MedWorm: Steroid Therapy

Same Lung Injury Risk With Pre-Hospital Steroids (CME/CE)

MedPage Today Meeting Coverage — Wed, 08 Feb 2012 22:13:06 +0100

HOUSTON (MedPage Today) -- Pre-hospital steroid therapy did not reduce the risk of acute lung injury in critically ill patients and might have increased inhospital mortality risk, according to a study reported here. (Source: MedPage Today Meeting Coverage)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Preterm Infants: Risk for Death Estimated More Precisely Preterm Infants: Risk for Death Estimated More Precisely

Medscape Today Headlines — Tue, 07 Feb 2012 21:32:28 +0100

A new model to predict mortality rates among very low birth weight infants takes into account not only gestational age but also sex, sex-specific birth-weight percentile, and lack of prenatal steroid therapy. Medscape Medical News (Source: Medscape Today Headlines)

Differentiation of autoimmune pancreatitis with pancreatic carcinoma remains a challenge to physicians

Chinese Journal of Digestive Diseases — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion: Although some recent advances have been made in helping the diagnosis of AIP, the differentiation of AIP with pancreatic carcinoma is still a challenge. In clinical practice, it must be reminded to exclude AIP before making the diagnosis of pancreatic carcinoma.© 2012 The Authors. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd. (Source: Chinese Journal of Digestive Diseases)

Poor Outcomes at Discharge Among Extremely Premature Infants: A National Population-Based Study [Article]

Archives of Pediatrics — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions The combined outcomes of deaths or severe morbidities in the neonatal period of infants born at 24 to 26 weeks' gestation could be simply estimated at birth. The provision of an appropriate and up-to-date estimate of poor neonatal outcomes for specific infants may be useful in counseling families on treatment options for these infants. (Source: Archives of Pediatrics)

Health utility after emergency medical admission: A cross-sectional survey

Health and Quality of Life Outcomes — Fri, 03 Feb 2012 05:00:00 +0100

Conclusions: Health utility can be measured after emergency medical admission, although responder bias may be significant. Health utility after emergency medical admission is poor compared to population norms. We have identified independent predictors or health utility that need to be measured and taken into account in non-randomized evaluations of emergency care. (Source: Health and Quality of Life Outcomes)

Clinical analysis of osteonecrosis of the femoral head induced by steroids

Orthopaedic Surgery — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: Most patients with ONFH induced by steroids complained of pain within 3 years of commencing steroid therapy. Pain was associated with lesion size, collapse and BME. Atypical location of pain, failure to perform a physical examination and MRI findings were the main causes of misdiagnoses. (Source: Orthopaedic Surgery)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Skin toxicity from external beam radiation therapy in breast cancer patients: protective effects of Resveratrol, Lycopene, Vitamin C and Anthocianin (Ixor(R))

Radiation Oncology — Mon, 30 Jan 2012 05:00:00 +0100

IntroductionThis is an observational study and the aim is to evaluate the effect of dietary supplements based on Resveratrol, Lycopene, Vitamin C and Anthocyanins (Ixor(R)) in reducing skin toxicity due to external beam radiotherapy in patients affected by breast cancer. Materials and Methods: 71 patients were enrolled and they were divided in two different groups: a control group (CG) of 41 patients treated with prophylactic topical therapy based on hyaluronic acid and topical steroid therapy in case of occurrence of radiodermatitis, and a Ixor-Group (IG) of 30 patients treated also with an oral therapy based on Resveratrol, Lycopene, Vitamin C and Anthocyanin (Ixor(R)) at a dose of 2 tablets/day, starting from 10 days before the radiation treatment until 10 days after the end of treatmen...

Steroids for acute spinal cord injury.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: High-dose methylprednisolone steroid therapy is the only pharmacologic therapy shown to have efficacy in a phase three randomized trial when administered within eight hours of injury. One trial indicates additional benefit by extending the maintenance dose from 24 to 48 hours, if start of treatment must be delayed to between three and eight hours after injury. There is an urgent need for more randomized trials of pharmacologic therapy for acute spinal cord injury. PMID: 22258943 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Impact of periodontal treatment in combination with tonsillectomy plus methylprednisolone pulse therapy and angiotensin blockade for pediatric IgA nephropathy.

Clinical Nephrology — Sat, 21 Jan 2012 18:13:05 +0100

Conclusions: Careful examination and thorough elimination of infectious foci in oral and ENT lesions can optimize the effect of tonsillectomy plus MP pulse therapy, promoting recovery from IgAN. PMID: 22257544 [PubMed - in process] (Source: Clinical Nephrology)

Tuberculosis-related choriocapillaritis (multifocal–serpiginous choroiditis): follow-up and precise monitoring of therapy by indocyanine green angiography

International Ophthalmology — Tue, 17 Jan 2012 07:12:50 +0100

Abstract To report the case of a patient initially diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), characterized by relentless evolution despite high-dose steroid therapy. An interferon-gamma release assay (IGRA) indicated a diagnosis of suspected tuberculous choriocapillaritis and the disease responded only to massive inflammation suppressive therapy and antibiotic therapy. Case report. Review of clinical features and investigational procedures. Smoldering relentless evolution and subsequent arrest of progression could be precisely monitored by indocyanine green angiography (ICGA). The patient did not recover after standard anti-tubercolosis (TB) therapy combined with corticosteroid. A fourth antibiotic had to be added in order to stop t...

Primary IgG4-related lymphadenopathy with prominent granulomatous inflammation and reactivation of Epstein–Barr virus

Virchows Archiv — Tue, 17 Jan 2012 07:07:43 +0100

We report a unique case of primary IgG4-related lymphadenopathy showing prominent granulomatous inflammation and Epstein–Barr virus (EBV) reactivation. Involved lymph nodes showed an expanded interfollicular zone with prominent granulomatous inflammation, including a predominance of epithelioid macrophages and occasional Langhans multinucleated giant cells. Bundles of spindle cells were also observed. Intermingled with the granulomatous inflammation were numerous mature plasma cells, eosinophils, and neutrophils. The percentage of IgG4+/IgG+ plasma cells was markedly elevated (70%), along with raised serum IgG4 levels. The plasma cells did not show immunoglobulin light-chain restriction. EBV-positive lymphocytes were scattered throughout the paracortical areas. Corticosteroid treat...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Systemic lupus erythematosus following HPV immunization or infection?

Lupus — Sun, 15 Jan 2012 14:30:03 +0100

This report describes three patients with either newly diagnosed systemic lupus erythematosus (SLE) or SLE flare, following vaccination for human papilloma virus (HPV). Case 1: A 17-year-old female completed two doses of HPV vaccine uneventfully. Two months later, she developed arthralgias with pruritic rashes on both lower extremities, later accompanied by livedo reticularis, bipedal edema with proteinuria, anemia, leucopenia, hypocomplementemia and high titers of anti-nuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA). Kidney biopsy showed International Society of Nephrology/Renal Pathology Society Class III lupus nephritis. She was started on high dose steroids followed by pulse cyclophosphamide therapy protocol for lupus nephritis, and subsequently went into remission. Ca...

Single Nucleotide Polymorphisms and Type of Steroid Impact Functional Response of the Human Glucocorticoid Receptor

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:13 +0100

Introduction: Clinical trials evaluating the use of steroids in septic shock have shown variable outcomes, yet little insight has developed as to why some patients improve with steroids and others do not. Studies have implicated polymorphisms of the human glucocorticoid receptor (hGR) coding sequence as a possible cause of altered steroid response. We previously identified a combination of 3 single nucleotide polymorphisms (SNP) of the hGR coding sequence that altered response. in order to further evaluate the role of hGR variations in humans, we further hypothesize that hGR polymorphisms along with type of steroid will influence the stress response and may lead to individualized tailoring of steroid therapy. Methods: Total RNA was isolated from 97 healthy human blood samples and surveyed ...

Interventions for treating oral lichen planus

British Journal of Dermatology — Fri, 13 Jan 2012 05:00:00 +0100

Conclusions: Although TCSs are considered to be first line treatment, we identified no RCTs that compared TCSs with placebo in patients with symptomatic OLP. From the 28 trials included in this systematic review, the wide range of interventions compared means there is insufficient evidence to support the effectiveness of any specific treatment as being superior. (Source: British Journal of Dermatology)

Interventions for treating oral lichen planus.

The British Journal of Dermatology — Fri, 13 Jan 2012 05:00:00 +0100

Severity of nephrotic IgA nephropathy according to the Oxford classification

International Urology and Nephrology — Mon, 09 Jan 2012 19:37:16 +0100

Conclusion Nephrotic IgAN is a very severe form of IgAN, with renal dysfunction, massive hematuria, and active and chronic histopathological lesions. Renal outcome is severe; however, steroid therapy can improve prognosis in cases with higher eGFR and lower T-grade, according to the Oxford classification. Content Type Journal ArticleCategory Nephrology – Original PaperPages 1-8DOI 10.1007/s11255-011-0109-5Authors Takahito Moriyama, Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JapanKayu Nakayama, Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JapanChihiro Iwasaki, Department of Medicine, Kidney Center, Tokyo Women’s M...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Early initiation of low-dose corticosteroid therapy in the management of septic shock: a retrospective observational study

Critical Care — Sat, 07 Jan 2012 05:00:00 +0100

Conclusions: Early initiation of low-dose corticosteroid therapy was significantly associated with decreased mortality. (Source: Critical Care)

Kawasaki disease and sensorineural hearing loss: an (un)expected complication

European Journal of Pediatrics — Fri, 06 Jan 2012 16:49:34 +0100

Conclusion: Sensorineural hearing loss is an uncommonly reported complication of KD. Pediatricians should be aware of this potential complication to allow for early intervention. Content Type Journal ArticleCategory Short CommunicationPages 1-4DOI 10.1007/s00431-011-1667-3Authors Ana Novo, Pediatrics Department, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, PortugalSusana Pinto, Pediatrics Department, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, PortugalAna Catarina Prior, Pediatrics Department, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, PortugalSílvia Álvares, Pediatric Cardiology Department, Centro Hospitalar do Porto, Porto, PortugalTeresa Soares, Otorhinolaryngology Department, Centro Hospitalar do Po...

A hairy affair: tarantula setae-induced panuveitis requiring pars plana vitrectomy

International Ophthalmology — Thu, 05 Jan 2012 17:05:47 +0100

This article describes a case of chronic panuveitis as a result of ocular penetration by tarantula setae, and its challenging management that ultimately required pars plana vitrectomy. Interventional case report: A 29-year-old male presented with chronic panuveitis secondary to tarantula-hair penetration. Initial management with mechanical removal of hairs from the cornea and intensive topical steroid therapy for 18 months did not adequately control his symptoms. Pars plana vitrectomy was carried out and at 6-month follow-up the patient was symptom-free without any pharmacological therapy. We propose early pars plana vitrectomy as a management option for treatment-resistant panuveitis in cases of ophthalmia nodosa secondary to setae-related injury. Content Type Journal Arti...

Novel treatment concepts for graft-versus-host disease

Blood — Thu, 05 Jan 2012 05:00:00 +0100

Acute and chronic graft-versus-host disease (GVHD) are potentially lethal complications after stem cell transplantation (SCT). Steroids are the appropriate first-line treatment for both. However, if patients do not adequately benefit from steroid therapy, mortality is high and standardized treatment algorithms are lacking. This is mainly because of limited data from prospective, randomized clinical trials. In addition, most of the available treatment options only induce clinical benefits in a limited proportion of patients. Thus, there is an urgent clinical need to develop more potent immunosuppressive treatment strategies for patients suffering from acute or chronic steroid-refractory GVHD while maintaining the graft versus tumor effect to avoid a potential rise in relapse-related mortali...

An immunoglobulin G4-related disease mimicking postoperative lung cancer recurrence

Modern Rheumatology — Wed, 04 Jan 2012 16:59:27 +0100

Abstract A postoperative lung cancer patient presented with lymphadenopathy, pleural thickening, and 18F-fluorodeoxyglucose (FDG) uptake on a positron emission tomography–computed tomography (PET–CT) scan. Lung cancer recurrence was initially suspected, but bilateral submandibular masses with 18F-FDG uptake indicated the possibility of a systemic disease, such as Mikulicz’s disease. High serum immunoglobulin G4 (IgG4) and IgG4-positive plasma cell infiltration in the submandibular glands led to the diagnosis of IgG4-related disease. After systemic steroid therapy, 18F-FDG uptake decreased in both the submandibular glands and the suspected recurrent lesions. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s10165-011-0580-yAuthors Seshiru Nak...

MedWorm Sponsor Message: Find the best January Sales in the UK.

High risk of osteonecrosis of the femoral head in autoimmune disease patients showing no immediate increase in hepatic enzyme under steroid therapy

Rheumatology International — Wed, 04 Jan 2012 06:59:42 +0100

Abstract Aim of the study is to determine the relationship between liver function and the incidence of ONF after steroid therapy in AID patients. The present study investigated 58 AID patients who had received high-dose systemic steroid therapy to determine whether a correlation exists between parameters of hepatic function and steroid-induced ONF at the precise time-point when steroid-induced ONF develops. The patients were divided into two groups on the basis of MRI findings: ONF (n = 31) and non-ONF (n = 27). The ONF group showed no increase in AST, ALT, or LDH within 4 weeks after the commencement of steroid therapy. By contrast, the non-ONF group showed an immediate and significant increase in all of these parameters. In the ONF group, hepatic ...

