The patient with vasculitis

2015 ◽  
Author(s):  
David Jayne
Keyword(s):  
Clinical Presentation ◽  
Renal Involvement ◽  
Disease Process ◽  
Small Vessel Vasculitis ◽  
Clinical Presentations ◽  
Severe Manifestation ◽  
Definition Of ◽  
End Stage ◽  
Autoimmune Aetiology

The definition of vasculitis syndromes relies on clinical, serological, and pathological descriptions. A number of primary syndromes are recognized, of presumed autoimmune aetiology, but vasculitis may also occur as a secondary disease process. The heterogeneity of clinical presentation, low specificity of many clinical features, and mimics of other diseases complicate vasculitis diagnosis. The kidney is the most common severe manifestation for small vessel vasculitis syndromes and the severity of renal involvement predicts end-stage renal failure risk and death. Suspicion of vasculitis is key to early diagnosis and improving outcomes of vasculitis patients.The current understanding of the classification of vasculitis syndromes is presented in this chapter along with descriptions of clinical presentations, and approaches to diagnosis.

scholarly journals The Banff Working Group Classification of Definitive Polyomavirus Nephropathy: Morphologic Definitions and Clinical Correlations

2017 ◽  
Vol 29 (2) ◽  
pp. 680-693 ◽  
Author(s):  
Volker Nickeleit ◽  
Harsharan K. Singh ◽  
Parmjeet Randhawa ◽  
Cinthia B. Drachenberg ◽  
Ramneesh Bhatnagar ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Working Group ◽  
Classification Scheme ◽  
Clinical Presentation ◽  
Interstitial Fibrosis ◽  
The United States ◽  
Systematic Analysis ◽  
Definition Of ◽  
Morphologic Classification

Polyomavirus nephropathy (PVN) is a common viral infection of renal allografts, with biopsy-proven incidence of approximately 5%. A generally accepted morphologic classification of definitive PVN that groups histologic changes, reflects clinical presentation, and facilitates comparative outcome analyses is lacking. Here, we report a morphologic classification scheme for definitive PVN from the Banff Working Group on Polyomavirus Nephropathy, comprising nine transplant centers in the United States and Europe. This study represents the largest systematic analysis of definitive PVN undertaken thus far. In a retrospective fashion, clinical data were collected from 192 patients and correlated with morphologic findings from index biopsies at the time of initial PVN diagnosis. Histologic features were centrally scored according to Banff guidelines, including additional semiquantitative histologic assessment of intrarenal polyomavirus replication/load levels. In-depth statistical analyses, including mixed effects repeated measures models and logistic regression, revealed two independent histologic variables to be most significantly associated with clinical presentation: intrarenal polyomavirus load levels and Banff interstitial fibrosis ci scores. These two statistically determined histologic variables formed the basis for the definition of three PVN classes that correlated strongest with three clinical parameters: presentation at time of index biopsy, serum creatinine levels/renal function over 24 months of follow-up, and graft failure. The PVN classes 1–3 as described here can easily be recognized in routine renal biopsy specimens. We recommend using this morphologic PVN classification scheme for diagnostic communication, especially at the time of index diagnosis, and in scientific studies to improve comparative data analysis.

The patient with vasculitis

2018 ◽  
Author(s):  
Alan D. Salama
Keyword(s):  
Patient Outcomes ◽  
End Stage Renal Disease ◽  
Impaired Renal Function ◽  
Systemic Vasculitis ◽  
Renal Involvement ◽  
Small Vessel Vasculitis ◽  
Organ Systems ◽  
Primary Systemic Vasculitis ◽  
Stage Renal Disease ◽  
End Stage

Primary systemic vasculitis frequently leads to renal involvement and is responsible for significant numbers of patients progressing to end-stage renal disease. Frequently this is due to small vessel vasculitis, in association with antineutrophil cytoplasm antibody, which requires prompt recognition and timely therapeutic intervention to optimize renal and patient outcomes. Other organ systems are often affected. Relapses occur in about 50%.Less commonly medium or larger vessel vasculitis may involve the kidneys and through ischaemia lead to impaired renal function and renovascular hypertension, as in Takayasu’s or Kawasaki disease, and polyarteritis nodosa (PAN).

