OP0167 THE ROLE OF LUNG ULTRASOUND IN THE DIAGNOSIS OF INTERSTITIAL LUNG DISEASE IN CHILDREN WITH DERMATOMYOSISTIS

Background:

Dermatomyositis is a multi organ autoimmune disease wich is commonly complicated with interstitial lung disease. Chest high-resolution computed tomography (HRCT) is still considered the diagnostic gold standard for interstitial lung disease and is quantification, however he increasing use of lung ultrasound may play an important role in the future.

Objectives:

The aim of our study was to determine the diagnostic value of lung ultrasound in the detection and progression of interstitial pulmonary disease in patients with dermatomyositis.

Methods:

Twenty two subjects with dermatomyositis diagnosed according to the American College of Rheumatology criteria were enrolled (6 males, 16 females; mean age: 15,8 ± 8.8 years; range: 6 to 29 years). All subjects underwent high resolution computed tomography followed by transthoracic ultrasound for comet tail sign detection and pleural irregularity in order to predict the degree of interstitial lung disease. The modified transthoracic ultrasound assessment was performed at 06 thoracic regions each side. The Warrick score was calculated according standard high-resolution chest computed tomography images that were evaluated independently from each other by two thoracics radiologists.

Results:

A significantly positive correlation between transthoracic ultrasound and the severity of pulmonary involvement, as seen by the number of B lines (Spearman ‘s correlation coefficient = 0.80, p < 0.001), and the number of positive areas (regions wih more than 3 B lines) (Spearman ‘s correlation coefficient = 0.75, p < 0.001) were found. When compared with high-resolution chest computed tomography as the gold standard method, the sensitivity, specificity, of transthoracic ultrasound was 96.4%, 83,3% respectively. Addicionally the number of B lines (sum of 35 or more B lines) and a number of B lines positive areas (7 or more regions with at least 3 B lines) cut of allowed to discriminate the inflamatory pattern (ground glass) to those with structural pattern (honeycomb and pulmonary cysts).

Conclusion:

Our study showed that transthoracic ultrasound comet tails scoring system could be useful in the assessment of the pulmonary involvement in patients with dermatomyositis, and should be considered as a primary screening exam to exclude lung involvement, rather than routine chest CT scans in assimptomatic patients.

Disclosure of Interests:

None declared

A pilot study on the effect of a symbiotic mixture in irritable bowel syndrome: an open-label, partially controlled, 6-month extension of a previously published trial

BACKGROUND

In recent years, the efficacy of probiotics has received considerable attention in the treatment for irritable bowel syndrome (IBS). In this regard, a symbiotic mixture (Probinul(®)) has shown beneficial effects. The aim of this study was to extend the previously published 4-week randomized, double-blinded, placebo-controlled study of this symbiotic mixture.

METHODS

This is an open-label prospective, partially controlled, 6-month extension period pilot study in which patients continued to receive the symbiotic mixture (Group 1) or were switched from placebo to symbiotic mixture (Group 2) using cyclic administration (last 2 weeks/month). The primary endpoints were the overall satisfactory relief of bloating and flatulence (assessed as proportions of responders). The secondary endpoints were evaluation of the symptom severity scores (bloating, flatulence, pain and urgency) and bowel function scores (frequency, consistency and incomplete evacuation).

RESULTS

Twenty-six IBS patients completed the 6-month extension period (13 patients in Group 1 and 13 patients in Group 2). In the per-protocol analysis, the proportions of responders across time were not significantly different in the groups but in Group 2, there was an increased percentage of responders for flatulence (p = 0.07). In addition, the score of flatulence was reduced significantly during the 6-month treatment period in Group 2 (p < 0.05), while no other significant differences were detected.

CONCLUSIONS

Treatment with this symbiotic mixture was associated with persistence of relief from flatulence or new reduction in flatulence in the present 6-month long extension study. These results need to be more comprehensively assessed in large, long-term, randomized, placebo-controlled studies.

