Baseline factors predicting the risk of conversion from ocular hypertension to primary open-angle glaucoma during a 10-year follow-up.

PurposeTo evaluate the ability of baseline clinical, morphological, and functional factors to predict the conversion to primary open-angle glaucoma (POAG) in ocular hypertensive (OHT) patients.MethodsThis single-center prospective longitudinal observational study included 116 eyes of 116 OHT patients followed for a 10-year period. All patients had intraocular pressure (IOP) ≥24 mm Hg in one eye and >21 mm Hg in the other eye, normal visual fields (VFs) and normal optic disc (OD) appearance in both eyes at baseline. All OHT patients were untreated at baseline with subsequent treatment upon need according to clinical judgement. Only one eye per subject was randomly selected. Patient age, gender, IOP, central corneal thickness (CCT), and ibopamine test results were collected at baseline. All patients underwent standard automated perimetry, short-wavelength automated perimetry (SWAP), frequency-doubling technology, confocal scanning laser ophthalmoscopy (CSLO), and scanning laser polarimetry (SLP) at baseline and every 6 months thereafter. Main outcome measure was the conversion to POAG, defined as the development of reproducible VF and/or OD abnormalities attributable to glaucoma. Cox proportional hazards models were used to identify the baseline factors predictive of POAG conversion.ResultsDuring the 10-year follow-up, 25% of eyes converted to POAG. In multivariate Cox models, baseline factors that were significant predictors of POAG development included: older age (hazard ratio (HR) 1.0, 99% confidence intervals (CIs) 1.0-1.2, per 1 year older); SWAP Glaucoma Hemifield test 'outside normal limits' (HR 4.3, 99% CIs 1.2-17.9); greater SLP 'Inter-eye Symmetry' (HR 1.1, 99% CIs 0.4-3.0, per 1 unit lower); lower CSLO Rim Volume (HR 1.1, 99% CIs 0.3-3.2, per 0.1 mm(3) lower); and greater CSLO cup-to-disc ratio (HR 6.0, 99% CIs 3.6-16.8, per 0.1 unit greater).ConclusionsThe baseline parameters that proved to be useful in assessing the likelihood of an OHT patient to develop POAG included age, functional variables provided by SWAP, and structural variables provided by SLP and CSLO. In this cohort of patients, baseline IOP, CCT, and ibopamine provocative test results were not significant predictors of POAG conversion.

Respiratory allergy in immigrants to a highly industrialised area in Italy according to area of origin and time period

BACKGROUND: Migrants from developing to Western countries tend to become more sensitised to host than to origin country allergens, although substantial changes in migration patterns have occurred in recent decades. Methods We investigated adult immigrants with respiratory allergy, first tested for allergic sensitisation between 1985 and 2012 in a highly industrialised area in Italy. A comparison was made of the sensitisation pattern between immigrants and a random sample of native-born subjects affected by a respiratory allergy, and among immigrants according to macro-region of origin and time period. RESULTS: Between 1985 and 2012, 480 immigrants with respiratory allergy had a first positive allergy test. Immigrants were sensitised mainly to grass (67.1%), house dust mites (HDM) (38.5%) and birch (27.5%), with a pattern of sensitisation very similar to that observed in Italians (native-born). An increase in the proportion of subjects with asthma and of subjects with polysensitisation was observed from the first (1985-2002) to the middle (2003-2007) and the most recent period (2008-2012). In recent years, the proportion of subjects with polysensitisation in immigrants is higher than in Italians (native-born) (53.3% vs. 40.1%). Among immigrants, the risk of sensitisation to grass was higher in those from Sub-Saharan Africa (odds ratio, OR = 2.76) and Latin America (OR = 2.49), whereas risk of sensitisation to HDM was higher among immigrants from South Asia (OR = 2.71), compared to immigrants from Eastern Europe. CONCLUSIONS: Immigrants develop multiple sensitisations more frequently than native-born people, and are especially sensitised to local allergens; the country of origin seems to play a role

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Respiratory allergy in immigrants to a highly industrialised area in Italy according to area of origin and time period.