scholarly journals Classification of Intervertebral Disc Disease

2020 ◽  
Vol 7 ◽  
Author(s):  
Joe Fenn ◽  
Natasha J. Olby ◽  
Keyword(s):  
Intervertebral Disc ◽  
Intervertebral Disc Degeneration ◽  
Clinical Findings ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Clinical Presentations ◽  
Disc Material ◽  
Definition Of ◽  
Current Systems

Intervertebral disc disease (IVDD) has been recognized in dogs since the 1800s, when the first descriptions of extruded disc material within the vertebral canal were published. In the intervening time our understanding of intervertebral disc pathology in dogs and cats has increased dramatically, with many variations of IVDD described. Whilst the volume of literature and collective understanding of IVDD has expanded, there has also been scope for confusion as the definition of intervertebral disc disease, with its myriad different manifestations, becomes more complicated. A large volume of literature has aimed to combine the use of histopathology, diagnostic imaging and clinical findings to better understand the various ways in which IVDD can be classified. Much of this research has focused on the classification of mechanisms of intervertebral disc degeneration, centering around the differences between, and overlaps in, IVDD in chondrodystrophic and non-chondrodystrophic dog breeds. However, with the increasing availability of advanced imaging modalities allowing more accurate antemortem diagnosis, the concept of IVDD has expanded to include other clinical presentations that may not fit into traditional models of classification of IVDD. This review aims to provide an up to date overview of both historical and current systems of IVDD classification, highlighting the important findings and controversies underpinning them.

scholarly journals Lupus nephritis: clinical presentations and outcomes in the 21st century

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_5) ◽  
pp. v39-v51 ◽  
Author(s):  
Michela Gasparotto ◽  
Mariele Gatto ◽  
Valentina Binda ◽  
Andrea Doria ◽  
Gabriella Moroni
Keyword(s):  
Lupus Nephritis ◽  
New Drugs ◽  
The Past ◽  
Disease Prognosis ◽  
Clinical Presentations ◽  
Retrospective Cohort Studies ◽  
Severe Manifestation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Therapeutic Research

Abstract Lupus nephritis (LN) is a frequent and severe manifestation of SLE. Along the decades, the epidemiology of LN and its clinical presentation have been changing. However, even though retrospective cohort studies report a decreased mortality rate and an improvement in the disease prognosis, the percentage of patients progressing into end stage renal disease (ESRD) keeps steady despite the improvements in therapeutic strategies. Current in-use medications have been available for decades now, yet over the years, regimens for optimizing their efficacy and minimizing toxicity have been developed. Therapeutic research is now moving towards the direction of precision medicine and several new drugs, targeting selectively different pathogenetic pathways, are currently under evaluation with promising results. In this review, we address the main changes and persistent unmet needs in LN management throughout the past decades, with a focus on prognosis and upcoming treatments.

scholarly journals Pressure ulcers: Back to the basics

2012 ◽  
Vol 45 (02) ◽  
pp. 244-254 ◽  
Author(s):  
Karoon Agrawal ◽  
Neha Chauhan
Keyword(s):  
Pressure Ulcer ◽  
Disease Process ◽  
Medical Personnel ◽  
Decubitus Ulcer ◽  
Intrinsic Factors ◽  
Care Givers ◽  
Sick Patient ◽  
Definition Of ◽  
Assessment Scales

ABSTRACTPressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of "prevention is better than cure" suits this condition the most.

scholarly journals An Uncommon Case of Bilateral Breast Enlargement Diagnosed as Tumoral Pseudoangiomatous Stromal Hyperplasia: Imaging and Pathological Findings

