Purpose skin involvement can severely alter body image thus representing a major concern for patients with Systemic Lupus Erythematosus (SLE).The aim of this study was to analyze the impact of active ...skin involvement on Health-Related Quality of Life (HRQoL), mood disorders and self-perception of disease activity in a monocentric cohort of SLE patients.Methodsa cross-sectional study including consecutive outpatients with SLE with active skin involvement. The severity of skin lesions was assessed through the CLASI index.Consecutive SLE outpatients with at least one active disease manifestation, but without active skin involvement or irreversible skin damage served as a control group.The following data have been collected: demographics, clinical and laboratory data, SLEDAI-2K and SLICC-DI. Each patient completed the following Patient-Reported Outcomes (PROs): SF-36, FACIT-F, LIT for disease burden, SLAQ for self-assessment of disease activity; the HADS for anxiety and depression was available for a subgroup of patients. Patients with skin involvement also completed the SKINDEX-16 (a questionnaire for the evaluation of HRQoL in patients with dermatological conditions).Results we enrolled 72 consecutive SLE patients, 38 with active skin lesions (‘skin group’) and 34 without active mucocutaneous manifestations or irreversible skin damage (‘no-skin group’); 88.9% were female, 94.4% Caucasians. Mean age at enrollment was 43.9 ± 12.2 years and median disease duration was 11.5 (IQR 7–18.5) years. In the ‘skin group’ the median CLASI activity score was 5 (IQR 3–7.5) and the median CLASI damage score was 1 (IQR 0–4).In the ‘no-skin group’, we found a significantly higher percentage of patients with active hematological and renal manifestations (p<0.01).No other significant differences emerged between the two groups with respect to age, disease duration, disease activity and damage, ongoing treatment and fibromyalgia.By comparing PROs results between the two groups, we found no significant differences for the SF-36, the LIT and the FACIT-F. However, although the SLEDAI score did not significantly differ between the two groups, we found that patients in the ‘skin group’ had a significantly higher score of the SLAQ questionnaire compared to patients in the ‘no-skin group’ (p<0.01).The HADS questionnaire was available for 50 patients: patients with active skin involvement presented significantly higher scores for depressive symptoms compared to patients without skin manifestations (p=0.01).Finally, among patients with active skin lesions, we did not demonstrate a significant correlation between the CLASI activity score and the scores of all PROs used, not even with the SKINDEX, which is specific for dermatological conditions.Conclusion although skin involvement is not generally considered a severe disease manifestation in SLE, it seems to be strongly associated with patients’ perception of higher disease activity and with depressive symptoms. These results underline as skin involvement still represents an unmet need in the management of patients with SLE, with a potentially negative impact on patient satisfaction with the care process.
Objectives A concealed penis is defined as a phallus of normal size buried in prepubic tissue (buried penis), enclosed in scrotal tissue (webbed penis), or trapped by scar tissue after penile surgery ...(trapped penis). We report our results using a standardized surgical approach that was highly effective in both functional and cosmetic terms. Methods From January 2002 to December 2005, 56 patients (median age 7 years) underwent surgery for a buried penis, 11 (median age 5 years) for a webbed penis, and 20 (median age 8 years) for a trapped penis. All 20 patients with a trapped penis had previously undergone circumcision for phimosis, except for 3 (1 for multioperated lymphangioma, 1 for repaired hypospadias, and 1 for corrected glanular epispadia). All webbed penises were phimotic, requiring circumcision. The surgical technique consisted of complete exteriorization of the shaft and reconstruction of the penopubic and penoscrotal angles. These maneuvers, however, proved extremely straightforward, with the addition of an incision along the scrotal raphe without any incision of the penile skin. Results All the patients were observed for at least 1 year after repair. Recurrence was observed in 3 boys with a buried penis (5.3%); all 3 boys were obese. Two cases of a trapped penis (10.0%) recurred, but no case of a webbed penis recurred. Regarding complications, 2 patients with a buried penis presented with mild lymphatic stasis of distal shaft that spontaneously subsided within a few months. Conclusions The scrotal approach we have described has simplified the complete exteriorization of the penile shaft, with easy bleeding control, avoiding the use of flaps, grafts, and additional ventral Z -plasty often described in published reports. In addition, the cosmetic results were judged to be good by the parents.
