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Biomedical subjects

G Pasero

Publications and source records attributed to G Pasero.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Treatment of the idiopathic inflammatory myopathies: a retrospective analysis of 63 Caucasian patients longitudinally followed at a single center.

OBJECTIVE: To analyze the therapies used over the past 20 years at a single center to treat patients with idiopathic inflammatory myopathies (IIM), and to compare their effectiveness. METHODS: Sixty-three Caucasian IIM patients were selected for this study based on the following parameters: (i) a definite diagnosis of IIM; (ii) a follow-up period of at least one year; and (iii) a complete record of clinical and serological data for the course of the follow-up. The following data were collected from the patients' records: the first choice and subsequent therapies, the patient's response to these treatments, the outcome at the end of the follow-up. RESULTS: Two therapeutic approaches were identified: steroids alone and the combination of steroids with immunosuppressive drugs. Of the 63 patients studied, 36 received steroids alone and 27 received steroids plus immunosuppressors. Sixteen patients did not respond to the initial therapy, 33 showed a stable response, and 14 experienced a relapse in disease activity during the follow-up. No statistically significant differences among these 3 groups of patients were observed with respect to sex, age at disease onset, diagnosis, CPK levels at disease onset, and therapeutic approach. CONCLUSION: Corticosteroids represent the mainstay of IIM therapy, both as the first choice treatment and as maintenance therapy. The use of immunosuppressive agents should be restricted to those patients with severe contraindications to steroid treatment.

Age of Onset↗
PubMedDate not supplied

Association between hepatitis C virus and mixed cryoglobulinemia [see comment].

The prevalence of hepatitis C virus (HCV) RNA and of antibodies to HCV in an unselected series of 42 mixed cryoglobulinemia patients was investigated in this study. HCV RNA was detected by the polymerase chain reaction technique, and HCV antibodies by two enzyme-linked immunosorbent assays (Chiron ELISA HCV, Second Generation, Emeryville CA, USA; Wellcome Diagnostic, England). HCV RNA was found in 86% of the mixed cryoglobulinemia patients. Using either the Chiron ELISA or the Wellcome ELISA, HCV antibodies were present in 90% of the same samples; anti-HCVAb seropositivity was confirmed in all cases by immunoblot assay (Chiron RIBA HCV, Second Generation Assay). A striking correlation between HCV RNA and anti-HCV antibody seropositivities was recorded. HCV RNA in mixed cryoglobulinemia patients was not correlated with the presence or absence of biopsy-proven liver involvement. These results suggest that the association between HCV and mixed cryoglobulinemia is not fortuitous, and therefore that HCV may have an etiopathogenetic role in this disorder.

Adult↗
PubMedDate not supplied

Blood viscosity and filtration abnormalities in mixed cryoglobulinemia patients.

Blood, plasma and serum viscosity and blood filtration were investigated in 43 unselected mixed cryoglobulinemia patients. A hyperviscosity syndrome was present in only one patient, and rapidly improved after plasma exchange and cyclophosphamide therapy. A clear-cut increase in blood viscosity was infrequently observed in mixed cryoglobulinemia, although significant differences were present in the plasma and serum viscosity of patients and controls. In contrast, blood filtration was severely impaired in a high percentage of cases (51 and 72% of the values recorded at 37 degrees and 25 degrees C, respectively), and was on the average significantly higher in patients than in controls. Indirect evidence suggests that blood viscosity is at least in part related to cryoglobulins. In 19 patients studied before and after cryoglobulin removal, serum viscosity significantly decreased when the serum was deprived of cryoglobulins. In addition, the cryocrit correlated with all the hemorheological parameters with the exception of blood filtration. The hemorheological findings were compared with multisystemic features of the disease, i.e. liver, renal, lung, neurologic, vascular and funduscopic alterations. The potential clinical relevance of the hemorheological parameters was stressed by the close correlation between blood filtration parameters and serum creatinine. Furthermore, by discriminant analysis, viscosity and blood filtration changes were the serological parameters most significantly associated with the presence of renal, liver and neurological involvement. Thus, hemorheological parameters are frequently abnormal in mixed cryoglobulinemia patients, and seem to play a significant clinical role; they should therefore be included in the work-up of these patients.

Adult↗
PubMedDate not supplied

Evidence of neuromuscular hyperexcitability features in patients with primary fibromyalgia.

