Panminerva medica
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Review
Cerebrovascular disease and the pathophysiology of Alzheimer's disease. Implications for therapy.
Dementia is a disease of the elderly, and although there are many causes of dementia, Alzheimer's disease (AD) and vascular dementia (VaD) account for the majority of cases world- wide. Many patients with dementia have radiological and neuropathological features of AD and VaD, with the classical neurofibrillary tangles and senile amyloid-beta (Abeta) plaques of AD together with the cerebral infarcts of VaD. In this review we examine the close relationship between AD and VaD and suggest that the age changes in cerebral blood vessels that are the basis of cerebrovascular disease and VaD may also be responsible for the failure of elimination of Abeta from the brain in AD. ⋯ In aged individuals, insoluble Abeta amyloid fibrils are deposited in the ISF drainage pathways resulting in cerebral amyloid angiopathy (CAA). We review the evidence that age changes in cerebral arteries and cerebrovascular disease inhibit the perivascular drainage of ISF and Abeta along the walls of cerebral arteries resulting in the accumulation of insoluble and soluble Abeta in the brain in AD. Therapies for AD are reviewed, especially those involving immunotherapy for the removal of insoluble Abeta from the cerebral cortex and the facilitation of drainage of ISF and soluble Abeta from the brain.
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Asthma and allergic rhinitis are common conditions that have a substantial impact on patient quality of life, severely disrupting physical, emotional and social functioning. These diseases share many pathophysiological characteristics and recent research has provided evidence that a strong causal relationship exists between allergy and both asthma and allergic rhinitis. As a root cause of allergic diseases of the airways, immunoglobulin E (IgE) represents an appropriate target for the development of new therapies. ⋯ Omalizumab significantly improved disease symptoms and reduced the use of rescue antihistamines. In patients with concomitant asthma and perennial allergic rhinitis, omaliuzumab significantly prevented asthma exacerbations and improved quality of life compared with placebo. Taken together, these results suggest that omalizumab represents an important clinical advance in the management of allergic disease.
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Hematopoietic stem cell transplantation has become increasingly important in the treatment of hematologic malignancies over the past 20 years. While it is associated with significant morbidity, it offers the only chance of cure in many circumstances. ⋯ Timing of transplantation and selection of patients are also discussed. New innovations in stem cell transplantation including umbilical cord blood and non-myeloablative transplantation are reviewed.
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Review
Management of treatment resistant obsessive-compulsive disorder. Algorithms for pharmacotherapy.
Treatment resistant OCD subjects, defined as those patients who undergo an adequate trial of SRI (clomipramine or SSRI) and do not respond or show unsatisfactory results, account for 40-50% of all patients. Once the appropriateness of the trial has been assessed, several options exist for the clinicians. If clomipramine or citalopram have been used, an appropriate strategy consists in giving the same drug intravenously. ⋯ An unresolved question is whether augmentation should be preferred to switching. No data exist in OCD; a practical approach would suggest augmentation first, considering that response should be obtained faster than by switching compound. When all the available and effective strategies prove uneffective, clinicians should consider switching the patient to other compounds in monotherapy, such as venlafaxine, sumatriptan, inositol, although research is strongly needed before conclusions on the efficacy of such compounds can be drawn.
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Case Reports
A case of Sweet's syndrome associated with monoclonal immunoglobulin of IgG-lambada type and p-ANCA positivity.
We report a case of Sweet's syndrome associated with monoclonal gammopathy of uncertain significance (MGUS) and positivity for perinuclear antineutrophil cytoplasmic antibodies (p-ANCA). A 65-year-old man patient came to our hospital complaining of remittent-intermittent fever, weight loss, associated with papules affecting all his body and without mucosal or ocular involvement. ⋯ This is the first case of this rare syndrome associated both with MGUS and p-ANCA positivity. The monoclonal immunoglobulin, possibly directed to neutrophils like an antibody, may cause both their fragmentation and release of antigens responsible of p-ANCA appearance.