만성 구강 궤양을 동반한 건선 1예

Psoriasis is a chronic inflammatory disease with epidermal hyperplasia. Th 1 cells are thought to be important in the pathogenesis of psoriasis and Behcet`s disease. However, both diseases rarely develop in the same patient. We report here a case of a 50-year-old man who was diagnosed with psoriasis 15 years prior. During the last three years, ulcers and erosions had recurrently developed on the perianal area and oral mucosa. In addition, the patient had mild arthralgia on the both knees and hand for two years. In this case, Behcet`s disease accompanying psoriasis was suspectedope

The use of x-ray CT and MRI in the study of sacroiliac joints in patients with Behcet disease and acute anterior uveitis

Objective: It's controversial if Behcet Disease (BD) must be included in the group of seronegative spondyloarthropathy (SpA). Our aim was to establish the prevalence of sacroiliitis (SI) in patients with BD using X-Ray, CT and MRI, in comparison with patients with Acute Anterior Uveitis (AAU), that is known to belong to the subgroups of SpA. Methods: We considered, in the period from 04/2006 to 04/2009, 21 consecutive patients with BD, positive for HLA B51 and 28 consecutive patients with AAU, positive for HLA B27. These patients were previously selected by our Rheumatological Ward. Altogether we evaluated 98 sacroiliac joints (SIJ); each side of any patient was graded separately. Results: X-ray of the pelvis showed advanced SI (grade 4) in 14% of the cases in patients with AAU; in BD group only 7% CT showed advanced SI in 14% within AAU patients versus 6-12% of advanced SI (right to left) within BD patients. MR showed 14% of advanced SI (bilateral) within AAU versus 6-11% of advanced SI (right to left) in BD patients. Conclusions: This study supports the trend to not consider BD within the SpA, being the prevalence of SI in BD patients not very different from general population and anyway lower than that observed in patients with AAU. On the other side the prevalence of SI in AAU patients is higher than in BD patients and very similar to the one observed in patients with seronegative arthritis, and anyway high enough to consider joint involvement as an important feature of the disease

Autoimmune diseases and their manifestations on oral cavity: diagnosis and clinical management

Oral signs are frequently the first manifestation of autoimmune diseases. For this reason, dentists play an important role in the detection of emerging autoimmune pathologies. Indeed, an early diagnosis can play a decisive role in improving the quality of treatment strategies as well as quality of life. This can be obtained thanks to specific knowledge of oral manifestations of autoimmune diseases. This review is aimed at describing oral presentations, diagnosis, and treatment strategies for systemic lupus erythematosus, Sjögren syndrome, pemphigus vulgaris, mucous membrane pemphigoid, and Behcet disease

Massive Gastrointestinal Bleeding due to Aneurysmal Rupture of Ileo-colic Artery in a Patient with Behcet's Disease

Behcet`s disease has been recognized as a systemic vasculitis characterized by the involvement of multiple organs such as orogenital ulcers, eye lesions including uveitis and optic neuritis, and skin lesions including folliculitis and erythema nodosum. Vascular involvement occurs occasionally and is classified into thrombosis and aneurysm. However, massive gastrointestinal bleeding from arterial aneurysm is a rare manifestation of intestinal Behcet`s disease. Recently, we experienced a case of intestinal Behcet`s disease presenting with massive gastrointestinal bleeding due to aneurysmal rupture of ileo-colic artery. A 30-year-old male with Behcet`s disease was admitted because of massive gastrointestinal bleeding. A large ileo-cecal ulcer was revealed as a bleeding focus on colonoscopic examination. Celiac angiography showed aneurysm and stenosis of ileo-colic artery. After the failure of hemostasis with arterial embolization, ileocecectomy was performed. After the resection hematochezia was completely stopped.ope

Triple valve infective endocarditis - a late diagnosis

Behcet\u27s disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established. We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation. The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and evaluation of rheumatic diseases and permits optimal management in daily practice

Corticosteroid implants for chronic non-infectious uveitis.

