scholarly journals From theory to practice: immunotherapy of purulent-inflammatory diseases and purulent-septic complications

2021 ◽  
Vol 40 (3) ◽  
pp. 19-26
Author(s):  
Nataliya Yu. Alekseeva ◽  
Denis A. Dyumnikov ◽  
Ivan A. Solovyev ◽  
Oleg V. Kalyuzhin
Keyword(s):  
Postoperative Period ◽  
Soft Tissues ◽  
Clinical Symptoms ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Septic Complications ◽  
Treatment Comparison ◽  
Theory To Practice ◽  
Group 2 ◽  
Immunomodulatory Potential

Lack of anti-infective protection is one of the reasons for the occurrence of purulent-inflammatory diseases of the skin, soft tissues and purulent-septic complications in the postoperative period. Immunocorrective therapy is extremely relevant in surgical practice, and it can be used both for the prevention and treatment of postoperative complications. In this regard, special attention should be paid to low molecular weight fragments of peptidoglycan of cellular bacteria muramyl peptides. The study included 65 patients with purulent inflammatory diseases, of which 35 men aged 2355 years with chronic recurrent pyoderma (ostiofolliculitis, folliculitis, sycosis, furunculosis), and 30 patients aged 18 to 65 years with purulent inflammatory diseases of soft tissues, mainly abscesses and phlegmons of various localization without pronounced concomitant pathology. The examination included 26 patients with purulent-septic complications in the postoperative period. The patients included in the study were divided into 2 equal groups: 1 is the main group, in which patients received intramuscularly Polimuramil 200 mg daily for 5 days in addition to treatment; Comparison group 2, in which patients received only standard treatment. The clinical symptoms of pyoderma were assessed from day 0 to day 7, then on day 14, after 1 and 6 months of the study. Blood samples were taken from all patients for hematological and immunological studies. The timing of the appearance of granulations was monitored daily. The inclusion of Polimuramil in the complex treatment of pyoderma accelerated the regression of the main clinical manifestations of the disease and promoted the induction of stable remission. In patients with soft tissue infections, Polimuramil increased the degree of regression of the depth and area of the wound and accelerated the appearance of granulations. The clinical efficacy of Polimuramil in patients with purulent-septic complications in the postoperative period correlated with a decrease in CRP and procalcitonin levels. The study confirms the effectiveness of Polimuramil in the treatment of purulent-inflammatory diseases and purulent-septic complications in the postoperative period and its high immunomodulatory potential (8 figs, 2 tables, bibliography: 5 refs).

scholarly journals Necrotizing fasciitis in obstetric practice: review of literature and description of own clinical саse

2019 ◽  
pp. 150-155
Author(s):  
V. M. Husiev ◽  
V. M. Astakhov ◽  
S. A. Dubyna
Keyword(s):  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Soft Tissues ◽  
Clinical Symptoms ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Fatty Tissue ◽  
Superficial Fascia ◽  
Surgical Infection ◽  
Surgical Infections

Despite the successes of modern medicine, the problem of purulent surgical infection still remains relevant and is one of the unsolved and most debatable in clinical surgery. In the structure of purulent-inflammatory diseases of soft tissues, there are forms of surgical infections that are characterized by progressive necrosis of fascial formations and particular clinical course. They are accompanied by the development of endotoxemia, which further leads to the development of severe sepsis and multiple organ failure. Among generalized surgical infections, necrotizing fasciitis is of particular interest – one of the varieties of a large group of surgical infections of soft tissues, in the pathomorphological basis of which lies the rotten-necrotic lesion of the superficial fascia and subcutaneous fatty tissue. It has various clinical manifestations, the absence of specific signs that make it difficult for clinicians of various specialties to diagnose in time, the development of serious complications and deaths. The basis for the early diagnosis of necrotizing soft tissue infections, therefore, the key to successful treatment of these seriously ill patients, as before, is the timely analysis of anamnestic data and clinical symptoms. The treatment of necrotizing fasciitis is a difficult and complex task, which is explained by the peculiarity of the pathological process, the success of which is determined by early diagnosis and urgent radical surgical intervention. Rarely rare publications on this issue are the cause of the information vacuum and the lack of awareness of the majority of doctors in this pathology, potential for the development of critical states, once again necessitates the imperative informing of narrow specialists, as well as doctors practicing in the outpatient network and hospital level. Тhe article describes the own clinical observation of the fulminant form of necrotising fasciitis diagnosed by autopsy data.

Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

2020 ◽  
pp. 64-75
Author(s):  
E. Burleva ◽  
O. Smirnov ◽  
S. Tyurin
Keyword(s):  
Postoperative Period ◽  
Chronic Venous Insufficiency ◽  
Thermal Ablation ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Statistical Processing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

SALMONELLA SPONDYLITIS IN NON-SICKLE CELL PATIENTS

2001 ◽  
Vol 05 (04) ◽  
pp. 253-260
Author(s):  
PO-QUANG CHEN ◽  
SHU-HUA YANG ◽  
CHANG-CHOU YEN ◽  
WEN-JER CHEN ◽  
TIFFANY T. F. SHIH
Keyword(s):  
Antibiotic Treatment ◽  
Sickle Cell ◽  
Clinical Symptoms ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Positive Culture ◽  
Surgical Debridement ◽  
Treatment Modalities ◽  
Endemic Region ◽  
Treatment Comparison

This article was a retrospective study of Salmonella spondylitis in seven non-sickle cell anemic patients. The objective of this study was to clarify the clinical manifestations of spinal infection by Salmonella, and to select the proper method of treatment. Comparison with the reported 25 cases in the literature was also attempted. The clinical symptoms and signs, laboratory data, bony images, treatment modalities and outcomes were documented, and compared with the 25 cases in the English literatures. The patients all suffered from insidious onset of low back pain, with progressive increasing intensity. Leucocytosis (>9000) and body temperature elevation (>37°C) were noted in four cases. Positive cultures were mainly obtained from blood (5 cases) and surgical specimens (one case) before treatment. One patient also had positive culture in the stool and urine. Six patients underwent surgical debridement of the infected foci, while one patient received antibiotic treatment only. The outcome was good in the uncomplicated cases. One patient with concurrent aortic aneurysm died of sepsis. We stress that Salmonella infection can be found in the apparently healthy persons. In the endemic region, high suspicion is needed. Surgical debridement, bone grafting and two months of antibiotic treatment are recommended.

scholarly journals Experience in the treatment of patients with fusiform aneurysms of cerebral vessels

2020 ◽  
Vol 30 (4) ◽  
pp. 23-30
Author(s):  
D.V. Shchehlov ◽  
Ya.E. Kudelskyi ◽  
O.A. Pastushyn ◽  
O.E. Svyrydiuk ◽  
O.M. Goncharuk
Keyword(s):  
Postoperative Period ◽  
Neurological Deficit ◽  
Clinical Symptoms ◽  
Control Period ◽  
Clinical Manifestations ◽  
Clinical Results ◽  
Early Postoperative Period ◽  
Neurological Symptoms ◽  
Selection Of Patients ◽  
Selection Of

