Il Fattore Enzima (Salute e alimentazione) (Italian Edition)

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He referred that the fever appeared after a surgery for a voluminous inguinal hernia. At the physical exam we noted hepatomegaly,upper abdominal pain,bilateral basal hypophonia. Thorax Rx showed a bilateral pleural effusion and the abdominal echography indicated a perihepatitis liquid collection. Blood culture proved the presence of E.

We started a therapy with parenteral nutrition N9G15 and meropenem 1gr x 2 e. We made an EGDS, which proved an atrophic gastritis,and a thorax-abdominal-pelvis TC which demonstrated the presence of little abscesses before the left part of the liver, near the gallbladder and in the Morrison.

After 7 days of treatment the fever got down with an improvement of general condition. During the eighth day he restarted the normal nutrition. The patient was dismissed after 15 days,when the thorax RX and abdominal echography have showed the resolution of pleural effusion and liquid collection. This case stresses the efficacy of association meropenem plus ciprofloxacin in post-surgery abdominal infection, generally made by gram - and anaerobic germs. Asti, A. D'alessandro, C.

Cristiano, G. D'alessandro, G. Perrone, L. Viscardi, M. Coppola, P. We report a case of a young woman, 35 years old,hospitalized for abdominal pain,vomiting and asthenia for 20 days. During the physical exam we noted pale skin, hepatosplenomegaly, basal hypophonia on the left side of thorax, no lymphadenopathy. Was begun therapy with growth factors erythropoietin and filgastrim and antibiotics ceftriaxone 2 g e.

The patient showed an improvement after six days. Total-body TC proved a mild pleural effusion on the left side and hepatosplenomegaly. Classical risk factors for atherosclerosis have been studied more in men than in women, and their impact is different in the sexes: diabetes is much more dangerous for cardiovascular complications in women, lipids profiles are differently influencing atherogenesis in women HDL-cholesterol, triglycerides and non-HDL cholesterol are more important than total cholesterol, and LDL-choles-terol , inflammation biomarkers as CPR and cytokines seem to be higher in the presence of risk factors in women.

However women are less treated for diabetes, dislipidemias, hypertension, obesity and the goal of treatment is far less reached. Evidence Base Medicine for prevention of CVD in women is scanty, and Women Guidelines are obtained from populations not existing in the "real word". Thus how should be treated women in primary end secondary prevention of CVD in our routinely work? Caso clinico Donna 46 anni, senza fattori di rischio cardiovascolare. Si ricovera per comparsa di emiparesi facio-brachiale sinistra, con deviazione dello sguardo a destra, con emineglet e deficit faciale sinistro NIHSS In DEA una TC del cranio ha evidenziato una vasta area infartuale fronto-insulare destra di competenza della cerebrale media, gli esami di laboratorio evidenziavano un'anemia microcitica severa, senza indicazione al trattamento di trombolisi sistemica o a trattamento endovascolare.

La successiva valutazione strumentale ecocardiogramma trans toracico e trans esofageo, ecocolor doppler TSA e transcranico con conta dei microemboli, Holter cardiaco, angio TC dei vasi intracranici non evidenziava una patologia dei vasi o una causa cardioembolica. Il profilo coagulativo e il dosaggio anticorpale sono risultati nella norma. Conclusioni Il caso da noi descritto conferma che la frequente origine criptogenetica dell'ictus giovanile anche dopo un'estensiva valutazione diagnostica e il ruolo incerto come fattore di rischio della terapia estro progestinica.

Introduction and aim of the study The need for instruments that record and measure clinical problems rapidly and efficiently exists in many departments RSA, departments of long hospitalisation and medicine. We have tried to verify the usefulness and limits of these instruments in elderly patients. Materials and methods We evaluated 30 hospitalised subjects older than 70 years of age. IMM and TSA appear to provide results that are less encouraging and precise, and we do not advise them for these patients. Conclusions The use of the above-described tests involves a better and less stressful handling of the patient.

It reduces complications, times and costs of hospitalisation, and contributes to reinforcing a culture that is shared among operators in the department. Barzaghi, F. Borin, F. Taurasi, C. Morichetti, D. Ciapanna, A. Porro AO "G. Il test di tolleranza con molecola alternativa a quella responsabile della reazione rappresenta una metodica validata al fine di reperire un farmaco alternativo sicuro. Conclusioni Le RAF di natura allergica rappresentano una considerevo-le quota di reazioni indesiderate a farmaco.

Il test di tolleranza appare sicuro per trovare una valida alternativa al farmaco responsabile della RAF. Basilico, T. Lavazza, L. Marchionni, M. Cimpanelli, P. Cozzi, M. Draisci, G. Nador, S. Marinoni, M. Valentini, A. Tosi, A. Le localizzazioni extranodali sono estremamente rare.

Nel giunge alla nostra osservazione una donna di 71 anni per linfoadenopatie diffuse e componente monoclonale CM IgM. La biop-sia linfonodale depone per linfoadenite cronica reattiva e la biopsia os-sea non permette di giungere ad alcuna diagnosi, pertanto la paziente viene posta in follow-up. Nel progressione delle linfoadonopatie ed incremento della CM.

In atte-sa di chemioterapia la paziente viene sottoposta a procolectomia sini-stra e colostomia destra per quadro di occlusione intestinale. L'istologia su colon depone per localizzazione di malattia di Castleman. Basilico, I. Stefani, S. Marinoni, P. Cozzi, G. Nador, M. Draisci, M. Valentini, E. Re, A. Nel dicembre u. Vengono pertanto escluse le cause di vera iponatriemia: ridotto apporto di NaCl, stato di diluizione e sindrome da inappropriata secrezione di ADH SIADH , perdite urinarie o gastro-ente-riche, salt wasting syndrome.

