Autonomic dysfunction in multiple sclerosis. A case report.
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Biomedical subjects
Publications and source records attributed to L Mirone.
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Biochemical characteristics employed to identify tuberculous and non tuberculous mycobacteria were evaluated. Tests for detection of nitrate reductase, catalase, gamma-glutamyl-transferase, niacin assay and growth on TCH media (2-thiophene carboxylic-acid hydrazide) were regarded of discriminating value. These tests have been applied to identification of 78 clinical isolates of mycobacteria. All strains were identified as Mycobacterium tuberculosis, that suggest the infrequency of human infections from Mycobacterium bovis and mycobacteria other than tubercle bacilli in our geographic area. It is also outlined that the gamma-glutamyl-transferase test constitute a rapid and simple assay for discriminating Mycobacterium tuberculosis from other closely related mycobacteria.
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Serum insulin and C-peptide response to an oral glucose tolerance test (OGTT) and serum growth hormone (GH) response to an intravenous insulin tolerance test (IVITT) were investigated in six non-obese patients, with normal glucose tolerance, affected by diffuse idiopathic skeletal hyperostosis (DISH). Basal serum insulin, C-peptide and GH values were similar in DISH patients and in controls. After OGTT, insulin and C-peptide values were not significantly different in the two groups at any time interval. In contrast, after IVITT, a significant increase in GH concentrations was noted at 30 and 45 minutes in DISH patients when compared to controls. Growth hormone either acting alone or through somatomedin intermediaries results in new bone growth in acromegaly, and the same may be true for DISH. Recent reports suggest that GH promotes tissue growth by stimulating precursor cells in various tissues including cartilage and bone. The increased GH response to IVITT corroborates the hypothesis that GH may act as a bone growth-promoting factor in DISH.
Autoimmune thyroid disorders have been shown to occur in patients with connective tissue diseases. Hypothyroidism and thyrotoxicosis have been recognized in systemic lupus erythematosus (SLE). Moreover, a high prevalence of antithyroid antibodies has been found in patients with SLE. We studied thyroid function in a group of SLE female patients without a history or clinical diagnosis of thyroid disease and then correlated the prevalence of abnormal function test results with the laboratory indexes of active disease and with the presence of antithyroid antibodies. The SLE patients had significantly lower T4 levels than the controls. Basal TSH and TSH concentrations after TRH stimulation were significantly higher in patients with active SLE in comparison to both patients with inactive SLE and to controls. 45.5% of patients with active SLE presented antithyroid antibodies. Antithyroglobulin and antimicrosomal antibodies were not found in patients with inactive SLE nor in controls. Our results confirm the existence of a mild hypothyroidism in SLE that is clinically silent. The altered thyroid function appears to be dependent on the activity of the systemic autoimmune process.
We studied 19 women (mean age 35 +/- 13 years) with systemic lupus erythematosus (SLE), in order to evaluate whether or not alterations in the circadian rhythm of heart rate (HR) occur in patients with pathologic responses to stimulation tests of the autonomic nervous system (ST-ANS). The duration of SLE was 5.3 +/- 5 years. None of the patients had clinical signs of cardiopathy or dysautonomy, nor were any of them taking drugs with known effects on the heart or ANS. Nine patients (47%, group A) had normal ST-ANS and 10 (53%, group B) had an abnormal response to at least 1 ST-ANS (5 to sympathetic ANS, 3 to parasympathetic and 2 to both ST-ANS). Age, duration of disease and therapy were not different between the 2 groups. All patients underwent 24-hour ambulatory ECG monitoring, and chronobiologic analysis of hourly HR was carried out by single and mean cosinor methods. A significant circadian rhythm was found both in the total sample (mesor 80 b/min, acrophase h 13:12; p less than 0.01), and, separately, in group A (mesor 82 b/min, acrophase h 13:11; p less than 0.01) and group B (mesor 78 b/min, acrophase h 13:12; p less than 0.01). No difference existed between the HR circadian rhythms of the 2 groups. Thus, our data show the possibility of ANS involvement in SLE patients without clinical signs of dysautonomy; the analysis of the HR circadian rhythm does not appear to be a sensitive method to identify early involvement of the ANS in these patients.
Cardiovascular diseases and atherosclerotic manifestations have been reported to be the most common causes of death in rheumatoid arthritis (RA). In the present investigation the levels of serum lipids, apolipoproteins (A1 and B100), total proteins, and albumin were studied in 35 female patients affected by active RA. Apolipoproteins A1 and B100 were significantly lower in RA patients than in controls. No significant difference was observed in total cholesterol, LDL cholesterol, or triglycerides. In contrast, HDL cholesterol and serum albumin were significantly lower in RA patients compared to controls. The finding of reduced apolipoproteins and HDL-cholesterol levels may represent an important factor in the etiology of cardiovascular and atherosclerotic disease in RA. Reduced levels of albumin in active RA may indicate a reduced rate of proteins like lipoproteins in the liver.