Factors associated with the initiation of proton pump inhibitors in corticosteroid users

Pharmacoepidemiology and Drug Safety — Sun, 01 Jan 2012 05:00:00 +0100

ConclusionsOverall, PPI therapy among corticosteroid users was uncommon, even among those with risk factors for gastrointestinal toxicity. PPI use was significantly more common among patients who had recently been hospitalized, had a greater burden of comorbid illness, or were receiving high daily doses of corticosteroids. Copyright © 2012 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)

IgG4-Related Sclerosing Disease, an Emerging Entity: A Review of a Multi-System Disease.

Yonsei Medical Journal — Tue, 27 Dec 2011 03:59:17 +0100

Authors: Divatia M, Kim SA, Ro JY Abstract Immunoglobulin G4-related systemic disease (IgG4-RSD) is a recently defined emerging entity characterized by a diffuse or mass forming inflammatory reaction rich in IgG4-positive plasma cells associated with fibrosclerosis and obliterative phlebitis. IgG4-RSD usually affects middle aged and elderly patients, with a male predominance. It is associated with an elevated serum titer of IgG4, which acts as a marker for this recently characterized entity. The prototype is IgG4-related sclerosing pancreatitis or autoimmune pancreatitis (AIP). Other common sites of involvement are the hepatobiliary tract, salivary gland, orbit, and lymph node, however practically any organ can be involved, including upper aerodigestive tract, lung, aorta, mediasti...

[Acute disseminated encephalomyelitis associated with herpes virus infection: A case report.]

Archives de Pediatrie — Sat, 24 Dec 2011 05:00:00 +0100

We report a case of ADEM in a 4-year-old girl, who was diagnosed based on the data from a brain MRI, which revealed multiple demyelinization foci in the periventricular white matter, the semi-oval centers, and the thalamic regions, both bilaterally and symmetrically. The clinical course was characterized by complete recovery 10 days after steroid therapy. In the literature, more than the half of the patients treated for ADEM had a good prognosis, with recovery and no sequelae. Clinical improvement is generally noted in the hours or days following the initiation of treatment. However, in the most severe cases of ADEM, the most frequent neurological sequelae consist in focal deficiencies of the limbs and ataxia or visual disorders. Cognitive and behavioral disorders are noted in 6 to 50% of ...

Mesenchymal stromal cell therapy for steroid-refractory acute and chronic graft versus host disease: a phase 1 study.

International Journal of Hematology — Tue, 20 Dec 2011 05:00:00 +0100

Authors: Herrmann R, Sturm M, Shaw K, Purtill D, Cooney J, Wright M, Phillips M, Cannell P Abstract Steroid-refractory acute graft versus host disease (AGVHD) and chronic graft versus host disease (CGVHD) after allogeneic haematopoietic stem cell transplantation are major causes of morbidity and mortality. We undertook a phase I trial in patients with steroid-refractory AGVHD and CGVHD utilising bone marrow-derived mesenchymal stromal cells (MSC). Additionally, all refractory patients were treated with etanercept concomitantly. The primary end point was safety, and secondary end points were best response achieved and overall survival. A median of two infusions per patient were administered. The response rate overall for AGVHD was complete in seven, partial in four and no response i...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Familial Pulmonary Capillary Hemangiomatosis Early in Life

International Journal of Biomedical Imaging — Mon, 19 Dec 2011 20:22:14 +0100

Conclusion. Despite the differences in clinical course, the trias of PCH, PDA, and pulmonary hypertension in the two life born girls suggests a genetic background. (Source: International Journal of Biomedical Imaging)

Degree of mucositis and duration of neutropenia are the major risk factors for early post‐transplant febrile neutropenia and severe bacterial infections after reduced‐intensity conditioning

European Journal of Haematology — Fri, 16 Dec 2011 10:29:30 +0100

Conclusions: After an RIC‐allo, FN and early SBI occurred mostly in patients with severe mucositis and early‐onset neutropenia, while postengraftment high‐dose steroid therapy for acute GVHD was the major RF. (Source: European Journal of Haematology)

Alterations in the gut microbiome of children with severe ulcerative colitis

Inflammatory Bowel Diseases — Fri, 16 Dec 2011 09:30:58 +0100

Conclusions:Richness, evenness, and biodiversity of the gut microbiome were remarkably reduced in children with UC compared with healthy controls. Children who did not respond to steroids harbored a microbiome that was even less rich than steroid responders. This study is the first to characterize the gut microbiome in a large cohort of pediatric patients with severe UC and describes changes in the gut microbiome as a potential prognostic feature. (Inflamm Bowel Dis 2011;) (Source: Inflammatory Bowel Diseases)

Outcomes of toll-like receptors’ antagonism in steroid-resistant optic neuritis; a pilot study

Graefe's Archive for Clinical and Experimental Ophthalmology — Wed, 14 Dec 2011 16:41:09 +0100

Conclusions Mw appears to improve steroid resistant optic neuritis; future randomized clinical trials would help affirm this observation. Content Type Journal ArticleCategory NeurophthalmologyPages 1-7DOI 10.1007/s00417-011-1896-1Authors Aditya Sudhalkar, M & J Institute of Ophthalmology, Baroda, IndiaMayuri Khamar, Raghudeep Eye Clinic, Ahmedabad, IndiaBakulesh Khamar, Nagri Eye Hospital, M & J Institute Of Ophthalmology, Ahmedabad, India Journal Graefe's Archive for Clinical and Experimental OphthalmologyOnline ISSN 1435-702XPrint ISSN 0721-832X (Source: Graefe's Archive for Clinical and Experimental Ophthalmology)

Surgical Treatment of Neer Group VI Proximal Humeral Fractures: Retrospective Comparison of PHILOS(®) and Hemiarthroplasty.

Clinical Orthopaedics and Related Research — Tue, 13 Dec 2011 05:00:00 +0100

CONCLUSIONS : Angular stable open reduction and internal fixation was associated with high complication and revision rates, especially in patients who smoked and those receiving steroid therapy. Primary hemiarthroplasty provides limited function, which had little influence on the quality of life in this elderly collective. There are predictive factors for complications after the treatment of Neer Group VI proximal humeral fractures with the PHILOS(®) plate. Primary hemiarthroplasty remains a good option, especially when treating elderly patients. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 22161081 [PubMed - as supplied by publisher] (Source: Clinical Ortho...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Follow-up investigation of open trigger digit release

Archives of Orthopaedic and Trauma Surgery — Thu, 08 Dec 2011 18:21:53 +0100

In this study, we could show that the incidence of this disease is not significantly correlated with the manual strain, trauma, BMI, hand dominance or concomitant diseases like diabetes mellitus, rheumatoid arthritis, renal insufficiency, and hypothyroidism. Additionally, this study illustrates the importance of a careful postoperative follow-up treatment to avoid potential persistent functional limitations. Content Type Journal ArticleCategory HandsurgeryPages 1-7DOI 10.1007/s00402-011-1440-0Authors Fedaye Cakmak, Department of Hand Surgery, Vulpiusklinik, Bad Rappenau, GermanyMaya B. Wolf, Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, GermanyThomas Bruckner, Department of Medical Biometry and Informatics, University of Heidelb...

New AAN Guideline Examines Evaluation and Treatment of Transverse Myelitis

American Academy of Neurology — Wed, 07 Dec 2011 21:00:00 +0100

The guideline recommends that plasma exchange may help treat people with acute transverse myelitis (TM) who are not helped by steroid therapy. (Source: American Academy of Neurology)

Type 1 autoimmune pancreatitis

Orphanet Journal of Rare Diseases — Wed, 07 Dec 2011 05:00:00 +0100

Before the concept of autoimmune pancreatitis (AIP) was established, this form of pancreatitis had been recognized as lymphoplasmacytic sclerosing pancreatitis or non-alcoholic duct destructive chronic pancreatitis based on unique histological features. With the discovery in 2001 that serum IgG4 concentrations are specifically elevated in AIP patients, this emerging entity has been more widely accepted. Classical cases of AIP are now called type 1 as another distinct subtype (type 2 AIP) has been identified. Type 1 AIP, which accounts for 2% of chronic pancreatitis cases, predominantly affects adult males. Patients usually present with obstructive jaundice due to enlargement of the pancreatic head or thickening of the lower bile duct wall. Pancreatic cancer is the leading differential diag...

The first reported case of compound heterozygous IL1RN mutations causing deficiency of the interleukin‐1 receptor antagonist

Arthritis and Rheumatism — Thu, 01 Dec 2011 05:00:00 +0100

We report the case of a 2‐week‐old male who presented with a swollen, erythematous left index finger and elevated serum markers of inflammation. He later developed cyclical fevers, diffuse pustular skin lesions, and thrombus formation. After not responding to broad‐spectrum antimicrobial therapy and achieving only moderate success with systemic steroid therapy, he was ultimately treated with recombinant IL‐1Ra, anakinra, and experienced significant clinical improvement. Sequencing of his IL1RN gene revealed that the patient was compound heterozygous for a known mutation (E77X) associated with IL‐1Ra deficiency and a novel mutation in exon 2 of the gene (c.140delC; p.T47TfsX4). His case highlights IL‐1Ra deficiency as an autoinflammatory disease that is distinct from neonatal‐...

[The two types of auto-immune pancreatitis.]

Presse Medicale — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Rebours V, Lévy P Abstract Autoimmune pancreatitis (AIP) is a rare disease (less than 5% of all chronic pancreatitis). AIP concept was first described 20 years ago but usual diagnostic criteria were published in 2006 (HISORt criteria). Since 2 years, a new AIP concept was described distinghing two AIP types because of differences between Asian and Western series. This new classification is based on pathological features. AIP type 1 is a systemic IgG4-related disease, defined by periductal lymphoplasmacytic infiltrate with obliterative phlebitis and storiform fibrosis and/or lymphoplasmacytic infiltrate with abundant IgG4 positive-plasma cells at immunostaining. AIP type 1 fits the classic description of the disease reported in Asian series. It appears to be a pancreatic m...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Orbital inflammation: a rare association of common variable immunodeficiency.

Orbit — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: To our knowledge this is the first reported case of non-granulomatous orbital inflammation in association with CVID. This case serves to remind ophthalmologists encountering a patient with CVID that they may have associated orbital inflammatory disease which is responsive to steroid therapy similar to sterile inflammatory masses described in other organs. PMID: 22132851 [PubMed - in process] (Source: Orbit)

[Pneumopericardium after pericardiocentesis: a case report].

Turk Kardiyoloji Dernegi arsivi — Thu, 01 Dec 2011 05:00:00 +0100

We present a 61-year-old cachectic woman who developed pneumopericardium after pericardiocentesis. She presented with complaints of fatigue and shortness of breath. The chest X-ray showed an increased cardiothoracic ratio, and echocardiographic examination showed a marked pericardial effusion. Pericardiocentesis was performed and a total of 860 ml hemorrhagic pericardial fluid was aspirated. At the end of the first week after removal of the catheter, control chest radiography showed air-fluid levels in the pericardial cavity, and echocardiography revealed dense air bubbles in the decreased pericardial effusion. As the patient was hemodynamically stable, she was monitored on medical treatment. However, five days later, pericardiocentesis was repeated due to a significant increase in the per...

Glucocorticoid therapy of antigen-induced arthritis depends on the dimerized glucocorticoid receptor in T cells [Immunology]

Proceedings of the National Academy of Sciences — Tue, 29 Nov 2011 05:00:00 +0100

Despite several side effects, glucocorticoids (GCs) have been widely used for 60 y to treat rheumatoid arthritis on the basis of their antiinflammatory effects. However, the cells targeted by GCs and the transcriptional mechanisms underlying their actions through the glucocorticoid receptor (GR) in steroid therapy remain poorly defined. Using cell type-specific GR-deficient mice subjected to antigen-induced arthritis (AIA) as a model of human rheumatoid arthritis, we show that GC action on T cells but not myeloid cells is critical for therapeutic intervention in AIA. Furthermore, the resistance of mice expressing a DNA binding-defective GR (GRdim) to GC treatment reveals that dimerization of the GR is indispensable for the antiinflammatory effects. In these mice, the GC-induced suppression...

The rapid efficacy of abatacept in a patient with rheumatoid vasculitis

Modern Rheumatology — Mon, 28 Nov 2011 16:58:21 +0100

We report a case of rheumatoid vasculitis (RV) that responded well to abatacept, a cytotoxic T lymphocyte-associated antigen 4 (CTLA4)-immunoglobulin fusion protein. A 38-year-old woman developed RV despite treatment with methotrexate and tumor necrosis factor (TNF) inhibitors. The effects of steroid therapy, immunoabsorption plasmapheresis, and interleukin-6 inhibitor were insufficient, however, administration of abatacept rapidly improved her clinical symptoms with almost normalization of the immunological findings. This is the first published case report of the successful treatment of RV with abatacept. Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s10165-011-0559-8Authors Wataru Fujii, Inflammation and Immunology, Graduate School of Medical Science, Ky...

