Search

The term "inflammation" is certainly one of the oldest medical terms still in use. However, its meaning has changed over the centuries. This work gives a historical and critical review of the concept of inflammation, with special reference to kidney diseases. Over time the definition of inflammation has shifted from a pure collection of symptoms to a histopathological definition, characterized by the tissue "inflammatory infiltrates" and different subcategories according to the cell type involved. The advantages of this classification are the generally good response to corticosteroids (with only a few exceptions) and the availability of specific drugs for each inflammatory infiltrate. Finally, a "molecular" definition of inflammation has arisen, where the inflammatory infiltrates make room to a plethora of plasma mediators. The authors show that the use of plasma biomarkers as a tool to define inflammatory state leads to net inflation of the number of "inflammatory" diseases - an effect that shows clearly in the field of nephrology.

Interferon(IFN)γ-induced protein 10 (IP-10) and its receptor, CXC receptor 3, appear to contribute to the pathogenesis of Graves' disease (GD) and Graves' ophthalmopathy (GO). Under the influence of IFN-γ, IP-10 is secreted by thyrocytes (in GD), fibroblasts and preadipocytes (in GO). Determination of high level of IP-10 in peripheral liquids is therefore a marker of a Th1 orientated immune response. Circulating IP-10 is associated with the active phase of GD in both newly diagnosed and relapsing hyperthyroid patients. Methimazole reduces IP-10 secretion by isolated thyrocytes, decreases serum IP-10 levels, and promotes a transition from Th1 to Th2 dominance in patients with GD active phase. In GD patients the decrease of IP-10 after thyroidectomy and radioiodine strongly suggests that this chemokine is mainly produced by the thyroid itself. In GO patients the increased concentrations of IP-10, at least in part, reflect the activity of orbital inflammation. A significant reductions in IP-10 serum concentrations during corticosteroids and or radiotherapy treatments, as compared both to control group and to basal values in GO patients, suggest that this chemokine could serve as a guideline in therapeutic decision-making in patients with GO. Further studies are needed to evaluate whether IP-10 is a novel therapeutic target in GD and GO.

To evaluate the role of bronchoalveolar lavage (BAL) in patients with interstitial lung disease associated to antisynthetase syndrome.We describe 5 patients, anti-Jo1 positive, with interstitial lung disease (lung fibrosis and/or diffusion capacity of CO80%). Patients were monitored with lung function tests every 6 months, with high-resolution computed tomography (HRCT) every 12 months, and with bronchoalveolar lavage (BAL) at baseline and in the subsequent follow-up. Patients were treated as follows: a) azathioprine with colchicine, or cyclosporine alone b) cyclophosphamide when high neutrophil or eosinophil count on BAL was observed. Only low-dose steroids were used for mild muscular or articular involvement.Pulmonary involvement remained stable in all patients at months +24. Lung function remained unchanged compared to the baseline evaluation; HRCT was stable in patients with fibrosis and no progression into fibrosis was observed in patients with ground glass areas at baseline. Bacterial pneumonia occurred in one patient treated with cyclophosphamide and resolved after antibiotic therapy.Clinical manifestations, instrumental tests and BAL may be of value to choice the best immunosuppressive therapy in the single case. An early less aggressive approach (azathioprine with colchicine, or cyclosporine alone) may be useful. BAL could be performed when a progression of the lung involvement is demonstrated in the subsequent follow-up. Cyclophosphamide may be a valid alternative treatment in the presence of a neutrophilic or eosinophilic alveolitis. Efficacy and safety of the aforementioned immunosuppressive approach were observed in our series, avoiding prolonged high-dose steroid administration.

The patients treated by chemotherapy should be considered at high-risk for developing serious lesions of upper gastrointestinal tract. Several factors should be considered during the initial management of these patients, such as the presence and the staging of the malignancy, the cytotoxic effects of the antiblastic drugs, the co-administration of NSAIDs and corticosteroids, and the possible co-existence of Helicobacter pylori infection, hiatal hernia, and gastro-esophageal reflux. In order to prevent gastro-duodenal damage, the optimal approach first has to include an accurate clinical and pharmacological evaluation. The upper gastrointestinal endoscopy should also be performed in neoplastic patients undergoing chemotherapy before starting treatment. Proton pump inhibitors can play a major role in these patients to prevent gastro-duodenal damages, and to relieve dyspeptic symptoms.

