[Syndrome of the aortic arch and rheumatic polymyalgia. Description of a case]. / Sindrome dell'arco aortico e polimialgia reumatica. Descrizione di un caso.

The paper reports a recently observed case of a 76-year-old man suffering from claudication of the upper limbs, undetectable brachial pressure and bilateral absence of radial, brachial and axillary pulses. During the previous two years the patient had complained of symptoms reminiscent of polymyalgia rheumatica. On admission to hospital, he also presented elevated ESR without temporal arteritic symptoms or involvement of other arterial districts, excluding the main supra-aortic branches, and without ocular signs. Arteriography showed the typical radiological findings of arteritis with bilateral occlusion of the subclavian arteries. Steroid therapy, which was commenced without previous histological biopsy, resulted in a clear subjective and objective improvement in the patient's condition. Following a review of the literature, the A. focus on the incidence of extra-temporal localisations of arteritis associated with polymyalgia rheumatica and on other related problems. They emphasise the importance of beginning steroid therapy as early as possible.

[Critical observations on changes in gamma-glutamyl-transpepdidase in hepatopathies]. / Osservazioni critiche sulle modificazioni della gamma-glutamil transpeptidasi nelle epatopatie

The behaviour of gamma-glutamyl transpeptidase was compared with other serum enzyme activities and functional parameters in a carefully selected and relatively extensive series of patients with liver disease, including alcoholics, in an investigation of the underlying pathogenesis and its clinical expression. Reference. to the literature and to personal data showed that increased gamma-glutamyl transpeptidase levels could be attributed to enzyme induction (caused by drugs or alcohol), liver damage in the broad sense, and intra- or extrahepatic cholestasis. These causes were individually predominant, or nearly so, on occasions, though their concomitance was more common. High levels, however, were not pathognomonic for a given disease. In alcoholism, they were highly indicative, especially if accompanied by GLD changes. They were a virtually constant, early, and typical finding in intra- and extra-hepatic cholestasis, and tended to persist for a time after the resolution of icterus. Lastly, they were an aid in the early diagnosis of aggressive hepatitis and liver cancer.

Hyperosmolar hyperglycemic nonketotic coma in Waldenström's macroglobulinemia associated with type II diabetes and complicated by pulmonary tuberculosis.

In this paper we describe a successfully treated case of hyperosmolar hyperglycemic non ketotic coma (HHNC). The HHNC was observed in a patient affected by Waldenström's macroglobulinemia, associated with type II diabetes and complicated by pulmonary tuberculosis. Hyperosmolar hyperglycemic nonketotic coma is a clinical condition with a high mortality rate associated with a severe increase in blood viscosity. This increase in blood viscosity justifies several clinical manifestations of the HHNC. We believe that an increase in the blood viscosity produced by the simultaneous presence of the single diseases mentioned above may have encouraged the development of hyperosmolar coma in the case reported.

Serum albumin and others parameters in intravenous drug users HIV-infected.

In 37 intravenous drug users (IVDUs) in the first stages of HIV-infection (17 in stage II and 20 in stage III according to CDC), compared with 32 IVDUs HIV-negatives, we found a significant decrease in circulating leucocytes (p less than 0.01), lymphocytes (p less than 0.005), platelets (p less than 0.005), serum albumin (p less than 0.005), and C3 (p less than 0.02) and significant increase in serum gammaglobulins (p less than 0.0005) and IgG (p less than 0.0005). On the other hand no difference was observed in hemoglobin and in IgA levels; nevertheless an inverse relationship between serum IgA and CD4+ lymphocytes was present in HIV-positive (HIV+) patients (r = -0.34; p = 0.04). This observation agrees with that is observed in the advanced stages of HIV-infection, which presents an increase in IgA serum levels. In these stages this fact could be due to a decrease of secretory IgA, with a deficient barrier effect; the consequent recirculation of intestinal antigens should enhance the antibody production, as well as serum IgA. In the IVDUs HIV-infected a reverse correlation between albumin serum levels and the length of HIV-positivity (r = -0.44; p = 0.008) and a direct correlation between albumin serum levels and circulating CD4+ lymphocytes (r = 0.37; p = 0.05) were present. There was no direct linear relationship between albumin serum levels and creatinine, on the contrary to what was observed in the control group. The decrease of albumin levels could have a prognostic value as in other clinical conditions, in which it is associated with a higher mortality risk. Many factors could act to decrease albumin levels, but the most important one is perhaps the malnutrition of HIV-infected patients that can also be present in the first stages of infection, negatively influencing the associated immunodeficiency.

Modification of phlogosis indices in pneumonia during antibiotic therapy.

50 consecutive cases of pneumonia were treated using a standardized diagnostic-therapeutic protocol. The variations of the more common phlogosis indices (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], leucocytes) during the antibiotic therapy were evaluated, together with clinical progress. Comparative evaluations of the phlogosis indices were taken as well as the X-ray picture. The data analysed, according to the literature, showed a significantly faster and more widespread response to the therapy by the CRP, in respect to ESR and the leucocytes number. This data has been substantially confirmed even in individual groups into which the case study was subdivided. In the "compromised" (according to the British Thoracic Society) patients, the fall in the CRP level was not so early as in the "uncompromised" group. There did not seem to be however different behaviour of ESR and leucocytes between these two groups. Modifications in these two tests over time were rarely significant. An age equal to or greater than 70 appears the element which best defines the state of "compromised host". A comparison of the clinical progress with the variations of the tests of phlogosis and the radiographic tests confirms the usefulness of CRP as an early index of the clinical evolution and the lateness of X-ray tests.