Checchi, D. Belliti, R. Culli, P. Apicella, G. Panigada U. Materiali e metodi Analisi della casistica oncologica tiroidea nel periodo con successivo follow-up. Inoltre in 21 pazienti 8 lesione sospetta, 9 dubbia e 4 con proliferazione follicolare l'esame istologi-co dopo intervento chirurgico di tiroidectomia totale era compatibile con carcinoma papillare. Sono stati sottoposti a tiroidectomia: 97 pazienti seguita in 51 da trattamento radiomatabolico.

Sono deceduti 2 pazienti con K anaplastico. Conclusioni Il Day service internistico garantisce il percorso gestionale del nodulo tiroideo, dalla diagnosi alla programmazione di terapie ra-dio-metaboliche o chirurgiche, al successivo follow-up. In anamnesi pregres-sa ulcera peptica, osteosintesi femore dx, ernioplastica inguinale, ictus cerebri. Febbre da 30 giorni. All'ingresso condizioni discrete, lievi edemi declivi e soffio sistolico alla punta irradiato all'ascellare con splenomega-lia. All'ecogra-fia addome lesioni spleniche ipoecogene di ndd.

All'ecocardiogramma insufficienza mitralica di grado medio. Rifiuta ecocardiotransesofageo. Alla Tac addome multiple aree post-infartuali spleniche. Splenectomizza-to in urgenza per rottura di milza, nel post-operatorio presenta insufficienza renale e scompenso cardiaco ingravescente: all'ecocardiogramma multiple vegetazioni valvolari, rotture di corde ed insufficienza mitralica severa.

Sottoposto a coronarografia preoperatoria negativa ma complicata da emorragia in sede di accesso femorale con necessita di sutura dell'ar-teria ed evacuazione di ematoma. Stabilizzato emodinamicamente, viene sottoposto a sostituzione valvolare mitralica con esito positivo. Conclusioni I pazienti ricoverati in Medicina sono molto complessi, so-prattutto per comorbidita e polifarmacoterapia, e necessitano di un ap-proccio multidisciplinare ma al contempo globale e non frammentario.

Scopo 1 fornire agli operatori sanitari della SCMP le indicazioni per gestlre il paziente ricoverato secondo il modello dell'intensita di cure, per migliorare l'appropriatezza dell'assistenza e ridurre il rischio clinico generale, in ordine al grado di complessita del paziente. Metodi Utilizzando specifici indicatori MEWS modificato, Indice di Dipendenza Assistenziale , differenziare i pazienti in 3 macro-gruppi alta, media e bassa intensita di cure , sia all'inizio del ricovero che durante la degenza.

Stabilire il minimo livello assistenziale per ogni macro-gruppo, in merito a: indicazioni terapeutiche, Parametri Vitali da monitorare, urgenza degli esami richiesti, Scheda Unica di Terapia set-timanale, o giornaliera per il gruppo di pazienti piu critici. Conclusioni Dopo riunioni formative del personale coinvolto, e stata avviata una fase di sperimentazione, i cui dati verranno rivalutati a 3 mesi, prima dell'attivazione definitiva.

An efficacy and safety evaluation. Belvedere1, A. Privitera2, M. Mastronardi3, M. Cappello4, L. Grossi5, A. Lauria6, M. Principi7, N. Della Valle8, N. Buccianti9, W. Carlo, Potenza. Data on clinical observations on Ifx use in terms of treatment success and safety in CD are mainly limited to 1 year. The aim of this study was to evaluate the efficacy and safety of Ifx in patients treated longer than 2 years.


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Methods Data from 9 centres of Southern Italy were analyzed and. We identified patients with more than 2 years treatment and extracted demographics, Harvey-Bradshaw index HBI , indications for treatment, and endoscopy, before Ifx therapy and at 1, 2,and 3 years; adverse events AE and withdrawal of therapy were recorded. Results We identified patients with more than 14 consecutive infusions; HBI dropped from Steroid-free remission was maintained at 2 and 3 yrs.

Treatment was stopped in 9 due to severe AE. Conclusions Long term Ifx therapy showed clinical efficacy by maintaining steroid-free remission. Benatti1, C. Sacchetti1, P. Ballesini1, A. Pedrazzi1, L. Medici2, M. Trani3, M. Pinelli4, C. Salvarani5, M. Case report This report studies the case of a 46 year-old woman who underwent exeresis of right mammary cysts with a histologic examination showing granulomatous inflammation.

The patient presented progressive dehiscence of the surgical wound with detachment of the areola. The results of coulture and blood biochemistry testes, performed in day-service, were not significant. The clinical picture was complicated by recurring episodes of sinusitis and bronchitis for which the patient was hospitalised. Objectively, there was rhino-sinusitis, bronchial spasm, hearing loss, right mammary crater of 14 cm. A systemic pathology was suspected and autoimmune tests were performed with positivity of ANCA. Discussion The data gathered led to the formulation of the diagnosis of Wegener Granulomatosis WG involving the mammary, nasal, acoustic, laryngeal, ocular and bronchial areas.

WG is a necrotizing vasculitis that usually affects the respiratory tract, while subcutaneous localization is rare. The illness, if untreated, has a serious prognosis; therapy is based on the use of immunosuppressants and biological drugs. Previous collaborative projects between Medical and Surgical wards hadn't unique outcomes.

Even if optimal management models don't exist, actual data promote multidisciplinary management of "complex" patients pts. This is the source of our collaboration project with Orthopaedic ward. The project The Medical Ward provides consultants for emergencies every days and a dedicate doctor twice a week to the Orthopaedic Ward.

The doctor visits the patient, he issues an evaluation form about him, he takes care of him during hospitalization, he proposes his transfer if it is necessary , he revalues therapy at the moment of discharge from hospital. Conclusion Our data don't allow outcome processing,but they stimulate our reflections about in-hospital co-management activity where the Internist plays a key role in the management of surgical complex patient.