Objective – to analyze there sults of treatment of patients with fusiform aneurysms (FA) depending on localization and type of surgery.Materials and methods. In the period from 2007 to 2019 127 patients with intracranial fusiform cerebral aneurysms underwen treatment in Scientific and Practical Center of Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine. 133 fusiform aneurysms were identified. The following neuroimaging methods were used to diagnose FA: magnetic resonance imaging, multispiral computed tomography and cerebral selective angiography according to Seldinger. In this study, patients with fusiform aneurysms are divided according to localization in the FA of the carotid poolsand the FA of the vertebrobasilar basin. Patients with FA of carotid basins were 56 (27 (29 (51.8 %) men and 48.2 %) women). The average age of patients was 45.2 year. 31 (55.3 %) patients were operated. Patients with FA in the vertebrobasilar basin were 71 (43 (60.6 %) men and 28 (39.4 %) women). The average age of patients was 54.5 year. It was operated 48 (67.6 %) patients.Results. It was possible to completely eliminate FA from the bloodstream intraoperative in 16 (51.6 %) patients. In the early postoperative period in this group 5 (16.1 %) patients had a decrease in disease symptoms, in 3 (9.6 %) patients neurological symptoms increased. In other patients the dynamics of neurological manifestations remained unchanged. There were nofatal out comes in either the early or late post operative period. According to the extended Glasgow outcome scale at the time of discharge from the hospital 22 (71 %) patients had > 5 points, 9 (29 %) – 4 points. In the period from 3 to 5 weeks 2 symptomatic thromboses of flow-directingstents were noted, in the form of clinical manifestations of ischemic stroke. In the period from 3 to 6 months 22 (71 %) patients underwent control examination. Angiographically in 19 (86.3 %) revealed a completes hut down of FA from the bloodstream, in 3 (13.7 %) – decrease of volume of FA > 65 %. Clinical symptoms completely regressed in 16 (72.7 %) patients, partially regressed – in 3 (13.7 %), increased – in 2 (13.6 %). In the period from 12 to 18 months 7 (31.8 %) patients underwent control examination. Total FA shut down from the bloodstream was detected in 5 (71.4 %) patients, in 2 (28.6 %) aneurysms decreased by 80 %. Eighteen-month survival was 100 %.It was possible to intraoperatively switch off FA in the vertebrobasilar basin from the bloodstream in 11 (22.9 %) cases. In the early postoperative period a partial regression of neurological symptoms was observed in 7 (14.5 %) patients. In 10 (20.8 %) cases a new or increasing neurological deficit was observed after intracranial stent implantation, which partially regressed against the background of conservative treatment. Four (8.3 %) deaths were recorded in the early postoperative period. The clinical results of 48 patients on the Glasgo woutcome scale at the time of discharge were > 5 points in 27 (56.2 %) patients, 4 points – in 17 (35.4 %) and 1 points – in 4 (8.3 %). In the period from 3 to 6 months 19 (39.5 %) patients underwent control examination. Angiographically in 14 (73.7 %) patients the aneurysm was completely turned off from the blood circulation, in 2 (10.5 %) the decrease in the volume of the aneurysm was > 70 %, in 3 (15.8 %) patients the decrease in the volume of the aneurysm was 47–64 %. Clinical symptoms regressed in 7 (36.8 %) patients, a decrease in neurological deficit was noted in 2 (10.5 %) patients, an increase in neurological deficit in 3 (15.8 %) patients. Three deaths were recorded. In the period from 12 to 18 months, 12 (25 %) patients underwent control examination. Angiographically in 10 (83.3 %) patients FA was excluded totally from the bloodcirculation, in 2 (16.7 %) – the volume of aneurysm was reduced by 80 %. Clinical symptoms regressed in 8 (66.6 %) patients and increased in 1 (8.3 %). During the control period 2 patients died. The 18-month survival rate was 89.5 %, 5 (10.5 %) patients died.Conclusions. Fusiform aneurysms are more common in people of working age, more common in men. A more unfavorable course of the disease occursin patients with symptomatic FA of the vertebrobasilar basin, due to the compression and dysfunction of the brainstem and stem structures. Deconstructive methods for eliminating FA from the bloodstream provide long-termsatis factory treatment results, butrequire careful selection of patients for such in terventions. Endovascular treatment should be considered as the main treatment, asitentails fewer risks for the patient. For aneurysms that cannot be treated with endovascular methods, microsurgical treatments hould be considered. The main forsuccess ful treatment of patients with fusiform aneurysms is th ecareful selection of patients and individual approach to the choice of treatment based on the shape, location and size of the FA.

