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Uzuner B, Ketenci S, Durmus D, Atay HM. The frequency of sarcopenia in haemophilia patients: Effects on musculoskeletal health and functional performance. Haemophilia 2024; 30:505-512. [PMID: 38353986 DOI: 10.1111/hae.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION In patients with haemophilia A, chronic arthropathy develops over time as a result of recurrent joint bleeds, which leads to restricted mobility and disability in the affected joints. There are limited studies in the literature evaluating sarcopenia in patients with haemophilia. The present study aims to determine the prevalence of sarcopenia in severe haemophilia-A patients and to evaluate musculoskeletal health and functional performance. METHODS Thirty haemophilia-A patients and 26 adult male volunteers were enrolled in the study. For detection of sarcopenia, the appendicular skeletal muscle mass (ASM) obtained by bioelectrical impedance analysis (BIA) was divided by height squared (m2 ) to obtain the appendicular skeletal muscle mass index (ASMI) value. The thighs of both lower extremities were measured using the Modified Sonographic Tight Adjustment Ratio (STAR) method, which was obtained by adding the bilateral rectus femoris and vastus intermedius muscle thicknesses measured by ultrasound. Hand and quadriceps muscle strength (MS) were measured with a dynamometer. Physical performance was determined using the walking speed (WS), timed up-and-go test (TUGT), 5-repetition sit-to-stand test (5RSTS), and 6-min walk test (6MWT). Haemophilia Joint Health Score (HJHS) and Haemophilia Early Arthropathy Detection-Ultrasonography (HEAD-US) were also used to assess the musculoskeletal system. RESULTS According to the modified STAR values calculated based on body mass index, sarcopenia was present in 15 (50%) of 30 patients. However, based on the ASMI-BIA values, sarcopenia was present in only two (6.6%) patients. A weak correlation was found between ASMI and HJHS, HEAD-US, WS, TUGT, and hand MS (left), while a moderate correlation was found with knee MS (right), knee MS (left), and 5RSTS. A strong correlation was found between the modified STAR score and HEAD-US, HJHS, knee MS (left), 5RSTS, TUGT, and WS, while a moderate correlation was found with hand MS (left), hand MS (right), and knee MS (right). CONCLUSION This study showed muscle loss, joint mobility restrictions, and decreased functional capacity in haemophilia patients and demonstrated the presence of sarcopenia in these patients. The STAR measurement method showed stronger relationships with MS and functional performance values than ASMI measurements in terms of evaluating sarcopenia.
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Affiliation(s)
- Bora Uzuner
- Department of Physical Medicine and Rehabilitation and Department of Algology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Sertaç Ketenci
- Department of Physical Medicine and Rehabilitation and Department of Rheumatology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Dilek Durmus
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Hilmi Memis Atay
- Department of Internal medicine, Hematology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
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Chen WH, Yang DH. Spontaneous Retroperitoneal Bleeding in a Patient with Systemic Lupus Erythematosus. Medicina (Kaunas) 2023; 60:78. [PMID: 38256339 PMCID: PMC10820223 DOI: 10.3390/medicina60010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Systemic lupus erythematosus (SLE) is a disease with multiple organ involvement, and spontaneous hemorrhage, especially perirenal hemorrhage, is rare. Case Presentation: We report the case of a 19-year-old teenager with SLE who experienced left flank pain and hypovolemic shock. Abdominal computed tomography revealed a large left retroperitoneal hematoma. Recurrent hypovolemic shock occurred despite the transcatheter arterial embolization of the left renal artery. Repetitive abdominal computed tomography results showed active hemorrhage. Result: An exploratory laparotomy was used to confirm descending colonic mesenteric artery bleeding, which was resolved. The patient needed temporary regular kidney replacement therapy for active lupus nephritis, which terminated one month after discharge. Conclusions: When patients with SLE experience acute abdominal pain, flank pain, or back pain combined with hypovolemia, there is a higher risk of bleeding due to spontaneous hemorrhage, which should be included in the differential diagnosis. Therefore, early diagnosis and adequate emergency intervention are necessary.
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Affiliation(s)
- Wei-Hung Chen
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung 411, Taiwan;
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung 411, Taiwan;
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung 406, Taiwan
- Institute of Biomedical Science, National Chung-Hsing University, Taichung 402, Taiwan
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Komagamine J, Kano Y. Renal Pelvic Haemorrhage Complicating Emphysematous Pyelonephritis. Eur J Case Rep Intern Med 2023; 11:004241. [PMID: 38223272 PMCID: PMC10783457 DOI: 10.12890/2023_004241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
Abstract
Subepithelial haemorrhage of the renal pelvis is a rare cause of haematuria and can be diagnosed based on radiographic findings. This haemorrhage often appears as a non-enhancing hyperdense mass in the renal pelvis on computed tomography, which sometimes results in unnecessary nephrectomy because it can mimic renal neoplasms. It can be managed conservatively, and its prognosis is generally benign. We report a case of renal pelvic haemorrhage complicating emphysematous pyelonephritis that needed emergent nephrectomy. Our case highlights the importance of careful observation for complications of urinary tract infection, although complications are rare. LEARNING POINTS Renal pelvic haemorrhage is an uncommon cause of haematuria. It can mimic renal neoplasms, which sometimes results in unnecessary nephrectomy.Although the prognosis of renal pelvic haemorrhage is generally benign, careful observation for complications of urinary tract infection is important.
