The Case of Reactive Arthritis Secondary to Echinococcus Infestation.

Reactive arthritis is an inflammatory joint disease that develops after an infection and it usually occurs following a gastrointestinal or genitourinary system infection and it belongs to the family of arthritis called "spondyloarthritis." We wanted to represent a rare case of reactive arthritis secondary to Echinococcus infestation. Cyst hydatid disease is common in endemic regions like Turkey. Internal organ involvements, especially liver and lung, are most frequent involvements. Primary bone involvement is rare complication of Echinococcus infestation. In our case, the patient with Echinococcus infection developed right knee arthritis and sacroiliitis. Other reactive and oligoarthritis causes were excluded and diagnosis of reactive arthritis secondary to cyst hydatid infestation was done with the present findings. Cold pack and TENS treatment were applied as symptomatic treatment to the right knee of the patient. Acemetacin was given as medical treatment. On the 5th day of treatment, right knee and ankle arthritis were clinically regressed. In regions where the disease is seen as endemic, such as Turkey, patients with musculoskeletal symptoms should consider the possibility of musculoskeletal involvement due to the hydatid cyst.

Microvascular abnormalities in Rett syndrome.

Rett syndrome (RTT) is a post-natal neurological disorder that represents the second most common cause for mental retardation. The presence of cold hands and feet, and blue, a feature frequently observed in these patients, is one of the non-neurological phenotypes that characterizes RTT, up to now not well explained. We have performed videocapillaroscopy in subjects affected by Rett syndrome. We have observed ramified and bushy capillaries, characteristic features of neoangiogenic capillaries, dilated capillaries and an irregular and chaotic microvascular pattern. To quantify these features and to evaluate the microvascular pattern complexity, we have performed a fractal analysis. Fractal dimension and Lempel-Ziv indexes resulted higher in Rett females than in age-matched healthy females (p < 0.001; p < 0.001). Our findings indicate the presence of previously unrecognized microvascular abnormalities in Rett syndrome.

Thyroid autoimmunity may represent a predisposition for the development of fibromyalgia?

In our previous study, we observed that the presence of autoimmune thyroid disease worsens fibromyalgia (FM) symptoms. The aims of this study are to evaluate whether there is a predisposition for the development of FM in patients with Hashimoto's thyroiditis (HT) with or without subclinical hypothyroidism (SCH) and in patients with SCH alone and what is the weight of antithyroid antibody positivity and SCH on FM comorbidity. Fifty-two patients, 39 affected by HT with or without SCH and 13 by SCH, were matched with 37 patients affected by FM and 25 healthy subjects. Blood samples were collected from all study subjects for the determination of serum TSH, free triiodothyronine, free thyroxine, antithyroperoxidase antibody (TPOAb), antithyroglobulin antibody (TgAb) and non-organ-specific autoantibodies. Clinical assessment of patients and controls included the "Fibromyalgia Impact Questionnaire" (FIQ), while pain severity was evaluated using a visual analogue scale (VAS). Patients and controls were also characterized by the presence of diffuse pain, fatigue, paresthesiae, muscle spasms, non-restful sleep, tension headache and presence of mood disorders. FM comorbidity resulted in twelve HT subjects (31%) and none in SCH patient. In particular, FM comorbidity in HT patients without SCH was 33.3% and in HT patients with SCH was 28.5%. Based on our data, we speculate that maybe there is more than a hypothesis regarding the cause-effect relation between thyroid autoimmunity and the presence of FM, thus suggesting a hypothetical role of thyroid autoimmunity in FM pathogenesis.

Structural and functional abnormality of systemic microvessels in cardiac syndrome X.

BACKGROUND AND AIM: Microvascular damage of coronary bed has been considered the main pathogenetic factor of cardiac syndrome X (chest pain, exercise-induced ischemic ST-segment changes and angiographically normal coronary arteries). Previous studies have demonstrated that vascular abnormalities are not confined to the heart, suggesting a peripheral vascular dysfunction. On the hypothesis of a generalized microvascular disturbance in cardiac syndrome X, we performed a morphologic and functional study of systemic microcirculation in patients with syndrome X compared to normal subjects. METHODS AND RESULTS: Microvessels were evaluated with intravital videocapillaroscopy (VCP) executed in peripheral and conjunctival observation sites which explore micro and paramicrocirculation; biohumoral study included markers of inflammation and of endothelial function, coagulative-fibrinolytic system and lipid metabolism. Videocapillaroscopy showed several morphologic changes (present in high percent of patients with syndrome X and not in controls) and significant quantitative alterations (capillary density, granular flow score, alterations of vessel profile, length of capillary loop branches and of arteriole/venule diameter) which indicated a severe alteration of whole vessel structure and an important rearrangement of microvascular disposition. In a similar way, the humoral study showed some significant changes of endothelial (vWF, ICAM-1, E-sel, PAI-1), inflammatory (C-reactive protein (CRP), fibrinogen) and metabolic factors (HDL-chol) which are commonly associated with inflammatory response. CONCLUSIONS: We conclude that patients with cardiac syndrome X exhibited some structural and functional alterations of systemic microvasculature; the pattern is similar to that detected in systemic inflammatory diseases and suggests a vascular lesion of inflammatory type. The same changes could be operating also in coronary microvessels of patients with syndrome X.

