Biomedical subjects

Augusto Vaglio

Publications and source records attributed to Augusto Vaglio.

22 records · Page 2Linked to original sources

PubMed2003

[Churg-Strauss syndrome].

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis occurring in patients with a history of asthma or allergy and eosinophilia. Although lungs, skin, and peripheral nervous system are the most common sites of involvement, many other organs, including heart, kidneys, and gastrointestinal tract, can be affected. CSS is an eosinophil-mediated disease, but its pathophysiology is not fully known. There are no specific laboratory tests for CSS. The main laboratory characteristics are peripheral blood eosinophilia, elevated serum IgE levels, and the presence of an inflammatory syndrome. Antineutrophil cytoplasmic antibodies directed against myeloperoxidase are positive in approximately one-half of patients. The diagnosis of CSS rests on the association of the clinical features of the disease with its histologic hallmarks. The biopsy of affected tissues may show a spectrum of histologic changes, including leukocytoclastic or necrotizing vasculitis, eosinophilic tissue infiltration, vascular and extravascular granulomas. The involved vessels are small arteries, veins, arterioles, venules, and capillaries. Corticosteroids, sometimes in combination with a cytotoxic agent, such as cyclophosphamide, are the most effective treatment of CSS. Intravenous immunoglobulins or interferon-alpha may be useful for patients refractory to conventional treatment.

Cardiomyopathies↗

PubMedDate not supplied

Adult idiopathic subglottic stenosis: a diagnostic and therapeutic challenge.

A 22-year-old woman presented with effort dyspnea unresponsive to bronchodilators. Harsh respiratory sounds were audible at the neck. Thoracic and cardiac evaluation was normal. Spirometry revealed an obstructive ventilatory defect, and the flow-volume loop indicated upper airway obstruction. Bronchoscopy and tracheal computed tomography revealed a stenosis of the subglottic larynx. A biopsy specimen of the stenotic area of the trachea showed a normal mucosa and non-specific chronic inflammation. The tracheal stenosis was managed by means of endobronchial laser therapy, which led to the resolution of the patient's symptoms. As we could not identify any specific pathogenetic process, our final diagnosis was idiopathic subglottic tracheal stenosis.

Adult↗

PubMedDate not supplied

Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation.

BACKGROUND: The prevalence of renal itch in patients on dialysis is approximately 30%, but its treatment is often ineffective. We describe an index case of a hemodialysis (HD) patient suffering from painful diabetic neuropathy (PDN) treated with gabapentin; the first administration of the drug led to the complete remission of the concomitant uremic pruritus. Subsequently, we report the results of a pilot evaluation aimed at testing the effectiveness and safety of low gabapentin doses in HD patients with uremic pruritus. METHODS: Five consecutive HD patients unresponsive to antihistamines received 4-week gabapentin treatment at a starting dose of 100 mg after every thrice-weekly HD, which was subsequently adjusted based on clinical response. Puritus severity was evaluated by means of a visual analogue scale (VAS) before each HD session on days 0, 2, 4, 7, 14, 21, 28 and 35. Safety was assessed using adverse event data. RESULTS: All patients experienced a rapid subjective improvement in pruritus, with the mean VAS score decreasing from 8.4-1.6 after the first drug administration. Three patients required a dose increase to 100 mg four times a week to obtain better itch control. Two patients experienced complete itch remission. CONCLUSION: Although a double-blind placebo-controlled clinical trial should be conducted to better elucidate the efficacy and toxicity of gabapentin in patients with uremic itch, our data suggest that gabapentin could be considered an effective and safe alternative treatment for uremic pruritus.

Aged↗

PubMedDate not supplied

Hepatitis C virus-related cryoglobulinemia and glomerulonephritis: pathogenesis and therapeutic strategies.

Mixed cryoglobulinemia (MC) and glomerulonephritis are the most important extrahepatic manifestations of chronic hepatitis C virus (HCV) infection. MC is a non-neoplastic B cell lymphoproliferative process induced by HCV in an antigen-driven mechanism. The clinical expression of cryoglobulinemia varies from an indolent course to the development of systemic vasculitis. Glomerulonephritis is predominantly associated with MC, and almost always takes the form of membranoproliferative glomerulonephritis. The renal manifestations may range from isolated proteinuria to overt nephritic or nephrotic syndrome with variable progression towards chronic renal insufficiency. The treatment of these virus-related diseases must be individualized on the basis of the severity of clinical symptoms. Antiviral therapy with interferon alpha and ribavirin (the currently recommended treatment of HCV infection) may be successful in patients with mild-to-moderate disease, but sustained responses are uncommon. In case of severe and rapidly progressive disease, although it is capable of suppressing viremia and cryoglobulinemia, antiviral therapy is not fully effective in controlling the inflammatory and self-perpetuating reaction consequent to the deposition of cryoglobulins in the glomeruli and vessel walls. In such cases, a short course of steroids and cytotoxic drugs (with or without plasmapheresis) may be needed to improve the vascular manifestations and decrease the production of cryoglobulins. Once the acute disease flare has been controlled, antiviral therapy may be administered to eradicate HCV, the causative agent of the cryoglobulinemic syndrome. In patients in whom antiviral therapy is ineffective, contraindicated or not tolerated, rituximab, a monoclonal anti-CD20 antibody, may be an alternative to standard immunosuppression.

Adrenal Cortex Hormones↗