13 research outputs found
Topical negative pressure therapy for para-ileostomal ulceration in a patient with Behçetâs disease
Intracardiac thrombus in Behçetâs disease
Behçetâs disease (BD) is a multisystem inflammatory disorder. Intracardiac thrombus (ICT) formation is an uncommon but important complication of BD. Of the cases of Behçetâs disease, we selected those with ICT. All patients fulfilled the diagnostic criteria of the International Study Group of Behçetâs disease. The ICT in each case was confirmed by ultrasonography, computed tomography and MRI. Clinical features and laboratory parameters were determined. Among our 518 patients with BD, 8 were diagnosed as having intracardiac thrombus (ICT). All were male; the mean age at the time of the ICT diagnosis was 30.8 years. The main presenting symptoms were hemoptysis, chest pain, and dyspnea. It was associated with pulmonary artery aneurysm and vena cava thrombosis in 3 cases each, pulmonary embolism, and lower limbs deep venous thrombosis in 1 case each. The coexistence of other cardiac complications was as follows: pericarditis in 2 cases, myocarditis, endomyocardial fibrosis, and coronary arteritis with consequent myocardial infarction in one case each. In all cases, echocardiography was sufficient to reach the diagnosis. Chest computed tomography performed in all cases led to the diagnosis of associated pulmonary vasculo-Behçet lesions in 4 cases. All patients received colchicine, anticoagulation, and corticosteroids. Seven patients were on immunosuppressant agents (2 patients received azathioprine and 5 cyclophosphamide). Clinical remission with ICT resolution was observed in 5 cases. Combined immunosuppressive therapy with prednisone and cyclophosphamide might be needed to treat ICT due to BD
Automated Analysis of Pedestrian Crossing Speed Behavior at Scramble-phase Signalized Intersections Using Computer Vision Techniques
This study investigates changes in pedestrian speed behavior following the implementation of a scramble phase. The aim is to demonstrate the feasibility of automatic collection of pedestrian data; and to study pedestrian speed variations with respect to design changes to intersection crossings. The results show that the average crossing speed is higher after the implementation of the scramble phase. Within the scramble, the average crossing speed is higher for diagonal crossing than side crosswalk crossing. The average crossing speed is lower for pedestrians crossing during the Walk interval. Pedestrians have higher speed through the first half of the crosswalk
Les manifestations neurologiques de la maladie de Behçet : analyse dâune sĂ©rie de 27 patients
International audiencePurpose. â To describe epidemiological and clinical characteristics of neurological involvement in Behçetâs disease (BD) and to determine a subgroup of patients at high risk for this complication.Patients and methods. â The medical notes of 105 patients with BD fulfilling the criteria of the international Study Group for Behçetâs disease were retrospectively reviewed. Patients were divided into two groups according to the presence (group 1) or not (group 2) of neurological and/or psychiatric involvement attributable to BD. The epidemiological, clinical and genetic (HLA B51 and MICA 6 frequency) features in the two groups were analysed and compared using the Kruskall-Wallis and the chi-square tests.Results. â Twenty-seven patients (25.7%) had clinical evidence of neurological involvement. They were 20 men and 7 women. The mean age at neurological onset was 34.26 ± 8.79 years. Nineteen patients (70.3%) had meningoparenchymal âMPâ central nervous system involvement (brainstem: 9, hemispheric involvement: 6, spinal cord: 4, psychiatric involvement: 2, isolated pyramidal signs: 1, aseptic meningitis:1). Seven patients (25.9%) had cerebral large vessels involvement that is cerebral angio-Behçet âCABâ (intracranial hypertension: 5 cases due to cerebral venous thrombosis: 3 and pseudotumor cerebri: 2, cerebral haemorrhage: 1, cerebral arterial thrombosis: 1). One patient (3.7%) had both âMPâ and âCABâ involvement. Headache was significantly more frequent in non-parenchymal patients. In group 1, complete recovery or improvement with mild neurological impairment was seen in 13 cases, improvement with severe disability in 3 cases, worsening in 1case, the course was stationary in 1 case and 3 patients died (11.2%). Arterial aneurysms were significantly more frequent in âCABâ subgroups than in subgroup 2.Conclusion. â Frequency of neurological involvements in BD was high in our study. Arterial aneurysms seem to be a risk factor to these complications. Cerebral angio-Behçet appears to be a protector factor against uveitis.Propos. â Analyser les caractĂ©ristiques cliniques de lâatteinte neurologique au cours de la maladie de Behçet (MB) et dĂ©terminer un sous-groupe de patients Ă haut risque pour cette complication.Patients et mĂ©thodes. â Cent cinq dossiers de patients atteints dâune MB rĂ©pondant aux critĂšres diagnostiques du groupe international dâĂ©tude sur la MB ont Ă©tĂ© rĂ©trospectivement revus. Les