Severe thrombophilia with antiphospholipid syndrome and hyperhomocysteinemia in a patient with Schnitzler's syndrome.

Schnitzler's syndrome is a rare condition with chronic urticaria, intermittent fever, bone pain, and a monoclonal IgM gammopathy. Most patients have a chronic and indolent course, but a small number ultimately progress to a lymphoplasmacytic malignancy. We describe a patient with Schnitzler's syndrome who entered an accelerated phase of clinical deterioration with repeated thromboses of the cerebral and coronary arteries that ultimately led to a fatal outcome. We found that the he fulfilled the Sapporo criteria for definite antiphospholipid syndrome and had elevated blood levels of homocysteine during the active clotting phase of the disease. We suggest that the association with immune-mediated or metabolic disorders, such as the antiphospholipid syndrome and hyperhomocysteinemia, may unfavorably affect the otherwise chronic and stable course of patients with Schnitzler's syndrome. The systemic clotting disorder, the association with the antiphospholipid syndrome and hyperhomocysteinemia, and the biclonal rather than monoclonal IgM gammopathy were striking features of this atypical case of Schnitzler's syndrome.

Factors related to virologic failure among HIV-positive injecting drug users treated with combination antiretroviral therapy including two nucleoside reverse transcriptase inhibitors and nevirapine.

Treatment strategies in human immunodeficiency virus (HIV)-positive active injecting drug users (IDUs) must take into account their lifestyles, that often result in low adherence to therapy. The nonnucleoside reverse transcriptase inhibitors (NNRTI) offer simpler treatment regimens, but the appearance of drug resistance during treatment failure may cause high levels of cross-resistance to all NNRTIs. We adopted a combination therapy of two NRTIs and nevirapine (NVP) for treatment of IDU patients to evaluate its feasibility in such patients. From October 1998 to December 1999, demographic, clinical, and laboratory data from 80 IDUs on this regimen were collected. Fisher's exact test, Kaplan Meier method, and Cox model were used for statistical analysis. Overall, 20 IDUs discontinued the treatment because of side effects and 20 IDUs experienced treatment failure. Considering the treatment failure as an end point, 55.6% (95% confidence interval [CI]: 37.9%-72.6%) of patients was still undergoing treatment after 12 months compared to 44.6% (31.8%-58.6%) when discontinuation was also taken into account. An increasing trend over time was observed in the CD4+ lymphocyte count, among failing and nonfailing IDUs. By multivariate analysis, baseline HIV-RNA, treatment breaks and low adherence and active injecting drug use turned out to be significantly associated with treatment failure. Our results show that continuing injecting drug use and treatment breaks are the main factors that can lead to treatment failure in IDUs and easily to NNRTI class resistance.

Female sex and the use of anti-allergic agents increase the risk of developing cutaneous rash associated with nevirapine therapy.

To identify factors associated with cutaneous rash, we performed a retrospective multicentre analysis of HIV outpatients starting a highly active antiretroviral therapy regimen containing nevirapine. A total of 62 cutaneous adverse events were observed in 429 patients. Rash hazard was increased in women, by the prophylactic use of glucocorticoids or antihistaminics, and was reduced by escalating the initial dose of nevirapine. Women receiving glucocorticoids had a 3 month cumulative probability of rash of 0.41.

[Leukocyanidines and collagenases: in vitro enzyme inhibition activity]. / Leucocianidine e collagenasi: inibizione dell'attività enzimatica "in vitro".

OBJECTIVE: The matrix metalloproteinases (MMPs) play a key role in the extracellular matrix turnover. This protein family has been involved in some ocular pathologies such as glaucoma, diabetic retinopathy, macular degeneration, vitreous degeneration and corneal stroma ulceration cleaving all the matrix components. In the present study we evaluated the action of leucocyanidin from Vitis vinifera seeds as non toxic inhibitor of these proteinases. MATERIALS AND METHODS: To this purpose we used a fluorimetric method to evaluate the effect of this substance on the collagenase activity. We evaluated "in vitro" the inhibitory potency of the tested drug on type III collagenase activity, and the recover of the metalloprotease activity upon removal by dialysis of the inhibitor. RESULTS: The leucocyanidines extract (minimum procyanidines value of 95.0) resulted to be a good collagenase activity inhibitor showing an inhibition constant value, Ki, of 82 microM, evident index of affinity between the extract and the enzyme. Furthermore, the dialysis experiments demonstrated that the inhibitory effect persisted 24 h later, probably because the extract forms a stable complex with the enzyme. CONCLUSIONS: These results should be related to the pharmacokinetic profile of leucoanthocyanins, a family of natural polyphenols belonging to the class of bioflavonoids of grape seds extract (Vitis vinifera L.).