BACKGROUND: Migrants from developing to Western countries tend to become more sensitised to host than to origin country allergens, although substantial changes in migration patterns have occurred in recent decades. METHODS: We investigated adult immigrants with respiratory allergy, first tested for allergic sensitisation between 1985 and 2012 in a highly industrialised area in Italy. A comparison was made of the sensitisation pattern between immigrants and a random sample of native-born subjects affected by a respiratory allergy, and among immigrants according to macro-region of origin and time period. RESULTS: Between 1985 and 2012, 480 immigrants with respiratory allergy had a first positive allergy test. Immigrants were sensitised mainly to grass (67.1%), house dust mites (HDM) (38.5%) and birch (27.5%), with a pattern of sensitisation very similar to that observed in Italians (native-born). An increase in the proportion of subjects with asthma and of subjects with polysensitisation was observed from the first (1985-2002) to the middle (2003-2007) and the most recent period (2008-2012). In recent years, the proportion of subjects with polysensitisation in immigrants is higher than in Italians (native-born) (53.3% vs. 40.1%). Among immigrants, the risk of sensitisation to grass was higher in those from Sub-Saharan Africa (odds ratio, OR=2.76) and Latin America (OR=2.49), whereas risk of sensitisation to HDM was higher among immigrants from South Asia (OR=2.71), compared to immigrants from Eastern Europe. CONCLUSIONS: Immigrants develop multiple sensitisations more frequently than native-born people, and are especially sensitised to local allergens; the country of origin seems to play a role.

Comparison of iCare tonometer and Goldmann applanation tonometry in normal corneas and in eyes with automated lamellar and penetrating keratoplasty.

PURPOSE: To compare intraocular pressure (IOP) measurements with Goldmann applanation tonometry (GAT) and iCare tonometry in normal and post-keratoplasty corneas and to assess the influence of central corneal thickness (CCT), corneal curvature (CC), and corneal astigmatism (CA) on IOP. METHODS: This prospective cross-sectional study included one eye of 101 subjects with normal corneas (58 healthy subjects, 43 glaucoma); and 90 post-keratoplasty patients: 34 penetrating keratoplasties (PK); 20 automated-lamellar-therapeutic keratoplasties (ALTK); 19 Descemet-stripping-automated-endothelial keratoplasties (DSAEK); 17 edematous grafts. All subjects underwent GAT and iCare IOP measurements in random order, and CCT, CC, and CA evaluation. The Bland-Altman method and multivariate regression analysis were used to assess inter-tonometer agreement and the influence of CCT, CC, and CA on IOP. RESULTS: iCare significantly underestimated IOP in all groups compared with GAT (GAT minus iCare of 3.5±3.5 mm Hg, P<0.001), but overestimated IOP in the edematous grafts (GAT minus iCare of -6.5±1.9 mm Hg, P<0.001). In normal corneas, both tonometer measurements were directly related to CCT values; iCare readings appeared inversely related to CC. There was no significant relationship between IOP and CCT, CC and CA in post-keratoplasty eyes, except between CC and iCare measurements for PK eyes. CONCLUSIONS: The agreement between GAT and iCare was clinically acceptable in control, ALTK and DSAEK groups, and poor in PK and edematous grafts eyes. In normal corneas, GAT was significantly affected by CCT; iCare was influenced by CCT and CC. The iCare appeared less influenced by corneal edema when compared with GAT. High IOP readings taken with both tonometers in grafts should raise suspicion of true elevated IOP.

Non-conventional perimetric methods in the detection of early glaucomatous functional damage.

