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We present a patient with isolated steroid resistant autoimmune haemolytic anaemia successfully treated with cyclosporin A for 7 months with no adverse side effects and free of disease after 2 years of therapy. We thus recommend to consider cyclosporin A as a first choice in steroid resistant patients with autoimmune haemolytic anaemia. More studies are necessary to assess the efficacy and safety of this treatment.

Celiac disease (CD), a gluten-induced enteropathy, is characterized by typical intestinal involvement with classical clinic features in childhood and less frequent features in adult patients. Recognizing pauci- and asymptomatic patients is a critical point in the clinical management of CD because of the high mortality associated with the onset of complications. Among these, malignant diseases are the most severe, particularly squamous cell carcinoma and lymphoma, the latter accounting for 50% of all malignancies occurring in CD patients. The authors describe a 57 years old patient with CD and Enteropathy-Associated-T-Cell Lymphoma, who had no intestinal symptoms but only severe pruritus and hypereosinophilia.

Chest pain, one of the cardinal manifestations of cardiovascular disease, is a symptom of many other diseases. The diagnosis of coronary artery disease is often difficult to relieve on history and physical examination, so many sophisticated tests have been developed to allow an early and more accurate diagnosis. Physicians must decide the appropriate indications and strategies to correctly utilize different non-invasive diagnostic tests, in order to minimize the risks and maintain the cost effectiveness of their decisions. The Bayes' theorem can be utilized to calculate the probability of coronary artery disease starting from clinical data and multiple non-invasive tests results. This is a mathematical method by which the results of the different tests can be integrated into a quantitative statement of the post-test probability of coronary artery disease to reach a more accurate final prediction of the chance of disease. The prevalence of the pre-test probability of disease can be determined in every patient from informations readily obtained by clinical evaluation, in accordance with the data of the Framingham and other studies. The post-test likelihood of disease depends on the sensitivity and specificity of the test: this estimate, before any test is performed, is crucial both for further decisions on the need for other tests and for determining the final likelihood of coronary artery disease.

The aim of this study was to evaluate the variations of blood flow velocity in the skin microcirculation before and after vasoactive drugs' administration. Eight patients affected by progressive systemic sclerosis have been treated with synthesis prostacyclin for six hours during a period of fifteen days at the standard dosage of 0.5-2 ng/kg/min. We used computerized dynamic capillaroscopy with Capiflow technique to evaluate cutaneous microcirculation before and after the treatment. The Capiflow technique is a new videophotometric technique to study and quantify the diameter, density and velocity blood flow in the nutritional skin capillary. The quantitative analysis of blood flow velocity detected an increase, statistically significant, at the end of the treatment. The statistic analysis was performed by "t Student" test.

The discovery of cyclosporine A (CsA) was a major development in the evolution of organ transplantation. In renal transplantation use of CsA improved graft survival such that HLA-matching is no longer as important and determinant as before. Liver transplantation prior to the arrival of CsA was almost abandoned by Starzl because of uncontrollable rejection. Hearth transplantation, after initial enthusiasm, was soon restricted to few centers as the difficulties in caring for these patients became apparent. Availability of CsA allowed more than 2500 hearth transplants to be performed annually today. At Stanford initially cardiac transplant survival at one year was 40% and at 5 years was approx 20%. The best results in patients treated with azathioprine-prednisone, just prior to the introduction of cyclosporine, were 65% and 40%. At present survival is 83% at 1 year and 50% at 6-7 years, as in other active centers around the world. CsA is the first drug specifically developed to target immunocompetent T-lymphocytes, and is the gold standard model for other new drugs. Its action is modification of rejection, so that when it occurs it is less acute in onset and less fulminant. The prevalence and mortality of infections have also been reduced. The major drawback of cyclosporine is nephrotoxicity: all patients undergo a progressive decline in creatinine clearance and within one year 90% have hypertension. A second problem is post-transplant lymphoproliferative disease, that takes the form of an aggressive and potentially lethal B-cell lymphoma appearing most commonly within one year from surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Infections are one of the most important problems in heart transplants recipients: they are responsible for half total mortality within one year after surgery and one third of mortality during the following period. Underlying medical illness of the host, lack of specific immunity, prior colonization are conditions that may contribute to infections after surgery: immunosuppression to contrast rejection or due to Cytomegalovirus (CMV) infection are other factors favoring infections. Lung infections are most frequent. During the first month after surgery microorganisms responsible are the same found in cardiosurgery patients, staphylococci and gram negative, and occasionally herpes simplex virus (ESV) reactivated infections occur. From the second to the sixth month most of the CMV and Toxoplasma infections occur, with some Pneumocystis and mycotic events. Both are so frequent that in a seronegative host a specific prophylaxis against CMV and Toxoplasma is regularly recommended. The very late period more than six month after surgery is characterized by common infections seen in any population, that may present in altered or more severe fashion due to immune suppression. Another late event is cryptococcal meningitis.

Literature reports that patients affected by X-linked ichthyosis (XLI) have a reduction of sweat glands and a decrease of sweat production. The sweat physiology of 28 patients, 14 with XLI, 7 with lamellar ichthyosis, 7 with dominant ichthyosis and 28 control subjects were examined with sweat test, performed by pilocarpine iontophoresis. In the same patients we have performed skin biopsy to evaluate quantitative and qualitative reduction of sweat glands.