Slight Clinical Improvement Research Articles

Use of probiotics in the treatment of erythematotelangiectasic and papulopustular rosacea

Background: The interaction between the gut and skin microbiota is linked to skin diseases. It is believed that through the use of oral probiotics it is possible to modulate the intestinal microbiota and regulate skin diseases. Objective: The study aims to analyze the efficacy of oral probiotics in the treatment of erythematotelangiectatic and papulopustular rosacea through the theory of the relationship between intestinal and skin microbiota. Methods: The study consisted of a randomized, controlled, double-blind, experimental clinical trial with comparative efficacy. The study sample (n=25) was divided into two groups: the experimental group received the oral probiotic plus a topical cream of Adapalene 1mg and the control group received the placebo and the same topical cream of Adapalene 1mg. To assess the effectiveness of the treatment, two questionnaires were proposed regarding the impact of rosacea on the patients' lives before and after one month of treatment. Results: In the experimental and control groups, the sum of the RosaQol and DLQI questionnaire scores decreased compared to before the treatment was applied. There was no significant difference between the results before and after treatment with probiotics and placebo. Conclusion: Both groups showed slight clinical improvement, with no superiority of probiotics. However, more clinical trials are needed due to the limitations of the study, such as the small sample size and the interference of the winter climate in the southern region of the country, which may have interfered with the clinical and statistical analysis of this study.

Tuberculosis miliar en paciente inmunocompetente: Reporte de caso

Milar Tuberculosis (TB) is a presentation with a fatal outcome if it is not diagnosed or treated on time; although certain conditions are required to develop this presentation. In this In this article, the case of a 48-year-old man with no pathological history is studied, who started the disease with a time of six months with an initial diffuse gastrointestinal pain and later one month before admission presented progressive respiratory symptoms; he was admitted for emergencies where bilateral diffuse miliary compromise was evident in the chest computed tomography; upon admission, he was administered oxygen and support measures, an HIV test was obtained which was negative, and positive results were obtained in the sputum smear microscopy. His clinical evolution was stationary until the administration of antituberculosis therapy, observing slight clinical improvement, likewise, low doses of corticosteroids were administered after which a favorable evolution was demonstrated and he was discharged.

Corticobasal degeneration or hepatic encephalopathy, False positive and/or congruence between clinic and PET‐FDG imaging

AbstractBackgroundto put into perspective the relative clinical evidence meeting the criteria of corticobasal degeneration but modified by the treatment of a metabolic diseaseMethodMultidisciplinary clinical follow‐up of a patient meeting the cognitive, speech and neurological criteria for a degenerative disease by documenting the evolution of both functional, cognitive and functional imaging during the treatment of hepatic encephalopathyResultPt of 82 y/o presents with a deterioration over 6 months of a left extrapyramidal syndrome with dystonia of this hemibody, with a dysphasia‐dysphonia spastic and ataxic documented in speech therapy compatible with corticobasal degeneration. MRI shows mild leukoaraiosis, The FDG PET‐Scan is also compatible with corticobasal degeneration. EEG done for abnormal movements is suggestive of hepatic encephalopathy in the absence of laboratory abnormality except for a very slight increase in ammonia. Ultrasound suggests the onset of liver disease. After 6 months of treatment of encephalopathy there is a slight clinical improvement. After one year of treatment the patient becomes totally autonomous with complete regression of neurological signs, dysexecutive disorders and social cognition deficits and PET‐FDG has normalized. 36 months later he is totally autonomous and is back to works as a historical tour guide.ConclusionIt is impossible for us after 36months of follow‐up to determine whether the metabolic disease has unmasked a degenerative disease early or has simulated it. We review some possible false positive situations on FDG PET‐Scan. DAT‐Scan will be done.

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty.

The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes. This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman's rank correlation coefficient. During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients. Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies. IV, retrospective case series.

