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The prevalence of coeliac disease at endoscopy units in Romania: routine biopsies during gastroscopy are mandatory (a multicentre study).

UNLABELLED: The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is known about the prevalence of coeliac disease. THE AIM: of this study was to evaluate the prevalence and the clinical features of coeliac disease in adults biopsied during upper endoscopy in Romania. This is the first incidence study of the coeliac disease in Romania. METHODS: The study was initiated by the Romanian Society of Digestive Endoscopy for the period 1 January 2002 - 31 May 2002. It was carried out in 9 Academic Centres in Romania, which ensured an even geographical distribution and therefore significant statistical results at a national level. The study included 2436 patients according to following criteria: age over 16 years, with no known history of coeliac disease, visiting the participating upper endoscopy units or patients with documented coeliac disease presenting for follow-up check or recurrence of clinical symptoms. At least two bioptic samples were obtained from the distal duodenum, as distally as possible, which were submitted to histopathological examination and scored according to the modified UEGW Marsh criteria (2001). A database was set up to include all the patients with data regarding sex, age, urban or rural background, full clinical diagnosis, clinical symptoms, history of the coeliac disease. RESULTS: Of the 2436 patients studied, 54 (2.22%) were diagnosed with coeliac disease. Their demographic features: 48.15% men, 51.85% women, 68.52% living in urban areas, 31.48% in rural ones, mean age 42 +/-17.0 years. The most frequent reasons for performing upper digestive endoscopy were: dyspeptic syndrome - 15.93%, anemia - 24.07%, and chronic diarrhoea - 22.22%. The most frequently recorded clinical manifestations were: chronic diarrhoea in 46.3%, asthenia in 29.63%, anemia in 24.07%, aphthae in 24.07%. Histopathological results according to Marsh classification were: Marsh III- 64.81 %, Marsh II-35.19%. CONCLUSIONS: The prevalence of the coeliac disease in Romania is 2.22%: its sex distribution is fairly equal, the age distribution includes two peaks, at 30-40 and 50-60 years respectively, and patients from urban areas predominate. The most frequent (over 50% of the cases) histological type was M III. The most common clinical symptoms were diarrhoea, asthenia, anemia, aphthae, while the most frequent associated diseases were diabetes mellitus and Duhring-Brocq dermatiti

Adult↗

[A scale to assess psychasthenia].

"Psychasthenia exists--we meet it every day". Despite this affirmation, Pierre Janet's views remain unappreciated by international psychiatry. Psychasthenia is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R). This pathology, described by Janet as both benign and terrible, is presently broken into many diagnostic categories with respect to the principal symptomatology of the patient. When a mood disorder is present, these patients can have diagnostic criteria for major depression or dysthymia. Patients with prevalent anxiety, phobia or obsessive-compulsive symptoms, must also be classified in having anxiety disorders. When somatic complaints are major symptoms, the patient's disease can be, on the whole, attributed to a somatoform disorder. This scale is a global evaluation of psychasthenia. It is made up of three lists of items. The first concerns asthenia or fatigue sine materia. The items in this group allow an evaluation of the physical and mental characteristics of asthenia associated with an inability of acting. Difficulties in mental concentration are measured by items in the second list. Mental processes are associated with doubts and waverings. They are interrupted by interferences caused by obsessions with recurrent and persistent ideas, impulses or images. Physical symptoms without organic pathology or a pathophysiologic mechanism constitute the neurasthenic part of psychasthenia. In the third list, somatic complaints are spelled out in a check-list of these potential symptoms. This scale can be used as a help in the diagnosis. Items 2, 3, 5, 25, 26 and 29 have a specific reference to the history of the disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

[Analysis of the correlations between immunological changes and syndrome groups in patients with immunological thrombocytopenic purpura (ITP)].