Development of intrahepatic cholangiocarcinoma after a 14‐year follow‐up of a patient with primary sclerosing cholangitis and ulcerative colitis

Hepatology Research — Mon, 28 Nov 2011 08:00:32 +0100

Intrahepatic cholangiocarcinoma (ICC) is one of the life‐threatening complications of primary sclerosing cholangitis (PSC). However, the incidence of ICC in Japanese PSC patients is low, and the association between the development of ICC and morbidity duration of PSC is largely unknown. Here, we describe a case of ICC that developed after a long‐term follow‐up of a patient with PSC and ulcerative colitis (UC). At the age of 10 years, the patient was first diagnosed with UC and its remission was achieved with systemic steroid therapy. Since then, he was routinely followed‐up. At the age of 19 years, laboratory tests showed abnormalities in liver function parameters, and the patient was diagnosed with PSC. Although treatment with ursodeoxycholic acid improved the abnormalities in...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Treatment-responsive pandysautonomia in an adolescent with ganglionic α3-AChR antibodies.

European Journal of Paediatric Neurology — Mon, 28 Nov 2011 05:00:00 +0100

We report a 13 year old girl who presented with gut pseudo-obstruction, bladder dysfunction and dilated pupils unresponsive to pilocarpine. She had positive α3-AChR Ab plus other autoantibodies suggesting an autoimmune diathesis. Our patient was initially resistant to steroid therapy but responded to the addition of azathioprine resulting in a near complete clinical remission. We conclude that pandysautonomia associated with α3-AChR Ab can occur in children and has multi-organ involvement. PMID: 22130491 [PubMed - as supplied by publisher] (Source: European Journal of Paediatric Neurology)

Immunoglobulin m nephropathy in a patient with systemic lupus.

The American Journal of the Medical Sciences — Sat, 26 Nov 2011 16:06:29 +0100

Authors: Benz RL, Finnigan NA, Elfenbein B Abstract Immunoglobulin M (IgM) nephropathy is an uncommon glomerular disease characterized by IgM deposits in the mesangium. This case report describes a 52-year-old woman with a 10-year history of underlying systemic lupus erythematosus with minimal proteinuria who developed sudden onset of nephrotic syndrome. Renal biopsy revealed IgM nephropathy, with no clear evidence of lupus nephritis. Complements and dsDNA serologies were negative. The nephrotic syndrome resolved with prednisone therapy. Four months later, while receiving a maintenance dose of prednisone, the proteinuria relapsed. Remission was achieved after a repeat course of steroid therapy. Low-dose prednisone therapy was maintained thereafter for long-standing steroid-dependen...

Cytokine Storm of Acute Necrotizing Encephalopathy

Pediatric Neurology — Fri, 25 Nov 2011 13:48:58 +0100

We describe a rare North American case of acute necrotizing encephalopathy attributable to human herpes virus-6 is a 9-month-old white male. The infant moved to the United States from Hong Kong, 3 months before disease onset. A workup revealed elevations in serum interleukin-1β, interleukin-2, and interleukin-10, with normal values of interleukin-6 and tumor necrosis factor-α after the initiation of high-dose steroids. This profile is unique compared with previous cytokine profiles of this disease, possibly because of the effects of steroid therapy. A rare North American case with a history of birth in East Asia underscores the possibility of a role for environmental pathogens in this disease. (Source: Pediatric Neurology)

Discordant clinicopathological features in monozygotic twins with IgA nephropathy

Nephrology Dialysis Transplantation — Fri, 25 Nov 2011 05:00:00 +0100

This report describes a pair of identical twins with IgA nephropathy (IgAN). One of them showed diffuse mesangial proliferation with crescent formations in the glomeruli, moderate proteinuria and required intensive therapies including corticosteroids for remission. In contrast, the other had only focal mesangial alterations and exhibited only a subtle level of urinary abnormalities throughout the follow-up without steroid therapy. Although our monozygotic twins have completely identical genotypes, the clinicopathological features of their IgAN were quite discordant. The present cases suggest that not only genetic factors but also epigenetic differences may be involved in the progression of IgAN. (Source: Nephrology Dialysis Transplantation)

Emergency versus elective living-donor liver transplantation: a comparison of a single center analysis

Surgery Today — Thu, 24 Nov 2011 17:49:42 +0100

Conclusion Careful perioperative management, including preoperative investigation of aspergillosis and empiric antibiotic therapy, should be considered for emergency LDLT patients who fulfill IPA risk factors. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00595-011-0040-5Authors Kazuhisa Takeda, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JapanKuniya Tanaka, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JapanTakafumi Kumamoto, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, ...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Comparison of the effects of intravenous methylprednisolone pulse versus oral prednisolone therapies on the first attack of minimal‐change nephrotic syndrome in adults

Nephrology — Thu, 24 Nov 2011 05:00:00 +0100

Conclusion: Intravenous methylprednisolone pulse followed by oral prednisolone therapy shows an earlier responsiveness but a much frequent relapse compared to conventional oral prednisolone alone therapy for the first attack of adult‐onset MCNS. (Source: Nephrology)

Two Japanese patients with esophageal eosinophilia detected by routine medical examination

Esophagus — Wed, 23 Nov 2011 17:38:04 +0100

Abstract Eosinophilic esophagitis (EoE) is rarely diagnosed condition involving eosinophilic infiltration of the esophageal mucosa. EoE in adults has been increasingly recognized and actively investigated in Western countries, but few cases have been reported in Asian populations. Herein, we report two Japanese cases of esophageal eosinophilia detected by routine medical examination. One patient had heartburn, and endoscopy of the esophagus showed whitish elevated lesions resembling papillomas and persistent concentric rings. Esophageal biopsies confirmed esophageal eosinophilia and EoE was diagnosed. The patient’s condition improved with proton pump inhibitor treatment followed by topical steroid therapy. The other patient was asymptomatic, but endoscopy revealed white ...

Local Steroid Therapy As The First Line Treatment For Boys With Symptomatic Phimosis – A Long Term Prospective Study

Acta Paediatrica — Mon, 21 Nov 2011 05:00:00 +0100

Conclusion: Local Steroid Therapy is safe and successful in alleviating symptomatic tight foreskin in a large majority of children. The response can be seen as early as one week, most of the children respond by week 2 and continuing therapy further may not be very effective. (Source: Acta Paediatrica)

Local steroid therapy as the first‐line treatment for boys with symptomatic phimosis – a long‐term prospective study

Acta Paediatrica — Mon, 21 Nov 2011 05:00:00 +0100

Conclusion: Local steroid therapy is safe and successful in alleviating symptomatic tight foreskin in a large majority of children. The response can be seen as early as 1 week; most of the children respond by week 2 and continuing therapy further may not be very effective. (Source: Acta Paediatrica)

Testicular adrenal rest tumor in infertile man with congenital adrenal hyperplasia: case report and literature review.

Sao Paulo Medical Journal — Sun, 20 Nov 2011 21:06:02 +0100

We present the case of a male patient with CAH due to 21-hydroxylase deficiency who presented a testicular tumor and azoospermia. Treatment with low daily corticoid doses had previously been started by an endocrinologist, but after 12 months, no significant change in sperm count was found. Although the adrenocorticotrophic hormone and 17-hydroxyprogesterone levels returned to normal values, the follicle-stimulating hormone (FSH), luteinizing hormone and testosterone levels remained unchanged. Ultrasound examination confirmed that the testicles were small and heterogenous bilaterally, and revealed a mosaic area at the projection of the testis network bilaterally. Magnetic resonance imaging confirmed the finding. Testicular biopsy revealed the presence of preserved spermatogenesis and spermi...

MedWorm Sponsor Message: Find the best January Sales in the UK.

The level of native and oxidized lipoprotein(a) in children with nephrotic syndrome.

Clinical Biochemistry — Sat, 19 Nov 2011 05:00:00 +0100

CONCLUSIONS: Lp(a), ox-Lp(a) and Lp(a)-IC levels were increased in NS children, which may play an important role in the processes of atherosclerosis. PMID: 22122998 [PubMed - as supplied by publisher] (Source: Clinical Biochemistry)

Immunoglobulin subclass 4 for the diagnosis of immunoglobulin subclass 4‐associated diseases in an unselected liver and pancreas clinic population

HPB: official journal of the International Hepato Pancreat Biliary Association — Wed, 16 Nov 2011 05:00:00 +0100

Conclusion: IgG4 has a reasonable sensitivity and specificity in a liver and pancreas clinic population, where liver cirrhosis appears to be the most frequent differential diagnosis for elevated IgG4 concentrations. (Source: HPB: official journal of the International Hepato Pancreat Biliary Association)

The ophthalmic side-effects of imiquimod therapy in the management of periocular skin lesions

British Journal of Ophthalmology — Wed, 16 Nov 2011 05:00:00 +0100

Conclusion Conjunctivitis and ocular stinging were the commonest ophthalmic side-effects encountered with the application of imiquimod for periocular skin lesions. These effects were temporary and resolved on terminating the imiquimod therapy. (Source: British Journal of Ophthalmology)

A treatment dilemma in adult immunoglobulin A nephropathy: what is the appropriate target, preservation of kidney function or induction of clinical remission?

Clinical and Experimental Nephrology — Tue, 15 Nov 2011 16:47:22 +0100

Abstract Immunoglobulin (Ig) A nephropathy is the most common type of glomerulonephritis worldwide. Data on its natural history suggest that approximately 40% of patients progress to end-stage renal failure after 20 years. Various therapies such as antiplatelet medication, fish oil, oral prednisolone, intravenous prednisolone, tonsillectomy, and tonsillectomy plus steroid pulse (TSP) have been proposed. Japanese nephrologists face challenging issues regarding this disease, such as the usefulness of the annual urinary screening system (kenshin) and kidney biopsies, the desire of patients and their families for treatment despite insufficient clinical evidence, and the risk of overtreatment with TSP versus the loss of a ‘golden period’ with late intervention. We revi...

Iliopsoas abscess caused by Aspergillus fumigatus complicated by pulmonary aspergillosis

Journal of Infection and Chemotherapy — Mon, 14 Nov 2011 06:35:13 +0100

We report a case of iliopsoas abscess caused by Aspergillus fumigatus with pulmonary complications. A 60-year-old man was admitted to the Showa University Hospital Department of Gastroenterology with fulminant hepatitis B on April 14, 2010, and treated with steroids. Although fulminant hepatitis B was improved by steroid and symptomatic therapy, he developed a fever on hospital day 39. The chest X-ray film showed a nodular lesion in the right middle-lower lung field, and both the (1 → 3)-β-d-glucan and Candida mannan antigen tests were positive. The β-d-glucan level increased despite treatment with fluconazole and other drugs, including low-dose micafungin. Abdominal computed tomography showed a low-density area in the right iliopsoas muscle. He was then referred to the D...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Long-term outcome of cap polyposis, with special reference to the effects of steroid therapy

Gastrointestinal Endoscopy — Mon, 14 Nov 2011 05:00:00 +0100

Since the first description of cap polyposis as a particular type of colorectal polyp with an inflammatory “cap,” many patients with this condition have been described. These caps are characterized by fibrinopurulent exudates covering the surface of the polyp on colonoscopic examination. Clinically, these caps cause mucoid diarrhea and are histologically associated with inflammatory granulation tissue covering the top of the polyp. Despite the clear endoscopic and histologic features of cap polyposis, its pathogenesis is still obscure, and effective treatment modalities have not been established. Various treatment modalities have been tried, including avoidance of straining at defecation, treatment with metronidazole, antibiotics, 5-aminosalicylic acid (5-ASA), steroids, Helicobacter p...

Musculoskeletal Complications of Severe Acute Respiratory Syndrome

Seminars in Musculoskeletal Radiology — Fri, 11 Nov 2011 05:00:00 +0100

Semin Musculoskelet Radiol 2011; 15: 554-560DOI: 10.1055/s-0031-1293500ABSTRACTThe severe acute respiratory syndrome (SARS) was a highly infectious pneumonia that emerged in southern China early in 2003. A large number of SARS patients experienced large joint arthralgia, although this was, for the most part, not associated with any abnormality on magnetic resonance imaging. The main musculoskeletal complications of SARS were osteonecrosis and reduced bone mass, and these arose not from the disease per se but as a sequel to treatment of SARS with high-dose steroids. SARS patients were almost universally steroid naive with no other known predisposition to osteonecrosis. Prevalence of osteonecrosis in SARS patients treated with steroids ranged from 5% to 58%. Osteonecrosis most commonly affec...

