RESUMEN
BACKGROUND: There is limited data about the clinical meaningfulness of the Scoring of Atopic Dermatitis (SCORAD) and Patient-Oriented SCORAD (PO-SCORAD), particularly in children with mild-to-moderate AD. Regular use of patient-reported outcomes, may deliver more accurate information about the overall health status of AD patients than routine but sparse physician assessments. OBJECTIVE: To confirm the correlation between SCORAD, PO-SCORAD, Patient-Oriented Eczema Measure (POEM) and Investigator's Global Assessment (IGA). To evaluate the interpretability and clinical usefulness of the SCORAD and PO-SCORAD scores in children. METHODS: Data were drawn from a 12-week randomized controlled trial in 335 children, aged 2-6 years, with mainly mild-to-moderate AD. Investigators captured SCORAD and IGA at each study visit. Parents used PO-SCORAD twice-weekly, and POEM once-weekly. RESULTS: There were strong correlations between PO-SCORAD and SCORAD (r = 0.874), PO-SCORAD and POEM (0.734) and PO-SCORAD and IGA (0.613). The best fit ('k' statistic: 0.68) between SCORAD and IGA classes was noted for the following SCORAD categories: <12 (clear/almost clear); 12-25 (mild); and ≥25 (moderate/severe). PO-SCORAD area under the curve over 8 weeks was significantly greater than that of SCORAD (p = 0.0002), giving a better estimate of disease severity between visits. Patients with a flare within the next 7 days had significantly higher PO-SCORAD scores 7 days before the flare (p < 0.0001). Moderate erythema was the most significant flare predictor (p < 0.0001). CONCLUSION: PO-SCORAD is robust and reliable and appears to warrant far greater utility in routine clinical practice than other scores. PO-SCORAD, used twice-weekly, may improve the management of patients with AD.
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Dermatitis Atópica , Niño , Humanos , Preescolar , Dermatitis Atópica/diagnóstico , Índice de Severidad de la Enfermedad , Gravedad del Paciente , Medición de Resultados Informados por el Paciente , Inmunoglobulina A , Calidad de VidaRESUMEN
BACKGROUND: SCORing for Atopic Dermatitis (SCORAD) is a tool developed by the European Task Force on Atopic Dermatitis (AD) which is used by physicians to assess AD severity during consultations with their patients. Patient-Oriented SCORAD (PO-SCORAD) is a self-assessment tool for use by patients which has been validated in a study performed in European countries. However, there is currently no adapted tool for evaluating AD severity in black skin. OBJECTIVE: To evaluate the performance of the version of the PO-SCORAD specifically adapted for black skin patients (children and adults) with AD. METHODS: In this multicenter, cross-sectional and non-interventional study, children and adults with AD were recruited during regular consultations. This international study was performed in seven sub-Saharan countries (Benin, Burkina Faso, Cameroon, Ivory Coast, Gabon, Mali and Senegal). During the consultation, AD severity was assessed by the physician using SCORAD score and by the patients or parents using PO-SCORAD. RESULTS: One hundred and thirteen patients were included, 72 children and 41 adults, mainly females (61.6%). SCORAD assessed by physicians and PO-SCORAD assessed by patients/parents were well correlated (r = 0.66, P < 0.0001). Correlation coefficients for SCORAD and PO-SCORAD subscale scores were also good, except for symptom intensity criteria. CONCLUSION: Altogether, these data indicate that PO-SCORAD for black skin correlates well with SCORAD and is therefore a valuable tool, which requires no specific level of education, for use by black skin patients with AD.