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Isabel Sollozo-Dupont ◽  
Héctor Alejandro Domínguez-Hernández ◽  
Cecilia Pavón-Hernández ◽  
Yolanda Villaseñor-Navarro ◽  
Robin Shaw-Dulin ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Definitive Diagnosis ◽  
Pathological Findings ◽  
Imaging Studies ◽  
Pseudoangiomatous Stromal Hyperplasia ◽  
Breast Enlargement ◽  
Clinical Presentations ◽  
Uncommon Case ◽  
Bilateral Breast Enlargement

The incidence of reported pseudoangiomatous stromal hyperplasia (PASH), as well as the variability and severity of clinical presentations, is increasing in the literature. In parallel, several authors posit the need for an improved classification of PASH to avoid possible variables associated with this diagnosis. Here, we present a 25-year-old woman with PASH accompanied by severe bilateral and symmetrical breasts enlargement, highlighting an uncommon clinical presentation of PASH as much as the careful interdisciplinary review and correlation of histology and all available imaging studies to confirm the definitive diagnosis.

scholarly journals Diverticular Disease of the Vermiform Appendix - Is it a Distinctive ClinicoPathological Entity?

2021 ◽  
Vol 02 ◽  
Author(s):  
Offir Ben-Ishay ◽  
Narmeen Abdalqader ◽  
Yaniv Zohar ◽  
Yoram Kluger
Keyword(s):  
Diverticular Disease ◽  
Clinical Presentation ◽  
Cohort Analysis ◽  
Postoperative Bleeding ◽  
Disease Process ◽  
Postoperative Outcome ◽  
Vermiform Appendix ◽  
Control Group ◽  
Definition Of ◽  
Postoperative Mechanical Ventilation

Background: Diverticular disease of the appendix [DDOA] is a rare occurrence. Although acquired in nature, its impact on the disease process of appendicitis is not well-defined. The purpose of the current study is to include a comprehensive clinico-pathological definition of the disease through a retrospective single-center cohort analysis with a prospective pathological re-evaluation. Methods: A retrospective analysis of post-appendectomy patients over a period of 16 years [2000-2015] was carried out. Patients with DDOA were identified and compared to a control group of patients with acute appendicitis. Histology was re-evaluated prospectively by a senior pathologist. Primary measures of the outcome included clinical and surgical differences. Pathological macroscopic differences between the two groups and a comprehensive description of the DDOA itself were performed. Results: 6846 post appendectomy patients were operated on during the study period, and 127 [1.9%] were diagnosed with DDOA. The DDOA group showed significantly higher age, longer duration of complaints, and a different clinical presentation. Operative time was significantly longer in the study group and had higher rates of severe postoperative complications such as postoperative bleeding, need for ICU recovery, and need for postoperative mechanical ventilation. All diverticula were pseudo-diverticula and were significantly shorter and wider. Multivariate analysis showed that age, length, and width of the appendix were independently associated with DDOA. Conclusions: The results of this study suggest that DDOA is an independent clinical entity, showing differences in etiology, clinical presentation, and postoperative outcome. Prospective studies are needed to assess whether the preoperative diagnosis is feasible and will change conventional surgical management.

Classification of Preterm Birth With Placental Correlates

2018 ◽  
Vol 21 (6) ◽  
pp. 548-560 ◽  
Author(s):  
Karen M Chisholm ◽  
Mary E Norton ◽  
Anna A Penn ◽  
Amy Heerema-McKenney
Keyword(s):  
Preterm Birth ◽  
Amniotic Fluid ◽  
Preterm Labor ◽  
Clinical Presentation ◽  
Maternal Factors ◽  
Premature Rupture Of Membranes ◽  
Multiple Gestations ◽  
Clinical Presentations ◽  
Preterm Rupture Of Membranes

