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OBJECTIVE: Chronic kidney disease (CKD) and ocular disease share several cardiovascular risk factors as well as pathogenetic mechanisms having Renin-Angiotensin-Aldosterone System (RAAS) as main actor. Moreover, kidney and eyes have common genetic and embryonic origin. In this literature review, we present main evidence supporting this association for early identifying diseases affecting both systems and evaluating potential multi-target therapeutic strategies.MATERIALS AND METHODS: We performed a literature review of the current peer- reviewed English-language randomized controlled studies (RCTs), reference lists of nephrology or ophthalmology textbooks, review articles and relevant studies with ocular or eye and kidney or renal diseases as keywords until March 2020. Prospective and retrospective studies as well as meta-analyses and latest systematic reviews were included.RESULTS: We evaluated a total of 683 records, finally selecting 119 articles related to ocular and renal diseases. Records were divided into two areas: chronic and acute kidney disease and ocular or eye diseases. Some of the examined studies were discarded for population biases/intervention or deemed unfit.CONCLUSIONS: Based on our results, we conclude that there is evidence of a clear association between kidney and eye diseases, being this cross-link mainly based on RAAS dysregulation. Our review suggests that it may be useful to screen CKD patients for associated ocular diseases, such as cataract, glaucoma, diabetic retinopathy and age- related macular degeneration. A comprehensive study of CKD and proteinuric patients should include careful eye ex- amination. Renal impairment in young patients should prompt a search for ocular disease, such as TUNA syndrome or oculo-renal syndrome, in particular if family history of concurrent ocular and renal disease is present. Anti-RAAS agents are mostly recommended in patients with renal and ocular impairment.

Kidney diseases are associated with many cardiovascular risk factors, such as anaemia, inflammation and chronic volume overload. Changes in the sympathovagal balance are common findings in patients with end-stage renal disease (ESRD). In particular, sympathetic hyperactivity is linked with an increase in resting heart rate leading to myocardial hypertrophy and fibrosis. The latter increases the risk of sudden cardiac death from fatal arrythmias and therefore assessment of both sympathetic and parasympathetic tones could be clinically relevant in ESRD patients. Heart rate variability and other indices are currently used to evaluate the functionality of the autonomic nervous system. Some of these have emerged as potential diagnostic tools that can support clinical decision-making processes and therapeutic strategies in patients with renal disease, including those who are on dialysis replacement therapy. In this review, we summarize the impact and the relationships between sympathovagal disturbances and kidney diseases, replacement therapies and transplantation.

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a heterogeneous inherited disease characterized by renal and extrarenal manifestations with progressive fluid-filled cyst development leading to end-stage renal disease. Our aim was to evaluate the prevalence of obstructive urological disease in ADPKD patients and possible associations with endothelial dysfunction, nutritional, metabolic and inflammatory markers.The study included ADPKD patients and control group, who carried out uroflowmetry, an assessment of renal function, metabolic and nutritional parameters and an evaluation of endothelial dysfunction and atherosclerotic markers, such as Renal Resistive Index (RRI), Intima-Media Thickness (IMT) and Flow-Mediated Dilation (FMD).We enrolled 37 ADPKD patients (20 males with 51.0 ± 14.3 years) and 34 control group (18 males with 60.7 ± 14.4 years). We showed a significant reduction in Max Flow Rate (Qmax) (p ≤ 0.001), age (p = 0.006), FMD (p = 0.023) and Voiding Volume (p = 0.053), in addition to a significant increase in Voiding Time and Diastolic Blood Pressure (p ≤ 0.001, p = 0.049; respectively) in ADPKD patients with respect to control group. Moreover, we found a negative correlation between Qmax and creatinine (r= -0.44, p = 0.007), RRI (r= -0.49, p ≤0.001) and intact Parathyroid Hormone (r = -0.329, p = 0.046), while we found a positive correlation between Qmax and MDRD (r = 0.327, p = 0.048) and between Voiding Time and serum uric acid (r= 0.34, p = 0.039) in ADPKD patients with respect to control group.In our study, we showed an elevated prevalence of urological functional diseases in ADPKD patients; therefore, we suggest to include uroflowmetry in the assessment of these patients, considering the non-invasiveness, repeatability and low cost of the exam. An early intervention could slow down the progression of renal damage and an early screening of the main cardiovascular risk factors could reduce the high morbidity and mortality in ADPKD patients.

We show that the adelic limit of the quantum commutator between operators gives a suitable generalization of the Poisson-bracket on p-adic phase space.