Gain of function TSH receptor mutations and iodine deficiency: implications in iodine prophylaxis.

Iodine deficiency is widely known to be the main cause of nodular goiter (NG). In iodine deficient areas subclinical and overt hyperthyroidism is the major cause of morbidity and it is mainly due to toxic NG rather than Graves' disease. Toxic NG, including toxic multinodular goiter and toxic thyroid adenoma is usually encountered in subjects with long-standing NG, in whom thyrotoxicosis is usually preceded by a long phase of euthyroidism and then subclinical hyperthyroidsm (abnormally low TSH with normal circulating thyroid hormones). Epidemiological studies indicate that, compared to Graves' disease, the incidence and prevalence of non-autoimmune hyperthyroidism due to toxic adenoma and toxic multinodular goiter differ in different regions of the world, being much more frequent in areas of iodine deficiency. Recently, mutations of the TSH receptor (TSHr) gene causing permanent activation of the thyroid follicular cell adenylate-cyclase, have been shown to be the most probable cause of the hyperfunction and growth of toxic adenoma. In this review we will focus our attention on the role of external factors (i.e. iodine deficiency) with respect to individual factors (i.e. genetic mutations) in the pathogenesis of toxic NG.

Microvascular assessment in Behçet disease: videocapillaroscopic study.

The aim of this study was to evaluate microvascular assessment in patients with Behcet disease (BD) by means of an intravital videocapillaroscopic study. Sixteen BD patients were compared with an equivalent group of healthy subjects matched for age and sex. Videocapillaroscopy (VCP) was performed in peripheral areas and in conjunctiva, and morphological and quantitative parameters were assessed. In both areas VCP showed several morphological alterations (microaneurysms, megacapillaries, desertification areas) detectable in a high percentage of patients; quantitatively we found significant changes of incisuring and sludging score, of capillary loop intermediate branch length (in peripheral areas) and of arteriole/venule diameter (in conjunctiva). Therefore, vessel involvement included both the number and the whole vessel structure and was seen both in peripheral and conjunctival areas when the two different vascular beds of micro- and paramicrocirculation were examined. We conclude that an important rearrangement of microcirculation is detectable in BD and that VCP may have diagnostic and prognostic value, providing qualitative and quantitative information able to define the systemic extension of vascular damage and the degree of vessel wall alteration.

[Hemicrania: comparison of physiopathogenetic theories]. / Emicrania: teorie fisiopatogenetiche a confronto.

The authors tackle the complex question of the physiopathogenesis of migraine by examining the various theories which have been proposed, underlining that only through an open and constructive comparison it is possible to reach a real understanding of such a complex pathology such as migraine.

[Headache: new epidemiologic and nosographic trends]. / Cefalee: nuovi orientamenti epidemiologici e nosografici.

Most recent epidemiological data on headaches are here discussed. These data clearly show the great social-economic importance of this problem, giving at the same time many hints of discussion on the different aspects of this complex syndrome. It is here also analyzed the latest international classification of the headache.

[Use of cholinesterase inhibitors in Alzheimer disease]. / Impiego degli inibitori della colinesterasi nella malattia di Alzheimer.

According to the cholinergic theory of Alzheimer's disease, the cognitive failure depends on a deficit in acetylcholine. The study reported above examines the efficacy and tolerability of cholinesterase inhibitors, such as tetrahydroamino acridine (THA), for the management of this pathology.

[A case of beriberi on the threshold of the year 2000]. / Un caso di Beri-beri alle soglie del 2000.

The authors report a case of beriberi due to a deficit in thiamine, which became apparent in a young Chinese woman with polyneuropathy, distal oedema and epigastralgia. Parenteral administration of thiamine lead to the virtually complete resolution of symptoms.

Plasma thiobarbituric acid reactive substances a predictive marker of cerebral ischemia in patients at high risk?