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Affiliation(s)
- Junpei Komagamine
- Department of Emergency Medicine, NHO Tokyo Medical Center, Tokyo, Japan
| | - Yasuhiro Kano
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Yegnanew Adela A, Endrias Beshada N, Dias AB, Krishna S, Kebede T. Spontaneous Suburothelial Hemorrhage: The Crucial Role of Radiology in Preventing Unnecessary Interventions. Int Med Case Rep J 2023; 16:611-616. [PMID: 37789832 PMCID: PMC10543732 DOI: 10.2147/imcrj.s431377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
Spontaneous suburothelial hemorrhage (SSH), also known as Antopol Goldman lesion, is a rare condition characterized by spontaneous bleeding into the renal sinus and proximal ureter wall. This case report describes the clinical presentation, imaging findings, and management of SSH in a 20-year-old female initially suspected to have urothelial malignancy. Imaging features of SSH include pre-contrast hyperdensity and non-enhancing thickening of the pelviureteric wall, which can mimic transitional cell carcinoma (TCC) and lead to unnecessary interventions. Radiologists should maintain a high level of suspicion for SSH and be aware of its imaging characteristics to avoid misdiagnosis. Additionally, clinical data, such as bleeding dyscrasia, can aid in the imaging diagnosis. This report provides insights into the diagnosis and management of SSH while offering a comprehensive literature review on its clinical presentation and imaging features. Increased awareness of SSH will facilitate accurate diagnosis and appropriate management, avoiding unnecessary interventions for patients with this benign condition.
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Affiliation(s)
- Amanuel Yegnanew Adela
- Radiology Department, Tikur Anbessa Specialized Referral Hospital (TASH), Addis Ababa University, Addis Ababa, Ethiopia
- Radiology Department, Gondar University Specialized Comprehensive Referral Hospital, University of Gondar, Gondar, Amhara Regional State, Ethiopia
| | - Nebiyu Endrias Beshada
- Radiology Department, Asela Referral and Teaching Hospital, Arsi University, Asela, Oromia Regional State, Ethiopia
| | - Adriano Basso Dias
- Joint Department of Medical Imaging, University Medical Imaging Toronto; University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging, University Medical Imaging Toronto; University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tesfaye Kebede
- Radiology Department, Tikur Anbessa Specialized Referral Hospital (TASH), Addis Ababa University, Addis Ababa, Ethiopia
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Ibrahim AY, Aloqaily M, Saadeh A, Aloqaili T, Al-Smair A. Antopol Goldman lesion: A case report. Radiol Case Rep 2022; 18:40-44. [PMID: 36324845 PMCID: PMC9619337 DOI: 10.1016/j.radcr.2022.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Antopol Goldman lesion is a renal pelvis subepithelial hematoma or hemorrhage, a sporadic disease. Although the causes are not well established yet, multiple factors were linked. Radiology is the cornerstone for the diagnosis. However, it may be mistaken for renal tumors. Herein we present a case of a 17-year-old male who presented with recurrent flank pain and gross hematuria and was diagnosed with an Antopol Goldman lesion.
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Affiliation(s)
- Ala’ Y. Ibrahim
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | | | - Ahmad Saadeh
- The University of Jordan, Faculty of Jordan, Amman, Jordan,Corresponding author.
| | | | - Ali Al-Smair
- Medray International Radiology Center, Amman, Jordan
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Liu M, Zheng C, Wang J, Wang JX, He L. Solitary fibrous tumor of the renal pelvis: A case report. World J Clin Cases 2022; 10:9798-9804. [PMID: 36186182 PMCID: PMC9516909 DOI: 10.12998/wjcc.v10.i27.9798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/12/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm. SFT derived from the renal pelvis is an exceedingly rare entity. In this study, we report a case of renal pelvis SFT and review the relevant literature on this rare tumor.
CASE SUMMARY A 76-year-old man was hospitalized due to right lumbar and abdominal pain. Abdominal computed tomography showed a hypervascular space-occupying renal lesion, sized 2.3 cm × 1.8 cm. Based on the computed tomography findings, the patient was diagnosed with right renal pelvis tumor and underwent nephrectomy. Postoperative immunohistochemical results confirmed the diagnosis. As of the 3-year follow-up, there were no signs of recurrence, and the patient has recovered well.