Hearing function was tested in 20 patients affected by rheumatoid arthritis. Audiological examination was performed by pure tone audiometry thresholds, tympanometry, a stapedial reflex threshold test and auditory brainstem responses (ABR). Hearing impairment was observed in 55% of patients. Conductive hearing loss and the absence of stapedius reflex were never recorded. Five patients with abnormal audiograms had normal ABR and normal stapedial reflex thresholds while 6 patients showed abnormalities in their audiograms, stapedial reflex thresholds test and ABR. Abnormal audiometric results associated with normal ABR are compatible with cochlea involvement, while abnormal audiometric results associated with an altered ABR and stapedial reflex test may be due to retrocochlear involvement. Sensorineural hearing loss appeared to significantly correlate with active disease and with the presence of rheumatoid factor.
Non-steroidal anti-inflammatory drugs, essential for the treatment of rheumatic diseases, are frequently associated with significant adverse effects on the integrity of the gastrointestinal mucosa. Sulglicotide (S), a natural product, has been found to possess gastromucosal protective properties. Aim of the present study was to evaluate whether (S) 200 mg t.i.d prevented or reduced the severity of gastric and/or duodenal mucosal injury induced by Diclofenac. A total of 30 patients with either rheumatoid arthritis (RA) or osteoarthritis (OA) who required NSAID therapy for at least 8 weeks were enrolled into a double-blind randomized placebo-controlled study. The main criteria for entry into the trial was the absence of gastrointestinal symptoms, and gastric/duodenal lesions assessed by endoscopy. At the end of the treatment endoscopy and relative symptoms were assessed. Six out of 15 patients, in both groups of treatment developed mucosal injury, but only in the placebo group the gastric damage was important (ulcer and petechiae) while in the group (S) we observed only hyperemia of the gastric mucosa. These preliminary data indicate the usefulness of Sulglicotide in preventing or reducing mucosal injury from NSAID treatment.
Association between diabetes and some rheumatic diseases have been proposed. The aim of our work is the evaluation of the prevalence of diabetes mellitus (DM) in a population of patients affected by some common rheumatic disease. We evaluated 356 consecutive out-patients [205 (71.66%) women and 101 (28.34%) men] attending the Rheumatology Unit of the Dept. of Internal Medicine of the Catholic University of Rome. The control group consisted of 200 out-patients, age and sex matched, who were examined in the Dept. of Surgery. The diagnosis of rheumatic patients were osteoarthritis (OA) (45.5%), rheumatoid arthritis (RA) (34%) and periarthritis (PA) (20.5%). The prevalence of diabetes mellitus in our rheumatic population was 5.78% in RA, 6.17% in OA, 10.9% in PA. The prevalence of DM in the control group was 4%. Our data suggest that the prevalence of DM in OA and RA patients is similar to that of general population, while it is significantly higher in PA patients probably for an active role of microangiopathy and hyperglycemia in the genesis of such disease.
It is becoming more apparent that the common gastritis and ulcer complications associated with non steroidal anti-inflammatory drugs (NSAID's) are distinct from classic peptic ulcer disease. To assess the incidence of gastrointestinal lesions and the existence of correlation with gastrointestinal symptoms, patients affected by rheumatic diseases treated with NSAIDs were carefully questioned to evaluate gastrointestinal symptoms and then underwent an esophagogastroduodenoscopic examination. The study demonstrates a relevant absence of gastrointestinal symptoms with an high incidence of gastric mucosal lesions in this patients. Asymptomatic lesions seem to be a characteristic feature of NSAID gastropathy. The blockade of synthesis of prostaglandins, due to the inhibition of cyclooxygenase by NSAIDs, may create an environment conducive to gastritis or ulcer disease and may be responsible of the absence of gastrointestinal symptoms.
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In order to evaluate the autoantibody pattern of subjects affected by rheumatoid arthritis (RA) with clinical features of keratoconjunctivitis, we studied 32 out- and in-patients (26 women, 6 men, average age 52 years, average disease duration 5.5 years) at the Division of Rheumatology, Catholic University of Rome. We found keratoconjunctivitis sicca and xerostomia in 22 (68.75%) patients with RA. Rheumatoid factor was present in 17 (53.1%) patients, antinuclear antibodies (ANA) were observed in 15 (48.4%) patients, and anti-rheumatoid arthritis nuclear antigens (RANA) in 22 (68.7%) patients; anti-SSA antibodies were confirmed in 3 (9.4%) patients and anti-SSB antibodies in 2 (6.2%) patients. None of the patients evidenced anti-U1RNP. Although keratoconjunctivitis sicca and xerostomia correlated significantly with the presence of rheumatoid factor, we found no relationship between these two conditions and ANA or anti-RANA antibodies. The high frequency of keratoconjunctivitis sicca and xerostomia in our RA patients is the expression of extra-articular involvement in this disease and is correlated with the presence of rheumatoid factor. ANA and anti-RANA antibodies may represent aspecific polyclonal activation in RA.