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Población Negra , Dermatitis Atópica/patología , Índice de Severidad de la Enfermedad , Adolescente , Adulto , África del Sur del Sahara , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Although acne vulgaris is a common skin disorder, limited epidemiological data exist specifically for European populations. OBJECTIVE: To determine the prevalence of self-reported acne among young people in Europe and evaluate the effect of lifestyle on acne. METHODS: We conducted a cross-sectional population-based online survey in representative samples of individuals aged 15-24 years in Belgium, Czech and Slovak Republics, France, Italy, Poland and Spain (n = 10 521), identified by a quota sampling method based on age, geographic location and socio-professional category. RESULTS: The overall adjusted prevalence of self-reported acne was 57.8% (95% confidence interval 56.9% to 58.7%). The rates per country ranged from 42.2% in Poland to 73.5% in the Czech and Slovak Republics. The prevalence of acne was highest at age 15-17 years and decreased with age. On multivariate analysis, a history of maternal or paternal acne was associated with an increased probability of having acne (odds ratio 3.077, 95% CI 2.743 to 3.451, and 2.700, 95% CI 2.391 to 3.049, respectively; both P < 0.0001), as was the consumption of chocolate (OR 1.276, 95% CI 1.094 to 1.488, for quartile 4 vs. quartile 1). Increasing age (OR 0.728, 95% CI 0.639 to 0.830 for age 21-24 years vs. 15-17 years) and smoking tobacco (OR 0.705, 95% CI 0.616 to 0.807) were associated with a reduced probability of acne. CONCLUSION: The overall prevalence of self-reported acne was high in adolescents/young adults in the European countries investigated. Heredity was the main risk factor for developing acne.
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Acné Vulgar/epidemiología , Estilo de Vida , Acné Vulgar/genética , Adolescente , Factores de Edad , Chocolate , Estudios Transversales , Dieta , Europa (Continente)/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Prevalencia , Factores Protectores , Factores de Riesgo , Autoinforme , Fumar Tabaco , Adulto JovenRESUMEN
BACKGROUND: Acne is common among young people. OBJECTIVE: To describe the burden, management and sources of advice of acne in a representative sample of young people in Europe. METHODS: This cross-sectional survey was conducted in a representative sample of individuals aged 15-24 years from Belgium, Czech and Slovak Republics, France, Italy, Poland and Spain (n = 3099). RESULTS: Most individuals considered their acne (all severity stages) to be no/minor problem, although 29.7% considered it a major problem/burden. Over-the-counter (OTC) topical treatments were used more frequently than prescribed treatments. Acne was diagnosed by physicians in 47.6% of cases; other health professionals (nurses, pharmacists) or patients accounted for the remainder of diagnoses. Physicians were the source of acne information in just over one-quarter of cases (27.0%). The vast majority of advice was from friends/family and the Internet. CONCLUSION: Almost one-third of young people consider acne to be a major problem/burden. Fewer than half of acne diagnoses are made by a physician, and acne is often self-managed using OTC treatments.
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Acné Vulgar/epidemiología , Acné Vulgar/psicología , Conocimientos, Actitudes y Práctica en Salud , Percepción , Acné Vulgar/diagnóstico , Acné Vulgar/tratamiento farmacológico , Adolescente , Adulto , Estudios Transversales , Europa (Continente)/epidemiología , Familia , Amigos , Humanos , Internet , Medicamentos sin Prescripción/uso terapéutico , Educación del Paciente como Asunto/métodos , Medicamentos bajo Prescripción/uso terapéutico , Prevalencia , Automedicación , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Emollients are considered as a first-line therapy for the treatment of atopic dermatitis (AD). However, evidence-based proof that the regular use of emollients reduces AD severity is lacking. OBJECTIVE: To assess whether the regular use of emollients results in a reduction in AD severity in children with AD. METHODS: In this multicentre randomized, parallel group, open-label study, children with mild-to-moderate AD were recruited during a flare. After flare resolution with a topical corticosteroid, patients were randomized to V0034CR emollient, reference emollient or no emollient (1:1:1 ratio), for 12 weeks. AD severity was assessed regularly by physicians [Scoring for Atopic Dermatitis (SCORAD) and subcomponents, IGA] and by parents (PO-SCORAD and POEM). RESULTS: A total of 335 patients were randomized to V0034CR (n = 111), reference emollient (n = 116) or no emollient (n = 108). After 12 weeks of treatment, SCORAD score was reduced by 5.28 points in the V0034CR group and by 3.36 points in the reference emollient group compared with the no emollient group (+4 points; P < 0.001 in both emollient groups vs. no emollient group). In a similar manner, PO-SCORAD score was reduced by 4.88 and 2.67 points in the V0034CR and reference emollient groups, respectively, but increased by 2.90 points in the no emollient group (P < 0.001). Similar results were observed for POEM. A continuous decrease in all scores was observed over the 12-week treatment period. At the end of the study, the percentage of patients in complete remission (i.e. without a new flare over the treatment period) was higher in the V0034CR (59.5%) and reference emollient (44.3%) groups than in the no emollient group (29.8%; P < 0.001). CONCLUSION: These results demonstrate that the regular use of emollients in children with mild-to-moderate AD reduces the severity of symptoms and, therefore, support their use as a first-line treatment for these patients.