826 NEW THERAPEUTIC PERSPECTIVES IN CARDIAC AMYLOIDOSIS

Abstract Man, 72 years old, smoker, hypertensive and dyslipidemic, came to our clinic suspected of heart disease with a hypertrophic phenotype. In anamnesis there was a recent hospitalization for heart failure in the course of undated atrial fibrillation. During hospitalization because of the presence of antero-septal and lateral QS complexes, a coronary disease was excluded by coronary angiography while the echocardiogram showed a left ventricle with moderate concentric wall thickening, LVEF 38% with a restrictive transmitral pattern. The patient was discharged on therapy with ramipril, bisoprolol, canrenone, furosemide and rivaroxaban with an electrical cardioversion program which had been subsequently ineffective. At the time of the first evaluation the patient was symptomatic of dyspnea in functional class NYHA III, he also reported in anamnesis a progressive reduction of exercise tolerance for about two years and a previous surgery for bilateral carpal tunnel syndrome 5 years earlier. The echocardiogram showed concentric parietal thickening in the presence of granular sparkling, apical sparing, thickening of the valvular apparatus and reduced GLS (- 12%) which led to a suspect of cardiac amyloidosis. To complete the diagnosis, the patient underwent: total-body bone scan with 99-Tc-DPD (Perugini score = 2); assay of serum kappa and lambda light chains (negative), serum and urinary immunofixation (negative), NT-proBNP (980 pg / mL) and a determination of troponin I (32 ng / L) which showed a picture of transthyretin cardiac amyloidosis. The genetic sampling confirmed the presence of the Ile68Leu transthyretin mutation and a neurological evaluation with electromyography ruled out a peripheral polyneuropathy. During follow-up the patient presented a worsening of clinical and instrumental pattern despite the progressive uptitration of diuretic therapy and the addition of metolazone with a simultaneous deterioration of left ventricular dysfunction (LVEF 30%) at echocardiogram. Therefore, the patient's case and possible therapeutic strategies were discussed collectively as it was not possible to access conventional therapies for cardiac amyloidosis with Tafamidis, Inotersen and Patisiran due to the contextual functional class NYHA&amp;gt; II and the absence of polyneuropathy, not it was possible to undertake biventricular resynchronization in the absence of intraventricular block or to implement therapy for heart failure with reduced ejection fraction due to intolerance. As a last option, implantation of a cardiac contractility modulation device (CCM) was proposed and performed via right subclavicular. At the successive follow-up after implantation, the patient showed a slight clinical and instrumental improvement and it was possible to reduce the diuretic dose, discontinuing metolazone. The echocardiogram also showed a slight increase in LVEF (35%). The long-term outpatient evaluation of the patient is currently underway with the aim of undertaking specific therapy with Tafamidis if the prescription criteria are met. Family screening has started. Conclusion the present clinical case represents an example of the application of alternative and potentially effective therapeutic strategies in patients with cardiac amyloidosis not susceptible to conventional pharmacological treatments.

Dyspnoea – a valuable clue in a rare disease diagnosis

Abstract Pulmonary veno-occlusive disease (PVOD) is a rare microvasculopathy associated with dyspnoea, pulmonary arterial hypertension (PAH) and poor prognosis. A 42-year-old female, with a known history of cured thyroid neoplasm, complained of severe inspiratory progressive dyspnoea, chest pain, dry cough and asthenia. The initial investigations established the diagnosis of idiopathic PAH. Specific associated vasodilator treatment was initiated but with sildenafil intolerance. The clinical condition continued deteriorating, and thus the investigations were extended. DLCO was unnaturally low (24%). Angiography detected a minimal left distal CTEPH (not suitable for balloon angioplasty). Genetic test came positive for biallelic mutations of EIF2AK4, suggestive for PVOD. Finally, the diagnostic was changed to PAH in the PVOD context. A decision was made to refer the patient for lung transplant and to associate treprostinil treatment (with slight clinical improvement). Therefore, severe dyspnoea, hypoxia, decreased DLCO and poor response to vasodilator treatment compel physicians to search for PVOD and refer to lung transplant.

Effects of Low-Level Diode Laser on the Level of Interleukin 1-Beta in the Gingival Crevicular Fluid and the Incidence of Gingivitis Caused by the Use of Orthodontic Separators: A Randomized Clinical Trial

Background: In recent years, there has been an increased tendency for using dental lasers for the treatment of soft tissue problems. The aim of this study was to evaluate the effect of low-level diode laser (980 nm) on the level of interleukin 1 beta (IL-1β) in the gingival crevicular fluid (GCF) and the incidence of initial gingivitis caused by the use of orthodontic separators. Methods: In this randomized clinical trial, 30 patients, who were beginning a fixed orthodontic treatment without gingivitis, were randomly assigned to control and diode laser radiation (980 nm wavelength, 3 J of energy, a density of 3 J/cm2 , a power of 0.2 W, and at a distance of 1 cm away from the tissue for 15 seconds on the buccal and palatal sides of the tooth) groups. The gingival index (GI) and bleeding on probing (BOP) were measured at the beginning of the study and one week after the treatment. The level of IL-1β was evaluated using an enzyme-linked immunosorbent assay at the beginning of the study and one week after the placement of the separator. Finally, the inter-group and intra-group statistical analyses were performed using independent and paired t tests, and P&lt;0.05 was considered as the significance level. Results: The evaluation of clinical variables in the entire mouth showed a slight clinical improvement in the experimental group although there was no significant difference between the two groups. No significant difference was observed between intra-group and inter-group evaluations of clinical indices in the studied specific teeth. Eventually, no difference was found between the two groups in terms of IL-1β changes. Conclusions: In general, the single-diode laser radiation session is not effective in the treatment of gingivitis in patients undergoing orthodontic treatment. Thus, it is recommended to perform frequent laser radiation sessions in further studies.

