169,892 research outputs found
Effectiveness and safety of oxycodone/naloxone in the management of chronic pain in patients with systemic sclerosis with recurrent digital ulcers: two case reports
No full textNicola Ughi, Chiara Crotti, Francesca Ingegnoli Division of Rheumatology, Department of Clinical Sciences and Community Health, Gaetano Pini Institute, The University of Milan, Milan, Italy Abstract: Digital ulcers (DUs) are a severe and frequent clinical feature of patients with systemic sclerosis (SSc). The presence of DUs may cause severe pain and often lead to impairment of patient’s functional activities and health-related quality of life. Moreover, poor patient cooperation during the wound care procedure due to pain may be associated with a negative outcome of DU healing. Therefore, pain management has a key role in patients with SSc. These two case reports describe the effectiveness and safety of oxycodone/naloxone in patients with SSc complicated by painful chronic DUs. Such a therapy has provided pain relief and consequently an increased compliance during redressing wounds. Keywords: oxycodone, naloxone, systemic sclerosis, pain, digital ulcer, scleroderma, analgaesia, wound healing, opioids, calcinosis, UCLA-SCTC GIT 2.
Outcomes, rates, and risk factors of transition of Raynaud's phenomenon to a connective tissue disease: systematic review and meta-analysis
No full textBackground: A number of observational studies were carried out in patients with isolated Raynaud's phenomenon (RP) to investigate the predictors of transition to RP secondary to connective tissue diseases (CTDs). Data from a meta-analysis, including studies until June 1996, highlighted the potential role of nailfold capillaroscopy and/or antinuclear antibodies (ANAs) in predicting such transition [1].
Objectives: To provide an updated comprehensive review and meta-analysis on the rates and the role of predictors of transition to CTDs and systemic sclerosis (SSc) in patients with RP.
Methods: A systematic search of observational studies was undertaken using Medline and Embase (07/1996 to 08/2014). From the list of records retrieved, studies were screened by titles/abstracts and the full papers were sought where abstracts were felt to be relevant. Cohort studies reporting incidence and risk factors of transition from primary RP (pRP) or suspected secondary RP (ssRP) to CTDs were selected and data collected in ad hoc forms. pRP was defined according to Leroy and Medsger criteria (no history or physical findings suggestive of a secondary cause, normal capillaroscopy, negative serologic findings); ssRP was defined in presence of positive ANAs and/or abnormal capillaroscopy (even in association with symptoms or physical findings suggestive of a secondary cause without fulfilling criteria for a definite CTD). Relative risk (RR) and 95% confidence interval (CI) were extracted or calculated to present the association between risk factors and transition to CTDs. Random effects model was used to pool the results.
Results: From 2.221 articles captured, 36 met the predefined criteria, 29 were excluded on full text, and 7 selected studies provided information on transition from pRP and/or ssRP to secondary RP: 5 prospective and 2 retrospective cohort studies. Six studies included a total of 4051 patients with pRP with a cumulative mean follow-up of 20241 person-years (mean follow-up 4.9±2 years); a total of 1220 transitions to overt CTDs were recorded (pooled incidence rate 2.5/100 person-years of observation, range 0–7.7); among these, 321 transitions were to SSc (pooled incidence rate 1.58/100 person-years, range 0–2.8). Five studies included 657 patients with ssRP with a cumulative mean follow-up of 2377 person-years (mean follow-up 3.6±1.1 years); a total of 188 transitions to CTDs were recorded (pooled incidence rate 7.9/100 person-years, range 3.3–26) and 135 to SSc (pooled incidence rate 5.7/100 person-years, range 2.1–13). With respect to the patients with pRP, having ANA without capillary abnormalities provided a modest risk to develop SSc (pooled RR 2.8, CI 2.1–3.8), even weaker resulted the association between capillary abnormalities without ANA and the risk of SSc transition (RR 1.3, CI 0.7–2.4). On the other hand, the coexistence of ANA and abnormal capillaroscopy significantly increased the risk of transition to SSc (RR 8.1, CI 6.9–9.7).
Conclusions: A low incidence rate of transition from pRP to overt CTDs was confirmed. In patients with ssRP, whilst accepting the influence of selection bias of different studies, there appears to be a strong risk of transition toward a CTD regarding the concomitant presence of ANAs and abnormal capillaroscopy.