Nephroangiosclerosis (NAS) is increasingly diagnosed in adult and elderly patients with slowly progressive chronic renal insufficiency. Since these patients usually present with arterial hypertension, this is considered the main cause of NAS (sometimes called, in fact, hypertensive NAS or hypertensive nephropathy). However, there is evidence that other factors such as aging, black race, smoking, and metabolic disturbances contribute to the development and progression of the disease. In some patients, these factors may be prominent while hypertension may be mild or even absent: this form has been denominated ischemic nephropathy (IN). Are NAS and IN really two different diseases or just different presentations of cardiovascular disease involving the kidney? The latter hypothesis is supported by evidence that (a) NAS and IN share a relative aspecificity in their clinical symptoms (low proteinuria, microhematuria, high blood pressure, dyslipidemia) and histopathological features (as determined in the few cases that undergo a kidney biopsy), and (b) there is a high likelihood that atheromatous and hypertensive lesions coexist in the same patient. In this ''Controversy in Nephrology'', Rosario Cianci and Alessandro Zuccala' analyze this issue and try to answer the following questions: 1 - Are NAS and IN two different diseases or two different expressions of the same disease? Rosario Cianci, ''They are two different diseases''. Alessandro Zuccala', ''They represent two different expressions of the same disease''. 2 - Is the pathogenesis different in nephroangiosclerosis and IN? Rosario Cianci, ''The pathogenesis is high blood pressure in NAS and renal ischemia in IN''. Alessandro Zuccala', ''NAS and IN share the same multifactorial pathogenesis: vascular metabolic alterations can cause chronic renal ischemia with or without hypertension''. 3 - Is a biopsy necessary for the diagnosis? Rosario Cianci, ''Yes, it is''. Alessandro Zuccala', ''No, it is not''. 4 - Is it possible to prevent or to slow the progression of the renal damage in this (these) disease(s)? Rosario Cianci, ''Yes it is, by reducing blood pressure''. Alessandro Zuccala', ''Normalization of blood pressure is not enough but all the other risk factors of vascular damage must be addressed, when possible''.

The metabolic syndrome is a combination of diabetes mellitus type 2, hypertension, central obesity and combined hyperlipidemia. The metabolic syndrome and its components have been largely associated with psoriasis. We report the case of a 66-year-old man affected with metabolic syndrome and psoriasis in which a multidisciplinary approach with endocrinologists and nutritionists led to an improvement of both conditions. After only 4 months of diet and an appropriate therapeutic regimen we observed an improvement of the hyperglycaemia, dyslipidemia, significant lose of weight, BMI switching from obesity to overweight and improvement of plaque psoriasis in absence of other treatments. We report this case to emphasise the need of a major control of the metabolic syndrome and associated comorbidities in psoriatic patients. Moreover we suggest that diet counselling and regular nutritional visits should be recommended in some patients to obtain dual benefits.

The pathogenesis of coeliac disease (CD) is complex. One controversial aspect is the role of IgA anti-endomysial (EMA) antibodies. Despite being the most reliable marker for CD diagnosis, its role in the pathogenesis (if any) remains obscure. The paradox is reinforced by the observation that CD is more common in IgA-deficient individuals. In this review, we discuss recent data suggesting that IgA autoantibodies may be related to aspecific dysregulation of IgA. In addition, new insights have elucidated new genes involved in IgA production and linked to CD. Allelic frequency of HS1,2 enhancer which regulates Ig synthesis is altered in CD and other IgA mediated disorders. We suggest that in CD, a T-cell mediated disease, the role of IgA anti-EMA autoantibodies remains elusive and could well be merely an epiphenomenon not directly related to pathogenic mechanisms, but rather to a state of heightened immunological responsiveness in genetically predisposed individuals.

Cellular immunity has a pivotal role in the pathogenesis of chronic pancreatitis (CP), resulting in pancreas infiltration by T-cells. Studies on systemic immunity are few and contradictory. One study reported a decrease of naive CD45RA+ cells. The presence of naive T cells, detected as recent thymic emigrants (RTEs), is evaluated with a new molecular technique by using real-time PCR to detect the T-cell receptor excision circles (TREC). To elucidate the role of naive T-cells in the pathogenesis of CP, we investigated the percentage of sj-TREC in CP patients.Thirty CP patients were studied and compared to 30 sex- and age-matched healthy volunteers.Genomic DNA was isolated from peripheral blood mononuclear cells (PBMC) of each patient. RTEs were evaluated by measuring sj-TREC by real-time PCR.The mean percentage of sj-TREC+ cells present in CP was not significantly different from that of control group (0.02319% vs 0.02338%, respectively).Our data show that naive TREC+ cells are normally represented in CP. The presence of active thymopoiesis may be the underlying mechanism resulting in continuous production of T-cells, responsible of maintaining the inflammatory process.

A constantly growing part of consumers considers the organic foods healthier than the conventional foods. However, so far few nutritional intervention studies in humans are available on the comparison of organic and conventional food products.The aim of the present work was to compare the total antioxidant activity of organic versus conventional fruits (apples, pears, red oranges, lemons, strawberries and bananas), vegetables (lettuces, tomatoes, onions, garlics, carrots, beans, potatoes, celeries, peas, courgettes and zucchinies), red wine and milk.The oxygen radical absorbing capacity (ORAC) procedure was used to determine both the antioxidant activity of food from organic or conventional origin, and the human plasma antioxidant capacity. Ten Caucasian Italian men, aged 30-65 years, were recruited. The subjects were healthy, according to the clinical examination and the disease history, none smoked or took any drug. Anthropometric parameters of all the participants were measured.The ORAC values of most part of organic foods, i.e. fruits, vegetables as well as red wine and milk were significantly (p0.005) higher than those of the conventional homologues. Three organic foods, i.e. pears (-25%) (p0.01), lettuces (-20%) (p0.01), and tomatoes salsas (-4%) showed ORAC values lower than the conventional homologues. After the consumption of 14 days Mediterranean organic diet a significant (p0.005) increase (21%) of the human plasma total antioxidant capacity was observed.Our results clearly show that the organic food products have an higher total antioxidant activity and bioactivity than the conventional foods. The results could be used in public health campaign to increase the consumption of products able to provide a significant health protection and prevention of chronic diseases.

