Fulminant ulcerative colitis

Opinion statement  

Lymphocytic and collagenous colitis: Medical management

Opinion statement  

PPVI in children under 20 kilograms: A quid pro quo?

• Percutaneous PV implantation can be achieved in very small children (<20 kg)
• The clinic impact appears beneficial in the early term
• Studies to determine whether this treatment pathway will preserve RV function and translate to better survival needs investigation

     

Imaging of the seronegative spondyloarthropathies

The group of seronegative spondyloarthropathies consists of ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, enteropathic spondylitis, and a fifth entity known as undifferentiated spondyloarthropathy. All of these diseases share common clinical and radiographic features with characteristic involvement of the sacroiliac joints, spine, and to various degrees, the peripheral joints. Although plain radiographs are the first line of imaging investigation, they are often insensitive for demonstrating the early changes of sacroiliitis, an important feature for establishing the early diagnosis of seronegative spondyloarthropathy. Other imaging modalities, including conventional tomography, bone scintigraphy, and computed tomography, have improved visualization of inflammatory changes at the sacroiliac joints. This article will review these modalities and emphasize the role of magnetic resonance imaging. By directly imaging changes in the synovium, articular cartilage, and subchondral bone, findings on magnetic resonance imaging are the most sensitive and specific for sacroiliitis and other changes in the axial skeleton. Its role and that of ultrasound in the assessment of the peripheral joints will also be highlighted.     

Sleep apnea in heart failure: Implications of sympathetic nervous system activation for disease progression and treatment

Mortality risk in heart failure relates to the degree of chronic sympathetic nervous system activation. Do acute increases in central sympathetic outflow, as occur nightly in patients with sleep apnea, augment this risk? This review explores 4 novel concepts: 1) sleep disordered breathing is common in heart failure, 2) the acute effects of sleep apnea and the chronic effects of heart failure on the sympathetic nervous system are additive when these conditions coexist, 3) such convergence has adverse clinical and prognostic implications, and 4) treating sleep apnea can attenuate sympathetic nervous system activation and improve ventricular systolic function.