Objective: To determine the effect of tumour necrosis factor α (TNFα) blockade with etanercept in refractory knee joint synovitis (KJS) in rheumatoid and psoriatic arthritis, by local and systemic ...disease activity assessment and combined grey scale and power Doppler ultrasonographic monitoring. Methods: 27 knees affected by rheumatoid KJS (n = 12) and psoriatic KJS (n = 8) were assessed before receiving treatment and at 3 and 12 months’ follow up. Time dependent clinical changes in disease activity were monitored by C reactive protein, erythrocyte sedimentation rate (ESR), global health status (GHS), and Ritchie (RAI) and knee joint articular (KJAI) indices; synovial changes were monitored by ultrasonographic and power Doppler indices for grey scale synovial thickening and for distinct intrasynovial vessel power Doppler flow configurations (fluid/synovium interface (F/SI-PD) and pannus/cartilage interface (P/CI-PD)). Interobserver and intraobserver variability of grey scale and power Doppler ultrasonographic was evaluated. Response to treatment was assessed by analysis of variance for repeated measures on clinical and ultrasonographic variables. Results: Rapid (3 months) reduction in F/SI-PD flow (p<0.001), parallel to reductions of C reactive protein (p<0.05), ESR (p<0.001), KJAI (p<0.002), RAI, and GHS (p<0.001), was sustained at 12 months when it was accompanied by reduction in both synovial thickening and P/CI-PD flow (p<0.001). No differences (ANOVA) were noted at baseline or at 12 months in clinical and ultrasonographic variables between either the rheumatoid or the psoriatic KJS groups. Conclusion: Grey scale and power Doppler ultrasonography are reliable measures of long term change in rheumatoid and psoriatic KJS disease activity in response to anti-TNFα treatment with etanercept.
To elucidate the relationships between insight and alexithymia in a sample of adult outpatients with obsessive-compulsive disorder (OCD).
112 adult outpatients with OCD were tested. Severity of OCD ...was assessed with the first 10-items of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and score for item # 11 on the Y-BOCS was considered as a measure of insight. Alexithymia was measured with 20-item Toronto Alexithymia Scale (TAS-20). Additional measures were Maudsley Hospital Obsessive Compulsive Inventory (MOCI) and Montgomery Asberg Depression Rating Scale (MADRS).
Of the patients, 29.5% showed poor or no insight. Patients with poor or no insight were more alexithymic than patients with excellent, good and moderate insight. TAS-20 total score and subfactors positively correlated with score for item # 11 on the Y-BOCS, severity of OCD and MADRS scores. In stepwise regression model, MADRS scores, factor 3 of TAS-20 (Externally Oriented Thinking), somatic and hoarding-saving obsessions were significantly associated with lower insight.
Results show a relationship between poor or absent insight and high alexithymia levels in OCD patients.
Wetlands store large amounts of C in biomass, sediments and water. A major C fraction is in the dissolved organic matter (DOM) with multiple regulatory functions. Patagonian wetlands undergo changes ...in the water cycle due to climate warming and lower precipitation, causing shorter hydroperiods and reduced landscape connectivity with effects on C budgets. This study focuses on the optical characterisation of the DOM of an ephemeral wetland of North Patagonia. Along the hydroperiod the DOM showed optical signatures indicating terrestrial inputs, degradation and internal production. Dissolved organic carbon (DOC) concentration ranged between ∼4 and ∼9 mg L
−1
. The DOM pool displayed high molecular weight/size and aromatic fingerprints. Humic components C1 (microbial and/or vegetation derived) and C2 (soil/sediment) prevailed in the DOM, whereas the non-humic component C3 (from aquatic processes) increased from early spring. Experimental exposure to PAR + UVR produced slight changes in DOC and reduction in DOM molecular weight/size. The components showed distinctive photoreactivity/lability: C1 > C3 > C2. Along the hydroperiod the relative contribution of the humic vs. non-humic components (C1 and C3) determined the reactivity/lability of the DOM. In Fantasma pond, the DOM pool fluctuates in response to hydrology and degradation processes, and the alternance between dry and flooded periods determines C dynamics.
Objectives
To show the wide spectrum of computed tomography (CT) findings in blunt renal trauma and to correlate them with consequent therapeutic implications.
Methods
This article is the result of a ...literature review and our personal experience in a level II trauma centre. Here we describe, discuss and illustrate the possible CT findings in blunt renal trauma, and we correlate them with the American Association for the Surgery of Trauma (AAST) classification and their therapeutic implications.
Results
CT findings following blunt renal trauma can be grouped into 15 main categories, 12 of them directly correlated with the AAST classification and 3 of them not mentioned in it. Non-operative management, which includes the “watchful waiting” approach, endourological treatments and endovascular treatments, is nowadays widely adopted in blunt renal trauma, and surgery is limited to haemodynamically unstable patients and a minority of haemodynamically stable patients.
Conclusions
The interpretation of CT findings in blunt renal trauma may be improved and made faster by the knowledge of their therapeutic consequences.
Teaching Points
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The majority of blunt renal injuries do not require surgical treatment
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CT findings in blunt renal injury must be evaluated considering their therapeutic consequences
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Some CT findings in blunt renal trauma are not included in the AAST classification
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