CONCLUSION We report a rare case of SFT derived from the renal pelvis and discuss the imaging and histopathological features that distinguish renal pelvis SFT from other renal pelvis tumors.
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Affiliation(s)
- Min Liu
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Chao Zheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jin Wang
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ji-Xue Wang
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Liang He
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Gualtierotti R, De Magistris C, Biguzzi E, Acquati Lozej J, Iurlo A, Solimeno LP, Peyvandi F. Successful Chemical Synovectomy in a Patient with Acquired von Willebrand Syndrome with Chronic Synovitis Due to Recurrent Knee Hemarthrosis: A Case Report. Rheumatol Ther 2022. [PMID: 35947268 DOI: 10.1007/s40744-022-00477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/30/2022] [Indexed: 10/25/2022] Open
Abstract
Acquired von Willebrand syndrome (AVWS) is a rare, non-hereditary bleeding disorder related to heterogeneous medical conditions such as hematological malignancies and cardiovascular and autoimmune diseases. We describe the clinical course of a 62-year-old man with polycythemia vera who experienced post-traumatic knee and leg swelling due to hemarthrosis. He was treated at another center with low molecular weight heparin due to misdiagnosed deep vein thrombosis further exacerbating the ongoing bleeding. At our center, he was diagnosed with AVWS with reduced von Willebrand factor (VWF):GPIbR plasma activity and loss of high molecular weight multimers (HMWM). He was treated with compressive bandages with resolution. Five months later, on clinical recurrence of knee and leg swelling, knee ultrasound scan showed the presence of chronic synovitis and a hemorrhagic Baker's cyst with signs of rupture. The treatment consisted of chemical synovectomy with rifampicin and steroids preceded by systemic replacement therapy using plasma-derived factor VIII-VWF concentrate. At the end of the treatment cycle, our patient reported complete resolution of knee pain and restoration of joint range of motion and function. Ultrasound evaluation confirmed complete resolution of knee capsule distension and Baker's cyst. Hemarthrosis is an anecdotal presentation of AVWS and chemical synovectomy was successful in treating this complication. A multidisciplinary approach allowed an effective management of this rare complication.
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Hakimi Z, Santagostino E, Postma MJ, Nazir J. Recombinant FVIIIFc Versus BAY 94-9027 for Treatment of Patients with Haemophilia A: Comparative Efficacy Using a Matching Adjusted Indirect Comparison. Adv Ther 2021; 38:1263-1274. [PMID: 33377987 PMCID: PMC7889532 DOI: 10.1007/s12325-020-01599-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/05/2020] [Indexed: 12/13/2022]
Abstract
Introduction Prophylaxis with recombinant factor VIII (rFVIII) is the current standard of care for haemophilia A. Several approaches have been used to extend the half-life of rFVIII to improve prophylaxis outcomes. An indirect comparison of pivotal clinical trial data was performed to evaluate the relative efficacy of two extended half-life therapies approved for the prophylactic treatment of haemophilia A: recombinant FVIII–IgG1 Fc domain fusion protein (rFVIIIFc) and pegylated rFVIII (BAY 94-9027). Methods Matching-adjusted indirect comparison (MAIC) was conducted to compare the rFVIIIFc individualised prophylaxis arm of the A-LONG phase III clinical trial (n = 117) and the BAY 94-9027 approved dosing regimens of the PROTECT VIII phase II/III study (n = 110). Following matching for baseline characteristics, mean annualised bleeding rate (ABR) and the proportion of patients with zero bleeds were compared for rFVIIIFc and BAY 94-9027. Additional supportive analyses comparing rFVIIIFc individualised prophylaxis and the individual prophylaxis regimens included in the PROTECT VIII group (twice weekly, and every 5 and 7 days [Q5D and Q7D]) were conducted. Results Mean ABR was lower in the rFVIIIFc individualised prophylaxis group versus the BAY 94-9027 pooled prophylaxis population (3.0 versus 4.9), providing a clinically relevant and statistically significant difference (mean difference [MD] − 1.9; 95% confidence interval [CI] − 3.5 to − 0.4). A statistically significant difference in ABR was also observed for rFVIIIFc compared with BAY 94-9027 Q7D (3.2 versus 6.4; MD − 3.3; 95% CI − 6.4 to − 0.2). The difference in the proportion of patients with zero bleeds between rFVIIIFc (46.5%) and BAY 94-9027 pooled prophylaxis population (38.2%) was not statistically significant (odds ratio 1.4; 95% CI 0.8 to 2.5). Conclusions This indirect treatment comparison indicates a statistically significant and clinically relevant difference in ABR favouring individualised prophylaxis with rFVIIIFc versus BAY 94-9027 prophylaxis. The proportion of patients with zero bleeds was numerically greater with rFVIIIFc treatment but did not achieve statistical significance.
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