The term Erythema Multiforme (EM) include actually a wide range of clinical expressions, from exclusive oral erosions (Oral EM) to mucocutaneous lesions (EM Minor), sometimes with severe involvement of multiple mucosal membrane (EM major, Stevens-Johnson syndrome [SJS]) or with involvement of a large area of the total body surface (toxic epidermal necrolysis [TEN]). However, this terminology is not worldwide accepted and often the various clinical categories show some overlapping features. Among the great number of suspected etiological factors, herpes simplex virus is involved in many cases of EM minor whereas SJS and TEN are caused in 80% of cases by systemic drugs, mainly by anticonvulsivants, sulfonamides, nonsteroidal anti-inflammatory drugs and antibiotics. Several oral EM seem idiopathic, but data on this topic are very few. There is no specific or consistent microscopic and immunopathologic pattern of EM and the diagnosis should be done by excluding other similar diseases. The treatment include the use of antivirals for EM minor, mainly if recurrent, and of immunosuppressants (especially systemic corticosteroids) for SJS. TEN patients require adequate supportive care and often they have to be treated in emergency departments. Finally, patients with exclusive oral lesions may be treated with both topical and systemical corticosteroids.

The study was performed to evaluate the efficacy of the combination of a topical corticosteroid with topical antimicrobic drugs in the therapy of the atrophic-erosive forms of oral lichen planus. Clobetasol propionate, a very potent corticosteroid in the Miller and Munro classification, was used in a 4% hydroxy ethylcellulose bioadhesive gel and applied twice daily for the first four months and once daily for the last two months. Because of the high frequency of candidal infections during corticosteroid therapy, chlorhexidine 0.12%, 3 mouthwashes daily, and miconazole gel, once daily, were added for the whole period of the treatment. Twenty-five patients (17 female, 8 male) participated in the study; 20 concluded the six months of therapy and the six months of follow-up. All 20 patients (100%) had an improvement, while 75% had a complete remission of oral signs. No cases of oral candidiasis were seen. After six months from therapy suspension, 65% of patients were stable in their oral conditions. Our study confirms the efficacy of the combination of a topical corticosteroid with topical antimicrobic drugs in the therapy of the atrophic-erosive forms of oral lichen planus. The stability of our results suggests that, extending the therapy, control of the disease is better.

After analysing of recurrent aphthous stomatitis the clinical and morphological aspects, the authors consider various therapeutic possibilities. They underline the relationship between therapy and clinical aspects of the pathology.

The authors review the literature on aetiopathogenesis and therapeutic management of recurrent aphthous stomatitis. The data regarding the role of genetic, nutritional and microbiological factors in the genesis of recurrent aphthous stomatitis has been particularly examined. Despite significant associations with some antigens HLA have been reported in Southern Europe, there is no clear genetic predisposition in recurrent aphthous stomatitis. Several studies have analyzed the importance of iron, folic acid and vitamin B12 deficiencies, gluten intolerance and sensitivity to certain foods in the triggering of recurrent aphthous stomatitis however the results have been controversial. Recently, it has been suggested that recurrent aphthous stomatitis could be caused by reactivation of varicella-zoster virus and/or cytomegalovirus but these viruses may be reactivated by the immunodysregulation known to underlie recurrent aphthous stomatitis. Moreover, antiviral drugs appear to have only an equivocal effect on recurrent aphthous stomatitis. Recurrent aphthous stomatitis is probably determined by immunological mechanisms although there actually no unifying hypothesis which attempt to integrate the results of the many immunologic studies on recurrent aphotous stomatitis. Moreover, the target antigen and the cause of recurrences of recurrent aphthous stomatitis are still unknown. As far as the management of this disease it is important to recognize recurrent aphthous stomatitis secondary to systemic diseases like Behcet's syndrome, gluten enteropathy and haematinics deficiencies. Subsequently, the symptoms can be reduced with several drugs (mainly topical corticosteroids) but there are no effective therapies preventing recurrences.

As complete as possible a picture of the current state of cytostatic chemotherapy in the treatment of metastatic breast carcinoma is offered. Attention is therefore mainly concentrated on application modalities of this form of therapy in relation to the clinical stage of the disease and to the use of other treatment possibilities. Methods and results of cytostatic therapy are then considered. The present situation is reviewed and the pharmacological and toxic aspects of prolonged antiblastic treatment are assessed. After outlining a number of special problems relating to the treatment of CNS and pleural metastases, the personal series is presented and results, which do not differ from other reported series, reported. In conclusion, stress is laid on the importance and effectiveness of cytostatic therapy in the treatment of metastatic breast carcinoma, but extended, controlled studies are also recommended.