Consensus treatments for moderate juvenile dermatomyositis: Beyond the first two months

Arthritis Care and Research — Thu, 10 Nov 2011 05:00:00 +0100

Conclusions:We were able to develop consensus treatment plans which describe therapy for moderate JDM throughout the treatment course. These treatment plans can now be used clinically, and data collected prospectively regarding treatment effectiveness and toxicity. This will allow comparison of these treatment plans and facilitate the development of evidence‐based treatment recommendations for moderate JDM. © 2011 by the American College of Rheumatology. (Source: Arthritis Care and Research)

Granulomatous mastitis: is it an autoimmune disease? Diagnostic and therapeutic dilemmas

Surgery Today — Wed, 09 Nov 2011 07:02:20 +0100

Conclusions The diagnosis of GM should be made carefully to avoid a misdiagnosis. Steroid therapy should be considered based on the idea that this is an autoimmune disease. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00595-011-0046-zAuthors Leyla Özel, Department of 1st General Surgery and Transplantation, Haydarpasa Numune Training and Research Hospital, Istanbul, TurkeyAysun Ünal, Department of Gynecology and Obstetrics, Haydarpasa Numune Training and Research Hospital, Istanbul, TurkeyEthem Ünal, Department of 1st General Surgery and Transplantation, Haydarpasa Numune Training and Research Hospital, Istanbul, TurkeyMelih Kara, Department of 1st General Surgery and Transplantation, Haydarpasa Numune Training and Research Hospital, ...

Symptomatic severe hypertriglyceridaemia with asparaginase therapy in acute lymphoblastic leukaemia (ALL) and lymphoblastic lymphoma: is rechallenging safe?

International Journal of Hematology — Tue, 08 Nov 2011 05:00:00 +0100

We report six cases, four of which developed significant problems with severe hyperlipidaemia during induction therapy for ALL and lymphoblastic lymphoma. The median triglyceride level was 22.3 mmol/L and the median cholesterol level was 12.3 mmol/L. None of the patients showed signs or symptoms of pancreatitis. Three children were re-exposed with Peg asparaginase, and one with Erwinia asparaginase, without recurrence of hyperlipidaemia or other symptoms. These cases highlight the dilemma in managing such rare cases of symptomatic hypertriglyceridaemia secondary to asparaginase and steroid therapy. PMID: 22057510 [PubMed - as supplied by publisher] (Source: International Journal of Hematology)

MedWorm Sponsor Message: Find the best January Sales in the UK.

The bittersweet of steroid therapy

Cleveland Clinic Journal of Medicine — Wed, 02 Nov 2011 04:00:00 +0100

(Source: Cleveland Clinic Journal of Medicine)

[Idiopathic retroperitoneal fibrosis.]

Orvosi Hetilap — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Székely H, Hagymási K, Sápi Z, Hartmann E, Mihály E, Műzes G, Tulassay Z Abstract Retroperitoneal fibrosis is the chronic, nonspecific inflammation of the retroperitoneum. About 75% of the cases are idiopathic. The pathomechanism of the disorder is not clearly defined. Autoimmune inflammation and secondary fibrosis are the main suspected mechanisms against an unknown factor possibly related to atherosclerosis. Symptoms and laboratory parameters are nonspecific which make the diagnosis difficult. At the time of the diagnosis complications are often present. After the urological and surgical management of the complications, the aim of the medical treatment is immunosuppression. Corticosteroids are usually used for treatment, although the optimal dosage and the duration ...

Studies of Circulating Microparticle Release in Peripheral Blood After Pancreatic Islet Transplantation

Transplantation Proceedings — Tue, 01 Nov 2011 04:00:00 +0100

Abstract: The loss of graft function after intraportal islet transplantation is likely multifactorial involving allogeneic rejection, recurrent autoimmunity, graft exhaustion due to a marginally implanted islet mass, immunosuppressant toxicity, and impaired β-cell regeneration. Because early markers of the loss of β-cell mass or function are lacking, monitoring of islet function remains a challenging issue. We have reported herein monitoring of membrane procoagulant microparticles (MPs) as markers of cell stress in the plasma of three recipients with various clinical histories. Early kinetics of C-peptide and MPs followed identical patterns during the first weeks after transplantation; a major increase probably reflected processes related to cell infusion and islet engraftment. Important...

Early non-invasive diagnosis and treatment of acute eosinophlic myopericarditis by cardiac magnetic resonance.

J Korean Med Sci — Tue, 01 Nov 2011 04:00:00 +0100

We report a case of early non-invasive diagnosis of acute eosinophilic myopericarditis (AEM) by cardiovascular magnetic resonance (CMR) before cardiac biopsy. A 35-yr-old woman presented with a flu-like illness, followed by pleuritic chest pain and shortness of breath. Transthoracic echocardiography revealed mild left ventricular (LV) systolic dysfunction with borderline LV wall thickness and moderate pericardial effusion. The patient had peripheral eosinophilia and CMR was performed immediately at first day of visit before cardiac biopsy. CMR showed diffuse subepicardial high T2 signals and diffuse late gadolinium enhancement in LV. Steroid therapy was immediately initiated and patient's symptom was rapidly improved. Endomyocardial biopsy at hospital day 3 reported multifocal mild infiltr...

Comparison of inhibitors of renin–angiotensin–aldosterone system (RAS) and combination therapy of steroids plus RAS inhibitors for patients with advanced immunoglobulin A nephropathy and impaired renal function

Clinical and Experimental Nephrology — Fri, 28 Oct 2011 17:24:54 +0100

Conclusion Combination therapy with steroids and RASIs was not superior to monotherapy with RASIs for advanced IgAN with impaired renal function. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s10157-011-0545-7Authors Takahito Moriyama, Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JapanKayu Nakayama, Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JapanAyami Ochi, Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JapanNobuyuki Amemiya, Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Sh...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Degree of Mucositis and Duration of Neutropenia are Major Risk Factors for Early Post‐Transplant Febrile Neutropenia and Severe Bacterial Infections after Reduced‐Intensity Conditioning

European Journal of Haematology — Mon, 24 Oct 2011 04:00:00 +0100

Conclusions: After an RIC‐allo, FN and early SBI occur mostly in patients with severe mucositis and early‐onset neutropenia, while post‐engraftment high‐dose steroid therapy for aGVHD was the major risk factor. (Source: European Journal of Haematology)

Recurrent partial seizures with ictal yawning as atypical presentation of Hashimoto's encephalopathy (steroid-responsive encephalopathy associated with autoimmune thyroiditis).

Epilepsy and Behaviour — Mon, 24 Oct 2011 04:00:00 +0100

We describe a 19-year-old female patient who had been referred to the psychiatric unit because of behavioral disorders characterized predominantly by delirium with sexual content. She developed recurrent focal seizures characterized by atypical ictal semiology (repetitive forceful yawning) and a rare EEG pattern (recurrent seizures arising from the left temporal region without evident "encephalopathic" activity). The presence of anti-thyroperoxidase antibodies in her cerebrospinal fluid and a good response to steroids confirmed the diagnosis of HE. The atypical presentation in the case we describe appears to widen the electroclinical spectrum of HE and highlights its importance for differential diagnosis purposes in the neuropsychiatric setting. PMID: 22030535 [PubMed - as supplied by ...

Cerebral edema following photodynamic therapy using endogenous and exogenous photosensitizers in normal brain

Lasers in Surgery and Medicine — Thu, 20 Oct 2011 03:42:31 +0100

ConclusionsT2 and contrast enhanced T1 MRI scanning proved to be a highly effective and noninvasive modality in following the development of the edema reaction and the degree and time course of blood–brain barrier dysfunction thus allowing the use of fewer animals. ALA mediated PDT induced a lower edema reaction than that observed with the photosensitizer AlPcS2a. Lasers Surg. Med. 43:892‐900, 2011. © 2011 Wiley Periodicals, Inc. (Source: Lasers in Surgery and Medicine)

Immunoglobulin G4-related Periaortitis and Periarteritis: CT Findings in 17 Patients [Vascular and Interventional Radiology]

Radiology — Wed, 19 Oct 2011 04:00:00 +0100

Conclusion: IgG4-related arterial lesions occur mainly in the aorta and its main branches and are radiologically characterized by homogeneous arterial wall thickening corresponding to pathologic features of IgG4-related sclerosing inflammation in the adventitia. © RSNA, 2011 (Source: Radiology)

Steroid-induced psychosis in a child: treatment with risperidone

General Hospital Psychiatry — Wed, 19 Oct 2011 04:00:00 +0100

Abstract: Steroid-induced psychosis is one of the most serious adverse effects of steroid therapy but is a little-known complication in children. There is no clear mechanism model for steroid-induced behavioral disturbance, but it may be related with dose or level of free fraction of steroids. Our case is a 12-year-old boy diagnosed with steroid-induced psychosis and treated with risperidone, an atypical antipsychotic, due to distinct psychotic symptoms. Pediatricians should be aware of this rare complication when administering corticosteroids for various medical illnesses. (Source: General Hospital Psychiatry)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Retinal photoreceptor focal disruption secondary to accidental Nd:YAG laser exposure

International Ophthalmology — Fri, 14 Oct 2011 15:43:49 +0100

Abstract Retinal injuries caused by accidental laser exposure include retinal or vitreous hemorrhages, macular holes and edema. We describe the imaging of a bilateral macular lesion secondary to accidental Nd:YAG laser exposure. Observational case report. We performed color photography, fluorescein angiography and autofluorescence (AF) with a scanning laser ophthalmoscope, as well as time-domain and spectral-domain optical coherence tomography (OCT). After accidental exposure to a 1064 nm Nd:YAG laser, a patient experienced blurred vision in the left eye (LE) with visual acuity of 20/60. Color, fluorescein angiography and OCT imaging showed a retinal hemorrhage in the foveal area of the left eye and in the inferomacular region of the asymptomatic right eye. Steroid th...

New onset sarcoid‐like granulomatosis developing during Anti‐TNF therapy: an under‐recognised complication

Internal Medicine Journal — Wed, 12 Oct 2011 04:00:00 +0100

Conclusion: Development of sarcoidosis‐like granulomatosis in patients treated with TNF‐α antagonists is a phenomenon previously under‐recognised. All 3 anti‐TNF agents have been observed to cause this phenomenon, suggesting of a ‘class effect’ rather than being drug specific. (Source: Internal Medicine Journal)

Perifollicular granulomatous inflammation in reactive lymph nodes: a possible morphologic marker for IgG4 plasmacytosis

Journal of Hematopathology — Tue, 11 Oct 2011 15:53:21 +0100

This study adds to the morphologic spectrum of IgG4-related lymphadenopathy. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s12308-011-0117-5Authors Imran N. Siddiqi, Department of Pathology, University of Southern California Keck School of Medicine, 2011 Zonal Ave., HMR 209, Los Angeles, CA 90033, USARussell K. Brynes, Department of Pathology, University of Southern California Keck School of Medicine, 2011 Zonal Ave., HMR 209, Los Angeles, CA 90033, USAKate Grimm, Clarient Inc./GE Healthcare, Aliso Viejo, CA, USADennis P. O’Malley, Clarient Inc./GE Healthcare, Aliso Viejo, CA, USAEndi Wang, Department of Pathology, Duke University Medical Center, Durham, NC, USA Journal Journal of HematopathologyPrint ISSN 1868-9256 (Source: Journal of Hematopat...

D-penicillamine in the treatment of eosinophilic fasciitis: case reports and review of the literature

Clinical Rheumatology — Tue, 11 Oct 2011 15:53:07 +0100

Abstract Eosinophilic fasciitis (EF) is a rare disease characterized by symmetrical thickness and hardening of the skin, especially localized to forearms and thorax, with eosinophilia. Corticosteroids represent the first-line therapy, even if some patients are scarcely responsive and/or may develop important side effects due to long-term treatment. Here, we describe three cases of EF, two of them refractory to previous steroid therapy, successfully treated with D-penicillamine. The present clinical observations together with the updated review of the literature suggest usefulness of D-penicillamine in EF patients, as well as its potential steroid-sparing value. Content Type Journal ArticleCategory Case Based ReviewPages 1-5DOI 10.1007/s10067-011-1866-3Authors CU Manz...

Idiopathic hypertrophic cranial pachymeningitis: Three biopsy-proven cases including one case with abdominal pseudotumor and review of the literature

Annals of Indian Academy of Neurology — Tue, 11 Oct 2011 04:00:00 +0100

We report three biopsy-proven cases of idiopathic hypertrophic cranial pachymeningitis. All our patients had headaches and multiple cranial neuropathies; ataxia was seen in one patient. One patient had recurrent anterior and posterior cranial neuropathies, while one each had recurrent anterior and posterior cranial neuropathies. Two patients had profound irreversible mono-ocular visual loss. All of them showed prominent pachymeningeal thickening on imaging. Infarcts were seen in one patient, which have rarely been documented. All patients showed biopsy evidence of meningeal thickening and nonspecific chronic inflammation of the dura. The disease may have a remitting and relapsing course, and usually responds to steroids. Clinical improvement was excellent in two patients and modest in one ...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Cardiovascular Disease and Primary Ovarian Insufficiency

Seminars in Reproductive Medicine — Mon, 03 Oct 2011 04:00:00 +0100

Semin Reprod Med 2011; 29: 328-341DOI: 10.1055/s-0031-1280918ABSTRACTCardiovascular disease (CVD) is the number-one killer of women. Women with primary ovarian insufficiency (POI) may be more burdened by cardiovascular disease, such as myocardial infarction and stroke, as compared with women with normal menopause. The increased burden may be mediated by a worsening of cardiovascular risk factors, such as lipids, corresponding with the loss of ovarian function. In contrast, the increased burden may be caused by factors that precede and potentially contribute to both CVD events and ovarian decline, such as X-chromosome abnormalities and smoking. Regardless of the cause, women with POI may serve as an important population to target for CVD screening and prevention strategies. These strategies...

