The pivotal role of interleukin-1 in the clinical manifestations of rheumatoid arthritis

The role of the cytokine network in mediating inflammation and joint destruction in rheumatoid arthritis (RA) has been investigated extensively in recent years. Interleukin-1 (IL-1) and tumour necrosis factor alpha (TNFα) are two pivotal proinflammatory cytokines that have been shown to contribute to the clinical manifestations of RA. The ability of IL-1 to drive inflammation and joint erosion and to inhibit tissue repair processes has been clearly established in in vitro systems and animal models. Under physiological conditions, the activity of IL-1 is balanced by IL-1 receptor antagonist (IL-1Ra). Understanding of the respective roles of IL-1 and IL-1Ra in conditions of health and disease has led to the development of a recombinant IL-1ra, anakinra (Kineret®; Amgen Inc., Thousand Oaks, CA), which offers a new therapeutic modality for R

Antibiotic prophylaxis of infective endocarditis

Links between infective endocarditis (IE) and den-tal and other invasive procedures were first identified in the1920s, and the use of antibiotic prophylaxis (AP) to prevent IEwas first recommended by the American Heart Association in1955. Recognising the weak evidence to support this practiceand the wider risks of anaphylaxis and antibiotic resistance,guidelines in the USA and Europe have been rationalised inthe last decade with restriction of AP to those patients per-ceived to be at the highest risk. In the UK, the NationalInstitute for Health and Care Excellence controversially rec-ommended the complete cessation of AP for all invasive pro-cedures in 2008 and subsequent epidemiological studies havesuggested a significant increase in cases above the baselinetrend. AP appears to be safe and is likely to be cost-effective.Until further data are available, we recommend continued ad-herence to US and European guidelines

Do patients at risk of infective endocarditis need antibiotics before dental procedures?

What you need to know: - Patients with prosthetic heart valves, previous infective endocarditis, and some types of congenital heart disease are at highest risk of infective endocarditis - Invasive dental procedures cause bacteraemia, which can be complicated by infective endocarditis in those at increased risk of the disease - Antibiotic prophylaxis reduces the incidence of bacteraemia, but high level studies confirming that this reduces the incidence of infective endocarditis are lacking - Warn high risk patients undergoing high risk dental interventions of the risk of infective endocarditis. Offer these patients antibiotic prophylaxis, and discuss with them the risks and benefits of this option - Where patients are at moderate risk, encourage preventative measures, such as maintaining good oral hygiene and infection control, and discourage tattooing or piercin

Is antibiotic prophylaxis to prevent infective endocarditis worthwhile?

Infective endocarditis (IE) is a rare condition which is associated with considerable morbidity and mortality. Almost 100 years ago, the links between endocarditis and procedures, particularly dental procedures, were postulated. Over 50 years ago the first guidelines recommending antibiotic prophylaxis (AP), with the aim of preventing IE developing after procedures, were proposed. However, there has only ever been circumstantial evidence in humans that AP prevents IE. The rarity of IE has made a randomised controlled clinical trial impractical to date. This article outlines the history of AP and reviews the evidence base for the use of AP to prevent IE

Laparoscopic Gastric Banding Outcomes Do Not Depend on Device or Technique. Long-Term Results of a Prospective Randomized Study Comparing the Lapband® and the SAGB®.

BACKGROUND: Gastric banding still represents one of the most widely used bariatric procedures. It provides acceptable weight loss in many patients, but has frequent long-term complications. Because different types of bands may lead to different results, we designed a randomized study to compare the Lapband® with the SAGB®. We hereby report on the long-term results. METHODS: Between December 1998 and June 2002, 180 morbidly obese patients were randomized between Lapband® or SAGB®. Weight loss, long-term morbidity, and need for reoperation were evaluated. RESULTS: Long-term weight loss did not differ between the two bands. Patients who maintained their band had an acceptable long-term weight loss of between 50 and 60 % EBMIL. In both groups, about half the patients developed long-term complications, with about 50 % requiring major redo surgery. There was no difference in the overall rates of long-term complications or failures between the two groups, but patients who had a Lapband® were significantly more prone to develop band slippage/pouch dilatation (13.3 versus 0 %, p < 0,001). CONCLUSIONS: Although in the absence of complication, gastric banding leads to acceptable weight loss; the long-term complication and major reoperation rates are very high independently from the type of band used or on the operative technique. Gastric banding leads to relatively poor overall long-term results and therefore should not be considered the procedure of choice for the treatment of morbid obesity. Patients should be informed of the limited overall weight loss and the very high complication rates