Allopurinol-induced Sweet's syndrome.

Sweet's syndrome, or acute febrile neutrophilic dermatosis, is an uncommon severe cutaneous condition, not previously associated with allopurinol therapy. We describe the case of an 87-year-old woman with hyperuricemia who developed classic Sweet's syndrome manifestations 8 days after being treated with allopurinol. Patient's symptoms included fever, painful edema in the hands and lower limbs with non-pruritic erythematous plaques topped by pus-filled skin blisters, right eye conjunctivitis, splenomegaly and joint pain. At the emergency department, blood tests showed neutrophilic leukocytosis, inflammatory state and altered liver function. During hospitalization, she received unsuccessful treatments with two different antibiotics (namely ceftriaxone and levofloxacin), while treatment with intravenous methylprednisolone produced a rapid clinical remission of symptoms, cutaneous lesion pain improvement, normalization of her body temperature and her blood values returned to normal. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship between the patient's development of Sweet's syndrome and allopurinol therapy. Because the signs and symptoms of Sweet's syndrome resemble an infectious process, the correct diagnosis may be delayed and inappropriate treatment regimen with antibiotics may often precede glucocorticoid therapy.

Severe septal panniculitis in a multiple sclerosis patient treated with interferon-beta.

We report a memorable case of severe septal panniculitis in an MS patient following the subcutaneous administration of interferon beta-1b, manifesting as a painful, indurated, erythematous lesion of the thigh, which appeared at the injection site.

Neuroinflammation and neuroprotection: an update on (future) neurotrophin-related strategies in multiple sclerosis treatment.

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS), characterized by inflammation, demyelination and axonal loss underlying progressive clinical disability. The chronic inflammatory tissue damage involving myelin and axons is driven by autoreactive T cells and represents a key mechanism in the immunopathogenesis of MS. Over the last few years, evidence from MS and experimental models of neuroinflammation has suggested that autoimmune responses could exert neuroprotective effects through the release of neurotrophins by autoreactive T cells. Specifically, the role of the Brain-derived neurotrophic factor (BDNF) in facilitating brain tissue repair in experimental traumatic injury has been well recognized. Support for this hypothesis comes from recent studies showing that glatiramer acetate, a currently approved treatment for MS, promotes the expansion of T cell clones crossing the blood-brain barrier and releasing BDNF in situ. A small subset of autoreactive T cells expresses the high-affinity full-length receptor for BDNF (TrkB-TK) in the periphery. In MS patients, T cells show reduced susceptibility to activation-induced apoptosis, a crucial mechanism eliminating autoreactive T clones and contributing to peripheral immunologic tolerance. These findings suggest the existence of a dual effect exerted by BDNF, which not only provides neuroprotection in the CNS but also promotes the survival of autoreactive T cells through an autocrine/paracrine loop. The aim of this review is to discuss the neuroprotective effects of currently approved immunomodulatory treatments for MS and their role in regulating neurotrophin production. We will also describe novel therapeutic strategies arising from new insights on "neuroprotective autoimmunity".

Pityriasis rosea during etanercept therapy.

Multiple bioengineered agents has been recently developed to attack other parts of the immune/inflammatory system, achieving therapeutic implications for dermatologic diseases. On the other side, each new therapy has the potential for adverse cutaneous reactions. We present herein the first two cases of Gibert's pityriasis rosea occurring during etanercept therapy and discuss possible links between this common, etiologically still unexplained exanthema and anti-tumor necrosis factor-alpha drugs.

Bone morphogenetic proteins for periodontal and alveolar indications; biological observations - clinical implications.

Surgical placement of endosseous oral implants is governed by the prosthetic design and by the morphology and quality of the alveolar bone. Nevertheless, often implant placement may be complexed, if at all possible, by alveolar ridge irregularities resulting from periodontal disease, and chronic and acute trauma. In consequence, implant positioning commonly necessitates bone augmentation procedures. One objective of our laboratory is to evaluate the biologic potential of bone morphogenetic proteins (BMP) and other candidate biologics, bone biomaterials, and devices for alveolar ridge augmentation and implant fixation using discriminating large animal models. This focused review illustrates the unique biologic potential, the clinical relevance and perspectives of recombinant human BMP-2 (rhBMP-2) using a variety of carrier technologies to induce local bone formation and implant osseointegration for inlay and onlay indications. Our studies demonstrate a clinically relevant potential of a purpose-designed titanium porous oxide implant surface as stand-alone technology to deliver rhBMP-2 for alveolar augmentation. In perspective, merits and shortcomings of current treatment protocol including bone biomaterials and guided bone regeneration are addressed and explained. We demonstrate that rhBMP-2 has unparalleled potential to augment alveolar bone, and support implant osseointegration and long-term functional loading. Inclusion of rhBMP-2 for alveolar augmentation and osseointegration will not only enhance predictability of existing clinical protocol but also radically change current treatment paradigms.

