Hydromorphone (HMP) is a semisynthetic opioid that has been widely used over many years in the treatment of chronic moderatesevere pain. A number of studies have demonstrated the use of HMP in patients with cancer pain as safe and affective, and more recently HMP has been also utilised in the treatment of chronic degenerative pain (CDP). Then, some opioids are able to influence several immune parameters. Aim of our study was to assess HMP in patients with CDP in terms of safety and efficacy, to evaluate effects of HMP, within 2 months of observation, on cutaneous cell-mediated immunity (CCMI) as well as other basic immune parameters, and the production of interleukin-2 (IL-2) and interleukin-6 (IL-6). Results have shown that HMP does not influence CCMI nor the sieric levels of immunoglobulins or other immune parameters. Furthermore, it also has no effects on the 3rd and 4th complement fractions, on white blood cells count and T-lymphocyte subpopulations, on presence of seric autoantibodies, nor on production of IL-2 and IL-6. Therapy with HMP has not effects on the studied parameters of the immune system and does not seem to have any influence on the immune competence and immune response in patients with chronic pain. Clin Ter 2013; 164(2):e97-99. doi: 10.7417/CT.2013.1539.

Uveitis represents the inflammatory process of uvea being caused by an autoimmune mechanism. Similarly, systemic connective tissue diseases (CTDs) present as well an autoimmune pathogenesis and numerous are the reports of a correlated association of the two different conditions, according to their serological characteristics. In this work, we have studied a number of subjects affected by uveitis as well as a number of subjects affected by CTDs associated with uveitis (14.2%). Only one significant correlation has been observed here, and it is the one between uveitis and the Systemic Lupus Erythematosus (SLE, 42.8%). The observation has been made up to through a time-lapse of 18 months during which, the signs of uveitis showed a clear trend to faintly diminish till completely disappearing. At the same time, the presence of uveitis has not stressed out any correlation either with the general positivity for the autoantibodies, nor with the titration or the pattern of single fluorescent antibodies. This study seems to confirm the presence of a weak association between uveitis and CTDs (SLE excluded), where the research of antinuclear antibodies does not seem to give any useful element in terms of diagnostics and clinics, able to value the risk of developing CTDs when uveitis is already stated. Clin Ter 2013; 164(2):e93-96. doi: 10.7417/CT.2013.1538.

Aim.

In this study, we aimed to evaluate serum CP levels in the serum samples before and after the surgical interventions in patients with pulmonary cystic echinococcus (CE). Materials and Methods. Forty-eight patients with pulmonary CE who underwent surgery and 48 healthy individuals were enrolled to the study. Patients were divided in two groups; group 1 (n=48) consisted of patients with pulmonary CE, and group 2 (n=48) consisted of healthy subjects. Before and after surgical interventions serum CP levels were measured.

Results.

Compared to group 2, group 1 had significantly higher CP levels at baseline (p <0.001). In group 1, CP levels were significantly decreased after the surgical intervention (p <0.001).

Conclusions.

The present study showed that CP levels increased in patients with pulmonary CE; chronic inflammation may cause these rises, and may be an immune response of the host, and these levels decreased after the surgical intervention. Clin Ter 2013; 164(2):e89-92. doi: 10.7417/CT.2013.1537.

Background.

Oxidative stress is believed to have a role in the development of preeclampsia (PE). It is known that an increased ceruloplasmin (CP) level is also associated with PE. The aim of this study was to investigate the relationship between oxidative stress parameters and CP levels in patients with severe PE. Patients and Methods. Sixty patients with severe PE and 60 healthy pregnant women were recruited to the study. All study subjects were divided into 2 groups; group 1(n=60) consisted of patients with severe PE, and group 2 (n=60) consisted of healthy pregnant subjects. Blood samples were obtained to measure CP, total antioxidant status and total oxidant status from all subjects. Oxidative stress index was calculated.

Results.

