[Efficacy of alpha interferon treatment in patients with chronic hepatitis C associated to mixed cryoglobulinaemia]

Objective. Mixed cryoglobulinaemia is closely associated with hepatitis C virus (HCV) infection. The aim of this trial was to evaluate in a prospective open study the efficacy of ?-interferon in the treatment of chronic hepatitis C virus associated to mixed cryoglobulinaemia (MC). Methods. Thirty-one consecutive patients were treated for the first time with ?-interferon at a dose of 6 MU three times a week for 12 months. All the patients presented cryoglobulins, which were responsible for clinical manifestations in 9. Results.At the end of interferon treatment, 11 patients presented complete responses (biochemical and virological), including 7 subjects who presented MC-related clinical manifestations. Cryoglobulins had disappeared in 48.4% of the patients and a clinical improvement was observed in 7 out of 9 patients. Twelve months after interferon treatment was stopped, only 25.8% of patients still had undetectable cryoglobulins and 5 subjects who presented complete responses, all with MCrelated clinical manifestations had a relapse both of HCV-related biochemical and virological indexes and of MC clinical manifestations. Conclusions. A 12-month course of ?-interferon is effective treatment for HCV-related cryoglobulinaemia, especially during therapy. However we obtained scarce results in the follow-up above all in the patients with clinical manifestations of MC.

Increased concentrations of eosinophilic cationic protein in whole-gut lavage fluid from children with inflammatory bowel disease

BACKGROUND

Eosinophils may be involved in the pathogenesis of inflammation in inflammatory bowel disease. The purpose of this study was to verify whether concentrations of eosinophilic cationic protein in gut lavage fluid from children with inflammatory bowel disease correlate with clinical and laboratory indexes of disease activity.

METHODS

Twenty-three children with Crohn's disease, 14 with ulcerative colitis, and 22 age-matched control subjects entered the study. Radioimmunoassay and sandwich enzyme-linked immunosorbent assay techniques were used to measure eosinophilic cationic protein, total immunoglobulin G and interleukin-1beta, respectively.

RESULTS

Gut lavage eosinophilic cationic protein levels were significantly (p < 0.005) higher in patients with Crohn's disease and ulcerative colitis than in control subjects. Intestinal eosinophilic cationic protein levels decreased in three of four children with Crohn's disease who were fed an elemental diet. There was a significant (p < 0.001) correlation between eosinophilic cationic protein concentrations and immunoglobulin G and interleukin-1beta levels in gut lavage fluid.

CONCLUSIONS

Elevated intestinal eosinophilic cationic protein levels in inflammatory bowel disease suggest that eosinophils are involved in the gastrointestinal inflammation in this disease. Intestinal eosinophilic cationic protein concentration is another marker with which to discriminate between active and inactive inflammatory bowel disease.

Use of a new thickened formula for treatment of symptomatic gastrooesophageal reflux in infants

BACKGROUND

Paediatricians are familiar with infants complaining of regurgitation and emesis from gastrooesophageal reflux. These subjects, usually growing satisfactorily and healthy, are affected by "functional" or "symptomatic" gastrooesophagel reflux and are treated with posture changes and thickened feedings.

AIM

To evaluate in infants with symptomatic gastrooesophageal reflux the effect of a new formula (Nutrilon AR), containing carob flour/locus bean gum as a thickening agent; both clinical features and oesophageal acid exposure were evaluated.

PATIENTS

Twenty-four infants (age range: 5-11 months; median age: 8 months; 8 females) presented at our Unit with a history of chronic postprandial regurgitation.

METHODS

During a 24-hour intraoesophageal pH test a traditional formula thickened with rice flour at a concentration of 5% was alternated with the formula Nutrilon AR; thereafter infants were randomly allocated to receive, for two weeks, either a traditional thickened formula or the new formula, in addition to posture changes.

RESULTS

Intraoesophageal acid exposure was significantly lower in the periods following the new formula than after traditional formula; at the end of the treatment period patients receiving the new formula had a more significant decrease of both symptomatic score and number of episodes of emesis than patients on traditional formula.

CONCLUSIONS

The new available formula, with the characteristics of a thickened meal, is better than a formula, traditionally thickened with added rice flour, in the conservative treatment of infants with symptomatic gastrooesophageal reflux.

Oral cimetropium bromide, a new antimuscarinic drug, for long-term treatment of irritable bowel syndrome

Most drugs are ineffective for the long-term treatment of irritable bowel syndrome (IBS). The beneficial effects of medical treatment of IBS are poor and last for only a relative short time. Over a period of 6 months, we investigated the effectiveness of cimetropium bromide, a new antimuscarinic compound, in patients with IBS. Forty-eight patients were treated at random and in double-blind fashion with cimetropium bromide (50 mg, tid) or placebo for 6 months. Personal diary cards and monthly check-ups guaranteed the monitoring of symptoms (mainly pain). In addition, personality patterns (MHQ-CBA tests) were obtained for the patients before and after therapy, both to detect possible psychoneurotic traits and to observe the changes in these traits in relation to the changes in pain symptoms. Three patients on placebo and one on cimetropium dropped out. At the end of therapy, pain scores had decreased an average of 16% in the placebo group and 87% in the cimetropium group (p less than 0.01). Twenty patients (87%) on cimetropium versus five patients (24%) on placebo considered themselves to be globally improved (p less than 0.01). The MHQ test showed significant improvement in the anxiety score in the cimetropium group only. The CBA test confirmed a significant decrease in anxiety state (STAI-X-1) after cimetropium treatment. Eleven patients (48%) on cimetropium reported side effects (mainly dry mouth and sleepiness), but none withdrew from the study. The results of this trial indicate that long-term treatment of IBS with cimetropium bromide significantly improves symptoms and associated psychological disorders.

"Hemicrania continua": a new clinical entity or a further development from cluster headache? A case report

A case of "hemicrania continua" after cluster headache in the same subject is described. Indomethacin exerted an absolute, persistent effect on the present headache. Even though our data are insufficient to demonstrate a causal relation between the two forms of headache, they do suggest this real possibility.

[Essential headache as an equivalent to a withdrawal syndrome: experience with naloxone]

The Authors, starting with the hypothesis that could exist a correlation between the opiate withdrawal and the migraine crisis, used the naloxone, opiate pure antagonist, in order to induced the migraine crisis. 30 patients affected by migraine were studied; naloxone was administered acutely (2 mg e.v.) during the asintomatic period. The naloxone administration never caused the migraine crisis. The patients didn't complain variations regarding the psycho-physical status or the monitored clinical parameters.

DHE retard for prophylactic therapy of migraine: efficacy and tolerability

The authors evaluated the efficacy of a DHE methanesulphonate for migraine attacks and its tolerability on liver, gallbladder and cardiovascular system functions. Twenty-eight patients affected by migraine were studied. They were withdrawn from preventive therapy for at least one month and treated for three months. The drug showed a good efficacy with a statistical significant reduction of severity and duration of attacks. No variation of the biochemical and morphological parameters of liver, gallbladder and cardiovascular function were found throughout the treatment.

Non-familial hemiplegic migraine responsive to naloxone

Two cases of non-familial hemiplegic migraine are described. Naloxone reversed the neurological deficits accompanying attacks, whereas the pain was uninfluenced. The possibility that the opiate-antagonist naloxone facilitates regression of neurological symptoms associated with migraine attacks in general is voiced.