Aim of the study Tako Tsubo cardiomyopathy is a stress induced ballooning of left ventricular apex with hypercontractile base. The syndrome, named Tako Tsubo after an octopus trap in Japan, is more commonly seen in postmenopausal women. Aetiology involves many factors, mainly high circolating levels of cathecolamines. Coronary angiogram doesn't reveal any stenosis. Materials and methods A 60 y old woman suffering from Myelofibrosis, previously treated with Idrossiurea and splenectomy for multiple infarctions, was admitted with pulmonary thromboembolism and severe pulmonary hypertension.

After 48h, during chest pain, the ECG showed T inversion on V3-V6, the echocardiogram showed the typical akinesia and ballooning of the apex with basal hyperkinesia. The coronary angio-gram revealed no stenosis. Results The clinical syndrome severa dyspnea, chest pain, tachiar-rhytmias and the ventricular apical wall motion abnormalities dramatically improved within few days with rest in bed, ASA and light doses of beta blockers. No recurrence of the syndrome was noted during 6 months follow up. Conclusions The Tako Tsubo syndrome has favorable prognosis, also when EF is heavily compromised; no specific therapy is mandatory,but Aspirin.

Aim of the study Clostridium difficile CD , a gram-anaerobic spore forming rod causes diarrhea, abdominal pain, fever and foul stool odor when normal flora has been destroyed by antibiotics Fluoroquinolones, 3rdgeneration Cephalosporines, Clindamycin Spores remain viable in the environment for a long time and can be easily picked up accidentally. Materials and methods 32 patiens have been admitted in mean age 81,8 years; min 41, max 99 years.

All the patients were infected prior to admission to hospital, but one exception. Results All the patiens were successfully treated with Metronidazole schedule mg tid x 12 days. Probiotics were added. Metronidazole was also effective in Vancomycin previously treated patients. No resistance was noted. Metronidazole is first choice treatment, Vancomycin being second line. Bertolino, C. Pieresca, R. Invernizzi, G. Gamba, P. Noris, C. Scavariello, C. Picchi, F. Melazzini, C. Matteo, Pavia. Descriviamo il caso di un paziente di 79 anni, autonomo, cardiopatico, che giunge alla nostra attenzione per angina da discrepanza insorta in seguito ad anemizzazione da sanguinamento di angiodisplasie del colon, aggravato dalla terapia antiaggregante in atto.

A complicare ulteriormente il quadro clinico, nel settembre ultimo scorso viene posta diagnosi di sindrome mielodisplastica, che evolve. Valutata l'eta, le comorbilita ed i rischi correlati si decide di effettuare trattamento chemioterapico con arabinosina citoside ed azacitidina, ma il paziente decede a 6 settimane circa dalla diagnosi, per complicanze cardiocircolatorie.

Introduzione Dispnea e deossigenazione arteriosa, accentuate dall'orto-statismo e minori o assenti in clinostatismo, caratterizzano la sindrome platipnea-ortodeoxia causata da uno shunt destro-sinistro intracardia-co o intrapolmonare. Caso clinico Donna, 77 anni, recente ictus talamico destro, fumatrice, si ricovera per eseguire ERCP per calcolosi del coledoco, gia trattata con ERCP in anestesia generale. La valutazione clinico-strumentale evidenzia insufficienza respiratoria ipossico-ipocapnica con significativa quota di shunt, ridotta in posizione supina. L'angio-TC spirale del torace, lo studio ad alta risoluzione del parenchima e la scintigrafia polmonare, escludono tromboembolia e patologie parenchimali o in-terstiziali polmonari.

Il rilievo all' ETE di aneurisma del setto intera-triale con pervieta del forame ovale e shunt destro-sinistro precoce all'iniezione di soluzione fisiologica a paziente supina, in aumento a paziente seduta, pone diagnosi di sindrome platipnea-ortodeoxia. Si procede a chiusura percutanea di forame ovale pervio con risoluzione del quadro. Conclusioni La diagnosi e il trattamento della sindrome platipnea or-todeoxia comportano un apporto interdisciplinare. Come descritto in letteratura, procedure interventistiche, richiedenti anestesia e suppor-to ventilatorio possono slatentizzare la sindrome.

Boari, E. Agliozzo, O. Angelini, B. Bonzi, P. Desenzani, N. Orlandi, G. Pasini, M. Tusi, E. Zanotti, O. Di Stefano. Syncope is an abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery. Although often benign and self-limited, its cause is often not obvious, and it can be difficult to detect subjects at risk for sudden death.

Natura e Stile

Tilt table test TTT may be helpful particularly in young, otherwise healthy patients to better define neurocardiogenic syncope. An healthy 51 years old male, with no familiarity for cardiovascular disease was admitted to our department due to a syncope lasting less than one minute, associated with sweating, with no seizures nor urine loss, with full recovery and no residual neurological deficit. Physical examination was normal, all routine blood samples were in range.

No orthostatic hypotension was documented. We decided to perform a TTT to rule out neurocardiogenic syncope.

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At about 30 minutes of the test, syncope associated with bradycardia and asystole occurred. External cardiac massage was started with complete recovery. Although neurocardiogenic syncope is usually considered a benign event, TTT may be a useful tool to recognise its malignant variant, as in our case. Introduzione Ipoglicemia e iperinsulinemia possono essere dovuti a di-versi processi patologici: insulinoma, abuso di farmaci ipoglicemizzan-ti, nesidioblastosi e ipoglicemia autoimmune Insulin Autoimmune Sindrome IAS.

Caso clinico Una donna di 45 anni e ricoverata per tachicardia ed epi-sodi lipotimici. Dopo il riscontro di ipoglicemia ed iperinsulinemia sono stati esclusi l'abuso di farmaci e la presenza di un insulinoma. Per la positivita degli anticorpi antiinsulina e di un'intolleranza glicidica al test da carico e stata posta diagnosi di IAS.

E stata trattata con octreotide a lunga durata d'azione per 6 mesi. Patogenesi Nella IAS l'ipoglicemia e causata da anticorpi anti-insulina. La cinetica del legame tra insulina e anticorpi determina una inappro-priata secrezione di insulina con una biodisponibilita che varia nel tempo e che determina una ipoglicemia nelle fasi post-prandiali tardive. Conclusioni La IAS e una situazione clinica estremamente rara nel mondo occidentale dove sono stati descritti meno di casi.

