ABSTRACT
El síndrome de pinzamiento isquiofemoral suele ser una patología infradiagnosticada que forma parte de uno de los diagnósticos diferenciales a tener en cuenta en el dolor de cadera. Inicialmente fue descrito con procedimientos quirúrgicos, pero con el paso del tiempo se han ido describiendo diferentes entidades médicas, así como técnicas y posturas mantenidas, que puede agravar el cuadro, pudiendo asociar incluso afectación neurológica. En la actualidad el tratamiento es inicialmente conservador con medidas de reposo, analgesia, frío e inicio progresivo de ejercicios dirigidos a la musculatura lumbar, glútea y de miembros inferiores, pero no existe un protocolo de actuación establecido unificado.(AU)
Ischiofemoral impingement syndrome is usually underdiagnosed; this syndrome forms part of the differential diagnoses to be included in hip pain. It was initially described with surgical procedures but, with the passage of time, various medical entities have been described, as well as techniques and postures that can aggravate this syndrome, which can even be associated with neurological involvement. Current treatment is initially conservative, consisting of rest, analgesia, cold and progressive exercises aimed at the lumber and gluteal muscles and lower extremities but there is no established standard of care.(AU)
Subject(s)
Humans , Female , Adult , Hip Injuries , Sciatic Nerve , Arthralgia/diagnosis , Arthralgia/etiology , Femur/injuries , Joints/injuries , Joints/surgery , Rehabilitation , Pain ManagementABSTRACT
Ischiofemoral impingement syndrome is usually underdiagnosed; this syndrome forms part of the differential diagnoses to be included in hip pain. It was initially described with surgical procedures but, with the passage of time, various medical entities have been described, as well as techniques and postures that can aggravate this syndrome, which can even be associated with neurological involvement. Current treatment is initially conservative, consisting of rest, analgesia, cold and progressive exercises aimed at the lumber and gluteal muscles and lower extremities but there is no established standard of care.
Subject(s)
Arthralgia , Hip Joint , Arthralgia/diagnosis , Arthralgia/etiology , Diagnosis, Differential , Humans , Pain , SyndromeABSTRACT
OBJECTIVES: Metabolic syndrome (MetS) is highly prevalent in patients with systemic lupus erythematosus (SLE) and it has been associated with increased cardiovascular risk. We examined the contribution of MetS to inflammatory markers, arterial stiffness and circulating endothelial progenitor cells (EPCs) as surrogates of subclinical atherosclerosis. METHODS: Cardiovascular risk factors, SLE-specific factors and peripheral blood EPCs were assessed in 50 female SLE patients. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Simultaneously, atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by doppler velocimetry. RESULTS: Beyond the factors included in the definition, SLE patients with MetS have a significantly higher serum level of uric acid (6.88 ± 2.20 vs 4.45 ± 1.17, p < 0.001) and some inflammatory biomarkers such as homocysteine, IL-8, sICAM-1 or complement molecules. The presence of MetS in our patients was closely linked with a significantly increased patient organ damage score (3.20 ± 1.97 vs 1.60 ± 1.67, p = 0.008), a decreased percentage of circulating EPCs (0.53 ± 0.24 vs 0.85 ± 0.57, p = 0.007) and an increased arterial stiffness (9.89 ± 2.40 vs 7.13 ± 1.51, p < 0.001). CONCLUSIONS: MetS may contribute to the development of atherosclerosis by significantly increasing inflammation levels and arterial stiffness and decreasing circulating EPCs. This finding would justify close monitoring of these patients.