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Dermatitis Atópica/tratamiento farmacológico , Grasas de la Dieta/uso terapéutico , Emolientes/uso terapéutico , Glicerol/uso terapéutico , Ácido Glicirretínico/uso terapéutico , Parafina/uso terapéutico , Extractos Vegetales/uso terapéutico , Preescolar , Dermatitis Atópica/complicaciones , Combinación de Medicamentos , Femenino , Humanos , Masculino , Prurito/etiología , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/etiología , Evaluación de Síntomas , Brote de los Síntomas , Resultado del TratamientoRESUMEN
BACKGROUND: Peripheral neuronal impairment compromises foot health in patients with diabetes. Clinically, xerosis is the most common mild complication, but it should not be underestimated. An effective treatment must be able to restore the cutaneous barrier and prevent water loss, to maintain adequate hydration and protection. OBJECTIVE: This study aimed to assess the efficacy of an emollient cream on foot xerosis in patients with diabetes. METHODS: This is a prospective, multicenter, randomized, double-blind contralateral vehicle-controlled study in 57 patients with diabetes. Patients were treated twice daily for 27 ± 2 days with the study emollient containing glycerol 15%, liquid and soft paraffin 10%, glycerol monostearate, stearic acid, polydimethylcyclosiloxane, silicone oil, macrogol 600, trolamine, propyl parahydroxybenzoate and purified water (Dexeryl® ; Pierre Fabre Medicament, Boulogne, France) or its vehicle (glycerol monostearate, stearic acid, polydimethylcyclosiloxane, silicone oil, macrogol 600, trolamine, propyl parahydroxybenzoate and purified water). Efficacy was assessed after a 28-day treatment period using a validated score [Xerosis Assessment Scale (XAS) score], instrumental measurements and subjective assessment. RESULTS: The XAS score decreased to 3.2 ± 2.6 points with the emollient and 4.1 ± 2.3 with the vehicle (P = 0.001). Improvement was observed from day 14 (P = 0.012). Compared with the vehicle, the emollient also significantly improved the overall skin score, hydration index, D-Squame® (CuDerm Corporation, Dallas, TX, USA) test, skin roughness and patients' opinions. CONCLUSION: Treatment with an emollient is effective for improving foot xerosis in patients with diabetes.
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Pie Diabético/complicaciones , Emolientes/uso terapéutico , Glicerol/uso terapéutico , Parafina/uso terapéutico , Crema para la Piel/uso terapéutico , Enfermedades de la Piel/tratamiento farmacológico , Anciano , Método Doble Ciego , Emolientes/efectos adversos , Femenino , Glicerol/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Parafina/efectos adversos , Vehículos Farmacéuticos/uso terapéutico , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Crema para la Piel/efectos adversos , Enfermedades de la Piel/etiologíaRESUMEN
BACKGROUND: Hydration with topical emollients forms the backbone of treatment for mild atopic dermatitis (AD), but few randomized controlled trials have assessed their efficacy in young children. OBJECTIVES: Assess the efficacy and tolerability of long-term emollient therapy in the treatment of moderate to severe xerosis in young children with AD. METHODS: This was a phase III, multicentre, double-blind, randomized, vehicle-controlled trial. Children (n = 251) aged 2-6 years with AD-associated xerosis were randomized 1 : 1 to a 28-day treatment with an emollient combining glycerol and paraffin or its vehicle. Non-responders at the end of the double-blind period were treated open label with emollient until day 84. Responders stopped treatment until reassessment on day 56. Those who relapsed after stopping treatment were treated open label with emollient until day 84. RESULTS: During the double-blind period, xerosis score (XS) of the scoring atopic dermatitis (SCORAD) index, objective SCORAD and visual analogue score decreased and skin hydration increased more in the emollient group than in the vehicle group (P < 0.001 for all measures). More patients were responders with emollient than with vehicle (66.1% vs. 45.6%, P < 0.001). During the open-label period, stopping emollient treatment led to relapse but improvement returned if treatment was restarted with emollient. Regular use of the emollient also yielded improvement in children who did not initially respond. Adverse events were similar in the two groups, and no treatment-related severe adverse events were reported. CONCLUSIONS: Long-term therapy with emollient is effective and well tolerated for the treatment of xerosis in children with atopic dermatitis.
