Annali italiani di medicina interna : organo ufficiale della Società italiana di medicina interna
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Bronchial asthma is a chronic inflammatory disease of the airways. Several mediators are involved in the inflammatory process, including leukotrienes B4, C4, D4 and E4. These compounds promote bronchoconstriction, mucus hypersecretion, eosinophil infiltration, monocyte/macrophage activation, and smooth muscle proliferation. ⋯ However, the response rate for leukotriene modifiers approximates 70 to 80% suggesting that there are "responders" as well as "non-responders" for whom leukotrienes, as inflammatory mediators, may be less important. A 2 to 4-week therapeutic trial, with objective monitoring of response, may be a reasonable approach to initiating leukotriene modifier therapy. Additional controlled trials will be required to define more fully the role of these new drugs for long-term control and treatment of asthma.
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Ann. Ital. Med. Int. · Jan 1998
[Effectiveness of long-term ACE-inhibition on pulmonary diffusion and ventilation-perfusion ratio in chronic heart failure: correlation with physical performance].
Pulmonary dysfunction contributes to exercise intolerance in patients with chronic heart failure, and ACE-inhibition improves the functional capacity of these subjects. In this study, we investigated whether and how ACE-inhibitors affect pulmonary function and ventilatory response during exercise in chronic heart failure. Twenty patients with idiopathic dilated cardiomyopathy and left ventricular ejection fraction < 35% underwent pulmonary function tests and exercise evaluation with analysis of expired gases before and after 1 year of treatment with enalapril (10 mg bid). ⋯ A negative correlation was found between the variations in oxygen consumption and those in dead space to tidal volume ratio at peak exercise. We conclude that in patients with chronic heart failure, ACE-inhibition restores diffusing lung properties and improves ventilation-perfusion matching during exercise. In this syndrome, sustained reduction in gas exchange resistance is a fundamental therapeutic property of this class of drugs.
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The complement system consists of several proteins present in human serum interacting among themselves and with the other compounds of the immune system in the host defence process. In particular, late complement component (C5, C6, C7, and C8) deficiencies (LCCD) are closely associated with Neisseria, mainly meningitidis, infections. The aim of our study was to verify this association in an Italian population by analyzing the complement profile in survivors of meningococcal meningitis. ⋯ Anti-meningococcal vaccination is usually recommended for LCCD subjects because it increases, both quantitatively and qualitatively, the antibody component of anti-meningococcal immune defence. We therefore analyzed the levels of anti-polysaccharide (PS) A and PSC antibodies in the members of 4 families including normal subjects and subjects with homozygous and heterozygous C7, C8 or factor H defects, before and after vaccination with only PSA+C. Surprisingly, we found the highest levels of antibodies before vaccination in homozygous subjects, followed by heterozygous and normal controls, whereas, after vaccination, homozygous subjects showed the lowest increase of specific antibodies, indicating their relative incapacity to respond to meningococcal PS alone.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann. Ital. Med. Int. · Jul 1991
Comparative Study Clinical Trial[ProMACE-MOPP vs. ProMACE-CytaBOM polychemotherapies in the treatment of large-cell and unclassifiable non-Hodgkin's lymphomas].
The results of two distinct and successive clinical pilot studies investigating feasibility of aggressive chemotherapy in large cell and unclassified non-Hodgkin's lymphomas are reported. In the first study (1986-87) the ProMACE-MOPP chemotherapy (P-M), a 2nd generation regimen, was administered to 10 patients, whereas in the second study (1987-88) the ProMACE-CytaBOM schedule (P-C), a 3rd generation regimen, was administered to 13 patients. ⋯ Hematological toxicity was higher in the P-M study, while gastrointestinal (mucositis, hepatic transitory damage) and neurological toxicity (peripheral neuritis) were somewhat lower. In conclusion, the P-M regimen is worth considering for the treatment of high grade malignant lymphomas, although it was not recently designed and is not widely used at present.
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The clinical course of patients with cirrhosis of the liver is frequently complicated by progressive impairment of renal sodium handling leading to the formation of ascites. The occurrence of ascites is generally accompanied by the activation of several hormones and intrarenal autacoids and a complex derangement of systemic, portal and renal hemodynamics. The earliest "underfilling" theory of sodium retention proposes that ascites formation leads to hypovolemia and secondary sodium retention. ⋯ In patients with compensated cirrhosis, i.e. without ascites, compensatory events maintain blood volume despite vascular underfilling, and so these patients do not develop ascites. In patients with decompensated cirrhosis, vascular underfilling due to arterial vasodilation, together with a reduced oncotic pressure and a severe degree of portal hypertension, favours the development of ascites. Underfilling of the arterial circulation is at its maximum in functional renal failure and the hepatorenal syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)