ABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Vasculitis, Central Nervous System/complications , Vasculitis, Central Nervous System , Fluorodeoxyglucose F18/administration & dosage , Fluorodeoxyglucose F18/analysis , Positron-Emission Tomography/methods , Positron-Emission Tomography , Giant Cell Arteritis/complications , Giant Cell Arteritis , Paresis/complications , Risk Factors , Intermittent Claudication/complications , Adrenal Cortex Hormones/therapeutic use , Magnetic Resonance Imaging/trends , Aorta, Thoracic/pathology , Aorta, ThoracicABSTRACT
OBJECTIVE: To assess the feasibility of granulocyte apheresis (GCAP) in patients with Ocular Behçet's Disease (BD) resistant to immunosuppressive therapy (prednisone, cyclosporin, azathyoprine or mycophenolate mofetil). METHODS: Prospective observational study of five cases, carried out in a university centre. Four patients were resistant to medical treatment and one refused immunosuppressive drugs. The intervention procedure consisted of an extracorporeal GCAP using a column filled with cellulose acetate beads (Adacolumn, JIMRO, Takasaki, Japan). All patients received underwent a schedule of therapy of five sessions, once a week for five consecutive weeks. Visual acuity (Snellen lines), the degree of intraocular inflammation and doses of immunosuppressive therapy were measured and observed every week. RESULTS: Visual acuity improved in the five cases. Intraocular inflammation was measured and observed in every case, relapses were avoided, and treatment with prednisone was reduced by more than half of the initial dose (average reduction 52.7%, SD 14). CONCLUSIONS: GCAP has been shown to be safe and effective as a new therapy in five cases of Ocular Behçet's Disease refractory to medical treatment. Further research is needed in order to confirm the promising results of these initial investigations.
Subject(s)
Behcet Syndrome/therapy , Cytapheresis , Granulocytes , Adult , Drug Resistance , Female , Humans , Male , Prospective StudiesABSTRACT
Objetivo: El objetivo del estudio fue evaluar la viabilidad de la granulocitoaferesis (GCAP) en pacientes con enfermedad de Behçet (EB) ocular resistente al tratamiento con inmunosupresores (prednisona, ciclosporina, azatioprina o micofenolato mofetilo). Métodos: Estudio prospectivo de cinco pacientes, realizado en un hospital universitario de tercer nivel. Cuatro pacientes eran resistentes al tratamiento médico y uno rechazaba los fármacos inmunosupresores. El procedimiento consistió en realizar una GCAP extracorpórea mediante una columna rellena con gránulos de acetato de celulosa (Adacolumn®, JIMRO, Takasaki, Japón). Todos los pacientes fueron tratados con cinco sesiones, una semanal durante cinco semanas consecutivas. En cada sesión se controlaba la agudeza visual (AV) mediante las lineas de Snellen, el grado de inflamación intraocular y las dosis de tratamiento inmunosupresor. Resultados: La agudeza visual mejoró en los cinco casos. La inflamación intraocular se controló, no hubo recidivas y el tratamiento con prednisona se redujo en más de la mitad de la dosis inicial (reducción media de 52,7%, DE 14 ). Conclusiones: La GCAP ha demostrado ser un nuevo tratamiento seguro y eficaz en cinco casos de EB ocular resistente al tratamiento médico. Es preciso seguir investigando para confirmar los esperanzadores resultados de estos estudios iniciales(AU)
Objective: To assess the feasibility of granulocyte apheresis (GCAP) in patients with Ocular Behçets Disease (BD) resistant to immunosuppressive therapy (prednisone, cyclosporin, azathyoprine or mycophenolate mofetil). Methods: Prospective observational study of five cases, carried out in a university centre. Four patients were resistant to medical treatment and one refused immunosuppressive drugs. The intervention procedure consisted of an extracorporeal GCAP using a column filled with cellulose acetate beads (Adacolumn, JIMRO, Takasaki, Japan). All patients received underwent a schedule of therapy of five sessions, once a week for five consecutive weeks. Visual acuity (Snellen lines), the degree of intraocular inflammation and doses of immunosuppressive therapy were measured and observed every week. Results: Visual acuity improved in the five cases. Intraocular inflammation was measured and observed in every case, relapses were avoided, and treatment with prednisone was reduced by more than half of the initial dose (average reduction 52.7%, SD 14). Conclusions: GCAP has been shown to be safe and effective as a new therapy in five cases of Ocular Behçets Disease refractory to medical treatment. Further research is needed in order to confirm the promising results of these initial investigations(AU)
Subject(s)
Humans , Male , Female , Adult , Behcet Syndrome/drug therapy , Immunosuppressive Agents/therapeutic use , Prospective Studies , Visual Acuity , Prednisone/therapeutic use , Adrenal Cortex Hormones/therapeutic useABSTRACT
No disponible
Subject(s)
Middle Aged , Aged , Male , Female , Humans , Succinates , Anemia, Iron-Deficiency , Metalloproteins , Ferric Compounds , HematinicsABSTRACT
