[Intra-articular therapy with infliximab in psoriatic arthritis: efficacy and safety in refractory monoarthritis]. / Terapia intra-articolare con infliximab nell'artrite psoriasica: valutazione di efficacia e tollerabilità nel trattamento della monoartrite refrattaria.

OBJECTIVE: To evaluate efficacy and safety of intra-articular therapy (IA) with infliximab (IFX), in patients with psoriatic arthritis (PsA) and refractory monoarthritis. METHODS: Four male and 1 female aged from 25 to 71 years and disease duration from 1 to 25 years, affected by PsA (CASPAR criteria) were observed . All patients were treated with immunomodulators (methotrexate, leflunomide, cyclosporin A), 3/5 with concomitant steroids, 4/5 with NSAID's. Only 1 patient were treated with IFX 5 mg/kg IV every 6 weeks. Before the IFX injection an amount of synovial fluid was aspired from the inflamed site and the anti-TNF injection was echographic guided. Patients were evaluated at regular intervals through clinical and echographic examination and retreated in case of flare. RESULTS: At follow-up visit after 7 days, in all patients treated with the first injection was detected total regression of the inflammation and no new inflamed synovial fluid was observed; power doppler examination shows reduction of local vascularization. Two patients experienced full remission after 6 months and only one injection, 1 patient (arthritis of the wrist) was in remission after 2 injections (3 months of interval). In 2 patients with knee arthritis and important synovial hypertrophy good results obtained after the first injection were not maintained afterwards and second injection was ineffective: these patients were evaluated for surgical intervention. CONCLUSIONS: Local injections of IFX were safe and well tolerated in all patients. The efficacy in short term was observed in all cases; our supposition is that presence of synovial hypertrophy is cause of worsening.

Effects of a new nutraceutical ingredient on allergen-induced sulphidoleukotrienes production and CD63 expression in allergic subjects.

Allergic diseases represent conditions affecting millions of individuals across the world. The objective of this study was to investigate the potential anti-allergic effects of a new nutraceutical ingredient, Pantescal (Bionap, Italy), contained in different food supplements. Pantescal is a mixture of plant extracts, such as Capparis spinosa, Olea europaea, Panax Ginseng and Ribes nigrum. The study was a randomized, double-blind, placebo controlled design. 60 patients allergic to common aeroallergens were chosen. Allergic patients were divided into two groups: one group was supplemented by Pantescal and the other, using a placebo formulation. Two in vitro tests were performed on blood samples taken from patients before and at 2 h, 2, 3 and 10 days after supplementation: cellular antigen stimulation test (CAST) was used to analyze the amount of sulphidoleukotrienes (SLT) production and flow-cytometric antigen stimulation test (FAST) to measure expression of basophil degranulation marker (CD63) was also performed. CAST showed that after 2 and 3 days, a slight decrease of SLT production was evident but only after 10 days did it become significant with a percentage of inhibition (P.I)=43.3%. FAST revealed that there were no statistical differences for the first 2 days after supplementation although there was an inhibitory trend in the supplemented patients. CD63 expression was significantly reduced after 10 days (P.I.=64.8%). This study suggests that Pantescal is effective in reducing allergic biomarkers such as CD63 protein and SLT in atopic subjects. The higher inhibitory effect on CD63 expression compared to SLT production allows us to hypothesize cell membrane stabilization as the main potential mechanism to explain the observed Pantescal protective effects.

Macrocephaly with multiple soft tissue and visceral hamartomas ("Bannayan-Zonana" syndrome). Case report.

Since its first description few cases of the rare association of macrocephaly with multiple soft tissue and visceral hamartomas (Bannayan-Zonana syndrome) have been reported. In this paper we report a case of a 7 year old child in whom lipomas of the abdomen and right flank have been treated with liposuction. We could find no previous evidence that this surgical technique has been used in the treatment of this syndrome.

Treatment of major depressive disorder in primary care in Rome, Italy.

This study describes the treatments that 253 patients affected by major depressive disorder, according to DSM-III-R criteria, received by their general practitioner prior to their referral to the outpatients clinic of the Department of Psychiatry of the University of Rome "La Sapienza". Out of 253 study subjects only 97 had received prescriptions of antidepressant drugs. In about 50% of these cases (corresponding to 27.4% of the study population) prescribed dosages were inadequate. In 34.7% of subjects who sought medical help antidepressants were not prescribed and other psychotropic drugs (mostly benzodiazepines) or pseudodrugs were used. In 6% of cases no treatment was prescribed. Over one third of the outpatients had been ill for over one year prior to their referral to a psychiatrist. Remedial actions are considered.

[Post-traumatic penoscrotal avulsion: cosmetic and uro-andrologic evaluation after surgical reconstruction]. / Scuoiamento penoscrotale post-traumatico: valutazione plastica e uro-andrologica post-intervento ricostruttivo.

A case of surgical reconstruction after penoscrotal skin avulsion is described. Penile coverage was gained by two full thickness grafts helicoidally placed to avoid retractions. Scrotal reconstruction was carried out in two steps, after testis subcutaneous implantation, with axial flaps expanded in abdominal region. The procedure has the advantage of flaps sure vitality, avoids patient discomfort produced by a perineal expansion with satisfactory cosmetic appearance and restore of a normal sexual function.

Prevention of glucocorticoid-induced osteopenia: effect of oral 25-hydroxyvitamin D and calcium.

Twenty-four patients (9 M and 15 F, age range 51-82) with polymyalgia rheumatica receiving 6-methylprednisolone for a period of 9 months (16 mg/daily/two weeks, 14 mg/daily/two weeks, 12 mg/daily/1 month, 10 mg/daily/1 month, 8 mg/daily/1 month, 6 mg/daily/1 month and 4 mg/daily for the last four months) were randomly assigned to receive either 250HD3 (35 mcg/day for 25 days/month) (Group A) or placebo (Group B) in a double-blind study. All patients also received 500 mg elemental calcium daily. Before and at 3, 6 and 9 months ESR, tenderness on palpation and subjective pain were evaluated. At the same times, mineral metabolism parameters (serum calcium, phosphorus, alkaline phosphatase, 24-h urinary calcium, phosphate and 24-h hydroxyproline excretion) and radial bone mineral content (BMC) were evaluated. Activity indexes (ESR and clinical parameters) improved in both groups. Furthermore, serum alkaline phosphatase and 24-h hydroxyproline excretion decreased significantly only in Group A, and BMC decreased significantly in Group B but rose slightly in Group A. No side effects were observed in any of the patients.