Presentations and outcomes of interstitial lung disease and the anti-Ro52 autoantibody.

BACKGROUND: Distinct clinical presentations of interstitial lung disease (ILD) with the myositis-specific antibodies, including anti-synthetase antibodies, are well-recognized. However, the association between ILD and the myositis-associated antibodies, including anti-Ro52, is less established. Our objectives were to compare presenting phenotypes of patients with anti-Ro52 alone versus in combination with myositis-specific autoantibodies and to identify predictors of disease progression or death. METHODS: We performed a retrospective cohort study of 73 adults with ILD and a positive anti-Ro52 antibody. We report clinical features, treatment, and outcomes. RESULTS: The majority of patients with ILD and anti-Ro52 had no established connective tissue disease (78%), and one-third had no rheumatologic symptoms. Thirteen patients (17.8%) required ICU admission for respiratory failure, with 84.6% all-cause mortality. Of the 73 subjects, 85.7% had a negative SS-A, and 49.3% met criteria for idiopathic pneumonia with autoimmune features (IPAF). The 50 patients with anti-Ro52 alone were indistinguishable from patients with anti-Ro52 plus a myositis-specific autoantibody. ICU admission was associated with poor outcomes (HR 12.97, 95% CI 5.07-34.0, p < 0.0001), whereas rheumatologic symptoms or ANA > = 1:320 were associated with better outcomes (HR 0.4, 95% CI 0.16-0.97, p = 0.04, and HR 0.29, 95% CI 0.09-0.81, p = 0.03, respectively). CONCLUSIONS: Presentations of ILD with the anti-Ro52 antibody are heterogeneous, and outcomes are similar when compared to anti-Ro52 plus myositis-specific antibodies. Testing for anti-Ro52 may help to phenotype unclassifiable ILD patients, particularly as part of the serologic criteria for IPAF. Further research is needed to investigate treatment of ILD in the setting of anti-Ro52 positivity.

Effects of uridine in the treatment of diabetic neuropathy: an electrophysiological study.

The authors performed a controlled double-blind neurophysiological study (uridine vs placebo) in 40 diabetic patients with peripheral neuropathy. Twenty subjects were treated with uridine and 20 with placebo. The neurophysiological evaluation consisted of a study of the MCV of the median nerve, the common Peroneal, the posterior Tibial, the SCV of the radial nerve, the median and the sural as well as the amplitudes of the motor and sensory responses. The nerves examined were on the dominant side. The evaluations were performed at baseline and after 60, 120, 180 days of therapy with a follow up control after 90 days from the completion of therapy. No statistically significant modifications were observed in the placebo group. In the drug group, the neurophysiological parameters improved significantly from the 120th day post therapy compared with baseline and were maintained through to follow up. The authors discuss the results which demonstrated that treatment with uridine can bring about a neurophysiological improvement in peripheral nerves.

Effect of patient positioning after needle aspiration lung biopsy.

Fifty-five patients who underwent fluoroscopically guided needle aspiration lung biopsy were randomly assigned to one of two postbiopsy treatment groups: Patients were placed recumbent with puncture site either down (n = 36) or up (n = 19) for at least 1 hour. No significant difference in pneumothorax rate was seen between the two groups. Chest tube placement, however, was required in 21% (four of 19) of the puncture-site-up group versus 3% (one of 36) of the puncture-site-down group, which was a significant difference (P = .04). Puncture-site-down postbiopsy positioning reduces the proportion of patients requiring chest tube placement after lung biopsy.

A clinical and neurophysiological trial on nootropic drugs in patients with mental decline.

The different expressions of mental decline in elderly people, from simple senile benign forgetfulness to SDAT, can be evaluated by psychometric and neurophysiological tests. In the present study, the effects of oxiracetam, piracetam and placebo were compared in a group of elderly subjects. The results of the trial, structured as single blind, clearly showed that nootropics positively effect both clinical and neurophysiological performances and that oxiracetam produces a more pronounced effect when compared to piracetam. In fact, oxiracetam was found more effective in improving psychometric scales such as GDS (clinical performances) as well as the amplitude and the latency of the P300 (neurophysiological performances), which reflect a functional recovery of the cerebral pathways related to attention and memory.

Study of the P300 and cerebral maps in subjects with multi-infarct dementia treated with cytidine.

A study of event-related P300 potential and cerebral EEG maps was performed in 20 patients affected by multi-infarct dementia (MID): 10 subjects were treated with placebo and 10 with cytidine. The trial was divided into three intervals. The patients, after a period of washout, were evaluated throughout the course of the trial by electrophysiological examination performed at baseline, after 90 min from the first IV injection, again after 30 days of IM therapy, and finally after 60 days of continued IM therapy. In the group treated with cytidine, the findings relevant to the study of the P300 showed a significant decrease in latency values compared to baseline (P less than 0.05 ANOVA) and an improvement. though not significant, in the amplitude values. Calculation of the mean relative power of EEG values showed a significant decrease in delta activity and an increase in alpha activity. In the subjects treated with placebo, no statistically significant variation was found in either P300 or EEG map recordings. On the basis of these investigations it has been demonstrated that the variations in the registrations can be correlated to the improved neuronal activity following treatment with cytidine.

Bone-ingrowth hip prostheses in asymptomatic patients: radiographic features.

The radiographic changes of 85 bone-ingrowth femoral prostheses in 77 asymptomatic patients were reviewed. The average postoperative follow-up time was 21.8 months. In decreasing order of frequency, the alterations included (a) remodeling of the proximal medial edge of the cut femoral neck (stress shielding) (98%), (b) linear lucency with a thin sclerotic margin at the prosthesis-bone interface (that may increase in width or length with time) (79%), (c) endosteal sclerosis at the prosthesis tip (36%), (d) heterotopic bone (24%), (e) cortical thickening at the tip of the prosthesis (12%), (f) prosthetic subsidence (7%), (g) intraoperative fracture (7%), and (h) periosteal reaction (4%). In this study, radiographic evidence of these findings was not associated with clinical failure. This is in distinction to the findings in cemented prostheses, in which many of these phenomena (especially the development of increasing width of the lucent line adjacent to the cement or prosthesis) have been associated with failure. Long-term investigations of porous-coated prostheses are necessary. Currently, however, an awareness of the radiographic alterations that occur with asymptomatic bone-ingrowth prostheses can prevent their misinterpretation as abnormal.