Some clinical aspects of rheumatoid arthritis

In our department we have been placing a special emphasis on the treatment and study of rheumatoid arthritis, and during the last four years we have handled about 1,600 cases visiting our outpatient clinic and approximately 100 hospitalized cases. Our experiences with these patients are only what might be called an introductory phase in the study and treatment of rheumatoid arthritis when compared with those in Europe and America. In estimating the incidence of rheumatoid arthritis in Japan from various available data, although it would not reach the level of England and U.S.A., it will be about 100 cases per 100,000 population, matching more or less the incidence in the northern Europe. As regards sex and the predisposing age we find no great difference from those in Europe and America. One striking difference that we find is the fact that patients in our country have very little resistance against salicylic acid drug used in treatment. Therefore, it is unreasonable to expect a good anti-inflammatory action by administering a large dosage of 5-10g of such a drug as aspirin per day. It must be limited within a comparatively small dosage of 1.0 to 2.0 g or with concomitant administration of prednisolone and aspirin in the hope of utilizing its analgesic effect. Furthermore, it is not feasible to introduce the results of studies made in Europe and America on the salicylic drug and its prescription all of them showing the concentration in blood 35 mg%, which is on the borderline of intoxicating dosage. This is only one example, and with some more experiences we shall undoubtedly encounter many dissimilar points. Therefore, it is essential that rheumatology specific to Japan needs to be established.</p

Liver cirrhosis-epidemiological and Clinical Aspects

Liver cirrhosis is the end-stage of many different chronic liver diseases. Limited data exists on the epidemiology, natural history and complications of liver cirrhosis such as esophageal varices and malignancies in the Nordic countries after the discovery of hepatitis C (HCV). Most hepatocellular carcinomas (HCC) develop in patients with liver cirrhosis but data on the occurrence of other malignancies than HCCs in these patients are scarce. Gastrointestinal (GI) symptoms such as nausea, vomiting, abdominal pain, and diarrhea are common in patients with advanced liver disease but the importance of portal hypertension for these symptoms is unexplored. The aims of the present study were to evaluate the incidence, outcome and complications of liver cirrhosis in a Swedish population and in Iceland and the effects of portal hypertension on small bowel motility and small intestinal bacterial overgrowth (SIBO) in patients with liver cirrhosis. The annual incidence of liver cirrhosis in Gothenburg was 15.3 ±2.4/100.000 compared to 3.3 ±1.2/100.000 in Iceland, p<0.0001. In Gothenburg 50% of the patients had alcoholic cirrhosis compared to 29% in Iceland (p<0.0001). Only 9% of patients died in their first variceal bleeding, that is within one week of their first bleeding episode. Of the patients diagnosed with esophageal varices after a bleeding episode, 55% had a bleeding episode during follow-up compared to only 13% of the patients diagnosed without a bleeding episode. Variables predicting mortality in a multivariate analysis were: Child-Pugh class, bleeding before diagnosis, age and bilirubin levels. Causes of death were in 26% of cases liver failure, 19% variceal bleeding and the rest other causes. Patients with liver cirrhosis had 267 times increased risk of hepatocellular cancer. Among patients with HCV cirrhosis, 19% developed HCC and 20% of those with HCV and alcoholic liver disease (ALD). We observed 13 times increased risk of cholangiocarcinoma and also increased risk for esophageal, pancreatic, pulmonary and colorectal cancer than in the general population. Patients with liver cirrhosis and portal hypertension had more motility disturbances in the small intestine compared to those without portal hypertension and seemed to have a higher risk of small intestinal bacterial overgrowth. Conclusions: The incidence of liver cirrhosis is low in Iceland, 24% of the incidence in Gothenburg. The difference is due to lower incidence of alcoholic liver disease and HCV cirrhosis in Iceland. In patients with liver cirrhosis and esophageal varices a bleeding is still a strong risk factor for recurrent bleeding. The mortality is high but mainly from other causes than variceal bleeding and few die in the first bleeding. The risk of HCC in cirrhosis is mostly associated with HCV and is the same in HCV patients with and without alcohol overconsumption. Other malignancies than HCC are more common in patients with cirrhosis than in the general population. Abnormal small bowel motility and SIBO is common in patients with liver cirrhosis with concomitant portal hypertension. Portal hypertension per se might be significantly related to small bowel abnormalities observed in patients with liver cirrhosis

Cryoglobulinaemic vasculitis: classification and clinical and therapeutic aspects