La presenza di anticorpi anti-insulina e una curva glicemica caratterizzata da iperinsulinemia con un quadro di intolleranza glicidica permette di por-re diagnosi. Boccacci1, S. Bisogno2, A. Dainelli3, A. Gobbini4, G. Campanella5 U. Medicina Interna Ospedale Abbadia S. Salvatore U. Donna, 24 anni, giunge al PS per astenia, dispnea, tosse e febbricola da 2 settimane. Riferiva recente episodio di emoftoe.

Attivita lavorativa con esposizione a solventi. La TC torace documentava esteso interessamento alveolare ed aspetto "a vetro smerigliato"; la broncoscopia non mostrava segni di rexin vasale; BAL nel bronco medio con recupero di materiale parzialmente ematico. E stata iniziata terapia con Prednisone 25 mg x 2. Al fine di chiarire l'etiopatogenesi del quadro, la paziente e stata tra-sferita presso la Nefrologia di Siena per effettuare biopsia renale eco-guidata che ha evidenziato una gromerulonefrite con semilune e, 3 ci-cli di plasmaferesi seguiti dalla somministrazione di mg metil-prednisolone in bolo con miglioramento clinico e radiografico.

Conclusioni: pur avendo escluso la S. Premesse e scopo dello studio La trombosi venosa TV costituisce una importante causa di morbilita. Materiali e metodi L'esecuzione dell'esame avviene entro 72 ore dal con-tatto del medico di famiglia con l'internista. Nei casi positivi il paziente viene rinviato a domicilio dopo inizio e prescrizione del trattamento anticoagulante.

In caso di assenza di fattori di rischio viene ricercata la se-condarieta della TV. Il paziente viene ricoverato in caso di impossibilita a stabilire l'estensione prossimale della trombosi, recidiva in corso di trattamento con Warfarin con INR tra 2 e 3, sospetta Embolia Polmonare.

Conclusioni L'accesso entro 72 ore dal sospetto clinico ad un sevizio di diagnostica vascolare ultrasonografica e un sistema efficiente per la gestione del paziente con sospetta trombosi venosa. Introduction Hyponatremia is the most common electrolyte imbalance among hospitalized patients. We report 4 cases identified in the last year. Case reports In the first case a non secreting pituitary macroadenoma was found; in the second one a small cell lung tumor secreting vasopressin AVP.

The third case was associated to bilateral pneumonia and the fourth to escitalopram. Confusion and headache were always present. The first patient suffered also from nausea, vomiting and severe vision impairment. Essential clues to diagnosis were measurements of plasmatic and urinary electrolytes and osmolality.

Water restriction and hypertonic saline infusions corrected hyponatremia in the first 2 cases, along with drug withdrawal in the fourth. The third one required the administration of tolvaptan. Conclusions SIADH is not as rare as it is believed among patients with severe and symptomatic hyponatremia. On our experience, it should be suspected in any patient with euvolemic hypotonic hyponatremia; hyponatremia with high urinary sodium output in euvolemic patients is an important diagnostic feature. AVP measurement is not essential. Introduction Posterior Interosseous Nerve PIN palsy is a very rare complication of rheumatoid arthritis of the elbow; so far in literature are reported only eighteen cases and anyone is referred during the course of psoriatic arthritis.

Case report We present the case of a woman of 42 years old with PIN palsy secondary to arthritis of the elbow joint, affected by psoriatic asymmetric oligoarthritis treated with infliximab, in addition to meto-trexate and prednisone. The woman was diagnosed multifocal mono-neuropathy by means of electromyography. The ultrasound of the elbow showed joint effusion, synovial hyperplasia and compression of the radial nerve. We proceeded through U. The ultrasound follow-up showed the reduction of joint effusion and of the synovial hyperplasia associated with the reduction of the neurological deficit and a full functional recovery was obtained in four months.

Conclusion Electromyography is the essential investigation for the diagnosis of PIN palsy, but in the case described above, EMG has led to the suspect of demyelinating mononeuropathy, ultrasonography, instead was proved to be crucial both in the correct diagnosis and in the therapeutic choice. Materiali e metodi Abbiamo sviluppato un progetto di miglioramento dell'identificazione di pazienti ad alto rischio per prevenire l'arresto cardiaco e migliorare la sopravvivenza usando il MEWS Modified early warning score. Rispetto allo score originale coscienza, frequenza car-dio-respiratoria, temperatura e pressione arteriosa abbiamo inserito diuresi e scala del dolore.

L'algoritmo di intervento, secon-do l'aumento del MEWS, prevede: intervento del medico di reparto; rilevazione dei parametri ogni 6 o 3 ore; intervento del rianimatore. Una linfoadenomegalia acuta viene in genere considerata di origine infettiva, in particolare quando regredisce. Una donna di 64 anni in buona salute giunge ricoverata per febbre a Durante la degenza, febbre con puntate a Comparsa di voluminose linfoa-denomegalie laterocervicali e sottomentoniere, dure e non dolenti, di circa 3 cm. Negative emocolture e urinocoltura, marcatori di autoimmunity, esami sierologici, non vi e consumo di complemento, ferritinemia Viene eseguita BOM ed asportato un linfonodo sottomentoniero, nel frattempo la febbre e i sintomi regrediscono progressivamente, le linfo-adenomegalie si riducono notevolmente, gli esami bioumorali rientrano nei limiti.

Giungono i referti delle biopsie: midollo con aspetti rigenera-tivi e linfonodo con linfoadenite istiocitaria necrotizzante tipo Kikuchi Fujimoto. La paziente sta bene. Cruciale per la diagnosi l'esame istolo-gico dell'intero linfonodo eseguito precocemente. Bonfante, B. Ferri, F. Benini, W. Background Diet, physical activity, drugs, psycotherapy, surgery are useful for obesity; EIB was proposed to induce body weight loss. Aims Evaluate effectiveness and tolerance of EIB. Materials and methods: Between Jan '05 and dec '10, consecutive patients 90 women, age range mean weight Results In 8 patients, the balloon was removed before for side effects; no serious adverse effects were registred.