Subject(s)
Endothelial Progenitor Cells/pathology , Lupus Erythematosus, Systemic/metabolism , Lupus Erythematosus, Systemic/pathology , Metabolic Syndrome/metabolism , Metabolic Syndrome/pathology , Vascular Stiffness/physiology , Adult , Aged , Arteries/pathology , Atherosclerosis/metabolism , Atherosclerosis/pathology , Biomarkers/metabolism , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/pathology , Cross-Sectional Studies , Endothelial Progenitor Cells/metabolism , Female , Humans , Inflammation/metabolism , Inflammation/pathology , Male , Middle Aged , Risk Factors , Uric Acid/bloodABSTRACT
OBJECTIVES: We evaluated whether traditional or non-traditional cardiovascular (CV) risk factors and systemic lupus erythematosus (SLE)-related risk factors were associated with pathological arterial stiffness measured by pulse wave velocity (PWV) adjusted for patients' age and blood pressure. METHOD: CV risk factors were measured in the 46 SLE female patients studied. Activity and organ damage were assessed by the SLE Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index, respectively. Other lupus-related parameters and information concerning treatment were recorded. Subclinical atherosclerosis was assessed by PWV calculated from pulse wave recording by Doppler, a non-invasive method to measure arterial stiffness. Multivariate logistic regression analysis was used to identify independent determinants of increased PWV. RESULTS: PWV was categorized as normal or pathological arterial stiffness following the reference values adjusted by age and blood pressure recently published by the European Society of Cardiology. Pathological PWV was associated with CV risk factors including homocysteine (p = 0.01), high-sensitivity C-reactive protein (hs-CRP; p = 0.03), uric acid (p = 0.01), and metabolic syndrome (p = 0.007). With regard to SLE-specific risk factors, a significant association was found between PWV and SLICC/ACR score (p = 0.006). Multivariate analysis showed that increased PWV was independently associated with metabolic syndrome [odds ratio (OR) 6.6, 95% confidence interval (CI) 1.2-38, p = 0.03] and SLICC/ACR score (OR 1.5, 95% CI 1-2.32, p = 0.05). CONCLUSIONS: We have found a close link between metabolic syndrome and SLICC/ACR score with increased aortic stiffness. These variables might be an indicator of subclinical atherosclerosis in SLE women without clinical evidence of atherosclerotic cardiovascular disease (CVD).
Subject(s)
Lupus Erythematosus, Systemic/physiopathology , Metabolic Syndrome/physiopathology , Vascular Stiffness/physiology , Adult , Atherosclerosis/complications , Atherosclerosis/metabolism , Atherosclerosis/physiopathology , C-Reactive Protein/metabolism , Cross-Sectional Studies , Female , Humans , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/metabolism , Metabolic Syndrome/complications , Metabolic Syndrome/metabolism , Middle Aged , Risk Factors , Severity of Illness IndexABSTRACT
Liver transplantation activates the innate immune system by toll-like receptors (TLRs), potentially leading to allograft rejection and graft failure. The aim of this study was to evaluate the possible association of different single nucleotide polymorphisms (SNPs) in several TLR genes with the incidence of acute graft rejection in liver transplant recipients for hepatitis C virus (HCV)-related cirrhosis. This is a single-center study of 100 adult patients who received a first whole only liver graft from deceased donors at our institution between 1988 and 2009 for cirrhosis due to HCV infection. We examined 10 SNPs in the TLR1 (S6021), TLR2 (R753Q), TLR3 (L412F), TLR4 (D299G and T399I), TLR5 (R392X), TLR6 (S249P), TLR7 (Q11L), and TLR9 (-1237T/C and -1486C/T) genes. Genotyping was carried out with the LightSNiP typing assay (TIB-MolBiol, Berlin, Germany) by analyzing the melting curves with the LightCycler 480 system (Roche Applied Science, Mannheim, Germany). Recipient allelic and genotypic distributions for each SNP were compared among patients with and without acute rejection within the first 3 months after transplantation. We found the homozygous mutant TT genotype for TLR3 L412F was associated with a lower rate of acute rejection when compared with the homozygous wild-type genotype [odds ratio (OR) = 0.1, 95% confidence interval (95% CI) = 0.01-0.86; P = .017], and showed a trend toward a lower graft rejection rate when compared with patients carrying one or two C alleles (OR = 0.15, 95% CI = 0.02-1.2, P = .05). No other associations with acute rejection rates were found for any other SNP evaluated. This preliminary study suggests an important role for SNP TLR3 L412F in acute rejection in liver transplant patients for HCV-related cirrhosis. Nevertheless, these findings must be prospectively validated in other cohorts of patients as well as in patients after liver transplantation for other etiologies than HCV.