Integrating Outcome Benefit Into Anesthetic Design: The Promise of Steroids and Statins

Journal of Cardiothoracic and Vascular Anesthesia — Sat, 01 Oct 2011 04:00:00 +0100

Steroids and statins may facilitate the integration of anesthetic design with clinical outcome. Although steroids clearly benefit adult cardiac surgical patents, the evidence is weaker in pediatric cardiac surgery. Current large randomized trials of steroids likely will determine the future role of steroids in adult cardiac surgery. In the intensive care unit, steroid therapy is indicated in septic shock that is refractory to fluid and pressor therapy. Recent data, however, indicate that liberal steroid therapy for sepsis may have adverse outcome consequences. A 2nd concern in the intensive care unit is acute adrenal suppression secondary to bolus etomidate therapy because it may be deleterious in patients with septic shock. Possible clinical solutions include alternative induction agents,...

Relative efficacy of steroid therapy in immune thrombocytopenia mediated by anti‐platelet GPIIbIIIa versus GPIbα antibodies

American Journal of Hematology — Sat, 01 Oct 2011 04:00:00 +0100

AbstractImmune thrombocytopenia (ITP) is characterized by platelet clearance mediated primarily by autoantibodies against the platelet GPIIbIIIa and/or GPIbα. Steroid therapy is a first‐line treatment for ITP. However, some patients are refractory to this therapy and currently no method can predict which patients will respond. To evaluate whether steroids are equally efficacious in treating patients with ITP caused by anti‐GPIIbIIIa versus anti‐GPIbα antibodies, we performed a retrospective study on 176 newly diagnosed acute ITP patients who had severe bleeding symptoms and were admitted as resident patients to the hospital. The patients were treated first with intravenous administration of high‐dose Dexamethasone, followed by oral administration of Prednisone. Response to therap...

Predictive value of response to steroid therapy on response to splenectomy in children with immune thrombocytopenic purpura

Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Background: Many but not all studies suggest that a favorable response to preoperative steroid therapy predicts a successful outcome after splenectomy in children with immune thrombocytopenic purpura (ITP). The purpose of this study is to further examine the relationship between steroid response and outcome after splenectomy in children.Methods: After institutional review board approval, records of children undergoing splenectomy for ITP were reviewed. Patients’ responses were determined by platelet counts and grouped by complete response (CR; ≥150,000/μL), partial response (PR; 149,999– ≥50,000/μL), or no response (NR; (Source: Surgery)

Immunoglobulin G4-Related Periaortitis Mimicking an Intramural Hematoma [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

We present a case of IgG4-related periaortitis of the ascending aorta mimicking an intramural hematoma in the computed tomography (CT) scan, which led to an unnecessary surgery. IgG4-related periaortitis needs to be considered in the differential diagnosis in a patient with thickened aortic wall because the disease should be treated medically in light of its good response to steroid therapy. (Source: The Annals of Thoracic Surgery)

MedWorm Sponsor Message: Find the best January Sales in the UK.

Association of Glucocorticoid Use and Low 25-Hydroxyvitamin D Levels: Results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006.

The Journal of Clinical Endocrinology and Metabolism — Wed, 28 Sep 2011 04:00:00 +0100

Conclusion:Steroid use is independently associated with 25(OH)D deficiency in this nationally representative cohort limited by cross-sectional data. It suggests the need for screening and repletion in patients on chronic steroids. PMID: 21956424 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Combination of steroids and ischial weight-bearing knee ankle foot orthoses in Duchenne’s muscular dystrophy prolongs ambulation past 20years of age – A case report

Neuromuscular Disorders — Thu, 22 Sep 2011 04:00:00 +0100

We report the outcome of the ambulatory status of a patient with DMD treated with daily steroid therapy and orthoses. This male patient was diagnosed with DMD at age of 2. He has been treated with daily steroids since age 7years. He lost the ability to arise from the floor and walk up steps at age 14 and lost ambulation by age 16. He was fitted with orthoses at age 16 following surgical correction of his lower extremity contractures and regained independent ambulation. At age 20, he was able to stand independently in his orthoses and take steps with moderate support. We conclude that a combination of daily steroids and orthoses prolongs ambulation beyond that of the natural history DMD. (Source: Neuromuscular Disorders)

Prospective Comparison of Cisterna Chyli Ablation to Pericardectomy for Treatment of Spontaneously Occurring Idiopathic Chylothorax in the Dog

Veterinary Surgery — Fri, 16 Sep 2011 04:00:00 +0100

ConclusionsCCA‐TDL appears to offer improved outcomes over historical results with TDL. Results with PC‐TDL were more variable for unknown reasons. Venous pressure measurements did not support the hypothesis that venous hypertension was involved in chylothorax or response to therapy in these dogs. (Source: Veterinary Surgery)

BET 2: Steroid therapy in the treatment of intractable hyperemesis gravidarum

Emergency Medicine Journal — Wed, 14 Sep 2011 04:00:00 +0100

A short-cut review was performed to evaluate whether steroids could be an effective therapy in hyper-emesis gravidarum. A database search revealed 9 papers relevant to this question and the details of each study methods and results were displayed in a table. The quality of these studies was generally low. There is only weak evidence that steroids could be an effective treatment for intractable hyper-emesis gravidarum. (Source: Emergency Medicine Journal)

Cerebral Amyloid Angiopathy-related Inflammation Presenting with Steroid-responsive Higher Brain Dysfunction: Case Report and Review of the Literature

Journal of Neuroinflammation — Wed, 14 Sep 2011 04:00:00 +0100

A 56-year-old man noticed discomfort in his left lower limb, followed by convulsion and numbness in the same area. Magnetic resonance imaging (MRI) showed white matter lesions in the right parietal lobe accompanied by leptomeningeal or leptomeningeal and cortical post-contrast enhancement along the parietal sulci. The patient also exhibited higher brain dysfunction corresponding with the lesions on MRI. Histological pathology disclosed beta-amyloid in the blood vessels and perivascular inflammation, which highlights the diagnosis of cerebral amyloid angiopathy (CAA)-related inflammation. Pulse steroid therapy was so effective that clinical and radiological findings immediately improved.CAA-related inflammation is a rare disease, defined by the deposition of amyloid proteins within the lept...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

A patient with anti-aquaporin 4 antibody presenting hypersomnolence as the initial symptom and symmetrical hypothalamic lesions

Journal of the Neurological Sciences — Wed, 14 Sep 2011 04:00:00 +0100

Abstract: Here we report a case with positive serum anti-aquaporin 4 (AQP4) antibody who presented with hypersomnolence, symmetrical hypothalamic lesions and a reduced CSF orexin (hypocretin) level without optic nerve and spinal cord lesions on MRI. All of the symptoms, MRI finding and CSF orexin level improved simultaneously after steroid therapy. AQP4 is a member of the AQP superfamily which is strongly expressed in the hypothalamus where orexin (hypocretin)-containing neurons are primarily concentrated. Although there have been only a few reports similar to our case, the present case suggests a close relationship between the positive serum anti-AQP4 antibody and symmetrical hypothalamic lesions with hypersomnolence and without optic /spinal lesion, which is improved by steroid treatment...

P5.69 Bulbofacial myopathy with anti-amphiphysin 2 (BIN 1) antibodies – A new paraneoplastic neurological syndrome?

Neuromuscular Disorders — Tue, 13 Sep 2011 03:40:12 +0100

A 51year old woman presented with a four year history of slowly progressive dysphagia, dysarthria, mild facial and proximal muscle weakness. Her CK was elevated to >800U/l and EMG demonstrated pathological spontaneous activity in one iliopsoas muscle only, while other muscles were found normal. As work-up for motoneuron disease, amyloidosis and scleroderma did not provide a diagnosis, a deltoid muscle biopsy was taken to rule out myositis. Histology showed a marked, selective type II fibre atrophy without further relevant changes. Work-up for associated disorders revealed bilateral invasive ductal mammary carcinoma. After surgery, radio- and chemotherapy, dysphagia and dysarthria improved. The CK fell to about 400U/l. Serum screening for paraneoplasic diseases associated (’onconeural’)...

P5.65 The effects of Omega-3 fatty acid on skeletal muscle atrophy induced by Dexamethasone

Neuromuscular Disorders — Tue, 13 Sep 2011 03:40:11 +0100

In conclusion, while the Omega-3 is known to be effective in attenuating the muscle atrophy induced by sepsis and cancer, we were unable to demonstrate the same beneficial effect on muscle atrophy induced by DEXA. The identification of nutritional supplements that are able to alleviate the side effects of steroids on skeletal muscle, i.e. muscle atrophy, and the potential molecular pathways involved in this process, would be very important in the medical practice. (Source: Neuromuscular Disorders)

P4.3 Use of the motor function measure scale to analyze effects of steroid therapy on patients with Duchenne Muscular Dystropy

Neuromuscular Disorders — Tue, 13 Sep 2011 03:39:57 +0100

The objective of this study was to assess the evolution of motor function in patients with DMD treated with steroids (prednisolone or deflazacort) through the MFM. Thirty-three patients with DMD (22 ambulant, six non-ambulant and five who lost the capacity to walk during the period of the study) were assessed using the MFM scale on six times over a period of 18months. Motor functions remained stable during a period of 14months and in ambulant patients D2 improved during a period of 6months; an improvement in D3 was noted during the total follow-up. D1 and total score were useful to predict the loss of the ability to walk. The use of the MFM in DMD patients confirms the benefits of the steroid treatment for slowing the progression of the disease (Supported by CAPES). (Source: Neuromuscular ...

P4.4 Lung function monitoring in patients with Duchenne muscular dystrophy on steroid therapy

Neuromuscular Disorders — Tue, 13 Sep 2011 03:39:57 +0100

Duchenne muscular dystrophy (DMD) is a severe recessive X-linked inherited muscle disease characterized by a progressive loss in muscle strength and respiratory muscle involvement. After 12years of age, lung function declines at a rate of 6–10.7% per year in patients with DMD. Steroid therapy has been proposed to delay the loss of motor function and also the respiratory involvement. In this uncontrolled, prospective study, the objectives were to assess the pulmonary function of patients with DMD on steroid therapy and to evaluate the influence of chronological age, age at onset of therapy, and walking ability (ambulant or non-ambulant) on lung volumes. In 21 patients with DMD aged between seven and 16years, the forced vital capacity (FVC) and the forced expiratory volume in one second (F...

MedWorm Sponsor Message: Find the best January Sales in the UK.

P4.6 Efficacy of low-dose steroid therapy for scoliosis in patients with Duchenne muscular dystrophy

Neuromuscular Disorders — Tue, 13 Sep 2011 03:39:57 +0100

In this study, we evaluated the effect of low-dose and long-term steroid therapy on scoliosis in patients with DMD. In non-ambulatory DMD patients, the severity of scoliosis was evaluated in steroid-treated and non-steroid-treated groups. Twenty three DMD patients were evaluated. Steroids were not used in 12 patients (age 9–31years: mean 17.72years) and were used in the other 11 (age 10–24years: mean 18.18years). The steroid therapy regimen was 0.5mg/kg/day of prednisolone every other day, and the mean duration of therapy was 9.06years (1–18years). The mean age of losing ambulation was 11.0years in the steroid-treated group and 10.0years in non-steroid-treated group, without a statistically difference. In patients more than 20years of age, Cobb° angle was over 100° in 3 of 4 patien...

P1.9 Glucocorticoid therapy in a non-ambulant six year old boy with Duchenne muscular dystrophy

Neuromuscular Disorders — Tue, 13 Sep 2011 03:39:54 +0100

We report on a boy first seen in our outpatient clinic at the age of two years. In the context of a common cold blood samples were taken and showed a markedly increased result of creatine kinase level of about 36,000U/l. Genetic analysis (sequencing) showed a deletion of two bases in exon 27 in the dystrophin gene leading to an out-of-frame-mutation confirming the diagnosis of Duchenne muscular dystrophy. Until this age the boy showed a motor delay in sitting stable (age 27months), in crawling (age 30months), in babble (age 12months). Until the age of six he was not able to walk independently, only a few steps with assistance. Nevertheless we decided to treat the patient with daily Deflazacort (0.9mg/kg daily). The next four to six weeks he started to walk independently and by that he impr...

P1.36 Evaluation of the quality of life in patients with Duchenne Muscular Dystrophy

Neuromuscular Disorders — Tue, 13 Sep 2011 03:39:54 +0100

The objective of this study was to qualify and quantify QoL at different dominions of life and stages of DMD by means of the questionnaires AUQUEI, SF-36 and LSI-A, and comparing them regarding practicality and effectiveness. Ninety-five patients with DMD on steroid therapy were divided into four groups according to the stage of the illness: A=5–7years of age, B=8–10years, C=11–13years and D=older than 13 years. The questionnaires were applied four times in a period of one year. The results concerning the four applications and the reliability inter and intra-examiner were statistically examined. Comparing the different age groups using the LSI-A patients with DMD did not lose QoL, even with disease progression. Otherwise the results of AUQUEI and SF-36 showed that patients with DMD l...

