Modification of a sonographic enthesitis score to differentiate between psoriatic arthritis and young healthy volunteers

Objectives: We aimed to describe sonographic structural and inflammatory changes in entheses of patients with recently diagnosed psoriatic arthritis (PsA), patients with established PsA, and young healthy volunteers, and to investigate whether the MAdrid Sonographic Enthesitis Index (MASEI) enables us to distinguish these groups in an extreme comparison. Method: New and established PsA patients and healthy volunteers (aged 20–30 years) were recruited. The triceps, quadriceps, patellar, Achilles and elbow extensor tendon insertion, and plantar fascia entheses were investigated sonographically for structural changes, erosions, calcifications, increased thickness, bursitis, and power Doppler (PD) signal according to the MASEI. Results: The study included 25 new and 25 established PsA patients, and 25 healthy volunteers. Increased thickness and PD signal in knee entheses were common for patients and healthy volunteers, while changes at other locations predominantly occurred in patients only. PD was recoded (1, one spot; 1.5, two or three spots; 2, confluent signal; 3, severe confluent signal) and thickness of knee entheses excluded. This resulted in different modified MASEI scores between PsA patients and young healthy controls: median (interquartile range) modified MASEI of 13 (10–22.5) in new PsA, 13.5 (9.5–18) in established PsA, and 3 (1–8.5) in healthy volunteers (p = 0.002). Conclusions: Structural ultrasound changes and PD in entheses are common in both new and established PsA and healthy controls. MASEI score did not differentiate PsA patients from young healthy volu

Ultrasonographic assessment of enthesitis in HLA-B27 positive patients with rheumatoid arthritis, a matched case-only study

Introduction HLA-B27 has a modifier effect on the phenotype of multiple diseases, both associated and non-associated with it. Among these effects, an increased frequency of clinical enthesitis in patients with Rheumatoid Arthritis (RA) has been reported but never explored again. We aimed to replicate this study with a sensitive and quantitative assessment of enthesitis by using standardized ultrasonography (US). Methods The Madrid Sonography Enthesitis Index (MASEI) was applied to the US assessment of 41 HLA-B27 positive and 41 matched HLA-B27 negative patients with longstanding RA. Clinical characteristics including explorations aimed to evaluate spondyloarthrtitis and laboratory tests were also done. Results A significant degree of abnormalities in the entheses of the patients with RA were found, but the MASEI values, and each of its components including the Doppler signal, were similar in HLA-B27 positive and negative patients. An increase of the MASEI scores with age was identified. Differences in two clinical features were found: a lower prevalence of rheumatoid factor and a more common story of low back pain in the HLA-B27 positive patients than in the negative. The latter was accompanied by radiographic sacroiliitis in two HLA-B27 positive patients. No other differences were detected. Conclusion We have found that HLA-B27 positive patients with RA do not have more enthesitis as assessed with US than the patients lacking this HLA allele. However, HLA-B27 could be shaping the RA phenotype towards RF seronegativity and axial involvement.The study was supported by grants 10CSA918040PR from the Xunta de Galicia (http://www.sergas.e/MostrarContidos_N3_T01.aspx?IdPaxina=10142) and PI08/0744 of the Instituto de Salud Carlos III (http://www.isciii.es/) that are partially financed by the European Regional Development Fund of the European UnionS

Usefulness and estimation of proportionality constraints

Stata has for a long time the capability of imposing the constraint that parameters are a linear function of one another. It does not have the capability to impose the constraint that if a set of parameters change (due to interaction terms) they will maintain the relative differences among them. Such a proportionality constraint has a nice interpretation: the constrained variables together measure some latent concept. For instance if a proportionality constraint is imposed on the variables father’s education, mother’s education, father’s occupational status, and mother’s occupational status, than together they might be thought to measure the latent variable family socioeconomic status. With the proportionality constraint one can estimate the effect of the latent variable and how strong each observed variable loads on the latent variable (i.e. does the mother, the father, or the highest status parent matter most). Such a model is a special case of a so called MIMIC model. In principle these models can be estimated using standard ml algorithms, however as the parameters are rather strongly correlated ml has a hard time finding the maximum. An EM algorithm is proposed that will find the maximum. This maximum is than fed into ml to get the right standard errors.

