Annali italiani di medicina interna : organo ufficiale della Societa italiana di medicina interna最新文献

Interferon (IFN)-alpha with or without ribavirin is the treatment of choice for patients with chronic HCV-related hepatitis. Cough and dyspnea during IFN therapy are often regarded as a side effect and not as a possible sign of the onset of a pulmonary interstitial disease. It may therefore be claimed that the likelihood that patients treated with IFN develop sarcoidosis is being underestimated. Although they are not conventionally classified as etiopathologic agents of sarcoidosis, the IFNs have been proven to be capable of triggering macrophages and of promoting the expression of class II HLA antigens. It is therefore possible that IFN-alpha treatment could trigger macrophages and promote the polarization of the immune response towards Th1 in the presence of particular susceptibility conditions, thus starting the series of events that lead to the onset of sarcoidosis. We describe a case of pulmonary sarcoidosis in a 33-year-old patient treated with IFN-alpha2b and ribavirin for chronic HCV-related hepatitis after 6 months of therapy. The case we report here brings forth the issue of a possible underestimation of the real incidence of sarcoidosis during IFN therapy and highlights the need for more attention to and a more careful evaluation of respiratory symptoms manifesting in treated patients.

We report a case of benign idiopathic retroperitoneal fibrosis in a 39-year-old male, who was successfully treated with immunosuppressive drugs only. Advances in imaging techniques, especially in magnetic resonance imaging, often permit an accurate diagnosis in retroperitoneal fibrosis, avoiding open biopsy or biopsy by means of image-guided techniques. In addition, the modern medical approach with immunosuppressive drugs is based on evidence of disease regression following the medical therapy and is frequently effective. Hence, it is possible to avoid conventional surgery or laparoscopy. In the present case the response to immunosuppressive treatment was objectively assessed by means of enhanced computed tomography, magnetic resonance and nuclear medicine (Ga-67), showing an important decrease in the extent of the disease at follow-up. Our case shows the important role of the specialist in Internal Medicine in the treatment of this uncommon connective tissue disease.

Twelve to twenty-five percent of human population suffer from sleep disorders and sleep-related breathing disorders have a frequency of 5-10%. The association between sleep-related breathing disorders and several diseases, mainly cardiovascular and dysmetabolic, is well known. The aim of this study was to assess the prevalence of this association in a group of 620 patients, aged between 18 and 78 years and referred to the Laboratory of Respiratory Pathophysiology of the Umberto I Hospital of Rome. All patients had a clinical history of a sleep-related breathing disorder and answered a specific questionnaire. One-hundred-and-thirty-seven patients (120 males and 17 females, mean age 64 years), whose questionnaire was suggestive of a sleep-related breathing disorder, underwent clinical assessment including blood tests, lung function tests, blood-gas analysis, ECG and nocturnal polysomnography, either as in- or as out-patients. The main associated pathologies were: arterial hypertension (54.7%), chronic obstructive pulmonary disease (17.9%), obesity (63.1%), dyslipidemia (41%), type 2 diabetes mellitus (6.3%), gastroesophageal reflux (27.3%) and cardiac arrhythmias (4.2%); 95 patients with obstructive sleep apnea syndrome were treated, on the basis of the polysomnography outcomes and according to the Italian Association of Sleep Medicine Guidelines, either with preventive strategies for risk factor reduction, or with medical (positive pressure ventilation, oxygen, assessment of the best drug medication) and/or ear, nose end throat surgical therapies. In most patients, the improvement in the sleep-related breathing disorder was associated with an improvement in their systemic pathology, in particular cardiovascular disease, suggesting the need of a deeper consideration and comprehension of nocturnal apneas.

Osteoprotegerin (OPG) belongs to the tumor necrosis factor receptor superfamily and acts as a decoy receptor for the receptor activator of NF-kappaB ligand (RANKL), preventing its binding to RANK. Since 1997, the RANKL/RANK/OPG system has been intensively investigated in the fields of bone, immune and cardiovascular system pathophysiology. Specific anti-OPG antibodies have been developed, allowing for the measurement of OPG and, more recently, of soluble RANKL in both physiological and pathological conditions, often yielding unexpected results. When considering circulating OPG measurements, it should be borne in mind that this receptor is ubiquitously expressed, and that circulating levels do reflect the production by a number of tissues. Moreover, strikingly different values of circulating OPG have been reported. The aim of this paper is to summarize the available data on circulating OPG levels in a number of conditions; the pathophysiological significance and potential clinical utility will be emphasized.

An increased protein intake is one of the most common approaches to the dietary management of obesity. The authors analyze the issues related to protein requirement in normal-weight and obese subjects, to the use and to the usefulness of high-protein diets in the treatment of obesity. Caution with these diets is recommended in view of their only slight effect on weight and fat loss and owing to the scarce evidence of significant effects on satiety and energy intake. Furthermore, the risks of harmful outcomes may be correlated to an excessive protein intake. Moreover, these diets do not allow patients to adopt those nutritional behavior rules which are essential to maintain the weight and fat loss and, consequently, significantly reduce the cardiovascular and metabolic risks related to obesity.