Biomedical subjects
Publications and source records attributed to R Scarpa.
Peripheral enthesopathies have recently been attributed a crucial role in the definition of seronegative spondyloarthropathies. We report a case of psoriatic oligoarthritis in which a peripheral enthesopathy, occurring at the right olecranon, was the heralding sign of the disease.
HME (heat-moisture exchangers) filters (Hygrobaby DAR) have been compared with classical humidifiers (Bennett Cascade Humidifier) with regard to heating and humidification of inspired gases in anaesthetized neonates and infants. 28 young patients (2 days-12 months) have been randomized into two groups. Though traditional heaters-humidifiers offer slightly higher performances in terms of temperature and moisture, HME-filters appear to be a better choice from cost, handiness and safety considerations. Antibacterial efficacy of HME-filters is also a major quality.
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Cytogenetic studies have provided a great deal of useful information about the biology and diagnosis of renal cell tumors. Particularly papillary and non-papillary tumors seem to be characterized by different cytogenetic patterns. We report the cytogenetic and histologic analysis of 16 renal tumors, 5 of which showed clonal chromosome changes. Most had chromosome abnormalities which have so far been described as specific of particular histopathologic subgroups.
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Medical records of 138 patients with psoriatic arthritis and 138 with rheumatoid arthritis were reviewed for the occurrence of an environmental factor triggering arthritis. Twelve (9%) of the patients with psoriatic arthritis had had an acute disorder immediately preceding onset of arthritis (an operation in four cases, articular trauma in three, abortion in two, myocardial infarction, thrombophlebitis, and phosphoric ester intoxication in one case each). Peripheral arthritis occurred in all these patients. Among the rheumatoid patients, an acute event immediately preceding the onset of the disease was recorded in two cases (1%) only (chi 2 = 7.52; p = 0.006). No significant association was found in the arthritic patients between the incidence of acute events preceding arthritis onset and positivity of the HLA-B27 phenotype.
Sneddon's syndrome is a rare entity characterized by idiopathic livedo reticularis and cerebrovascular lesions. A case of a young woman with livedo reticularis and progressive cerebral arteriopathy is described. Abnormalities of sexual and gonadotropic hormones were present. Anticardiolipin and anticardiolipin-cofactor complex antibodies were not found.
A 43-year-old man presented with oliguria and hypertension. Renal arteriography showed bilateral renal artery occlusion. Circulating antiphospholipid antibodies were found together with a change in natural anticoagulant plasma levels. Immunofluorescence of examined vessels showed immune complex vasculitis. We discuss the pathogenetic mechanism leading to the development of this rare occlusive event.
Seventy-nine consecutive patients with active ulcerative colitis were studied to establish the prevalence and clinical features of articular involvement. HLA typing for A and B loci was performed. Forty-nine patients showed an articular involvement (62%). Three different clinical patterns were identified: ankylosing spondylitis occurring in 20 subjects; peripheral arthritis in 15; unclassifiable spondylitis in 14. When compared to the general population in our area, patients with colitis showed a significantly higher prevalence of the HLA-A1 (p less than 0.005), B21 (p less than 0.001) and B27 (p less than 0.05); among patients with colitis, those with arthritis revealed higher frequency of HLA-B27 (p less than 0.05). Our study reveals a high prevalence of unclassifiable spondylitis during ulcerative colitis, and suggests a new approach to the classification of seronegative spondarthritis.
The authors have carried out in TEM and SEM a correlative study on human urethral glands. In addition they have studied, at TEM level, the immunohistochemical localization of blood group substances.
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The endpieces of human bulbourethral (BU) glands, studied with SEM after removal of the connective tissue, consist of short, coiled tubules often dilated into alveoli. Immunohistochemical studies at the EM level have shown that the mucous cells of these glands have mucous droplets, which react to blood group antigens, suggesting that BU glands participate in the secretion of these antigens into the seminal plasma. The main excretory duct is lined by a stratified columnar epithelium consisting of six-seven cellular layers. Cells of superficial layers, that are endowed with typical secretory granules, seem to contribute some unknown components to the secretions of these glands.