scholarly journals LONG-TERM RESULTS AFTER VIDEO ENDOSCOPIC MYOTOMY BY HELLER WITH FUNDOPLICATION BY DOR IN PATIENTS WITH 2-4 STAGES OF ACHALASIA

2021 ◽  
pp. 40-49
Author(s):  
V. A. Gankov ◽  
E. A. Tseimakh ◽  
G. I. Bagdasaryan ◽  
A. R. Andreasyan ◽  
S. A. Maslikova
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Long Term Results ◽  
Esophageal Function ◽  
X Ray ◽  
Leading Symptom ◽  
Instrumental Methods

Relevance. Treatment of achalasia of the cardia (AС) is currently palliative, aimed at reducing the manifestation of clinical symptoms of the disease. Together with instrumental methods of examination of esophageal function, the Eckardt scale and the GIGLI questionnaire are convenient and simple tools for evaluating results in the long-term postoperative period.The aim of the study was to evaluate the long-term results of surgical treatment of patients with 2-4 stages of AС, after laparoscopic Нeller myotomy with anterior hemiesophagofundoplication by Dor to the results of special methods of esophageal examination and patient questionnaires using the Eckardt scale and the GIGLI questionnaire.Materials and methods. The work included the results of examinations of 103 patients who underwent video laparoscopic Нeller myotomy, with anterior hemiesophagofundoplication by Dor. The period of examination in the postoperative period was from 3 to 7 years. The results of X-ray examination of the esophagus and stomach, manometry of the esophageal and esophageal-gastric junction before and after surgery were studied , and patients were also surveyed according to the Eckardt scale and the GIGLI questionnaire.Results. The analysis of the results of instrumental methods of studying the function of the esophagus in the pre – and postoperative periods showed that the given manometry of the esophagus and esophageal-gastric junction, X-ray of the esophagus and stomach significantly improved in the postoperative period in patients with all stages of the disease. The results of patients of 4th stage AC compared with the results of 2nd and 3rd stages patients were worse(p<0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the results were better in patients with stage 2, worse in patients with stage 4 of AK (p<0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the 2nd stage patients results were better, 4th stage patients results were worse (p<0,05).Conclusions. After video-endoscopic Нeller myotomy with fundoplication by Dor, the indicators of esophageal manometry and esophageal and stomach radiography significantly improve, the results of the Eckardt scale and GIGLI questionnaire survey of patients show a significant decrease in the severity of clinical manifestations of AC in the balls. This method of surgical treatment can be recommended already at the 2nd stage of AC and as an organpreserving operation for 4th stage.

RETROSPECTIVE ANALYSIS OF FEATURES OF DETECTION OF NEW CORONOVIRAL INFECTION COVID-19 IN PATIENTS WITH SURGICAL PROFILE ARRIVING IN A EMERGENCY

2021 ◽  
pp. 139-148
Author(s):  
Дмитрий Валериевич Судаков ◽  
Евгений Владимирович Белов ◽  
Олег Валериевич Судаков ◽  
Ольга Игоревна Гордеева ◽  
Оксана Александровна Андросова
Keyword(s):  
Clinical Symptoms ◽  
Positive Impact ◽  
Clinical Manifestations ◽  
Reactive Protein ◽  
Group 4 ◽  
Group 3 ◽  
Ct Data ◽  
Group 2 ◽  
Group 1