Does the Sweating Severity of Primary Hyperhidrosis Sites Affect Post-Sympathotomy Results?

Improvement in quality of life (QOL) and patient satisfaction after endoscopic thoracic sympathotomy (ETS) in patients with primary hyperhidrosis may be affected by various factors. We examined whether the preoperative sweating severity of primary hyperhidrosis sites affects postoperative results. The records of 112 patients who underwent bilateral ETS were reviewed retrospectively. The patients were divided into three groups according to the sweating severity score obtained from all primary hyperhidrosis sites (primary hyperhidrosis severity score [PHSS]) and analyzed comparatively. Group A (PHSS = 1-4) included 22 patients, Group B (PHSS = 5-8) 36 patients, and Group C (PHSS ≥ 9) 54 patients. Outcome measures included QOL prior to surgery, improvement in QOL after surgery, degree of clinical improvement, presence, severity, localization, and site number of reflex sweating (RS) and general patient satisfaction after 6 months of surgery. The preoperative QOL of patients with higher PHSS (groups B, C) was worse than other patients (group A). More than 91% of all patients had any level improvement in QOL, and over 96% had slight or great clinical improvement. RS developed in 80% of the patients, mostly in the back, very severe in 8%, and in median two different body areas. The overall patient satisfaction rate was more than 95%. There was no significant difference between the three groups in terms of all postoperative results. Preoperative sweating severity of primary hyperhidrosis sites does not affect post-sympathotomy results. Surgeons should not be worried when deciding upon surgery, even in patients with high sweating severity.

Safety, feasibility, and efficacy of transcutaneous vagus nerve stimulation combined with upper-limb robotic rehabilitation after stroke

The efficacy of standard rehabilitation for improving upper limb functionality after stroke is limited; thus, alternative strategies are needed. Vagus nerve stimulation (VNS) combined with rehabilitation is a promising approach, but the invasiveness of this technique reduces its clinical application. Recently, a non-invasive technique for stimulating vagus nerve has been developed. Aim of this study is to evaluate safety, feasibility, and efficacy of noninvasive VNS combined with robotic rehabilitation for improving upper limb functionality in chronic stroke. We designed a proof-of-principle, double-blind, semi-randomized, sham-controlled trial. Fourteen patients with either ischemic or haemorrhagic chronic stroke were randomized to robot-assisted therapy associated with real or sham VNS, delivered for 10 consecutive working days. Efficacy was evaluated by change in upper extremity Fugl-Meyer score. After intervention, there were no adverse events and Fugl-Meyer scores were significantly better in the real group compared to the sham group. Our pilot study confirms that VNS is feasible in chronic stroke patients and can produce a slight clinical improvement in association to robotic rehabilitation. Compared to traditional stimulation, noninvasive VNS seems to be safer and more tolerable. Further studies are needed to confirm the efficacy of this innovative approach.

Dissecting the inflammatory response in polymyalgia rheumatica: the relative role of IL-6 and its inhibition