The aim of this study was to evaluate an immunofluorescence skin test, the lupus band test (LBT), in comparison to other criteria as classified by the American Rheumatic Association for the diagnosis of systemic lupus erythematosus (SLE). Twenty patients with SLE and another 24 with different connective tissue diseases (rheumatoid arthritis 16, dermatomyositis 3, necrotizing vasculitis 5) were studied. Antinuclear antibodies (ANA) appeared very sensitive (100%) in the diagnosis of LES, though with a low specificity (63%). LBT was however both sensitive (80%) and specific (100%). Others ARA laboratory criteria (anti-dsDNA, anti-Sm, VDRL and hematological disorders) were also less sensitive and/or less specific than LBT. Most interestingly, LBT was positive in 7 SLE cases in which both dsDNA and Sm antibodies were negative. Thus, LBT appears a useful test in the diagnosis of SLE. In addition, it may be of critical value in certain subsets of patients in which the present ARA criteria may not suffice for diagnosis.
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Clinical experience obtained in the management of 138 patients of psoriatic arthritis is reported. The correct recognition of arthritic subtype (according to Moll and Wright classification) always resulted essentially in the choice of the therapy. Our programme included rehabilitative, pharmacologic and surgical approaches. Our data suggest that psoriatic arthritis is a mild articular disease when compared to other affections such as rheumatoid arthritis or ankylosing spondylitis. Notwithstanding an accurate therapeutical programme, it is necessary to control atypical cases which not infrequently can occur.
Six hundred and forty-seven patients with psoriasis were studied in order to define prevalence and clinical features of psoriasis and psoriatic arthritis. After medical history review all patients were observed by a dermatologist and a rheumatologist. Successive laboratory tests and radiological and scintiscan examinations of joints were also performed. Diagnosis of arthritis was made according to Wright and Moll. In our district, the prevalence of psoriasis in respect to other dermatological diseases was 1.86%. Vulgaris pattern occurred in 85% of the total cases while eruptive was found in 10.5%. Erythrodermic and pustular forms were uncommon, occurring in 2.47% and in 1.23%, respectively. In 84.8% of the total cases, psoriasis onset was clinically evident while in 10.8% it affected non-evident cutaneous sites. Onycopathic onset occurred in 4.3%. Altogether 138 psoriatic patients exhibited arthritis and spondylitic and polyarticular patterns were very common (occurring in 42.7% and 33.3%, respectively). Psoriasis antedated arthritis in 68.4% of the cases but followed it in 21%. Synchronous onset occurred in 10.8%. The data obtained strengthen those of our previous reports. In particular, the marked articular involvement of psoriatic patients is confirmed. Moreover, our results, when compared with data of other authors, show a different distribution among the arthritic subtypes.
Erythema Nodosum (EN) is a painful nodular syndrome, most likely of immunologic origin, which involves dermis and subcutaneous tissue. Pathologic process is that of vasculitis of the small veins with inflammation of the septa of the fat lobules (septal panniculitis). It is generally agreed that EN represents a hypersensitive reaction to a variety of antigenic stimuli and thus may be observed in the course of several diseases (infections, immunopathies, malignancies) as well as during drug therapy (with halides, sulfonamides, oral contraceptives). In approximately 50 per cent of the cases an underlying etiology is not apparent (idiopathic form). The clinical picture is always that of a nonspecific systemic illness with low-grade fever (in 60%), malaise (in 67%), arthralgias (in 64%) and arthritis (in 31%), while when there is an associated illness, this may dominate the presentation. Laboratory tests show no specific abnormalities except for those related to an underlying disease. Treatment of idiopathic form includes nonsteroidal antiinflammatory agents which usually ease the discomfort. Steroids, although highly effective, are not recommended because of the benign nature of EN and the danger of disseminating an underlying disease.
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