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Biomedical subjects

I Portioli

Publications and source records attributed to I Portioli.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Polyarteritis nodosa and HIV infection: no evidence of a direct pathogenic role of HIV.

A case of polyarteritis nodosa identified by the American College of Rheumatology (ACR) 1990 criteria in a 44-year-old HIV-infected man is described. The search for cytomegalovirus, HBV and B19 parvovirus infections was negative. In situ hybridization did not reveal proviral HIV-1 DNA in a skin sample. A zidovudine-associated vasculitis was excluded. Corticosteroid therapy resolved vasculitis manifestations and was well tolerated without opportunistic infections during the 10-month follow-up period. An indirect pathogenetic role of HIV as a possible cause of vascular damage cannot be excluded in our patient.

Adult↗
PubMedDate not supplied

Plasma cortisol and aldosterone after ACTH 1-17: effect of different doses.

In order to evaluate the effects in adults of different doses of ACTH 1-17 on the cortisol and aldosterone secretion, 200 micrograms of ACTH 1-17 were injected i.m. at 07(00) in two groups of 6 patients each of both sexes. Sampling was done before and after ACTH 1-17 administration at 4-h intervals from 08(00) to 04(00) in order to define the circadian profiles of both cortisol and aldosterone. At the time of study all subjects were kept under the same routine conditions. The i.m. injection of 100 micrograms of ACTH 1-17 was followed by a maximum response of cortisol which coincided with the physiological circadian peak of the hormone (511.7 +/- 122.7 vs 195.5 +/- 92.9 ng/ml; mean +/- 1 SD; p less than 0.001). With this treatment no variations in the normal circadian rhythm were observed. After the injection of 200 micrograms ACTH 1-17, a marked variation in the circadian rhythm of cortisol (peak at 16(00): 390.0 +/- 49.8 ng/ml; mean +/- 1 SD) was observed. Significant variations in the circadian rhythm of aldosterone with respect to the normal profile were observed only after the injection of 200 micrograms ACTH 1-17 (peak at 16(00): 137.5 +/- 50.5 vs 50.8 +/- 36.1 ng/ml; mean +/- 1 SD; p less than 0.01). The hormone increase observed after the injection of 100 micrograms (peak at 08(00): 111.7 +/- 87.5 vs 61.3 +/- 16.5 ng/ml; mean +/- 1 SD) was not statistically significant. Our results indicate that the clinical use of ACTH 1-17 i.m. is not recommended at doses greater than 100 micrograms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗
PubMedDate not supplied

[The limits of controlled clinical studies: the case of rheumatology].

The double blind, placebo controlled, randomized clinical trial is the best tool for gathering evidence concerning the efficacy and safety of a drug. However, in some clinical situations--rheumatology is one--these trials have an intrinsic difficulty in representing the clinical reality: e.g., indicating how a drug influences course of a disease over the long-term. Beginning with the distinction between the "activity" of a drug as confirmed by randomized clinical trials, and its "efficacy" over time, as desired by the patient, we attempt to question why this difficulty arises. Several differentiating elements are involved. The objective of the randomized clinical trial design, that is, activity on acute parameters, may not coincide with the interests of the patient, i.e., efficacy in controlling disability or chronic pain. The duration of a randomized clinical trial is sufficient to measure drug activity but not to provide an indication of its effects on the course of the disease. In the randomized clinical trial, the size of the sample, generally from 10(2)-10(3) patients can, at the most, lead to the conclusion that a drug is "active" while the measurement of efficacy is based on a much greater number of observations. With regard to recruitment criteria, clinical trial patients are chosen on the basis of defined disease severity and activity, while in clinical practice, it is known that this often waxes and wanes. The presence of co-morbidity often leads to the exclusion of patients, yet it is known that up to 17% of rheumatoid arthritis patients are depressed. While concomitant therapy is not permitted during randomized clinical trials, it is generally almost always implemented in normal clinical practice. Drug dosage in a clinical trial is not variable, while in practice it is. The greatest difference is found in the measurement of efficacy, where the randomized clinical trial emphasizes the number of tender and swollen joints, acute phase reactants, disease activity indexes, to assess improvement, while for a typical patient, efficacy is measured in terms of non-evolution of radiologic alterations, work capacity and deformity, and/or the need for a joint prosthesis. The objective of the clinical trial is to seek improvement, while a patient with rheumatoid arthritis may consider simply the lack of worsening over a 5-10 year period as a success. Contrary to clinical trials, observational studies function well in this situation. In response to the difficulty that randomized trials have in reflecting the clinical reality of rheumatological outcomes, the solution is to utilize within the trial, the aspects of the disease course considered fundamental by the patient (that is, chronic pain, disability, radiographic alterations), parameters that are generally omitted from trials. A radical alternative, already proposed, is to abandon the randomized clinical trial model completely and adopt open approaches--much less stringent than randomized trials although as stringent as possible outside the framework of the trial model--that are able to reflect the problems of the patient and to respond to them.

Controlled Clinical Trials as Topic↗
PubMedDate not supplied

The history of polymyalgia rheumatica/giant cell arteritis.