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Dermatitis Atópica/tratamiento farmacológico , Emolientes/efectos adversos , Emolientes/uso terapéutico , Ictiosis/tratamiento farmacológico , Niño , Preescolar , Dermatitis Atópica/complicaciones , Método Doble Ciego , Femenino , Glicerol , Humanos , Ictiosis/etiología , Estudios Longitudinales , Masculino , Parafina , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Antiarrítmicos/administración & dosificación , Bradicardia/tratamiento farmacológico , Hemangioma/tratamiento farmacológico , Propranolol/administración & dosificación , Bradicardia/fisiopatología , Esquema de Medicación , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Hemangioma/fisiopatología , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Efficacy and tolerance should be considered in topical treatments of chronicle affections with impaired skin barrier function such as ichthyosis. OBJECTIVES: To demonstrate the efficacy of Dexeryl in reducing severity of ichthyosis. METHODS: A prospective, multicentre, randomized, placebo controlled study was performed with patients under 18 years suffering from a non-bullous form of ichthyosis. A double-blind period using Dexeryl (an emollient cream containing glycerol 15% and paraffin 10%) or placebo (its vehicle) during 4 weeks followed by an open label period with all patients treated by Dexeryl for 8 weeks. Improvement of ichthyosis was assessed by cutaneous xerosis evolution (SRRC score): the percentage of patients with 50% reduction of the SRRC score at D28 was the primary criterion. The assessment of pruritus [visual analogue scale (VAS)], global evaluation and safety were secondary. RESULTS: The percentage of patients with at least 50% reduction of SRRC score at D28 was significantly higher in Dexeryl group (60.3%) vs. vehicle group (43.5%; P = 0.008). Reduction of pruritus on VAS was significantly higher at D28 with Dexeryl (-2.16) compared to that in placebo (-1.49), P < 0.05. The improvement continues through the open label period: at D84 we observed -2.5 of SRRC score in the Dexeryl group vs.-1.8 for the group previously treated by vehicle. Investigators found Dexeryl efficacy as satisfying for about 80% of treated patients vs. 50% with vehicle. Concerning safety, most of the adverse events were not related to treatment. CONCLUSIONS: Dexeryl showed a significant improvement of xerosis and related symptoms in children with ichthyosis and was well tolerated.
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Glicerol/uso terapéutico , Ictiosis/tratamiento farmacológico , Parafina/uso terapéutico , Adolescente , Niño , Preescolar , Método Doble Ciego , Femenino , Humanos , MasculinoRESUMEN
Antiphospholipid syndrome (APS) is an autoimmune disease and one of the most common causes of acquired thrombophilia. It is characterised by the occurrence of thrombotic or obstetric events associated with the presence of persistent antiphospholipid antibodies. The diagnosis can be challenging, particularly because some biological tests can be disturbed by anticoagulant treatment or inflammation. In the recent years, new antiphospholipid antibodies, including anti-phosphatidylserine/prothrombin antibodies (anti-PS/PT), have emerged but their clinical significance and causality remain uncertain. Biologically, several studies have found a strong correlation between the presence of lupus anticoagulant (LA) and anti-PS/PT antibodies. Clinically, the presence of anti-PS/PT antibodies is associated with an increased risk of thrombosis and obstetric complications. There is also an association with thrombocytopenia, suggesting that the presence of anti-PS/PT antibodies may be associated with more severe clinical APS. Among seronegative APS patients, 6-17% of patients are positive for anti-PS/PT antibodies. This might influence the therapeutic management of patients. This article aims to provide an update on contribution of anti-PS/PT antibodies detection for the diagnosis and management of APS.