We have identified a subset of metabolically obese, but normal weight individuals, with potentially increased risks of developing the metabolic syndrome, despite their normal body mass index. We determined the relationship among body fat distribution, resting metabolic rate (RMR), total body water amount (%TBW), selected gene polymorphism on interleukin-15 receptor-alpha (IL-15Ralpha) and methylenetetrahydrofolate reductase 677C--T (MTHFR 677C--T), to distinguish normal weight obese (NWO) from nonobese with a normal metabolic profile and obese individuals. We analysed anthropometric variables, body composition by Dual energy X-ray Absorptiometry (DXA), RMR by indirect calorimetry, %TBW by bioimpedence analysis (BIA), MTHFR 677C--T and IL-15Ralpha genotypes of 128 clinically healthy Caucasian individuals. We compared a group of female, defined as NWO and characterised by a BMIor = 25 kg/m(2) and FMor = 30% with groups of others female, and males, represented by nonobese with a BMIor = 25 kg/m(2) and FMor = 30%, and preobese-obese individuals with BMIor = 25 kg/m(2) and %FMor = 30%; none of the males was classified as NWO. Significant correlations were found among body fat mass distribution, metabolic variables, percentage of total body water distribution and selected genetic variations. The variables that contributed significantly to the separation of classes were body tissue (Tissue), %TBW, RMR, the volumes of both oxygen (VO2) and carbon dioxide (VCO2). The distribution of MTHFR 677C--T and IL-15 genotypes was significantly different between classes. Our data highlight that NWO individuals showed a significant relationship between the decrease in the basal metabolism (RMR), body fat mass increasing and total water amount. Possession of wild type homozygotes genotypes regarding IL-15Ralpha cytokine and 677C--T MTHFR enzyme characterised NWO individuals.

There is a correlation between the fluid and ionic homeostasis and blood pressure but it is not known if these body fluid changes represent the cause or rather the effect of the blood pressure rise. We have estimated the compartmental distribution of body fluids by means of the Bioimpedance Spectroscopy (BIS) analysis in a hypertensive cohort compared to control subjects.We have enrolled 28 hypertensive patients (14 females, 14 males, mean age 47 +/- 5) and a sex- and age-matched control group of 37 healthy subjects (17 females and 20 males, mean age 45 +/- 8). They underwent anthropometric measurements, then extracellular (ECW) and intracellular water (ICW) were assessed using BIS.Both mean weight and BMI of hypertensive patients resulted significantly higher than of the control group (p0.05). We found higher ICW values in hypertensive compared to normotensive subjects. This difference was proportional to the difference of mean blood pressure values, reaching significance only as regards the stage II hypertensive subgroup (p0.03).Our data confirm that the blood pressure increases are associated to TBW, and caused mainly by ICW increases. The BIS, a simple, reliable, non invasive and cost effective methodical approach, estimating the distribution of body fluids, offers new possibility of the management of the hypertensive disease, to establish a more appropriate antihypertensive treatment. Moreover, the BIS, estimating the volume restoration of the different body compartments, may be helpful in evaluating the effectiveness of the pharmacological treatment.

We herein discuss the impact of biological agents based on the ability of monoclonal antibodies to target specific molecules. This approach has given to clinical immunologists a spectrum of drugs able to manipulate the immune system. In the first session, we discuss drugs targeting T-cell function by: (1) targeting CD28 mediated costimulation (Abatacept and Belatacept); (2) interfering with interleukin-2 receptor (Basiliximab and Daclizumab); (3) blocking cell adhesion and homing (Alefacept, Efalizumab, Natalizumab). The second session is dedicated to drugs targeting cytokines or their receptors. The best known and largely experimented case is represented by drugs targeting tumor necrosis factor (TNF) (Infliximab, Adalilumab, Certolizumab) or its p75 receptor (Etanercept). However, newer products are now available to target other inflammatory cytokines including IL-6, IL-8, IL-12, IL-15, IL-18, IL-23. These agents have the potential to become powerful tools in the control of several immune-mediated diseases, especially auto-immune and inflammatory ones. They traslate into reality the prediction that antibodies will eventually become "magic bullets which seek their own target" (P. Ehrich, 1906).

Laryngopharyngeal reflux is now of major interest as an aetiologic factor in chronic inflammatory and neoplastic lesions of upper digestive tract. However, reports in the literature refer only to the irritating action of the acid component of reflux, while possible damaging action of other reflux components remains unknown. Aim of this study was to verify the hypothesis that alkaline-bile reflux could also be involved in onset of inflammatory, precancerous and neoplastic laryngeal lesions. A total of 40 consecutive gastrectomized patients coming to our Clinic from Gastroenterology Outpatient Unit for an anamnestic and clinical evaluation with videolaryngoscopy of upper digestive airways, entered the study. All presented bile or alkaline reflux as a direct consequence of gastroduodenal anastomosis (Billroth I) and gastrojejunal anastomosis (Billroth II) performed over a time span20 years. Oesophagogastroduodenoscopy revealed the presence of bile in the residual gastric cavity in all operated patients objectively confirming duodenogastric reflux. Examination of data showed that 3 patients (7.5%) had undergone CO2 laser cordectomy in the 3 years prior to the study for squamous cell laryngeal carcinoma, 3 patients (7.5%) had leukoplakia, 8 (20%) vocal cord chronic oedema with signs of chronic diffuse laryngitis, 6 (15%) posterior laryngitis, 8 (20%) interarytenoid oedema while only 12 (30%) showed no ENT lesions. Statistical analysis revealed a significant correlation between incidence of inflammatory and neoplastic laryngeal lesions and type of surgery (Billroth II and total gastrectomy) with respect to other types of gastric resection. There was also a significant increase in presence and severity of laryngopharyngeal lesions in relation to time elapsed after surgery. These results, although preliminary, seem to confirm that some components of reflux (duodenal content), other than the acid component, play a damaging role involved in the onset of multiple clinical signs and symptoms of laryngopharyngeal reflux disease. It is concluded that systematic use of bile measurement, together with 24-hour pH monitoring, is advisable in subjects with clinical signs and symptoms of laryngopharyngeal reflux, but unresponsive to classic medical treatment, and in gastrectomized patients in order to confirm, on larger series, this fascinating aetiopathogenetic hypothesis.