Efficacy of budesonide therapy in the early phase of treatment of adult coeliac disease patients with malabsorption: an in vivo/in vitro pilot study

1. Budesonide is a glucocorticosteroid with a local anti-inflammatory effect. Coeliac disease is an immune-mediated disease caused by gluten ingestion in intolerant patients. The aim of the present study was to investigate the efficacy of budesonide in malabsorptive coeliac patients and its effect in an in vitro gliadin challenge. 2. Twenty coeliac patients with malabsorption were enrolled in the present study and were randomly assigned to one of two 4 week treatments: (i) a gluten-free diet alone; or (ii) a gluten-free diet plus 6 mg budesonide daily. At the end of 4 weeks treatment, all patients underwent clinical evaluation, laboratory tests and self-evaluation of well-being using a visual analogue scale. Intestinal biopsies from five coeliac patients (selected randomly) and four non-coeliac disease controls who underwent upper endoscopy for intestinal bleeding were challenged with gliadin (0.5 mg/mL) and budesonide (10-30 microg/mL) for 3 and 24 h. Biopsies were tested by immunohistochemistry and immunofluorescence for known markers of inflammation. 3. Treatment of patients with 6 mg budesonide daily for 4 weeks resulted in increased bodyweight, a decreased number of evacuations and decreased stool weight compared with patients on a gluten-free diet alone for 4 weeks. Well-being scores were higher in patients treated with both a gluten-free diet and budesonide compared with those receiving a gluten-free diet alone. 4. In vitro studies showed that budesonide reduced epithelial tyrosine phosphorylation and expression of histocompatibility leucocyte antigen complex DR (HLA-DR) elicited by gliadin-derived peptides. In addition, the expression of cyclo-oxygenase (COX)-2 and intercellular adhesion molecule (ICAM)-1 in the lamina propria was reduced in patients treated with both gliadin and budesonide compared with patients treated with gliadin alone. Budesonide alone decreased HLA-DR in crypt enterocytes, as well as ICAM-1 and COX-2 expression in the lamina propria of biopsy specimen of coeliac patients. Budesonide had no effect in control samples. 5. In conclusion, the results of the present study indicate that budesonide shows efficacy in the treatment of symptoms in adult coeliac patients with overt malabsorption. The mechanism underlying the effects of budesonide in reducing symptoms was elucidated by in vitro studies involving a gliadin challenge.

Body mass index and prevalence of skin diseases in adults with untreated coeliac disease

OBJECTIVE

Coeliac disease (CD) is associated with immune-mediated skin diseases such as dermatitis herpetiformis and others. The objective of the study was to investigate the relation of body mass index (BMI), as an index of absorptive status, with the prevalence of skin diseases in adults with untreated CD.

METHODS

Anthropometry, gastro-intestinal symptoms, nutritional indices and immune-mediated skin diseases (dermatitis herpetiformis, psoriasis, aphthosis and alopecia) at diagnosis were analysed.

RESULTS

223 men and 924 women with untreated CD (aged 20-60 years) were included, the commonest skin disease was dermatitis herpetiformis (18.4 and 6.9%, respectively), the rarest one was alopecia (1.8 and 2.1%). The BMI was positively associated with male gender, age at diagnosis and nutritional indices, negatively with diarrhoea and dyspepsia (p < 0.001). A BMI difference of 3.5 (1 standard deviation) was related to an excess prevalence of dermatitis herpetiformis (odds ratio, OR = 1.46, 95% confidence interval, CI = 1.23-1.72) and of psoriasis (OR = 1.40, 95% CI = 1.10-1.79) but not of other immunological disorders. Findings were similar in analyses by gender or age group and controlled for gender and age. The relation of BMI to dermatitis herpetiformis was linear over the whole BMI range, also excluding overweight patients. The relation of BMI to psoriasis was flat for low-to-normal BMI and explained only by overweight patients.

CONCLUSION

In CD at diagnosis, the BMI is positively related to the prevalence of dermatitis herpetiformis and psoriasis, not to that of other immune-mediated skin diseases.

Effect of aqueous ozone on the NF-kappaB system

Ozone has been proposed as an alternative oral antiseptic in dentistry, due to its antimicrobial power reported for gaseous and aqueous forms, the latter showing a high biocompatibility with mammalian cells. New therapeutic strategies for the treatment of periodontal disease and apical periodontitis should consider not only antibacterial effects, but also their influence on the host immune response. Therefore, our aim was to investigate the effect of aqueous ozone on the NF-kappaB system, a paradigm for inflammation-associated signaling/transcription. We showed that NF-kappaB activity in oral cells stimulated with TNF, and in periodontal ligament tissue from root surfaces of periodontally damaged teeth, was inhibited following incubation with ozonized medium. Under this treatment, IkappaBalpha proteolysis, cytokine expression, and kappaB-dependent transcription were prevented. Specific ozonized amino acids were shown to represent major inhibitory components of ozonized medium. In summary, our study establishes a condition under which aqueous ozone exerts inhibitory effects on the NF-kappaB system, suggesting that it has an anti-inflammatory capacity.

