RESUMO
BACKGROUND: Angioedema due to hereditary deficiency of C1 inhibitor causes temporarily disability. Guidelines recommend early on-demand treatment of attacks to reduce morbidity. In this prospective observational study, we evaluated the efficacy of on-demand approach. METHODS: From January 2009 to August 2014, data on attacks and treatments were collected from 227 patients from our centre in Milan. RESULTS: A total of 4244 attacks were reported; 50% were treated with approved therapies (pdC1-INH or icatibant), 15% were with tranexamic acid, and 35% were not treated. Attack locations were peripheral cutaneous (46%), abdominal (34%), multiple (12%), facial (5%) and laryngeal (3%). Attack severities were moderate (48%), mild (28%) and severe (24%). Median attack duration (data available for 2393 attacks) with approved therapies was 10 h, significantly shorter than without treatment (45 h) or with tranexamic acid (38 h). Most of the treatments were self-administered: 93% with icatibant and 59% with pd-C1-INH. Median attack duration with icatibant was 8 and 11.5 h with pd-C1 INH. Median time from onset of symptoms to drug administration was 1 h with icatibant and 2 h with pd-C1INH and median time from drug administration to complete resolution was 5.5 and 8 h, respectively. Second treatment was required in 12.7% of icatibant-treated attacks and in 1.9% of pdC1-INH-treated attacks. CONCLUSION: This study provides evidence that on-demand treatment is effective in reducing disease-related morbidity. The use of on-demand treatment in Italy has increased up to 50% of attacks in the last years, reflecting a better adherence to international guidelines.
Assuntos
Bradicinina/análogos & derivados , Proteína Inibidora do Complemento C1/administração & dosagem , Inativadores do Complemento/administração & dosagem , Angioedema Hereditário Tipos I e II/tratamento farmacológico , Autoadministração , Adulto , Bradicinina/administração & dosagem , Feminino , Fidelidade a Diretrizes , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos ProspectivosRESUMO
The purpose of this study is to evaluate the usefulness of rapid palatal expansion in growing patients to eliminate the nasal pyramid stenosis as a cause of primary headache. Patients were invited to participate in the clinical study at the University of Milan, Department of Orthodontics. Forty-one growing patients of both genders suffering from primary neurovascular headaches and having transverse maxillary deficiency were studied before and after rapid palatal expansion. A clinical examination, postero-anterior radiography and rhinomanometry were performed. After rapid palatal expansion (RPE) therapy all patients showed a constant and important increase in the values relating to both skeletal and dental structures, a significant reduction in the mean nasal resistance, and a significant decrease or elimination of headache symptoms. This therapy provides a preventive alternative for surgical procedures, such as the neurovascular decompressive septo-ethmoidosphenoidectomy performed in adult patients.
