Extramedullary plasmacytoma of the tonsil: A new management

Introduction: Extramedullary plasmacytoma (EMP) is a rare tumor of all plasma cell neoplasms. The tumor is mainly localized in the head and neck region, but rarely involving the tonsil. Case presentation: The authors report the 5th case of EMP of the tonsil in the literature occurred in a 57-year-old Caucasian male. Conclusions: Through a review of the relevant literature, we consider adjuvant radiotherapy not necessary for EMP of tonsil because of an adequate resection achieved by surgery

UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN: FROM CASE HISTORY TO MANAGEMENT

Respiratory tract infections are the most common diseases in childhood. The respiratory tract, widely branched system of ducts, is particularly exposed to the action of microorganisms transmitted by air from here the high frequency of infections they face especially in the first years of life. It is usual distinguish: upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI). In particular, in infections of the upper airways, the inflammatory process, result of the interaction between microbes and the immune response, can be localized to the mucosa of the nose or sinuses (common cold and sinusitis), or the pharynx or larynx (pharyngotonsillitis and laryngitis) and it has predominantly a viral etiology although occasionally it may be followed by bacterial complications such as otitis media. The aim of the following article is the description of these different clinical pictures, highlighting the clinical and epidemiological features and current management guidelines

Acetaldehyde effects in the brain

The effects of alcohol have been widely studied during the past century as alcohol abuse is a major health problem in Western society. In the last years, a growing body of evidence indicates that acetaldehyde, the first oxidation product of ethanol, is one of the mediators of peripheral and central effects of ethanol. Indeed, acetaldehyde has been recently taken into account as the mediator of the rewarding properties of alcohol. The role of acetaldehyde in ethanol-related properties has been proved by enzymatic manipulation studies in which the inactivation of acetaldehyde potentially synthesized in the brain produces the same results as blocking the formation of acetaldehyde by inhibiting brain catalase activity. Moreover, electrophysiological and pharmacological analyses showed that acetaldehyde is able to stimulate dopamine release in the nucleus accumbens through enhancement of firing rate, spikes/burst, and burst firing of ventral tegmental neurons. Thus, the aim of this review is to summarize latest results on the role of acetaldehyde as the mediator of ethanol-central effects

Association between sleep-disordered breathing and hearing disorders: Clinical observation in Sicilian patients

Introduction: To examine the putative association between Sleep-Disordered breathing and hearing disorders Material and methods: 120 Sicilian subjects ranging from 14 to 85 years of age who were divided in 46 cases suffering from tinnitus (G1 group) and 74 controls (G2 group) were evaluated through STOP BANG screening questionnaire and Four-Variable Screening Tool; after Data collecting each subject underwent Audiological assessment by multi-frequency audiometry (PTA) and Transient-evoked otoacoustic emissions (TEOAE-diagnostic) for each ear. Results: Cases showed: PTA significantly severe than the control group (58.70% vs. 16.89% hearing loss; P<0.001), such as a lower signal-to-noise ratio (SNRs) (P<0.05). Moreover Tinnitus subjects had a higher risk to develop Sleep-Disordered breathing respect to controls (P<0.001). OSA risk population - subjects positive to both screening questionnaires - had tinnitus, wore hearing threshold mean values and, lower SNRs values than total cohort (P<0.01). The relative risk of Sleep-Disordered breathing and tinnitus was 4.83 (P<0.0001). Conclusions: Our results stress a probable association between tinnitus, hearing loss and Sleep-Disordered breathing even if further studies will be needed to confirm our findings