Mean weight loss was 12 9. Objective To describe clinical features and treatment outcomes of four cases of Churg-Strauss syndrome, the rarest of ANCA-associated vascu-litides, and to test current prognostic and therapeutic criteria. One patient with low FFS was needed to pass to i. Results Our cases differ from literature just for a lower involvement of CNS, heart and bowel. All achieved remission, but with some neurologic sequelae. PN seemed the least responder, even in case of early diagnosis.

On account of the risk of disability, we suggest to treat at first with boli of corticosteroids and immunosuppressors not only patients with visceral involvement high FFS , but all patients with PN and presence of ANCA. Background The role of viral infections in the etiopathogenesis of systemic lupus erythematosus SLE is debated.

Reactivations of cytomegalovirus CMV and Epstein-Barr virus have been often found during immunosup-pressor treatments, or have been correlated to different clinical features of SLE, however there are only few reports about such infections as triggers of SLE. Case report 17 years old girl; since one month fever, sore throat, malar rash, polyarthritis, weight loss, neck lymph nodes and spleen enlargement.

Lab: WBC 3. She was treated with prednisone and hydroxychloroquine and discharged in remission. Herpes viruses may contribute to SLE pathogenesis through triggering autoimmunity via molecular mimicry, encoding proteins that induce cross-reactive immune responses to self antigens or modulate antigen processing, activation or apoptosis of lymphocytes or histiocytes. Although relationships between viruses and autoimmune diseases are complex and vexed, our case raises the possibility that CMV may be related to the onset of SLE in certain patients.

Ematomi per traumi lievi. Lab: aPTTRatio2. Trasfusa, dimessa Hb In seguito, dolore tumefazione arto inf sn: iniziata EBPM, ematomi diffusi, ricovero. Lab Hb8. Assenza TVP, ma ematoma popliteo. VIII con inibitore.

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Terapia: steroidi, risoluzione s. Successivamente assenza inibitore, sospeso steroide, ripresa ASA. Discussione Emofilia acquisita, mal emorragica autoimmune da anti-corpo anti-f. VIII, presenza anticorpo-specifico. Terapia: 1-Con-trollo sanguinamente: desmopressina, f. Conclusioni Epatopatia cronica HCVrelata unico fattore responsabile di reazione autoimmune.

Scarsa letteratura in corso di infezione cronica HCV. LAC falsamente positivo ritardo diagnosi. Materials and methods 67 years old, male patient with chronic bronchopulmonary disease and anamnestic prostate cancer, admitted for fever, pulmonary infection and light maculopapular exanthema. Improvement of the respiratory involvement owing to antibiotic therapy, but progressive development of heavy erytrodermia, persistent low fever, general conditions'decay and pathological diffuse enlarged lymph nodes.

The patient underwent skin biopsy and axillary lymph node exeresis. Results Nonspecific skin biopsy framework of dermatitis but lymph node histology diagnostic for iperplastic lymphadenopathy, in particular Rosai Dorfman disease. Conclusions Erytrodermia arises differential diagnoses atopic disease, adverse drug reactions, lymphoproliferative diseases and paraneoplastic syndromes.

The rapid increase of lymph nodes made us initially hypothesize a lymphoproliferative disease, but the histological diagnosis showed Rosai Dorfman hystiocytosis, a rare proliferative hystiocitic benign disorder of unknown etiology, characterized by extended lymph-adenopathies and fever. Formazione a distanza FADOI e dimissione protetta: un'ipotesi di lavoro per superare le differenze regionali. Come d'abitudine, tre giorni prima, la vicina di casa si era recata al suo domicilio per le faccende domestiche, trovandolo a terra ai piedi del letto in evidente stato confu-sionale".

Comincia cos! Con l'obiettivo di superare le differenze regionali e attraverso il richiamo alla normativa di riferimento si ipotiz-zano strumenti di gestione della fragilita nel delicato momento della dimissione ospedaliera. La tecnica formativa e quella del Problem Based Learning, grazie alla quale si presentera una diversa chiave di let-tura della continuita assistenziale all'interno del Sistema Sanitario Nazionale, e nuove metodologie per la sua pragmatica realizzazione. The male patient, aged 82, had complained for several months of progressive anorexia and asthenia.

He had a mitro-aortic valve prosthetis. He was hospitalized with dyspnea at rest and orthopnea. A transthoracic echocardiogram had been performed a few days before, but his condition remained unchanged from previous examinations. When he was admitted to the ward he had signs of hemodynamic de-compensation, which was confirmed by radio film of his chest, there was no lung foci and no fever. Blood tests showed an increase in the PCR 1. Due to the presence of Streptococcus mutans in apyrexia in the blood cultures, a transesophageal echocardiogram was performed which showed two small mobile vegetation based on large plant mitral prosthetis.

The malnutrition may have rendered our patient anergic causing him to present with nonspecific symptoms and signs. This case reminds us that frail elderly patients risk falling through the cracks and not being accurately diagnosed as they often present with non classic symptoms thus making diagnosis more difficult.

Ricoverata per versamento pleurico bilaterale con nausea e vomito da alcuni mesi, si dimette con la suddetta terapia dopo evacuazione del versamento e avendo escluso diagnosi oncologica. A distanza di alcune settimane compaiono disci-nesie fini agli arti inferiori in un quadro di gambe senza riposo.

L'ana-lisi attenta delle interazioni farmaco-farmaco e farmaco-malattia, ha portato a sostituire Sevelamer, dall'effetto proemetico, con Idrossido di alluminio. Si sarebbe potuto pensare a un effetto di fine dose della L-Dopa modificando terapia antiparkin-soniana. Medicina Interna, Az.