Doppler ultrasound - a valid and reliable tool to assess spondyloarthritis

Enthesitis is the hallmark of spondyloarthritis and is observed in all subtypes. Namely, a wide information on spondyloarthritis abnormalities, including synovitis, bursitis, tendinitis, enthesitis and cortical bone abnormalities (erosions and enthesophytes), can be efficiently perceived by ultrasound power Doppler. Furthermore, several studies on imaging of enthesis showed that imaging techniques are better than clinical examination to detect pathology at asymptomatic enthesis. Vascularized enthesitis detected by ultrasound power Doppler appears to be a valuable diagnostic tool to confirm spondyloarthritis diagnosis. This article focuses on the validity and reliability of ultrasound enthesitis assessment in the management of spondyloarthritis patients

Abdominoplasty after massive weight loss

CME SANCOS, Catedra Chirurgie nr.4, Catedra Chirurgie nr.1 ”Nicolae Anestiadi”, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Peretele abdominal la pacienții cu pierdere masivă a masei corporale (PMMC) suferă deformații morfologice majore (exces de tegumente sub formă de pliuri și rulouri, laxitate a tegumentelor și complexului musculo-aponeurotic). Abdomenoplastia (AP) la acești pacienți este mult mai complexă. Scopul: Optimizarea rezultatelor la pacienții cu PMMC. Material și metode: Au fost operați 65 pacienți cu PMMC. Vîrsta pacienților era cuprinsăîntre 23 și 62 ani. PMMC a urmat după bypass-ul gastric în 41 cazuri, după „Gastric sleeve” – 2 cazuri, tratament dietetic și comportamental – 12 cazuri. AP clasică s-a efectuat la 3 pacienți, AP extinsă – 12, AP „Fleur des lis” – 46, AP circumferențială – 3, AP tip „corset” –1. Rezultate: AP s-a efectuat peste 12 luni după suportarea operațiilor metabolice, la pacienții cu masa corporală stabilă. AP clasică și cea circumferențială nu rezolvă deplin excesul dermal pe orizontală, în regiunea epigastrală. După AP „Fleur des lis” mai pot rămîne excese dermale în hipocondru, iar AP tip „corset” a permis înlăturarea lor adecvată și conturarea taliei. Complicații majore nu s-au înregistrat. Necroze moderate marginale s-au întîlnit în 5 cazuri la pacienții cu AP „Fleur des lis”. 4 pacienteau necesitat excizii suplimentare dermo-lipidice. Concluzii: Elecțiunea metodei de AP după PMMC depinde de caracterul deformațiilor peretelui abdominal, de elasticitatea țesuturilor, de excesul dermal, atît pe verticală, cît și pe orizontală.Introduction: The abdominal wall, in patients with massive weight loss (MWL), suffers major morphological deformities (excess of skin in the form of folds and rolls, laxity of the skin, muscle and aponeurosis). Abdominoplasty (AP) is much more complex in these patients. Aim: To optimize the results in patients with MWL. Material and methods: 65 patients with MWL had surgery. The patient’s age ranged between 23 and 62 years. MWL followed after gastric bypass in 41 cases, after "Gastric sleeve" - 2 cases, and after conservative treatment – 12 cases. The classic AP was performed on 3 patients, extended AP - 12, "Fleur des Lis" AP - 46, circumferential AP -3, "Corset" type AP-1. Results: AP was performed on patients with stable body mass, after undergoing metabolic surgeries (after 12 months from the surgery). The classic and circumferential AP do not solve completely horizontal dermal excess in the epigastric region. After "Fleur des Lis" AP dermal excesses may remain in the hypochondriac region, and the "corset" type AP allowed them to be removed appropriately and to contour the waist. Major complications were not recorded. Moderate marginal necrosis occurred in 5 cases and 4 patients have required additional dermo-lipid excisions. Conclusions: The choice of the AP method after MWL depends on the character of the deformations of the abdominal wall, the elasticity of the tissues, the dermal excess both vertically and on the horizontal

