ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We review our experience with needle muscle biopsy, including technique, results, complications, and outcome. We have collected data from 40 consecutive patients undergoing needle muscle biopsy of the quadriceps muscle. All biopsies were performed by the same operator and 98% were performed in the outpatient clinic. Specimens were sent to pathology for processing, staining, and interpretation. Follow-up clinical information was obtained by chart review. The ages of the patients ranged from 9 to 84 years, including three children. Of the 27 patients with a prebiopsy suspicion of idiopathic inflammatory myopathy (polymyositis, dermatomyositis, or inclusion body myositis) 13 had biopsies with consistent pathologic changes. Seven patients in this group had no pathologic diagnosis - none of these patients subsequently developed active myositis. Other conditions seen included mitochondrial myopathy, neuropathy, and type II fiber atrophy. Biopsies were very well tolerated, and no significant complications were seen. Therapeutic decisions were influenced most by needle muscle biopsy results obtained from patients suspected of having idiopathic inflammatory myopathy. Needle muscle biopsy charges were approximately 40% lower than those for open biopsies performed during the same interval. Needle muscle biopsy is a safe, care-effective, and cost-effective alternative to open muscle biopsy in the evaluation of a variety of myopathies.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Although Henoch-Schönlein Purpura (HSP) is widely believed to be a benign, self-limited form of vasculitis, this generalization, when applied to adults, may not be valid.We describe five patients with prolonged severe vasculitis, all of whom met American College of Rheumatology criteria and carried a clinical arid tissue diagnosis of HSP. In each case, the vasculitic manifestations necessitated treatment with steroids and/or immunosuppressant therapy. This experience suggests that the benign histopathology of HSP in adults does not guarantee a benign clinical course.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Because practice variation has been targeted as one major contributor to disproportional increases in healthcare costs, practice guidelines have become more popular in the management of diseases. Practice guidelines that reflect current evidence-based knowledge, including the collective judgment of clinical experts, have been promoted with increasing frequency as a tool to decrease undesirable variation in clinical practice. It is known that clinical guidelines are much more likely to be accepted by practitioners if they have been developed in close collaboration with corresponding professional societies. Consequently, German and American rheumatologists have independently developed practice guidelines for drug monitoring in rheumatic diseases that are endorsed by their national societies of rheumatology. Not surprisingly, both sets of guidelines are very much alike; however, there are distinct differences that mainly represent different healthcare systems in which rheumatology is practiced. Moreover, both guidelines demonstrate differences in the audience addressed, patients covered, and measures of how the guidelines are disseminated. This paper demonstrates the development and implementation process of guidelines for drug monitoring in rheumatic diseases in Germany and the United States. The guidelines are accessible in full length via the Internet.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Lumbar canal stenosis is an increasingly recognized condition in patients more than 65 years of age. The clinical syndrome is dominated by neurogenic claudication. The natural history of the Condition is not yet well described. Long-term results of surgical therapy are frequently disappointing, and reoperation is required in more than 10% of patients. Nonoperative treatment options include physical therapy exercise programs, calcitonin, analgesics, and epidural steroid injections. A clinical pathway for management of symptomatic stenosis, emphasizing an initial nonoperative approach, is suggested.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Thrombocytopenia is seen commonly in patients with rheumatic disorders. In general, thrombocytopenia is due to one of three mechanisms: reduced production, sequestration, or increased platelet destruction. In outpatients, the most common cause of thrombocytopenia is immune thrombocytopenia. Immune thrombocytopenia encompasses a broad group of disorders in which the rate of immune-mediated platelet destruction surpasses the rate of platelet production. This paper discusses the diagnosis of immune thrombocytopenia, its mechanisms, and potential therapies for this problem. Acute therapy is with corticosteroids and intravenous immunoglobulin. Splenectomy is used if these fail. There also are other second-line therapies for treatment of patients with refractory thrombocytopenia. Potential toxicities of therapy are reviewed within the context of patients with rheumatic disorders.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Reactive arthritis following antibiotic-associatedClostridium difficile(CD) colitis is becoming increasingly recognized in adults; 20 cases have been reported in the medical literature. We describe a 3-year-old patient with reactive arthritis following CD colitis, the first such reported case in a pediatric patient. The clinical features of reactive arthritis following CD colitis appear similar to those of more frequently described pathogens. The arthritis usually occurs 1–2 weeks after the onset of diarrhea, with an asymmetric oligoarticular distribution typically involving large lower extremity joints; resolution occurs in weeks to months. Reactive arthritis in children probably occurs less commonly than in adults, has fewer mucocutaneous manifestations, and follows infections caused by gastrointestinal pathogens much more frequently than genitourinary organisms.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A patient presented with acute de Quervain's tenosynovitis with no history of trauma or overuse. Infection was ruled out. Aspiration of the involved tendon sheath yielded a significant quantity of tenosynovial fluid closely resembling viscous synovial fluid, which showed intracellular calcium pyrophosphate dihydrate crystals. X-rays showed flecks of linear calcification in the region of the tendon sheath. This is a rare clinical presentation of calcium pyrophosphate dihydrate disease.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A patient with acute onset of purpuric rash and arthritis is presented. He was taking acetaminophen 10 days before the onset of the symptoms. The cutaneous lesions were caused by leukocytoclastic vasculitis on histologic examination. Rechallenge with the drug was followed by the appearance of new similar lesions.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We present the case of a 71-year-old patient with rugger-jersey vertebrae who was referred to us with a tentative diagnosis of Paget's disease. After considering other conditions causing similar bone sclerosis, such as metastases, lymphoma, renal osteodystrophy, myelofibrosis, thalassemia, and Gaucher's disease, we agreed on a diagnosis of osteopetrosis. This is a rare entity of genetic origin, manifest by variable generalized symmetric skeletal sclerosis caused by defective bone resorption.

ISSN:1076-1608    

出版商:OVID    

年代:1997

数据来源: OVID