References: Spencer - Green G. Arch Intern Med. 1998;158(6):595 – 600
On a quasilinear parabolic system modelling the diffusion of radioactive isotopes
No full textWe consider a model for the diffusion of N species
of isotopes of the same element in a medium, consisting in a
parabolic quasilinear system, with Dirichlet boundary condition,
in the general hypothesis that the diffusion coefficients possibly
are all different. We prove existence and uniqueness of classical solution in the physically relevant assumption that the total
concentration of the element is positive and bounded
Outcomes, rates and predictors of transition of isolated Raynaud's phenomenon: a systematic review and meta-analysis
No full textPublished studies lack clear indicators of risk and predictors of transition from Raynaud's phenomenon (Rp) to connective tissue diseases (CTDs). Therefore, we aimed to study the outcomes, rates and predictors of transition to CTDs in patients with Rp
Update on the epidemiology, risk factors, and disease outcomes of systemic sclerosis
No full textSystemic sclerosis (SSc) is a chronic immune-mediated connective tissue disease with heterogeneous organ involvement. New classification criteria were developed allowing disease identification even before the onset of its hallmark, skin fibrosis. Incidence and prevalence vary among reports and are influenced by methodology. Despite earlier diagnosis, mortality of SSc is still considerable, mainly because of cardiopulmonary causes. Genetic predisposition is entangled and implies genes of the major histocompatibility complex and also other loci related to immune regulation. Known environmental risk factor is exposure to organic solvents and silica, but no single risk factor has emerged. Disease outcome measures including patient-reported outcomes have been proposed and validated, and their use is expected to contribute to measure treatment response in clinical trials. Because of the low frequencies and the high heterogeneity of the disease, large multicenter research collaborations are envisaged to achieve advancement in SSc management
Muscle thickness in infants with hypertrophic pyloric stenosis
No full textAbstract
Hypertrophic pyloric stenosis (IHPS) is the most common abdominal abnormality requiring surgery in infants. It occurs due to the hypertrophic and hyperplasia of the muscular layers of the pyloric. The usual age of clinical presentation is about three weeks of life. The most important symptom is non bilious emesis, intermittent or after each feeding. From march 1996 to June 2001, 21 infants, 20 males and 1 female, were subjected to ultrasonographic, radiographic exams and after diagnosis to the pyloromyotomy extramucosa. Ultrasonography was the study of choice used to identify hypertrophic pyloric stenosis; the markers to analyse were the length and the overall diameter of the pyloric canal and the muscle thickness of the wall. The results showed that a length of the pyloric canal 20 +/- 6 mm, a diameter 13.6 +/- 2.5 mm and a muscle thickness 4.1 +/- 1 mm are diagnostics for hypertrophic pyloric stenosis
Effectiveness and safety of ciclosporin as therapy for autoimmune diseases of the liver in children and adolescents
No full textBackground: Conventional treatment for autoimmune hepatitis results in a significant percentage of failures and several, poorly tolerated, side-effects. Therapy for autoimmune cholangitis and giant cell hepatitis associated with autoimmune haemolysis is poorly documented. Ciclosporin is a promising treatment for all of these diseases. Methods: We reviewed the records of 12 patients treated in our unit between 1987 and 2001. Eight had autoimmune hepatitis, two had autoimmune cholangitis and two had giant cell hepatitis. Indications for ciclosporin were treatment failure (four patients) and contraindications to/refusal of steroids (eight patients). Ciclosporin was administered in five untreated cases and in seven patients during relapse. The mean duration of ciclosporin administration was 35.6 months (8-89 months). The median follow-up was 6.5 years (1.5-15 years). Results: All patients achieved complete remission in a median period of 4.5 weeks (2-12 weeks). No treatment withdrawal due to side-effects occurred. Three patients required a combination of ciclosporin with conventional treatment due to severe liver function impairment. Tolerance to ciclosporin was excellent. A 20% transient elevation of serum creatinine occurred in one case, gingival hypertrophy in two and moderate hypertrichosis in two. Conclusions: Ciclosporin may be considered as a safe treatment for all autoimmune liver diseases and as an effective alternative for front-line therapy
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