Relationship Between Capillaroscopic Alterations and Bone Ultrasound Parameters in Patients with Raynaud Phenomenon

The aim of this study was to evaluate phalangeal bone quantitative ultrasound (QUS) parameters in patients with Raynaud phenomenon (RP) and relate it with nailfold capillaroscopy findings. Patients referring to our Rheumatology Unit with RP were enrolled and studied for capillaroscopy alterations; bone quality profile was measured by QUS of the phalanxes: AD-SoS (Amplitude Dependent Speed of Sound) UBPI (Ultrasound Bone Profile Index), UBI (ultrasound Bone Index), Z score and T score were collected. One hundred thirty six females with RP had investigated for age, height, weight, Body Mass Index, previous diseases and therapies, menopausal age were enrolled. Nailfold capillaroscopy revealed minor alterations (borderline capillary dilatation, no capillary loss) in 36.8% (Group I), major alterations (capillaries definitely dilated, avascular areas, microbleeding) in 37.5% (Group II) and no significative alterations in 25.7% of patients (Group 0). A higher frequency of low QUS parameters in phalanxes was observed in group II when compared to group I or 0 (72.5% vs 54% vs 18%; p<0.01). With an ANOVA analysis we found a significant difference between the three groups in terms of Ad-SOS (Group II 1750±140; Group I 1890±132; Group 0 1990±167, p<0.001), UBPI (Group II 0.21±0.17; Group I 0.36±0.21; Group 0 0.51±0.24, p<0.001), UBI (Group II 1.2±0.43; Group I 1.4±0.32; Group 0 1.5±0.41, p<0.001), Z-scores (Group II -2.8±1.45; Group I -1.85±1.27; Group 0 -1.1±1.39, p<0.001) and T-scores (Group II -4.8±2.1; Group I -3.2±1.8; Group 0 -1.8±2.4, p<0.001). A standard linear regression analysis revealed an association between the capillaroscopy findings and QUS (R 0.47±0.8, p<0.01). In our study patients with capillaroscopy alterations showed reduced phalangeal quantitative ultrasound parameters, more markedly in patients with scleroderma pattern or other major capillaroscopy alterations, independently from confounding variables

Langzeitmedikation und perioperatives Management

Zusammenfassung: Anästhesisten und Operateure sehen sich zunehmend mit Patienten konfrontiert, die unter einer medikamentösen Dauertherapie stehen. Ein Teil dieser Medikamente können mit Anästhetika oder anästhesiologischen und/oder chirurgischen Interventionen interagieren. Als Folge können Komplikationen wie Blutungen, Ischämien, Infektionen oder schwere Kreislaufreaktionen auftreten. Andererseits birgt oft gerade das perioperative Absetzen von Medikamenten die größere Gefahr. Der Anteil ambulant durchgeführter Operationen hat in den letzten Jahren stark zugenommen und wird voraussichtlich auch in Zukunft zunehmen. Seit Einführung der Fallpauschalen (in der Schweiz bevorstehend) wird der Patient in der Regel erst am Vortag der Operation stationär aufgenommen. Somit sind sowohl zuweisende Ärzte als auch Anästhesisten und Operateure gezwungen, sich frühzeitig mit Fragen der perioperativen Pharmakotherapie auseinanderzusetzen. Dieser Übersichtsartikel behandelt das Management der wichtigsten Medikamentenklassen während der perioperativen Phase. Neben kardial und zentral wirksamen Medikamenten und Wirkstoffen, welche auf die Hämostase und das endokrine System wirken, werden Spezialfälle wie Immunsuppressiva und Phytopharmaka behandel

AB0901 PREVALENCE OF OSTEOPOROSIS IN ITALIAN POSTMENOPAUSAL WOMEN ACCORDING TO DEFRA ALGORITHM

Background:Osteoporosis is a recognized health problem and the burden of the disease is mostly associated with the occurrence of hip and vertebral fracture.Objectives:This study was aimed at evaluating the prevalence of osteoporosis in Italian postmenopausal women, defined by DeFRA calculation as a 10 years fracture risk equal or higher than 20%.Methods:This is a monocenter cohort study evaluating 1850 post-menopausal women aged 50 years and older. All the participants were evaluated as far as anthropometrics. Defra questionnaire was administered and calculated with bone mineral density (DXA) measured at lumbar spine and femoral neck.Results:The prevalence of osteoporosis as assessed by DeFRA was 29.8% in the whole population, according to literature. The frequency of a risk fracture equal or higher than 20% varied from 7.9% in the group aged 50-59 years to 35% in subjects aged >80. Among clinical risk factors for fracture, the presence of a previous fracture (spine primarily) was the most commonly observed.Conclusion:Our data showed that about one third of post-menopausal women aged 50 and older in Italy has osteoporosis on the basis of DeFRA algorithm, with a high 10 years fracture risk. A previous fracture is the most common risk factor. The data should be considered in relation to the need to increase prevention strategies and therapeutic intervention.Disclosure of Interests:None declare

Remifentanil does not impair left ventricular systolic and diastolic function in young healthy patients

Background Experimental studies and investigations in patients with cardiac diseases suggest that opioids at clinical concentrations have no important direct effect on myocardial relaxation and contractility. In vivo data on the effect of remifentanil on myocardial function in humans are scarce. This study aimed to investigate the effects of remifentanil on left ventricular (LV) function in young healthy humans by transthoracic echocardiography (TTE). We hypothesized that remifentanil does not impair systolic, diastolic LV function, or both. Methods Twelve individuals (aged 18-48 yr) without any history or signs of cardiovascular disease and undergoing minor surgical procedures under general anaesthesia were studied. Echocardiographic examinations were performed in the spontaneously breathing subjects before (baseline) and during administration of remifentanil at a target effect-site concentration of 2 ng ml−1 by target-controlled infusion. Analysis of systolic function focused on fractional area change (FAC). Analysis of diastolic function focused on peak early diastolic velocity of the mitral annulus (e′) and on transmitral peak flow velocity (E). Results Remifentanil infusion at a target concentration of 2 ng ml−1 did not affect heart rate or arterial pressure. There was no evidence of systolic or diastolic dysfunction during remifentanil infusion, as the echocardiographic measure of systolic function (FAC) was similar to baseline, and measures of diastolic function remained unchanged (e′) or improved slightly (E). Conclusion Continuous infusion of remifentanil in a clinically relevant concentration did not affect systolic and diastolic LV function in young healthy subjects during spontaneous breathing as indicated by TT