Antonio Dal Lago

The -174 G/C polymorphism of the interleukin-6 gene promoter is associated with Alzheimer's disease in an Italian population [corrected].

Interleukin-6 (IL-6) is a multifunctional cytokine playing a crucial role in inflammation and tissue injury. A role for this molecule in neurodegeneration and Alzheimers disease (AD) has been proposed. The aim of this study was to evaluate the association between a common polymorphism of the IL-6 gene promoter and AD in the Italian population. We found that the frequency of the GG genotype was significantly higher in AD patients than controls on both univariate ( rho< 0.0001) and multivariate analysis ( rho< 0.0001). In contrast, the CC genotype seems to be associated with a reduced risk of disease ( rho< 0.0001). Our data indicate that the IL-6 gene polymorphism is associated with AD in Italians and confirm that IL-6 is crucial in the pathophysiology of neurodegenerative disorders.

Intestinal permeability in cirrhotic patients with and without spontaneous bacterial peritonitis: is the ring closed?

OBJECTIVES:Impaired intestinal permeability (IP) may have a role in the pathogenesis of ascites and in spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis (LC). The aim of this study was to assess IP in LC patients with respect to healthy controls.METHODS:IP was evaluated by the 51Cr-ethylenediaminetetraacetic acid (51Cr-EDTA) permeability test in 52 LC patients and in 48 sex- and age-matched controls. The presence of 51Cr-EDTA was also evaluated in ascitic fluid after therapeutic paracentesis in all LC patients with ascites.RESULTS:An altered IP was found in 45% of LC patients compared with 4% of controls (P<0.00001). IP impairment was significantly associated with Child–Pugh status (75% of Child C patients vs. 39% of Child B and 22% of Child A patients), with the presence of ascites (60% in ascitic patients vs. 31% in nonascitic patients), and with a history of SBP (100% of patients with SBP vs. 50% of those without SBP). 51Cr-EDTA was present in all ascitic samples obtained from patients with SBP compared with 22% of patients without SBP.CONCLUSIONS:IP derangement was a common finding in LC, especially in patients with more advanced disease (presence of ascites and history of SBP). The presence of 51Cr-EDTA in ascites in patients with SBP suggests an altered permeability of splancnic vessels and/or peritoneal membranes. Further studies are required to assess 51Cr-EDTA urine and ascite cutoffs to set up SBP preventive strategies.

Helicobacter pylori Eradication Ameliorates Primary Raynaud's Phenomenon

Raynauds phenomenon is defined by anintermittent vasospasm of the arterioles of the distallimbs. Helicobacter pylori infection has been recentlyassociated with Raynauds phenomenon. The aim of this study was to assess the effects of H. pylorieradication on Raynauds attacks. Forty-six patientsaffected by primary Raynauds phenomenon were evaluated.H. pylori infection was assessed by [13C]urea breath test. Eradication therapy was given toinfected patients for seven days. Discomfort and theduration and frequency of attacks of Raynaudsphenomenon per week were assessed. Thirty-six subjectswere infected with H. pylori; the bacterium waseradicated in 83% of these after therapy. Attacks ofRaynauds phenomenon completely disappeared in 17% ofthe patients with H. pylori eradication. Discomfort and the duration and frequency of attacks ofRaynauds phenomenon were significantly reduced in 72%of the remaining patients. Conversely, attacks ofRaynauds disease did not change significantly during the 12-week follow-up period either in the H.pylori-negative patients or in the infected subjects inwhom the bacterium was not eradicated by therapy. Thestudy shows that H. pylori eradication causes a significant decrease in clinical attacks ofRaynauds disease. The reduction of vasoactivesubstances determined by the eradication of thebacterium may be the pathogenetic mechanism underlyingthe phenomenon.

Celiac Disease and Myointimal Proliferation: A Possible Correlation?

Celiac disease (CD) is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages, from middle infancy, and is caused by a reaction to gliadin, a gluten protein. Some patients are diagnosed with symptoms related to the decreased absorption of nutrients or with various symptoms which, although statistically linked, have no clear relationship with the malfunctioning bowel. Classic symptoms of CD include diarrhea, weight loss, and fatigue; bowel symptoms may be limited or even absent. In this article we describe the case of a young woman with CD who presents with myointimal proliferation. However multiple cases of vessel thrombosis have been reported in patients with CD. Despite the fact that no definitive relationship between these diseases could be explained, we think this association must be remembered especially in cases of young and tenuous women with these vascular abnormalities.

