Treatment of Psoriasis Vulgaris with Calcipotriol Betamethasone Dipropionate Combination Followed by Calcipotriol and Assessment of the Adjuvant Basic Use of Urea-Based Emollients

A new combination product containing betamethasone dipropionate and calcipotriol (Dovobet® ointment) has been proven very effective and well tolerated in patients with psoriasis vulgaris. Emollients are adjunctive modalities commonly used in psoriasis; however, their actual role in combination with topical drugs as well as well as their compatibility with these drugs have not been well elucidated. In 313 adult patients with psoriasis vulgaris, we studied the efficacy and tolerability of treatment with Dovobet® ointment combined with urea-based emollients (Excipial U®) for 4 weeks, followed by treatment with calcipotriol (Daivonex®) either alone (group A) or combined with urea-containing emollients (Excipial U®, group B) for 8 weeks. Clinical evaluations were performed at baseline, at 4 and 12 weeks, assessing the clinical score for erythema, scaling, infiltration and pruritus, graded on the basis of a 5-point scale. After the initial 4-week treatment, a significant improvement of all clinical parameters was observed (p<0.05). Overall, clinical results improved further during the maintenance treatment phase; significant changes (p<0.05) were observed in each group. Most patients considered treatment efficacy positively at both 4 weeks and 12 weeks. Interestingly, at the end of the study, a greater percentage of patients in group B than in group A judged the efficacy as excellent. Treatment was very well tolerated. Only two patients complained of mild and transient burning sensation during the first days of treatment. The results of this study confirm the great efficacy and tolerability of sequential treatment with Dovobet®, and Daivonex® in psoriasis vulgaris and show the enhanced acceptability of this treatment associated with urea-based emollients.

The fermentable fiber content of the diet alters the function and composition of canine gut associated lymphoid tissue

The ingestion of plant fibers and their susceptibility to microbial fermentation in the large bowel modulate intestinal morphology but little is known about effects on the gut associated lymphoid tissue (GALT). The aim of the present study was to determine the effect of consuming diets containing different levels of fermentability fiber on immune function. Sixteen adult mongrel dogs (23 +/- 2 kg) were fed (14 days) in a randomized cross over design two isoenergetic isonitrogenous diets containing 8.3 g/kg non-fermentable or 8.7 g/kg fermentable fibers. Lymphocytes were isolated from blood prior to starting the study and at the end of each diet period. At study completion, lymphocytes were isolated from the gut associated lymphoid tissue (GALT) of the small intestine for characterization by immunofluorescence and to determine their ability to respond to mitogenic stimulation. Feeding high fermentable fibers increased (P < 0.05) the CD4/CD8 ratio and decreased (P < 0.05) the proportion of B cells in peripheral blood without changing natural killer cell activity or the response to mitogens. Mesenteric lymph node cells from dogs fed the low then high fermentable fiber diet contained a higher (P < 0.05) proportion of CD4+ cells and a higher (P < 0.05) response to mitogens. Intraepithelial, Peyer's patches and lamina propria cells contained a greater (P < 0.05) proportion of CD8+ cells when dogs were fed a low fermentable fiber diet followed by a high fermentable fiber diet. T cell mitogen responses in vitro were higher for intraepithelial but lower for Peyer's patches and lamina propria cells from dogs who were fed the low fermentable fiber diet followed by the high fermentable fiber diet (P < 0.05). In conclusion, the fermentable fiber content of the diet had very little effect on the type and function of immune cells in peripheral blood. However, feeding dogs a high fermentable fiber diet for 2 weeks (after 2 weeks of consuming a low fermentable fiber diet) altered the T-cell composition of GALT and produced a higher mitogen response in the predominantly T cell tissues and a lower response in areas involved in B cell functions. In conclusion, the level of fermentable fiber in the diet appears to alter GALT properties. Further studies are required to determine the direct contribution of a high or low fiber diet to these changes and the physiological implications to the health of the animal.

[Our experience in tailoring definitive terminal colostomies and in the follow-up of such patients]

Between January 1983 and July 31, 1988 at the 1st Division of General Surgery of Cuneo S. Croce Hospital, 57 patients (33 m, 24 f) were subjected to abdomino-perineal amputation for rectal A.D.K. A definitive colostomy was fashioned for all patients. Neostoma complications were encountered in 33% of cases. 91% of patients completed the rehabilitative programme and 40% saw satisfactory results as regards the regularisation of the alvus and return to social life.

[Acute mesenteric infarct. II. Problems of early diagnosis]

The symptomatology and diagnostic procedure adopted in 11 cases of acute mesenteric infarction are examined. Stress is laid on the importance of early, aetiologically accurate diagnosis for the purpose of instituting profitable treatment. In order to comply with such needs it is essential to perform urgent selective arteriography and/or urgent laparoscopy which only with rare exceptions is carried out even in hospitals that should be better equipped.

[Acute mesenteric infarct. III. Therapeutic problems]

The treatment adopted in 11 cases of acute mesenteric infarction is described: 6 cases involved arterial occlusion due to embolism and 5 arterial occlusion due to thrombosis. Six explorative laparotomies, 4 intestinal resections and one embolectomy of the superior mesenteric artery were carried out. Mortality was 63%. Stress is therefore laid on the need for very early, etiopathogenetic accurate diagnosis so as to commence treatment during the phase of reversible ischaemic intestinal lesion, targeting treatment to the cause of the ischaemia. The problem of the postoperative treatment problem is then discussed with special regard to the treatment of shock, the prevention of recurrences and the short intestine syndrome.

[Anomalies in gastric stump emptying of patients who have undergone resections for duodenal ulcer previously treated with histamine H2 receptor antagonists]

The problem of obstructed emptying of the gastric stump after Billroth II operations in patients previously treated with H2 receptors is discussed. Statistical comparison using the Student's "t" test revealed a significant difference (t = 2.173) between those given and not given H2-antagonists and confirmed the existence of greater postoperative hypotonia in the gastric stumps of the former group. This clinical syndrome demands careful monitoring of the hydroelectrolytic balance and possibly the use of a double naso-gastric and nasojejunal tube as a precaution to ensure the delivery of the jejunal contents to the stomach. The gastrokinetic drugs metoclopramide and domperidone are also beneficial.