Diffuse cutaneous systemic sclerosis treated with intravenous iloprost.
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Biomedical subjects
Publications and source records attributed to C Coviello.
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In this paper the Authors report their personal experience of the use of exchange transfusion, secondary to classic indication, in the treatment of neonatal hyperbilirubinemia, in order to: 1) determine the trend over the past wears in the number of exchange transfused neonates, both from a global point of view and in relation to indications; 2) critically assess the risks, in terms of complications and mortality, correlated to exchange transfusion. Four hundred and eighty-eight neonates, who were subjected to 693 exchange transfusions in the Pediatric Clinic and Neonatal Division of the Policlinico Gemelli in Roma, were studied over a period of 15 years (1972-1986), according to the following indications: 214 cases of neonatal hyperbilirubinemia with MEN-Rh, 106 cases of neonatal hyperbilirubinemia with MEN-ABO and 168 cases of idiopathic hyperbilirubinemia. The total number of exchange transfused neonates decreased drastically from 304 in the period 1972-76 to 65 in the period 1982-86. The frequency of exchange transfused neonates because of idiopathic hyperbilirubinemia decreased significantly (p greater than 0.001), booth in comparison to the number of live births and in comparison to the number of exchange transfused neonates, probably due to the gradual introduction of phototherapy. The frequency of exchange transfused neonates with iso-Rh and iso-ABO decreased or remained stationary on account of the confirmed relative lesser efficacy of phototherapy on hemolytic jaundice. With regard to mortality and morbidity, 27 out of 488 neonates died during the neonatal period, but only 4 within six hours of exchange transfusion; the majority of those who died had a reduced gestational age and low birthweight, and were affected by a severe associated pathology.
Twenty-four in- or out-patients (12 males and 12 females) with chronic cutaneous (CCLE) (n = 19) or subacute cutaneous (SCLE) (n = 5) lupus erythematosus have been treated with oral isotretinoin. The initial dose 0.15 mg/kg/day was progressively increased to a maximum of 0.50 mg/kg/day; the total treatment period was 16 weeks. One female patient with SCLE stopped the therapy for sudden fever. None of the other known side effects induced interruption of treatment. In 20 subjects (86.9%) isotretinoin therapy was associated with clearing or improvement of clinical lesions and histopathologic changes. Best responses with isotretinoin therapy was seen in patients with CCLE. No changes were observed in the laboratory parameters before, during, and at the end of the study. In the light of these results, isotretinoin can be considered as an effective and well-tolerated drug in the treatment of cutaneous lupus erythematosus.
An experimental study is reported of the irritant potential of oil of purcellin , isopropyl palmitate, nonyl phenol, Modulan , Amerchol and Acetulan when massaged in fixed amounts into the rabbit's skin daily for 30 days. Skin biopsies provided data on the number of epithelial cell layers, cell counts of the superficial dermis, and the fibre and basement membrane changes. All the test compounds induced changes in the form of increased number of epithelial cell layers and of the papillary dermis cell count, more marked for Acetulan or Amerchol . The difficulties in the evaluation of the results and their applications to human pathology are discussed.
The capacity of tegobetain, pyrrolnitrin, tolcyclate and chlorquinaldol to induce delayed-type contact sensitization was studied in guinea pigs in 2 series of tests using the method of Magnusson & Kligman and the authors' modification of the wholly intradermal Draize technique. Histological examination of skin biopsies obtained from the test area demonstrated that tegobetain, pyrrolnitrin and tolcyclate are potential sensitizers.
Reference is made to the clinical and instrumental results observed in 40 subjects with chronic obliterating arteriopathy of the lower limbs treated for 90 days with a projective protocol based on a per os retard combination of bufenine and beta-escine. Attention is drawn to the vasoactive and antioedemigenic activity of the combination, its good tolerance, and easy administration.
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A further study of the topical effects of certain pharmaceutical and cosmetic bases on rabbit skin is reported. Cetyl alcohol, myristic acid, castor oil and sorbitol were applied in fixed doses daily for 30 days and their irritant activity was assessed. The macroscopic and microscopic changes were on the whole minimal. Castor oil alone produced some macroscopic alterations in the form of slight erythema and edema, and microscopic changes consisting of acanthosis, disorganization of the basal layer and slight infiltration of the dermis.
A staged histological study of skin changes induced in rabbits by daily application of five bases used for topical medicaments and cosmetics, namely glycols, petrolatum, Modulan, Acetulan and Amerchol L 101, over periods of 100 days, is reported. Sections obtained every 10 days were examined for changes in the epithelium, in the character of the dermal infiltrate and in the superficial collagen fibers. Glycols showed no particular effects on the skin; petrolatum produced acanthosis and vacuolization in the epidermis, and mononuclear cell infiltration of the dermis but evident collagen changes. Lanolin derivatives produced acanthosis and vacuolization of the epidermis, with lymphomonouclear infiltration of the dermis and with dissociation of collagen; examination around the 30th day showed a tendency to basal layer disorganization by the infiltrate.
Tumour necrosis factor (TNF)-alpha plays an important role in the pathogenesis of psoriasis. Infliximab is an anti-TNF-alpha chimeric monoclonal antibody, which is licensed for the treatment of rheumatoid arthritis and Crohn's disease. Some reports have shown the efficacy of infliximab, either in monotherapy or in combination with methotrexate, for the treatment of psoriatic arthropathy and psoriasis. The efficacy and tolerability of infliximab monotherapy was evaluated in 29 patients with moderate to severe psoriasis, unresponsive to conventional treatments. Fourteen patients suffered from concomitant arthropathy. Patients received intravenous infliximab, 5mg/kg, at weeks 0, 2, and 6. After this 3-dose-induction regimen, patients were followed-up at monthly intervals and retreated with a single-dose infusion in case of relapse of signs and symptoms. Clinical assessment was performed using the psoriasis area and severity index (PASI) to monitor psoriasis activity; pruritus and joint pain were assessed on a scale of 0 to 3. A marked improvement of skin lesions and subjective symptoms was noted in the majority of patients; an excellent reduction of PASI score (> or =75%) was observed in 13.8% of cases at week 2, 71.4% at week 6 and 78.6% at week 10. During the follow-up period, some patients maintained satisfactory clinical results without requiring any additional infusions. In general, skin lesions showed a trend towards a more prolonged and sustained improvement as compared with subjective symptoms. Treatment was well tolerated and no serious adverse events occurred.
Infliximab is an anti-tumour necrosis factor (TNF)-alpha chimeric monoclonal antibody which is effective in diseases associated with a T-helper (Th) 1 response, such as rheumatoid arthritis, Crohn's disease and psoriasis. There are sporadic case reports of atopic dermatitis (AD) induced or precipitated by anti-TNF-alpha therapy, which have been attributed to the switch towards Th2-mediated reactions. We report the case of a 30-year-old man with long-standing severe AD associated with contact allergy and poorly responding to conventional treatments. The use of infliximab resulted in a dramatic amelioration of AD lesions and pruritus, persisting at follow-up examinations over a 3-year period. Probably, the unexpected response to infliximab therapy in this case might be due to some peculiar features of AD in our patient (i.e. chronic-continuous course and concomitant contact allergy) which could have been responsible for a more preponderant recruitment of Th1 cells as compared to common forms of AD.
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