Subject(s)
Graft Rejection/prevention & control , Graft Survival , Hepatitis C/surgery , Liver Cirrhosis/surgery , Liver Transplantation/immunology , Polymorphism, Single Nucleotide , Toll-Like Receptor 3/genetics , Acute Disease , Adult , Aged , Chi-Square Distribution , Female , Gene Frequency , Genotype , Graft Rejection/genetics , Graft Rejection/immunology , Hepatitis C/complications , Humans , Liver Cirrhosis/virology , Male , Middle Aged , Odds Ratio , Phenotype , Retrospective Studies , Risk Assessment , Risk Factors , Spain , Time Factors , Treatment OutcomeABSTRACT
In the last few years, it has been suggested that the involvement of human leukocyte antigen-G (HLA-G) in several tumoral processes and its likely participation as a factor of immune tolerance in malignant cells. Recently, positive HLA-G surface expression has been associated with a poor prognosis in a small group of patients with B-cell chronic lymphocytic leukemia (B-CLL), a lymphoproliferative disorder characterized by a heterogeneous clinical course. In the present work, 169 patients suffering from B-CLL were analyzed for the expression of HLA-G by flow cytometry in order to verify its prognostic value in a larger cohort. We observed a low expression of this molecule on leukemic B cells and no significant relation to clinical data or progression-free survival time, indicating that this molecule is not as good immunologic prognostic marker for B-CLL as suggested.
Subject(s)
B-Lymphocytes/immunology , HLA Antigens/analysis , Histocompatibility Antigens Class I/analysis , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Adult , Aged , Aged, 80 and over , Female , HLA-G Antigens , Humans , Kaplan-Meier Estimate , Leukemia, Lymphocytic, Chronic, B-Cell/mortality , Male , Middle Aged , PrognosisABSTRACT
Cardiac output (CO) is monitored in critically ill patients to maintain and improve cardiac function with the primary goal of adequate tissue perfusion. For a long time, this monitoring has been done using the pulmonary arterial catheter, which has been provoking increasing controversy. For some years, monitoring of CO has been evolving with the appearance of new invasive and non-invasive monitoring systems. In this chapter we review some aspects of CO monitoring with the PiCCO system based on transpulmonary thermodilution. This system is based on the injection of a cold fluid bolus centrally in the vein. A thermistor located in the tip of the arterial catheter, usually femoral, is used to measure blood temperature changes. A thermodilution curve is created and the hemodynamic parameters obtained after its analysis.
Subject(s)
Cardiac Output , Hemodynamics , Pulse , Humans , Monitoring, Physiologic/methodsABSTRACT
La monitorización del gasto cardíaco (GC) en lospacientes críticos tiene como objetivo el mantener yoptimizar la función cardíaca con el objetivoprimordial de obtener una adecuada perfusión tisular.Dicha monitorización se ha realizado, desde haceaños, mediante el empleo del catéter de arteriapulmonar, el cual, cada vez suscita mayorcontroversia. Desde hace algunos años lamonitorización del GC ha ido evolucionando con laaparición de nuevos sistemas de monitorización tantode manera invasiva como no invasiva. En estecapítulo repasamos algunos aspectos de lamonitorización del GC mediante el empleode termodilución transpulmonar con el sistemaPiCCO®. Dicho sistema se basa en la inyecciónde un bolo de suero salino por vía central. Untermistor situado en la punta de un catéter arterial,normalmente femoral, mide los cambios detemperatura sanguíneos creando una curvade termodilución, que tras su análisis nos informará delos parámetros hemodinámicos
