Vitamin B deficiency-induced pseudothrombotic microangiopathy without macrocytosis presenting with acute renal failure: a case report.

Background: Vitamin B deficiency-induced thrombotic microangiopathy, known as pseudothrombotic microangiopathy, is a rare condition which resembles the clinical features of thrombotic thrombocytopenic purpura but requires a markedly different treatment. Most cases of vitamin B deficiency have only mild hematological findings, but in approximately 10% of patients life-threatening conditions have been reported.

Case Presentation: We report a case of a 46-year-old Moroccan man presenting with severe hemolytic anemia, thrombocytopenia, and renal failure in absence of macrocytosis, thus mimicking a genuine thrombotic thrombocytopenic purpura.

Granulomatosis with polyangiitis presenting with diffuse alveolar hemorrhage requiring extracorporeal membrane oxygenation with rapid multiorgan relapse: A case report.

Rationale: Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmatic antibodies (ANCA)-associated vasculitis affecting small- and medium-sized blood vessels, mostly involving lung and kidney.

Patient Concerns: We report the case of a 33-year-old man that presented with acute respiratory distress syndrome caused by alveolar hemorrhage.

Diagnoses: Aggressive GPA presenting with diffuse alveolar hemorrhage and multiorgan involvement.

Oxidative stress is associated with arterial dysfunction and enhanced intima-media thickness in children with hypercholesterolemia: the potential role of nicotinamide-adenine dinucleotide phosphate oxidase.

Background: Endothelial dysfunction and intima-media thickness are precocious manifestations of hypercholesterolemia, but the mechanism is unclear.

Objective: The aim of the study was to analyze the interplay among endothelial dysfunction, intima-media thickness, and oxidative stress in children with hypercholesterolemia.

Methods: We performed a cross-sectional study comparing flow-mediated dilation, intima-media thickness, lipid profile, urinary isoprostanes as markers of oxidative stress, and platelet expression of gp91(phox), the catalytic unit of nicotinamide-adenine dinucleotide phosphate oxidase, in a population of 50 children with hypercholesterolemia (mean age +/- SD: 10.

Tumour necrosis factor alpha upregulates platelet CD40L in patients with heart failure.

Aims: Patients with heart failure (HF) have elevated values of the pro-inflammatory protein CD40L but the underlying mechanism is unclear. This study was performed to evaluate the interplay between tumour necrosis factor alpha (TNFalpha) and CD40L in HF.

Methods And Results: In patients with HF (n=86) and healthy subjects (HS, n=43), plasma levels of soluble CD40L (sCD40L), TNFalpha, soluble receptors of TNFalpha such as soluble TNF receptors I and II (sTNFR1 and sTNFR2), and 8OH-dG, a marker of oxidative stress, were determined.

Early decrease of oxidative stress by atorvastatin in hypercholesterolaemic patients: effect on circulating vitamin E.

Aims: Statins inhibit oxidative stress, but the interplay between cholesterol lowering and antioxidant vitamins is still unclear. Aims of the study were to assess if statins inhibit oxidative stress independently from cholesterol lowering, to assess the behaviour of vitamin E simultaneously with the changes of oxidative stress, to determine in vitro if atorvastatin was able to directly influence platelet-mediated LDL oxidation and vitamin E consumption.

Methods And Results: In 30 hypercholesterolaemic patients (HC) and 20 healthy subjects (HS), urinary isoprostanes and plasma vitamin E were determined.

A review of picotamide in the reduction of cardiovascular events in diabetic patients.

Picotamide is an antiplatelet drug with a dual inhibitory action. Thus, picotamide inhibits both thromboxane A2 (TxA2) receptors and TxA2 synthase and, at variance with aspirin, does not interfere with endothelial prostacyclin (PGI2) production. Two large randomized trials have been performed to assess the clinical efficacy of picotamide in patients at risk of atherothrombosis.

Oxidative-stress-mediated arterial dysfunction in patients with peripheral arterial disease.

Aims: To investigate the existence of a relationship among flow-mediated dilation (FMD), nitric oxide (NO), and oxidative stress in patients with peripheral arterial disease (PAD), and to assess if the administration of an antioxidant was able to improve arterial dilatation.

Methods And Results: We performed a cross-sectional study comparing FMD, 8-Hydroxy-2-deoxy-2-deoxyguanosine (8-OHdG), a marker of oxidative stress, and nitrite/nitrate (NOx) serum levels in a population of 25 PAD patients and 40 controls. In the second part of the study, 21 PAD patients were randomly allocated to a treatment sequence of 7 days of i.

Drugs improving insulin resistance for non-alcoholic fatty liver disease and/or non-alcoholic steatohepatitis.