P1.2 Phenotypic profile of dystrophinopathy patients with deletion of exons 3–7 of the dystrophin gene

Neuromuscular Disorders — Tue, 13 Sep 2011 03:39:53 +0100

Deletion of exons 3–7 is an out of frame deletion predictive of Duchenne muscular dystrophy (DMD) but is commonly associated with a milder phenotype. An accurate clinical profile of such patients would be of value for prognosis and patient selection for clinical trials. To characterize the clinical phenotype of dystrophinopathy patients with deletion of exons 3–7. IRB approved retrospective case series’ review. Patient characteristics: 14 ambulatory males with deletion of exons 3–7. Mean age at last visit – 11.1yrs (range 5.7–15.8); mean CK (4–10yr) – 13310 (4269–26,020); FH DMD in 6/14 – mean age of loss of ambulation (LOA) 12.9yr (10–18) in 5; and deaths at 19–44yrs. Muscle biopsy (3/14) – decreased dystrophin. MRI pelvic muscle (13/14) – mild to moderate fatt...

Thrombotic Thrombocytopenic Purpura Associated with Mixed Connective Tissue Disease: A Case Report

Clinical and Developmental Immunology — Mon, 12 Sep 2011 16:38:54 +0100

We describe the case of a 42-year-old female with MCTD who developed thrombocytopenia, microangiopathic hemolytic anemia, fever, and neurological symptoms. The patient had a good clinical evolution with infusion of high volume of fresh frozen plasma, steroid therapy, and support in an intensive care unit. Although the occurrence of TTP is rare in MCTD patients, it is important to recognize TTP as a cause of thrombocytopenia and hemolytic anemia in any patient with autoimmune diseases. Prompt institution of treatment remains the cornerstone of treatment of TTP even if plasma exchange is not available like what frequently happens in developing countries. (Source: Clinical and Developmental Immunology)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Autoimmune Neuromuscular Disorders in Childhood

Current Treatment Options in Neurology — Mon, 12 Sep 2011 15:51:08 +0100

Opinion statement Autoimmune neuromuscular disorders in childhood include Guillain-Barré syndrome and its variants, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), juvenile myasthenia gravis (JMG), and juvenile dermatomyositis (JDM), along with other disorders rarely seen in childhood. In general, these diseases have not been studied as extensively as they have been in adults. Thus, treatment protocols for these diseases in pediatrics are often based on adult practice, but despite the similarities in disease processes, the most widely used treatments have different effects in children. For example, some of the side effects of chronic steroid use, including linear growth deceleration, bone demineralization, and chronic weight issues, are more consequential...

Diffuse alveolar damage in patients with dermatomyositis: a six-case series

Modern Rheumatology — Fri, 09 Sep 2011 05:47:01 +0100

In conclusion, promptly beginning IVCY therapy may be beneficial for patients with DM and interstitial pneumonia who show elevated serum levels of ferritin or KL-6 with minimal pulmonary abnormalities. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s10165-011-0502-zAuthors Yuko Matsuki, Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 JapanHiroyuki Yamashita, Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 JapanYuko Takahashi, Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655 JapanToshikazu Kano, Division of Rheumatic Diseases, National Center...

Prolonged versus standard prednisolone therapy for initial episode of idiopathic nephrotic syndrome.

Journal of Nephrology — Wed, 07 Sep 2011 04:00:00 +0100

Conclusions: A prolonged course of prednisolone therapy for an initial episode of nephrotic syndrome can be considered, as it reduces the rate of relapses without increasing the risk for steroid side effects. PMID: 21928226 [PubMed - as supplied by publisher] (Source: Journal of Nephrology)

Proposal for diagnostic criteria for IgG4-related kidney disease

Clinical and Experimental Nephrology — Tue, 06 Sep 2011 08:53:50 +0100

Conclusion The provisional criteria and algorithm appear to be useful for clarifying the entity of IgG4-RKD and seeking underlying IgG4-RKD cases; however, further experience is needed to confirm the validity of these criteria. Content Type Journal ArticleCategory Speicial ArticlePages 1-12DOI 10.1007/s10157-011-0521-2Authors Mitsuhiro Kawano, Division of Rheumatology, Department of Internal Medicine, Kanazawa University Hospital, Kanazawa, JapanTakako Saeki, Department of Internal Medicine, Nagaoka Red Cross Hospital, Nagaoka, JapanHitoshi Nakashima, Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 JapanShinichi Nishi, Division of Nephrology and Kidney Cent...

Hashimoto’s encephalopathy presenting with micrographia as a typical feature of parkinsonism

Neurological Sciences — Tue, 06 Sep 2011 05:47:51 +0100

We describe here a 63-year-old woman who presented with gait disturbance and micrographia. Laboratory tests demonstrated the presence of anti-thyroperoxidase (TPO) antibodies and vitamin B12 deficiency accompanied by the presence of anti-parietal cell antibodies. Lymphocytosis with increased protein was detected in cerebral spinal fluid (CSF). Serum autoantibodies against the anti-NH2 terminal of α-enolase (NAE), a specific diagnostic marker for Hashimoto’s encephalopathy (HE), were also detected. Since underlying autoimmune conditions were suspected to be associated with Hashimoto’s disease, steroid therapy was conducted, and the neurological symptoms improved a few days after the therapy was started. Attention should be given to the possibility that typical parkinsonism showing...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Diagnosis of adrenal failure in critically ill patients

Arquivos Brasileiros de Endocrinologia e Metabologia — Sat, 03 Sep 2011 15:39:34 +0100

In the last two decades there was important evolution on the knowledge of the function of the hypothalamic-pituitary-adrenal axis. In the last decade, the expression "relative adrenal insufficiency" (RAI) was created, and more recently "critical illness-related corticosteroid insufficiency" (CIRCI) was used to designate those patients in which cortisol production was not sufficiently increased in stress situations. Patients with CIRCI have elevated hospital morbidity and mortality. Currently, there is a wide discussion about diagnostic criteria for this dysfunction. Besides basal cortisol, some publications now study the role of other tests, such as cortrosyn test - either in low (1 μg) or high doses (250 μg); free cortisol, salivary cortisol, metyrapone test and others. With this review...

Use of systemic steroid after successful macular surgery in eyes with epiretinal membrane: a randomized, controlled clinical study

Eye — Fri, 02 Sep 2011 07:00:00 +0100

Authors: M Ritter, S Sacu, G Matt, R Dunavölgyi, W Bühl, C Prünte & U Schmidt-Erfurth (Source: Eye)

Serum osteoprotegerin (OPG) in children with primary nephrotic syndrome.

Saudi Journal of Kidney Diseases and Transplantation — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Mohamed GB, Abdel-Latif EA Abstract A novel cytokine system secreted by osteoblast, osteoprotegerin (OPG) and its ligand (OPGL) regulates osteoclastogenesis. To determine the relation of the serum OPG levels in children with nephrotic syndrome (NS) to the renal disease, we studied 30 patients with NS in comparison with 30 healthy children serving as controls. The study patients were divided into three equal groups: group 1 included newly diagnosed patients who were studied before and after a short course (one month) of steroid therapy for the first time, group 2 included frequent relapsers (FR), and group 3 included infrequent relapsers (IFR). In addition to serum OPG (ELISA), osteocalcin (OC), parathormone (PTH), alkaline phosphatase (ALP), and 24- hour urinary Ca and pro...

Tracheal stenosis due to relapsing polychondritis managed for 16 years with a silicon T-tube covering the entire trachea.

The Annals of Thoracic Surgery — Wed, 31 Aug 2011 23:00:00 +0100

In this report we discuss the advantages and disadvantages of different stents in treating relapsing polychondritis. PMID: 21871319 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

General practitioners' knowledge of, and attitudes to, inflammatory bowel disease (ibd)

Internal Medicine Journal — Wed, 31 Aug 2011 23:00:00 +0100

Conclusion: Individual GPs care for few IBD patients and have variable attitudes in their practice. Whether improvement can realistically be achieved given individual GP's paucity of patients, is questionable. These data support the provision of better support and specific action plans for IBD patients. (Source: Internal Medicine Journal)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Tracheal Stenosis Due to Relapsing Polychondritis Managed for 16 Years With a Silicon T-Tube Covering the Entire Trachea [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 30 Aug 2011 23:00:00 +0100

In this report we discuss the advantages and disadvantages of different stents in treating relapsing polychondritis. (Source: The Annals of Thoracic Surgery)

Autoimmune pancreatitis

Journal of Gastroenterology and Hepatology — Sat, 27 Aug 2011 16:03:31 +0100

AbstractThe purpose of this review is to provide a concise view of the existing knowledge of autoimmune pancreatitis (AIP) for practicing clinicians. AIP is a rare disease whose recognition and understanding are evolving. It is a type of chronic pancreatitis that often presents as obstructive jaundice, has a distinctive histology, and is exquisitely sensitive to steroid therapy. This form of chronic pancreatitis has a unique clinical, biochemical, and radiological profile. The term “AIP” encompasses two subtypes: types 1 and 2. Type 1 AIP is the pancreatic manifestation of a systemic fibro‐inflammatory disease called immunoglobulin G4‐associated systemic diseases. Type 2 AIP has been shown to be associated with inflammatory bowel disease. Existing criteria are geared towards the di...

Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double-masked, controlled 2-year study

Journal of Allergy and Clinical Immunology — Fri, 26 Aug 2011 04:00:00 +0100

To the Editor: Vernal keratoconjunctivitis (VKC) is a severe allergic disease that affects the pediatric population. Treatment involves topical antiallergic agents, which are effective in patients with mild disease, whereas most patients with severe disease require some topical steroid therapy. The remarkable recovery with steroids tempts the caretaker to overuse these drugs, and the chronicity of this disease demands strict surveillance against steroid abuse, which inevitably leads to side effects, such as cataracts and glaucoma. The physician’s primary objective with the patient with VKC is to prevent and minimize acute flare-ups, as well as to treat them when they do occur with the safest therapy available. A major risk factor for a worse visual outcome is a higher number and severi...

Hashimoto encephalopathy and antibodies against dimethylargininase-1: A rare cause of cognitive decline in a pediatric Down's syndrome patient

Clinical Neurology and Neurosurgery — Thu, 25 Aug 2011 23:00:00 +0100

Hashimoto encephalopathy (HE) is a rare disorder with an estimated prevalence of about 2.1/100000. HE is diagnosed in patients with otherwise unexplained neurological and/or psychiatric symptoms in whom antithyroid antibodies are positive regardless of their thyroid function. The core presenting feature of HE is a progressive or fluctuating encephalopathy with alterations of mental state and changes in behavior and personality. Other common features are seizures, myoclonus, tremor and stroke-like episodes. Mean age of onset is between 45 and 55 years of age, with a female predominance of 5:1. Only about 27 pediatric patients with HE are reported. Children present more with seizures, confusion, headache, hallucinations and ataxia. In contrast to adults, gender distribution is equal in child...

Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis

Intensive Care Medicine — Wed, 24 Aug 2011 16:04:35 +0100

Conclusion Hospital mortality remains high in hematology patients requiring MV with IPA, particularly when concommittant infection occurred. The use of voriconazole improved survival. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-011-2344-8Authors Gaston Burghi, AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, FranceVirginie Lemiale, AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, FranceAmélie Seguin, AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, FranceJérôme Lambert, AP-HP, Hôpital...

MedWorm Sponsor Message: Find the best January Sales in the UK.

A case of rheumatoid meningitis: pathologic and magnetic resonance imaging findings

Neurological Sciences — Tue, 23 Aug 2011 15:50:46 +0100

We present a report of a 66-year-old man who was diagnosed with rheumatoid meningitis and CNS vasculitis without a history of RA. His initial symptom was seizure. Brain magnetic resonance imaging showed leptomeningeal enhancement.CSF analysis revealed slight increase in the number of white blood cells. An examination of viral markers and culture studies for infectious etiology were unremarkable. However, the rheumatoid factor was positive and the levels of anti-cyclic citrullinated peptide antibody were very high. The patient was diagnosed with rheumatoid meningitis and received steroid therapy. However, he developed CNS vasculitis. We suggested that the possibility of rheumatoid meningitis should be considered during the differential diagnosis stage in patients with uncontrolled men...

Disseminated cutaneous mucormycosis in a patient on high-dose steroid therapy for severe ARDS

Intensive Care Medicine — Fri, 19 Aug 2011 15:59:07 +0100

Content Type Journal ArticleCategory CorrespondencePages 1-2DOI 10.1007/s00134-011-2347-5Authors Martin Geisen, Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital, Birmensdorferstrasse 497, 8063 Zurich, SwitzerlandPatricia Fodor, Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital, Birmensdorferstrasse 497, 8063 Zurich, SwitzerlandGerhard Eich, Division of Infectious Diseases, Department of Internal Medicine, Triemli City Hospital, Birmensdorferstrasse 497, 8063 Zurich, SwitzerlandAndreas Zollinger, Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital, Birmensdorferstrasse 497, 8063 Zurich, SwitzerlandOmer Dzemali, Department of Cardiac Surgery, Triemli City Hospital, Birmensdorferstrasse 497, 8063 Zuri...