Diagnosis of renal artery stenosis using echo color-Doppler is subjected to several limitations. The aim of this study was to examine if the routine use of a contrast agent could be helpful in identifying renal artery stenosis (RAS).We analysed 35 patients affected by RAS using an echo color-Doppler coupled with a contrast agent. All patients presented arterial hypertension, with a good drugs control, and mean serum creatinine of 1.8 mg/dL. All patients previously underwent angiography. RAS was at the origin of the artery in 27 patients, at the intermediate tract in 8. All patients had already been submitted to a basal echo color-Doppler.The contrast agent determined a significant increase in the average colour signal in all the subjects, and a better evaluation of the spectral waveforms, if compared to the basal examination.The results obtained showed that the contrast agent doesn't improve the diagnosis of RAS, especially in vascular origin stenosis, while it shows a real advantage in the intermediate or distal stenosis which are better visualized.

The major risk factors for the onset of precancerous lesions and squamous cell carcinoma of the larynx are, above all, tobacco smoke, alcohol abuse and exposure to viral and toxic agents. In recent years, however, gastro-esophageal reflux (GER) has also aroused significant interest not only as carcinogen but also as co-carcinogen in association with smoking and alcohol consumption. The purpose of the present work is to provide an objective evaluation of the presence of distal and proximal esophageal reflux using multi-electrode pH monitoring in patients with precancerous lesions of the larynx and laryngeal and pharyngolaryngeal neoplasms. A total of 24 patients consecutively hospitalized during 2000 were evaluated: 20 with squamous cell carcinoma of the larynx and/or pharynx-larynx and 4 with precancerous vocal cord lesions. All the patients provided a case history using a validated questionnaire and underwent electronic videolaryngoscopy and 24-hour pH monitoring. Data analysis showed that in 83.3% of the cases (20/24) pH monitoring was indicative of pathological GER and 63.7% of these patients had no complaints related to reflux. Moreover, 7/24 patients have had a previous gastrectomy (Billroth II) strictly related to the presence of bile reflux. The Authors conclude that, according with recent literature, pH monitoring data further indicate that patients with precancerous or neoplastic pharyngeal-laryngeal lesions present often a positive history of GER, even though no direct cause-effect relationship can yet be established because of the co-existence of other important risk factors such as smoking and alcohol consumption. Additionally, the achlorhydria found in 7/24 patients with an history of gastrectomy could suggest a possible, as yet unproven, role of other reflux components--in particular, of bile (alkaline) and chlorhydro-peptic (acid) components--as a risk factor or co-factor for tonset of precancerous and/or neoplastic lesions of the larynx.

Gastro-esophageal reflux (GER) is a complex pathology characterized by many clinical symptoms: gastroenterological (typical symptoms) and odontostomatological, pneumological and, more frequently, otorhinolaryngological (atypical symptoms). For this last manifestations no cause-effect relationship has yet been proven. Using a validated questionnaire about the typical reflux symptoms and the use of substances of abuse (tobacco and alcohol) and with the application of instrumental means such as electronic videolaryngoscopy and multi-electrode 24 hours esophageal pH monitoring, the Authors have studied 34 selected patients (16 female, 18 male) suffering from chronic clinical laryngeal symptoms and presenting a peculiar pharyngeal-laryngeal objectivity. Both these manifestations could be ascribed to atypical GER symptoms. Analysis of the data showed that 67.6% of the subjects presented pathological reflux, with a significant prevalence of inflammatory lesions in the posterior portion of the larynx (in 47.8% laryngitis and retrocricoid edema). The validated questionnaire on typical reflux symptoms showed that 69.5% did not complain of the typical gastro-esophageal symptoms thus indicating that pharyngeal-esophageal reflux can be totally asymptomatic. While confirming the strong association between inflammatory pathologies and GER, not enough cases have been studied to identify a direct cause-effect relationship and this is complicated by the presence of other concomitant risk factors such as cigarette smoking or alcohol consumption. Therefore the Authors underline the importance of an in-depth, multi-discipline approach in the evaluation of pharyngeal-laryngeal phlogoses. This approach must make use of all available modern diagnostic techniques (Electronic videolaryngoscopy, multi-electrode pH monitoring) in order to obtain as much information as possible to throw light on the pathogenic mechanism responsible for the damage and find more effective forms of anti-reflux therapy.