The clinical meaning of high values of blood lipid peroxides, assessed as thiobarbituric acid reactive substances (TBA-RS), was investigated in 19 selected high risk patients with transient ischemic attacks (TIA). Patients were checked every 3-6 months and followed-up for 3 years. 8 patients experienced further vascular episodes, 4 having minor stroke and 4 TIA; one of the latter died from myocardial infarction. Unlike blood cholesterol and glucose. TBA-RS values discriminated patients with vascular episodes: they, indeed, showed significant higher values of TBA-RS. Discriminant analysis further indicated that TBA-RS levels differentiate patients with and without vascular accidents, suggesting that high blood values of lipid peroxides could represent a predictive sign of vascular ischemia.

Blood lipid peroxides in TIA: relation to platelet function and metabolic profile.

Patients with transient ischemic attacks (TIA) were previously shown to have high plasma values of thiobarbituric acid-reactive substances (TBA-RS). To study whether these changes could be related to platelet activability, TBA-RS was investigated in 24 TIA patients before and 24 h after 1 g aspirin, an inhibitor of platelet cyclooxygenase pathway. Baseline TBA-RS values were significantly higher in TIA than in controls. Conversely, TIA patients had TBA-RS values after aspirin similar to controls, suggesting that the increase of plasma TBA-RS was not attributable to platelet hyperfunction. The evaluation of metabolic profile showed that patients with highest TBA-RS had hypercholesterolemia, hypertriglyceridemia, and/or diabetes mellitus. This study suggests that the increase of plasma TBA-RS in TIA could be an epiphenomenon of altered metabolic pathway.

Leukocyte response in patients suffering from acute stroke.

The oxidation of adrenaline to adrenochrome has been shown to reflect the activation of leukocytes in vivo. We tested the in vivo activation of leukocytes by measuring plasma oxidation of adrenaline to adrenochrome in patients suffering from cerebral ischemia, cerebral hemorrhage, and transient ischemic attacks and in healthy subjects. Patients with cerebral ischemia and cerebral hemorrhage had significantly higher values than healthy subjects, while patients with transient ischemic attacks had values similar to those of healthy subjects. In some patients with cerebral ischemia, the test was repeated 4 and 15 days after the acute event, but the follow-up data did not differ from baseline values. Our study shows that leukocyte activation occurs in cerebral ischemia and cerebral hemorrhage.

One year follow-up of patients clinically preselected for excessive risk of stroke.

From a consecutive series of 812 patients at risk of stroke we selected 100 who seemed to be at high risk (excessive stroke risk--ESR) on the following clinical criteria: either multiple reversible ischemic attacks in one carotid territory or multiple (or bilateral) severe stenotic carotid lesions. The patients of the first subgroup received medical therapy and those of the second were referred for surgery. The 100 patients were followed up for 12 months, during which 29 patients had cerebral ischemic events: 17 having stroke and 12 TIA. This study suggests that it is possible to identify beforehand subgroups of ESR patients, thereby facilitating the selection of patients for brain protection and avoiding huge trials of unselected cerebrovascular patients.

Mitral valve prolapse as a risk factor for TIA. A study with echocardiography and dynamic ECG.

The present study has been devoted to the analysis of 120 patients presenting with reversible focal cerebral ischemia without conventional signs of cardiopathy and/or relevant atherosclerotic disease. In 77% of the patients vascular risk factors, such as hypertension or hyperlipemia, were present. In 23% of the patients, no abnormal finding was discovered at clinical, hematochemical and cardiological examinations. In these patients a further cardiological evaluation was performed with echocardiography. Dynamic electrocardiography was performed in 52 patients. Echocardiography and dynamic electrocardiography revealed the occurrence of 6 cases of mitral valve prolapse (MVP), 2 cases of frequent premature ventricular beats, and 1 proximal atrial arrhythmia. All 6 cases of MVP were detected in the subgroups of patients without vascular risk factors. In our patients younger than 45 years, the relative frequency of MVP attains 21.5%. This study confirms that MVP has to be regarded as a risk factor for focal cerebral ischemia in young patients.

[Therapeutic action of vitamin C on cholesterol metabolism]. / Azione terapeutica della vitamina C sul metabolismo del coleste rolo.

As a part of the research work on the role played by Vitamin C on lipidic metabolism, the effects on man were considered that result from the administration of high vitamin C doses, chiefly with reference to the serum levels of colesterol, of total lipids and of triglycerides. Our research was conducted on male subjects of 65-90 years, who were administered 3 g/day of vitamin C for three weeks. Our findings show that the administration of high vitamin C doses causes a statistically significant decrease in colesterol, in total lipids and in triglycerides, in all the subjects under consideration. This takes place not only when colesterol, total lipids and triglycerides present normal serum levels, but also when such levels show an increase. Conversely, vitamin C significantly increases, with treatment, in all subjects treated, both in plasma and in leukocytes.