS and we recently showed a possible association via anxiety and depression between IBS and food allergy (FA). The aim of the present study was to confirm our preliminary observation. METHODOLOGY: Sixty-high IBS, 44 FA, 48 non-healthy controls with lactose intolerance (LI) and 52 healthy controls were considered for the study. All the subjects were given the State and Trait Anxiety Inventory and the Zung depression scale. RESULTS: The percentage of subjects with high levels of state anxiety, trait anxiety and depression was significantly higher in IBS than in both LI and healthy controls; psychological findings in patients with FA were very similar to those of IBS. There were higher levels of state anxiety in LI compared to healthy controls. CONCLUSIONS: A higher prevalence of state anxiety found in patients complaining of bowel symptoms could be linked to the presence of chronic ill status. The higher presence of trait anxiety and depression in IBS and FA patients could be responsible for an increase in the activity of the autonomic nervous system and could provoke motility alterations through mast cell mediator release as well as enhancing release due to allergen crosslinking with IgE at the mast cell surface. However, it is debatable whether psychological findings are characteristic of all IBS or FA patients, or just represent the subset that see physicians.

Alpha-1-thymosin and transcatheter arterial chemoembolization in hepatocellular carcinoma patients: a preliminary experience.

BACKGROUND/AIMS: To evaluate the tolerability and therapeutic potential of the immunostimulating adjuvant alpha-1-thymosin in patients with hepatocellular carcinoma. METHODOLOGY: Twelve patients with hepatocellular carcinoma were treated with alpha-1-thymosin (900 micrograms/m2 subcutaneously twice per week for 6 months) and transcatheter arterial chemoembolization and compared to a historical control group (matched for gender, age, Okuda staging, Child's score, alpha-fetoprotein serum levels and viral infection) treated with transcatheter arterial chemoembolization alone. RESULTS: No severe side effects were recorded in the 2 treatment groups. The combination of alpha-1-thymosin plus transcatheter arterial chemoembolization resulted in a longer survival that reached statistical significance 7 months after the end of treatment (p < 0.05). Patients receiving combined treatment demonstrated a significant increase in peripheral blood mononuclear cells expressing CD3 (p < 0.05) and CD8 (p < 0.025) 3 months after beginning treatment. They also had a significant increase (p < 0.05) in CD16+ and CD56+ cells after 1 month, and a slight reduction in mononuclear cells expressing CD25, a marker for cell activation. No alterations in the response to phytohemagglutinin stimulation were seen during the alpha-1-thymosin treatment. CONCLUSIONS: The absence of toxicity and the favourable effects observed in this open study call for a double blind control study to confirm the efficacy of the combined treatment.

Orthotopic liver transplantation for alcoholic liver disease: rates of survival, complications and relapse.

BACKGROUND/AIMS: Liver transplantation for alcoholic end-stage liver disease remains controversial at many transplant centers. The aim of the present study was to evaluate the outcome of patients with alcoholic liver disease who underwent liver transplantation at Centro Trapianti, Policlinico S. Orsola, Bologna. METHODOLOGY: We describe the outcomes of 18 alcoholic patients with end-stage liver disease who received orthotopic liver transplants at our center from April, 1986 to February, 1996. The data obtained was compared with that of 114 patients with virus-related cirrhosis selected as transplant controls. An absolute period of abstinence from alcohol consumption for at least six months was required. RESULTS: Regarding the actuarial survival rate and non-fatal post-transplant complications, no significant differences were noted in comparing the non-alcoholic with the alcoholic recipients, except for a higher incidence of Cytomegalovirus infection in the alcoholic group followed-up for more than four months. The alcoholic relapse rate was 27.2%, but only one patient returned to harmful drinking. Seventy-three percent of subjects who were followed-up for at least six months were occupied in gainful employment. Alcoholic relapse did not affect employment status. CONCLUSION: This data demonstrates that liver transplantation for selected patients with end-stage alcohol-related cirrhosis achieves good results in survival, complications and employment status, and it appears difficult to defend an inflexible claim to have demonstrated an absolute long-term abstinence before transplantation when a severe deterioration of liver function is present.

Chemoembolization versus chemotherapy in elderly patients with unresectable hepatocellular carcinoma and contrast uptake as prognostic factor.