To study the relationship between the immunological changes and syndrome (Zheng,) groups by TCM of ITP, the T-lymphocyte subsets, B-lymphocyte, NK cell, platelet-associated IgG (PAIgG, PAIgA, PAIgM) and antiplatelet-autoantibodies (GPIIb, GPIIIa, GP I b) of 66 patients with ITP were assisted using APAAP and ELISA method separately. It was found that the T-lymphocyte subsets, PAIg and syndrome groups of ITP were closely related. From the group of blood-heat (Xuerewangxing) to the group of deficiency of both Qi and blood, the group of asthenia of both Spleen and Kidney, the group of deficiency of Liver-yin and Kidney-yin, and the group of deficiency Yin and Yang Ts lymphocyte successfully increased (from 29. 0 +/- 8.0% to 47.2 +/- 10.0%), Th/Ts ratio declined (from 1.35 +/- 0.60% to 0.69 +/- 10%), PAIg increased gradually except for PAIgM,PAIgG of the group of deficiency Yin and Yang. Only the Th of the group of asthenia of both Spleen and Kidney among 5 syndrome groups was decreased significantly and contrary to the group of deficiency of Liver-Yin and Kidney-Yin. These results indicated that every syndrome group has specific characteristics, and immunological changes of ITP could have prognostic value.

Adolescent↗

[Correlation between syndrome types of traditional Chinese medicine and peripheral T lymphocytes subsets in Graves' disease].

This paper reports the determined results of OKT3, OKT4, OKT8, ERFC, smIg and CIC, TMCA, TGA in 31 cases of Graves disease and in 20 normal controls. The results showed that the OKT3, OKT4, OKT8, ERFC were significantly lower than those in the normal controls, whereas the smIg was higher than that in normal controls. The difference between the two groups was very significant. Even though the ratio of OKT4/OKT8 showed no significance of both. Typology of Graves disease according to the theory of TCM, all 31 cases were divided into two types: (1) 14 cases of depression of Liver-energy and asthenia of Spleen; (2) 17 cases of deficiency of yin leads to hyperactivity of Fire. The OKT8 and the ratio of OKT4/OKT8 in the latter respectively were lower and higher than those of the former. The difference between the two types was significant (P less than 0.01, P less than 0.05) whereas the positive rates of the CIC, TMCA, TGA also were higher in the deficiency of Yin leads to hyperactivity of Fire than those in the depression of Liver-energy and asthenia of Spleen. After treatment with combined TCM-WM on 31 cases of Graves disease, it was found that the OKT4, OKT8, ERFC were significantly elevated, the smIg was markedly decreased than those without treatment. It was also found that smIg markedly decreased in two types, OKT8, ratio of OKT4/OKT8 in the latter and ERFC in both types all returned to normal. Remainder indexes had no obvious change before and after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Structure of psychological needs of patients over 60 years of age, hospitalized for ischemic heart disease complicated by asthenic- depressive syndrome, and in healthy persons].

Using psychotherapy methods such as MMPI-Wiskad, ACL-37 and 16PF the patterns of psychological needs were studied in postproductive-age subjects with ischaemic heart disease complicated or not with asthenia-depression syndrome and in healthy subjects. Statistical analysis showed that in relation to old people with ischaemic heart disease or without it patients with ischaemic heart disease and depression with asthenia showed a higher psychological sensitivity and their needs were concentrated around the need for self-manifestation, aid-seeking and taking care of oneself. In old people a tendency was maintained for persistence of psychological needs in the previously formulated forms.

Activities of Daily Living↗

[Necrotising histiocytic lymphadenitis in a patient with hypothyroidism. Aetiopatho-genesis and description of a rare clinical case].

Necrotising histiocytic lymphadenitis or Kikuchi-Fujimoto's disease is a rare benign disease characterised by cervical necrotising lymphadenopathy, high temperature, asthenia with complete restitutio ad integrum of the lymphnodal stations affected. A female patient A.B., aged 36, reached our clinic at the Medical Physiopathology Department of Rome's Umberto I Polyclinic in March 2001 for an endocrinological examination. The patient reported symptoms that led us to suspect hypothyroidism, a diagnosis that was later confirmed by haematochemical examinations and treated with Eutirox 100 g. After one month the patient returned to our clinic complaining of intensive asthenia, a feeling of general malaise, lack of appetite, serotin fever and painful laterocervical lymphadenopathy. Lymphnode biopsy gave an outcome of NHL. The histological finding suggested we should treat the case with anti-inflammatory drugs and after one month the symptoms had substantially retreated. To conclude, we suppose there is a possible relationship between the viral aetiology with chronic evolution of hypothyroidism in our patient and that of NHL.

