27 research outputs found
Intima-media thickness in patients with psoriatic arthritis : a case-control study
No full textFil: Perrotta, F. M. University of Rome. Dipartimento di Medicina Interna e Specialità Mediche; ItaliaFil: Scarno, A. University of Rome. Dipartimento di Medicina Interna e Specialità Mediche; ItaliaFil: Carboni, A. University of Rome. Dipartimento di Medicina Interna e Specialità Mediche; ItaliaFil: Cardini, F. University of Rome. Dipartimento di Medicina Interna e Specialità Mediche; ItaliaFil: Montepaone, M. University of Rome. Dipartimento di Medicina Interna e Specialità Mediche; ItaliaFil: Lubrano, E. Università del Molise. Dipartimento di Medicina e di Scienze per la Salute; ItaliaFil: Spadaro, A. University of Rome. Dipartimento di Medicina Interna e Specialità Mediche; Itali
Clinical and ultrasonography assessment of peripheral enthesitis in ankylosing spondylitis
No full textObjective. The aim of this study was to compare clinical examination with power Doppler US (PDUS) in the detection of entheseal abnormalities in patients with AS. Methods. Thirty-six AS patients underwent clinical and PDUS examination of the following bilateral entheseal sites: common extensor tendon at its insertion at the lateral humeral epicondyle; gluteus tendons at their insertion at the greater trochanter; quadriceps tendon at its insertion at the superior pole of the patella; patellar tendon at its proximal insertion at the inferior pole of the patella; patellar tendon at its distal insertion at the tibial tuberosity; Achilles tendon at its insertion at the calcaneus; and plantar aponeuroses at its insertion at the calcaneus. Results. Clinical and PDUS examination revealed at least one abnormal enthesis in 23 (63.9%) and 35 (97.2%) AS patients, respectively. Furthermore, of 432 entheses examined in our 36 AS patients, 64 (14.8%) were considered abnormal by clinical examination and 192 (44.4%) by PDUS. US abnormalities most commonly found were enthesophytes (31.7%), calcifications (33.7%), thickening (29.8%) and hypoechogenicity (26.6%). We found erosions and PD signals in 9.7 and 6% of examined entheseal sites, respectively. The evidence of entheseal abnormalities by clinical examination has a poor likelihood ratio (LR) for the presence of US abnormalities with vascularization (LR = 1.61), without vascularization (LR = 1.24) or erosions (LR = 1.51) at all sites. Conclusions. PDUS permits detection of structural and inflammatory abnormalities of the enthesis in AS and may complement the physical examination in order to better evaluate enthesitis
LATE POST-TRAUMATIC DIAPHRAGM RUPTURE IN A POLYTRAUMATIZED PATIENT: A CASE STUDY
No full textCase History: 50 years old male with traumatic brain, chest and skeletal injuries after a car crash, transferred from a peripheral hos- pital to our ED. A Total Body CT-Scan was performed. After the positioning of a trans-skeletal traction of the left leg and 12 h of observation in our ED, he was admitted to the floor with the diagnosis of: ‘‘Head Trauma, Small Left Pneumothorax, Multiple costal frac- tures, Pulmonary Contusions, Pneumomediastinum, Sternal Fracture, Left Acetabulum Fracture’’.
19 days after the trauma the patient underwent a reduction and fixa- tion of the acetabulum fracture without complications.
23 days after the trauma suddenly occurred a change in the clinical condition of the patient.
Clinical Findings: The patient appeared lethargic but aroused by oral stimulation, dyspnoeic, the hemodynamic was stable, no fever. At the clinical examination, the ventilation of the left hemithorax was remarkably reduced if compared to the contralateral; the patient reported pain to the palpation of the epigastrium and the bowel sounds were reduced.
Investigation/Results: Firstly a Chest X-Ray was performed: it showed the presence of the gastric bubble in the left thoracic sec- tion. Afterwards a Chest and Abdomen CT-scan was performed. Diagnosis: Late post-traumatic rupture of the left diaphragm (lacer- ation of 8-10 cm) with thorax herniation of the upper 3/4th of the stomach and of the omentum, associated with a massive left pneu- mothorax with shift of the mediastinum.
Therapy and Progressions: An emergency surgery for the reparation of the diaphragm rupture with a laparotomy approach was performed, followed by the positioning of a pleural drainage.
Comments: Although unexpected it is necessary to consider a late diaphragmatic injury in a patient involved in a car crash where there is the possibility of a traumatic-related increase of the abdomen pressure
[Arterial hypertension and cardiovascular risk: need for a combined strategy of intervention].