В статье рассматриваются особенности своевременного выявления новой короновирусной инфекцией (НКИ) у пациентов хирургического профиля на уровне приемного отделения областной клинической больницы. Представленная работа является в настоящее время крайне актуальной, в виду продолжающейся в мире пандемии НКИ - Covid-19. Важное значение данному исследованию придает то, что оно направлено на как можно более раннюю диагностику Covid-19, уже на уровне нахождения в приемном отделении при поступлении в многопрофильный стационар. Подобные меры могут существенно помочь в сохранении здоровья медицинских работников и могут оказать положительное влияние на эпидемиологическую обстановку в целом. Интересной составляющей данного исследования является и то, что диагностика Covid-19 основывается лишь на тех лабораторных анализах, которые можно быстро определить в условиях приемного отделения. Объектами исследования послужило 200 пациентов, поступающих в приемное отделение БУЗ ВО ВОКБ №1 исключительно с хирургической патологией. Все больные были подразделены на 4 группы по 50 человек, всем им был поставлен сопутствующий диагноз Covid-19. В 1 группу вошли пациенты, поступающие в приемное отделение без сознания, сбор анамнеза и сбор жалоб у которых был невозможен. 2 группу составили пациенты, у которых НКИ была диагностирована непосредственно после оперативного вмешательства. В 3 группу вошли пациенты, у которых была выявлена НКИ, но объем оперативного вмешательства и объем поражения легких позволял им дальнейшее амбулаторное лечение. 4 группу составили пациенты, у которых Covid-19 выявлялся в течение 3 дней после оперативного вмешательства. У всех больных подробно собирался анамнез жизни и эпидемиологический анамнез (за исключением 1 группы), анализировались наиболее частые клинические проявления и показатели общего и биохимического анализа крови, обрабатывались данные КТ легких. Были определены основные клинические симптомы НКИ, такие как: повышенная температура тела, кашель, слабость и утомляемость. Наиболее важными лабораторными показателями стало определение уровня лейкоцитоза, с уровнем нейтрофилов и лимфоцитов, а также СОЭ, D-димера, С-реактивного белка. Представленная статья представляет большой интерес для врачей, работающих в условиях приемных отделений многопрофильных стационаров. По результатам работы планируется продолжение исследования с большей выборкой пациентов и большим количеством изучаемых параметров The article discusses the features of the timely detection of a new coronavirus infection (NCI) in surgical patients at the level of the admission department of a regional clinical hospital. The presented work is currently extremely relevant, in view of the ongoing NСI pandemic in the world - Covid-19. The importance of this study is attached to the fact that it is aimed at the earliest possible diagnosis of Covid-19, already at the level of being in the admission department upon admission to a multidisciplinary hospital. Such measures can significantly help preserve the health of medical workers and can have a positive impact on the epidemiological situation in general. An interesting component of this study is the fact that the diagnosis of Covid-19 is based only on those laboratory tests that can be quickly determined in the conditions of the admission department. The objects of the study were 200 patients admitted to the admission department of BUZ VO VOKB № 1 exclusively with surgical pathology. All patients were divided into 4 groups of 50 people, all of them were diagnosed with a concomitant Covid-19 diagnosis. Group 1 consisted of patients admitted to the emergency department unconscious, and it was impossible to collect anamnesis and collect complaints. Group 2 consisted of patients in whom NCI was diagnosed immediately after surgery. Group 3 included patients who had NCI, but the volume of surgery and the volume of lung lesions allowed them further outpatient treatment. Group 4 consisted of patients in whom Covid-19 was detected within 3 days after surgery. In all patients, a detailed life history and epidemiological history were collected (except for group 1), the most frequent clinical manifestations and indicators of general and biochemical blood tests were analyzed, and CT data of the lungs were processed. The main clinical symptoms of NCI were identified, such as: fever, cough, weakness and fatigue. The most important laboratory indicators were the determination of the level of leukocytosis, with the level of neutrophils and lymphocytes, as well as ESR, D-dimer, C-reactive protein. The presented article is of great interest to doctors working in the admission departments of multidisciplinary hospitals. Based on the results of the work, it is planned to continue the study with a larger sample of patients and a large number of studied parameters