Local delivery of antimicrobial drugs in the treatment of chronic adult periodontitis

AIM

The aim of this study was to evaluate the clinical and microbiologic results of local delivery of adjunctive antimicrobials in the treatment and management of patients with periodontitis.

METHODS

The study population included 33 patients (age range, 37-49 years), with chronic adult periodontitis. Eleven of 33 received local treatment with 10% doxycycline injected directly into the periodontal pocket; 11 received local treatment with a chlorhexidine-based gel (1.5%) in situ; 11 received mechanical treatment with scaling and root planing. The crevicular fluid of the doxycycline-treated group was analyzed using high performance liquid chromatography over a period of 1 month.

RESULTS

In the 11 patients treated with an antibiotic we observed a reduction in attachment loss and a reduction in probing depth of 1.4 mm; in the 11 chlorhexidine-treated patients we observed a reduction in attachment loss and a reduction in probing depth of 0.9 mm; in the remaining 11 patients the reduction in attachment loss and probing depth was less than those measured in the other two treatment groups.

CONCLUSIONS

Our results suggest that direct delivery of antimicrobial agents to the infection site may be a useful adjunctive to conventional periodontal treatment.

[The treatment of the cardiac patient in dentistry and oromaxillofacial surgery. I. The practical management of patients with arrhythmias]

Cardiac patients consist of a high incidence rate in odontostomatology, both clinical and surgical. Moreover this serious complication disease conditions odontostomatological and, particularly, surgical works. In this article the authors present the results of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical dentistry. After an introduction on the clinical features of heart diseases the most important clinical cases of heart dysrhythmia are discussed: like, i.e. hypokinetic arrhythmia, hyperkinetic arrhythmia and the management of patients with pacemakers. The principal diacritic features of dysrhythmic diseases are illustrated. Anxiety is a sort of disease not directly related with dysrhythmia. Moreover a lot of clinical studies find in heart arrhythmia the principal problem caused by anxiety on heart physiology. Consequently the authors describe anxiety in the same part of pathologies commonly known as heart dysrhythmia. In the last phase the authors illustrate the most opportune therapeutic steps corresponding to the principal pathologies described above. These matters were dealt with from an odontostomatological point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.

[The treatment of the cardiac patient in dentistry and oromaxillofacial surgery. II. The practical management of patients with hemodynamic pathologies]

When odontostomatological or surgical treatment is performed we suggest, in a first phase, to distinguish cardiac patients from the others. In a second phase a careful nosological diagnosis will be performed. Consequently, patients' medical history plays a fundamental role in both diagnostic phases. In this article the authors present the results of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical Odontostomatology. After an introduction on the clinical features of heart hemodynamic pathologies the most important clinical cases are discussed: like, for example, acardiohemia, valvulopathies and heart decompensation. The principal diacritic features of hemodynamic diseases are illustrated. Essential hypertension (borderline and resident) is a sort of disease not directly related to hemodynamics pathology. Moreover a lot of clinical studies find in heart hemodynamic pathologies the principal problem caused by hypertension on heart physiology. Consequently the authors describe essential hypertension in the same part of pathologies commonly known as heart hemodynamic pathologies. In the last phase the authors illustrate the most opportune therapeutic steps corresponding to the principal pathologies above-described. These matters were dealt with from an odontostomatological point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.

[Treatment of diastolic dysfunction of the left ventricle]

Numerous studies have already recognized the importance of diastole in the pathogenesis of congestive heart failure. Non-invasive evaluations are based particularly on echo-Doppler, on radionuclide angiography and on cine-nuclear magnetic resonance: they have enabled an accurate evaluation of diastolic function and dysfunction, although invasive hemodynamic study maintains a gold standard position. All these methods of study have consented the identification of 3 basic components (anatomic and functional): active relaxation, passive elastic relaxation, atrial function. The Authors have identified the causes of diastolic failure with a particular attention to the various components of diastole. They have analyzed the implication of therapy on the basis of a clear understanding of the etiology, pathogenesis and pathophysiology of the underlying cardiac disease.