No full textRuptured middle colic artery aneurysm: A rare vascular presentation in a patient with Still's disease. A systematic literature review
No full textBackground
Aneurysms of visceral abdominal arteries represent less than 3 % of all splanchnic aneurysms. Pathology is poorly understood but recent studies have focused on the role of inflammation which it can be further enhanced by a systemic inflammatory disease.
Materials and Methods
A systematic literature review was conducted to highlight the unsolved aspects of this pathology and a total of 43 patients were retrieved to whom we added 1 patient treated at our Institution.
Results
Mean age at presentation was 54 years with a peak of incidence between the 6th and the 7th decades of life. No racial, sex, and age differences were observed among the two groups (P=NS). In 10 (23 %) patients an inflammatory disease was associated. However, the risk of rupture was similar between patients affected with an inflammatory disease and those with a sporadic presentation (P=NS). Color ultrasound was seldomly used but its role is questionable especially in an emergency setting because of the well-known limitations. On the other hand, computed tomography angiogram always permitted diagnosis. Surgery is the treatment of choice to prevent emergent surgery. If feasible, an endovascular approach should be used either in elective or emergent setting. However, hemodynamically unstable patients should be promptly operated on with an open approach. There were 4 (9 %) deaths 1 before surgery, 3 during operation.
Conclusions
Although in our revision we were unable to demonstrate that patients affected with an autoimmune diseases or chronic inflammatory conditions might have a higher risk of visceral aneurysm rupture, we recommend a proactive screening approach based on regular monitor of these patients for the presence of visceral aneurysms
Rapid effectiveness of certolizumab pegol in non-radiographic axial spondyloarthritis
No full textIn axial spondyloarthritis (SpA), the efficacy of certolizumab pegol (CZP), a novel pegylated anti-tumor necrosis factor alpha drug has not been investigated. We report that CZP showed a rapid effectiveness, assessed clinically and by magnetic resonance imaging, in a patient with a non-radiographic axial SpA, classified according to Assessment in SpondyloArthritis International Society (ASAS) criteria. This case suggests that CZP could be considered an useful treatment in non-radiographic axial SpA, supporting that an earlier therapeutic approach could play a relevant role in the management of the disease
Assessment of subclinical atherosclerosis in ankylosing spondylitis: correlations with disease activity indices
No full textThe aim of the study was to evaluate atherosclerosis in ankylosing spondylitis (AS) through the assessment of morphological and functional measures of subclinical atherosclerosis. Twenty patients [M/F=12/8, age (median/range) 43.5/28-69 years; disease duration (median/range) 9.7/1-36) years] with AS classified according to modified New York criteria and twenty age and sex related healthy controls with negative past medical history for cardiovascular events were enrolled in the study. In all patients and controls, the intima-media thickness (IMT) of common carotid artery, carotid bulb and internal carotid artery, and the flow-mediated dilatation (FMD) of non-dominant arm brachial artery were determined, using a sonographic probe Esaote GPX (Genoa, Italy). Furthermore, we assess the main disease activity and disability indices [bath ankylosing spondylitis disease activity index, ankylosing spondylitis disease activity score-eritrosedimentation rate (ASDAS-ESR), ASDAS-C-reactive protein (CRP), bath ankylosing spondylitis metrology index, bath ankylosing spondylitis functional index) and acute phase reactants. Plasmatic values of total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride and homocysteine were carried out in all twenty patients. IMT at carotid bulb was significant higher in patients than in controls (0.67 mm vs 0.54 mm; P=0.03). FMD did not statistically differ between patients and controls (12.5% vs 15%; P>0.05). We found a correlation between IMT at carotid bulb and ESR (rho 0.43; P=0.04). No correlation was found between FMD and disease activity and disability indices. This study showed that in AS patients, without risk factors for cardiovascular disease, carotid bulb IMT, morphological index of subclinical atherosclerosis, is higher than in controls
La terapia eparinica nel management del rischio trombotico in gravidanza
No full text.Review sulla gestione della terapia eparinica in gravidanz
Sequential treatment of daylight photodynamic therapy and imiquimod 5% cream for the treatment of superficial basal cell carcinoma on sun exposed areas
No full textTo the best of our knowledge, this is the first time that MAL-DLPDT alone and in combination with TIC were compared. The combined therapy reduced the number of MAL-DL-PDT treatments and increase significantly the long-term effectiveness especially on sun exposed area
