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Biomedical subjects

G Valesini

Publications and source records attributed to G Valesini.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Ultrasound imaging for the rheumatologist. I. Ultrasonography of the shoulder.

Ultrasonography (US) has proved to be a useful diagnostic tool in patients with shoulder pain and/or limited range of motion. It allows careful assessment of a wide range of changes involving many different anatomic structures of the shoulder girdle, such as the rotator cuff tendons (tendonitis, tendon tears and calcific deposits), the long head of the biceps tendon (tenosynovitis, tendonitis, tears, rupture and displacement), the bursae (bursitis), the soft tissues of the gleno-humeral (synovial proliferation, joint effusion) and acromioclavicular joints (synovial proliferation and joint effusion). In addition, it is also a reliable tool in the evaluation of bony profiles detecting the presence of erosions and osteophytes. The use of high quality equipment and the application of a standard scanning protocol are mandatory for reliable US assessment of shoulder pathology.

Humans↗
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Ultrasound imaging for the rheumatologist II. Ultrasonography of the hand and wrist.

The hand is one of the anatomical regions most frequently explored by ultrasonography (US) in rheumatology. The last generation US systems equipped with high frequency probes allow for a quick and accurate assessment of even minimal pathological changes in patients with rheumatic conditions affecting the small joints and the soft tissues of the hand and wrist. Several studies have demonstrated the great value of US imaging of the hand and wrist in rheumatology but there are still controversial issues which yet have to be adequately addressed, particularly with regard to US semi-quantitative evaluation of synovitis and bone erosions in patients with chronic arthritis. This paper provides the basic knowledge, reviews the available evidence and discusses the potential of US in the evaluation of the hand and wrist.

Rheumatic Diseases↗
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Leishmania in SLE mimicking an exacerbation.

Systemic lupus erythematosus is a protean disease which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Visceral leishmaniasis is a parasitic infection, endemic in 88 countries, whose hallmarks may mimic a lupus flare. Fever, pancytopenia, splenomegaly, hypergammaglobulinemia, production of autoantibodies and complement consumption are some of the overlapping features between the two diseases. Thus, extra attention must be paid to patients with lupus who present with the mentioned symptoms. Diagnosis of visceral leishmaniasis relies on the detection of leishmania antibodies, on the presence of amastigotes in bone marrow aspirates, biopsies and cultures of the parasite. Treatment is based on the use of i.v. liposomal amphotericin B. The missed recognition of a leishmania infection in a lupus patient may lead to death, since both the omission of a specific anti-parasite treatment and the increase of the immunosuppressive therapy, in the conviction of a lupus flare, accelerate a fatal outcome. In this paper we present a case of visceral leishmaniasis occurring in a lupus patient. The clinical and laboratory features that overlap in the two diseases and the current literature on the topic were discussed.

Adult↗
PubMedDate not supplied

Ultrasound imaging for the rheumatologist III. Ultrasonography of the hip.

Ultrasonography (US) is a reliable and useful diagnostic tool for the assessment of hip pathology. It depicts changes within the coxo-femoral joint (synovitis, erosions, osteophytes) and in the adjacent peri-articular tissues (calcifications, tendonitis, enthesitis, bursitis) in many rheumatic diseases (rheumatoid arthritis, spondyloarthritis, osteoarthritis, polymyalgia rheumatica ) and in some orthopaedic disorders (septic arthritis, trauma, abscess, painful hip after arthroplasty). It is commonly used both in adults and in children. In the assessment of hip joint pathology, US exerts considerable diagnostic supremacy over physical examination. In fact, by virtue of its size and position, reliable physical examination of the hip is often difficult thus making US particularly useful as a bedside tool for the evaluation of a painful hip. Hip US has also proven to be of great practical benefit when performing aspiration and injection within the joint and in the periarticular soft tissues. The relatively limited acoustic windows available to the US beam is the principal limitation to hip US thereby making detailed examination of some important structures impossible together with the interpretation of power Doppler signal sometimes unreliable. In addition, the deep location of the hip can confer further problems to US scanning in obese or particularly muscular subjects.

Hip Joint↗
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Ultrasound imaging for the rheumatologist IV. Ultrasonography of the knee.

Ultrasound examination of the knee is particularly useful in the detection of synovitis, early degenerative changes within the articular cartilage of the femoral condyles, calcifications within the articular cartilage layer and menisci, bursitis, and popliteal cysts. Also, important anatomical information about the structural integrity of the supporting tissues around the knee can be obtained by ultrasound in patients presenting with 'knee pain'. We review the available evidence about the use of ultrasound in knee examination, provide information on the technical equipment and scanning methods and discuss the still controversial issues.

Humans↗
PubMedDate not supplied

Recommendations for the use of biologic (TNF-alpha blocking) agents in the treatment of rheumatoid arthritis in Italy.

The present report is devoted to drawing up and disseminating specific recommendations for the use of anti-TNF-alpha therapies in patients with rheumatoid arthritis (RA) in Italy. The document reports and discusses the published literature concerning the criteria for inclusion, assessment of response and for withdrawal of treatment with TNF blocking agents in RA. Several specific points concerning more sensitive warnings are discussed: tuberculosis, hepatitis, lymphoma, and cardiovascular risk and induction of autoimmunity. The recommendations are summarized in an 8-point table approved by the executive committee of the Italian Society for Rheumatology.

Antibodies, Monoclonal↗
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Ultrasound imaging for the rheumatologist V. Ultrasonography of the ankle and foot.