Cryoglobulinaemia may cause cutaneous vasculitis and glomerulonephritis, potentially leading to end stage renal failure. An important proportion of cryoglobulinaemias are secondary to hepatitis C virus infection. Emerging antiviral treatment options offer a chance for causal therapy of these cases of cryoglobulinaemia. This review summarises the classification and clinical and therapeutic aspects of cryoglobulinaemic vasculitis and glomerulonephritis

Some clinical aspects of prolonged clinostatic hypokinesia

Attendant problems which arise with prolonged confinement of patients to bed are discussed. These disorders are of a hyperkinesic nature, and the symptoms are treated with pharmacological substances

Clinical Aspects of Feline Retroviruses: A Review

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are retroviruses with global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FeLV is more pathogenic, and was long considered to be responsible for more clinical syndromes than any other agent in cats. FeLV can cause tumors (mainly lymphoma), bone marrow suppression syndromes (mainly anemia), and lead to secondary infectious diseases caused by suppressive effects of the virus on bone marrow and the immune system. Today, FeLV is less commonly diagnosed than in the previous 20 years; prevalence has been decreasing in most countries. However, FeLV importance may be underestimated as it has been shown that regressively infected cats (that are negative in routinely used FeLV tests) also can develop clinical signs. FIV can cause an acquired immunodeficiency syndrome that increases the risk of opportunistic infections, neurological diseases, and tumors. In most naturally infected cats, however, FIV itself does not cause severe clinical signs, and FIV-infected cats may live many years without any health problems. This article provides a review of clinical syndromes in progressively and regressively FeLV-infected cats as well as in FIV-infected cats

Ictal epileptic headache. an old story with courses and appeals

The term "ictal epileptic headache" has been recently proposed to classify the clinical picture in which headache is the isolated ictal symptom of a seizure. There is emerging evidence from both basic and clinical neurosciences that cortical spreading depression and an epileptic focus may facilitate each other, although with a different degree of efficiency. This review address the long history which lead to the 'migralepsy' concept to the new emerging pathophysiological aspects, and clinical and electroencephalography evidences of ictal epileptic headache. Here, we review and discuss the common physiopathology mechanisms and the historical aspects underlying the link between headache and epilepsy. Either experimental or clinical measures are required to better understand this latter relationship: the development of animal models, molecular studies defining more precise genotype/phenotype correlations as well as multicenter clinical studies with revision of clinical criteria for headache-/epilepsy-related disorders represent the start of future research. Therefore, the definition of ictal epileptic headache should be used to classify the rare events in which headache is the only manifestation of a seizure. Finally, using our recently published criteria, we will be able to clarify if ictal epileptic headache represents an underestimated phenomenon or not

Oropouche virus: clinical, epidemiological, and molecular aspects of a neglected orthobunyavirus.

Oropouche virus (OROV) is an important cause of arboviral illness in Latin American countries, more specifically in the Amazon region of Brazil, Venezuela and Peru, as well as in other countries such as Panama. In the past decades, the clinical, epidemiological, pathological, and molecular aspects of OROV have been published and provide the basis for a better understanding of this important human pathogen. Here, we describe the milestones in a comprehensive review of OROV epidemiology, pathogenesis, and molecular biology, including a description of the first isolation of the virus, the outbreaks during the past six decades, clinical aspects of OROV infection, diagnostic methods, genome and genetic traits, evolution, and viral dispersal

Familial Ménière's disease: clinical and genetic aspects

ABSTRACT Background and purpose:Mre's disease is not uncommon, with an incidence in Caucasians of about one in 2000. The incidence peaks in the fifth decade. Cases are usually isolated or sporadic, but in perhaps five per cent other family members are affected. We report here the clinical and genetic characteristics of a comprehensive set of familial Mre's disease cases from the UK.Methods:Forty-six affected families were studied. All cases were diagnosed using the American Academy of Otolaryngolog 8211;Head and Neck Surgery committee on hearing and equilibrium 1995, or more stringent, criteria.Outcomes and results:Autosomal dominant inheritance with reduced penetrance was the most likely mode of inheritance overall. Apparent genetic anticipation was observed, but may also be a result of ascertainment bias given the collection strategy. There was also a slight tendency for cases to result from maternal transmission within the families in this set. The family pedigrees are presented, and the authors have also set up a website at which all the pedigrees may be viewed in greater detai

Response to. comment on optic nerve sheath diameter ultrasound evaluation in intensive care unit: possible role and clinical aspects in neurological critical patients' daily monitoring

Comment on "Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients' Daily Monitoring"