Adult↗

[Clinical analysis of 91 cases of median and small vessel vasculitis in adults].

OBJECTIVE: To evaluate the clinical and biological differences between medium sized vessel vasculitis and small vessel vasculitis. PATIENTS AND METHODS: descriptive and retrospective study of 91 patients with vasculitis attended in our hospital from January 1991 to mars 2001. We describe the characteristics of clinical and analytic features. RESULTS: 57% were males. The mean age was 61.9 +/- 18.6 years (17 to 90 years). The symptoms and affected organs were: palpable purpura (89%), fever (36%), asthenia (20%), arthromyalgias (19%), nephropathy (18%), arthritis (16%), abdominal pain (16%), neuropathy (8.7%), pulmonary involvement (6.5%). 25% had several episodes, lasting clinical, chronic disease, 42% had evidence of two or more involve organs. The patients with pauci-inmune vasculitis presented more asthenia, nephritis, pulmonary involvement, multi-organic involvement and mortality related to the process. We did not found significant differences respect to the others clinical manifestations analysed. CONCLUSIONS: There is a substantial overlap among different vasculitis, the presence or absence of some clinical and biological features can help in the differentiation and characterization of the different entitles.

Adolescent↗

[Skeletal and occlusal alterations in the diagnosis of Marfan syndrome].

The Marfan syndrome is an autosomal dominant hereditary connective tissue disorder with variable expressivity. The incidence is estimated to be at least 1 case per 10000 individuals in most populations. The syndrome is caused by mutations in the gene coding for Fibrillin-1 (FBN1), an extracellular matrix glyco-protein. The gene responsible for the mutations was identified in the chromosome 15q21.1 region. Presented for the first time in 1896 by Dr Antoine Bernard Marfan, it was subsequently included among hereditary disorders of the connective tissue. Nowadays the Marfan syndrome is considered to be a heterogeneous pathology, that can derive from many mutations in the gene coding for Fibrillin-1. The ocular, cardiovascular and skeletal manifestations present in the individual affected by Marfan syndrome are consistent with a defect in the gene coding for a structural component of the connective tissues. From the different expressivity derive 4 types or variants of the syndrome: a) asthenia; b) non-asthenia; c) arachnodactyly; e) abnormal joint mobility. In this study the authors show that radiography and cephalometry analysis are important as diagnosis techniques in order to make an early diagnosis of Marfan syndrome, carry out differential diagnosis with other maxillo-facial pathologies and correct the therapeutic approach (orthodontic or surgical) of this syndrome.

Abnormalities, Multiple↗

Factors predicting docetaxel-related toxicity: experience at a single institution.

We studied factors predicting docetaxel-related toxicity in 113 unselected patients with metastatic cancer treated under routine daily practice. Docetaxel was administered in either a weekly, bi-weekly or tri-weekly schedule. All patients received prophylactic dexamethasone. Twenty-six patients were aged 70 or more, and 28 (24.8%) had an ECOG performance status (PS) score > or = 2. Primary tumors were mainly in breast, lung, and stomach (58, 25, and 14 patients, respectively). Most patients had metastases at two or more sites and were heavily pretreated. NCI-CTC graded toxicities were mild. Grade 3/4 leucopenia and neutropenia occurred in 19.4% and 10.6% of patients, respectively, with febrile neutropenia in 2 patients. Severe nonhematologic toxicities were rare, except for asthenia (8 patients). Complete alopecia occurred in 26.6% of patients. A proportional-odds regression analysis demonstrated that the tri-weekly schedule and older age represented independent risk factors for all-grade leucopenia, whereas a poor PS for anemia. Primary tumor in breast, tri-weekly schedule, an abbreviated and low dose of corticosteroids premedication, and high duration and cumulative dose of docetaxel were factors predicting asthenia. Risk factors for alopecia and vomiting were tri-weekly schedule and high docetaxel cumulative dose, respectively. In conclusion, in daily clinical practice docetaxel toxicity may be correlated with factors related to patient, disease, and treatment characteristics. Taking into account these variables could be a first step toward individualizing treatment.

Adult↗

[Typing of bronchiectasis according to syndrome differentiation].