SURGICAL TACTICS FOR PURULENT-SEPTIC COMPLICATIONS OF COMBAT BELLY INJURIES

2021 ◽  
pp. 103-108
Author(s):  
O. S. Gerasimenko ◽  
Y. I. Gaida ◽  
A. V. Okolets ◽  
K. R. Muradian
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
Clinical Manifestations ◽  
Gunshot Wounds ◽  
Treatment Method ◽  
Combat Trauma ◽  
Comprehensive Treatment ◽  
Vacuum Therapy ◽  
Septic Complications ◽  
Severity Of Injury

Summary. Combat injury of the abdomen, according to the ATO / OOS is from 6.7 to 9 %. The specificity of gunshot wounds to the abdomen causes the development of functional disorders and complications (51–81 %) and, as a consequence, a high mortality rate (12–31 %). Objective: To improve the effectiveness of surgical treatment of purulent-septic complications in the wounded with combat trauma to the abdomen (BTC). Materials and methods. The Military Medical Clinical Center of the Southern Region (VMKC PR) analyzed the treatment of 86 wounded who were hospitalized with purulent-septic complications of BTZ from 2014 to 2020, taking into account the location, clinical manifestations and severity of injury, used modern treatment methods , namely: puncture and drainage interventions under the control of ultrasonography and installation of NPWT systems. Comprehensive treatment was supplemented with antibacterial therapy and oxygen barotherapy. First of all, the wounded underwent puncture and drainage interventions under ultrasonic navigation and gradual rehabilitation for diagnostic and therapeutic purposes. NPWT therapy was used in 11 patients with extensive wounds and purulent-septic complications of the soft tissues of the anterior abdominal wall. Thus, the use of interventional sonography, as the primary diagnostic and treatment method for the treatment of purulent-inflammatory complications of combat trauma to the abdomen, has improved the quality of diagnosis and reduced traumatic interventions, which has reduced postoperative complications and inpatient treatment. Results and discussion. Eleven (14.2 %) cases of puncture and drainage interventions were ineffective, in connection with which we had to resort to traditional methods of treatment — opening and drainage of purulent-inflammatory foci and the use of NPWT-therapy. Vacuum therapy is an effective method of treatment of purulent-septic complications of gunshot wounds of the soft tissues of the abdomen, which in combination with puncture-drainage interventions, can reduce by 2.5 times the number of repeated operations (mainly multi-stage surgical treatments), thereby reducing 1.8 times the length of stay of patients in the hospital. Conclusions. Thanks to the use of modern methods it was possible to improve the results of surgical treatment of purulent-septic complications in the wounded with purulent-septic complications of combat trauma to the abdomen. The use of the latest techniques has helped reduce the number of invasive treatments, accelerate recovery, reduce bed rest, reduce intoxication, and increase the rate of return of servicemen.

scholarly journals Wheat Consumption Leads to Immune Activation and Symptom Worsening in Patients with Familial Mediterranean Fever: A Pilot Randomized Trial

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1127 ◽  
Author(s):  
Antonio Carroccio ◽  
Pasquale Mansueto ◽  
Maurizio Soresi ◽  
Francesca Fayer ◽  
Diana Di Liberto ◽  
...  
Keyword(s):  
Familial Mediterranean Fever ◽  
Clinical Symptoms ◽  
Inflammatory Diseases ◽  
Activity Index ◽  
Clinical Manifestations ◽  
University Hospital ◽  
Double Blind ◽  
Amyloid A ◽  
Tnf Α ◽  
Mediterranean Fever