Only two years separate the initial descriptions of polymyalgia rheumatica (PMR) by Bruce in 1888 and giant cell arteritis (GCA) by Hutchinson in 1890. However, the existence of an association between these two conditions was definitely accepted only in 1964. Even if PMR is generally accepted as a different disease from GCA, some authors deem PMR to be a manifestation of a generalised arteritis and use the term GCA to define PMR/GCA as a whole. The time has come to clarify this issue.

Giant Cell Arteritis↗
PubMedDate not supplied

Chronic neutrophilic leukemia (CNL) with karyotypic abnormalities associated with plasma cell dyscrasia: a case report.

A case of chronic neutrophilic leukemia (CNL), a rare myeloproliferative syndrome associated with monoclonal gammopathy of uncertain significance (MGUS-Type IgGk), is reported. Karyotypic study, carried out on bone marrow, excluded Philadelphia-pos. chronic myeloid leukemia (CML) and showed Y loss (45 XO). Only a few cases of CNL with paraproteinemia have been reported, but no case of associated karyotypic abnormalities and paraproteinemia has so far been described.

Aged↗
PubMedDate not supplied

The role of interleukin 1, erythropoietin and red cell bound immunoglobulins in the anaemia of rheumatoid arthritis.

Since interleukin 1 (IL-1) and erythropoietin (Epo) are believed to play a role in the pathogenesis of rheumatoid arthritis (RA) anaemia we measured IL-1 alpha and Epo concentrations in 10 RA patients with chronic disease anaemia (CDA) and in 14 RA patients without anaemia. Anaemic RA patients had significantly higher IL-1 alpha concentrations than patients without anaemia. IL-1 alpha correlated negatively with haemoglobin and correlated positively with ESR. The results of a multivariate analysis showed that the best predictors of the presence and absence of anaemia were IL-1 alpha and ESR. No clinical parameters permitted a distinction between these two groups of patients. Epo levels were not different in anaemic and non-anaemic RA patients. No correlation was found between Hb and Epo, indicating the presence of an impaired Epo response in RA patients with CDA. We completed our study with the determination of the mean red cell lifespan and with the quantification of IgG and IgM bound to the surfaces of red blood cells (RBC-IgG and RBC-IgM) using a sensitive ELISA method. We observed a modest reduction in red cell survival in anaemic RA patients compared to normal controls. We did not find any correlation between Hb and red cell lifespan and between Hb and RBC-IgG. RBC-IgG and RBC-IgM were not found to be more elevated in anaemic RA than in non-anaemic patients.

Adult↗
PubMedDate not supplied

Clinical subgroups and HLA antigens in Italian patients with psoriatic arthritis.

The frequencies of HLA antigens were studied in 101 Italian patients with psoriatic arthritis. The total group showed a significant increase in frequency of A1 and B38, and a reduction of B5 when compared to healthy controls. No association between DR and/or DQw antigens and PA were demonstrated. The comparisons between the clinical subgroups and normal controls revealed a significant association of B38 with asymmetric peripheral arthritis, B27 and B39 with spondylitis (with or without peripheral involvement). When intergroup comparison were made, the patients with spondylitis had an increase in frequency of B27 and DQw3 as compared to those with symmetric and asymmetric peripheral disease. DR4 and DRw53 were associated with earlier age of onset of arthritis. There were also significant associations between DQw3 and severe disease, and between A9, B5 and presence of erosions and joint space narrowing. No association with DR4 was showed in a subgroup of patients with symmetric polyarthritis without DIP involvement.

Adult↗
PubMedDate not supplied

Bartter's syndrome and chondrocalcinosis: a possible role for hypomagnesemia in the deposition of calcium pyrophosphate dihydrate (CPPD) crystals.

A new case of association between Bartter's syndrome and chondrocalcinosis is reported. The patient was shown to have marked hypomagnesemia. Indomethacin and magnesium therapy was started and resulted in increased magnesemia, even if it did not reach normal levels. There was complete remission of articular symptoms and no progression on the radiological picture after 2 years of continuous magnesium and indomethacin therapy. The 7 available family members were studied to assess the possible presence of a familial form of chondrocalcinosis and/or hypomagnesemia. The literature is reviewed and reports of previously described associations between Bartter's syndrome and chondrocalcinosis are summarized. The possible role of hypomagnesemia in predisposing to deposition of calcium pyrophosphate dihydrate crystal in cartilagine is also discussed.

Adult↗
PubMedDate not supplied

Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia, Italy.

Among the population of Reggio Emilia, Italy, 56 patients with polymyalgia rheumatica (PR) and giant cell arteritis (GCA) were identified during the 5-year period 1981-85. The average annual incidence rates of PR and GCA were 12.8 and 8.8 respectively per 100,000 population aged 50 years or older. Forty-nine patients were followed up and the mean duration of follow-up was 32 months. All the patients received steroid therapy. We have evaluated the cumulative probability of requiring continued steroid therapy between patients with PR only, GCA only, and PR associated with GCA using life-table methods with permanent discontinuation of therapy as an end point. The different duration of steroid therapy between these 3 groups did not achieve statistical significance by the method of Lee and Desu. We identified a 5 variable discriminant function that correctly predicted whether the duration of therapy would be longer or shorter than 16 months (median duration of therapy) in 80% of our patients followed up for at least 24 months. The presence of synovitis in PR is also discussed.

Aged↗