PURPOSE: To compare the ability of frequency-doubling technology (FDT), rarebit perimetry (RBP), and pulsar perimetry (PP) in detecting early glaucomatous functional damage. METHODS: This prospective observational cross-sectional case study included 52 patients with early primary open-angle glaucoma (mean deviation -2.3+/-1.1 dB; pattern standard deviation 3.0+/-1.2 dB) and 53 healthy controls. Visual field (VF) testing included standard automated perimetry (SAP) Humphrey Field Analyzer 30-2, FDT N-30, RBP (version 4.0), and PP T30W. One eye per patient was considered. Sensitivity at fixed specificities and area under the receiver operating characteristic curve (AROC) for discriminating between healthy and glaucomatous eyes were calculated and compared. RESULTS: The parameters associated with the largest AROC, which were not statistically different (Hanley-McNeil method, P0.42-0.71) were as follows: number of locations in the pattern deviation probability (PDP) plot with P<5% for FDT (0.93); mean hit rate for RBP (0.95); and mean defect for PP (0.94). PP test duration was significantly shorter than FDT and RBP (P<0.002). CONCLUSIONS: FDT, PP, and RBP are useful non-conventional VF methods in detecting early glaucomatous VF defects with similar AROCs. The methods were rapid and easy, and PP took less than half the time than SAP. These non-conventional testing may prove to be useful in providing additional information in the diagnosis of glaucoma suspect with normal SAP results, in the therapeutic decision-making process of early glaucomatous patients, and in subjects unable to perform VF testing with SAP.

A reassessment of diagnostic criteria and treatment of idiopathic urticarial vasculitis: a retrospective study of 47 patients.

BACKGROUND: Urticarial vasculitis (UV) is an uncommon type of chronic urticaria (CU), which exhibits leucocytoclastic vasculitis. Painful and long-lasting (> 24 h) weals associated with purpura or bruising are considered indicative of UV. It is often responsive to oral corticosteroids and poorly to oral antihistamines. Hypocomplementaemia and systemic involvement are also commonly reported. AIMS: To diagnose patients with UV histologically and then compare their clinical features and response to various treatment regimens. METHODS: Biopsies were taken from 312 subjects with CU unresponsive to oral antihistamines; of these, 47 were histologically diagnosed as having UV. Biopsies were taken irrespective of the clinical features of weal eruption. Other diseases known to be associated with small-vessel vasculitis had previously been excluded. Results. Individual weals lasted < 24 h in 57.4% of patients, and pain or tenderness was reported only by 8.6%. Extracutaneous features were present in 81%, hypocomplementaemia in 11% and abnormalities of other laboratory parameters (i.e. raised erythrocyte sedimentation rate, microscopic haematuria) in 76.6%. Hydroxyzine was effective in only one patient. Both oral corticosteroids and cinnarizine were effective in a high percentage of the patients. CONCLUSION: This diagnostic approach allowed us to identify a large group (47 patients) with UV. Most did not present the clinical (prolonged duration of weals and bruising) and laboratory features that have previously been described as characteristic of UV. Cinnarizine was found to be a valuable treatment option.

Stratus-OCT imaging in early glaucomatous and in ocular hypertensive patients with and without frequency-doubling technology abnormalities.

AIM: To compare Stratus-OCT measurements in controls, ocular hypertensive (OHT) patients with (FDT+) and without (FDT-) frequency-doubling technology (FDT) abnormalities, and in patients affected with early primary open-angle glaucoma (POAG). METHODS: Thirty-two controls, 78 OHT patients (38 FDT- and 40 FDT+), and 45 early POAG patients (six FDT- and 39 FDT+) underwent the following tests within 3 months: standard automated perimetry (SAP) HFA 30-2; FDT N-30-F; and, Stratus-OCT imaging with retinal nerve fibre layer (RNFL) and optic nerve head (ONH) scans. One eye per patient was considered. Differences among groups were evaluated using the Kruskal-Wallis, analysis of variance, and Duncan's tests. RESULTS: There were no significant differences in all Stratus-OCT parameters between POAG and OHT FDT+ patients. Statistically significant differences were found between the control group and both the POAG and OHT FDT+ groups for 15 of the 21 Stratus-OCT parameters. Control eyes compared to OHT FDT- showed significant differences in 13 of the 21 parameters. The comparison between the OHT FDT- group, and both the POAG and OHT FDT+ group resulted in 13 of the 21 parameters to be significantly different. CONCLUSIONS: Stratus-OCT seems to show a higher ability in detecting significant differences between healthy, OHT, and early POAG eyes when compared to SAP and FDT. This suggests that the Stratus-OCT could show structural abnormalities before SAP or FDT visual field defects appear in patients at risk of developing glaucoma, which may be beneficial in making therapeutic decisions, especially in OHT patients.