Ultrasonography (US) is a useful tool for imaging, which can be used for the assessment of joints and periarticular structures in all rheumatological disorders. In patients with pain and/or swelling of the ankle and foot, US provides information about the presence of joint effusion, synovitis, tenosynovitis, tendinosis, and tendons tears, helping in the differential diagnosis between joint or tendon/enthesis involvement. Moreover, US allows clinicians to monitor and guide needle positioning to inject pharmaceutical substances more safely and effectively even in hard-to-reach sites. US represents an accurate, safe and low-cost technique that can be used for the examination of the ankle and foot in rheumatic disorders.

Ankle Joint↗
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Ultrasound imaging for the rheumatologist. VI. Ultrasonography of the elbow, sacroiliac, parasternal, and temporomandibular joints.

Ultrasound (US) examination of the elbow and parasternal joints is very useful to detect synovitis, degenerative changes, intrarticular calcification or soft tissue abnormalities. More recently new fields of research involving the sacroiliac and temporomandibular (TM) joints have evolved. Moreover, important information has been obtained about vascularization of the synovial joint in the sacroiliac region and structural modification such as internal derangement in the TM joint.. In this paper, we review and discuss the role of US in the evaluation of elbow, sacroiliac, parasternal and TM joint pathology.

Elbow↗
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The pathophysiology of anti-phospholipid antibodies.

Anti-phospholipids represent a heterogeneous family of antibodies able to react with the negatively charged phosphodiester groups of phospholipids. It includes the antibodies directed against the cardiolipin moiety of the VDRL antigen, the antibodies reacting with the phospholipids of the prothrombin activator complex and the antibodies able to react with solid phase cardiolipin. Data are reported indicating that reagins share distinct characteristics in comparison to the autoimmune anti-cardiolipin antibodies (ACA). On the contrary anti-phospholipid antibodies responsible for lupus-like anticoagulant activity display a quite similar reactivity with ACA, even if a complete overlapping cannot be demonstrated. The relationships between ACA and anti-DNA antibodies are also reported. The biological and clinical significance of these crossreactivities are discussed.

Autoantibodies↗
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Anticardiolipin antibodies possess anticoagulant activity which is blocked by a monoclonal antibody against a cross reacting idiotype of antiphospholipid antibodies.

Anticardiolipin (aCL) antibodies were isolated from systemic lupus erythematosus serum using cardiolipin liposomes. In a sensitized activated partial thromboplastin time (aPTT) system, low concentrations of aCL were found to significantly prolong aPTT in a dose-dependent fashion. This effect was abolished by adding phosphatidylserine/phosphatidylcholine liposomes to the aPTT system, and could be significantly reduced by a monoclonal antibody against a cross-reacting idiotype of antiphospholipid antibodies (MoAb 5.2) previously incubated with aCL. These results suggest that the anticoagulant properties of aCL are mediated by an interaction with phospholipid components of the coagulation system. The functional block of this activity using monoclonal MoAb 5.2 antibody could be useful for investigating the mechanisms by which aCL is associated with clinical thrombosis.

Antibodies, Anti-Idiotypic↗
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Clinical serological correlations in the evaluation of Sjögren's syndrome.

Fifty-six subjects (46 females and 10 males) with signs of Sjögren's Syndrome (SS) have been evaluated for clinical and serological parameters. In 12 subjects such clinical signs were associated with a definite connective tissue disease (secondary SS): Rheumatoid Arthritis (2 cases), Systemic Lupus Erythematosus (4 cases), Progressive Systemic Sclerosis (4 cases), Essential Mixed Cryoglobulinemia (2 cases). All patients underwent a lip biopsy which was evaluated according to the Chisholm-Mason scale. Six out of 56 subjects (10.7%) had a normal salivary gland with few lymphocytes (class I); 5 (10%) had a scattered lymphoid infiltrate containing less than 1 focus/4 mm2 (class II); 36 (64.3%) had one focus/4 mm2 (class III) and, finally, 9 (16%) had more than 1 focus/4 mm2 (class IV). The great majority (91%) of the patients had some abnormalities at the ophthalmological examination (Schirmer test, Break up times, van Bijsterveld score): even those with a class I lip biopsy. Xerostomia was present in 69% of the patients, xerophthalmia in 78%, arthralgias in 78%, parotid swelling in 19%, Raynaud's phenomenon in 16%, recurrent abortion in 9 patients. The prevalence of autoantibodies in the group of primary SS was high: ANA 43.2%, anti-Ha 40%, anti-Ro 12%, anti-phospholipids 52.2%, rheumatoid factor (RF) 45.7%. A decrease of lysozyme concentration in tears and saliva has been demonstrated and a correlation between level of lysozyme and lip-biopsy has been observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Plasma exchange in the treatment of acute systemic lupus erythematosus without circulating immune complexes.

One patient affected by systemic lupus erythematosus with recurrent phlebothrombosis and peripheral neuropathy is described. False positive VDRL test, anticardiolipin antibodies, and high titres of antinuclear antibodies were present. Circulating immune complexes were not found. The effect of plasma exchange on clinical symptoms and on serological abnormalities was rapid and striking.

Adult↗
PubMedDate not supplied

Class II MHC antigen expression on epithelial cells of salivary glands from patients with Sjögren's syndrome.

Class II MHC molecules are two-chain glycoproteins normally expressed only on the membrane of cells involved in the immune response. These molecules are restriction elements for helper T cells. Using indirect immunofluorescence on cryostat sections of biopsied salivary glands we have demonstrated epithelial expression of class II antigens in patients with Sjögren's syndrome. The HLA DR+ epithelial cells were seen in close proximity to lymphocyte infiltrates. The finding that class II molecules are also expressed in salivary glands without focal lymphocytic infiltrates suggests a "modulation" as opposed to "induction" of HLA DR antigens on epithelial cells in Sjögren's syndrome, the distinction being related to the enhancement of low levels of expressions vs. de novo synthesis.

Adult↗