Postoperative lactorrhea after reduction of mammary gland

Catedra Chirurgie nr.4, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, CME SANCOS, Chșinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Cauzele galactoreei sunt considerate dereglările hormonale, creșterea nivelului de prolactină, efecte secundare ale administrării unor medicamente. Nu am întîlnit descrise cazuri de galactoree agresivă după reducția mamară (RM). Material și metode: În Clinica SANCOS a fost operată pacienta R, 48 ani, cu diagnosticul: “Macromastie bilaterală. Asimetrie mamară”. Cu 8 ani în urmă pacienta a urmat un tratament hormonal din cauza galactoreei. La data de 24.10.18 s-a efectuat reducția mamară. Masa glandulară redusă a fost de 220 g din dreapta și 250 g din stînga. Transpoziția complexului mamelono-areolar s-a efectuat pe lambou superior-lateral. Rezultate: În perioada postoperatorie s-a dezvoltat o lactoree agresivă, cu formare,peste 15 zile de la operație,de colecții masive de lactifore în ambii sîni, după care s-a asociat cu febră. Prolactina depășea limitele normei de 10 ori. S-a luat decizia de a deschide și a drena colecțiile. La data de 16.11.18 s-au deschis și drenat 3 colecții din care s-au evacuat 180 ml de lapte. Pacienta a fost consultată de endocrinolog. S-a indicat tratament hormonal, după care prolactina a scăzut și s-au stopat eliminările lactifore. Plăgile s-au vindecat după aplicarea suturilor secundare. Rezultatul estetic al operației a fost satisfăcător. Tratamentul hormonal a fost continuat cu supravegherea endocrinologului. Concluzie: Mamoplastia poate provoca o galactoree agresivă la pacientele cu prolactina mărită.Introduction: The causes of galactorrhea are considered the hormonal disruption, elevation of prolactin levels, side effects of some medicine administration. We have not encountered cases describing aggressive galactorrhea after mammary gland reduction. Material and methods: Patient R, 48 years old, who has been diagnosed with “Bilateral macromastia. Mammary gland assimetry”,had surgery, in SANCOS Clinic. 8 years earlier the patient followed a hormonal treatment because of galactorrhea. On 24.10.18 the breast reduction was performed. The reduced glandular mass was 220 g on the right and 250 g on the left. The transposition of nipple-areolar complex was realized on upper-lateral flap. Results: In the postoperative period, an aggressive lactorrhea developed, with formation of massive lactiferous collections in both breasts, after 15 days of surgery, after which fever associated. The prolactin exceeded the normal limit by 10 times. It was decided to open and drain the collections. On 16.11.18 three collections were opened and drained, from which 180 ml of milk was discharged. The patient was consulted by the endocrinologist. Hormonal treatment was indicated, after which prolactin decreased and the lactiferous eliminations stopped. The plagues were healed after secondary sutures. The esthetic result of the surgery was satisfactory. The hormonal treatment continued, under the endocrinologist’s supervision. Conclusion: Mammoplasty may provoke an aggressive galactorrhea in patients with increased prolactin

Sarkopenija – skrandžio vėžio chirurgijoje neįvertintas rizikos veiksnys

Surgery remains the only potentially curative option for gastric cancer, although it is related to high postoperative morbidity and mortality rate. Approximately every second gastric cancer patient is diagnosed with sarcopenia, which is a significant risk factor for postoperative complications and poor long-term outcomes. However, sarcopenia is underestimated in routine clinical practice, since it remains the interest of clinical trials. Sarcopenia diagnostic criteria are not fully standardized, but it consists of tests for muscle strength, quantity and quality. They include grip strength, chair stand test, computed tomography, magnetic resonance imaging, ultrasound, bioelectrical impedance analysis and densitometry tests. Regarding the growing evidence for sarcopenia impact on surgical gastric cancer treatment results, it is a high probability that sarcopenia assessment will come to routine clinical practice. Although, until then there is a need for further clinical trials to standardize the diagnostic and to find effective treatment strategies.Chirurgija yra pagrindinis skrandžio vėžio gydymo metodas, leidžiantis tikėtis visiško pasveikimo. Operacijos dėl skrandžio vėžio yra didelės apimties, jos susijusios su didele pooperacinių komplikacijų rizika. Maždaug pusei sergančiųjų skrandžio vėžiu nustatoma sarkopenija. Tai reikšmingas pooperacinių komplikacijų rizikos veiksnys, lemiantis prastesnius atokiuosius gydymo rezultatus.Sarkopenija vis dar yra tik klinikinių tyrimų objektas, šiandienos rutininėje klinikinėje praktikoje ji nevertinama. Sarkopenijos diagnostika apima tyrimus, kuriais siekiama nustatyti raumenų jėgą, masę ir kokybę, tačiau diagnostikos metodika nėra galutinai standartizuota. Diag­nostikai taikomi plaštakos griebimo jėgos, „sėsti – stoti“ testo, kompiuterinės tomografijos, magnetinio rezonanso, ultragarso, bioimpedanso ir densitometrijos tyrimai.Sarkopenijos reikšmė skrandžio vėžiui gydyti vis labiau auga. Tikėtina, kad netolimoje ateityje sarkopenijos vertinimas ir gydymas taps kasdienės klinikinės praktikos dalimi. Taigi tikslinga atlikti papildomus klinikinius tyrimus, kurie padėtų standartizuoti diagnostiką ir rasti efektyvius gydymo metodus

Exploatarea bunurilor limitate in termenii dreptatii intergenerationale. Precautie sau libera utilizare? Analiza normativa a Legii Protectiei Mediului si a Codului Silvic

The aim of this study is to analyse the way in which compensations and principles of intergenerational justice function toward the environment issues. I will analyse the capacities of environment policies to generate tools for protecting and preserving the limited goods such that to fulfil both the prerogatives of intergenerational principles and to secure goods demanding of the next generations(intergenerational criterion). The main assumption is that the next generatons will have a claim for environment resources to maintain their lives and for economic, social, technological development, at least in the same measure as the present generations. So through normative theories I will argue that next generations cannot determine the amount of inherited resources and the responsability lies on actual generations, to assume their successors quality and level of welfare, therefore is a need to institute some compensations and policies of fairness to restrict the abusive exploitation, to imply pecuniary and moral costs for today?s citizens and to guarantee a minimal level of the next generations welfare by maintaining a good environment quality