Diagnostic and therapeutic iter in chronic urticaria patients.

We describe a diagnostic and therapeutic protocol for the management of chronic urticaria. It is derived from an extensive review of current literature, with a cost-effective evaluation of laboratory investigations and therapeutic approaches. Our protocol may not represent a cornerstone for chronic urticaria: much has in fact to be clarified on pathogenetic mechanisms and aetiological factors. Nevertheless, its application should be able, in our opinion, to identify what is useful or not in the everyday management of chronic urticaria patients.

Ocular hypertension and corneal thickness: a long-term prospective study. Results after two years.

PURPOSE: To study the importance of the central corneal thickness (CCT) in patients with ocular hypertension in a 2-year follow-up. METHODS: A total of 110 subjects with ocular hypertension (intraocular pressure [IOP] >21 mmHg and normal automated visual field test) were admitted to the study. All patients periodically underwent the following tests: 1) circadian IOP curve; 2) standard automated perimetry (SAP, Humphrey 30-2 SITA test); 3) short wavelength automated perimetry (SWAP); 4) frequency doubling technology perimetry (FDT, N-30 threshold test); 5) nerve fiber layer analysis with GDx; 6) ibopamine test; 7) ultrasonic pachymetry. Patients were divided into three groups, based on corneal thickness. The frequency of abnormal tests within these groups was evaluated with the Pearson's chi2 test. Baseline IOP was corrected using the Doughty and Zaman formula. CCT was also considered as a continuous variable. A control group of 48 normal subjects was also considered. RESULTS: The mean CCT was 562.8 microm +/- 37.7. The difference with respect to normal subjects was statistically significant (p < 0.01). Using the correction formula, 43 eyes (39.1%) had an IOP <21 mmHg. Abnormal test results were more frequently found with FDT. The percentage of abnormal results was found to be inversely proportional to CCT. The other tests gave inconsistent or conflicting results. Using the values of CCT as a continuous variable, no significant association was found with the GDx number and the visual field indices. CONCLUSIONS: The results of our 2-year study confirm the importance of CCT measurement in the evaluation of the risk of developing glaucomatous damage.

Discrimination between normal and early glaucomatous eyes with scanning laser polarimeter with fixed and variable corneal compensator settings.

PURPOSE: To evaluate the ability of scanning laser polarimetry (SLP) with a fixed corneal polarization compensator (GDx-FCC Nerve Fiber Analyzer) compared to one with a variable one (GDx-VCC) in the discrimination between healthy and early glaucomatous eyes. METHODS: Forty patients with early glaucomatous visual field defects, having a mean deviation of 3.1-/+1.6 dB and a pattern standard deviation of 3.1-/+0.9 dB, and 40 controls underwent both GDx-FCC and GDx-VCC. One eye per patient was considered. The cut-off point, taken as the value dividing healthy from glaucomatous eyes with highest probability, was determined for each GDx parameter. Linear discriminant functions (LDFs) were separately developed for GDx-FCC and GDx-VCC parameters. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) for discriminating between healthy and glaucomatous eyes were calculated for each GDx parameter, both according to the GDx normative database and after the selection of new cut-off points, and for the LDFs. RESULTS: All software-provided parameters showed low sensitivity and high specificity. The selection of new cut-off points improved the performance of all GDx parameters: VCC parameters performed better than FCC parameters; the largest AROCs were associated with the superior/nasal ratio for the GDx-FCC (0.86) and with the Number for the GDx-VCC (0.87). The LDFs provided an AROC of 0.89 with both the GDx-FCC and the GDx-VCC parameters. CONCLUSIONS: The GDx-VCC showed a higher ability in the early diagnosis of glaucoma when compared with the GDx-FCC. The individuation of the right cut-off point of selected parameters with both GDx settings performed better than the software-provided parameters, and comparably to the GDx parameters-based LDFs.

