Long-term salvage therapy with cyclosporin A in refractory idiopathic thrombocytopenic purpura

Treatment of severe, chronic idiopathic thrombocytopenic purpura (ITP) refractory to most usual therapies is a difficult challenge. Little information exists on the clinical use of cyclosporin A (CyA) in the treatment of ITP. This report describes long-term treatment with CyA (median, 40 months) and follow-up (median, 36.8 months) in 12 adult patients with resistant ITP. CyA used in relatively low doses (2.5-3 mg/kg of body weight per day) led to a clinical improvement in 10 patients (83.3%). Five had a complete response (41.1%), 4 a complete response to maintenance therapy (33.3%), and one a partial response (8.3%). Two patients had no response. Most patients with a response (60%) had a long-term remission (mean, 28.6 months) after discontinuation of CyA. One patient had a relapse of ITP 4 years after CyA therapy was stopped. Side effects were moderate and transient, even in patients dependent on continued CyA treatment. CyA seems to represent reasonable salvage treatment in severe, potentially life-threatening, refractory ITP

The internist in the surgical setting: results from the Italian FADOI-ER survey

More and more frequently, patients admitted to surgical wards present characteristics similar to those admitted to medical units. They are fragile patients, often elderly, with significant comorbidity. In recent years, to address these emerging clinical issues in a surgical setting, different organizational models involving specialists of different backgrounds were studied, and in particular involving internists and geriatricians. To widen our current knowledge, in 2011 the Federation of Associations of Hospital Doctors on Internal Medicine of Emilia-Romagna, northern Italy (FADOI-ER), proposed a questionnaire to the public healthcare internal medicine departments of the Emilia Romagna region to collect information as to in what way and to what extent internists are involved in the management of surgical patients. In this article, we analyze the results of the questionnaire and make some organizational considerations and proposals. The questionnaire was very simple, consisting of 14 items. The survey was conducted from 1-28 February 2011. Replies were received from 20 internal medicine departments of a total of 75 in the Emilia Romagna region. The FADOI-ER survey has some limitations, the first of which is that only just under 25% of internal medicine departments in the Emilia Romagna region took part. However, the results are still interesting and seem to suggest that internists, because of their particular cultural background and training, could be the preferred partners for comanagement within the context of inpatient surgical procedures. The results of the FADOI-ER questionnaire are also consistent with the data reported in literature and daily clinical experience that highlight the need for a more multi-specialist approach to patient management with medical internists. Further studies will help provide answers as to the best way to conduct this multidisciplinary approach that could represent one of the future challenges for healthcare