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Síndrome Antifosfolípido , Trombosis , Anticuerpos Antifosfolípidos , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/terapia , Femenino , Humanos , Inhibidor de Coagulación del Lupus , Fosfatidilserinas , Embarazo , ProtrombinaRESUMEN
BACKGROUND: SARS-CoV-2 uses Angiotensin-Converting Enzyme 2 as a viral gateway to the cell and could interact with the renin-angiotensin-aldosterone system. Other studies have shown kalemia abnormalities in patients with severe forms of coronavirus disease 2019. Our goal was to assess the prognosis value of kalemia within ten days of symptom offset in the COVID-19 hospitalized population. METHODS: We analyzed data from a prospective cohort that included 65 patients with COVID-19, admitted between March 15, 2020, and March 21, 2020. The study aimed at determining the relationship between baseline kalemia and the admission to an intensive care unit (ICU) or death. RESULTS: The median age of the patients was 65 [54-79] years old, and 66.2% of the patients were men. Baseline kalemia under 3.8mmol/l occurred in 31 patients (48%), including 11 patients (35.5%) who were admitted to an ICU and one patient (3.2%) who died before ICU admission. In the primary end-point analysis, the adjusted hazard ratios for admission to an ICU or death were 3.52 [95% confidence interval (CI), 1.12 to 11.04] among patients with low baseline kalemia. CONCLUSION: Our study suggests that low kalemia levels within ten days of the first symptom onset might be associated with an increased risk of intensive care unit admission or death. The future perspective should be to better understand this relationship.
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COVID-19 , Anciano , Estudios de Cohortes , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , SARS-CoV-2RESUMEN
The purpose of this retrospective review of the charts of 6 children who underwent surgical treatment of chylous ascites refractory to conservative measures between 1993 and 2006 was to evaluate the efficiency of fibrin glue application for control of lymph leakage. Five children had postoperative chylous ascites (neuroblastoma, 4; cystic lymphangioma, 1) and 1 had a congenital malformation. Surgical exploration revealed large areas of diffuse lymphatic leakage in all of the patients. Lymphatic fistula was not identified intraoperatively in any patient. Ingestion of lipophilic dye in a concentrated fatty meal was not helpful in locating a lymph fistula. Absorbable mesh was used in association with glue application in the last 3 patients treated. Control of ascites was achieved immediately in 2 patients and within 3 weeks in 2 patients. Repeat surgery was required in the remaining 2 patients. The mean follow-up time was 4.3 years. One patient died of tumor recurrence 12 months after surgical treatment without relapse of the ascites. Two mild late recurrences were observed at 6 and 11 months after surgery and were managed conservatively. The findings of this study show that fibrin glue application on absorbable mesh after dissection of the leakage zones is easy, safe, and effective. We recommend that surgery with glue application be repeated until control of ascites is achieved. We suggest fibrin glue application as a preventive measure against postoperative chylous ascites.
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Ascitis Quilosa/prevención & control , Ascitis Quilosa/terapia , Adhesivo de Tejido de Fibrina/farmacología , Mallas Quirúrgicas , Adhesivos Tisulares/farmacología , Materiales Biocompatibles , Niño , Preescolar , Ascitis Quilosa/etiología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Complicaciones Posoperatorias , Reoperación , Estudios Retrospectivos , Factores de TiempoRESUMEN
Over the past two decades, dramatic improvements in the treatment of children with Non-Hodgkin's Lymphoma have led to cure rates close to 90%, even in advanced-stage disease. The most frequent localization is abdominal, where Burkitt or Burkitt-like subtypes are predominant. Initial management often occurs in the setting of a urgent surgical intervention where multiple complications may gravely threaten prognosis within days or even hours. The SFCE Lymphoma Committee's guidelines for optimal management include: 1) The diagnosis of lymphoma should be systematically evoked whenever the clinical context is not consistent with idiopathic intussusception, particularly in children over the age of 3 or when clinical and/or ultrasound findings are not typical; 2) Limited bowel resection should be performed only if it allows complete tumor removal and is technically simple without extensive dissection or risk of major complications; 3) If surgical resection is likely to be difficult, risky, or incomplete, surgery should be limited to sampling of peritoneal fluid and tumor; 4) In all cases, adequate tissue should be obtained and sent to the pathology department in appropriate media Analysis of tumor material may require, in addition to histology and cytology, immunophenotyping, cytogenetics, and molecular biology studies in order to arrive at an accurate diagnosis and prognosis and to guide treatment choices.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Intestinales/tratamiento farmacológico , Neoplasias Intestinales/cirugía , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/cirugía , Guías de Práctica Clínica como Asunto , Dolor Abdominal/etiología , Quimioterapia Adyuvante , Niño , Medicina Basada en la Evidencia , Francia , Humanos , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/diagnóstico , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/diagnóstico , Sociedades Médicas , Resultado del TratamientoRESUMEN
