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1.
Praxis (Bern 1994) ; 102(7): 391-8, 2013 Mar 27.
Artigo em Alemão | MEDLINE | ID: mdl-23531906

RESUMO

Lumbar Spinal Stenosis is a typical disease of the elderly patient that mainly originates in degenerative multisegmental changes of the lumbar vertebral column. The classical symptom of pain irradiation into the legs whilst walking and relief with standing is similar to peripheral arterial disease presentation but differs in the sense that symptoms can be triggered through lumbar extension and relieved with lumbar flexion whereas arterial disease is correlated with pathological arteriovascular findings. Diagnosis is usually confirmed through magnetic resonance imaging (MRI) and response to conservative treatment (analgetics, physiotherapy, epidural injections) is usually good in the majority of cases. Only a minority of about 20% of all cases show progressive disease and may necessitate surgical interventions.


Assuntos
Vértebras Lombares , Estenose Espinal/diagnóstico , Estenose Espinal/reabilitação , Corticosteroides/administração & dosagem , Analgesia Epidural , Analgésicos/uso terapêutico , Descompressão Cirúrgica , Diagnóstico Diferencial , Progressão da Doença , Seguimentos , Humanos , Injeções Epidurais , Exame Neurológico , Modalidades de Fisioterapia , Tomografia Computadorizada por Raios X
2.
Rheumatol Int ; 27(8): 747-51, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17401566

RESUMO

To investigate the follow-up of the 17 patients during the period of 1995-2001 of the outpatient Clinic for Rheumatology at the University Hospital of Zurich with arthritis and the presence of parvovirus B19 DNA demonstrated by PCR in synovial biopsies. Seventeen patients of 163 with arthritis, which were routinely examined by needle arthroscopy during 1995-2001 with a positive parvovirus B19 DNA by PCR of synovial biopsy were reevaluated. Investigations included medical history, clinical examination and blood tests. Joint fluid was taken on patients with joint effusion. The observation period of the 17 patients (F:M = 11:6) was 2-8 years (Ø = 6.5 years). In 8 of 17 patients the arthritis could not be classified neither at entry nor during the follow up of the study. The arthritis could be diagnosed in six patients early in the onset of the disease and included three cases of lyme arthritis of the knee joint, two cases with arthritis following a gastrointestinal infection (one with Salmonella typhimurium--positive faecal test--and the other one with a culture negative agent), one patient probably had an infection-associated arthritis after a gastrointestinal infection with Entamöeba histolytica (Schirmer et al. in Rheumatol Int 18:37-38, 1998; Kasliwal in Am J Proctol Gastroenterol Colon Rectal Surg 32:12, 16, 28, 1981; Haslock and Wright in J R Coll Phys Lond 8:1554-162, 1974; Than-Saw et al. in Trop Geogr Med 44:355-358, 1992) with remission after antibiotic therapy. After a disease course of 9 months one patient could be classified as rheumatoid arthritis in the presence of anti-cyclic citrullinated antibodies but lack of rheumatoid factor. One patient with polyarthritis developed psoriasis of the skin 22 months later. From the nine patients with unclassified arthritis 4 (45%) got into complete remission with no symptoms or signs of joint inflammation after a disease course of 9-45 months, whereas 5 (55%) still demonstrate active non erosive arthritis (disease duration between 3 and 10 years). The presence of parvovirus B19 DNA in synovial tissue of patients with joint inflammation does not allow the diagnosis of parvovirus induced arthritis. If the arthritis remains unclassified and without erosions over time a virus associated aetiology may be assumed. However, no definitive diagnosis is possible even in the presence of parvovirus B19 DNA in synovial tissue.