patients ont Ă©tĂ© divisĂ©s en 2 groupes selon lâexistence (groupe 1) ou non (groupe 2) de manifestations neurologiques et/ou psychiatriques attribuĂ©es Ă la MB. Les diffĂ©rentes caractĂ©ristiques cliniques et gĂ©nĂ©tiques (HLA-B51 et MICA A6) ont Ă©tĂ© comparĂ©es au moyen des test de Kruskall Wallis et du Ï2.RĂ©sultats. â Vingt-sept patients (25,7 %) ont prĂ©sentĂ© des manifestations neurologiques. Il sâagissait de 20 hommes et 7 femmes ayant un Ăąge moyen de 34,26 ± 8,79 ans. Dix-neuf patients (70,3 %) avaient une atteinte centrale mĂ©ningoparenchymateuse « MP » (tronc cĂ©rĂ©bral : 9, hĂ©misphĂšres cĂ©rĂ©braux : 6, moelle : 4, atteinte psychiatrique : 2, syndrome pyramidal isolĂ© : 1, mĂ©ningite aseptique isolĂ©e : 1). Sept patients (25,9 %) avaient une atteinte des gros vaisseaux cĂ©rĂ©braux qualifiĂ©e dâangio-Behçet cĂ©rĂ©bral (ABC) (hypertension intracrĂąnienne : 5 cas dont 3 par thromboses veineuses cĂ©rĂ©brales et 2 « idiopathiques », 1 thrombose artĂ©rielle cĂ©rĂ©brale et 1 hĂ©morragie cĂ©rĂ©bromĂ©ningĂ©e). Un patient (3,7 %) avait les 2 types dâatteinte. Parmi les signes cliniques les cĂ©phalĂ©es Ă©taient significativement plus frĂ©quentes dans le groupe « MP ». Dans le groupe 1, lâĂ©volution des manifestations neurologiques (prĂ©cisĂ©e dans 21 cas) sâest faite vers la rĂ©mission complĂšte ou avec des sĂ©quelles minimes dans 13 cas, la persistance de sĂ©quelles importantes dans 3 cas, lâaggravation dans 1 cas et la non-amĂ©lioration dans 1 cas ; trois patients sont dĂ©cĂ©dĂ©s. Aucun Ă©lĂ©ment clinique ou paraclinique nâavait de valeur pronostique significative dans le groupe 1. Par comparaison au groupe 2, les anĂ©vrismes Ă©taient significativement plus frĂ©quents dans le sous-groupe « ABC ». LâuvĂ©ite Ă©tait plus frĂ©quente dans le sous-groupe « ABC » que dans le sous-groupe « MP » de façon significative et que le groupe 2 mais avec une diffĂ©rence Ă la limite de la signifiance.Conclusion. â La frĂ©quence de lâatteinte neurologique dans la MB est Ă©levĂ©e dans notre sĂ©rie (25,7 %). Les anĂ©vrismes artĂ©riels semblent constituer un facteur de risque pour lâangio-Behçet cĂ©rĂ©bral. Lâangio-Behçet cĂ©rĂ©bral paraĂźt protĂ©ger les patients contre lâuvĂ©ite
Successful treatment of refractory adult onset Stillâs disease with rituximab
Adult-onset Stillâs disease (AOSD) is an uncommon inflammatory condition of unknown origin. In chronic disease, joint involvement is often predominant and erosions are noted in one third of patients. Therapeutic strategies derive from observational data. Corticosteroids are usually the first-line treatment. With inadequate response to corticosteroids, methotrexate appears the best choice to control disease activity and allow for tapering of steroid use. For refractory disease, biological therapy seems the most promising. We report here the case of a 38-year-old female patient with AOSD refractory to cytotoxic agents, treated by rituximab infusion therapy with favorable outcome
Particularités de la thrombose de la veine cave sur une série de 1045 thromboses veineuses
Indications et efficacité du rituximab dans le traitement du lupus érythémateux systémique
EULAR recommendations for the management of Behçet disease
Objectives: To develop evidence-based European League Against Rheumatism (EULAR) recommendations for the management of Behcet disease (BD) supplemented where necessary by expert opinion. Methods: The multidisciplinary expert committee, a task force of the EULAR Standing Committee for Clinical Affairs (ESCCA), consisted of nine rheumatologists (one who was also a clinical epidemiologist and one also a Rehabilitation Medicine doctor), three ophthalmologists, one internist, one dermatologist and one neurologist, representing six European countries plus Tunisia and Korea. A patient representative was also present. Problem areas and related keywords for systematic literature research were identified. Systematic literature research was performed using Medline and the Cochrane Library databases from 1966 through to December 2006. A total of 40 initial statements were generated based on the systematic literature research. These yielded the final recommendations developed from two blind Delphi rounds of voting. Results: Nine recommendations were developed for the management of different aspects of BD. The strength of each recommendation was determined by the level of evidence and the experts' opinions. The level of agreement for each recommendation was determined using a visual analogue scale for the whole committee and for each individual aspect by the subgroups, who consider themselves experts in that field of BD. There was excellent concordance between the level of agreement of the whole group and the "experts in the field". Conclusion: Recommendations related to the eye, skin-mucosa disease and arthritis are mainly evidence based, but recommendations on vascular disease, neurological and gastrointestinal involvement are based largely on expert opinion and uncontrolled evidence from open trials and observational studies. The need for further properly designed controlled clinical trials is apparent