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Biomedical subjects

L Lepore

Publications and source records attributed to L Lepore.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Fracture of the os tibiale externum in a decathlete.

The upsurge in popularity in sports activities has produced a large number of lower extremity injuries. This article describes acute fracture of the os tibiale externum in a 28-year-old decathlete. The injury was treated conservatively, and excellent functional recovery was obtained. This is the second case of traumatic fracture of this accessory bone of the foot described in the English literature. When dealing with the feet of an athlete, supernumerary bones must be taken into consideration as a possible cause of serious discomfort.

Adult↗
PubMedDate not supplied

Treatment and prevention of osteoporosis in juvenile chronic arthritis with disodium clodronate.

Osteoporosis is one of the most difficult problems in the management of Chronic Juvenile Arthritis (JCA). The available data suggest that bone loss results from multifactorial processes which lead to bone degradation through the activation of osteoclasts. Biphosphonates are synthetic factors that, once localized on the surface of hydroxyapatite crystals, do not allow either the production or destruction of the crystals. This activity seems to be due to cytotoxicity against osteoclasts and to inhibition of prostaglandin E2 synthesis. There is some evidence that these drugs are effective in the treatment of osteoporosis in several diseases. In an attempt to reduce or prevent osteoporosis in children affected by JCA we started a trial with disodium clodronate, a type of biphosphonate. Thirteen patients were enrolled in the study: 7 received disodium clodronate and 6 acted as control subjects. Before starting the therapy and after one year we performed a CT scan to evaluate the mineral bone density in all patients. The mean bone density increased from a bone mineral content of 129 mg/cc before treatment to 134 mg/cc after treatment (8% increase); control patients passed from 123 mg/cc to 115 mg/cc (7% decrease) in the same period. Only one child stopped treatment because of gastrointestinal side effects. The small number of patients enrolled in the trial does not allow any definite conclusions to be drawn, but the data are interesting and worthy of further study.

Arthritis, Juvenile↗
PubMedDate not supplied

[Septic arthritis].

Septic arthritis is a serious medical problem that should be promptly recognized and requires appropriate treatment to avoid permanent joint damage. The disease is caused by several different microorganisms but the most frequent in children and in adults is Staphylococcus aureus. Pathogenetic mechanism, general (antiblastic therapy, diabetes, rheumatoid arthritis) and local (intra-articular injections) promoting factors are discussed. Usefulness of laboratory and radiological investigations is debated. Finally indications for needle aspiration, adequate drainage as well as guide lines on general and local antibiotic therapy are reported.

Arthritis, Infectious↗
PubMedDate not supplied

[Neutropenia caused by low-dose trimethoprim-sulfamethoxazole in children with chronic pathology of the urinary tract].

Neutropenia is the most common hematologic abnormality detected as consequence of Trimethoprim Sulfamethoxazole (TMP-SMX) therapy. Its incidence is evaluated in 27 children affected by urinary tract anomalies and treated with low doses of TMP SMX (2 + 10 mg/kg/die) for more than one month. A slight neutropenia was detected in 8 children (6 of these were in their first two years of life). In all the 27 cases a supplementation of folinic acid was started: a significant increase of PMN count was noted in all cases. Neutropenia can also appear after low (prophylactic) dosage of TMP-SMX, and can be prevented by concomitant administration of folinic acid.

Adolescent↗
PubMedDate not supplied

[Compromised function of the masticatory apparatus in juvenile rheumatoid arthritis].

A clinical and epidemiological study was conducted on a sample of 30 J.R.A. patients in order to identify the signs and symptoms of masticatory dysfunction. Helkimo's indices were used to quantify the data obtained. The incidence of masticatory dysfunction was significantly high as was confirmed by comparison with a random sample of healthy adolescents. The most common signs were alterations in the quality of mandibular movement, pain on muscle palpation and joint crepitus. The symptoms included spontaneous pain during mastication and tension headache with obvious psychobehavioural implications. The importance of early orthognathodontic intervention to reduce the sequelae of the joint damage became evident as did the role of the dentist in the framework of a broader and more specific multidisciplinary approach.

Adolescent↗
PubMedDate not supplied

Total dislocation of the talus.

A 24-year-old male Caucasian gymnast suffered from a total anterolateral dislocation of the talus during a training session. The injury was treated conservatively. The functional result was good 26 months after the trauma, although the athlete was not training any more. Isolated total talar dislocation is a rare injury, and only 73 cases have been so far described. A literature survey concerning mechanism of injury, diagnosis, treatment, and possible complications is presented.

Adult↗
PubMedDate not supplied

[Long-term remission induced by measles infection and followed by immunosuppressive therapy in a case of refractory juvenile rheumatoid arthritis].

