La Clinica terapeutica
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La Clinica terapeutica · Jul 2005
[New CT and MR imaging techniques in non-traumatic neurological emergencies].
New CT and MR imaging techniques used for non-traumatic neurologic emergencies (represented mostly by ischemic stroke) fulfil the exigency to know quickly and with high accuracy the presence of abnormalities in cerebral perfusion, with the final aim to practise immediately all the treatments needed to prevent the progression of the neurologic damage, by selecting those patients to undergo fibrinolysis, which is useless and not indicated in many occasions. The diagnosis of ischemia is only the first goal reached by these new diagostic tools, while it is nowdays possible and required to stratify the risk factors for the therapy and to accurate select those patients candidates to fibrolnilysis, in order to minimize the risck related to the inadequate treatment choice.
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La Clinica terapeutica · Jul 2005
Case Reports[Hydrothorax in absence of ascites: an unusual complication of hepatic cirrhosis with portal hypertension].
Authors, describing a clinical case of hepatic hydrothorax in absence of ascites, analyse the disease physiopathology and their therapeutic options. ⋯ Hepatic hydrothorax without ascites is an uncommon complication of cirrhosis with portal hypertension. Treatment could be pharmacological, with diuretics administration, or operating. A simple and cheap method is thoracentesis. If hydrothorax relapses, most effective method is transjugular intrahepatic portosystemic shunt.
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La Clinica terapeutica · Jul 2005
Review[Therapeutic advances in neoplastic hematology: target therapy anti-CD33].
Antibodies capable to recognize antigen expressed on cancer cells represents the ideal approach for targeted anti neoplastic therapies. The CD33 antigen is present on 90% of acute myeloid leukemia blasts and is shared on normal hemopoietic cells only on the non stem dillerentiating fraction. Gemtuzumab Ozogamicin (GO) is an engineered humanized antibody anti-CD33 conjugated with a potent intercalating agent, named calicheamicin, which is release only at intracellular level (lower pH), following a selective binding to CD33-positive cells, thus representing a promising approach for target anti-leukemia therapy. ⋯ The strong and homogeneous CD33 expression in Acute Promyelocytic Leukemia (APL), have resulted in an effective treatment of this disease with GO used as salvage treatment, as well as innovative approach for molecular relapsed patients. However, the incidence of veno-occlusive disease, better defined as sinusoidal occlusive syndrome (SOS), must be taken into account as potential complication associated with the GO administration, especially in patients treated with ablative regimens. In conclusion, the extension of the approval in Italy to AML CD33+ in relapsed, regardless age limitation, along with the ongoing evaluation by the European EMEA, represent the basis for a large clinical application of GO in myeloid malignancies potentially extended to paediatric patients with AML and to ALL CD33+.
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Rheumatoid Arthritis (RA) is a chronic inflammatory disease resulting in diarthrodial joints inflammation (particularly joints of hands, wrists, feet, knees, cubitus, ankles, shoulder, etc.) that is manifested by swelling and functional impairment. The associated complications, osteoporosis and cardiovascular disease, make RA important in public health terms. During the active phase of disease, elevated plasma concentrations of inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha) and acute-phase proteins, lead to reduction of fat free body mass (FFM) with a loss mean of 15% of cell body mass (CM) and consequent reduction of muscle strength. ⋯ Proper antioxidant nutrients (Vitamin A, Vitamin C, selenium) may provide an important defence against the increased oxidant stress and a supplementation of folate and vitamin B12, in patients treated with methotrexate (MTX), reduce the incidence of side effects and offset the elevation in plasma homocysteine frequent in these patients. Calcium and vitamin D, in patients treated with corticosteroids, reduce the bone loss, while a supplementation with iron may prevent anaemia. Finally, elimination diets may be feasible therapy only in patients with positive skin prick test.
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Sepsis is a clinical syndrome resulting from a systemic inflammatory response to infection. Genetic factors may be important risk factors for sepsis. The present study determines whether the most frequent polymorphism of NOD2, a cytosol sensor of peptidoglycan, are independent risk factors for nosocomial sepsis. 80 sepsis patients and 90 unmatched controls admitted to the Campus Bio-Medico School of Medicine Hospital in Rome were studied. ⋯ This resulted in an Odds Ratio (OR) of 3.95 for sepsis and NOD2 mutation patients and in an OR of 4.26 adjusting for cancer incidence and age in a logistic model. NOD2 mutations are an independent risk factor for nosocomial sepsis. The present study has shown, for the first time, the association between NOD2 mutations and sepsis, and it has determined NOD2 essential part of the innate immunity response to bacteria.