RESUMEN
We retrospectively analyzed therapy efficacy and the adverse reactions of 10 patients suffering from systemic lupus erythematosus (SLE) with intestinal involvement treated with rituximab (RTX). Patients were hospitalized in the Department of Rheumatology and Immunology of the First Medical Center of PLA General Hospital from January 2015 to January 2023. Among the 10 patients, two were men and eight were women. The age of the cohort was (41.9±8.8) years. The age at disease onset was (28.8±9.2) years. The total course of the SLE diagnosis was(109.6±59.9) months. The course of the diagnosis of SLE with intestinal involvement was (89.3±50.2) months. The time from the appearance of intestinal symptoms to the diagnosis of SLE with intestinal involvement was 1.5 (1.0,8.0) months. The time from the diagnosis of SLE with intestinal involvement to RTX use was 13.0 (1.0,46.3) months. Follow-up duration after application of RTX treatment was (55.3±28.4) months. There were five cases of abdominal pain, four cases of abdominal distension, nine cases of diarrhea, three cases of nervous-system involvement, nine cases of lupus nephritis, and seven cases of serositis. All 10 patients underwent computed tomography and radiology of the abdomen. Eight patients had intestinal-wall edema, seven suffered intestinal dilation, four had target signs, three suffered congestion of mesenteric blood vessels, eight had increased mesenteric-fat density, and six had false intestinal obstruction. All 10 patients showed a low level of complement C3 (250-750 mg/L). Nine cases showed a low level of complement C4 (10-90 mg/L). The SLE disease activity index 2000 (SLEDAI-2K) at baseline in 10 patients was 20.5 (17.8, 30.0). After receiving RTX (0.5 g: day 1, day 14, or 375 mg/m 2: day 1, day 14) induction treatment, the intestinal symptoms of 10 cases were relieved completely. Four patients had adverse reactions, of which three received a high-dose glucocorticoid combined with RTX treatment simultaneously. Adverse reactions manifested mainly as a reduced level of IgG and infection with herpes simplex virus in one case, reduced level of IgG and lung infection in one patient, lung infection in one case, and reduced IgG level in one patient. RTX may an efficacious treatment strategy for patients suffering from refractory SLE with intestinal involvement.
RESUMEN
Background: In this review, author analyzed the cases of Acute Intussusception that underwent Ultrasound guided hydrostatic reduction during a one-year period. Author reviewed this treatment protocol and guidelines of non-operative and surgical therapy. The procedure followed and guidelines of therapy were reviewed and are detailed in the study.Methods: Retrospective analysis of the hospital data of all patients who were treated for acute Intussusception during the period of January 2017 to December 2017 was done. All records including admission data, investigations, procedure records, preoperative details and operation notes, where applicable, post procedure recovery data and incidence of recurrence were studied. Inclusion criteria included confirmed sonological diagnosis of Intussusception verified by the treating paediatric surgeon, availability of all necessary records and absence of other co-morbidities. Exclusion criteria included age more than 2 years, children who had other major systemic disease, doubtful sonological diagnosis and postoperative intussusception. The paediatric surgeon himself performed the procedure in the dedicated ultrasound suite.Results: The study was done in the mother and child wing of a medical college which is a tertiary referral centre catering to more than 200 cases of Intussusception per year. The records of 194 cases of Intussusception were available for analysis, of which only 176 could be included in the study. The age group included is 3 months to 3 years. The mean age was 11 months. The sex incidence was 94 cases in males and 82 in females.Conclusions: Ultrasound guided hydrostatic reduction is a safe, effective and convenient modality for treatment of acute Intussusception, which can be performed by the treating Paediatric surgeon himself with requisite training and exposure.