Defibrotide versus heparin in the prevention of coronary reocclusion after thrombolysis in acute myocardial infarction

A multicenter controlled study versus heparin was conducted to explore the activity of defibrotide, a polydesoxyribonucleotide drug, in preventing reocclusion after urokinase thrombolysis in patients with acute myocardial infarction (AMI). The study involved 137 consecutive patients with AMI and a time from the onset of symptoms < or = 6 hours, treated with urokinase (1,000,000 U intravenous bolus followed by 1,000,000 U slow-drip infusion over 12 hours). Immediately after thrombolysis, patients were allocated to treatment with defibrotide (group D: day 0, 3.6 g by intravenous infusion in 12 hours; days +1 to +6, 800 mg tid intravenously; days +7 to +10/+12, 400 mg tid intramuscularly), or heparin (group H: day 0, 1000 IU/hour infused over 12 hours; days +1 to +10/+12, 5000 IU tid subcutaneously). Coronary angiography was done, whenever possible, at +10/+12 days. The following parameters were assessed: (a) noninvasive estimate of myocardial reperfusion, through the analysis of CPK time-activity curves; (b) incidence of infarct-related artery (IRA) patency (TIMI scores 2-3) at coronary angiography. A total of 125 patients had a complete enzymatic curve (63 in group D and 62 in group H) and 106 had coronary angiography as well. IRA patency (the main end point) was observed in 63% of group D versus 43% of group H patients (p = 0.07). No statistically significant differences were found in the proportion of patients with indirect signs of early reperfusion (63% in group D versus 52% in group H patients).(ABSTRACT TRUNCATED AT 250 WORDS)

[The adverse effects induced by ornipressin during oral and maxillofacial surgical interventions under general anesthesia]

There are various methods used in maxillofacial surgery for the control of superficial hemorrhage. The purpose is to achieve a better identification of the anatomical structures and reduce operating times without side effects. Ornipressin has no arrhythmogenic effects in presence of inhalational anesthetics and should therefore be considered safer then adrenalin. The authors examined the cardiocirculatory effects of this drug by means of an invasive hemodynamic study on five patients. The results showed that ornipressin causes worrying increases in blood pressure and peripheral vascular resistances, with reduction in the cardiac output.

[Hemodynamic effects of the nitroprusside test in chronic congestive heart failure treated with long-term beta blocking therapy]

In patients with congestive heart failure (CHF) sympathetic reflexes are attenuated because of down regulation of beta receptors. Many Authors suggest that betablockers therapy can be useful in selected patients. We wanted to test if betablockers therapy could modify sympathetic reflex during nitroprusside test. We studied 20 patients: 10 were healthy volunteers and 10 were affected by CHF of different origin. They were divided in 4 groups in relation to therapy. During nitroprusside infusion we evaluated the following parameters: heart rate (HR), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR). In normal subjects we observed that the heart rate increased and the PAM and SVR decreased significantly. Betablockers therapy did not modify hemodynamic response of PAM and SVR, while we did not find any modification of the heart rate. In patients with CHF we observed a decrease of PAM, MPAP, SVR and PVR. Betablockers therapy in CHF did not modify the hemodynamic response to nitroprusside test. This effect is probably due to beta adrenergic receptor down regulation that decrease the responsiveness to sympathetic stimulation evoked by vasodilatation.

Informational and psychosocial needs of women choosing conservative surgery/primary radiation for early stage breast cancer

Recent advances in the treatment of early stage breast cancer give women a choice of treatments. Prospective and retrospective studies demonstrate the comparable efficacy of treatment with a modified radical mastectomy and treatment with conservative surgery and primary radiation. While the number of women with early stage breast cancer choosing the latter treatment continues to increase, there is a paucity of information in the nursing literature assessing the informational and psychosocial needs of this group. This article reports the results of a questionnaire assessing the informational and psychosocial needs of patients choosing breast conservation surgery, and the future implications of these results for the nursing profession.

Effect of amrinone on myocardial mitochondria function

The effect of amrinone on cardiac mitochondria of guinea pig was studied. It was found that amrinone does not change the respiratory function of cardiac mitochondria in the presence of alpha-ketoglutarate, whereas it inhibits glutamate oxidation. It was also found that amrinone strongly inhibits the activity of glutamic dehydrogenase of both crude extract from sonicated heart mitochondria and of purified preparation from bovine liver. This inhibition may explain the effect of amrinone on the oxidation of glutamate in mitochondria. These results are discussed in view of the contradictory effects of amrinone on cardiac and other tissues.