BACKGROUND: Age is considered one of the important contraindications to surgery for hepatocellular carcinoma (HCC) in cirrhosis patients. We therefore evaluated the safety and prevalence of side effects in endoarterial therapy (EAT) in subjects aged over 65 years compared with younger treated patients. METHODS: Thirty-eight patients with HCC aged 65 years and over underwent transcatheter arterial chemoembolization (TACE) (n = 28) or intraarterial chemotherapy (IAC) (n = 10). The survival rate was calculated using Kaplan-Meier's method with respect to a control group consisting of younger treated subjects (44 TACE; 21 IAC) comparable for stage of HCC and severity of the underlying cirrhosis. RESULTS: The comparison between the two groups regarding side effects, procedure-related death, and survival did not show any difference considering the whole EAT procedure. TACE in elderly subjects reached a statistically lower outcome with respect to younger patients (p < .025) but remained statistically superior in survival versus both older and younger patients treated with IAC (p < .05, respectively). Stratifying the patients following the degree of Lipiodol uptake of tumor mass in the three groups (Group I, > 75%; Group II, 50-75%; Group III, < 50%), in the young subjects a higher probability of survival was strictly correlated to a degree of uptake over 75%, while in the elderly patients an impregnation over 50% was sufficient to obtain a satisfactory survival curve. CONCLUSIONS: EAT is a reliable and safe therapeutic option for the geriatric patient with HCC, with TACE showing a better efficacy than IAC, requiring a lesser degree of Lipiodol uptake to achieve an improvement of outcome.

An open multicentric study evaluating 4-hydroxybutyric acid sodium salt in the medium-term treatment of 179 alcohol dependent subjects. GHB Study Group.

We report the results of an "open' multicentre study evaluating the use, tolerability and therapeutic efficacy of the sodium salt of 4-hydroxybutyric acid (GHB) for the medium-term treatment of withdrawal symptoms in 179 patients with alcohol dependence followed up as outpatients. The follow-up of patients was 6 and 12 months after drug discontinuation. Following a daily oral administration of 50 mg/kg for approximately 6 months, no serious systemic or single-organ consequences leading to drug discontinuation were reported, and tolerability was fair in all patients. Eleven subjects (10.1%) showed craving for the drug and voluntarily increased their doses (6-7 times the recommended levels). GHB led to complete abstinence during drug administration in 78.0% of the patients. A significant reduction of compulsive desire ("craving') was observed in parallel, as deduced from evaluation of a specific questionnaire, the Alcohol Craving Scale. At follow-up examination, 43 of the treated subjects remained abstinent at 6 months, and 30 subjects were abstinent for 1 year after drug discontinuation.

Normalization of immune response and phosphoinositide fatty acid composition of peripheral blood lymphocytes in an alcoholic patient after alcohol abstinence.

After 10 months of alcohol abstinence a malnourished alcoholic patient improved his nutritional status. The analysis of peripheral blood lymphocyte response to mitogenic stimulation with the antibody anti-CD3 and of the fatty acid composition of the (poly)-phosphoinositide fraction derived from lymphocytes revealed: 1) a similar [3H]-thymidine uptake as in control (non-drinker) subjects; 2) a similar relative molar content of the main fatty acids in the (poly)-phosphoinositides as in control subjects. Alcohol abstinence can normalize both the parameters, which are greatly altered during alcohol abuse. This suggests a link between nutritional status and lymphocyte responsiveness via phosphoinositide fatty acid composition.

A rare case of peritoneal mesothelioma in a male with ascites.

Mesothelial lesions can present significant diagnostic problems. An accurate identification of the lesion is important in deciding what course of action to follow, as well as what the required treatment will be. We report the case of a man with untreatable ascites. Four years after the first symptom appeared, the patient suddenly began to lose weight. The CT scan showed a thickening of the peritoneal profile; a diffuse lesion of the mesothelium was then observed at laparotomy. Histological examination led to a diagnosis of malignant mesothelioma in a well-differentiated mesothelial lesion with diffuse involvement of the serosa of the small intestine and the lesser omentum.

Eosinophilic gastroenteritis in a patient with large-cell anaplastic lung carcinoma: a paraneoplastic syndrome?

A 39-year-old man was hospitalized with abdominal pain and diarrhoea. The total eosinophil count was 11,800/dL; the jejunal biopsy showed diffuse and patchy eosinophils and plasma cell infiltration of the lamina propria; symptoms and hypereosinophilia disappeared after steroid therapy. Two months later the symptoms reappeared together with left supraclavicular lymphnode enlargement. The chest X-ray showed a mass within the left lung apex. Lymph node biopsy showed metastases from large-cell anaplastic carcinoma. The possibility of eosinophilic gastroenteritis as a paraneoplastic manifestation is discussed.