[The usefulness of plasmapheresis in a case of nephrotic syndrome in Berger's disease]. / Utilità della plasmaferesi in un caso di sindrome nefrosica in corso di malattia di Berger.

Berger's disease, or IgA mesangial nephropathy, is a frequent form of focal and/or segmental proliferative glomerulonephritis that occasionally may present as nephrotic syndrome. The authors reports a clinical case of a young woman come to their observation with a severe clinical picture characterized by asthenia, anasarca, serious no selective proteinuria, microscopic hematuria, blood hypotension from mesangial proliferative glomerulonephritis IgA. Because of the null response to traditional therapy the patient was submitted to plasmapheresis "cascade model", or double filtration, a certainly experimental treatment for this disease, and a remission of the nephrotic syndrome was obtained as confirmed by follow-up at three, six months and one year. Since at present times the therapy is supportive only and no therapeutic maneuvers have been found to be consistently effective in the Berger's disease, plasma exchange plus immunodepressive therapy seems to be useful particularly in the rare patients with rapidly progressive glomerulonephritis. Further and more extensive studies and a fair follow-up are necessary to prove our results.

[Main cardiotoxic drugs]. / I principali farmaci a tossicità cardiaca.

A review of the most important iatrogenic pictures is reported. Chemotherapeutic agents, antidepressants, cocaine and amphetamine, oral contraceptives and antiarrhythmic drugs are examined.

[Calcium antagonists in the therapy of arterial hypertension in the aged]. / Trattamento con calcio-antagonisti dell'ipertensione arteriosa nell'anziano.

A large number of epidemiologic and interventional studies go to show that acute cerebral and cardiac events and chronic organ injury are significantly less frequent in treated compared to untreated elderly hypertensives. These observations clearly show that hypertension in the elderly must be treated. As to water-electrolyte metabolism, activity of the renin-angiotensin-aldosterone axis as well as volemia are reduced in the elderly while extravascular liquid compartment and activity of the natriuretic atrial factor are both increased. In addition, there is reduction of the baroceptor reflexes accompanied by vasoconstriction and hypertrophy of the smooth muscles associated with increased intracellular calcium ion content. These pathophysiologic conditions appear to supply the rationale for the preference accorded to calcium channel blockers compared to other drugs usually employed in the management of younger hypertensives. Moreover, second generation dihydropyridines, thanks to their liposolubility and ties with calcium channel subunits, show rapid onset and long action that allows for a single daily dose and lowers the incidence of side effects. A large number of interventional trials employing calcium channel blockers have demonstrated the efficacy of these drugs for reducing arterial hypertension. However, these trials concern young hypertensives whereas there is a lack of similar studies in elderly subjects, were clinical trials are few and involve limited numbers of subjects. Results of multicentre studies, at present in progress, will permit to assess the efficacy and incidence of side effects of second generation calcium channel blockers in hypertension of the elderly.

Chronic obstructive pulmonary disease. A possible correlation between platelet aggregation tests and respiratory indexes. ECOB Group.

It has been suggested that thrombotic events occurring in patients with chronic obstructive pulmonary disease could be partially due to abnormalities in blood coagulation and fibrinolysis, as well as to changes in platelet function. In the present study in vitro platelet aggregation, in addition to clotting activity, has been studied in 20 patients with chronic obstructive pulmonary disease and different degrees of alteration of blood gas analysis. The results obtained suggest that the presence of a condition of platelet hypoaggregability characterizes patients with marked hypercapnia and/or hypoxemia, whereas the improvement of respiratory indexes is followed by a trend to normalization, or, more often, to an increase of platelet activity.

Circadian variations in platelet aggregability in non insulin dependent diabetes patients (NIDDM).

Circadian rhythms of platelet activity have been extensively investigated in recent years in view of a possible correlation with the increased morning frequency of thrombotic events. Since a role of enhanced platelet activity has been suggested in diabetic macro- and microvascular disease, the aim of the present study was to analyze the circadian variations of in vitro platelet aggregability in patients with non insulin-dependent diabetes mellitus. Eighteen in-patients, ranging in age from 49 to 73 years, all in good metabolic control, were included in the study. Aggregometric patterns were analyzed in blood samples collected at 0700, 0900, 1100 and 1700. A significant increase of the threshold concentrations for ADP-collagen- and arachidonic acid-induced platelet aggregation has been observed in the interval 0700-1100 or 0700-1700, suggesting, also in diabetic patients as in normal subjects, a maximum of platelet activity in the morning, regardless of postural changes and timing of meals.

[Amebic liver abscess: clinical and therapeutic considerations]. / Ascesso amebico epatico. Considerazioni cliniche e terapeutiche.

The authors report the case of a young adult with an amebic liver abscess. The primary infection localized in the gut occurred during a vacation in Africa. This disorder is fairly uncommon in western countries which is why the authors considered it worthwhile to draw practitioners' attention to it, stressing that it should be taken into account in differential diagnosis of fever of unknown origin in young adults who have travelled to regions where amebiasis is endemic. In addition, the diagnostic procedures used and especially the treatment applied are briefly set out. Medical therapy is almost always successful but if significant improvement is not achieved within a reasonable lapse of time and if complications are suspected, all possible therapeutic measures, including surgery, must be applied.