Assuntos
Artrite/virologia , Infecções por Parvoviridae/complicações , Parvovirus B19 Humano/isolamento & purificação , Membrana Sinovial/virologia , Adulto , Artrite/diagnóstico , Estudos de Coortes , DNA Viral/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parvovirus B19 Humano/patogenicidade , Reação em Cadeia da Polimerase
3.
Curr Med Res Opin ; 22(12): 2429-38, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17257457

RESUMO

BACKGROUND: Data from two randomised, double-blind, placebo-controlled studies were considered in order to investigate the efficacy and safety of a bio-adhesive plaster for topical administration containing diclofenac epolamine (DHEP) in patients with symptomatic knee osteoarthritis (OA). METHODS: Patients with radiologically confirmed symptomatic knee OA were included. The 14-day treatment consisted of two daily applications of either DHEP or placebo plaster. The algofunctional Lequesne index and pain intensity, measured by means of the Huskisson's visual analogue scale (VAS), were considered as main efficacy parameters. The main analysis of the pooled data was by intention-to-treat. RESULTS: Of the 258 patients included, 235 completed the study. At the end of the study, the mean decrease in the Lequesne index was 35% in the DHEP group and 15% in the placebo group (p < 0.0001). The mean decrease in pain intensity was 59.5% in the DHEP group and 29.9% in the placebo group. No interaction resulted between treatment and study effects (p > or = 0.2 whatever the test). The non-parametric Hodges-Lehmann estimator of the treatment effect resulted in a reduction of 21.9% for the Lequesne index and of 30.0% in pain intensity. The number needed to treat (NNT) for at least a 50% reduction of pain was 3.0 and the effect size for pain was 0.75. CONCLUSIONS: Topical application of DHEP plaster was shown to be an efficacious and safe short-term treatment for symptomatic knee OA, reducing pain and increasing physical function and may be similar in efficacy to oral non-steroidal anti-inflammatory drugs (as indicated by relative benefit data and NNT value).


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Diclofenaco/análogos & derivados , Osteoartrite do Joelho/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/tratamento farmacológico , Diclofenaco/administração & dosagem , Diclofenaco/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
AJR Am J Roentgenol ; 184(1): 169-74, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15615969

RESUMO

OBJECTIVE: The objective of this study was to describe MRI findings in patients with eosinophilic fasciitis (EF) and to correlate clinical and laboratory findings with the MRI findings. MATERIALS AND METHODS: Six patients with histologically proven EF underwent MRI at the time of diagnosis and after therapy (15 MRI examinations). Unenhanced T1-weighted, T2-weighted, and STIR sequences were performed using a 1.5-T MRI system. In addition, all patients were imaged with contrast-enhanced T1-weighted sequences. MRI findings, clinical findings, and laboratory parameters were retrospectively reviewed. RESULTS: At the time the six patients presented, all eight MRI examinations revealed symmetric thickening and hyperintensity of the superficial muscle fasciae of the thigh, calves, or arms on unenhanced T1-weighted, T2-weighted, or STIR sequences, with strong enhancement after administration of IV contrast agent. In seven of the eight MRI examinations, similar signal changes were also present in the deep muscle fasciae. After treatment, the fascial abnormalities found on MRI disappeared on six of eight MRI examinations performed in five patients-a rate that correlated well with the clinical findings. In one patient with EF involvement of the thigh, the MRI abnormalities showed partial remission, which also correlated well with the clinical findings. CONCLUSION: In EF, MRI reveals characteristic findings including thickening, signal abnormalities, and contrast enhancement of the superficial and, to a lesser extent, deep muscle fasciae. MRI is useful for establishing the diagnosis, guiding the choice of biopsy site, and assessing treatment response.


Assuntos
Eosinofilia/diagnóstico , Extremidades , Fasciite/diagnóstico , Imageamento por Ressonância Magnética/métodos , Infecções dos Tecidos Moles/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Eosinofilia/patologia , Fasciite/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções dos Tecidos Moles/patologia
5.
J Spinal Disord Tech ; 17(5): 395-400, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15385879