The presence of clinical and electromyographic (EMG) features of neuromuscular hyperexcitability (NMHE) and of the commonly associated neurovegetative disturbances (NVD) were investigated in 49 patients with primary fibromyalgia (PF) and in a control group of 33 patients with rheumatoid arthritis (RA). At least two clinical features of NMHE were present in 39%, and at least three NVD in 63% of PF patients. In contrast, only 1 RA control had two NMHE features (p greater than 0.005) and three NVD (p less than 0.001). Moreover, a significant post-ischemic spontaneous EMG hyperactivity was observed in 11 PF patients, and in only 1 control with RA (p less than 0.05). Finally, in patients with PF the number of tender points were correlated with psychological tests for depression (p less than 0.02), and the number of NVD. The present study shows that in patients with PF there is a large prevalence of NMHE complaints and NVD. The potential underlying pathogenetic mechanisms are also discussed.

Adolescent↗
PubMedDate not supplied

Hepatitis C virus as a lymphotropic agent: evidence and pathogenetic implications.

Hepatitis C virus has been proven to be the major cause of NANB hepatitis, cirrhosis and hepatocellular carcinoma worldwide. Based on the genome similarities between HCV and flavivirus or pestivirus, this agent has been included within the family Flaviviridae as a separate genus. Among the analogies between HCV and the other members of the same family there is the possibility of infecting blood cells. In particular, significant evidence obtained through studies performed in vivo and in vitro support the concept that HCV is not only a hepatotropic but also a lymphotropic virus. This suggests that, in addition to playing a role in inducing hepatic diseases (both of a non-tumoral and a neoplastic nature), HCV infection may also play a role in extrahepatic pathologies. The striking association observed between HCV infection and some autoimmune-lymphoproliferative disorders of either benign or neoplastic nature is consistent with this hypothesis. However, in analogy with what has been observed in the case of liver disease, the mechanisms involved in the pathogenesis of HCV-related extra-hepatic manifestations have to be more deeply analysed and clarified.

B-Lymphocytes↗
PubMedDate not supplied

Etiopathogenetic role of hepatitis C virus in mixed cryoglobulinemia, chronic liver diseases and lymphomas.

Hepatitis C virus (HCV) infection has been found in the majority of patients with mixed cryoglobulinemia (MC) in studies conducted in different countries. In our series of 110 MC patients the frequency of HCV markers was significantly high (91%) compared with other rheumatic diseases (6.4%) and with healthy Italian controls (1.2%). Moreover, HCV RNA was detected in 81% of the peripheral lymphocytes from MC patients. Comparable percentages of HCV infection were detectable in other disorders, i.e. porphyria cutanea tarda (77%) and autoimmune hepatitis type 1 (77%). The HCV infection of peripheral lymphocytes suggests that this virus could be the triggering factor for the lymphoproliferation underlying MC. In a number of patients with MC the evolution from a benign lymphoproliferation to frank B-cell lymphoma was observed. In these subjects HCV RNA in the sera and in fresh and cultured peripheral lymphocytes was constantly detected. The same phenomenon has been observed in patients with long-lasting type C chronic hepatitis. Interestingly, HCV infection has also been recorded in 32% of idiopathic B-cell non-Hodgkin's lymphomas. Taken together, the above findings suggest that HCV can cause benign B-cell proliferation with the consequent production of various autoantibodies, including rheumatoid factor and mixed cryoglobulins. These serological abnormalities characterise different clinical disorders, including the appearance of lymphoma in a not negligible number of individuals.

Cryoglobulinemia↗
PubMedDate not supplied

Bone involvement in Gaucher's disease: 'bone crisis' or disease complication?

Bone involvement can represent the inaugural symptom of Gaucher's disease (GD). Here, we report the case of a 68-year old man diagnosed as having GD since 1963. In June 1994 the patient was referred to our Rheumatology Unit because of a long-lasting coxalgia on the left hip and progressive walking impairment following traumatic fracture of the left femur. Multicystic osseous changes at standard X-ray and hyper-gamma-globulinemia with an elevated ESR (122 mm, 1st hour) suggested the diagnosis of either osteonecrosis of the femoral head or multiple myeloma. On bone marrow biopsy examination, Gaucher's cell infiltrates were detected and an increased uptake in the distal left femur and proximal tibia were demonstrated by lipophilic tracer scan (99mTc-Sestamibi). Subsequently, the patient suffered another femoral fracture at a site of Gaucher's infiltrates previously documented by bone scan. We conclude that in patients with GD, 99mTc-Sestamibi bone scan can selectively evaluate the presence of bone lipid deposits, and could indirectly differentiate this bone condition from other serious skeletal complications of the disease.

Aged↗