Le malattie infiammatorie immuno-mediate (IMID) di interesse internistico: fisiopatologia, aspetti clinici e prospettive di terapia

Le IMID: inquadramento introduttivo A. Fontanella, G. Uomo Infiammazione e IMID T. d’Errico, M. Laccetti Malattia IgG4-relata C. Mastrobuoni, G. Uomo IMID in ematologia F. Rezzonico, A. Mazzone IMID in reumatologia A. Parisi, R. Buono, R. Russo, G. Uomo IMIDs in neurologia G.T. Maniscalco, C. Florio IMID in diabetologia R. Nicosia, C. Ricordi IMIDs in endocrinologia M.R. Poggiano, V. Nuzzo Malattie infiammatorie intestinali M. Salice, L. Calandrini, C. Praticò, M. Mazza, A. Calafiore, G. Carini, C. Calabrese, A. Belluzzi, F. Rizzello, P. Gionchetti, M. Campieri La malattia celiaca nel terzo millennio: nuove prospettive su patogenesi, clinica, diagnosi e terapia G. Caio, F. Giancola, R. De Giorgio, U. Volta Malattie epato-biliari autoimmuni M. Visconti, L. Fontanella, G. Marino Marsilia Pancreatiti autoimmuni P.G. Rabitti, R. Boni IMID e tumori F. Gallucci La sindrome infiammatoria da ricostruzione immune I. Ronga, G. Uomo Le malattie autoinfiammatorie M. Gattorno, A. Brucato Il rischio cardio-vascolare nelle IMIDs A. Fontanella, P. Gnerre, R. Nardi Quale ruolo degli inibitori delle PCSK9 in Medicina Interna nella prevenzione cardio-vascolare in alternativa alle terapie tradizionali? P. Gnerre, P. Zuccheri, M. Campanini, G. Pinna, R. Nardi Trombo-embolismo venoso e malattie autoimmuni sistemiche A. Fontanella, P. Gnerre, R. Nardi IMID nell’anziano: cenni sul trattamento M. Masina Farmaci biosimilari e farmaci innovativi in reumatologia: quale futuro? M. Todoerti, C. Montecucc

Patologia sistemica da virus dell'epatite C: la crioglobulinemia mista e altre manifestazioni extraepatiche

La malattia o sindrome da virus dell'epatite C 1M. Visconti, R. NardiIl virus C 5V. Iovinella, G. IovinellaCrioglobuline, crioglobulinemie e sindromi crioglobulinemiche 10M. Visconti, A. SalvioPatogenesi 14A. IlardiLa vasculite cutanea 19G. Monti, P. Novati, L. Castelnovo, F. SaccardoLe neuropatie periferiche 23R. BoniLa sindrome sicca 29G. ItalianoIl fenomeno di Raynaud 33F. Gallucci, A. Parisi, R. BuonoLa nefropatia crioglobulinemica 40F. SalvatiI linfomi 46M. LaccettiLa patologia articolare 52T. d'Errico, M. Varriale, C. Ambrosca, S. TassinarioSindrome da iperviscosità 56A. Fontanella, L. FontanellaDiagnosi 60G. Uomo, F. GallucciTerapia antivirale 65P.G. Rabitti, F. LampasiDiabete mellito 74A. Maffettone, M. RinaldiMalattie cardiovascolari 80R. Nardi, D. BorioniMalattie dermatologiche 86D. Galasso, D. D'AmicoMalattie neurologiche e psichiatriche 91M. ImparatoCorrelazioni tra patologia epatica e patologia tiroidea. Malattie tiroidee in corso di infezione da virus C 96M. Grandi, C. Sacchetti, S. PederzoliNeoplasie extraepatiche 101S. Fiorino, A. Domanico, E. Accogli, D. Borioni, P. LeandriSarcoidosi e malattie polmonari 109A. Zuccoli, N. Corcione, V. Nuzzo</p

Diagnosis and treatment of acute pancreatitis: The position statement of the Italian Association for the study of the pancreas

