Anemia in chronic renal insufficiency and chronic failure

Complicated metabolic changes in chronic renal insufficiency interfere with the formation and survival of erythrocytes at many levels. Anaemia which thus develops influences in a significant way not only the quality of life but also the prognosis of nephrological patients. The confirmed relationship between cardiovascular morbidity and mortality must be the starting point for early diagnosis and treatment of this anaemia. Administration of recombinant human erythropoietin in the early stage of renal insufficiency can moreover probably retard its progression. European guidelines for the treatment of anaemia give clear instructions how to proceed in the treatment of anaemia. The results of current, so far not completed studies, may modify in future the demands on target haemoglobin values and may elucidate how normalization of the red haemogram can influence the survival of patients with impaired renal function.     

Pathology of chronic hepatitis B and chronic hepatitis C

Histologic evaluation of the liver is a major component in the medical management and treatment algorithm of patients with chronic hepatitis B (HBV) and chronic hepatitis C (HCV). Liver biopsy in these patients remains the gold standard, and decisions on treatment are often predicated on the degree of damage and stage of fibrosis. This article outlines the clinical course and serologic diagnosis of HBV and HCV for the clinician and the pathologist, who together have a close working relationship in managing patients with acute and chronic liver disease. The salient histologic features are elucidated in an attempt to provide the clinician with an understanding of the basic histopathology underlying chronic HCV and HBV.     

Pain patterns in chronic pancreatitis and chronic primary pain

BackgroundAbdominal pain is the most distressing symptom of chronic pancreatitis (CP), and current treatments show limited benefit. Pain phenotypes may be more useful than diagnostic categories when planning treatments, and the presence or absence of constant pain in CP may be a useful prognostic indicator.AimsThis cross-sectional study examined dimensions of pain in CP, compared pain in CP with chronic primary pain (CPP), and assessed whether constant pain in CP is associated with poorer outcomes.MethodsPatients with CP (N = 91) and CPP (N = 127) completed the Comprehensive Pancreatitis Assessment Tool. Differences in clinical characteristics and pain dimensions were assessed between a) CP and CPP and b) CP patients with constant versus intermittent pain. Latent class regression analysis was performed (N = 192) to group participants based on pain dimensions and clinical characteristics.ResultsCompared to CPP, CP patients had higher quality of life (p < 0.001), lower pain severity (p < 0.001), and were more likely to use strong opioids (p < 0.001). Within CP, constant pain was associated with a stronger response to pain triggers (p < 0.05), greater pain spread (p < 0.01), greater pain severity, more features of central sensitization, greater pain catastrophising, and lower quality of life compared to intermittent pain (all p values ≤ 0.001). Latent class regression analysis identified three groups, that mapped onto the following patient groups 1) combined CPP and CP-constant, 2) majority CPP, and 3) majority CP-intermittent.ConclusionsWithin CP, constant pain may represent a pain phenotype that corresponds with poorer outcomes. CP patients with constant pain show similarities to some patients with CPP, potentially indicating shared mechanisms.     

Managing chronic heart failure patient in chronic kidney disease

Management of systolic heart failure can be particularly challenging in patients with chronic kidney disease, especially those who are not yet receiving dialysis. Few clinical trials have been performed in this particular population, so management is directed by evidence from studies of patients with limited or no renal impairment. Their heightened risk for many treatment complications mandates additional considerations regarding drug selection, dosing, and monitoring. Subspecialty consultation is driven by patient instability or disease progression, intolerance of standard treatment, or need for device placement.     

Acupuncture for chronic prostatitis/ chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) is prevalent in urological practice and has a significant impact on quality of life. Standard therapies often fail to achieve sustainable amelioration of symptoms. This article attempts to show that neuromodulatory treatment in the form of electroacupuncture can be a minimally invasive and effective treatment for CP/CPPS that is refractory to standard therapies. This neuromodulatory therapy lends support to the hypothesis that the end stage of CP/CPPS may be a neuropathic pain syndrome.     

Sweet's syndrome during the chronic phase of chronic myeloid leukaemia

We report the case of a 52 year-old male in the chronic phase of chronic myeloid leukaemia, with Philadelphia chromosome due to t(9;22) in the karyotype. He was treated with courses of busulfan and hydroxyurea. Fourteen months after initial presentation, the patient developed fever, non-productive cough, maculonodular violaceous painful skin lesions and bilateral pulmonary infiltrates visible on a chest roentgenogram. Laboratory data, repeated bone marrow aspiration and biopsy and karyotype analysis showed findings similar to those of the initial diagnosis. A biopsy taken from one of the trunk lesions was consistent with Sweet's syndrome. Oral methylprednisolone therapy was initiated at doses of 64 mg daily, and the skin lesions and fever were rapidly resolved. When we reduced the steroid dose, skin lesions and fever recurred. Two further courses of steroid therapy were given with similar results. Finally we treated him with naproxen (750 mg daily for 1 month) with a rapid and stable response. This drug should be considered as an alternative treatment for patients with Sweet's syndrome not responding to corticosteroids or for immunocompromised hosts.     