We have identified a clinical association between self-reported non-celiac wheat sensitivity (NCWS) and Familial Mediterranean Fever (FMF). Objectives: A) To determine whether a 2-week double-blind placebo-controlled (DBPC) cross-over wheat vs. rice challenge exacerbates the clinical manifestations of FMF; B) to evaluate innate immune responses in NCWS/FMF patients challenged with wheat vs. rice. The study was conducted at the Department of Internal Medicine of the University Hospital of Palermo and the Hospital of Sciacca, Italy. Six female volunteers with FMF/NCWS (mean age 36 ± 6 years) were enrolled, 12 age-matched non-FMF, NCWS females, and 8 sex- and age-matched healthy subjects served as controls. We evaluated: 1. clinical symptoms by the FMF-specific AIDAI (Auto-Inflammatory Diseases Activity Index) score; 2. serum soluble CD14 (sCD14), C-reactive protein (CRP), and serum amyloid A (SSA); 3. circulating CD14+ monocytes expressing interleukin (IL)-1β and tumor necrosis factor (TNF)-α. The AIDAI score significantly increased in FMF patients during DBPC with wheat, but not with rice (19 ± 6.3 vs. 7 ± 1.6; p = 0.028). sCD14 values did not differ in FMF patients before and after the challenge, but were higher in FMF patients than in healthy controls (median values 11357 vs. 8710 pg/ml; p = 0.002). The percentage of circulating CD14+/IL-1β+ and of CD14+/TNF-α+ monocytes increased significantly after DBPC with wheat vs. baseline or rice challenge. Self-reported NCWS can hide an FMF diagnosis. Wheat ingestion exacerbated clinical and immunological features of FMF. Future studies performed on consecutive FMF patients recruited in centers for auto-inflammatory diseases will determine the real frequency and relevance of this association.

scholarly journals POS0913 UVEAL CATARACT IN PATIENTS WITH SPONDYLOARTHRITIS AND OTHER IMMUNO-INFLAMMATORY DISEASES AND ITS SURGICAL TREATMENT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 717-718
Author(s):  
S. Avetisov ◽  
I. Razumova ◽  
K. Avetisov ◽  
A. Godzenko
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Inflammatory Diseases ◽  
Systemic Diseases ◽  
Iol Implantation ◽  
Group 2 ◽  
Results Of Surgery ◽  
Group 1

Background:Uveitis is a common extra-skeletal manifestation of various systemic diseases, in particular, spondyloarthritis (SpA). Uveal cataract is the frequent complication of endogenous uveitis. Surgical treatment of uveal cataracts is associated with certain problems, the main being a potential risk of recurrence of uveitis, especially in the case of intraocular lens (IOL) implantation.Objectives:To analyse the results of surgery of complicated uveal cataract in patients with SpA and other rheumatic disorders.Methods:30 pts (34 eyes) with uveal cataract as a result of systemic immuno-inflammatory diseases were assessed in the “Research Institute of Eye Diseases” in the period from 2006 to 2018. The postoperative follow-up period ranged from 2 to 12 years. 20 pts had different variants of SpA (Group 1):7 (7 eyes) - ankylosing spondylitis, 1 (1 eye) –reactive arthritis, 1 (1 eye) - psoriatic arthritis, 4 (6 eyes) – juvenile spondyloarthritis, 8 (8 eyes) non-radiological SpA. 10 patients (11 eyes) had other systemic diseases (Group 2): 1 (1 eye) Behcet’s disease, 1 (1 eye) - multiple sclerosis, 3 (3 eyes) - Fuchs heterochromic cyclitis, 2 (2 eyes) -cutaneous psoriasis, and 3 (4 eyes) -uveitis of unknown etiology. 4 pts (6 eyes) with juvenile arthritis and pronounced corneal ribbon degeneration were underwent standard intracapsular cryoextraction of the cataract, followed by optical correction of aphakia using spectacle lenses. In other cases, ultrasound phacoemulsification with IOL implantation was used as a surgical aid. All patients had a period of uveitis remission before opreation for at least 2 months.Аnti-inflammatory therapy using local glucocorticoid and local and systemic nonsteroidal antiinflammatory drugs was prescribed 2 weeks before and within a month after the operation. Intra and postoperative complications, fluctuations in intraocular pressure (IOP), improvement of visual acuity, and the frequency of uveitis flares after surgery were assessеd as the main criteria for analyzing the results of surgery.Results:А statistically significant decrease in the number of uveitis exacerbations was observed in all pts: in group 1 - from 2,5 ± 0,65 to 1, 2 ± 0,65 per year (p<0.0001), in group 2 - from 2,55 ± 0,21 to 0,89 ± 0,21 per year (p<0.0001), while there were no statistically significant differences between the groups (p=0.31). Statistically significant increase in maximum visual acuity was observed in all groups: in group 1 - from 0,2± 0,38 to 0,58 ± 0,74, p<0.0001, in group 2 – from 0,24 ± 0,05 to 0,69 ± 0,07, p<0.0001. No complications were observed during operations. The phenomena of bullous keratopathy after intracapsular extraction were noted in 2 pts with juvenile arthritis and ribbon-like corneal degeneration. No рrogression of corneal changes was observed. Opacity in the central zone of the posterior capsule in the period from 2 to 24 months after surgery occurred in 7 cases. In all cases, laser dissection of the posterior lens capsule was performed. Transient increase in IOP in the early postoperative period, normalized by local hypotensive therapy, occurred in 8 cases in groups I. In the long- term follow-up period (2-24 months), persistent IOP decompensation occurred in 6 cases in groups 1 and in 3 cases in groups 2, which required various types of anti-glaucoma operations. Cystic macular edema developed in one case 5 months after surgery as a result of uveitis exacerbation and was stopped by corticosteroid therapy.Conclusion:Surgery of uveal cataracts in pts with SpA and other immuno-inflammatory diseases providing adequate pre- and postoperative аnti-inflammatory therapy improves visual acuity and reduces the frequency of uveitis relapses. Monitoring of IOP is necessary in the postoperative period.References:[1]Mora P., Gonzales S., Ghirardini S. et al. Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitis patients a two-centre, prospective, randomized trial. Acta Ophthalmol. Scandinavica Fondation. 2016 Sept.; 94(6): e 390-394. http//doi. 10.1111/aos.12955. Epub 2016 Feb 5.Disclosure of Interests:None declared