RESUMO

OBJECTIVE: The objective of this work was to investigate the clinical and histologic features of patients with pseudocystic lesions of the ligamentum flavum in the lumbar region of the spinal canal and ascertain the existence of genuine ligamentum flavum pseudocysts. METHODS: Retrospective chart and histologic study of a patient cohort with lumbar radiculopathy due to a cystic intraspinal lesion and who had undergone decompressive surgery was conducted. Intraoperatively, the stenosing process had been found to be different from common etiologic entities and had been submitted for histologic examination. RESULTS: The 33 patients with symptoms and signs of lumbar radiculopathy were between 48 and 85 years of age (mean 63.5 years). Twenty (61%) of them were women. All patients showed degenerative changes of the bony structures of the spine by conventional radiography. Segmental instability due to degeneration of the lumbar spine was present in 45%. Computed tomography and/or magnetic resonance imaging showed a cystic lesion. Clinical and histologic examination confirmed their origin from within the severely degenerated ligamentum flavum. CONCLUSIONS: Radiologic, surgical, and histologic findings suggest that the pseudocystic degeneration of the ligamentum flavum represents a genuine entity that is associated with degenerative changes of the structures of the respective lumbar spine segment. These pseudocystic lesions may compress the adjacent nerve roots, provoking symptoms and signs of radiculopathy. The findings suggest that the surgical treatment not only must consist of removal of the pseudocyst but must also include a radical extirpation of the ligamentum flavum surrounding the pseudocyst to avoid recurrence of such a lesion.


Assuntos
Cistos/diagnóstico por imagem , Cistos/patologia , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Idoso , Idoso de 80 Anos ou mais , Cistos/cirurgia , Descompressão Cirúrgica/estatística & dados numéricos , Tecido Elástico/patologia , Feminino , Humanos , Ligamento Amarelo/cirurgia , Dor Lombar/etiologia , Dor Lombar/patologia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiculopatia/etiologia , Radiculopatia/patologia , Radiculopatia/cirurgia , Estudos Retrospectivos , Prevenção Secundária , Canal Medular/diagnóstico por imagem , Canal Medular/patologia , Canal Medular/cirurgia , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/fisiopatologia , Raízes Nervosas Espinhais/cirurgia , Estenose Espinal/etiologia , Estenose Espinal/patologia , Estenose Espinal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Arthritis Res ; 4(6): R11, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12453314

RESUMO

To examine whether the lack of sufficient neoangiogenesis in systemic sclerosis (SSc) is caused by a decrease in angiogenic factors and/or an increase in angiostatic factors, the potent proangiogenic molecules vascular endothelial growth factor (VEGF) and basic fibroblast growth factor, and the angiostatic factor endostatin were determined in patients with SSc and in healthy controls. Forty-three patients with established SSc and nine patients with pre-SSc were included in the study. Serum levels of VEGF, basic fibroblast growth factor and endostatin were measured by ELISA. Age-matched and sex-matched healthy volunteers were used as controls. Highly significant differences were found in serum levels of VEGF between SSc patients and healthy controls, whereas no differences could be detected for endostatin and basic fibroblast growth factor. Significantly higher levels of VEGF were detected in patients with Scl-70 autoantibodies and in patients with diffuse SSc. Patients with pre-SSc and short disease duration showed significant higher levels of VEGF than healthy controls, indicating that elevated serum levels of VEGF are a feature of the earliest disease stages. Patients without fingertip ulcers were found to have higher levels of VEGF than patients with fingertip ulcers. Levels of endostatin were associated with the presence of giant capillaries in nailfold capillaroscopy, but not with any other clinical parameter. The results show that the concentration of VEGF is already increased in the serum of SSc patients at the earliest stages of the disease. VEGF appears to be protective against ischemic manifestations when concentrations of VEGF exceed a certain threshold level.


Assuntos
Indutores da Angiogênese/sangue , Inibidores da Angiogênese/sangue , Colágeno/sangue , Fatores de Crescimento Endotelial/sangue , Fator 2 de Crescimento de Fibroblastos/sangue , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Linfocinas/sangue , Fragmentos de Peptídeos/sangue , Escleroderma Sistêmico/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoantígenos/imunologia , Capilares/crescimento & desenvolvimento , Capilares/patologia , DNA Topoisomerases Tipo I , Endostatinas , Ensaio de Imunoadsorção Enzimática , Feminino , Dedos , Humanos , Masculino , Angioscopia Microscópica , Pessoa de Meia-Idade , Unhas/irrigação sanguínea , Unhas/patologia , Proteínas Nucleares/imunologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/patologia , Úlcera Cutânea/etiologia , Úlcera Cutânea/patologia , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio Vascular
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