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Biomedical subjects

G Tirri

Publications and source records attributed to G Tirri.

64 records · Page 4Linked to original sources
PubMedDate not supplied

[Clinico-developmental aspects in 44 cases of polymyositis/dermatomyositis].

A retrospective study, paying particular attention to the clinical and evolutive aspects of the disease, was performed on 44 subjects affected by polymyositis/dermatomyositis (PM/DM) and hospitalized at the Institute of Medical Clinics of the 1st School of Medicine of Naples University. On the basis of the different clinical pictures, the cases were classified into the following groups: primary PM (4); primary DM (19); DM/PM associated with malignancy (6); childhood DM/PM (3); PM/DM associated with connective tissue disorders (12). Diagnosis was established in terms of the following criteria: a) symmetrical and mostly proximal bilateral muscle weakness (100%); b) elevation of serum enzymes (86.3%); c) electromyographic findings of myopathy sometimes with fibrillation potentials, increased insertional irritability and pseudo-myotonic discharges (93.1%); d) muscle biopsy changes compatible with a clinical form of polymyositis (83.3% out of 30 cases); e) dermatological manifestations including particularly pink or lilac edema-erythema over the periorbital areas, wine-red maculae, Gottron's sign, "poikiloderma vasculare atrophicans", telangiectasias and skin vasculitis (86.3%). An involvement of the extraneural apparatus and organs was present in 40 patients; the most damaged was the osteoarticular apparatus, followed by esophagus, lung, heart and kidney; such pathology was rarely present in the childhood form. A follow-up of the disease has been performed in 36 cases and the therapy consisted fundamentally of high dose corticosteroids (mostly prednisone), associated, in a minority of cases, with methotrexate. A clinical improvement was observed in most cases and a remission of the disease in part of the latter. However, a worsening of the illness was noticed only in the patients suffering from PM/DM associated with malignancy, and mortality rate was 11.1% in all.

Adolescent↗
PubMedDate not supplied

[Thrombocytosis in progressive generalized sclerosis (scleroderma) and in other rheumatic diseases].

A platelet count was made in 37 patients with Progressive Systemic Sclerosis (PSS), 6 with Sjögren's Syndrome, 11 with Rheumatic Polymyalgia with or without Horton's Arteritis (PMR-AH), 26 with Ankylosing Spondylitis (A.Sp.), 29 with Psoriatic Arthritis, 15 with Gout and in 65 healthy subjects. In this last group the mean platelet count was 215.692/mm3, S.E. 4.167. In the various groups of patients the following mean platelet counts were determined: PSS 242.108 +/- 11.766; Sjögren 245.000 +/- 22.620; PMR-AH 276.818 +/- 25.577; A.Sp. 272.846 +/- 14.124; Psoriatic Arthritis 245.833 +/- 9.374; Gout 265.333 +/- 24.628. Statistical analysis showed a significant difference (P less than 0.05), (P less than 0.01) or (P less than 0.001) between each group of patients and the controls. However, the platelet count in the majority of patients in each group was not higher than 300.000/mm3. Statistically significant correlations were found between platelet count and some biolgoical inflammation parameters. All patients with platelets higher than 300.000/mm3 showed a high disease activity. Yet some patients with marked inflammation did not present thrombocytosis. According to literature data thrombocytosis in Rheumatoid Arthritis is considered to be correlated to disease activity. The results of this study indicate that even in other rheumatic diseases thrombocytosis is often present, apparently correlated to the inflammation. Therefore thrombocytosis is an inflammation parameter; but it is less sensitive than other ones.

Adult↗
PubMedDate not supplied

Clinical and radiological investigations on cervical spine involvement in rheumatoid arthritis in adults.

The radiological and clinical features of cervical spine involvement observed in 49 patients with rheumatoid arthritis are described. The forward atlas-odontoid subluxation, after an x-ray with full flexion of the cervical spine, occurred in 36.9% of the cases. The upward subluxation was found in 8 (17.4%) cases, but only in one (2.2%) case it was of high degree. In one case lateral subluxation could be suspected by the asymmetrical involvement of the atlanto-axial joints. Erosions of the odontoid peg, subluxation at various levels, discitis and osteoporosis with various frequency were observed. A statistically significant relation has been observed between duration of the disease and radiological signs at the level C1-C2; between radiological features and severity of general clinic picture; between cervical lesions at the level C1-C2 and presence of osteolysis affecting hands, wrists, feet. Clinically, signs concerned with cervical spine involvement were found in 83.6%. Besides cervical pain and functional limitation, the headache was the most frequent clinical sign. It was confined to the occipital region in 69.4% of the cases, and was present at awakening or occurred in connection with movements of the cervical spine and head (53.1%). This study confirms the frequent involvement of the cervical spine in rheumatoid arthritis and shows that performing a complete examination of C1-C2 area is useful, in the most serious forms of RA, since the third year of course.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Interferon in the treatment of mixed cryoglobulinemia.