Cardiovascolale, Az. San Camillo Forlanini - Roma, 1Med. San Camillo Forlanini - Roma. Primary tumors of the major central veins are unusual; inferior vena cava IVC is more frequently interested. We report a case of intravascular lipoma of the superior vena cava SVC in an asymptomatic year-old man with 5-day history of abdominal and lumbar pain. Laboratory analysis were normal. A computed tomography scan CT showed a SVC filling defect with a subtotal occlusion extended into right atrium and suprahepatic IVC, with inhomogeneous aspect.

The mass lying within the lumen of the SVC had fatty density. Magnetic resonance angiogra-. The patient was eligible for surgery. During cardiopulmonary bypass and hypothermia SVC was opened: the tumor arised from the distal end of the posterior surface of the SVC just before bifurcation, with a small base of plan and was completely removed by pulling it out from the right atrium chamber and cut distally; a pericardial patch was posed.

Macroscopically the mass was soft, lobulated, filled with fat, with a surface smooth, enclosed by a thin capsule; histology showed mature adipocytes and collagen. The patient was free of complications. After 3 months, there was no signs of recurrences. Briozzo, C. Norbiato, S. Marengo, R. Cavaliere Sc Medicina Interna, A. Ordine Mauriziano Torino.

Donna di 80 anni ricoverata per astenia, dimagramento e ipertermia. In anamnesi tiroidectomia per GMN, resezione del retto per adenoCa. Coniuge con storia di recente TBC polmonare. Alla fenotipizzazio-ne su sangue periferico evidenza di linfocitosi B monoclonale. Il Quan-tiferon risultava positivo; pertanto veniva richiesta PET total body che evidenziava elevata attivita metabolica dell'intero colon. La ricerca BAAR su urine e feci era negativa, l'ecografia intestinale nella norma, la colonscopia con biopsie multiple anche ileali negativa per neopla-sia.

Nel sospetto di TBC intestinale veniva iniziata terapia specifica con isonia-zide, rifampicina e pirazinamide con normalizzazione di curva termica e indici di flogosi, incremento ponderale, significativo miglioramento dell'anemia e netta regressione dei reperti colici alla PET di controllo dopo terapia.

Conclusioni: la paziente ha presentato un evidente beneficio con la terapia specifica, pur in assenza di elementi patognomoni-ci per TBC intestinale. Troponina e BNP: biomarkers consolidati ed emergenti nella gestione e stratificazione del paziente affetto da scompenso cardiaco. Conclusioni Nella nostra realta ospedaliera il BNP e ancora poco utiliz-zato. Premesse e scopo dello studio Nella Cardiologia di Sassari esiste dal un ambulatorio specialistico per l'HF.

Analizzare il data-base dei pazienti pz che vi afferiscono per una disamina globale. Materiali e metodi Valutare dieci anni di attivita. Risultati Abbiamo seguito pz. Attualmente ve ne afferiscono di cui 15F, 88M. Conclusioni L'ambulatorio dedicato raggiunge ancora pochi pz. Molto resta da fare per creare un modello assistenziale che coinvolga tutte le figure specialistiche che hanno in carico questi soggetti. Cardarelli", Napoli. Caso clinico Anni 36, sesso F, non etilista. Anamnesi di vari episodi di dolore addominale intenso, con due ricoveri ospedalieri e diagnosi di pancreatite acuta.

Giunge in PS per dolore addominale. Indagini strumentali eco, TC con mdc, RMN mostrano soffusione fluida peripancreatica, edema globale della ghiandola, pseudocisti della testa-uncus, dilatazione del dotto pancreatico e calcificazioni intraduttali. ERCP mostra pancreas divisum con morfologia come da pancreatite acuta sul pancreas ventrale e da pancreatite cronica sul dorsale.

Nel tempo riassorbi-mento della pseudocisti acuta della testa e riduzione della dilatazione del Santorini. Sindrome McCune-Albright paucisintomatica: fibrodisplasia ossea poliostotica associata ad ipertiroidismo. Premesse La fibrodisplasia ossea FDO e una malattia rara caratteriz-zata da una FDO monostotica o piu poliostotica lesioni scheletriche fibrose espansive costituite da tessuto mesenchimale. L'associazione della FDO poliostotica con endocrinopatie varie e macchie cutanee identifica la sindrome di McCune-Albright.

La piu comune endocrino-patia e la pseudopuberta precoce; molto piu rara e l'associazione con ipertiroidismo. Caso clinico Anni 34, sesso M. Da circa 18 mesi trattamento con tia-mazolo per ipertiroidismo. La nostra osservazione e dettata dalla comparsa di dolore toracico sordo, prevalente a sinistra, attenuato dal ripo-so e da FANS.

In Reparto si evidenzia la presenza di chiazze color caffelat-te a livello dell'addome e del dorso e una dolorabilita alla palpazione dello scheletro costale bilateralmente. TC con mdc: a livello dell'arco posteriore della VII costa sinistra tumefazione a profilo integro della corticale con spongiosa repleta di aree lacunari miste a trabecole os-see; a livello della spongiosa dell'ala iliaca sinistra presenza di multiple aree lacunari similari con corticale indenne. Non ulteriori lesioni a ca-rico dello scheletro assile, degli arti e del cranio. Alla dimissione trat-tamento con bifosfonati per os e paracetamolo.

Premesse La sindrome LAMB rientra nel cosiddetto "complesso di Carney" che configura, su base genetica, l'associazione di mixoma atriale con diverse espressioni cliniche. Caso clinico Anni 32, sesso M. Da due anni astenia per sforzi lievi. Da due mesi febbricola serotina associata a poliartralgie asimmetriche pre-valenti alle grosse articolazioni degli arti senza segni di flogosi locale.