Acute retinal necrosis. 3 case reports

Acta Ophthalmologica — Sat, 13 Aug 2011 09:27:18 +0100

Conclusion Acute retinal necrosis syndrome is one of the vision threatening diseases for immunocompetent patients with poor prognosis. Early diagnosis and urgent antiviral therapy is therefore of vital importance for visual outcomes. Long term follow‐up is necessary due to high risk of retinal detachment. (Source: Acta Ophthalmologica)

Immune modulation in the next decade

Acta Ophthalmologica — Sat, 13 Aug 2011 09:20:06 +0100

Conclusion Biologic therapy has the opportunity to not only specifically and powerfully immunomodulate but also with the increase in understanding of individual immune response adapt to generate a more stratified and personalised approach to therapy.Commercial interest (Source: Acta Ophthalmologica)

Dengue Shock Syndrome with Two Atypical Complications

Indian Journal of Pediatrics — Sat, 13 Aug 2011 06:06:20 +0100

Abstract The authors present 2 cases of dengue shock syndrome with unusual complications. In the first case, a 14-y-old boy with dengue shock syndrome who required aggressive fluid resuscitation, developed abdominal compartment syndrome (ACS). Patient developed severe shock, increased ventilator requirement and oliguria as a consequence of ACS. Patient responded well to abdominal paracentesis draining 2.7 l of fluid and made rapid recovery. In the second case, 8-y-old girl was treated for dengue shock syndrome, including mechanical ventilation for ARDS. In the second wk of illness, she developed severe neurological manifestations including frequent episodes of convulsions, hallucinations and altered sensorium. She was diagnosed to have acute demyelinating encephalomyel...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Achalasia With Dense Eosinophilic Infiltrate Responds to Steroid Therapy

Clinical Gastroenterology and Hepatology — Fri, 12 Aug 2011 04:00:00 +0100

A patient presented with chronic substernal discomfort and intermittent dysphagia for solids. High-resolution impedance manometry (HRIM) of the esophagus showed that there was no peristalsis in the esophageal body but incomplete relaxation of the lower esophageal sphincter and incomplete bolus transit, so the patient was diagnosed with achalasia. Moreover, probably because of esophageal stasis, eosinophilic infiltration that mimicked a pattern of eosinophilic esophagitis was observed, on the basis of multiple biopsies of the esophagus. The patient was given 50 mg prednisolone once daily; the symptoms improved dramatically, and HRIM showed complete recovery of esophageal peristalsis, deeper relaxation of the lower esophageal sphincter, and complete bolus transit profile. HRIM can therefore ...

Ipilimumab in pretreated patients with metastatic uveal melanoma: safety and clinical efficacy

Cancer Immunology, Immunotherapy — Thu, 11 Aug 2011 06:01:57 +0100

Abstract Current systemic treatments for metastatic uveal melanoma (UM) have not improved overall survival (OS). The fully human anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) monoclonal antibody, ipilimumab, improved OS of patients with advanced cutaneous melanoma in a phase 3 trial; however, UM patients were excluded. The aim of this subanalysis, performed by the ipilimumab-ocular melanoma expanded access program (I-OMEAP) study group, was to assess the activity and safety of ipilimumab in patients with UM in a setting similar to daily clinical practice. Patients participating in a multicenter expanded access program (EAP) received induction treatment with ipilimumab 10 mg/kg. Maintenance doses were administered in patients who experienced clinical benefit or at physicia...

Salt-losing crisis in infants—not always of adrenal origin

European Journal of Pediatrics — Thu, 11 Aug 2011 05:55:10 +0100

Conclusion Establishing the diagnosis of congenital adrenal disorders is essential in a baby who develops a salt-losing crisis in the first few weeks of life. However, pyelonephritis should be considered and can be rapidly excluded in any infant presenting with a salt-losing crisis with hyponatremia and hyperkalaemia, in particular, outside the neonatal period. Only then should an endocrine cause for this presentation be considered and treatment commenced. Content Type Journal ArticlePages 1-5DOI 10.1007/s00431-011-1541-3Authors Bharathi Pai, Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UKNick Shaw, Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH UKWo...

MRI Findings and Steroid Therapy for Neuralgic Amyotrophy in Children

Pediatric Neurology — Wed, 10 Aug 2011 22:18:49 +0100

Abstract: Neuralgic amyotrophy is not uncommon in adults but is relatively rare in children. We recently encountered 2 cases of neuralgic amyotrophy in children. Patient 1 was a 7-year-old girl who developed a right leg paralysis after an epileptic seizure. Lumbar plexus T2-weighted magnetic resonance imaging (MRI) revealed a hyperintense and thickened portion extending from the root to the knee region of the right sciatic nerve, and T1-weighted conventional spin echo with gadolinium administration revealed enhancement. Patient 2 was a 4-year-old boy who experienced a sudden onset of severe right arm pain and paralysis. T2-weighted MRI with a short tau inversion recovery revealed a slightly thickened and high intensity region at the right C6-C8 level. After high-dose methylprednisolone pul...

Pandemic H1N1 influenza A viral infection complicated by atypical hemolytic uremic syndrome and diffuse alveolar hemorrhage

Clinical and Experimental Nephrology — Tue, 09 Aug 2011 05:45:21 +0100

We report here on a case of a 27-year-old man with atypical hemolytic uremic syndrome and diffuse alveolar hemorrhage associated with influenza A H1N1 infection. Treatment with oseltamivir, plasma exchange and hemodiafiltration for the hemolytic uremic syndrome and meticulous supportive care with steroid pulse therapy for the pulmonary alveolar hemorrhage was successful in this case. We discuss the relationship between hemolytic uremic syndrome and influenza A and the underlying immunologic factors that should be tested in a patient with atypical hemolytic uremic syndrome. We also discuss using steroid therapy for patients with H1N1-related diffuse alveolar hemorrhage. Content Type Journal ArticlePages 1-5DOI 10.1007/s10157-011-0516-zAuthors Harin Rhee, Division of Nephrology, ...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Endoscopically Assisted Transesophageal Echocardiographic Probe Insertion

Journal of Cardiothoracic and Vascular Anesthesia — Mon, 01 Aug 2011 04:00:00 +0100

A 53-year-old man was scheduled to undergo an aortic arch replacement and native aortic valve resuspension for aortic aneurysm and severe aortic regurgitation. The patient originally had a transesophageal echocardiographic (TEE) examination by a cardiologist under sedation to establish the diagnosis and had a documented easy TEE probe passage.The patient had not had any history of dysphagia, upper gastrointestinal bleeding, or esophageal abnormalities nor was he receiving steroid therapy. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Acute pancreatitis: An initial presentation of systemic lupus erythematosus.

The Turkish Journal of Gastroenterology — Mon, 01 Aug 2011 04:00:00 +0100

We report a 24-year-old woman without significant medical history, who was admitted with abdominal pain, nausea and vomiting, which was diagnosed as pancreatitis. It was discovered to be the initial presentation of systemic lupus erythematosus. The first time she was admitted, she recovered with conservative management and steroid therapy. Two months later, she was readmitted to our hospital with symptoms and signs of acute abdomen, which was attributed to her discontinuation of the therapeutic regimen with corticosteroids just after her previous discharge. She underwent laparotomy twice for signs of peritonitis. Despite administration of a monoclonal antibody, rituximab, she died due to the progression of systemic lupus erythematosus activity. PMID: 21948578 [PubMed - in process] (Sou...

Rituximab in adult patients with immunosuppressive-dependent minimal change disease.

Clinical Nephrology — Sun, 31 Jul 2011 23:00:00 +0100

Conclusions: RTX could be an alternative in the therapy of patients with IS-dependent MCD, leading to successful cessation of other IS treatment. PMID: 21762648 [PubMed - in process] (Source: Clinical Nephrology)

Guillain–Barrè syndrome after treatment with human anti-tumor necrosis factorα (adalimumab) in a Crohn's disease patient: Case report and literature review

Journal of Critical Care — Fri, 29 Jul 2011 04:00:00 +0100

Abstract: Anti-tumor necrosis factor alpha antibodies have been used with increasing frequency despite the number of reported adverse effects. Further new information is still emerging. Here we report the case of a 71-years-old patient affected by Crohn's disease and HCV-positive who developed Guillain–Barrè syndrome after four injections of fully human anti-tumor necrosis factor alpha antibodies (adalimumab). Indication for the treatment was severe clinical recurrence of Crohn's disease following intestinal resection. Guillain–Barrè syndrome was treated by intravenous immunoglobulins, and methylprednisolone and plasmapheresis were started with a progressive partial resolution of neurological symptoms. To date, Crohn's disease was maintained in clinical remission with low dose steroi...

Immunoglobulin G4-related Periaortitis and Periarteritis: CT Findings in 17 Patients [Cardiac Imaging]

Continuous Publishing articles — Thu, 28 Jul 2011 23:00:00 +0100

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

The first case of compound heterozygous IL1RN mutations causing deficiency of the interleukin‐1‐receptor antagonist

Arthritis and Rheumatism — Mon, 25 Jul 2011 23:00:00 +0100

We report the case of a male infant who presented at two weeks of life with a swollen, erythematous left index finger and elevated serum inflammatory markers. He later developed cyclical fevers, diffuse pustular skin lesions, and thrombus formation. After failing to improve with broad‐spectrum antimicrobial therapy and achieving only moderate success with systemic steroid therapy, he was ultimately treated with the recombinant interleukin‐1‐receptor antagonist, anakinra, and experienced significant clinical improvement. Sequencing of his IL1RN gene revealed that the patient is compound heterozygous for a known DIRA‐associated mutation (E77X) and a novel mutation in exon 2 (c.140delC) of the gene (p.T47TfsX4). His case highlights DIRA as an autoinflammatory disease that is distinct ...

Autoimmune Pancreatitis: Pancreatic and Extrapancreatic MR Imaging-MR Cholangiopancreatography Findings at Diagnosis, after Steroid Therapy, and at Recurrence [Gastrointestinal Imaging]

Radiology — Wed, 20 Jul 2011 23:00:00 +0100

Conclusion: MR imaging with MR cholangiopancreatography enables the diagnosis of pancreatic and extrapancreatic AIP and the assessment of changes after steroid therapy. © RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101729/-/DC1 (Source: Radiology)

Idiopathic thrombocytopenic purpura and coronary artery disease: comparison between coronary artery bypass grafting and percutaneous coronary intervention [State-of-the-art - Coronary]

Interactive CardioVascular and Thoracic Surgery — Tue, 19 Jul 2011 23:00:00 +0100

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a low platelet count and an increased risk of bleeding. At the same time, ITP patients present an increased risk of thrombosis and atherosclerosis related to the high presence of haemostatic factors and chronic steroid therapy. Although relatively rare, the association of ITP and coronary artery disease represents a complex therapeutic challenge. In particular, no recommendations exist regarding the best management approach. We reviewed the literature making a comparison between coronary artery bypass grafting and percutaneous coronary intervention. (Source: Interactive CardioVascular and Thoracic Surgery)

Predictors for subsequent need for immunosuppressive therapy in early Crohn's disease

Journal of Critical Care — Mon, 18 Jul 2011 04:00:00 +0100

Conclusions: The simple clinical items age at diagnosis, gender, and need for systemic steroid therapy can predict a progressive disease course in early CD. Our model based on these parameters allows an individualized estimation of each patient's risk to develop a progressive disease course. Thereby, our model can help in deciding if patients will need immunosuppressive drugs early in the disease course or if a careful watch and wait strategy is justified.Highlights: ► Retrospective analysis from 6 German tertiary IBD centers involving 353 patients. ► Age, gender and effect of steroids are associated with necessity of immunosuppressors. ► A prognostic model predicts the patient's risk for a progressive disease course. (Source: Journal of Critical Care)

Regression of left main coronary ostium stenosis after surgical revascularization and steroid therapy

General Thoracic and Cardiovascular Surgery — Fri, 15 Jul 2011 16:04:16 +0100

We describe a patient in whom stenosis of the left main coronary ostium completely regressed after steroid treatment following surgical revascularization. A 46-year-old woman with unstable angina underwent double coronary artery bypass grafting. Although she did not fulfill diagnostic criteria for Takayasu’s disease, we began postoperative steroid therapy on postoperative day 14 based on clinical manifestations and histological findings. Coronary angiography 33 days after surgery showed the ostial stenosis of the left main coronary artery had disappeared. Steroid therapy for suspected Takayasu’s disease should be considered even after surgical revascularization. Content Type Journal ArticlePages 594-596DOI 10.1007/BF03218208Authors Yukihisa Isomatsu, Department of Cardiovas...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Current treatment of parotid hemangiomas

The Laryngoscope — Thu, 14 Jul 2011 23:00:00 +0100

Conclusions:Multiple treatment regimens have been used to successfully treat parotid hemangiomas. Although propranolol is a recent addition, it seems most promising. Further evaluation is warranted. (Source: The Laryngoscope)

Preliminary prospective explanatory observation on the impact of 3-month steroid therapy on the objective measures of sleep-disordered breathing

Sleep and Breathing — Thu, 14 Jul 2011 05:59:50 +0100

Conclusions We found that the objective measures of sleep-disordered breathing worsened after the 3-month steroid treatment. Future studies to define pertinent mechanisms and clinical relevance are warranted. Content Type Journal ArticlePages 1-5DOI 10.1007/s11325-011-0541-xAuthors Gidon Berger, Division of Pulmonary Medicine, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096 IsraelEmilia Hardak, Division of Pulmonary Medicine, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096 IsraelBeatrice Shaham, Division of Pulmonary Medicine, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096 IsraelEmili Avitan, Department of Dermatology, Rambam Health Care Campus, Haifa, IsraelMordechai Yigla, Division of Pulmonary Medicine, Rambam Health Care Campus, P.O. Box 960...

