Calf pain as a prominent feature of Behçet's Disease

Objective@#This study aimed to present four cases of Behçet's disease (BD) wherein recurrent calf pain was the first and prominent symptom experienced by the patients. @*Methodology@#The case series described the clinical features, disease development, management, and outcomes of these patients. Written consent was obtained from each participant for the review and publication of their case. @*Results@#All cases presented with chronic and recurrent calf pain, three of whom were bilateral. All four had skin changes on the lower extremities that may have contributed to leg pain. Only probing was a history of oral ulcers reported in all four; none had genital ulcers, eye abnormality, or sensory or motor deficits. All presented with elevated acute phase reactants. Based on the 2013 International Criteria for Behçet’s Disease (ICBD), a diagnosis of possible BD was made due to the presence of oral ulcers, skin lesions, and absence of other findings pointing to another connective tissue disease or systemic vasculitides. All four cases were given oral corticosteroids and colchicine, but two required the addition of methotrexate and azathioprine for control of symptoms. @*Conclusion@#A complaint of recurrent calf pain warrants inquiry and examination of the skin lesions over the affected area and other areas like the oral cavity and genital area. It also warrants consideration of a vasculitic process, especially in the background of oral ulcers and skin changes. In such cases, BD is the right differential diagnosis to be considered.

Adesão medicamentosa em pacientes com m¨²lltiplas doenças crônicas: estudo de preval¨ºncia em ambulat¨®rio de medicina interna de um hospital terci¨¢rio / Medication adherence in patients with multiple chronicdiseases: a prevalence study in an outpatient internalmedicine service of a tertiary hospital

Introdução: É frequente a associação de v¨¢rios medicamentos para controlardoenças em pacientes crônicos. Contudo, a adesão medicamentosa ¨¦ vari¨¢vel, eos fatores associados diferem, não havendo dados uniformes sobre o assunto.M¨¦todos: Estudo transversal em pacientes do ambulat¨®rio de Medicina Interna deum hospital terci¨¢rio, maiores de 18 anos, com duas ou mais doenças crônicas,visando a estimar a adesão medicamentosa pela Escala de Adesão Medicamentosade Morisky. Fatores associados ¨¤ adesão foram avaliados pela regressão dePoisson. O controle das doenças crônicas foi avaliado e definido como alvosatingidos de hipertensão, diabetes e dislipidemia.Resultados: Um total de 170 pacientes (idade m¨¦dia 65¡À9,8 anos), 61 homens(36%), foram inclu¨ªdos. Sessenta e sete pacientes tinham at¨¦ 4 anos de estudo;uma renda menor que mil reais foi referida por 56 pacientes. O n¨²mero m¨¦diode comorbidades foi 4¡À1,14, sendo hipertensão arterial sist¨ºmica a doença maisprevalente (96,5%), seguido de diabetes mellitus tipo 2 (67%). Cada paciente usava7,5¡À2,5 medicamentos. A taxa de controle das doenças crônicas mais prevalentesfoi: hipertensão arterial sist¨ºmica 72% (IC95% 65-79%), diabetes mellitus 53%(IC95%: 42¨C63%) e dislipidemia 51% (IC95% 41¨C61%). A preval¨ºncia de m¨¦dia ealta adesão foi 43%. Os fatores que se associaram independentemente ¨¤ adesãomedicamentosa foram pr¨¢tica de exerc¨ªcio f¨ªsico (RP= 1,63; IC 95%: 1,09¨C2,44;p= 0,017) e idade (RP= 1,02; IC 95%: 1,00¨C1,03; p= 0,032).Conclusão: Menos da metade dos pacientes do ambulat¨®rio de Medicina Internaadere ¨¤ prescrição m¨¦dica. É necess¨¢rio instituir novas estrat¨¦gias para que ospacientes se beneficiem das prescrições de medicamentos.

Introduction: The combination of several medications to control diseases inchronic patients is very common. However, medication adherence is variable, andassociated factors differ. Besides, there is no uniform data on this subject.Methods: Cross-sectional study in an outpatient Internal Medicine Service of atertiary care hospital, with patients ¡Ý 18 years old with two or more chronic diseases,aimed at assessing medication adherence using the Morisky Medication AdherenceScale. Factors associated with adherence were assessed by Poisson regression.The control of hypertension, diabetes and dyslipidemia was assessed.Results: A total of 170 patients (mean age 65¡À9.8 years), 61 of them men (36%), wasincluded. Sixty-seven patients had up to 4 years of study, and 56 patients reporteda monthly income of less than a thousand Brazilian reais. The average number ofcomorbidities was 4¡À1.14. Hypertension was the most prevalent disease (96.5%),followed by type 2 diabetes mellitus (67%). Each patient used 7.5 ¡À 2.5 medications.The control rate of the most prevalent chronic diseases was: hypertension 72%(95% CI 65-79%), diabetes mellitus 53% (95% CI 42-63%), and dyslipidemia 51%(95% CI 41-61%). The prevalence of medium and high adherence was 43%. Thefactors independently associated with medication adherence were physical exercise(PR = 1.63; 95%CI: 1.09-2.44; p= 0.017) and age (PR= 1.02; 95%CI: 1.00-1.03; p=0.032).Conclusion: Less than half of the chronic clinical patients adheres to the prescription.It is necessary to establish new strategies for patients to benefit from prescriptionmedication.