EFFICACY OF ILOPROST IN NONEXUDATIVE, AGE‐RELATED MACULAR DEGENERATION

age-dependent decline of shear stress was not observed. In young and middle aged subjects, mean shear stress was significantly lower in subjects with atherosclerosis than in those without. Mean shear stress in older subjects with atherosclerosis was about two-thirds that in young subjects without atherosclerosis. In summary, wall shear stress decreases with aging. Furthermore, wall shear stress was low in those with advanced atherosclerosis, even at a young age. Older subjects showed low wall shear stress even in the absence of atherosclerosis. These findings indicate that an age-dependent decrease in wall shear stress could be present as an agedependent risk factor for carotid atherosclerosis.

Pharmacologic reduction of factor XIII activity and fibrinogenemia in patients with peripheral arterial occlusive disease

Abstract Reports in the literature have shown plasma fibrinogen and factor XIII (FXIII) levels to be higher in patients with arteriopathy than in healthy subjects. Fibrinogen constitutes the basic matrix for the blood-clotting process. Excessive levels of fibrinogen in the blood result in increased clotting activity and increased aggregation of erythrocytes, leukocytes, and platelets, which can be important factors in thrombotic and atherosclerotic events. FXIII stabilizes fibrin monomers, facilitating the incorporation of alpha 2 -antiplasmin into the stabilized fibrin. In addition, this mechanism promotes the deposit of fibrin on arterial walls and within the arterial lumina; it also can delay activation of the fibrinolytic system and render it incapable of removing fibrin. Therefore, hyperfibrinogenemia and increased FXIII activity can lead to atherosclerosis. The aim of this study was to evaluate the possibility of a pharmacologic reduction of fibrinogen levels and FXIII activity in patients with peripheral arterial occlusive disease. Results of the study demonstrated that acute intravenous administration of high-dose defibrotide reduced both factors in these patients.

Splenomegaly as a Primary Manifestation of Gaucher Disease in a Young Adult Woman

Gaucher disease is the most common lysosomal storage disease. It is caused by the defective activity of acid β-glucosidase, which results in the accumulation of lipid glucocerebroside in macrophages throughout the body. In this case report we describe the case of a young adult woman with splenomegaly as the primary manifestation of this pathology. This is a case of type 1 Gaucher disease because there is a lack of primary neurological involvement but we have, instead, an age-independent involvement of the visceral organs. It is very important to classify or characterize these patients in a precise manner and to make a complete diagnosis with the help of the many diagnostic resources now at our disposal, especially with genetics, radiology and new techniques of advanced microscopy, also because Gaucher disease requires a long and complex management from early life to adulthood.

Evaluation of the forearm blood flow with C.W. Doppler in patients submitted to myocardial revascularization with the radial artery

Before harvesting the radial artery for coronary bypasses, investigating forearm vascularization to avoid postoperative ischemia of the hand is mandatory. The study involved 192 consecutive patients, 155 males and 37 females age 39–76 years (mean 56.1). The CW Doppler static and dynamic test was performed to evaluate the patency of the upper limbs arteries and the adequacy of the ulnar supply in the nondominant arm. The use of the radial artery was contraindicated in 14 patients (3 for stenosis of the subclavian artery and 11 for inadequate collateralization). One hundred and four patients were operated on with the radial artery used as a graft; another conduit was used in the remaining 74 patients. The vascularization of the hand was restudied within 10 days in all patients who underwent surgery; in 82 patients, it was studied again at 1 year. The early Doppler control showed a significant increase of blood flow velocities in the ulnar artery, with a flow redistribution in the common digital palmar arteries (decreased in the 1st and slightly increased in the 3rd). The late Doppler control showed superimposable findings. No local ischemic complications were observed after radial artery removal. Three patients showed thumb dysesthesias with no functional damage, probably due to surgical trauma of the radial nerve collateral branches. The authors conclude that a Doppler study is a useful tool to detect patients for radial artery surgical removal and to predict the efficacy of the ulnar supply through the distal anastomosis.