Giunge alla osservazione per l'aumento di intensita delle poliartralgie, non responsive a FANS, e per la persistenza della febbricola. Quadro obiettivo articolare negativo. Ecocardio: presenza di formazione ipereco-gena intra-atriale destra con insufficienza mitralica. TC: voluminoso espanso solido disomogeneo localizzato a livello della parete anteriore dell'atrio destro 57x54 mm , adeso al sacco pericardico. Indirizzo ad intervento cardiochirurgico di exeresi.

Follow-up attuale di 16 mesi, durante i quali non si e registrata ripresa della sintomatologia di esordio. Displasia neuronale intestinale tipo A associata a tromboembolia polmonare multipla, ipertensione polmonare e cirrosi cardiaca. Premesse La displasia neuronale intestinale di tipo A e un disordine genetico a trasmissione autosomica recessiva responsabile di malrota-zione intestinale e altre anomalie del tratto gastroenterico; possono associarsi anche malformazioni in altri distretti, in particolare del sistema cardiovascolare e respiratorio.

Caso clinico Anni 25, sesso F. Familiarita per patologia intestinale congenita e distrofia muscolare. In eta infantile diagnosi di "intestino corto" con malrotazione intestinale; vari interventi chirurgici e successiva sindrome da malassorbimento. Ricovero attuale per astenia, ascite, edemi declivi, dispnea per sforzi lievi. Le indagi-ni effettuate dimostrano la presenza di tromboembolia polmonare multipla con secondaria ipertensione polmonare di grado severo, cirrosi epatica a genesi cardiaca scompensata per ritenzione idrosalina. Si conferma la sindrome da malrotazione intestinale su base genetica con anemia cronica e ritardo staturo-ponderale secondari.

Viene esclusa diatesi trombofilica. Il catetere venoso centrale viene rimosso; terapia con diuretici, anticoagulan-ti orali e supporto nutrizionale. Alla dimissione miglioramento della sintomatologia con scomparsa della ascite e degli edemi. Caccetta, L. Iamele, M. Carbone, M. Insalata, S. Cappello, M. Pipino, G. Minafra, F. Women 51 yr. Hospitalization for worsening dyspnea with moderate bronchospasm, fever, skin rash on the face and trunk, diffuse arthralgias.

We found: autoantibodies and rheumatoid factor negative; increased inflammatory markers, ferritin, transaminases, leukocytosis, serositis pleural, pericardial, pelvic , pulmonary micronodules, moderate cervical, paratracheal lymphadenopathy. After antibiotics and steroids therapy, improved clinical and instrumental missing effusion and lung nodules were observed. The steroids suspension caused restarting of symptoms.

Female, 74 year old, with a history of CAD, hypertension, anemia, a euthyroid nodular goiter and recurrent fever She is treated with packed red blood cell transfusion and undergoes upper endoscopy, with evidence of haemorrhagic gastritis and, at the subcardial region, of two protrud-. Aspirin withdrawal and treatment with PPI resolved retrosternal pain.

On the 6th day of admission, she suffered a new episode of chills and fever. A CT scan performed because of a suspicion of a paraneoplastic fever was negative, except for the presence of a right thyroid nodule. At a new recurrence of chills and fever, we measured plasma procalcitonin PCT , whose level was markedly high. Since we did not find any microbiological abnormality or clinical clues suggesting infection and studies have shown that PCT is elevated in patients with medullary thyroid carcinoma MTC , we performed an ultrasound re-evaluation of the thyroid nodule, which showed sonographic signs of malignancy.

Fine needle aspiration was performed and established a diagnosis of isolated MTC. Accordingly, elevated plasma calcitonin levels were documented. Female, 50 year old, 15 pack-year active smoker, with a history of miscarriage, DVT while on estrogen-progestin oral contraceptives, heterozygous for MTHFR CT and factor V Leiden on follow-up, presented with 7 days of colicky abdominal pain and constipation. Her blood tests were unremarkable, except for elevated D-dimer level. With the clinical suspicion of bowel ischemia, we performed a CT scan which showed, posterior to the neck of the pancreas, a target image with a rim of increased density, compatible with portal vein PV thrombosis, and a similar image in the inferior vena cava IVC adjacent to the pancreatic head.

We started anticoagulant therapy with enoxaparin and a CT scans and echo-colorDoppler, performed after 48 hours, documented superior mesenteric vein thrombosis without any finding of either PV or IVC thrombosis. Intravenous fluid and bowel rest with no food by mouth brought about a clinically meaningful reduction in pain and restored bowel canalization whithin 72 hours, when we started warfarin.

In the absence of precipitating factors for the recurrent DVT episode, since it has been showed that the JAK2 VF mutation is associated with splanchnic vein thrombosis, we tested it in our patient, who resulted positive with an intermediate burden, and, after about 1 year, was diagnosed with polycythemia vera.

Valutazione retrospettiva delle fratture vertebrali in pazienti affetti da BPCO, trattati con steroidi. PaoloBorsellino Marsala , con diagnosi alla dimissione di bpco. Per ogni paziente sono stati valutati: rx della colonna tratto dor-so-lombare, calcemia, fosforemia e pth. Le indagini di laboratorio risultavano nella norma. Conclusioni Il primo passo,per quanto riguarda l'identificazione e trattamento dell'osteoporosi da glucocorticoidi, complicata da fratture vertebrali, consiste nell'identificare pazienti mediante l'esecuzione di rx colonna tratto dorso-lombare, misurazioni dell'altezza, curvatura spinale ed infine sottoporli a MOC.

Background Frailty is a condition of the elderly characterized by serious reduction of the functional reserve, very next to the threshold of the organ failure. Our study has analyzed, in a group of elderly, hospitalized for fracture of hip, the impact of the comorbidities on the ability to walk about in the period before the fracture.

Materials and methods In the year we have enlisted fifty frail patients of female sex with fracture of hip. The degree of autonomy in the walking about, in the fiftheen days preceding the admission, has been assessed through the Functional Ambulation Category FAC. Within the whole sample, forty-eight patients showed comorbidities. Two comorbidities or minus have been pointed out in thirty-five patients: of them, four had a FAC among 0 and 2, thirty-one a FAC among 3 and 5.