[Diagnosis and treatment of osteoporosis and rheumatoid arthritis in accordance with German guidelines : Results of a survey of patients, primary care physicians and rheumatologists.]

Zeitschrift fur Rheumatologie — Wed, 13 Jul 2011 23:00:00 +0100

Authors: Heberlein I, Demary W, Bloching H, Braun J, Buttgereit F, Dreher R, Kuhn C, Lange U, Zink A, Zeidler H, Häntzschel H, Raspe H In a cross-sectional study the prevalence of osteoporosis and osteopenia in patients with rheumatoid arthritis (ORA study) was investigated. Additionally, patients, their family doctors and rheumatologists were surveyed on their awareness of osteoporosis in RA, prevention, diagnosis, treatment and use of guidelines.In the years 2005 and 2006 a total of 532 patients with RA (98 men, 434 women) aged 23-87 years were consecutively recruited from 9 German centers for rheumatology. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure bone mineral density (BMD) at the lu...

Preliminary prospective explanatory observation on the impact of 3-month steroid therapy on the objective measures of sleep-disordered breathing.

Sleep and Breathing — Wed, 13 Jul 2011 23:00:00 +0100

CONCLUSIONS: We found that the objective measures of sleep-disordered breathing worsened after the 3-month steroid treatment. Future studies to define pertinent mechanisms and clinical relevance are warranted. PMID: 21755279 [PubMed - as supplied by publisher] (Source: Sleep and Breathing)

Sudden onset blindness treated with pulse steroid therapy in a patient with microscopic polyangiitis

Central European Journal of Medicine — Wed, 13 Jul 2011 06:14:43 +0100

We report a 71-year-old male with microscopic polyangiitis (MPA) who developed sudden-onset, progressive, bilateral visual loss associated with a relapse of MPA symptoms. The patient was referred to our hospital, and treated with intravenous pulse steroid therapy and high-dose oral prednisolone. Although the right eye remained vision deficient, visual acuity in the left eye recovered. Ocular manifestations of MPA are quite uncommon. This case emphasizes the necessity of early detection and initiation of prompt therapy where ocular manifestations of MPA occur. Content Type Journal ArticlePages 1-3DOI 10.2478/s11536-011-0069-2Authors Yoshiro Horai, Department of Internal Medicine and Rheumatology, Clinical Research Center, National Hospital Organization, Kyushu Medical Center, 1-8...

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

8. Ultrasonographic findings of muscular sarcoidosis—A case report

Clinical Neurophysiology — Wed, 13 Jul 2011 00:37:53 +0100

The patient was a 58-year-old female. Bilateral blepharoptosis appeared around the age of 54. Diplopia had appeared, and blepharoptosis had worsened recently. Neurological examination showed bilateral blepharoptosis, disturbed ocular movement, and leg muscle pain on grasping. Blood examination showed elevated serum transaminase levels (AST 164 IU/L, ALT 187 IU/L). Electromyography of the tibialis anterior muscle showed a myopathic change, and ultrasonography of the muscle showed tuberous images. Muscle biopsy of the same muscle showed non-caseous epithelioid granuloma, confirming diagnosis of muscular sarcoidosis. Lesions in heart, lungs, and skin were confirmed by further examinations. Disturbed ocular movement was improved by steroid therapy. Thus ultrasonography is useful for diagnosis ...

Endometrial Carcinoma Presenting as Vasculitic Sensorimotor Polyneuropathy

Infectious Diseases in Obstetrics and Gynecology — Tue, 12 Jul 2011 13:58:53 +0100

We present a case of a premenopausal woman with severe vasculitic, asymmetric sensorimotor polyneuropathy that developed in conjunction with an endometrial carcinoma responding to surgical therapy of primary tumor combined to steroid therapy. Neurological symptoms such as asymmetrical sensorimotor deficits and painful paresthesias are suspicious when they occur in otherwise healthy women with no medical history. The phenomenon of a paraneoplastic syndrome can point to an underlying malignancy and can be used as marker of progression or regression of the tumor. Due to the rarity of PNP, there is no standard treatment. Recommended therapy is stage-adjusted treatment of the primary tumor. (Source: Infectious Diseases in Obstetrics and Gynecology)

Post-infection immunocomplex glomerulonephritis and Legionnaires' disease in a patient with adult Still's disease during treatment with interleukin 1 receptor antagonist anakinra: a case report

BioMed Central — Fri, 08 Jul 2011 23:00:00 +0100

Conclusion: To the best of our knowledge, there is only a handful of reported cases of post-infection glomerulonephritis with a nephrotic syndrome in a patient with legionellosis. Our findings suggest that, in patients with Legionnaires' disease with renal failure, post-infection immunocomplex glomerulonephritis should be considered and steroid therapy may be an effective modality to treat the renal complication. (Source: BioMed Central)

Improved Outcome of Henoch-Schonlein Purpura Nephritis by Early Intensive Treatment

Indian Journal of Pediatrics — Fri, 08 Jul 2011 05:47:06 +0100

Conclusions The present study has demonstrated a superior effect of HCSS therapy in patients with mild HSPN disease, of MP therapy in patients with moderate disease, and of MP in combination with TG therapy in patients with severe disease. Intensive therapy administered initially reduces the duration of urinary protein abnormality. Content Type Journal ArticlePages 1-6DOI 10.1007/s12098-011-0519-5Authors Fang Deng, Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, No.218 Ji-Xi Road, Hefei, 230022 Anhui, ChinaLing Lu, Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, No.218 Ji-Xi Road, Hefei, 230022 Anhui, ChinaQin Zhang, Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, No.2...

A Case of acute sarcoid myositis treated with weekly low‐dose methotrexate

Muscle and Nerve — Thu, 07 Jul 2011 23:00:00 +0100

AbstractA 25‐year‐old man was referred to our hospital with a 2‐month history of progressive proximal extremity weakness. His serum creatine kinase (CK) level was extremely elevated, and a chest X‐ray revealed bilateral hilar lymphadenopathy and small nodules in bilateral lung fields. Biopsy specimens obtained from muscle and lung revealed non‐caseating epithelioid cell granulomas. On the basis of these findings, the patient was diagnosed with sarcoidosis and acute sarcoid myositis. Although steroid pulse therapy was administered repeatedly, the muscle symptoms did not improve, and the serum CK level remained high. We added 7.5 mg oral methotrexate once a week to oral prednisolone, and this improved both the muscle weakness and the CK level.Concurrent administration of methotrexa...

MedWorm Sponsor Message: Find the best January Sales in the UK.

Colchicine in the management of mucous membrane pemphigoid

Dermatologic Therapy — Fri, 01 Jul 2011 04:00:00 +0100

ABSTRACTMucous membrane pemphigoid (MMP) usually runs a chronic and potentially devastating course. Its management requires long‐term oral corticosteroids. Safe and effective adjuvant or steroid‐sparing agents are needed. In this retrospective observational study with a follow‐up extending to 16 years (mean: 4 years), 60% (9/15) of all patients with MMP were lesion‐free under oral steroid therapy combined with a second immunosuppressant agent. Colchicine was the most effective, clearing from at least one individual mucosal site lesions in 67% (8/12) of patients. Colchicine may be suggested as a first‐line corticosteroid‐sparing regimen in the management of MMP. (Source: Dermatologic Therapy)

Jejunal obstruction as initial presentation of polyarteritis nodosa in a 13-month-old boy

Journal of Pediatric Surgery — Thu, 30 Jun 2011 23:00:00 +0100

We report a case of pediatric PAN whose presenting symptom was jejunal obstruction owing to ischemic necrosis of the small bowel. The postoperative recovery was uneventful, and the patient responded well to steroid therapy. There are only a few cases of PAN with intestinal involvement described in the literature, some of them fatal. The diagnosis of PAN should be considered in children with acute intestinal obstruction with no obvious etiology, as early recognition and treatment may reduce its high mortality. (Source: Journal of Pediatric Surgery)

Long-Term Survival of Simultaneous Pancreas-Kidney Transplantation: Influence of Early Posttransplantation Complications

Transplantation Proceedings — Thu, 30 Jun 2011 23:00:00 +0100

Conclusions: Complications in the early posttransplantation period after SPKT were frequent, increasing morbidity and inpatient stay. One third of our patients underwent a reoperation, which had a negative impact on graft survival. (Source: Transplantation Proceedings)

IgG4-Related Tubulointerstitial Nephritis With Membranous Nephropathy

American Journal of Kidney Diseases — Sun, 26 Jun 2011 23:00:00 +0100

We describe a 67-year-old woman who presented with significant proteinuria and hematuria. Kidney biopsy showed immunoglobulin G4 (IgG4)-related tubulointerstitial nephritis (TIN) with concurrent membranous nephropathy. IgG4-related TIN is a recently described entity that presents with progressive decreased kidney function and is characterized by a plasma cell–rich infiltrate that is positive for IgG4. It is associated with patchy, often well-localized, tubular atrophy and interstitial fibrosis. Workup for circulating anti–phospholipase A2 receptor antibodies was negative, suggesting that the membranous nephropathy was not “primary” and may be linked to the IgG4-related disease. The presence of significant proteinuria and hematuria in the setting of IgG4-related TIN should raise sus...

Complications after ERCP in liver transplant recipients

Gastrointestinal Endoscopy — Sun, 26 Jun 2011 23:00:00 +0100

Conclusions: The rate of complications after ERCP in LT recipients seems to be similar to that of non-LT recipients. Complications in this analysis were more common in LT recipients receiving mammalian target of rapamycin inhibitors and those with renal failure, biliary sphincterotomy, and more than 2 pancreatic duct injections, whereas they were less common in those patients on steroid therapy. (Source: Gastrointestinal Endoscopy)

MedWorm Sponsor Message: Please support the Doctors In Chains campaign for the medics tortured and sentenced for up to 15 years in Bahrain. #FreeDoctors

Early steroid therapy for patients with H1N1 influenza A virus infection

Intensive Care Medicine — Tue, 21 Jun 2011 20:36:59 +0100

Content Type Journal ArticlePages 1-2DOI 10.1007/s00134-011-2289-yAuthors A. J. Petros, Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, London, UKJ. H. Rommes, Department Intensive Care, Gelre Ziekenhuizen, Apeldoorn, The NetherlandsL. Silvestri, Unit of Anesthesia and Intensive Care, Department of Emergency, Presidio Ospedaliero, Gorizia, ItalyN. Taylor, Institute for Ageing and Chronic Disease, University of Liverpool, Liverpool, UKH. K. F. van Saene, Institute for Ageing and Chronic Disease, University of Liverpool, Liverpool, UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Ruptured thoracic aortic aneurysm in patient with systemic lupus erythematosus

Revista Brasileira de Cirurgia Cardiovascular — Sun, 19 Jun 2011 11:09:59 +0100

It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative periodPaciente de 25 anos, do sexo feminino, portadora de lúpus eritematoso sistêmico, fazendo uso de corticoesteroide havia 19 anos, deu entrada em unidade de emergência com aneurisma roto de aorta torácica descendente. Foi submetida a tratamento endovascular com 2 stents, recebeu alta hospitalar no 13º dia de...

Evaluation of the pituitary-adrenal axis function in patients on topical steroid therapy

Journal of the American Academy of Dermatology — Sat, 18 Jun 2011 16:31:41 +0100

See commentary on page 250. To the Editor: Topical corticosteroids can be absorbed percutaneously in sufficient quantities to cause systemic adverse effects. Suppression of the hypothalamic pituitary adrenal (HPA) axis has been reported following topical corticosteroid therapy. We measured cortisol response to 1 μg of adrenocorticotropic hormone (ACTH) in patients receiving topical corticosteroids for dermatological disorders. (Source: Journal of the American Academy of Dermatology)

Etanercept shows promise for treating dermatomyositis, study suggests

ScienceDaily Headlines — Fri, 17 Jun 2011 12:15:15 +0100

A multicenter pilot study of etanercept for treatment of dermatomyositis found no major safety concerns and many patients treated with the drug were successfully weaned from steroid therapy. These results are encouraging, but larger studies are needed to further investigate the safety and efficacy of etanercept. (Source: ScienceDaily Headlines)