102,764 research outputs found
Conservative Treatment of Hemorrhoidal Disease
No full textBackground: Hemorrhoids are vascular cushions underlying the distal rectal mucosa and contributing to approximately 15-20% of the resting anal pressure with a complete closure of the anal canal. They can become pathological (hemorrhoidal disease, HD) being the most common cause of painless rectal bleeding during defecation with or without prolapsing anal tissue. The treatment of HD must be tailored to both the severity of disease and patient's expectation.
Methods: A narrative review of all the most relevant papers present on the three major databases (PUBMED, EMBASE and WEB OF SCIENCE) regarding conservative treatment was conducted.
Results: Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease. Dietary and lifestyle modifications are the first therapeutic step necessary to achieve a regular defecation with soft stool whereas oral phlebotonic drugs can help to control symptoms. The use of topical medications, particularly during the acute phase or in the post-operative period can also be beneficial for all patients complaining of HD.
Conclusion: Despite a large number of available products in the market and the high incidence of HD, very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series. Larger and better designed studies are necessary to establish the real benefit of all types of drugs for the treatment of early stages of H
LUPUS NEPHRITIS - PROGNOSTIC FACTORS AND PROBABILITY OF MAINTAINING LIFE-SUPPORTING RENAL-FUNCTION 10 YEARS AFTER THE DIAGNOSIS
No full textData from 659 patients with a diagnosis of lupus nephritis were retrospectively collected among 32 nephrology centers in Italy, as a result of the collaborative effort of the Gruppo Italiano per lo Studio della Nefrite Lupica (GISNEL, Italian Lupus Nephritis Study Group). The overall probability of renal survival was 80% 10 years after the diagnosis. The probability of maintaining life-supporting renal function was evaluated according to several variables (clinical characteristics at presentation, World Health Organization [WHO] histologic classification). The presence at the time of diagnosis of hypertension and diffuse proliferative nephritis (WHO class IV) was associated with a worse prognosis
Relative survival of patients with lupus nephritis significantly improved over time in an Italian region: comment on the article by Faurschou et al
No full textImmunosuppressive treatment has changed the prognosis of Lupus nephritis over time, but improvement in
prognosis is difficult to analyze in different historical periods, and should be better demonstrated in comparison
with life expectancy of sex-and age-matched people. Long-term patient and renal survival of 90 patients
diagnosed with Lupus nephritis at our center from 1968 to 2001 with a follow-up time of 14±8 years was
retrospectively evaluated. Patient and kidney survival significantly increased over time. Multivariate analyses
show that risks of patient and renal death decreased by 8% at each year of follow-up, and increased by more than
5 time in patients aged > 30 years at diagnosis. As only 14 patients were men, relative survival as compared to that
of the sex- and age-matched general population of the Piedmont Region was calculated for the 76 women.
Improvement in the survival of the cohort of women was seen at any time of follow-up: in particular, it was
sharply lower in the first period (relative survival at 5, 10 and 15 years = 0.784, 0.665, and 0.620, respectively) and
increased in the second (relative survival at 5, 10 and 15 years = 0.939, 0.921, and 0.850, respectively) nearly
approaching that expected for the general population, i.e. 0.993, 0.983 and 0.967, respectively. Taken together,
our data allow us to draw the conclusion that life expectancy in women with Lupus nephritis has improved over
time, paralleling an improved awareness of the disease and a significant increase in steroid pulse therapy as
induction/remission phase. Improvement in survival is for the first time demonstrated to cover the gap with life
expectancy of the general population for women with Lupus nephritis
Guidelines for looking at the antiphospholipid antibodies in systemic lupus erythematosus.
No full textLupus anticoagulant (LA), anticardiolipin (aCL), and/or antiphospholipid (aPL) antibodies are the hallmarks of the antiphospholipid syndrome, characterized by widespread thrombosis. The syndrome has been described as primary or secondary when aCL/aPL are the only classes of detectable autoantibodies or occur in the context of systemic lupus erythematosus (SLE) or SLE-like disease. However, since LA/aCL/aPL have been extensively looked for, it has become evident that they may also be detected in the absence of any clinical correlation with thrombosis. In particular, among SLE patients, these antibodies mean a high risk of thrombosis only in a small subset, sharing clinical features with primary antiphospholipid syndrome. As laboratory examination is still unable to distinguish between high-risk and non-high-risk antiphospholipid antibodies, it is crucial to have some reasonable criteria able to guide the day-to-day clinical practice. We attempt to trace the following guidelines: (1) distinguish between transient and persistent LA/aCL/aPL results; (2) do not forget the LA phenomenon in the era of aCL/aPL; (3) maintain a strict communication with the laboratory; (4) exclude other causes of primary coagulation abnormalities; (5) look at the time of appearance of LA/aCL/aPL with respect to thrombosis; (6) analyze any possible laboratory clue putatively useful to distinguish between ‘rouge’ and ‘non-rouge’ LA/aCL/aPL; (7) look for signs of widespread noninflammatory vasculopathy; (8) do not engage a war to the knife against LA/aCL/aPL by immunosuppressive therapies.
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A voltage-clamp analysis of NMDA-induced responses on dopaminergic neurons of the rat substantia nigra zona compacta and ventral tegmental area.
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