The efficacy of tocilizumab (TCZ), a monoclonal antibody to the interleukin (IL)-6 receptor, in suppressing disease activity in glucocorticoid-naïve patients with new-onset polymyalgia rheumatica (PMR) was studied. Its effect on a panel of cytokines and growth factors was evaluated. Three patients, fulfilling the PMR ACR/EULAR criteria, received TCZ at the dosage of 8mg/kg every 4 weeks for three times followed by prednisone 0.2mg/kg in case of inefficacy. Concentrations of IL-10, IL-6, tumour necrosis factor (TNF)-α, IL-1β, IL-10, IL-17, interferon (IFN)-γ, vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and leukaemia inhibitory factor (LIF) were measured at baseline, after 72h of the first TCZ infusion and then at weeks 1, 4, 5, 8, 9, 12, 13, 14, 16, and 22. A slight clinical improvement was seen only after the first TCZ infusion, but was largely inferior to that of conventional doses of GC administered subsequently. An ischaemic visual accident suggestive of GCA occurred in one patient during TCZ treatment. IL-6 was increased at baseline compared to controls, further increased after the first TCZ infusion, and was suppressed by GC. IL-17 production decreased during TCZ treatment and reverted to pre-treatment levels after GC. VEGF e PDGF showed a less constant pattern, but an increase of VEGF concentration antedated visual symptoms. The other cytokines were not detectable in patients and controls. In our small sample, TCZ was not able to suppress inflammation at the same degree as GC. As a result, monotherapy with TCZ in PMR cannot be recommended, although its efficacy as adjunctive treatment in GC-resistant patients should be further evaluated.

Kikuchi–Fujimoto disease: a case report of a multi-drug resistant, grueling disease

Histiocytic necrotizing lymphadenitis or Kikuchi–Fujimoto disease (KFD) is characterized by its rare occurrence. Mostly prevalent among Asian women, KFD manifests with lymphadenopathy—affecting mostly cervical and rarely generalized or retroperitoneal regions—in addition to fever. It is a self-limited disease that resolves within 1–4 months, responding remarkably to glucocorticosteroids or hydroxychloroquine. However, some rare cases prove to be unresponsive to the previously mentioned therapies. Here is a description of a case of KFD affecting a 67-year-old Syrian woman with a history of hypothyroidism due to iodine-deficiency. The patient’s initial clinical picture was malaise, fever, pericarditis and generalized lymphadenopathy. As treatment, she was given glucocorticosteroids with no significant response, while hydroxychloroquine proved to be partially effective. Until the date of this report, she has been receiving hydroxychloroquine with only slight clinical improvement. This case is proving to be resistant unlike most KFD cases that generally respond very well to treatment.

Transcutaneous Vagus Nerve Stimulation Combined with Robotic Rehabilitation Improves Upper Limb Function after Stroke.

The efficacy of standard rehabilitative therapy for improving upper limb functions after stroke is limited; thus, alternative strategies are needed. Vagus nerve stimulation (VNS) paired with rehabilitation is a promising approach, but the invasiveness of this technique limits its clinical application. Recently, a noninvasive method to stimulate vagus nerve has been developed. The aim of the present study was to explore whether noninvasive VNS combined with robotic rehabilitation can enhance upper limb functionality in chronic stroke. Safety and efficacy of this combination have been assessed within a proof-of-principle, double-blind, semirandomized, sham-controlled trial. Fourteen patients with either ischemic or haemorrhagic chronic stroke were randomized to robot-assisted therapy associated with real or sham VNS, delivered for 10 working days. Efficacy was evaluated by change in upper extremity Fugl–Meyer score. After intervention, there were no adverse events and Fugl–Meyer scores were significantly better in the real group compared to the sham group. Our pilot study confirms that VNS is feasible in stroke patients and can produce a slight clinical improvement in association to robotic rehabilitation. Compared to traditional stimulation, noninvasive VNS seems to be safer and more tolerable. Further studies are needed to confirm the efficacy of this innovative approach.

Cognitive behavioral therapy in a group of militaries with posttraumatic stress disorder

IntroductionPosttraumatic stress disorder (PTSD) has a high prevalence and severe impact in military populations. Cognitive behavioral therapy (CBT) is indicated in this condition but it is a structured therapy that requires patients’ motivation and doctors’ availability.Objectives and aimsAssess feasibility and effectiveness of CBT in a military group with PTSD.MethodsA group of six militaries that witnessed the same traumatic event (an armed attack) and were diagnosed with PTSD were involved in a structured individual session CBT with one therapist. An assessment using the PTSD checklist for DSM (PCL) was performed initially and in halfway therapy. The therapy included an education about PTSD, a cognitive restructuring, a behavioral approach via home tasks and relaxation techniques.ResultsThe initial PCL scores varied from 25 to 55. All patients were initially on sick leave. Five patients had adjunctive antidepressant medications and one patient was only on therapy. Three patients showed no motivation and were excluded after 3 sessions. Two patients have had 7 weekly sessions and were able to return to work in the same place. One patient with severe PTSD had 2 sessions monthly, he had slight clinical improvement and could not come back to military work. The three patients who are still in therapy have improved PCL scores.ConclusionsCBT can be effective in PTSD. The outcome depends on initial severity of PTSD and assiduity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Fatal disseminated varicella zoster infection following zoster vaccination in an immunocompromised patient