Compared to group 2; group 1 had significantly higher CP, total oxidant status, oxidative stress index and lower total antioxidant status levels (p<0.001, p<0.001, p=0.001, p=0.008, respectively). Serum CP levels were significantly correlated with oxidative stress index levels (r=0.385, p=0.002).

Conclusion.

The present study demonstrated that both oxidative stress and CP levels increased in patients with PE, and increased CP levels seem to be a consequence of oxidative stress. Clin Ter 2013; 164(2):e83-87. doi: 10.7417/CT.2013.1536.

Objectives.

Myocardial infarction is a relatively unusual phenomenon in young subjects. The aim if this work is to characterize the risk profile and factors influencing outcomes of these patients since it makes possible to manage prevention interventions. Patients and Methods. We examined cardiovascular risk factors, clinical presentation, angiographic picture and outcome of a group of young patients hospitalized for a myocardial infarction. We enrolled 121 young patients consecutively admitted to our hospital for a myocardial infarction and examined them not only at the initial stage, but also after 3 months and one year; finally a long-term telephonic follow up was performed, when possible.

Results.

We found some peculiarity making these patients quite different from the older ones who develop a myocardial infarction: cigarettes smoking, family history of ischemic heart disease and hyperlipidemia were the most frequent cardiovascular risk factors, while diabetes and hypertension were less represented; moreover coronary angiography showed more frequently a less extensive coronary atherosclerosis. Patients who developed a cardiovascular event at follow-up presented a significantly higher prevalence of hypertension and obesity and a significantly lower frequency of healthy coronary arteries and of previous revascularization.

Conclusions.

Myocardial infarction in young adults presents several peculiarities, represented not only by the risk profile, but also by the angiographic picture and the prognosis. Considering the long life expectancy of the involved population, the essential role of preventive interventions should be strongly underlined. Clin Ter 2013; 164(2):e77-82. doi: 10.7417/CT.2013.1535.

Urban pollution is a current problem, constituting a serious health risk. Many pollutants are present in the urban atmosphere, they are mainly anthropogenic, resulting from the combustion of coal. Several studies have shown the harmful effects of these pollutants, particularly on the respiratory system. Through a library review, we want to explore the effects on the health of general population and of outdoor workers exposed to the products resulting from the combustion of coal, in order to compare them with the estimated effects of the pollutants from the new generation coal plants, certainly less harmful to the environment. In recent years investments in "clean technologies" have resulted in a rapid and significant reduction of all polluting emissions: sulfur dioxide, dust, oxides of nitrogen, ash and gypsum resulting from the desulfurization process. To conclude in the light of the scientific literature we can say that the activation of coal plants based on technologies for the maximum containment and optimal treatment of the production cycle is essential to defend both the environment and the health of the population. Nevertheless it remains necessary to ensure a systematic monitoring of the environment of sanitation and food processing of the population living in the area, with a long-term follow-up. Clin Ter 2013; 164(2):e139-146. doi: 10.7417/CT.2013.1547.

Acute generalized exanthematous pustulosis (AGEP) is a significant adverse cutaneous reaction most often induced by drugs and by acute infections. Its clinical hallmark is the sudden onset of multiple, disseminated, non-follicular, sterile pustules on an erythematous background usually arising in intertriginous folds, associated with fever, massive neutrophilia and sometimes eosinophilia. Antitubercular therapy is described as an uncommon cause of AGEP. We report the onset of disseminated non-follicular sterile pustules on an erythematous background in a 68-year-old man receiving a combination of isoniazid, pyrazinamide and rifampicin that may have been the etiologic agents. A thorough history, including a medication history, with clinicopathologic correlation is crucial in patients presenting with acute diffuse pustular lesions. Clin Ter 2013; 164(2):e137-138. doi: 10.7417/CT.2013.1546.