FOKI AND BSMI VITAMIN D RECEPTOR GENE POLYMORPHISMS, PLASMA RENIN ACTIVITY AND ESSENTIAL ARTERIAL HYPERTENSION

Objective: Our aims were to analyze the relationship between 25hydroxyvitamin D(25[OH]D) plasma levels and clinical and ambulatory blood pressure (BP) values, and to identify any possible association between hypertension and FokI and BsmI vitamin D receptor (VDR) gene polymorphisms in essential hypertensive patients. Design and method: Seventyone essential hypertensive patients and seventytwo controls, 18–75 years old, were enrolled. Clinical physical examination, routine blood chemistry, clinical BP, 24 hour ambulatory blood pressure monitoring, 25[OH]D and Plasma Renin Activity (PRA) assay, and FokI and BsmI VDR polymorphisms analysis were obtained. Results:We observed a significant negative correlation between 25[OH]D and 24 h systolic BP (r = 0.277, p = 0.043) (Figure 1). This correlation persisted in backward stepwise multivariate analyses (b=0.337; p = 0.022) including as covariates first age, gender, body mass index, glomerular filtration rate estimated (eGFR) by MDRD equation, and secondly PRA. Furthermore body mass index (b=0.290; p = 0.037) and eGFRMDRD (b=0.301; p = 0.038) were independently correlated to 24 h systolic BP. We did not observe statistically significant correlation between 25[OH]D and PRA. When we compared anthropometric, clinical and biohumoral parameters among patients with different VDR (FokI and BsmI) genotypes, we found a significant difference of clinic diastolic BP values among the three FokI genotypes (p = 0.018). Significantly higher diastolic BP values in patients with ff FokI genotype compared with patients with Ff FokI genotype (p = 0.002) were disclosed through the MannWhitney U test. Lastly any association between a specific genotype or allele and hypertension or PRAwas not found when we compared allelic frequencies and genotype distribution between patients and controls. Conclusions: Our findings confirm the relation between 25[OH]D and BP values in essential hypertensive patients and they suggest that FokI and BmsI VDR polymorphisms is not associated either with hypertension or with PRA

Vitamin D receptor gene polymorphisms and plasma renin activity in essential hypertensive individuals

Several studies analyzed 25-hydroxyvitamin D (25[OH]D) and blood pressure (BP) relationship with mixed results. Moreover, a relationship between the risk of hypertension and vitamin D receptor (VDR) gene polymorphisms, FokI and BsmI, was reported. This study was aimed to analyze these relationships in essential hypertensive (EH) patients. Seventy-one EH patients, 18-75 years old, were enrolled. Patients underwent clinical BP, 24-h ambulatory BP monitoring, 25[OH]D and plasma renin activity (PRA) evaluations. FokI and BsmI VDR polymorphisms were analyzed and compared with those of 72 healthy controls. In EH patients, the median 25[OH]D levels were lower than 30 ng ml-1. We found a significant negative correlation between 25[OH]D and 24-h systolic BP (r=-0.277, P=0.043). This correlation persisted in backward stepwise multivariate analyses (β=-0.337; P=0.022), after adjustment for age, gender, body mass index, glomerular filtration rate, and PRA. We did not observe statistically significant correlation between 25[OH]D and PRA. We compared the allelic frequencies and genotype distribution between patients and controls, and FokI and BsmI VDR polymorphisms were not associated either with hypertensive status or with PRA. Further wide studies are needed to clarify this relationship

Hepatitis B virus reactivation and alemtuzumab therapy

Reactivation of hepatitis B virus infection in subjects receiving cytotoxic treatment for heamatological malignancies occurs in 21–53% of chronic HBsAg carriers and in an unknown number of HBsAg negative subjects harbouring occult HBV infection. Immmunotherapy with alemtuzumab, a humanized monoclonal antibody against CD52 epitopes on lymphocytes cells produces deep immunosuppression. We describe two subjects with chronic lymphocytic leukaemia and occult HBV infection who developed a virological and biochemical flare of hepatitis B following immunotherapy with alemtuzumab. One of them developed full blown hepatitis with seroreversion from anti-HBs to HBsAg after four weeks of alemtuzumab therapy. Lamivudine (100 mg die) achieved a complete clinical recovery and HBV-DNA clearance from blood within 8 weeks. The second patient (HBsAg and HBV-DNA seronegative, anti-HBs and anti-HBc positive before treatment) was kept under prophylaxis with lamivudine up to three months after alemtuzumab. Two months after withdrawal of lamivudine, clinical and laboratory features of acute hepatitis B developed. Lamivudine therapy was restarted and a prompt recovery was obtained with HBsAg and HBV-DNA clearance

Intraorbital injection of Rituximab in idiopathic orbital inflammatory syndrome: case reports

We report a case of a 66-year-old Caucasian female with a diagnosis of idiopathic orbital inflammatory disease (OID) refractory to azathioprine therapy. The coexistence of diabetes mellitus represented a relative contraindication to chronic prednisone use. After two infusions of rituximab, a chimeric anti-CD20+ antibody, ophthalmic signs and symptoms remarkably improved. To our knowledge, this is the first case of idiopathic OID successfully treated with rituximab