OBJECTIVE: To study the general law of typing of bronchiectasis according to syndrome differentiation. METHODS: We collected the symptoms, conditions of tongue and pulse in patients of bronchiectasis, using frequencies procedure, discriminant analysis and K-means cluster analysis in SPSS statistical software as research medium. RESULTS: Five hundred and sixty three patients with bronchiectasis were studied. It suggested that accumulation of phlegm-heat in the lungs (45.65%), liver fire attacking the lungs (24.51%), asthenia of pulmonosplenic qi (22.38%), asthenia of both qi and yin (7.46%) were the main types. CONCLUSION: Clinical epidemiology provided scientific basis for further studying of the typing of bronchiectasis according to syndrome differentiation. Building up differentiation of syndromes through differentiation and analysis of main symptoms can be used in clinical diagnosis.

Adolescent↗

[Use of cypramil in the treatment of depression in patients with gastrointestinal cancer].

Depressive state in cancer patients is known to meet the criteria of mild depressive episode (F33.0) according to ICD-10. In the earlier stages of the disease and after successful treatment, depressive symptoms are usually combined with anxiety and obsessive fear, moderate appearances of ideator and motor inhibition, with permanent presence of asthenic symptoms. Once the disease is getting severer and the treatment is less successful, asthenia acquires hyposthenic features, with symptoms of apathy and dysphoria being attached. Cypramil was shown to be an effective medication in the treatment of depression in patients with malignant tumors of gastric-intestinal tract. The most efficient was the treatment conducted on the earlier stages of the cancer process and in cases of successful surgery and chemotherapy, in combination of depression with anxiety, anxious hypochondria, asthenia. Antidepressants must be used together with psychotherapy.

Adult↗

Weekly paclitaxel as second/third-line treatment in advanced non-small cell lung cancer patients: efficacy and tolerability.

BACKGROUND: The aim of the present study was to evaluate the efficacy and toxicity of weekly paclitaxel as second- or third-line treatment in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS: The outcome measured in 37 patients were: response rates, symptom relief (dyspnoea, asthenia and pain), toxicity, overall survival (OS) and time to progression (TTP). RESULTS: Objective response was seen in 8%, stable disease in 27% and disease progression in 62%. Three paclitaxel courses reduced the frequency of WHO grade 2-3 dyspnoea and asthenia from 38% and 43% to 13.5% and &1%, respectively. Moderate to severe pain (VAS score 3-8) was reduced from 35.1% to 24.3%. Median OS was 38 weeks and TTP 12 weeks. Haematological toxicity included anaemia (30% grade 2-3) and neutropenia (8% grade 3). Nonhaematological toxicity included peripheral neuropathy (41% grade 1-2). CONCLUSION: In the routine outpatient setting, weekly paclitaxel is feasible, active and well-tolerated as second/third-line chemotherapy in patients with advanced NSCLC.

Adult↗

[Analysis on symptomatic factors of rheumatoid arthritis and its correlation with therapeutic efficacy].

OBJECTIVE: To analyze the symptomatic factors of rheumatoid arthritis (RA), and to explore the correlations between these factors and the efficacy of TCM herbal and western medicinal therapies. METHODS: Four hundred and thirteen patients with confirmed diagnosis as active RA came from 9 clinical centers were randomly divided into the Western medicine (WM) treated group (n=204) and the traditional herbal medicine (CM) treated group (n=209). The scheme of WM therapy included administration of voltaren extended action tablet, methotrexate and sulfasalazine. That of CM therapy included basic treatment and medication by syndrome differentiation. Eighteen items of often seen symptoms of the patients were collected before and after treatment. The therapeutic effect was evaluated by the American College of Rheumatology 20% improvement (ACR 20) and all data were analyzed using SAS 8.2 statistical software package. The category of symptoms was analyzed by factor analysis. The correlation of changes of various common factors with the therapeutic efficacy were analyzed by one-way ANOVA test. RESULTS: Four common factors were obtained from the 18 items of symptoms, which could better reflect respectively the local status of arthritis, and symptoms of Cold-syndrome, Asthenia-syndrome and Heat-syndrome in traditional Chinese medicine (TCM). Both CM and WM therapies showed consistent effect on the common factors that reflects the state of RA, but CM therapy showed superior effect on the common factors to improve Asthenia-syndrome to that of WM therapy. CONCLUSION: Factor analysis could be used to categorize and study the important factor symptoms in the syndrome differentiation of TCM, and the results of factor analysis were in accord with the category of TCM syndrome differentiation. The exploration on the correlation of common factor and therapeutic efficacy could better exhibit the characteristics of TCM efficacy.