A 79-year-old man with chronic lymphocytic leukaemia presented with fever and a widespread vesicular rash on 19 November 2014. The patient had not been under immunosuppressive regime for 6 months. He had received a shingles vaccine on 14th October and developed flu-like symptoms after 2 weeks. Intravenous antimicrobial therapy including aciclovir was started. He remained stable with no evidence of systemic involvement. On day 5, he developed respiratory and renal failure that required transfer to intensive care unit. Vesicle fluid, bronchoalveolar lavage and plasma were positive for varicella zoster virus by PCR. Slight clinical improvement allowed extubation on day 16. He subsequently deteriorated and died on day 25. Multiorgan failure was considered the immediate cause of death whereas disseminated varicella zoster infection was stated in the medical certificate as the other condition leading to this outcome. Varicella zoster Oka vaccine strain was detected in vesicle fluid, using PCR.

Cervical myelopathy due to chronic overshunting in a pediatric patient: case report and review of the literature

We present a rare cause of cervical myelopathy produced by an engorged suboccipital epidural venous plexus due to chronic cerebrospinal fluid (CSF) overdrainage. A 17-year-old boy with obstructive hydrocephalus due to a retrocerebellar cyst and secondary implantation of a ventricloperitoneal shunt (VP-shunt) presented with progressive spastic tetraparesis. MRI imaging revealed myelopathy due to significant compression of the cervical spinal cord by engorged epidural veins. Further assessment at a low-pressure setting revealed a broken shunt valve. The VP-shunt valve was changed with an additional anti-siphon device leading to a gradual increase of the intracranial pressure (ICP). After intensive physiotherapy, the patient showed slight clinical improvement. Follow-up imaging within nine days showed distinct regression of the dilated venous plexus at the cranial-cervical junction (CCJ) with the resolution of cord compression. Engorgement of the epidural venous plexus should always be considered in the differential diagnosis of myelopathy in long-term shunt patients even when classical clinical and radiological signs of overshunting are missing.

Results of Simplified Urethropexy in the Recovery of Continence After Radical Laparoscopic Prostatectomy

To analyze the effectiveness of simplified urethropexy in the evolution of urinary incontinence after radical laparoscopic prostatectomy. Between January 2007 and December 2008, 104 patients were included in a randomized trial to assess the effectiveness of simplified urethropexy. The simplified urethropexy technique was performed on conclusion of a urethrovesical anastomosis with running suture and, before cutting the suture material, a suture was applied using the same material with a needle through the pubic tubercle, tightening it and securing it with a Hem-o-lok. Fifty-one patients qualified for the trial in the simplified urethropexy group (group 1) and another 51 in the control group without urethropexy (group 2). Incontinence was defined as the lack of the need for protection for normal life, and the degree of continence was compared at 3, 6, and 12 months after surgery. Surgery lasted 141 minutes in group 1 and 139 in group 2 (NS). There were no secondary complications such as urine retention, osteitis pubis, or bladder perforation. After 3 months, 47.1% of patients in each group declared continence (NS). After 6 months, 72.6% of patients in group 1 and 66.7% in group 2 (P<0.05) declared continence. After 12 months, 92.2% of patients in group 1 and 84.3% in group 2 declared continence. In our experience, simplified urethropexy is a simple, nontime-consuming technique that shows a slight clinical improvement in continence within 6 and 12 months, without reaching significant differences with the Fisher Test. It would be necessary to perform a trial with a greater number of patients to confirm these data.

