Adult-onset Still’s disease, the most internistic of the rheumatic diseases: current concepts and a report of six cases

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown origin. It is characterized by spiking fever, evanescent rash, arthralgia/arthritis, and leukocytosis. The differential diagnosis includes a number of other conditions, and management is complicated by the lack of course predictors and the risks associated with complications and treatments. This report examines recent advances in our understanding of adult-onset Still’s disease (pathogenesis, diagnosis, complications, treatment). Current research in this field is focused on the significance of serum ferritin in AOSD, mechanisms underlying the hemophagocytic syndrome, and use of biologic therapies in patients who are refractory to conventional treatment. Six cases of AOSD diagnosed by our staff between 2002 and 2009 are also analyzed and compared with other cases reported in the literature. This analysis showed that Still’s rash and serum ferritin levels were not essential elements for diagnosis. In addition, the course of the disease showed little relation to the severity / characteristics of the presenting picture, but the evolution worsened with the age of the patient at diagnosis

De Quervain’s thyroiditis: current concepts and a report of four cases

Introduction: De Quervain’s subacute thyroiditis is a self-limiting granulomatous inflammatory disorder, which is thought to be virally induced in genetically predisposed individuals. It is characterized by thyroid pain and thyrotoxicosis, as well as by systemic symptoms like fever, hepatic cytolysis, and an elevated erythrocyte sedimentation rate. It is often mistaken for an upper respiratory tract infection. Materials and methods: The authors review recent advances in the understanding of the pathogenesis and pathophysiology of De Quervain’s subacute thyroiditis; risk factors for complications, with emphasis on relapses and end-stage hypothyroidism; differential diagnosis and the exclusion of other subtypes of thyroiditis; and current treatment options. Four cases of De Quervain’s thyroiditis are then analyzed and compared with cases in the literature. Discussion: In three of the patients, onset occurred in June and was probably related to a small, seasonal epidemic cluster. These cases were quite different from the fourth one, which occurred in October, suggesting that two distinct viruses might be involved. One of the patients presented a very rare complication, vocal-cord paralysis, which responded well to glucocorticoid therapy. Another presented with an even rarer post-partum form of painful thyroiditis

Competition Law and Intellectual Property: A European Perspective

This book focuses on competition law, regulation of IPRs and their convergent roles for a Single Market in an essential field for EU growth and development. The term ‘intellectual property’ is used with reference to a large category of rights and a variety of legal regimes. The Authors’ contributions focus only on those characteristics of IPRs that are useful to explain their interaction with competition law in the relevant markets. The rapidly evolving technical environment and the related ‘Community acquis’ make a systemic and coherent interpretation of the two topics very complex, especially considering the de-centralization process of competition (modernization) and the lack of a single, effective European jurisdiction for IPRs, mainly due to the long tradition of the territoriality principle in copyright and patents. Part I aims at providing a comprehensive overview of the strategic relationship between IPRs and competition. Part II is devoted to the standard-setting process, which is the key for the access to effective interoperability of high-tech systems. Part III addresses some sector-specific issues (e.g., the pharmaceutical sector). Part IV regards general competition issue, also relevant for IPRs, as actions for damages in the private-enforcement context. Finally, Parts V and VI contain insights into issues related to IPRs or competition law from a comparative-law perspective and that of several national legal systems