Conclusions The presence of comorbidities has joined a major degree of disability that can predispose the patient to fractures, with particular respect for the fracture of hip. Pathologic alterations of thyroid function have already been associated to an increased risk of AF. We evaluated if even among euthyroid patients lower TSH values could be associated to an increased prevalence of AF.

Methods We retrospectively evaluated consecutive patients affected by AF admitted to our department who underwent to a complete thyroid function evaluation. Results euthiroid patients were eligible for analysis. Larger and perspective studies should be obtained in order to validate this observation. The aim was to create a real link between the hospital and GPs through a channel in which all participants were involved. Materials and methods In the second half of GP's, responsable for about Before the operative phase was started a preliminary meeting was held.

The test was given within 24 hours. Every pt was interviewed about any predisposing factors. If no controindications existed, the pt with a confirmed DVT was given appropriate treatment and sent home. After 3 and then 6 months, all the patients, regardless the result of the first examination, were checked out if any complications occurred.

Results pt were studied. None had symptomatic complications. Among them, 80 had their DVT confirmed. One pt was admitted to the hospital due to an illness not DVT related. It must be outlined that an experienced doctor is required. In this way hospital admissions could be avoided. Caponetti1, T. Caponetti2, S. Di Carlo1, M. Martella1, L. De Marchis Preite1, S. Corbi1, S. Beccaria1, A. Purpose The aim of our study is to observe the prevalence, nature and risk factors of violent and accident-related injuries in prisoners and to estimate the presence of one correlation with the detention regime.

Materials and methods A retrospective analysis was conducted using data base of Department of Protected Medicine Sandro Pertini Hospital. From 31th of Jul till 31th Dec we have admitted to our department patients. They were classified in data base and we made an observation study about prevalence of admission for violent and accident-related injuries. Conclusions This study confirms that the incidence of violent and accident-related injuries is more frequently in incarcerated men than in free people.

The incarcerated men usually are more violent than free people and the detention regime increases this violent. Often the violent character is pre-existent to admittance in prison and the detention stresses that phenomenon. Cappelli1, M. Mazzetti1, G. Bacci2, M. Genovesi1, S. Manetti1, C. Rosi1, M. Rosito1, M. Sikora1, S. Stanganini1, A. Tufi1, E. Background Day-service is way of assistential that can be activated when a regular hospitalization or DH is innapropriate. It aims to meet demands for complex diagnostic and therapeutic services.

To this end were identified paths for diseases considered complex, whose management involves the use of integrated multi-disciplinary resources. The DH have therapeutic purposes only, or it's reserved for carefully selected cases with high complexity or invasive diagnosis. Field experience Day-service of Casentino Hospital offers to the patients complex outpatient performances on: high cardiovascular risk, heart failure, COPD, pneumonia, anemia, syncope, FUO, epilepsy in the elderly. The DS uses priority channels available in the hospital and preferential paths within the Hospital.

In the clinic of Medicine are for prospective patients of whom have taken advantage of the DS, 32 had a therapeutic DH and for the remaining investigations were organized on an outpatient basis. Results The purposes of the Day Service therefore are: limit the number of inappropriate admissions to DRG, reduce the number of accesses in the ER and hospital admissions for exacerbations of chronic diseases, also reducing waiting lists.

Pipino, L. Iamele, L. Caccetta, M. Insalata, G. I case - Woman 51 yr. Ketoacidosis resolved in 24 hours, fever persists for 7 days. Buffer AH1N1 virus: positive. II case - Man 82 yr, diabetic in diet therapy, hospitalized with fever and coma. Diagnosis: hyperglycemic hyperosmolar syndrome. We applied the above treatment protocol, unless the use of hypotonic 0.

Uno sguardo al futuro

Gradual normalization of blood glucose, but slow decline in serum sodium. To correct it using the Androgue's formula. Buffer A H1N1 virus: positive. TM, 82 aa. Ricoverato per epatocolangite febbrile e pancreatite acuta. Da alcuni mesi dolore ingravescente al ginocchio destro. All'ecografia calcolosi colecistica con dilazione VB.

School of Human Biology, University of Guelph. Care Med. Overview and Outlook - Free Radical Biol. KEYS A. TAN M. VEGA G. Lipid Res. Press, Cambridge, Mass.

Passaparola: i 12 comandamenti contro il cancro, dott. Franco Berrino

Medico, XII, 2: , In: 3rd lntern. J, Cardiol. Terapia - Roma Italia dic. In: Aspectos actuales de las hiperlipoproteinemias - Carmena R. Terapia, Roma Italia 2 dic. Terapia, Roma Italia dic. In: Olio di oliva e ricerca cardiovascolare - Roma Italia 12 dic. Zoppi S. In: Olio di Oliva ed il suo Futuro - Congr. Accademia Nazionale dell'Olivo, Spoleto Italia dic. Academy Sci. Scondinavicci, 1, GEY K. Dieta, 53, In: Free Radicals: Methodology and Concepts. Rice-Evans C and Alliwell B.

The Richilieu Press, London England , p. Asiago ltaly Dec. Gey K. Packer L. Hypertension , Diabetologio, 9: 77 , Care, , Care, GARG A. New York Acad. In: 5" lntern. An 8 Year Follow-up - J. Cancer lnst. Concer lnst. Medica, 40 7 : , ROSE D. ROSS M. Hypothesis, 83, Cancer Inst. Cancer, 67, Special Issue.

The linxian China lntervention Trial - Nov. WOOD A. In: lnhibition of Tumor lnduction and Development - Zedeck M. S, and lipkin M. Cancer Res.

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Plant Phenolics and Pyrrole Pigments - Nutr. Cancer, 6: 58, TEEI R. Oil Chem. Istituto Nazionale della Nutrizione, Roma Italia Ses incidences physiologiques et nutritionnelles - Ann. In: Simp. Ellis Horwood Publ. In: Symp.


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