OBJECTIVE: To assess the efficacy of alfa-IFN in HCV-associated type II cryoglobulinemia. METHODS: An open trial was carried out on 24 patients with HCV-associated type II mixed cryoglobulinemia using recombinant alfa-IFN (3 MU three times weekly for 12 months). The patients were followed for at least 18 months and visceral involvement was evaluated before and after IFN using a scoring system. RESULTS: Alfa-IFN treatment had a marked effect on skin and liver involvement, while a moderate response was obtained in relation to the nephropathy and peripheral neuropathy. A significant lowering of the cryocrit and an increase in serum C4 were observed. Eleven out of the 16 patients who responded favourably relapsed within six months. In 3 patients, all complete responders, HCV-RNA became undetectable at the end of treatment. CONCLUSION: Alfa-IFN may be regarded as the treatment of choice in HCV-associated type II MC, but further studies are required to clarify the factors associated with the lack of response or the relapses seen in some patients.

Adult↗
PubMedDate not supplied

Quality of life assessment during six months of NSAID treatment [Gonarthrosis and Quality of Life (GOAL) Study].

OBJECTIVE: To identify the time point of the greatest degree of improvement in daily living activities, pain and depression in patients with osteoarthritis (OA) of the knee during 6 months of treatment with NSAIDs, in order to define compliance and drop-out rate. METHODS: 107 patients were recruited into a multicentre, prospective, randomized, controlled trial comparing two treatments, piroxicam-beta-cyclodextrin (PBCD) and slow release diclofenac (DCL). RESULTS: The greatest improvement in quality of life occurred in both groups after 3 months, with a slight further gain observed by the end of treatment. The Stanford Health Assessment Questionnaire score improved (p < 0.05 vs baseline) at 3 and 6 months with PBCD and at 6 months with DCL. The Arthritis Impact Measurement Scale score improved (p < 0.05 vs baseline) after 6 months in both groups. Significant (p < 0.05 vs baseline) improvement in other psychological and pain scores were recorded in both groups after 3 and 6 months. Compliance with treatment at 3 months was 73% for PBCD and 72% for DCL, and was 60% in both groups at 6 months. CONCLUSIONS: The results of this study indicate that the optimal length of time for an NSAID trial in OA patients is 3 months, when assessment of daily living activities is considered as the main outcome criterion.

Activities of Daily Living↗
PubMedDate not supplied

[Variability of the clinical picture and the classification of progressive systemic scleroderma].

Fiftythree patients with progressive systemic sclerosis were studied. Four of them (3 males) had the diffuse form of the disease. The skin manifestation of this clinical picture is characterized by diffuse progression of the cutaneous sclerosis over almost the whole body surface, except for the hands where it eventually may appear late. The prognosis for these patients it especially poor. Fortyfive patients (44 females) had acrosclerosis in the widest sence. Twentyseven of these ("acrosclerosis stricto sensu") had cutaneous sclerosis of the hands, face, and often other parts of the body, but not on the abdomen, arms or thighs. The remaining 18 patients had sclerotic alterations on these surfaces also. In this syndrome (which the authors call "the intermediary syndrome"), i.e. where the abdomen, arms, and thighs also are affected, certain internal organs and the joints are more involved than in "acrosclerosis stricto sensu". With rare exceptions, a symptomatic tetrade (REST-syndrome) occurred in acrosclerosis and all the intermediary syndromes. This consisted of Raynaud's syndrome (R), esophagopathy (E), cutaneous sclerosis (S), and telangectasia (T). Fifty % of the patients in addition had calcinosis (C), either subcutaneous or para-articular. The tetrade "REST syndrome" becomes in these cases the pentade "CREST syndrome". The addition of calcinosis to the other four phenomena of the REST syndrome does not alter the frequency of internal organ involvement or the prognosis of the disease. The term "REST syndrome" and its variant "CREST syndrome" should replace the conservative term "acrosclerosis" because they add to the purely cutaneous phenomena other characteristic manifestations of the disease. Two patients could neither be classified under the REST syndrome nor the progressive diffuse syndromes. Two other patients had no cutaneous phenomena ("scleroderma sine scleroderma").

Adolescent↗