Premature birth lacks a widely accepted classification that unites features of the clinical presentation with placental pathology. To further explore associations between the clinical categories of preterm birth and placental histology, 109 infants with gestational age <34 weeks and birth weight <2000 g were selected and, based on electronic records, were classified into preterm birth categories of preterm labor, prelabor premature rupture of membranes, preeclampsia, indicated preterm birth for maternal factors (other than preeclampsia), indicated preterm birth for fetal factors, and the clinical diagnosis of abruption. Corresponding placentas were analyzed for gross and microscopic variables, with findings grouped into categories of amniotic fluid infection, lymphocytic inflammation, maternal vascular malperfusion, and fetal vascular malperfusion. Placental features of maternal vascular malperfusion were pervasive in all preterm birth categories and were commonly associated with amniotic fluid infection and lymphocytic inflammation. Features of maternal vascular malperfusion were significantly associated with preterm birth due to preeclampsia, and amniotic fluid infection was highly associated with prelabor preterm rupture of membranes. Findings of lymphocytic inflammation were significantly increased in cases of abruption. Laminar decidual necrosis was present in all cases of abruption. Placentas from multiple gestations had significantly less histologic findings compared to singletons. Given that 75% of placentas demonstrated at least 1 feature of maternal vascular malperfusion despite different clinical presentations, seemingly different pathologies such as ascending amniotic fluid infection or lymphocytic inflammation may be mechanistically related to processes established early in pregnancy. The concept of “uterine ischemia” may be too simplistic to account for all of the changes attributed to maternal vascular malperfusion in the preterm placenta.

Development and Evaluation of Fuzzy Criteria for the Diagnosis of Rheumatoid Arthritis

1996 ◽  
Vol 35 (04/05) ◽  
pp. 334-342 ◽  
Author(s):  
K.-P. Adlassnig ◽  
G. Kolarz ◽  
H. Leitich
Keyword(s):  
Rheumatoid Arthritis ◽  
Reference Model ◽  
American Rheumatism Association ◽  
Uniform Definition ◽  
Sensitivity Rate ◽  
Fuzzy Techniques ◽  
Definition Of ◽  
Different Levels ◽  
Specificity Rate

Abstract:In 1987, the American Rheumatism Association issued a set of criteria for the classification of rheumatoid arthritis (RA) to provide a uniform definition of RA patients. Fuzzy set theory and fuzzy logic were used to transform this set of criteria into a diagnostic tool that offers diagnoses at different levels of confidence: a definite level, which was consistent with the original criteria definition, as well as several possible and superdefinite levels. Two fuzzy models and a reference model which provided results at a definite level only were applied to 292 clinical cases from a hospital for rheumatic diseases. At the definite level, all models yielded a sensitivity rate of 72.6% and a specificity rate of 87.0%. Sensitivity and specificity rates at the possible levels ranged from 73.3% to 85.6% and from 83.6% to 87.0%. At the superdefinite levels, sensitivity rates ranged from 39.0% to 63.7% and specificity rates from 90.4% to 95.2%. Fuzzy techniques were helpful to add flexibility to preexisting diagnostic criteria in order to obtain diagnoses at the desired level of confidence.

ABOUT THE PROBLEM OF CLASSIFICATION OF THE CONCEPTS OF INFORMATICS STUDIED AT SECONDARY SCHOOL

2018 ◽  
pp. 4-7
Author(s):  
S. I. Zenko
Keyword(s):  
Secondary School ◽  
Foreign Language ◽  
Computer Science ◽  
Parts Of Speech ◽  
The Third ◽  
The Cross ◽  
Definition Of

The article raises the problem of classification of the concepts of computer science and informatics studied at secondary school. The efficiency of creation of techniques of training of pupils in these concepts depends on its solution. The author proposes to consider classifications of the concepts of school informatics from four positions: on the cross-subject basis, the content lines of the educational subject "Informatics", the logical and structural interrelations and interactions of the studied concepts, the etymology of foreign-language and translated words in the definition of the concepts of informatics. As a result of the first classification general and special concepts are allocated; the second classification — inter-content and intra-content concepts; the third classification — stable (steady), expanding, key and auxiliary concepts; the fourth classification — concepts-nouns, conceptsverbs, concepts-adjectives and concepts — combinations of parts of speech.

Sign in / Sign up

Export Citation Format

Share Document