Low-grade primary MALT (mucosa-associated lymphoid tissue) lymphoma of the stomach is a neoplasm with an indolent course and a good prognosis. Patients with this type of neoplasm seem to have a higher risk for other neoplasms. Of interest is the association of gastric MALT lymphoma with gastric adenocarcinoma of intestinal type. We report the case of a patient, with a history of H. pylori-related gastritis, in whom a diagnosis of synchronous gastric adenocarcinoma of intestinal type and low-grade MALT lymphoma, occurring as collision tumors, was made. The stage procedures confirmed the presence of a locally advanced gastric tumor staged as T3 N1. The patient underwent two cycles of neoadjuvant EEP (etoposide, epirubicin, cisplatin) chemotherapy. After 2 months, a R0 total gastrectomy with D2-lymphoadenectomy was successfully performed. The development of simultaneous primary gastric lymphoma and carcinoma is a rare event. The possible coexistence of both tumors should be kept in mind, especially in patients infected with H. pylori, since a possible etiopathogenetic role of this bacterium has been differently postulated for both disease.

The purpose of this study was to determine whether Helicobacter pylori infection can contribute to growth deficit, especially in pubescent children who need large amounts of iron for growth. A structured questionnaire was sent to the parents of 532 healthy children aged 10 to 15 years (mean 12.9) to obtain demographic information on the parents and the environment. Of the 532 questionnaires sent out, 375 (70.5%; 170 girls and 205 boys) were returned. After collecting blood samples from participants, haemoglobin, serum iron, total iron binding capacity, serum ferritin, and serum IgG antibodies to H pylori were measured. The effects of risk factors such as H pylori infection, iron deficiency anaemia, sex, socioeconomic status, type of house, and crowding index on growth were analysed using multiple regression analysis. Of 63 H pylori positive children, 18 (28.6%) were below the 25th centile values for height, compared with 63 of 312 (20.2%) H pylori negative children. The prevalence rate of H pylori infection was 15.5% (53 of 343) in children without iron deficiency anaemia and 31.3% (10 of 32) in those affected. The relative risk of short stature was 2.2 (95% confidence interval (CI), 1.0 to 4.8) for iron deficiency anaemia, and 1.4 (95% CI, 0.8 to 2.4) for H pylori infection. The mean height was significantly lower in the group having both H pylori infection and iron deficiency anaemia. Therefore, H pylori infection accompanied by iron deficiency anaemia, rather than H pylori infection per se, might delay pubertal growth.

Short-term ranitidine bismuth citrate-based triple regimens have been shown to be effective for the eradication of H. pylori. We investigated the efficacy of an eradicating therapy including ranitidine bismuth citrate, low-dose clarithromycin and tinidazole, administered for only 6 days.Forty-five consecutive patients, who underwent gastroscopy for symptoms and were found to be H. pylori-positive, were recruited. They received ranitidine bismuth citrate 400 mg b.i.d. plus clarithromycin 250 mg b.i.d. plus tinidazole 500 mg b.i.d., given for 6 days. The medications given in twice daily doses were taken after meals with an interval of 12 h. The H. pylori status was evaluated by means of histology and rapid urease test on admission, and by 13C-urea breath test alone 8 weeks after treatment.All 45 enrolled patients completed the study. Thirty-nine of 45 patients returned H. pylori-negative (both per protocol and intention-to-treat analysis = 87%; 95% confidence interval = from 73-95%), while 6 of 45 were still H. pylori-positive (13%). Slight or mild side effects occurred in 5/45 patients (11%).Ranitidine bismuth citrate-based triple therapy, containing low-dose clarithromycin and tinidazole, given for only 6 days, yielded high eradication rates with modest side effects. Regimens based on ranitidine bismuth citrate plus two antibiotics at low dosages, administered for less than 7 days, constitute highly promising strategies for eradication of H. pylori.

One-week low-dose proton pump inhibitor-based triple therapies have usually proved to be effective treatments for Helicobacter pylori infection.To investigate the eradication efficacy, safety profile and patient compliance of two triple therapies containing a standard dose of rabeprazole and a new fluoroquinolone, levofloxacin.One hundred patients referred to us for gastroscopy, who were H. pylori-positive, were consecutively recruited in a prospective, open-label study. The enrolled patients were randomised to receive a seven-day course of rabeprazole 20 mg o.d. plus levofloxacin 500 mg o.d. and either amoxycillin 1 g b.d. (RLA group) or tinidazole 500 mg b.d. (RLT group). Their H. pylori status was assessed by means of histology and rapid urease test at entry, and by 13C-urea breath test 8 weeks after the end of treatment.All 100 enrolled patients completed the study. Forty-six of 50 patients treated with RLA (both PP and ITT analysis: 92%; 95% CI: 81-98%) and 45 of 50 with RLT (both PP and ITT analysis: 90%: 95% CI: 78-97%), became H. pylori-negative. Slight or mild side-effects occurred in 4 (8%) patients of the RLA group and in 5 (10%) of the RLT group.This study demonstrates the efficacy of two 1-week rabeprazole-based triple therapies including levofloxacin to eradicate H. pylori. These regimens prove to be safe, well-tolerated, and achieved good eradication rates. Levofloxacin may be an effective alternative to clarithromycin in triple therapy regimens.