We present a 42-years-old male who developed a radial shaft pseudoartrosis and a chronic DRUJ dislocation/instability, following a Galeazzi fracture. He presented to our Office with a severe inability of wrist and forearm motion. A Sauve'-Kapandji procedure was adopted, performing a lateral approach to the ulna and grafting the excised ulnar block to retrieve radial length at the pseudoarthrosis level. Cancellous bone grafts from the iliac crest were also applied and mixed with autologous platelet rich plasma to promote callus formation. The goal was to create an intentional pseudoarthrosis of the distal ulna combined with a DRUJ arthrodesis, in order to resolve instability and regain forearm pronation/supination. We obtained bone healing, an excellent clinical recovery, and the patient returned to all his previous activities six months after surgery. To our knowledge, this is the first reported case of a radial shaft psudoarthrosis treated with the Sauve'-Kapandji technique. Clin Ter 2013; 164(2):e133-136. doi: 10.7417/CT.2013.1545.

Filariasis or Loiasis is an eye infection caused by a parasite belonging to the species Loa loa, also known as "African eye worm" since it is present in the rainforests belt of western and central Africa. The purpose of this study is the description of a clinical case presented to our department. A 40-years-old Congolese woman, in the third month of pregnancy, complained a foreign body sensation in the right eye for which she was submitted to complete ophthalmologic examination. Slit-lamp examination revealed, in the infero-temporal subconjunctival space, the presence of a live whitish worm that moved slowly in the thickness of the tissues. Place a clinical suspicion of subconjunctival filariasis, were performed parasitological and serological analysis; laboratory test showed peripheral blood eosinophilia and the blood film examination was negative for the presence of circulating microfilariae. The worm was surgically removed under topical anesthesia and the histological examinations of the parasite confirmed that it was an adult male worm belonging to the species Loa loa. Due to the large increase of migratory flows to Europe, number of reports of loiasis is becoming more frequent; the knowledge of this emerging pathogens is essential for diagnosis and treatment planning. Clin Ter 2013; 164(2):e127-131. doi: 10.7417/CT.2013.1544.

Aim.

This observational study was performed to evaluate the efficacy and safety of intra-vitreal injections of pegaptanib during a 12-month follow-up period. Patients and Methods. Forty eyes (20 patients) affected by diabetic macular edema were monitored. Twenty were subjected to treatment, and 20 were controls. The treatment involved a cycle of three intravitreal injections of pegaptanib (0.3 mg every 6 weeks), at the end of which treated patients were submitted to a monthly follow-up for a period of 12 months. The aim was to evaluate the clinical condition of the eye after therapy and gauge the efficacy of the long-term use of this drug. Specific criteria were used to measure the efficacy and safety of pegaptanib. Regarding efficacy, we considered the following: an average improvement in the power of vision, or visual acuity, of →10 letters (2 lines), equivalent to an average logMAR score of →0.2, and a reduction in the central macular thickness of →250 μm. Regarding safety, we considered the occurrence of undesired eye and systemic side effects correlated to either the drug itself or the injection procedure.

Results.

The logMAR score for the measurement of visual acuity at T3 (third intra-vitreal injection at week 13) with respect to T0 decreased from 0.7 ± 0.277 to 0.445 ± 0.216, suggesting an improvement, while the mean Early Treatment Diabetic Retinopathy Study (ETDRS) score increased from 25.75 ± 13.046 to 34.300 ± 11.770 letters. The central macular thickness was reduced from the initial value of 746.95 ± 293.601 to 334.050 ± 93.997 μm. In seven controls, we registered a worsening both in terms of visual acuity and macular thickness in some eyes, justifying a continuation of therapy in eight eyes of the control group.

Conclusions.

Pegaptanib proved to be efficacious and safe for the treatment of diabetic macular edema throughout the 12-month followup. To evaluate its long-term efficacy, further studies are required with larger numbers of patients and longer observational follow-up periods. Clin Ter 2013; 164(2):121-126. doi: 10.7417/CT.2013.1543.