BACKGROUND: Uveitis is a term used to describe a heterogeneous group of intraocular inflammatory diseases of the anterior, intermediate, and posterior uveal tract (iris, ciliary body, choroid). Uveitis is the fifth most common cause of vision loss in high-income countries, accounting for 5% to 20% of legal blindness, with the highest incidence of disease in the working-age population.Corticosteroids are the mainstay of acute treatment for all anatomical subtypes of non-infectious uveitis and can be administered orally, topically with drops or ointments, by periocular (around the eye) or intravitreal (inside the eye) injection, or by surgical implantation. OBJECTIVES: To determine the efficacy and safety of steroid implants in people with chronic non-infectious posterior uveitis, intermediate uveitis, and panuveitis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 10, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to November 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 15 April 2013), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for studies. We last searched the electronic databases on 6 November 2015.We also searched reference lists of included study reports, citation databases, and abstracts and clinical study presentations from professional meetings. SELECTION CRITERIA: We included randomized controlled trials comparing either fluocinolone acetonide (FA) or dexamethasone intravitreal implants with standard-of-care therapy with at least six months of follow-up after treatment. We included studies that enrolled participants of all ages who had chronic non-infectious posterior uveitis, intermediate uveitis, or panuveitis with vision that was better than hand-motion. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed studies for inclusion. Two review authors independently extracted data and assessed the risk of bias for each study. MAIN RESULTS: We included data from two studies (619 eyes of 401 participants) that compared FA implants with standard-of-care therapy. Both studies used similar standard-of-care therapy that included administration of prednisolone and, if needed, immunosuppressive agents. The studies included participants from Australia, France, Germany, Israel, Italy, Portugal, Saudi Arabia, Spain, Switzerland, Turkey, the United Kingdom, and the United States. We assessed both studies at high risk of performance and detection bias.Only one study reported our primary outcome, recurrence of uveitis at any point during the study through 24 months. The evidence, judged as moderate-quality, showed that a FA implant probably prevents recurrence of uveitis compared with standard-of-care therapy (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.14 to 0.59; 132 eyes). Both studies reported safety outcomes, and moderate-quality evidence showed increased risks of needing cataract surgery (RR 2.98, 95% CI 2.33 to 3.79; 371 eyes) and surgery to lower intraocular pressure (RR 7.48, 95% CI 3.94 to 14.19; 599 eyes) in the implant group compared with standard-of-care therapy through two years of follow-up. No studies compared dexamethasone implants with standard-of-care therapy. AUTHORS\u27 CONCLUSIONS: After considering both benefits and harms reported from two studies in which corticosteroids implants were compared with standard-of-care therapy, we are unable to conclude that the implants are superior to traditional systemic therapy for the treatment of non-infectious uveitis. These studies exhibited heterogeneity in design and outcomes that measured efficacy. Pooled findings regarding safety outcomes suggest increased risks of post-implant surgery for cataract and high intraocular pressure compared with standard-of-care therapy

Egy ritkán felismert ritka betegség: a Behcet-kór

A Behcet-kór multiszisztémás autoimmun betegség változatos klinikai megjelenési tünetekkel. Hazánkban a Behcet-kór a ritka betegségek közé tartozik, a témával foglalkozó közlemények száma elenyésző. Történelmünk során a népcsoportok keveredése, valamint a világszerte növekvő prevalencia és a szerzők tapasztalata is arra utal, hogy a betegség előfordulására az eddig vártnál nagyobb gyakorisággal kell számítani. A szerzők felhívják a figyelmet erre a sokoldalúan megjelenő, sok szakterületet érintő betegségre. A diagnózis nagy kihívást jelent a klinikus számára, akinek tisztában kell lennie a lehetséges tünetek spektrumával és kombinációival. Irodalmi adatok és saját tapasztalataik alapján a szerzők összefoglalják a betegség eddig ismert patogenetikai és patomechanikai tényezőit és a diagnózishoz nélkülözhetetlen szimptómák rendszerét, a kezelés lehetőségeit. A közleménnyel a szerzők a diagnosztikát, a magyar betegpopuláció feltérképezését és jobb kezelését szeretnék segíteni, és kezdeményezik hazai Behcet-regiszter felállítását. Orv. Hetil., 2013, 154, 93–101. | Behcet’s disease is a multisystem autoimmune disease with variable clinial manifestations. The diagnosis may pose a difficult challenge for the clinician, who has to be familiar with the wide spectrum and combination of the symptoms of Behcet’s disease. It is considered a rare disease in Hungary, and there are only few reports on Behcet’s disease in the Hungarian literature. However, the past history of Hungary, the worldwide growing incidence of the disease, and the authors’ experience raise the possibility that the occurrence of the disease is higher than previously thought. In this review the authors present and discuss literature data on the pathogenesis and pathomechanism, as well as their own experience concerning the symptomatology of Behcet’s disease in order to promote diagnosis and offer adequate therapy for the patients. The authors presume that the importance of the disease is underestimated in Hungary due to a considerable number of unrecognized cases and they propose to establish a national registry for Behcets disease. Orv. Hetil., 2013, 154, 93–101