Cutaneous CD30+ cells in children with atopic dermatitis.

BACKGROUND: CD30 expression can be considered a marker of Th2 cells. We investigated the presence of CD30+ cells in the lesional skin of children with atopic dermatitis (AD). We also analyzed the possible relationship between CD30+ cells and serum soluble CD 30 (sCD30) levels, and IgE, soluble interleukin-2 (IL-2) receptor (sIL-2R) or soluble CD23 (sCD23) levels in the blood, and clinical score. METHODS: Ten eczematous children (4 males, 6 females; median age: 4 years and 5 months; range: 11 months to 14 years), 9 sex- and age-matched control children and an adult control group were studied. A clinical score (SCORAD index), was given to eczematous lesions. Blood was taken for the determination of IgE, sCD30, sIL-2R and sCD23 levels. Punch biopsies of lesional skin were stained with hematoxylin and eosin or incubated with anti-CD30 monoclonal antibodies. Skin prick tests (SPTs) were also performed. RESULTS: In the biopsy specimens, CD30 expression was observed in high proportions of infiltrating cells. In children with AD, total serum IgE, sCD30, sIL-2R, sCD23 and eosinophils were significantly elevated compared to controls. CD30+ cells were not associated with serum IgE, sCD30, sIL-2R, sCD23, or SPT results, score of inflammatory cells in lesional skin or clinical score. Children with AD who had high total IgE and specific IgE antibodies did not differ from those with normal total IgE and negative specific IgE in respect of age, clinical score, number of CD30+ cells, sCD30, sIL-2R and sCD23 levels, score of inflammatory cells in skin or clinical score. CONCLUSION: Our results showed remarkable numbers of CD30+ cells in the lesional skin and high sCD30 in the serum of children with AD. CD30+ cells did not correlate with systemic markers of IgE reaction.

Quantitative mapping of the retinal thickness at the posterior pole in chronic open angle glaucoma.

The sensitivity of a new device, which is able to measure the thickness of the retina at the posterior pole (Retinal Thickness Analyzer), was assessed in a group of 21 glaucomatous patients, and in 24 patients with ocular hypertension. The specificity of RTA was evaluated in a control group of normal eyes. Of the glaucomatous eyes, 57.6% had a significant reduction in retinal thickness, while another 30.3% were borderline. In the ocular hypertension group, 37.5% of eyes were abnormal, and 45.8% were borderline. In the control group, no eye was abnormal, though 42.9% had borderline alterations. In many glaucomatous eyes (81.8%) there was a relationship between retinal thickness loss and visual field defects.

Corneal thickness in glaucoma: an important parameter?

Central corneal thickness was measured by pachometry in 49 patients with primary open-angle glaucoma (POAG), 41 with ocular hypertension (OHT), 14 with normal tension glaucoma (NTG) and 48 normal subjects. The mean corneal thickness of the OHT patients was significantly greater than that of the normal control group. The NTG patients, on the other hand, had a cornea on average thinner than the normals. These differences may cause misclassification of normals with a thick cornea as ocular hypertensive eyes or, contrarywise, cause those normals whose IOP is underestimated because of a thin cornea to be classed as NTG patients.

CD3-CD4+ cells with a Th2-like pattern of cytokine production in the peripheral blood of a patient with cutaneous T cell lymphoma.