Ranitidine bismuth citrate (RBC)-based triple therapies for a period of 7 days have proved to be an effective treatment for Helicobacter pylori.To investigate the eradication efficacy, safety profile and patient compliance of two RBC-based triple therapies given for 5 days.Eighty H. pylori-positive patients with dyspeptic symptoms, referred to us for gastroscopy, were consecutively enrolled in this prospective, randomized, open-label study. These patients were randomly assigned to receive a 5-day course of RBC 400 mg b.d. plus clarithromycin 500 mg b.d. and either tinidazole 500 mg b.d. (RBCCT group) or amoxycillin 1 g b.d. (RBCCA group). The H. pylori status was assessed by means of histology and rapid urease test at entry, and by 13C-urea breath test 8 weeks after the completion of treatment.All enrolled patients completed the study. Thirty-seven of 40 patients treated with RBCCT (both PP and ITT analysis: 93%; 95% CI: 80-98%) and 35 of 40 in the RBCCA group (both PP and ITT analysis: 88%; 95% CI: 73-96%) returned H. pylori-negative. Slight or mild side-effects occurred in 4/40 patients (10%) in the RBCCT group and in 5/40 (12%) in the RBCCA group.This is the first study demonstrating the efficacy of RBC-based triple therapies given for only 5 days. RBC regimens containing high-dose clarithromycin and either amoxycillin or tinidazole prove to be well tolerated, safe and preserve good eradication rates even when administered for a shorter than conventional duration.

We compared the efficacy of two therapies to eradicate H. pylori infection including ranitidine bismuth citrate (400 mg twice daily), clarithromycin (500 mg twice daily), and tinidazole (500 mg twice daily), administered for six or seven days. Eighty H. pylori-positive patients were consecutively recruited and randomly subdivided into groups A and B, receiving one of the two treatment regimens. The H. pylori status was evaluated by means of histology and rapid urease test at entry, and by [13C]urea breath test alone eight weeks after treatment. All 40 patients in group A and 39/40 in group B completed the study. Thirty-six of 40 patients in the group A (90%) and 36 of 39 in the group B (92%) became H. pylori-negative. Slight or mild side-effects occurred in 4/40 patients (10%) of group A and in 5/39 (13%) of group B. In conclusion, both regimens we tested yielded high eradication rates with modest side effects. This is the first trial investigating a triple-drug RBC-based regimen administered for only six days.

Low-grade gastric MALT-lymphoma is a neoplasia with a very indolent course and an excellent prognosis. Even if the most common endoscopic findings have described non-specific aspects, often suggestive for benign conditions, the endoscopy reveals a wide range of gastric mucosal changes both at diagnosis and at relapse. We report 2 cases of low-grade gastric MALT-lymphoma in which the diagnosis was made casually because the endoscopic presentation consisted only in mucosal hyperaemia in 1 case and in normal-appearing mucosa of the stomach in the second case. The patients were successfully treated with anti-Helicobacter pylori therapy. At 18 and 12 months of follow-up, respectively, the patients were disease-free. The bland appearance of this disease in some patients may reflect the early diagnosis of the tumor. Even if endoscopy and echoendoscopy often constitute useful and reliable diagnostic procedures, in the early phases of the tumor the histologic evaluation of endoscopic biopsies including immunohistochemistry represent the diagnostic procedure more reliably to detect this neoplasm.

The aim of this study was to evaluate the overall efficacy of Helicobacter pylori (H. pylori) infection treatment in our routine clinical practice. As proton pump inhibitor-containing regimens offer the advantage of rapid symptom relief and the highest rates of duodenal ulcer healing, we decided to prescribe these regimens to treat H. pylori infection in our daily practice.We prospectively carried out a study of unselected outpatients who were referred to our practices to undergo gastroscopy. The patients assessed as H. pylori-positive (by means of Giemsa stain and rapid urease test) were randomly assigned to one of the following four treatment schedules: omeprazole plus amoxycillin plus tinidazole (OAT) for 2 weeks; omeprazole plus amoxycillin (OA) for 2 weeks; omeprazole plus clarithromycin plus tinidazole (OCT) for 1 week; and, omeprazole plus clarithromycin plus amoxycillin (OCA) for 1 week. H. pylori status was re-assessed at least 2 months time after the end of the therapy when the patients were re-endoscoped.Out of a total of 200 patients returning for a follow-up visit and included in our study, 143 were H. pylori-eradicated, with an inclusive rate of 71.5% only. Side effects occurred in 37 (18%) patients.In our routine clinical practice, the overall eradication rate of H. pylori infection resulted in a little more than 70% of patients treated. Considering that more and more physicians routinely treat H. pylori infection, and that more and more patients require treatment, the management of this worldwide infection remains problematic.

A peculiar finding from penis eco color-Doppler, detected in healty subjects with erection dysfunction, is described.385 patients with erection dysfunction were studied, by using duplex scan with color Doppler, 85 of these patients normal Regiscan test were chosen and patients with Induratio penis plastica or hormonal disorder were excluded.A "reverse" flow during the entire diastolic phase was detected in 58 normal patients (68%) with ageof 41 years.In the evaluation of healthy subjects with erection dysfunction, the presence of a complete "reverse" diastolic flow is indicative of a venous reflux block, that may represent an important pathogenetic mechanism in this specific setting.

