The impact of rhinosinusitis in clinical practice: an Italian Survey.

Rhinosinusitis is a common disease that is classified in acute (ARS) and chronic (CRS). The current Survey was conducted on a sample of about 5,000 adult subjects in 5 Italian cities. A questionnaire, containing 15 questions, was administered on the road. RS affects about 20% of the general population. The most common diagnostic test was the skull x-ray. Antibiotics were the most frequently prescribed therapy. In conclusion, the current Survey demonstrated that RS is a common disorder in Italy, the diagnostic work-up is still incorrect, and the therapeutic approach does not adhere to the guidelines. Therefore, there is a need to implement adequate information on this topic in Italy.

Graves' Disease Thyrotoxicosis and Propylthiouracil Related Agranulocytosis Successfully Treated with Therapeutic Plasma Exchange and G-CSF Followed by Total Thyroidectomy.

Antithyroid drugs can be a rare cause of agranulocytosis (0.5% of treated patients). Suspension of these drugs is mandatory in these patients and may result in worsening hyperthyroidism. We report the case of a 27-year-old woman who is 3 months post-partum, breastfeeding, and suffering with Graves' disease hyperthyroidism treated first with methimazole and then with propylthiouracil due to a methimazole allergy. She was admitted for urosepsis and agranulocytosis. The patient was diagnosed with propylthiouracil related agranulocytosis, diffuse toxic goiter and thyro-gastric syndrome. Antithyroid drug therapy was stopped resulting in a worsening of thyrotoxicosis. Agranulocytosis was treated with 8 doses of G-CSF with full recovery. To rapidly restore euthyroidism and to perform a thyroidectomy, the patient received 6 therapeutic plasma exchange (TPE) procedures, to clear thyroid hormones and anti-TSH receptor antibodies from blood, resulting in a pre-surgical euthyroid state without antithyroid drug therapy. Two years after thyroidectomy, the patient is well under thyroid hormone replacement therapy with a normal granulocyte count.

Oxidative microenvironment exerts an opposite regulatory effect on cytokine production by Th1 and Th2 cells.

Oxidative stress occurs in allergic disorders and immunologic inflammatory responses and reactive oxygen metabolites have an additional role of cell-signaling mediators, influencing many biological processes. Using in vitro derived Th1 and Th2 clones or T cells derived from autoimmune thyroiditis we study the ability of Th1 or Th2 cells to expand and produce cytokine in an oxidative environment. We found that low-doses of H2O2 reduce the INF-gamma production of activated Th1 clones and potentiate the IL-4 secretion of activated Th2 clones. These effects were not due to altered cell proliferation and are not transient, since the modified secretion profile was still retained after 1 week from H2O2 stimulation by both Th1 and Th2 cells. H2O2 influence the profile of cytokine secretion in both Th1 and Th2. These effects are long lasting and are the result of an action of H2O2 on T cell. In conclusion we demonstrate that oxidative stress plays an important role in the pathogenesis of allergic respiratory diseases and can up-regulate Th2-driven inflammation, thus contributing to increase disease severity, bronchial hyper-responsiveness and airway remodeling.