scholarly journals Eosinophilic Gastrointestinal Diseases in Childhood

2018 ◽  
Vol 73 (Suppl. 4) ◽  
pp. 18-28 ◽  
Author(s):  
Eleni Koutri ◽  
Alexandra Papadopoulou
Keyword(s):  
Clinical Symptoms ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Gastrointestinal Diseases ◽  
Esophageal Stenosis ◽  
Eosinophilic Inflammation ◽  
Gi Tract ◽  
Laboratory Findings ◽  
Systemic Steroids ◽  
Steroid Dependent

Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically, by symptoms related to the dysfunction of the involved segment(s) of the GI tract, and histologically, by dense eosinophilic inflammation, in the absence of an identifiable secondary cause. The group of EGIDs comprises eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC). EoE is the most common and the best described EGID compared to EG, EGE, and EC. The clinical presentation of the EGIDs differs depending on the location and the extent of the eosinophilic infiltration in the GI tract, as well as its depth through the bowel wall. In the absence of biological markers, the diagnosis is based on the combination of clinical symptoms with the histological features of EGIDs, after the exclusion of secondary causes of eosinophilic inflammation of the GI tract. Treatment is individualized and includes elimination diets (mainly empiric or elemental) and/or drugs, according to the involved GI segment: proton pump inhibitors or local steroids in EoE; local or oral systemic steroids in EG/EGE limited to the duodenum; oral systemic steroids in EGE with lower small intestine and/or colon involvement. In patients with EoE, maintenance treatment with lower doses may be considered following histological remission with the means of drugs. In patients treated with elimination diets, disease food triggers identified during food reintroduction need to be further eliminated. Esophageal stenosis despite medical treatment requires endoscopic dilation, while the use of thiopurines or anti-TNF drugs may be considered in refractory or steroid-dependent EGID (other than EoE). The aim of this review is to provide the available evidence on each of the above disorders, to aid clinicians to interpret the clinical manifestations and the laboratory findings and choose the best available treatment option.

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