Adult↗

[Phase I/II clinical trial of weekly administration of docetaxel plus cisplatin for advanced non-small cell lung cancer].

OBJECTIVE: The purpose of this phase I/II study is to investigate the safety/toxicity profile of weekly administration of docetaxel in combination with cisplatin for the chemo-naive patients with advanced non-small cell lung cancer (NSCLC), and to evaluate the efficacy of this regime. METHODS: In phase I trial, 15 patients were included. IV infusion of escalating doses of docetaxel consisting of four levels from 25 to 40 mg/m2 (25, 30, 35, 40 mg/m2) on D1, 8, 15 and cisplatin of 75 mg/m2 on D1 was administered. The regime was repeated every 4 weeks. Blood samples were obtained on D1, 15 in the first cycle to measure the PK. Dose limiting toxicity (DLT) was determined in cycle 1 and defined as any grade 3 non-hematologic toxicity which could not be reverted into grade less than grade 2 within 4 days or any grade 4 hematologic toxicity. Eighty-three patients completed their phase II study with administration of docetaxel at a dose of 35 mg/m2 based on the data of phase I trial. RESULTS: In the phase I trial, grade 3/4 neutropenia was mainly observed in patients who received docetaxel of 40 mg/m2 (level 4) with one patient suffering from an infection signifying dose limiting toxicity (DLT). Non-hematological toxicities including nausea/vomiting, alopecia, fluid retension and asthenia were tolerable. Based on these data, the maximum tolerence dose (MTD) did not reach the level of weekly giving docetaxel at a dose of 40 mg/m2 in combination with cisplatin 75 mg/m2 every 4 weeks. The pharmacokinetic/dynamics results There was no statistically significant difference between clearance value among the 4 dose levels of docetaxel from 25 to 40 mg/m2 when measured by Cmax and AUC. The pharmacokinetics of docetaxel was not influenced by the presence of co-administration of cisplatin when compared D1 with D15 as based on CmaxN, AUCN and CL. In the phase II trial, totally 83 patients received 216 cycles of chemotherapy. One CR (complete response) and 22 PR (partial response) were achieved with an objective response rate of 27.7% in this series and 30.7% in the evaluable patients. The 1-year survival was 48.6% with a median survival of 10.7 months (range: 3-34 months). Hematologic toxicities were the major side effects, though most were mild; grade III/IV neutropenia developed in 15%. The common non-hematologic toxicities were nausea, vomiting and asthenia. CONCLUSION: Weekly consecutive administration of docetaxel on D1, 8, 15 for 3 weeks plus cisplatin on D1 is tolerable and effective with minimal myelosuppression in chemo-naive patients with advanced NSCLC.

Adult↗

[The impact of some bad habits and environmental factors on the somatic status of male adolescents].