Helicobacter pylori infection is probably one of the most widely spread infectious diseases in man and a growing body of knowledge provides evidence in favour of a causal link between this infection and the majority of upper gastrointestinal conditions. For example, we now know that peptic ulcer disease is an infectious disease; if the infection is diagnosed and treated, ulcer can be cured. On the other hand, in recent years, a number of epidemiological studies have focused on the possible relation between ischaemic heart disease and several infectious disorders, such as chronic dental infections, Cytomegalovirus, Coxsackie viruses, Chlamydia and, finally Helicobacter pylori. The results of studies on the association between ischaemic heart disease and Helicobacter pylori have, in particular, often been contradictory, and only some studies adjusted the results for confounding factors, and the adjustment of the results in some cases modified the association. In conclusion, even if coronary atherosclerosis may now be considered as an inflammatory process, according to several histologic and pathophysiologic studies, we cannot, for the moment, be sure that it is an infectious disease.

Testing conducted on a hip joint simulator verified the Charnley hypothesis that the diameter of the prosthetic head is proportional to wear. The study was conducted by pairing heads in Ortinox TM with acetabular cups in polyethylene at high molecular weight (UHMWPE). A comparison between the different sizes of the heads (26 and 30 mm in diameter) showed a different trend in the wear rate; in particular, the head with a smaller diameter behaves better tribologically than the head with a larger diameter.

Some studies have suggested that low-grade MALT lymphoma may regress after eradication of Helicobacter pylori infection. This case report describes a Helicobacter pylori-positive patient with very extensive ulcerated polypoid lesions involving gastric antrum and prepyloric region, diagnosed by histology, pathological analysis and staging procedures as low-grade MALT lymphoma of EI1 stage. The patient received eradication therapy with a one-week course of omeprazole plus amoxicillin plus clarithromycin and was seen at follow-up after 3, 6 and 15 months. At follow-up, Helicobacter pylori eradication appeared to be in resolution of the macroscopic and histological features of the lymphoma, as confirmed by endoscopic, histological and molecular findings. Until now, only a few cases with a large gastric MALT lymphoma has successful treatment of Helicobacter pylori resulted in regression. Although additional follow-up is needed, it would appear that Helicobacter pylori infection cure may be effective also for large low-grade stage EI1 MALT lymphoma.

Description of a case report.The case of a 55-years-old man with a previous history of hypertension, treated for several years with many antihypertensive drugs without improvement is described.The patient was affected with a unknown coarctation of the aorta. This disease, in fact, is an important cause of secondary hypertension. Adult patients, if asymptomatic, are most often diagnosed because of hypertension or murmur on a routine examination. This congenital disease can be demonstrated on suprasternal notch two-dimensional echocardiographic views along with increased Doppler flow velocity across the coarctation site. TC scan and aortography confirm the degree and nature of the aortic narrowing.In the case reported color Doppler ultrasonography demonstrated two peculiar aspects of the coarctation of the aorta: 1) detection of a stenotic flow in the abdominal aorta, abdominal and lower extremities arteries; 2) marked renal vasodilatation secondary to compensatory mechanisms that intervene in the renal flow reduction; this finding is detectable in the presence of bilateral stenosis of renal arteries as well as in the hypertensive forms of coarctation of the aorta.

H. pylori infection can be diagnosed by means of non-invasive tests or invasive techniques using endoscopy. The choice of the test depends on available instruments, type of diseases, aim of diagnostic research (therapeutic or epidemiological) and test features. PCR is able to reveal pathogenic germs in biological material with very high sensitivity and specificity. In vitro DNA amplification method consists of hybriding denaturated DNA by means of two oligonucleotide primers that allow to copy DNA fragment. The aim of our study was to determine, using PER, H. pylori colonization in the gastric mucosa of 18 consecutive patients under-went gastroscopy.Eighteen patients complaining of dyspeptic symptoms and referred to us for upper GI endoscopy participated in the study. The studied population comprised 9 males and 9 females with mean age of 55.4 yrs (range 26-73 years). All patients underwent gastroscopy during which 4 biopsies from the antrum and 4 from the corpus were obtained for Giemsa stain, PCR analysis and histologic examination. A pair of synthetic oligonucleotides for H. pylori urease A gene, designated as HPU1 and HPU2, were used. Urease A gene fragment amplified by PCR was analyzed by 1.5 agarose gel electrophoresis. Positivity for H. pylory corresponded to PCR DNA products migrating at 411 bp after staining with ethidium bromide.The patients were divided into two groups, according to H. pylori infection, determined by means of Giemsa stain: group A, comprising 11 H. pylori-positive patients; and group B, with 7 H. pylori-negative patients. Our PCR assay of gastric mucosa samples proved positive in 7 cases of group A (63.6%), whereas it always proved negative among group B subjects (100%).Our findings, apparently in contrast with the high sensitivity of PCR, may be attributed to the lower specificity of histology or, alternatively, the absence of H. pylori in the samples tested by PCR due to the patchy distribution of H. pylori colonization in the gastric mucosa. These observations are in agreement with those from other investigations.

Problems related to the use of total hip arthroplasty and the properties of the materials used to make prostheses have encouraged wear phenomena of the epiphysis-acetabulum combination of international importance and acknowledgement. Based on a review of the literature, the authors analyze the most recent years of study of wear phenomena and discuss the choice of materials to be used in total hip arthroplasty implant, with particular interest in any potential defects.