A case of cutaneous T cell lymphoma associated with mild eosinophilia and rise of IgE levels is reported. A population of CD3-CD4+ cells was observed in the peripheral blood. After activation, these purified CD3-CD4+ cells showed a Th2 pattern of cytokine production, secreting higher levels of IL-5 and IL-4 and lower levels of IFN-gamma compared to the patient's and controls' CD3+CD4+ cells. Moreover, high levels of IL-5 and soluble CD30, a marker of Th2 cell activation, were detected in the patient's serum.

Atypical hemispheric specialization in intellectual deficiency.

In order to determine the relation between hemispheric specialization for language and intellectual deficiency, two groups of lower-IQ subjects were compared to normal-IQ controls on word-dichotic listening tasks. Two conditions in which stimuli differed by their level of phonological complexity were used. Normal controls showed the expected right-ear advantage in both conditions. Moreover, they showed a greater magnitude of ear difference on the condition requiring higher-order phonological processing. In the mentally deficient group, almost half the subjects exhibited a left-ear advantage and they showed no difference between the two conditions in terms of the magnitude of ear difference. These results point to the presence of atypical hemispheric specialization in mentally deficient subjects.

A case of hypereosinophilic syndrome is associated with the expansion of a CD3-CD4+ T-cell population able to secrete large amounts of interleukin-5.

Interleukin-5 (IL-5) is the major soluble factor able to mediate hypereosinophilia. We report a case of hypereosinophilic syndrome in which the presence of a population of CD3-CD4+ cells able to overproduce IL-5 was shown. The lack of CD3 and TCRAB membrane expression on otherwise phenotypically normal mature T lymphocytes together with the absence of detectable TCRBV mRNA and clonal rearrangement of TCRB gene suggested that the abnormal lymphocyte population was the expression of a peripheral T-cell lymphoma with an indolent clinical course. Peripheral blood lymphocytes enriched in this population were able to secrete high levels of IL-5 but not IL-4, and no IL-2 or interferon-gamma, when stimulated in vitro with phytohemagglutinin and phorbol myristate acetate. The serum contained eosinophil survival factors whose activity was partially neutralized by a specific antihuman IL-5 antibody. This observation further emphasized the relationship between hypereosinophilic syndrome. IL-5, and T-cell lymphoproliferative disorders.

Idiopathic eosinophilic pneumonia and pregnancy: report of a case.

A case of chronic eosinophilic pneumonia and pregnancy is reported. In 1989, a 24-year-old woman with chronic eosinophilic pneumonia became pregnant. We decided not to stop steroid therapy. Except for premature preterm rupture of the membrane she had a uneventful pregnancy and a male infant with no distress syndrome.

[A high-resolution computed tomographic study of the pulmonary interstitium in systemic autoimmune diseases]. / Studio con tomografia computerizzata con alta risoluzione dell'interstizio polmonare in alcune malattie autoimmuni sistemiche.

This study was aimed at assessing the diagnostic capabilities of radiologic imaging in systemic autoimmune diseases. Forty-one patients (37 women and 4 men, mean age: 57.9 years, range: 37-73) were examined: 17 of them had rheumatoid arthritis, 8 Sjögren's syndrome, 11 progressive systemic sclerosis, 3 systemic lupus erythematosus, 1 mixed connective tissue disease and 1 undifferentiated connective tissue disease. The clinical features were compared with chest X-ray and HRCT findings. Functional lung examination (spirometry) was performed in 30 patients and in 22 of them chest X-ray findings could be compared with HRCT results since the examinations were performed on the same day. Seventeen patients complained of dyspnea (41.4%) and CO diffusion was reduced in 53% of the investigated patients. Chest films showed interstitial changes in 14 of 22 patients (63.6%), while HRCT findings were abnormal in 90.2% of the patients. Significant changes in HRCT patterns were detected only in 7 of the patients complaining of dyspnea (41.1%) and in 5 of the patients with reduced CO diffusion. In conclusion, HRCT proved to be much more sensitive than plain chest films. Dyspnea and functional respiratory tests correlated poorly with HRCT findings.