A. Delarue, C. Bergeron, F. Mechinaud-Lacroix, C. Coze, M. Raphael, C. Patte, pour le « Comité Lymphome ¼ de la SFCE Over the past two decades, dramatic improvements in the treatment of children with Non-Hodgkin's Lymphoma have led to cure rates close to 90%, even in advanced-stage disease. The most frequent localization is abdominal, where Burkitt or Burkitt-like subtypes are predominant. Initial management often occurs in the setting of a urgent surgical intervention where multiple complications may gravely threaten prognosis within days or even hours. The SFCE Lymphoma Committee's guidelines for optimal management include: 1) The diagnosis of lymphoma should be systematically evoked whenever the clinical context is not consistent with idiopathic intussusception, particularly in children over the age of 3 or when clinical and/or ultrasound findings are not typical; 2) Limited bowel resection should be performed only if it allows complete tumor removal and is technically simple without extensive dissection or risk of major complications; 3) If surgical resection is likely to be difficult, risky, or incomplete, surgery should be limited to sampling of peritoneal fluid and tumor; 4) In all cases, adequate tissue should be obtained and sent to the pathology department in appropriate media Analysis of tumor material may require, in addition to histology and cytology, immunophenotyping, cytogenetics, and molecular biology studies in order to arrive at an accurate diagnosis and prognosis and to guide treatment choices.
RESUMEN
PURPOSE: To assess the capabilities of a velocity ratio>3 for the diagnosis of Budd-Chiari syndrome (BCS) in children after split liver transplantation using Doppler ultrasonography (DUS). MATERIALS AND METHODS: A total of 28 children who underwent liver transplantation using a split procedure were included. There were 11boys and 17girls with a mean age of 3.8years (range: 0.7-12years). Velocity ratio between blood velocity upstream of the anastomosis and that at the level of the inferior vena cava anastomosis was calculated. Sensitivity, specificity and accuracy of DUS for the diagnosis of BCS were estimated using a velocity ratio>3. RESULTS: Eight children (8/28; 29%) had BCS and 20 (20/28; 71%) did not have BCS using the standard of reference. A velocity ratio>3 on DUS yielded 88% sensitivity (95% CI: 53-98%), 80% specificity (95% CI: 58-92%) and 82% accuracy (95% CI: 64-92%) for the diagnosis of BCS. CONCLUSION: A velocity ratio>3 on DUS is a reliable finding for the diagnosis of BCS in children after split liver transplantation.
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Velocidad del Flujo Sanguíneo/fisiología , Síndrome de Budd-Chiari/diagnóstico por imagen , Venas Hepáticas/diagnóstico por imagen , Ultrasonografía Doppler en Color , Vena Cava Inferior/diagnóstico por imagen , Anastomosis Quirúrgica , Síndrome de Budd-Chiari/fisiopatología , Niño , Femenino , Venas Hepáticas/fisiopatología , Humanos , Trasplante de Hígado/métodos , Masculino , Estudios Retrospectivos , Sensibilidad y Especificidad , Vena Cava Inferior/fisiopatologíaRESUMEN
BACKGROUND: Lymphangiomas are rare benign lesions of the lymphatic system. The most common symptoms are abdominal tumor or "acute abdomen" in children. The treatment of choice is complete surgical resection, but the recurrence rate with incomplete resection is high, and laparotomy exposes the patient to adhesions. The authors report their experience with the lymphangioma laparoscopic approach. METHODS: This retrospective study examined 15 consecutive operations for lymphangiomas in children, ages 5 months to 14 years, treated during the 5-year period from 1999 to 2004. RESULTS: Six patients were treated using the primary laparotomy approach, and nine patients underwent the laparoscopic procedure, six successfully. Three conversions were necessary (1 case requiring partial colectomy, 1 retroperitoneal case with adherence on the aorta and vena cava, 1 case with partial volvulus). Morbidity included two cases of acute occlusion caused by adhesions after laparotomy. There was no recurrence of lymphangioma during a mean follow-up period of 35 months. CONCLUSION: The laparoscopy procedure could be used successfully for abdominal lymphangioma, even in an emergency. When the laparoscopic resection is impossible, laparotomy or sclerotherapy can be discussed.