Orogenital ulcers and the Behcet’s disease

Behcet’s’s disease is a systemic vasculitis involving small to large veins and arteries. It is a sporadic disease, mostly prevalent among the ancestors of the silk route. It is characterized by recurrent oral ulcers, genital ulcers, and uveitis. It also can manifest as skin, vascular, gastrointestinal, neurological, cardiac, and renal involvement. Though overall mortality is around 5%, delay in diagnosis and treatment may lead to significant morbidity. Cardiovascular and pulmonary arterial aneurysms are dreadful complications of this disease. Being uncommon in south India it is liable to be wrongly diagnosed and treated. Delay in the diagnosis and treatment may lead to severe complications. Here we present a case of Behcet’s disease which was managed at primary health care inadequately. We also demonstrated a quick response to steroids which are the mainstay of treatment. In this case presentation we illustrated pre and post treatment scrotal and oral Behcet’s’s lesions for clinicians to memorize. We also discussed international criteria to diagnose Behcet’s disease (ICBD) in concurrence with our case. In this presentation, we briefly described the involvement of other systems and their treatment. This article also elaborated on the latest developments in the treatment of Behcet’s disease

PENGARUH PEMBERIAN MELATONIN TERHADAP JUMLAH LEUKOSIT PADA TIKUS WISTAR MODEL SEPSIS

Background : Melatonin was a free radical frequently used as an antioxidant. Melatonin played a role in increasing immune response, and supporting cytoprotective process. On some animal models, melatonin has been identified to be able to resist bacteria infections, viruses, and parasites through some mechanisms such as immunomodulation or antioxidant activities. Melatonin could decrease the level of inflammation cytokine, oxidative stress, and mitochondria dysfunction. Melatonin was one of medicine developed as a sepsis therapy. Objective : this research was to find out the melatonin influence on the amount of white blood cells of a wistar rat sepsis model and to obtain the information that melatonin could decrease the number of white blood cells. Methods : this research was an experimental research with a randomized control group using pre and post test. The samples were 12 male wistar rats with certain criteria divided into 2 groups. The first group was given an intraperitoneal injection of lipopolysaccharide (LPS) and was not given melatonin as control group. The second group was given an intraperitoneal injection of lipopolysaccharide (LPS) and was given melatonin by oral sonde as treatment group. After a week, in the eighth day, the blood of each rat was taken from the retro-orbital blood vessel. The statistical test used paired t-test, independent t-test, and Mann Whitney test. Results : In the independent test, the average score of the amount of white blood cells from control group was higher than the experimental group. In the paired t-test, the control group underwent a significant change (p<0,05) compared to experimental group which showed a meaningless result. In the Mann Whitney test, the result of pre-post 1 and post 2 from the control group got a significant increase while the result of pre LPS – post 1 and post 2 from the experimental group got a significant decrease (p<0,05). Conclusion : The melatonin treatment did not cause a significant decrease of the amount of white blood cells. Keywords : Sepsis,The amount of white blood cells, Melatonin, Lipopolysaccharide

Assessment of Vascular Change Using Swept-Source Optical Coherence Tomography Angiography: A New Theory Explains Central Visual Loss in Behcet’s Disease

Objective. To evaluate retinal vascular structural change in ocular Behcet’s using optical coherence tomography angiography (OCTA) and fluorescein angiography (FA). Methods. An analytic cross-sectional study of 37 eyes of 21 Behcet’s uveitic patients was performed. Foveal retinal thickness (FRT), perifoveal hypoperfusion areas in superficial capillary plexus (SCP), and deep capillary plexus (DCP) were measured with swept-source optical coherence tomography and OCTA. FA images were used for assessing the vascular features and correlation. Results. Twenty-one patients were enrolled (52.4% males). The average age at onset was 36.7 ± 12.93 years. The median of disease duration was 5 years (1–25). FRT was 118.1 ± 52.35 μm, which correlated with visual acuity (95% CI −60.47, −13.92). Using OCTA, the area of hypoperfusion in SCP (0.47 ± 0.17 mm2) was smaller than that in DCP (1.94 ± 3.87 mm2) (p<0.001). Superficial to deep capillary plexus nonperfusion (SCP : DCP) ratio was 0.57 ± 0.27 which had the positive coefficient correlation with visual acuity (95% CI −0.644, −0.015). Conclusions. OCTA is an alternative noninvasive method to monitor macular ischemia in Behcet. Behcet’s uveitis affects DCP more than SCP. Decreasing SCP : DCP ratio and decrease FRT correlates with poor visual acuity. Macular ischemia and DCP loss can be found early and can explain vision loss in Behcet