Tubular Duplication of the Esophagus - A Rare Cause of Dysphagia in the Adult

Purpose: Duplication of the esophagus is a rare congenital malformation caused by an error in early embryogenesis. The Dutch anatomist Gerhard Blaes first described this anomaly in the eighteenth century. The incidence is about 1 in 8200. While the cystic form is more commonly observed the tubular type of esophageal duplication seems to be extremely rare - with about 5-10% of these cases. Most of the patients suffering from esophageal duplication (70-90%) become symptomatic in childhood and are diagnosed before 2 years of age. To our knowledge, only few case reports exist with tubular esophageal duplication, incidentally discovered in adulthood. Methods: A 48-year-old male Caucasian was referred to our department, suffering from progressive dysphagia since 2 years. The findings leading to the diagnosis: “tubular duplication of the esophagus” will be presented. Results: Upper GI endoscopy revealed a stenosis of unknown origin at 25 cm from the incisors, which could not be passed with a conventional endoscope (Ø 8.8 mm). The stenosis was marked by two lumina separated by a bridge of intact mucosal epithelium. Using a filling catheter, both lumina could be explored by fluoroscopy showing that both tubular structures eventually lead into the stomach. CT scans showed extensive thickening of the esophageal wall, probably due to scarring, with formation of a septum in the esophageal lumen. After dilation therapy, upper GI endoscopy was again performed with a pediatric endoscope (Ø 5.9 ). The stenosis at 25 cm from the incisors could be passed and a normal gastro-esophageal junction was seen at 42 cm. At 38 cm from the incisors, a septum of intact mucosa was found similar to that in the proximal esophagus. Again, two lumina could be observed, however, only the larger lumen could be intubated. A guide-wire, introduced at 25cm showed communication of the two esophageal ducts at 35cm. Miniprobe endosonography revealed normal layers of the esophageal wall as well as within the septum. Kinematography showed a long-segment stenosis of the upper esophagus and an additional filiform, blind-ending lumen ventral of the esophageal main lumen. Conclusion: With regard to the present literature, surgery is the first-line treatment of tubular esophageal duplication. Esophagectomy and gastric interposition should also prevent malignant transformation, which may occur. Following this extensive operation, numerous adjustments in daily life have to be managed by the patients. PPI therapy is thought to relieve symptoms of dysphagia. In our case, dilation therapy and PPI medication have led to slight clinical improvement with satisfactory relief of the patients complaints. At the time being, the patient refuses surgery.

Thoracic spinal cord compression indicating Wegener's granulomatosis in a patient with a previous presumptive diagnosis of microscopic polyangiitis

Neurological signs are observed in 20–50% of cases of Wegener's granulomatosis consisting of peripheral and cranial neuropathy, and central nervous system involvement during the disease and rarely as initial symptom. We report here a case of thoracic spinal cord compression due to dural masses in a patient with a previous presumptive diagnosis of microscopic polyangiitis indicating Wegener's granulomatosis on histological examination. No other site of involvement was found. Slight clinical improvement was observed under immunosuppressive treatment probably because of spinal cord vessels lesions.

Pyoderma gangrenosum coexisting with acute myelogenous leukaemia

The frequency of occurrence of malignant neoplasms in the cases of pyoderma gangrenosum is not exactly determined, but it can be assessed to be at 7%. The aim of the study was to report a 26-year-old male patient with pyoderma gangrenosum coexisting with acute myelogenous leukaemia. The first skin lesions on both tibia occurred in June 2001. Prior to the proper diagnosis of pyoderma gangrenosum, the patient was treated surgically. Because of the dramatic dermatological and general condition in November 2001, the patient was admitted to the Dermatological Department of the Silesian Medical Academy in Katowice where the diagnosis of pyoderma gangrenosum was established. On the clinical and biochemical picture, the diagnosis of pyoderma gangrenosum within acute myelogenous leukaemia was made. Initially, cyclosporin A 200 mg orally per day in the therapy of pyoderma gangrenosum was administered to achieve a slight clinical improvement. Although chemotherapy leukaemia was performed, the patient died after 4 months of the confirmation of the acute myelogenous leukaemia diagnosis.

Controversias en torno a los nuevos fármacos en el tratamiento de la demencia. Postura desfavorable.

Currently, the important part played by the senile plaque and neurofibrillary tangles puts amyloid protein and tau hyperphosphorylation at the centre of a new direction in the investigation of the molecular biology and treatment of Alzheimer s disease. OBJECTIVE. To consider the scientific evidence regarding the limitations of anticholinesterase treatment. DEVELOPMENT. Most of the clinical trials with anticholinesterase inhibitor drugs have been too short (3-6 months in a disease lasting an average of 8.5 years). There is slight clinical improvement with a definite therapeutic ceiling. A small proportion of patients respond, but there is no way of knowing who these will be. Improvement occurs during the early stages of the illness. This means that when the illness is advanced or does not respond initially, treatment should be reconsidered. It is necessary for consensus to be reached to obtain uniformity of objectives and methodology in clinical trials, which have been heterogeneous until now, incorporating the results of epidemiological studies. CONCLUSION. Initial expectations of an analogy between the cholinergic deficit of Alzheimer s disease and the dopaminergic deficit of Parkinson s disease, with the effects on treatment implied by this, has been proved false with the passage of time and clinical, therapeutic and scientific experience.