A case of severe juvenile rheumatoid arthritis, polyarticular type, refractory to FANS and long acting therapy which showed a quick remission after measles is described. An immunosuppressive therapy to strengthen the immunosuppression induced by virus infection was performed for six months. The remission has been maintained for 4 years and appears up to now to be stable with no therapy. On the basis of this observation, the possibility of a vaccination therapy with measles virus, which equally gives immunosuppression, is discussed.

Arthritis, Juvenile↗
PubMedDate not supplied

[Evaluation of the effectiveness of thymomodulin in children with recurrent respiratory infections].

Numerous trials of prophylaxis of recurrent respiratory infections in children have been performed, even though the only controlled trials providing incontrovertible results were the ones carried out with levamisole and thymostimulin through intramuscular administration. We have experimented a calf-thymic extract administered by oral route (thymomodulin). During the summer we enrolled 40 children aged between 3.5, and 9 years who had suffered from RRI during the previous winter. The patients were randomly divided in two groups and respectively treated with thymomodulin or with placebo; 21 children were given the thymic extract and 19 the placebo. The trial was carried out according to a double-blind schedule for a period of four months, from the beginning of October '84. At the end of the trial we assessed the catharral bouts observed during the research period by the family doctors and the parents evaluation on the clinical state. The difference between the two groups is statistically highly significant both with reference to the reduction of the total number of catharral bouts and to the general clinical state according to the parents opinion. The research clearly demonstrates the protective effect of the thymomodulin, probably due to the "restorative" effect on some immunological functions, temporarily compromised during the infection bouts.

Child↗
PubMedDate not supplied

Immunological patterns in monoarticular juvenile rheumatoid arthritis.

Seven pediatric patients with monoarticular arthritis, three of whom had a recent onset form and the remaining four a disease of longer duration, were examined for possible modifications of their immunological parameters. The diagnosis of JRA was made on all these patients according to the ARA criteria after a follow-up of at least two years. Humoral and cellular abnormalities of the immune system were searched for in peripheral blood, synovial fluid and synovial membrane. No evidence for complement consumption and for increased levels of immune-complexes was found in the sera and in the synovial fluids of these patients, who were all seronegative. Some patients had antinuclear antibodies in their sera and synovial fluids. With regard to the lymphocyte distribution, whereas only some patients had an increased number of circulating B cells, the majority had a decreased CD4+/CD8+ ratio in the synovial fluid compared to the ratio found in the peripheral blood. A massive infiltration of CD4+ cells and macrophages and the presence of a substantial number of OKT9+ cells was found in the synovial membranes.

Adolescent↗
PubMedDate not supplied

[Immunologic function in children with recurrent respiratory infections evaluated in a state of well-being].

The purpose of the study is to analise the immunological function of children suffering from RRI long after the last episode in order to evaluate whether the immunological abnormalities reported by several authors have to be considered implicated in the pathogenesis or the mere consequence of recurrent infections. 65 children who had been suffering from RRI in the previous winter (s) have been studied during the wellbeing condition of the following summer season. A defective T cell function was no longer found; the study of humoral immunity showed low values of IgA even though no child had an IgA selective deficiency (IgA below 5 mg% ml). These data suggest that T cell defective function has to be considered mainly secondary to infections. It is conceivable that in these children the recovery of T cell function is impaired by viral infections and is somewhat slower. On the other hand low values of IgA have been detected in a higher percentage with respect to the general population and could be considered typically associated with the RRI syndrome in children.

Child↗
PubMedDate not supplied

[Therapy with plasmapheresis and lymphoplasmapheresis combined with immunosuppressive agents in 2 cases of intractable juvenile rheumatoid arthritis].

Two cases of JRA refractory to NSAID' steroids and long-acting drugs were successfully treated with plasmapheresis and combined lympho- and plasma-apheresis respectively. Case 1. A 8 year old female child who had been suffering from systemic JRA for 6 years received a course of three plasmapheresis followed by a 6 month cycle of azathioprine. Clinical and laboratory remission was promptly achieved and is still present after 18 months. Case 2. A 12-year old boy affected by poliarticular JRA received a course of 4 plasmapheresis followed by a 6 month cycle with azathioprine. The opportunity of performing plasma or lymphoplasmapheresis reinforced by immunosuppressive drugs such as azathioprine or methotrexate at low doses in refractory cases of JRA is discussed.

Arthritis, Juvenile↗
PubMedDate not supplied

[Experimental treatment with high-dose gamma globulins in autoimmune diseases].