Cardiac output (CO) is monitored in critically illpatients to maintain and improve cardiac functionwith the primary goal of adequate tissue perfusion.For a long time, this monitoring has been doneusing the pulmonary arterial catheter, which hasbeen provoking increasing controversy. For someyears, monitoring of CO has been evolving with theappearance of new invasive and non-invasivemonitoring systems. In this chapter we review someaspects of CO monitoring with the PiCCO® systembased on transpulmonary thermodilution. Thissystem is based on the injection of a cold fluidbolus centrally in the vein. A thermistor located inthe tip of the arterial catheter, usually femoral, isused to measure blood temperature changes.A thermodilution curve is created and the hemodynamic parameters obtained after itsanalysis
Subject(s)
Humans , Monitoring, Physiologic/nursing , Critical Care/methods , Hemodynamics , Thermodilution/nursing , Cardiac Output/physiology , Blood Pressure Determination/methods , Catheterization/methodsABSTRACT
The purpose of this study was to examine whether several allelic variants in the polymorphic interleukin (IL)-10 promoter region were related with an increased risk of developing systemic lupus erythematosus (SLE) in Spanish patients from Canary Islands. Microsatellites (MS) at positions -4000 and -1200 (IL10R and IL10G, respectively) and single nucleotide polymorphisms (SNPs) (MS) at positions -1082G/A, -819C/T and -592C/A of the IL-10 promoter were analysed in patients with SLE and healthy controls from Canary Islands (Spain). We found that SNPs but not MS were associated with SLE. The GCC haplotype frequency was significantly higher in SLE patients (0.43) than in healthy donors (0.33) [P = 0.02; OR = 1.50 (95% CI = 1.06-2.14)], whereas the ACC haplotype was less represented in patients (0.28 vs. 0.37) [P = 0.02; OR = 0.64 (95% CI = 0.44-0.92)]. To assess the functional role of genotypes, serum IL-10 levels from patients and controls were quantified by ELISA. Also, the lipopolysaccharide-induced IL-10 secretion by monocytes from healthy controls was evaluated in vitro. Serum IL-10 levels were higher in patients [median (interquartile range) = 2.8 pg/mL (1.8-4.2)] than in controls [0.9 pg/mL (0-3.5)] (P = 0.02), but no association was observed between serum IL-10 levels or lipopolysaccharide-induced IL-10 secretion and the IL-10 promoter haplotypes. These data suggest that the IL-10 promoter haplotype that produces higher levels of cytokine is associated with SLE in patients from Canary Islands.
Subject(s)
Interleukin-10/genetics , Lupus Erythematosus, Systemic/genetics , Microsatellite Repeats , Monocytes/metabolism , Polymorphism, Single Nucleotide , Promoter Regions, Genetic/genetics , Alleles , Cells, Cultured , Female , Genetic Predisposition to Disease , Genotype , Haplotypes/genetics , Humans , Interleukin-10/blood , Interleukin-10/metabolism , Lipopolysaccharides/pharmacology , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/metabolism , Male , SpainABSTRACT
Se determinó la frecuencia de la cardiopatía isquémica y su relación con algunos de los principales factores de riesgo coronario(diabetes mellitus, colesterol alto, hipertensión arterial) en la población de 15 y mas años de edad (14895 habitantes) del policlínico docente área 5 de Cienfuegos. Se escogió una muestra al azar(método de la loteria) representativa de dicha población que abarcó a 1640 individuos(11 porciento) al total de la muestra se le aplicó una encuesta durante el período comprendido entre octubre de 1988 y marzo de 1989, basada en los modelos de encuestas cardiovasculares de Rose y de Macias recomendados para este tipo de estudios. Con mayor afectaciones en los individuos diabéticos y con colesterol elevado, casi la mitad de los cardiopatas isquémicos(48,4 porciento) no eran conocidos, lo que resfuerza aún mas la importancia de la prevención y diagnóstico precoz de esta enfermedad
Subject(s)
Coronary Disease , Risk FactorsABSTRACT
Ascites secondary to endometriosis is extremely uncommon, but curable. We therefore report hemorrhagic ascites in a young woman with this disorder, and provide a literature review and summary of clinical features. The pathogenesis of ascites in this setting is unknown.
