An Evidence-Based Update on the Potential Association between Rheumatoid Arthritis and Lymphangioleiomyomatosis.

Lymphangioleiomyomatosis (LAM) represents an uncommon disorder characterized by cystic lung destruction and chronic respiratory failure. Lung damage caused by various mechanisms may represent a hypothesis for studying the association between LAM and rheumatoid arthritis (RA), which is the most prevalent autoinflammatory rheumatic disease and may affect the lungs as an extra-articular manifestation. Despite their distinct clinical presentations, the pathophysiology of both disorders includes dysregulated immunological function, abnormal cellular development, and inflammation. Current research suggests a potential relationship between RA and LAM, as some RA patients have been reported to develop LAM. However, the association of RA and LAM raises important therapeutic dilemmas. For this reason, the trajectory of a patient who was identified in our medical records as suffering from both LAM and RA, treated with many novel molecules and biological therapy, but with a negative outcome due to respiratory and multiorgan failure, has been exemplified. The delay in the diagnosis of LAM is due to a correlation between RA and LAM, worsening the vital prognosis and also hindering pulmonary transplantation. In addition, extensive research is essential for understanding the potential connection between these two disorders and discovering any similar mechanisms involved that may underlie their occurrence. This may contribute to the development of new therapeutic options that target shared pathways implicated in the pathogenesis of RA and LAM.

The role of color histograms in predicting the prognosis of patients with digestive tract adenocarcinoma.

OBJECTIVES: To establish the correlation between the degree of vascularisation detected using power Doppler ultrasonography in digestive tract adenocarcinoma and the prognosis of these patients. MATERIAL AND METHOD: Ultrasonography was performed in 45 patients diagnosed with digestive tract adenocarcinoma (16 stomach-35.6%, 6 cecum and ascending colon-13.3%, 2 transverse colon-4.4%, 5 descending colon 11.1%, 13 sigmoid colon-28.9%, and 3 rectum-6.7%). The degree of maximum tumor vascularization was determined using the highest percentage of colored pixels obtained in the histogram- maximum color pixels density (MCPD). The hepatic Doppler perfusion index (HDPI) was also calculated. The presence and development of liver metastases was evaluated by ultrasonography and computed tomography. The patients were monitored for a period of 18 months. The results of each method in detecting and predicting the development of liver metastases were compared. RESULTS: MCPD and HDPI had fairly similar results (p>0.05) in establishing the positive and negative predicting values for the entire group of patients with liver metastasis (55.9% compared to 66.7%, p>0.05, and 53.3%, compared to 54.6%, p>0.05) and the group that developed liver metastases during follow-up (80.0% compared to 90.0%, p>0.05, and 61.5%, compared to 75.0%, p>0.05). When comparing MCPD and HDPI for the group of patients who had or developed metastases, MCPD had an equal sensitivity (86.4%, compared to 90.9%, p >0.05), a higher specificity (65.0% compared to 46.5%, p<0.05), but a lower accuracy (60.0% compared to 73.3%, p<0.05). In detecting patients who developed metastases during the 18 months follow-up, MCPD had a superior sensitivity (85.7% compared to 64.3%, p<0.05), a lower specificity (66.7% compared to 88.9%, p<0.05) and an equal accuracy (78.3% vs. 73.9%, p >0.05.). CONCLUSIONS: The calculation of MCPD using color histograms can be a simple and quick method in the evaluation and prognosis of patients with digestive tract adenocarcinoma.

Patent ductus arteriosus.

Patent ductus arteriosus (PDA) is a congenital disorder in heart, wherein the ductus arteriosus fails to close after birth. This leads to the generation of a left-to-right shunt, leading to pulmonary hypertension. Color Doppler echocardiography is essential for the diagnosis. The identification of a diastolic flow oriented in the opposite direction in the pulmonary artery finalizes the diagnosis. We present the case of a 4 year old patient with systolic and diastolic left parasternal lift, echographically diagnosed with patent ductus arteriosus. The typical echographic aspects for this cardiac malformation are thoroughly detailed.

The sensitivity of transabdominal ultrasound in the diagnosis of ureterolithiasis.

OBJECTIVES: The ultrasonographic diagnosis of renal lithiasis colic is suggested by the existence of hydronephrosis, but the certainty is given by the direct visualization of the ureteral calculus. The aim of this study is to assess the performance of ultrasound in identifying ureteral calculi compared to other imaging methods (abdominal X-ray, urography and computed tomography). MATERIAL AND METHOD: We performed ultrasonographic examination (one or multiple examinations) in 217 patients with renal colic and ureterolithiasis. The calculus was identified by abdominal radiography, urography, computed tomography or by eliminating the calculus RESULTS: Ureteral calculi were ultrasonographically identified in 159 of the examined patients: 121 in the initial examination, 38 in the additional reexaminations (73.27% sensitivity compared to 48.39% X-ray, 68.37% urography, and 91.11% CT). Hydronephrosis was identified in 193 patients (88.94%). None of the imaging methods managed to identify ureteral calculus in 4 of the patients (1.84%), the diagnosis being retrospective, based on the urinary elimination of the calculus. The calculi were located 12.58% in the pelviureteric junction, 10.69% in the proximal ureter, 6.91% in the mid ureter, 28.93% in the distal ureter, and 40.88% in the pelviureteric junction. CONCLUSIONS: Ultrasound is a sensitive method for detecting UL in renal colic and can be used as the initial imaging method in investigating these patients. The presence or absence of hydronephrosis can not be considered as a discriminatory factor for the diagnosis of ureterolithiasis.