A study of case dynamic by fingerprints' fragments analysis.

Fingerprints are an extremely helpful tool for investigators as they can lead to personal identification through the observation and comparison of the characteristic minimal elements present in their structure. As forensic scientists and not only like investigators we have considered the hypothesis they may also be useful to study the dynamic of a gun shot murder in order to realize how the event took place. We have detected the presence of some papillary crest impressions on a gun which had shot and killed a person: afterwards, we have studied how those traces were oriented on the gun itself in order to determine how it was grasped, which led us to understand the murderer's behaviour on the crime scene.

A novel approach to identify the presence of fingerprints on wet surfaces.

In forensic science, one of the major problems is trying to reveal the presence of fingerprints on wet surfaces. Not often are fingerprints left in protect environments, so we have to detect their presence on the most different surfaces, after they underwent to the action of atmospheric agents or have been found, for example, on objects floating in the water. Small Particle Reagents (SPR) is a technique performed to detect latent fingerprints left on wet or moist surfaces based upon the reaction between the fatty-acid residuals present in the traces and hydrophobic tails of the specific reagents. Those tails are linked to a hydrophilic head reacting with a titanium dioxide salt giving a white precipitate plainly detectable. In this report, we want to show that exalting fingerprints left on plastic, glass and metal wet surfaces is possible with the SPR technique independently on the time fingerprints were in contact with water, as we performed in our experimental procedure. Results in details.

Small particle reagents technique can help to point out wet latent fingerprints.

SPR is a technique performed to detect latent fingerprints left on wet surfaces, based upon the reaction between the fatty components present in the traces and hydrophobic tails of the specific reagents. These tails are linked to a hydrophilic head, which reacts with metal salt to give a white or black precipitate. The literature reports that it is possible identifying latent fingerprints with cyanoacrylate fuming procedure, after drying the surface, but you cannot always do it. In the present report we want to show a casework that can concern a find completely dust covered.

[Epistaxis: emergency treatment approach]. / Epistassi: approccio terapeutico in urgenza.

After a brief summary of the causes of severe epistaxis and the surgical choices available for treatment, the authors present their own cases study. Starting from a brief description of the anatomy involved in the system of arterial irrigation of the nasal cavities, they focus on two fundamental concepts: the basis for a proper topographic picture of the site of bleeding and the success of surgery. First and foremost is the emergence of two arterial branches from the sphenopalatine formen; this differs from what is asserted in the classical treatise on anatomy and in line with what has been stated in the Nomina Anatomica, approved during the X World Congress on Anatomy (Tokyo 1975). Secondly, focus is placed on the existence of two important anastomotic systems in the arterial circulation of the nasal cavities: the one between nasal septum and anterior-posterior ethmoid arteries and the one between the lateral-posterior nasal and nasoseptal arteries. In the literature the failure of surgery in treating severe epistaxis is explained by the onset of supplementary anastomotic circulation. The indications for surgical treatment of epixstaxes are: copious bleeding in hospital or after the packing has been removed; underlying pathology or general status which has been aggravated by the packing; patient which has already been staunched several times. The results of 31 epistaxis procedures are presented: 8 (25.81%) upper and 23 (74.19%) posterior. The upper epistaxes were treated as follows: 3 cases with anterior ethmoid ligature, two of which failed; 2 cases with combined ligature of the anterior and posterior ethmoid; 3 cases of successful septoplasty. The posterior epistaxes were treated as follows: 11 cases of ligature of the lateral-posterior nasal artery, 2 of which failed; 12 cases of successful combined ligature of lateral-posterior nasal and nasoseptal arteries. These results confirm that it is possible to effectively resolve surgically severe epistaxis using microsurgery or transnasal endoscopy based on in depth knowledge of the complex architecture of the arterial circulation within the district of the paranasal sinuses, possible anatomic variations and collateral circulation.