Castleman's disease(CD) is an uncommon lymph node syndrome, generally located in mediastinum side, rarely systemic. Two histhologic types are described: the more common, termed the hyaline-vascular type, generally asymptomatic, and the second termed plasma cell type, with systemic manifestations of the disease, like fever, anemia and weight loss. The authors present a case of a young man with Castleman's disease, treated by prednisone without reduction of the adenopathy, and thus successfully operated, and discuss about aetiopathogenic theories and treatment of this disease.

The constant increase in the use of hip arthroplasty and the continuous search for the best possible adaptation of the implant to femoral anatomy have led to the development of methods of radiographic analysis that are increasingly precise and reliable. Among these the methods that include the use of traditional radiograms-despite their limits-deserve a place of importance. In fact, these methods offer the advantage of being easy to apply and of allowing for a comparison to be made with pre-existing files. Computer science is useful in this field, in particular, computerized analysis, both morphometric and statistical, of the data acquired by digitizer. The protocol of acquisition and analysis that we applied to x-rays in anteroposterior view allowed for an evaluation to be made of some of the morphologic parameters of 354 femurs (corresponding to 264 patients), relating them with the pathologies that led to hip arthroplasty. The duration of a cementless hip prosthesis strongly depends on primary stability. For this reason, an ever-increasing number of studies tends to make a precise evaluation of the morphology of the joint, in order to obtain excellent contact between bone and prosthetic component. The methods used are essentially radiological, with the use of computerized tomography and stereophotogrammetry. Morphometric studies of the proximal femoral area have in particular considered the width of the medullary canal at various levels; the cervico-diaphyseal angle; the flare index of the femoral canal (relationship between the internal metadiaphyseal diameter and that of the isthmus) and the distance between the rotation center of the femoral head and the diaphyseal axis. The evident absence of proportion between femoral sizes and shape of the medullary canal has led to the search for parameters capable of describing in simple fashion the shape of the femoral diaphyseal canal. A good describer of femoral morphology is the flare index, that allows for classification of the various shapes of the diaphyseal canal in three families: "stove-pipe like", "normal", "champagne glass like". The distinction between these groups is not clear, as the passage from one shape to another is gradual. The idea of obtaining more knowledge on femoral morphology, also to the purpose of determining possible new criteria that may be of help in preoperative planning and in the choice of a model to be implanted, has suggested our study on modifications caused by some of the pathologies that most frequently lead to arthroplasty.

Video-assisted thoracic surgical procedures continue to be performed with increased frequency; the role of this new technique in the treatment of pulmonary malignancies or metastatic mediastinal adenopathies is not yet defined. Out of a series of 100 consecutive video-assisted thoracic operations, 22 patients resulted affected by a malignancy in the lung or in the subcarinal lymphnodes: six patients had a primary lung cancer and were operated with a video-assisted small thoracotomy of 5 cm (three lobectomy and three segmentectomy) because of a very poor respiratory reserve. Nine patients received a video-assisted wedge resection of a nodule resulted at the frozen section a metastasis of a carcinoma: a small thoracotomy of 8 cm was made and a hand entered the thoracic cage to obtain a careful palpation of the entire lung; five patients had enlarged lymphnodes only in posterior and inferior mediastinum, inaccessible by cervical mediastinoscopy or anterior mediastinotomy: thoracoscopic exploration obtained a useful mediastinal nodal sampling for these adenopathies. In selected cases video-assisted thoracic surgery can be used for resection or assessment of thoracic malignancies.

From April 1991 to September 1993, 18 patients affected by a presumed operable IIIa (N2) non small cell lung cancer (NSCLC) with histologically confirmed bulky mediastinal metastases, received preoperative concurrent radiation therapy and continuous infusion of cisplatinum (CDDP). The radiotherapy consisted of 2 Gy given 5 days a week for a total dose of 50 Gy; CDDP was administered by means of a central catheter and a portable pump at the daily dose of 6 mg/m2 given on the same days as the radiation therapy (total dose: 150 mg/m2). Two weeks after the end of the treatment, the patients were reevaluated: 5 patients had either local or distant disease progression, the other 13 were submitted to thoracotomy: 12 received a complete resection and 1 patient underwent only a mediastinal lymphadenectomy, because pneumonectomy was impossible due to lack of respiratory function. No histological evidence of cancer cells was observed in the specimens of 6 patients (33%). Radiological response rate was 61% (11/18); resection rate was 66% (12/18) and complete resection rate was 61% (11/18). There was one postoperative death (5%). The 3 year actuarial survival rate is 63.6% for the patients who received a resection with a median survival time of 18 months. All non operated patients died within one year. Combined preoperative treatment was well tolerated. Better results were achieved in patients with squamous cell carcinoma who had a complete resection following a total tumor sterilization with radio-chemotherapy.

Methods for measuring metric size on radiograms constitute an instrument of proven utility. For example, when preoperatively evaluating hip arthroplasty the diameter of the medullary canal and the cervicodiaphyseal angle, must be measured in order to determine the center of rotation of the femoral head, and to establish the flare index of the diaphyseal canal. These results may be obtained by using a computer-controlled graphic table to place the coordinates for the areas of greater anatomical and physiological importance on the radiologic image. Thus, a calculation of distances, anatomical axes and angles is obtained immediately, accurately defining the morphometry of the joint. In this study, the anteroposterior preoperative radiographic views of 87 femurs in 84 patients were evaluated by this method. The values provided by the morphometric analysis were then related to sex, age and weight. The diaphyseal canal was classified by typology for the preoperative planning of hip arthroplasty.