[Suspected pulmonary nodule in a male heavy smoker: Is biopsy really necessary?] / Nodule pulmonaire suspect chez un grand tabagique : faut-il faire une biopsie ?

INTRODUCTION: Sclerotherapy is a widely used as a lifesaving therapeutic option in cases of upper gastrointestinal bleeding (UGB) due to ruptured gastro-esophageal varices (GOV) in cirrhotic patients, especially when there exists a portosystemic shunt. This endoscopic technique can entail many complications, including systemic and non-thrombotic pulmonary embolism (PE). While multiple pulmonary parenchymal manifestations have been described following sclerotherapy of GOV, to our knowledge no solitary suspicious pulmonary nodule has been described. CASE PRESENTATION: We report the case of 55-year-old man with heavy smoking history who was referred to our pulmonary clinic for work-up of a solitary pulmonary nodule. He was known to have liver cirrhosis with history of massive UGB due to rupture of GOV two months before. He was treated with sclerotherapy by injecting a 3 cc of Histoacryl/lipiodole solution. The post- endoscopic phase was unremarkable. An enhanced CT scan of chest and abdomen performed two months later showed a right upper lobe nodule, even though at that point, the patient was completely asymptomatic. This was ascribed to non-thrombotic PE secondary to sclerotherapy due to complete resolution of the nodule on a CT scan carried out at 2-month follow-up. At that point, his condition did not require any further treatment. CONCLUSION: Solitary pulmonary nodule is one of the radiologic manifestations of PE subsequent to sclerotherapy of GOV. Awareness and radiologic follow-up of this unusual radiologic presentation may prevent unnecessary biopsies.

Acute eosinophilic pneumonia induced by varnish particles: a diagnostic challenge

No disponible

Effects of physiological concentrations of steroid hormones and interleukin-11 on basal and stimulated production of interleukin-8 by human osteoblast-like cells with different functional profiles.

OBJECTIVE: IL-8 is a CXC chemokine involved in the pathogenesis of articular damage in rheumatoid arthritis. Local hyperproduction of IL-8 has been suggested to play a role in subchondral bone loss, since it suppresses osteoblast activity and promotes osteoclasts recruitment. Osteoblasts are a source of IL-8; its secretion is regulated by a number of hormones and cytokines. The aim of the present study was to evaluate the single and combined effects of physiological concentrations of cortisol, 17 beta-estradiol and IL-11 upon basal and IL-1 beta-inducible production of IL-8 in two human osteoblast-like cell lines, Saos-2 and MG-63. METHODS: Cells were incubated with cortisol (0.01 to 1 microM), 17 beta-estradiol (10 to 1000 pg/ml), IL-11 (1 to 100 ng/ml), in presence or absence of IL-1 beta (10 ng/ml), for 20 h. Combinations of 17 beta-estradiol and cortisol, and of IL-11 and cortisol, were also tested. After incubation, IL-8 levels in supernatants were measured by ELISA. RESULTS: Cortisol dose-dependently inhibited spontaneous IL-8 secretion in both cell lines, although statistical significance was attained in the MG-63 cells only (P < 0.01); no effect of 17 beta-estradiol was apparent. With regard to IL-1 beta-inducible production, cortisol dose-dependently inhibited IL-8 release in both cell lines (P < 0.01); 17 beta-estradiol resulted in only a non-significant decrease in Saos-2, but not in MG-63 cells. 17 beta-estradiol did not alter the effects of cortisol in experiments involving co-incubation. IL-11 did not have any effect on spontaneous IL-8 release, but exerted a significant inhibitory effect on IL-1 beta-inducible release in MG-63 cells (P < 0.05); no additional effect was observed upon the degree of cortisol-dependent inhibition. CONCLUSION: Cortisol is a potent physiological inhibitor of IL-8 production by osteoblast-like cells. The results of the present study support the use of exogenous supplemental glucocorticoids to prevent the deleterious effects of excess IL-8. The estrogenic milieu and local concentrations of IL-11 have little if any effect on the IL-8-dependent mechanisms of disease.

[Physical work capacity of the patient with myocardial infarction submitted to intensive rehabilitative training (author's transl)]. / Capacita' fisica funzionale dell'infartuato sottoposto a training riabilitativo intensivo.

The Authors have examined two homogeneous groups of patients with myocardial infarction; one underwent (61 patient) to a rehabilitating training, the other underwent (42 patient) to a domiciliary physical program. Patients have been considered by means of bicycle ergometer test at 2, 4, 12 and 24 months from myocardial infarction. They have been taken into consideration clinical and Ecg factors and also, as an index of physical work capacity was considered the complete work developed, the VO2 max/Kg per min., the product B.P. x H. R. and the pulse O2. The average value of parameters have been statistically compared by means of the t of Student, analysis of variation x2, and the test of Kolmogorov-Smirnov; moreover the correlation with linear coefficient has been studied. Afterwards the many-varied discriminating analysis and the test F di Snedelor have been carried out just for the index of functionality. From the statistical analysis of the data considered it results an increase of the functional capacity and its maintenance long after in the group that underwent to the rehabilitating training. However, two years after, this increase of capacity did not result greater than that obtained, in the same period of time, by the group of patients who underwent to a domiciliary physical rehabilitating program. These considerations point out the necessity of keeping physical exercise indefinitely or at least of repeating it periodically. In that event they suggest the right time to programme further cycles of training.

[Aorto-coronary by-pass: pre and post-operative ergometric evaluation of 95 patients (author's transl)]. / By-pass aorto-coronarico. Valutazione ergometrica pre e postoperatoria in 95 pazienti.

95 angina patients surgically treated by aortocoronary saphenous vein by-pass, have been studied by comparing the factors limiting the exercise (i.e. muscular exhaustion, angina, electrocardiographic changes), the total work performed, the O2 consumption and the heart rate-arterial pression product. After surgery the incidence of positive effort tests (effort angina and/or ecg evidence of myocardial ischemia) decreased from 79% to 27,4% (p less than 0,001), and the average amount of work performed increased from 2718 to 3504 Kgm (p less than 0,01), the MVO2 from 13,9 to 15,6 cc/min/Kg. (p less than 0,01) and the heart rate-arterial pression product from 206 to 243 (p less than 0,001). The patients who preoperatively were more invalidated (that is able to performe a lasser amount of physical work) presented a more pronounced improvement in comparison with those who had a greater tolerance to exercise. It seems therefore that for these latter patients the bypass grafting surgery should be justified only if a significant increase of life expectancy and reduction of myocardial infarction incidence could be definitely proved. The exercise performance improvement after surgery was statistically significant only in the patients with post infarction or with unstable angina not in those with chronic angina. The perioperative infarction (present in 8,4% of cases) did not show any unfavorable correlation with the result of the late postoperative effort test.