AIM: The aim of the study was to investigate whether some bad habits of sedentary lifestyle influence the occurrence of diagnoses in male adolescents, divided according to their environment into urban, rural and and island groups. PATIENTS AND METHODS: A total of 437 male adolescents underwent physical examination and functional diagnostic tests at Occupational Medicine Clinic in Rijeka, in order to evaluate their fitness for military service. The method of physical examination and anthropologic measurements was used. The results were analyzed by the Stat Soft, Statistics 6.0 software. Pearson chi-squared-test test and correlation matrices were used. RESULTS: The results showed obesity to be present in a relatively high percentage of subjects from urban area (10.94%) and rural area (13.19%), whereas asthenia was more pronounced in islanders (8.69%), yielding a statistically significant between-group difference (p<0.05). In contrast to asthenia, the islanders had the lowest percentage of flatfoot, with a significant difference from the two other groups (p<0.05). Refraction errors, primarily myopia, were not influenced by the place of residence. The incidence of myopia in all three groups was slightly over 20%. Contrary to our expectation, bronchial asthma was most common in the islanders (5.43%), however, there data could not be considered representative because of the rather big rate of migration from the inland to prevent relapses of respiratory diseases. The incidence of mild kyphoscoliosis ranged from 5.55% in the subjectss from rural settings up to 11.95% in the islanders, without a statistically significant between-group difference. DISCUSSION: It is difficult to identify the causes of differences in body weight among adolescents from urban, rural and island settings. It is not so easy to criticize the former for predominantly sedentary life, watching TV, video or Internet. Physical activity cannot be readily performed in towns because of the increasing presence of pollutants in the atmosphere. The prevalence of bronchial asthma was slightly higher than expected, which was explained by the permanent residence of atopics on the islands in order to prevent disease relapses. The lowest incidence of flatfoot among islanders was explained by their free lifestyle, barefoot walking along the rocky seaside, and high level of physical activity. Refraction errors including myopia as the leading diagnosis were equally present in the three groups, exceeding 20%. Besides heredity, the sight is influenced by intensified effects of ultraviolet radiation that causes changes of the eye structure. Also, neon signs and lights as well as too strong night streetlights lead to phototoxic vision damage in adolescents. Study results showed that male adolescents who lead physically inactive life should not to be blamed for the occurrence of the mentioned diagnoses. Like all of us they are daily affected by harmful pollutants that cause damage to the eyes, cardiovascular, respiratory and other organ systems. This study has helped identify the causes of the mentioned diseases in the group of male adolescents, emphasizing the role of occupational medicine. Specialists in occupational medicine should be involved in the monitoring of somatic and other parameters in adolescents from the early school age. In this period, it is still possible to reduce or and even prevent the occurrence of the mentioned diagnoses by examinations, education, exercises and diets. In this way, the candidates for military service would be healthier and fit.

Adolescent↗

[Vegetative nervous function and interleukin-2 receptor in patients with vertigo].

The authors used Wenger's vegetative nervous balance factor analysis to measure vegetative nervous function of 75 patients with vertigo revealing enhancement of sympathetic nervous function. The proliferation activity of IL-2 receptor was determined by the amount of 3H-TdR incorporated cpm in the peripheral blood lymphocyte after exogenous IL-2 stimulation (Lymphocult-T). The authors used this technique to measure the activity of IL-2 receptor in 49 patients with hepatitis and vertigo. The results showed that the activity of IL-2 receptor in patients with or without vertigo was lower than the controls (P less than 0.001). And patients with vertigo showed lower activity of IL-2 receptor than that without (P less than 0.01). In these patients with asthenia-syndrome the activity of IL-2 receptor was lower than those with asthenia syndrome. The activity of IL-2 receptor in these patients with long course was lower than those with short course. The difference of sex and age was not significant. The above results suggest that "Wind" in TCM might be related to the enhancement of sympathetic nervous function and the activity of IL-2 receptor.

Adolescent↗

[Classification and differential diagnosis of asthenic conditions].

The author describes the results of studies for many years into the clinical and pathophysiological characteristics of psychogenic (neurotic) and organic+ asthenias. Provides differential-diagnostic differences. Offers an original working classification of organic asthenias. The data presented may serve as a prerequisite for early diagnosis and differential therapy of asthenic conditions of different etiology.

Diagnosis, Differential↗

[Memory changes in patients with functional and vascular psychic disorders at a late age].

Mnestic functions were studied in 220 senile patients with neuroses, neurosis-like vascular disorders, endogenous depression, initial vascular psycho-organic syndrome. In senile functional psychic disorders a secondary affect-bound reduction of short-term memory was detected. Dynamic (affect-related) components could be shown as parts of initial vasculogenic psycho-organic syndrome. Relieving these affective disorders and asthenia was conductive to evaluation of the true degree of partially reversible mnestic disorders. Subjective estimates of memory deficit in these patients were inconsistent with actual conditions and correlated with asthenia, affective disorders, somatic state, microsocial environmental impacts. Goal-directed action on these components which are secondary ones in the memory defect structure can promote the treatment efficiency in these patients.

Cerebrovascular Disorders↗