BACKGROUND AND AIM: Till now, no Italian studies providing information on acute pancreatitis have been published. The aim of this study was to evaluate the epidemiological and clinical characteristics of acute pancreatitis in Italy. MATERIALS AND METHODS: The study involved 37 Italian centres distributed homogeneously throughout the entire national territory and prospectively collected epidemiological, anamnestic, laboratory, radiological, therapeutic (pharmacological, endoscopic and surgical) data, relevant to each individual case of acute pancreatitis consecutively observed during the period from September 1996 to June 2000. RESULTS: One thousand two hundred and six case report forms were collected, but 201 patients (16.6%) were subsequently eliminated from the final analysis. We therefore studied 1005 patients, 533 (53%) males and 472 (47%) females, mean age 59.6 +/- 20 years. On the basis of the Atlanta classification of acute pancreatitis, 753 patients of the 1005 cases analysed (75%) were mild and 252 patients (25%) severe. The aetiology was biliary in 60% of the patients, related to alcohol abuse in 8.5%, while in 21% of the cases it could not be identified. Over 80% of the patients (83%) were admitted to hospital within 24 h from the onset of clinical symptoms, while only 6% were admitted after 48 h. In particular, 65% of the patients were admitted to hospital within the first 12 h. Antibiotics were used in 85% of the severe and 75% of mild forms. Endoscopic therapy was carried out in 65% of the severe cases, but only in 40% it was carried out prior to 72 h. Eighty-five patients (8.5% of the total, 34% of the severe forms) underwent surgical intervention: 20% on the first day, 38.5% within the fourth day, and the remaining (41.5% of the cases) later on for infected necrosis. The mean duration of hospitalisation for patients with mild pancreatitis was 13 +/- 8 days, while for the severe disease it was of 30 +/- 14 days. The overall mortality rate was 5%, 17% in severe and 1.5% in mild pancreatitis. CONCLUSIONS: Acute pancreatitis in Italy is more commonly a mild disease with a biliary aetiology. The treatment of the disease is not optimal and, on the basis of these data, needs to be standardised. Despite this, the overall mortality rate is low (5%BACKGROUND AND AIM: Till now, no Italian studies providing information on acute pancreatitis have been published. The aim of this study was to evaluate the epidemiological and clinical characteristics of acute pancreatitis in Italy. MATERIALS AND METHODS: The study involved 37 Italian centres distributed homogeneously throughout the entire national territory and prospectively collected epidemiological, anamnestic, laboratory, radiological, therapeutic (pharmacological, endoscopic and surgical) data, relevant to each individual case of acute pancreatitis consecutively observed during the period from September 1996 to June 2000. RESULTS: One thousand two hundred and six case report forms were collected, but 201 patients (16.6%) were subsequently eliminated from the final analysis. We therefore studied 1005 patients, 533 (53%) males and 472 (47%) females, mean age 59.6 +/- 20 years. On the basis of the Atlanta classification of acute pancreatitis, 753 patients of the 10

JPN Guidelines for the management of acute pancreatitis:surgical management

Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. The mortality rate of severe acute pancreatitis exceeds 20%, and some patients diagnosed as mild to moderate acute pancreatitis at the onset of the disease may progress to a severe, life-threatening illness within 2–3 days. The Japanese (JPN) guidelines were designed to provide recommendations regarding the management of acute pancreatitis in patients having a diversity of clinical characteristics. This article sets forth the JPN guidelines for the surgical management of acute pancreatitis, excluding gallstone pancreatitis, by incorporating the latest evidence for the surgical management of severe pancreatitis in the Japanese-language version of the evidence-based Guidelines for the Management of Acute Pancreatitis published in 2003. Ten guidelines are proposed: (1) computed tomography-guided or ultrasound-guided fine-needle aspiration for bacteriology should be performed in patients suspected of having infected pancreatic necrosis; (2) infected pancreatic necrosis accompanied by signs of sepsis is an indication for surgical intervention; (3) patients with sterile pancreatic necrosis should be managed conservatively, and surgical intervention should be performed only in selected cases, such as those with persistent organ complications or severe clinical deterioration despite maximum intensive care; (4) early surgical intervention is not recommended for necrotizing pancreatitis; (5) necrosectomy is recommended as the surgical procedure for infected pancreatic necrosis; (6) simple drainage should be avoided after necrosectomy, and either continuous closed lavage or open drainage should be performed; (7) surgical or percutaneous drainage should be performed for pancreatic abscess; (8) pancreatic abscesses for which clinical findings are not improved by percutaneous drainage should be subjected to surgical drainage immediately; (9) pancreatic pseudocysts that produce symptoms and complications or the diameter of which increases should be drained percutaneously or endoscopically; and (10) pancreatic pseudocysts that do not tend to improve in response to percutaneous drainage or endoscopic drainage should be managed surgically

Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database

Aims Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. Methods and results We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018). Conclusion In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas

JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis

Acute pancreatitis is a common disease with an annual incidence of between 5 and 80 people per 100 000 of the population. The two major etiological factors responsible for acute pancreatitis are alcohol and cholelithiasis (gallstones). The proportion of patients with pancreatitis caused by alcohol or gallstones varies markedly in different countries and regions. The incidence of acute alcoholic pancreatitis is considered to be associated with high alcohol consumption. Although the incidence of alcoholic pancreatitis is much higher in men than in women, there is no difference in sexes in the risk involved after adjusting for alcohol intake. Other risk factors include endoscopic retrograde cholangiopancreatography, surgery, therapeutic drugs, HIV infection, hyperlipidemia, and biliary tract anomalies. Idiopathic acute pancreatitis is defined as acute pancreatitis in which the etiological factor cannot be specified. However, several studies have suggested that this entity includes cases caused by other specific disorders such as microlithiasis. Acute pancreatitis is a potentially fatal disease with an overall mortality of 2.1%–7.8%. The outcome of acute pancreatitis is determined by two factors that reflect the severity of the illness: organ failure and pancreatic necrosis. About half of the deaths in patients with acute pancreatitis occur within the first 1–2 weeks and are mainly attributable to multiple organ dysfunction syndrome (MODS). Depending on patient selection, necrotizing pancreatitis develops in approximately 10%–20% of patients and the mortality is high, ranging from 14% to 25% of these patients. Infected pancreatic necrosis develops in 30%–40% of patients with necrotizing pancreatitis and the incidence of MODS in such patients is high. The recurrence rate of acute pancreatitis is relatively high: almost half the patients with acute alcoholic pancreatitis experience a recurrence. When the gallstones are not treated, the risk of recurrence in gallstone pancreatitis ranges from 32% to 61%. After recovering from acute pancreatitis, about one-third to one-half of acute pancreatitis patients develop functional disorders, such as diabetes mellitus and fatty stool; the incidence of chronic pancreatitis after acute pancreatitis ranges from 3% to 13%. Nevertheless, many reports have shown that most patients who recover from acute pancreatitis regain good general health and return to their usual daily routine. Some authors have emphasized that endocrine function disorders are a common complication after severe acute pancreatitis has been treated by pancreatic resection

Inflammation and Pancreatic Cancer: Recent Development with Focusing on Potential New Drug Targets

Chronic inflammation has been identified as a significant factor in the carcinogenesis of various tumors, including pancreatic cancer. Both hereditary and classical forms of chronic pancreatitis are associated with an increased risk of developing pancreatic cancer. Cytokines and other mediators of the inflammatory process together with an upregulation of pro-inflammatory pathways play a pivotal role in oncogenesis' stimulation, tumor growth and metastasis. The presence of a strong desmoplastic reaction within and around pancreatic cancer cells renders the proteolytic degradation of extracellular matrix components an essential process for tumor invasion and metastasis. Various classes of proteases produced by the pancreatic acinar cells are involved in these proteolytic events. The multiple link between inflammation and pancreatic cancer may represent the basis for a novel antineoplastic strategy. Cytokines, proteases, reactive-oxygen-species, cyclooxygenase-2, nuclear-factor-κB and perixosome proliferator-activated receptor-γ may be a new molecular targets useful for therapeutic purpose

Management of acute pancreatitis in clinical practice. ProInf - A.I.S.P. Study Group. Progetto Informatizzato Pancreatite Acuta--Associazione Italiana Studio Pancreas.

Over the last few years, remarkable progress has been made in diagnosis, severity assessment and treatment as well as in our understanding of the pathophysiology of acute pancreatitis. New treatment modalities and new specific drugs have been introduced and this has led to practical changes in the daily bedside management of patients with acute pancreatitis. Treatment is essentially medical, both for mild and severe disease, and is aimed at reducing abdominal pain, restoring electrolyte and fluid losses, removing the aetiological factor(s), attenuating inflammation and autodigestive processes, as well as preventing local and systemic complications. Diagnostic and interventional percutaneous or endoscopic procedures are indicated mainly for patients with severe forms of the disease. Surgery is generally indicated for patients with necrosis infection or other local complications not manageable by percutaneous or endoscopic means