La enfermedad de Behçet, proceso inflamatorio de etiología desconocida, suele presentarse en forma de aftas orales recurrentes, úlceras genitales, uveítis y lesiones cutáneas. De todas formas su espectro clínico es amplio y puede afectar a otros órganos y sistemas como el sistema nerviosos central, articulaciones, vasos sanguíneos y el aparato digestivo.Su aproximación terapéutica es compleja y diferente en función de los distintos órganos afectados. En la aftosis compleja se suele iniciar el tratamiento con fármacos tópicos, colchicina y dapsona. La utilización de talidomida, prednisona por vía oral y metotrexate se reserva para casos en que no hay respuesta a los fármacos anteriores.En la afectación ocular severa y en la afectación sistémica el tratamiento es más agresivo y suele combinar corticoides con fármacos inmunosupresores, siendo los más utilizados la ciclosporina, azatioprina, ciclofosfamida, interferón-alfa-2a y el clorambucil (AU)
Subject(s)
Humans , Thalidomide , Methotrexate , Prednisone , Behcet Syndrome , Colchicine , DapsoneABSTRACT
OBJECTIVE: To report the prevalence of acute cerebrovascular accidents (ACVA) and risk factors for thrombosis among patients diagnosed of primary antiphospholipid syndrome (PAPLS) and to compare this group with that of patients with PAPLS but not ACVA. PATIENTS AND METHODS: Retrospective data analysis of 30 patients consecutively diagnosed of PAPLS. Episodes of ACVA were quantitated and other cardiovascular risk factors were determined. RESULTS: Thirty percent of patients (9/30) had one or more ACVA. No significant differences were found when the presence of other cardiovascular risk factors in both groups was compared. CONCLUSIONS: Antiphospholipid antibodies in young patients with ACVA should be determined, although some other cardiovascular risk factors may coexist.
Subject(s)
Antiphospholipid Syndrome/complications , Stroke/etiology , Adolescent , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Thrombosis/complicationsABSTRACT
Fundamento. Describir la prevalencia de accidentes cerebrovasculares agudos (ACV) y los factores de riesgo trombótico existentes en pacientes diagnosticados de síndrome antifosfolipídico primario (SAFP) y comparar este grupo con el de los pacientes que estando afectados de SAFP no presentaron ACV.Material y métodos. Se revisaron retrospectivamente los datos de 30 pacientes diagnosticados consecutivamente de SAFP. Se cuantificaron los episodios de ACV y se determinaron otros factores de riesgo cardiovascular. Resultados. El 30 por ciento de los pacientes (9/30) presentaron uno o más ACV. Al comparar la existencia de otros factores de riesgo cardiovascular en ambos grupos no se encontraron diferencias significativas.Conclusiones. En los pacientes jóvenes que sufren un ACV deben determinarse anticuerpos antifosfolipídicos, a pesar de que coexistan otros factores de riesgo cardiovascular (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Male , Female , Humans , Risk Factors , Thrombosis , Antiphospholipid Syndrome , Retrospective Studies , StrokeSubject(s)
Anemia, Iron-Deficiency/drug therapy , Ferric Compounds/therapeutic use , Hematinics/therapeutic use , Metalloproteins/therapeutic use , Succinates/therapeutic use , Aged , Female , Ferric Compounds/adverse effects , Hematinics/adverse effects , Humans , Male , Metalloproteins/adverse effects , Middle Aged , Succinates/adverse effectsABSTRACT
Behçet's disease is an inflammatory process of unknown origin, which usually presents with recurrent oral ulcers, genital aphthae, uveitis and cutaneous lesions. However, a wide variety of clinical manifestations have been reported, and virtually any organ system may be affected, showing central nervous system, joints, blood vessels or gastrointestinal tract involvement. Therapeutic approach remains complex, and varies in basis of the affected organs. Complex aphthosis may respond to topical therapy, colchicine and dapsone. If this therapy does not result in adequate disease control, thalidomide, oral prednisone and methotrexate may be useful. When severe ocular lesions or systemic manifestations are present, therapies tend to be more aggressive, usually combining corticosteroids with immunosuppressive agents as cyclosporin, azathioprine, cyclophosphamide, interferon-alfa-2a, and chlorambucil.
Subject(s)
Behcet Syndrome/drug therapy , Behcet Syndrome/diagnosis , Colchicine/therapeutic use , Dapsone/therapeutic use , Humans , Methotrexate/therapeutic use , Prednisone/therapeutic use , Thalidomide/therapeutic useABSTRACT
El síndrome de Sneddon es una arteriopatía no inflamatoria de vasos de mediano calibre. Las manifestaciones clásicas son enfermedad cerebrovascular en pacientes jóvenes, habitualmente mujeres, con livedo reticularis.Puede existir un patrón de herencia autosómico dominante, aunque la base etiopatogénica es desconocida. Es motivo de discusión la participación de los anticuerpos antifosfolípido que presentan algunos pacientes en la patogenia del síndrome. El diagnóstico suele establecerse a partir de pruebas de radioimagen como la resonancia magnética y por la biopsia de piel y arteria digital. El pronóstico a término medio con antiagregantes plaquetarios es bueno (AU)