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Neoplasias Abdominales/cirugía , Laparoscopía/métodos , Linfangioma/cirugía , Neoplasias Abdominales/diagnóstico , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Predicción , Humanos , Lactante , Laparoscopía/tendencias , Laparotomía/métodos , Laparotomía/tendencias , Linfangioma/diagnóstico , Linfangioma Quístico/diagnóstico , Linfangioma Quístico/cirugía , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/tendencias , Estadificación de Neoplasias , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
The aim of this study was to assess the effectiveness of a new nicotine lozenge ( Nicopass 1.5 mg) in reducing smoking urge after an overnight abstinence. Twenty-four moderate smokers participated in a randomized, double-blind, placebo-controlled, 2-period crossover trial. The results showed that 1.5 mg-nicotine lozenge is superior to placebo in reducing smoking urge (p = 0.0001). In addition, nicotine lozenge, but not placebo, significantly improved vigilance and psychomotor performances (p < 0.05) and displayed a cardiac chronotropic effect. Thus, the 1.5-mg nicotine lozenge appears as an effective aid to alleviate acute tobacco withdrawal symptoms in moderate smokers.
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Nicotina/uso terapéutico , Agonistas Nicotínicos/uso terapéutico , Cese del Hábito de Fumar/métodos , Fumar/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Administración Oral , Adulto , Estudios Cruzados , Método Doble Ciego , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Desempeño Psicomotor/efectos de los fármacos , Fumar/efectos adversos , Fumar/psicología , Síndrome de Abstinencia a Sustancias/etiologíaRESUMEN
OBJECTIVE: Previous studies demonstrated that mequitazine produces mild sedation after single doses. Its enantiomer, l-mequitazine, has a stronger potency for the H1 receptor. The aim of the current study was to assess the effects of l-mequitazine and mequitazine, alone and with alcohol, on driving. METHODS: Twenty-five healthy volunteers were treated with l-mequitazine 2.5, 5.0 and 10 mg, mequitazine 10 mg and placebo, alone and in combination with alcohol in a double-blind crossover design. Driving performance was assessed using the standardized highway driving test in normal traffic. Its primary measure is the Standard Deviation of the Lateral Position (SDLP). Secondary measures consisted of an auditory word learning test during driving, and subjective measures of driving performance. RESULTS: L-mequitazine 2.5 and 5.0 mg showed no effect on SDLP in the highway driving test, while SDLP significantly increased after l-mequitazine 10 mg (alone +1.59 cm; with alcohol +1.41 cm) and mequitazine 10 mg (with alcohol +1.17 cm). Alcohol significantly impaired all performance measures (SDLP +2.63 cm) but did not interact with the effects of treatment. Subjective measures indicated that participants were aware of the impairing effects of alcohol, but not of l-mequitazine and mequitazine. CONCLUSION: L-mequitazine can be considered safe to drive in dosages of 2.5 and 5.0 mg. L-mequitazine 10 mg led to mild driving impairment. Alcohol impaired all performance measures and added to the effects of l-mequitazine and mequitazine.
Asunto(s)
Conducción de Automóvil , Depresores del Sistema Nervioso Central/farmacología , Conducir bajo la Influencia , Etanol/farmacología , Antagonistas de los Receptores Histamínicos H1/farmacología , Fenotiazinas/farmacología , Desempeño Psicomotor/efectos de los fármacos , Adulto , Estudios Cruzados , Método Doble Ciego , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: The objective of this prospective comparative single centre study was to compare postoperative rotator cuff healing rates as assessed by magnetic resonance imaging (MRI) versus ultrasonography (US). MATERIAL AND METHODS: Between October 2012 and February 2013, 61 patients underwent arthroscopic repair of postero-superior rotator cuff tears. Each patient underwent MRI and US 6 months later. The findings were assessed independently by two observers. We compared intra-observer and inter-observer levels of agreement regarding healing rates assessed by MRI and US. RESULTS: Intra-observer agreement regarding the MRI interpretation was 95% (κ coefficient, 0.83) for one observer and 98% (κ coefficient, 0.94) for the other. Values of κ for inter-observer agreement ranged across readings from 0.76 to 0.90. When MRI was taken as the reference, US had 80% sensitivity and 98% specificity. DISCUSSION: MRI and US provide similar assessments of postoperative rotator cuff healing, although US is less sensitive. Intra-observer and inter-observer agreements are very good.