A Case of Vasculo-Behçet Disease Diagnosed by Right Atrial Mass and Inferior Vena Cava Thrombosis / 日本心臓血管外科学会雑誌

We report a rare case of 16-year-old boy who was given a diagnosis vasculo-Behçet disease after removing a right atrial thrombus. He was admitted to our hospital with abdominal pain and fever. He was underwent appendectomy for suspected appendicitis, but the appendix was normal. Additional image examinations revealed a mobile right atrial mass and inferior vena cava thrombosis, and the patient was sent to reoperation urgently to prevent pulmonary embolism. Surgery revealed the mass to be a thrombus. Vasculo-Behçet disease was diagnosed based on the patient's history and examination data. He was discharged on the 17th postoperative day. Cardiac mass excision should be immediately considered in such cases, and the differential diagnosis of Behçet disease was important for this case.

A Case of Vasculo-Behçet's Disease Complicated by an Intracardiac Thrombus / 日本心臓血管外科学会雑誌

We report a rare case of vasculo-Behçet's disease complicated by an intracardiac thrombus. A 48-year-old woman with a history of Behçet's disease and deep vein thrombosis in a lower limb, and who had been treated with colchicine and warfarin, was given a diagnosis of an appendectal tumor by colonoscopy. Preoperative examinations, including chest computed tomography, showed a pedunculated mobile tumor from her inferior <i>vena cava</i> (IVC) to the right atrium (RA). Urgent surgery was performed to prevent pulmonary embolism. We exposed the RA through a median sternotomy under cardiopulmonary bypass and extirpated the tumor that appeared macroscopically to be an organized thrombus attached to the IVC wall. The pathological diagnosis was organized thrombus. A month later, she underwent ileocecal resection and was given a pathological diagnosis of mucinous cystadenoma. Her postoperative course was uneventful. Intracardiac thrombus complicated by vasculo-Behçet's disease is rare, and it is important in the differential diagnosis of intracardiac tumor.

Surgical Repair of Various Pseudoaneurysms in 2 Patients with Vasculo-Behçet Disease / 日本心臓血管外科学会雑誌

Vasculo-Behçet disease (VBD) is a special type of Behçet disease (BD) involving some vascular disorders like aneurysmal formation, arterial occlusion, and venous thrombosis in various vessels. VBD has a poor prognosis due to aneurysmal rupture or recurrence of vascular disorders despite optimal treatment. However, definite diagnosis in BD is made on the basis of clinical features, and early diagnosis is difficult. We report 2 patients whose first clinical symptoms were femoral-pseudoaneurysms. They received a diagnosis of VBD after surgery. The first patient was a 69-year-old man, who underwent autologous-vein patch closure of a perforated region in the left femoral artery. One year later, he had a pseudoaneurysm of the right profunda femoris artery, which was ligated. The second patient was a 51-year-old man, who underwent the interposition of the saphenous vein for defective artery due to left superficial femoral-pseudoaneurysm.

A Case of Beh\ccet's Disease Successfully Treated with Keishibukuryogan, Whose Liver Damage Was Caused by Orengedokuto / 日本東洋医学雑誌

We present the case of 65 year-old male with Behçet's disease who was successfully treated with the Kampo medicine keishibukuryogan. The patient presented with hyperemic conjunctiva, ocular pain and uveitis at the age of 38, and was diagnosed with Behçet's disease. One year later he was affected with ulcerative glossitis, which was also diagnosed as a manifestation of Behçet's disease. At the age of 56 he was presented with acute arthritis of his ankle joint, followed by ulcerative stomatitis and glossitis. He was treated with colchicine and cyclophosphamide. Thereafter, he suffered from recurrent oral aphthous ulcers, and arthritis. Intractable oral ulcers, which did not respond to Western medicine, led him to seek Oriental herbal remedies. Keishibukuryogan was prescribed and, since then, his oral ulcers have completely subsided and his arthritis has not been a problem. He has been relieved from all manifestations of Behçet's disease.Thus, we believe that the Kampo medicine keishibukuryogan should be taken into consideration when treating Behçet's disease.Moreover, liver dysfunction caused by the Kampo medicine orengedokuto arose at an early stage of therapy, but immediately disappeared when its use was stopped. Pharmacoepidemiologically, Scutellariae radix, an ingredient of orengedokuto, was suspected of causing this liver dysfunction.