Background: Non-alcoholic fatty liver disease (NAFLD) is characterized by fat accumulation in the liver, which may progress to non-alcoholic steatohepatitis (NASH) and cirrhosis. It is suspected in persons with elevated aminotransferase levels and features of insulin resistance (or metabolic) syndrome. The pathogenesis of NAFLD is not clear and there is no universal treatment.

Imbalance between nitric oxide generation and oxidative stress in patients with peripheral arterial disease: effect of an antioxidant treatment.

Background: Nitric oxide (NO), a potent vasodilator produced by endothelial cells, is reduced in patients with peripheral arterial disease (PAD), but the mechanism has not been fully elucidated. Because NO is rapidly inactivated by superoxide anion, we speculated that enhanced oxidative stress could lower NO generation. The aim of our study was to investigate if an imbalance between oxidative stress and NO does exist in patients with PAD and if an increase of NO formation could be achieved by an antioxidant treatment.

Antioxidants and cardiovascular disease.

Oxidative stress appears to play a key role in the pathogenesis of atherosclerosis. Agents that prevent the oxidation of low-density lipoprotein have reduced the development and progression of this disease in a range of in vitro experiments and animal models. In the last decade, many trials of antioxidants in patients with cardiovascular disease have been conducted, but the results have been ambiguous.

Vitamin E for the treatment of cardiovascular disease: is there a future?

Oxidative stress seems to play a key role in the pathogenesis of atherosclerosis. Agents that protect low-density lipoprotein from oxidation have been shown in a range of in vitro and animal models to reduce the development and progression of atherosclerosis. These agents include antioxidant micronutrients such as vitamin E.

Should antioxidant status be considered in interventional trials with antioxidants?

The last decade has seen many trials with antioxidants in patients with cardiovascular disease, with equivocal results. One possible explanation for the disappointing findings is the lack of identification criteria of patients who are potential candidates for antioxidant treatment. Several studies have been carried out in patients at risk of cardiovascular disease, indicating that enhanced oxidative stress is associated with the presence of diabetes, hypercholesterolaemia, hypertension, and smoking.

[Polymyositis as a paraneoplastic syndrome in a case of non-Hodgkin lymphoma].

The authors describe the case of a patient with NHL, who had undergone a series of clinical and laboratory investigations for the presence of pain, oedema and functional deficiency of the lower limbs associated with generalized weakness. From the data of the literature in cases of myositis, labelled as paraneoplastic disorders, no histological classification or phenotypic characterization have been provided, with exception of a case diagnosed as K1 positive lymphoma. A meta-analysis of case control studies and cohort of myositis and neoplasia do not show an increased incidence of cancer before a diagnosis of polymyositis (PM), although it seems to be an increased risk following diagnosis.

[Angioedema: first manifestation of non-Hodgkin's lymphoma].

Angioedema can be hereditary or acquired. Hereditary angioedema is a genetic disease transmitted with an autosomal dominant mechanism. Acquired angioedema usually occurs after the second decade of life and is often related to an underlying disease.

[Staphylococcus aureus sepsis in hospitalized non neutropenic patients: retrospective clinical and microbiological analysis].

Staphylococcus aureus is one of the leading agents of nosocomial infection among adult patients. The aim of this study was to determine the predisposing factors and secondary complications of Staphylococcus aureus septicemia (SAS) in non neutropenic patients, as well as the predictors of the outcome in non neutropenic patients with SAS. We performed a retrospective study of 56 cases of SAS that occurred from January 1997 through June 2001 in patients hospitalized in medical wards at the Policlinico Umberto I, "La Sapienza" University of Rome; we excluded surgical patients and those admitted to the intensive care unit.

[Association between motoneuron disease and Waldenström macroglobulinemia].

The authors describe the case of a patient who was referred to their Unit because of polyneuropathy and was subsequently found to be affected by Waldenström's macroglobulinemia. A monoclonal paraproteinemia is frequently described in the serum of subjects with motor neuron disease. The association between motor neuron disease (MND) and lymphoproliferative disease (LPD) could be the result of a coincidence, but LPD seems to be disproportionally frequent in patients with MND, compared to the population in general.

Susceptibility and genetic relatedness of invasive Haemophilus influenzae type b in Italy.

Haemophilus influenzae type b (Hib) still causes a large portion of meningitis in children less than 5 year old in Italy because vaccination against this agent has not been fully implemented in the country. We have studied 78 Hib strains and 4 nontypable H. influenzae (NTHi) isolated from the cerebrospinal fluid of subjects with meningitis for susceptibility to ampicillin, chloramphenicol, and ceftriaxone.