[Metalloproteinase inhibition: therapeutic application in rheumatic diseases]. / L'inibizione delle metalloproteasi: applicazioni terapeutiche nelle patologie reumatiche.

PURPOSE: Matrix metalloproteinases (MMPs) play an important role in the degradation of articular cartilage in several diseases, including osteorthritis and rheumatoid arthritis. Aiming at developing new drugs with selective inhibiting action against enzyme damaging the extracellular matrix, research is mainly directed towards the: 1) development of new drugs with specific inhibitory effect on MMPs; 2) better understanding of the pharmacologic profile of drugs already used in the treatment of rheumatic diseases, in order to identify those having an inhibiting action on degradative enzymes. MATERIALS AND METHODS: The interaction between rifamycins and collagenase type XI were studied using a fluorogenic substrate MOCAc-Pro-Leu-Gly-Leu-A2pr(Dnp)-Ala-Arg-NH2. RESULTS: In our experimental conditions rifamycins showed a marked inhibition capacity with a IC50 ranging from 13 to 20.7 microM. This inhibition was reversible after extensive dialysis. CONCLUSIONS: Our results indicate that the effects of rifamycins in rheumatoid arthritis may correlate to the inhibitory activity of these molecules on collagenase activity.

[A case of atrial myxoma with connectivitis-like onset]. / Un caso di mixoma atriale ad esordio similconnettivitico.

A case of cardiac myxoma is reported. This tumor, although histologically benign, may be potentially lethal if an early diagnosis and an adequate surgical treatment is not performed. In an early stage, the disease may be asymptomatic or a large array of aspecific symptoms may be present. In this case, an initial diagnosis of polymyositis was made. This paraneoplastic syndrome is frequently associated with tumors, and should trigger a full evaluation for cancer.

Can non-steroidal anti-inflammatory drugs act as metalloproteinase modulators? An in-vitro study of inhibition of collagenase activity.

The in-vitro effects of some non-steroidal anti-inflammatory drugs and some analgesic drugs on collagenase activity were studied by use of a self-quenched fluorogenic esapeptide as substrate. The increased fluorescence signal arising as a result of peptide cleavage by collagenase was recorded and related to the inhibitory potency of the drugs. The effective concentrations in collagenase modulation were also correlated with the levels of the drugs in the plasma and synovial fluids of patients receiving therapeutic doses. Six of the tested drugs, nimesulide, piroxicam, tolmetin, meloxicam, sulindac and sodium meclofenamate, inhibited enzyme activity with IC50 values (concentrations resulting in 50% inhibition) ranging from 1.9 to 28.2 microM and Ki (apparent inhibition constant) ranging from 0.83 to 21.8 microM. Much of the activity was restored after dialysis of the enzyme-drug complex, demonstrating the reversibility of the effect. Although these results indicate that some anti-inflammatory drugs could modulate enzymatic activity involved in the degradation of the extracellular matrix, their possible pharmacological involvement as collagenase inhibitors in collagen degradative diseases remains to be assessed by clinical studies.

A pre-sealed overwrap method of protecting frozen blood components during water immersion thawing.

Forty samples of frozen human plasma were thawed in a 37 C water bath following storage at -80 C for 48 hours. Twenty of these samples were protected by heat-sealed polyethylene overwraps prior to freezing and thawing. The remaining 20 samples were unprotected. None of the protected samples leaked during thawing. The thawing times for the protected overwrap method were prolonged. This method represents a practical procedure for reducing bacterial contamination when blood components are thawed in nonsterile water baths.