High-dose intravenous gammaglobulin has been successfully used in several autoimmune diseases such as idiopathic thrombocytopenic purpura, autoimmune neutropenia; more recently this treatment has been experimented in other autoimmune conditions with conflicting results. After a review of recent literature, the article considers results obtained by high-dose intravenous gammaglobulin therapy in some conditions such as connective tissue diseases and vasculitis. A review of different mechanisms of action hypothesized in the different disorders is reported. In fact, it is quite clear today that this treatment has not only clinical effects but achieves also measurable immunological and biological results so that we can consider high-dose gammaglobulin as a immunomodulating treatment.

Arthritis, Juvenile↗
PubMedDate not supplied

Study of IL-2, IL-6, TNF alpha, IFN gamma and beta in the serum and synovial fluid of patients with juvenile chronic arthritis.

In the last few years the important role played by various cytokines in the pathogenesis of chronic inflammatory diseases has emerged. In the present study, serum and synovial fluid levels of IL-2, IL-6, TNF alpha, IFN beta and IFN gamma were evaluated in a group of 66 patients with juvenile chronic arthritis (JCA). At the same time the ESR, CRP, hemoglobin, immunoglobulins, platelet count and Ritchie index were measured. In the serum of pauciarticular patients, IL-6 and TNF alpha levels were only slightly elevated compared with controls, but there was no correlation between these cytokines and clinical and other laboratory parameters. Serum IL-2 and IFN gamma were undetectable. In contrast, in the synovial fluid IL-6 levels were very high in all of the patients examined and there was a significant correlation between synovial fluid IL-6 levels and Ritchie's articular index. TNF alpha tended to be elevated but to a lesser extent, while synovial fluid IL-2 and IFN gamma were undetectable or very low, as in the serum. In polyarticular and systemic patients, on the other hand, serum IL-6 was elevated and statistically correlated with the majority of the laboratory parameters and with the Ritchie articular index. TNF alpha levels were only slightly elevated; on the other hand, IL-2 and IFN gamma were undetectable. There was an inverse correlation between IFN beta levels and the Ritchie articular index and a significant correlation with hemoglobin levels. In conclusion, our study demonstrates that not only IL-1 (as shown in other studies), but also IL-6 and to a lesser extent TNF alpha play a central role in the pathogenesis of JCA. IFN beta on the other hand, would seem to play an anti-inflammatory role.

Adolescent↗
PubMedDate not supplied

Localized scleroderma after infection with Epstein-Barr virus.

Over a period of three years (1989-1992) five children suffering from localized scleroderma were seen at the Department of Pediatrics of the University of Trieste. Evidence of a previous infectious mononucleosis (IM) was present in four out of five patients. The clinical history of these four children is reported. The association between the appearance of scleroderma and a previous viral infection is not surprising. However, in the pediatric literature there is only one case of progressive systemic sclerosis (PSS) developing in a 15-month-old girl less than one month after she contracted IM. The presence of shared epitopes between an Epstein-Barr virus protein, BOLF1, and the hypervariable region of HLA associated with the pauciarticular form of JCA, recently reported, could provide a key to the pathogenesis of other collagen diseases such as scleroderma.

Adolescent↗
PubMedDate not supplied

[Vascular hyperfragility in systemic lupus erythematosus treated with low doses of cortisone].

We report an unusual cutaneous manifestation of systemic lupus erythematosus (SLE) in a 15-year old female. The diagnosis was made on the basis of clinical symptoms, cutaneous hystology (positive "lupus band test") and on laboratory findings (hypocomplementemia, positive antinuclear antibodies and rheumatoid factor). Treatment with methylprednisolone (0.5 mg/kg/die) improved the clinical symptoms but, after 2 months, large ecchymotic lesions appeared on the lower legs below the knee extending as far as the ankles, likely triggered by minor local traumas. Coagulative function was normal, the lupic anti-coagulant factor (LAF) was negative, anticardiolipin antibodies were absent and there was no thrombocytopenia. There was only a slight increase in clotting times in vitro, in presence of ADP. The amount of cortisone was reduced and the type of treatment modified; satisfactory control of the disease was attained with deflazacort (0.3 mg/kg/die). The ecchymosis on the lower limbs never disappeared even though they became slightly smaller. Ecchymotic lesions are not usually included in the wide range of cutaneous manifestations associated with SLE. Moreover vascular fragility resulting from pressure and minor traumas is known to be a cutaneous complication of hypercorticism; nevertheless the doses of cortisone administered to this patient were rather low and other clinical signs of steroid hyper-dosing were absent although cortisolemia assay at base and after stimulus with ACTH was not performed. We would suggest that the negligible platelet binding defect (whether primary or SLE-associated) together with the low amounts of cortisone administered caused ecchymotic lesions to appear in this patient suffering from a disease (SLE), in which the small cutaneous vessels are favourite targets.

Adolescent↗