Arrhythmias during acute and chronic exercise in chronic heart failure

Exercise can induce or prevent arrhythmias depending upon several factors, related to patient’s clinical characteristics and to exercise modalità (type, intensità, frequency, duration). In the present paper, the author reviews the mechanisms of arrhythmias during acute and chronic exercise in heart failure, and focuses on the relationship between exercise training programs and arrhythmias in chronic heart failure.     

Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome continues to pose a treatment challenge for urologists. Most commonly prescribed medications, such as antibiotics, α-blockers, androgen inhibitors, and anti-inflammatory agents, have been shown to help some patients. However, the efficacy and durability of such treatments lack consistency among men suffering from this disorder. The rationale for such treatments is described in this article, along with possible explanations for the apparent shortcomings. Also included is a brief summary of alternative therapies, which are growing in popularity among patients and gaining acceptance in our medical communities.     

Multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome

Category III chronic prostatitis/chronic pelvic pain syndrome is a syndrome rather than a specific disease and the cause can be multifactorial. In clinical practice, monotherapy often has proven ineffective. Multimodal therapy, which sequentially or simultaneously can address infection, inflammation, and neuromuscular spasm appears to have the greatest potential for symptom improvement, especially in patients with longstanding symptoms.     

Alcoholic chronic pancreatitis

Opinion statement The most important intervention in the treatment of alcoholic chronic pancreatitis is alcohol cessation, and therefore, it should be a primary treatment goal. This measure alters the natural course of the disease and may improve long-term survival. Smoking cessation should also be encouraged, since the risk of pancreatic cancer increases with prolonged chronic pancreatitis, and is again doubled by smoking. Maldigestion is treated in a way similar to other types of chronic pancreatitis. Treatment of pain should begin with an effort to identify reversible causes, including pseudocysts and duct obstruction. Chronic pain management should follow a multi-step treatment regimen that reserves narcotics for only the most severe cases. Since pain tends to diminish during the natural history of pancreatitis, treatment of pain needs to be continually reevaluated. Endoscopic or surgical interventions are indicated only for the management of complications, but have no significant effect on the natural history of alcoholic chronic pancreatitis. In the future, diagnosis of patients within the earliest stages of alcoholic chronic pancreatitis, and intervention with effective strategies to prevent progression of fibrosis and other complications, may offer the best solution for eliminating this disease. Thus, the focus of management should be early identification of patients at risk, and institution of effective new therapies.     

Nitroimidazole-induced chronic hepatitis

Drug-induced chronic hepatitis is a rare pathological condition. There is no reported case with chronic hepatitis secondary to nitroimidazole use. We report a patient who developed nitroimidazole-induced chronic hepatitis following acute exacerbation of hepatitis three times after nitroimidazole use.     

非感染性慢性腹泻

慢性腹泻是临床常见的症状。引起腹泻的原因很多,大约75%的慢性腹泻患者可以通过病史、体格检查、筛查实验及有针对性的实验室检查明确诊断。另外,25%的患者诊断较为困难,须住院,以行全面检查。腹泻指排便次数增多(>3/d),粪便量增加(>200g/d),粪质稀薄(含水量>85%)。腹泻超过4周,即为     

Idiopathic chronic pancreatitis

Idiopathic pancreatitis is diagnosed in up to 25% of patients with chronic pancreatitis by exclusion of other potential causes including rare ones. It has been shown that idiopathic pancreatitis comprises two clinically distinct entities characterised as early-onset and late-onset disease and that the natural courses of both forms differ from that of alcoholic chronic pancreatitis. Due to considerable progress in our understanding of hereditary and autoimmune mechanisms for development of chronic pancreatitis, a specific aetiology of chronic pancreatitis can be determined in an increasing proportion of cases. Nevertheless, the aetiopathogenesis of idiopathic chronic pancreatitis frequently remains obscure. This review focuses on the pathogenetic relevance of various endogenous and exogenous (co-)factors for the manifestation and the natural course of the disease. Moreover, it presents a multifactorial model for understanding the development of idiopathic chronic pancreatitis.     

Etiologic theories of chronic prostatitis/chronic pelvic pain syndrome

The etiology of chronic prostatitis/chronic pelvic pain syndrome is unknown. Whereas infection causes category I and II prostatitis, the evidence for an ongoing infection in category III patients is lacking. Immunologic, neurologic, and psychologic factors likely play a role in the development and maintenance of symptoms in these men. The traditional concept of pain as a simple response to a noxious stimulus has some merit, but modern research indicates that the response is much more complex, and we must look at a patient’s physiology and psychology to be able to interpret each individual’s pain response. It is some advance in the field to realize that we probably need to look beyond the prostate and address the entire biopsychosocial problem to be able to offer successful treatment to these men.