Maria Messina

Airway hyperresponsiveness in the elderly: prevalence and clinical implications

Airway hyperresponsiveness is associated with an increased risk of developing respiratory symptoms. The assessment of airway hyperresponsiveness can provide valuable information regarding the natural course of respiratory diseases. However, little information is available for populations of more advanced age, and data are conflicting. It was assessed whether age influences the occurrence of airway hyperresponsiveness by reviewing those studies that specifically addressed this issue, and attempting to identify the factors responsible for discrepancies between studies. Eighteen studies, published between 1983 and 2002, are included in this review. Overall, the results of the analysis are in favour of a positive association between age and airway hyperresponsiveness, the prevalence of which appears to increase in the elderly. The most important determinants were reduced lung function, probably due to geometric factors, and a history of smoking, primarily because of the length of exposure, although acute effects were also demonstrated. Atopy should also be considered as an independent determinant of airway hyperresponsiveness in the elderly population. In addition, inflammatory and neuronal mechanisms could be involved. Finally, the role of sex requires further investigation. Assessing the impact of age on the occurrence of airway hyperresponsiveness has important implications: the age-associated alterations to the lung provide a model for evaluating the contribution of structural changes to the pathogenesis of airway hyperresponsiveness. From a clinical standpoint, evaluation of the magnitude of airway hyperresponsiveness could permit the early identification of individuals who are at risk, even at more advanced age. Assessment of airway hyperresponsiveness in the aged should be considered as an additional tool in the diagnostic work-up in the subset of elderly subjects with long-term smoking exposure and/or documented atopy.

Interleukin-2, interleukin-2 receptor and γ-interferon synthesis by peripheral blood mononuclear cells in chronic hepatitis delta virus infection☆

The behaviour of the immune system during liver damage caused by chronic hepatitis delta virus (HDV) infection was evaluated by assessing, in 16 patients with HBsAg+ chronic liver disease and HDV superinfection (15 HBeAg-, 1 HBeAg+), phytohaemagglutinin (PHA)-induced interleukin-2 synthesis and interleukin-2 receptor expression, PHA and staphylococcal enterotoxin B (SEB)-induced gamma-interferon synthesis and, in some cases, the presence of hepatitis B virus DNA (HBV-DNA) within peripheral blood mononuclear cells (PBMC). The results were compared to those obtained in 13 patients without HBV replication (i.e., serum HBV-DNA and liver HBcAg-negative), in 15 with HBV replication (i.e., serum HBV-DNA and/or liver HBcAg-positive) with chronic liver disease without HDV superinfection, and in 15 HBsAg-negative healthy control subjects. The lymphokine pattern in HDV infection was comparable to that of healthy subjects and of HBV non-replicating patients without HDV superinfection. Interleukin-2 receptor expression and gamma-interferon synthesis were however significantly decreased in HDV-negative patients with active HBV replication. HBV-DNA was detected in PBMC from 8 of 23 patients, without any correlation with the lymphokine pattern. Our results suggest that in HDV-related chronic liver disease, immune system alterations are unlikely. HDV superinfection does not affect the occurrence of HBV-DNA sequences within the leukocytes. HBV-DNA in PBMC does not interfere with the interleukin-2 system nor with the gamma-interferon response in HBV- and HDV-related chronic liver disease.

Physical capacity in performing daily activities is reduced in scleroderma patients with early lung involvement.

Patients with systemic sclerosis (SSc) often complain reduced capacity at submaximal exercise; conversely, physical capacity in performing daily duties has never been measured in SSc. The aim of this study is to evaluate this performance and its correlates, in patients with SSc compared with healthy controls, in a free‐living setting.

USEFULNESS OF CT COLONOGRAPHY IN PATIENTS WITH OCCLUSIVE COLORECTAL CANCER BEFORE METALLIC STENT PLACEMENT: A SINGLE ENTER EXPERIENCE

Up to 15% of patients with colorectal cancer (CRC) present with large bowel obstruction. Currently, computed tomography colonography (CTC) is regarded as a promising technique for complete evaluation of the proximal colon and simultaneous assessment of extraluminal status. Aim of this retrospective, observational study is to evaluate the feasibility of using CTC for preoperative examination of the proximal colon before metallic stent placement in patients with colon obstruction caused by CRC. Sixteen patients who demonstrated colonic obstruction caused by CRC, underwent CTC immediately after incomplete colonoscopy. Perpatient sensitivity of CTC for lesions 5 mm or larger in diameter in the colon proximal to the stent was 100% (95% CI: 0.4385-1). Per-patient specificity for lesions 5 mm and larger in the proximal colon was 92.3% (95% CI:0.6669-0.9863). CTC did not generate any false diagnosis of synchronous cancer. False positive findings at CTC did not result in a change in surgical plan for any patients. Although the small number of