Plasmapheresis in a Patient With "Refractory" Urticarial Vasculitis

Immune complexes are found in the circulation of 30%-75% of patients with urticarial vasculitis and much evidence supports the role of these immune complexes in the pathogenesis of urticarial vasculitis. Plasmapheresis is effective for removing these immune complexes; however, there are few reports on the use of plasmapheresis in the treatment of urticarial vasculitis. We describe a case of "refractory" urticarial vasculitis in which the symptoms improved after plasmapheresis treatment. We suggest that plasmapheresis be considered as an option in patients with severe or treatment-resistant urticarial vasculitis

The international WAO/EAACI guideline for the management of hereditary angioedema – the 2017 revision and update

Abstract Hereditary Angioedema (HAE) is a rare and disabling disease. Early diagnosis and appropriate therapy are essential. This update and revision of the global guideline for HAE provides up-to-date consensus recommendations for the management of HAE. In the development of this update and revision of the guideline, an international expert panel reviewed the existing evidence and developed 20 recommendations that were discussed, finalized and consented during the guideline consensus conference in June 2016 in Vienna. The final version of this update and revision of the guideline incorporates the contributions of a board of expert reviewers and the endorsing societies. The goal of this guideline update and revision is to provide clinicians and their patients with guidance that will assist them in making rational decisions in the management of HAE with deficient C1-inhibitor (type 1) and HAE with dysfunctional C1-inhibitor (type 2). The key clinical questions covered by these recommendations are: 1) How should HAE-1/2 be defined and classified?, 2) How should HAE-1/2 be diagnosed?, 3) Should HAE-1/2 patients receive prophylactic and/or on-demand treatment and what treatment options should be used?, 4) Should HAE-1/2 management be different for special HAE-1/2 patient groups such as pregnant/lactating women or children?, and 5) Should HAE-1/2 management incorporate self-administration of therapies and patient support measures? This article is co-published with permission in Allergy and the World Allergy Organization Journal

Evaluation of vascular injury with proinflammatory cytokines, thrombomodulin and fibronectin in patients with primary fibromyalgia

2000-11OBJECTIVE Cold intolerance, cold induced peripheral vasospasm, Raynaud's phenomenon, livedo reticularis and immunoglobulin deposition in the skin are often encountered clinical and laboratory findings in patients with primary fibromyalgia (FM). These findings are suggestive of vascular injury. METHODS Eighty patients (4 male, 76 female) with fulfilling primary FM criteria (FM (+) patient group), 60 patients (3 male, 57 female) with chronic musculoskeletal complaints but without FM (FM (+) patient control group) and 40 healthy volunteers (1 male, 39 female) without musculoskeletal complaints (healthy control group) were enrolled in this cross-sectional study. The study was carried out in two steps. In the first step, the clinical findings, routine laboratory tests, autoantibodies and radiological findings were investigated. The second step were consisted of the laboratory investigations of thrombomodulin and fibronectin as the mediators indicating vascular injury and proinflammatory cytokines in FM patients with Raynaud's phenomenon and/or livedo reticularis and in control groups. RESULTS There were no differences between study and control groups with regard to laboratory, radiological and immunological (ANA, AntidsDNA, ENA, anticardiolipin IgG and IgM) results. No statistically significant differences were found in the levels of proinflammatory cytokines between FM (+) patient group and control groups (p > 0.05). Thrombomodulin was also shown statistically insignificant difference between FM (+) patient group and control groups (p > 0.05). However, fibronectin, another mediator of vascular injury, was higher in FM (+) patient group and the differences between FM (+) patients and each control groups were statistically significant (p < 0.0001). CONCLUSION Our results were suggestive of the presence of a non-immunological vascular injury in FM patients with Raynaud's phenomenon and/or livedo reticularis.departmental bulletin pape

Case Study of Physiotherapy Treatment of Closed Patella Fracture

Title: A Case Study of Physiotherapy Treatment of Closed Patella Fracture Thesis Aim: This thesis involves a case study on physiotherapeutic approach to a 35 year old male with closed patella fracture, 8 weeks after incident. This case study was conducted in the month of January of 2012 at Ústřední Vojenská Nemocnice under the supervision of physiotherapist Martina Puchmertlova. Materials used during this study include treatment table, measurement tape, neurological hammer, goniometer, overball, various sized pillows, and balance boards of different shape. The theoretical part aims to explain anatomical structure, biomechanics, kinesiology and etiology of this type of fractures. While the practical part refers to the case study; the examinations used and the effectiveness of the therapy with the approaches used. Methods: The therapy started with initial kinesiological examination. Along with the therapeutic methods taught at the Faculty of Physical Education and Sport, the chosen procedures included: post isometric relaxation and stretching by Lewit, soft tissues techniques by Lewit, sensomotoric training and mobilization by Lewit. Lastly final kinesiological examination was conducted. To enhance the effects of the therapy, the patient has been in addition required to perform home therapies as..

Optimization of Compressible Medium Filter for Secondary Effluent Filtration

Several innovative filtration technologies have been developed in the last two decades to decrease the backwash requirements, to increase the water production efficiency, and to improve the operational and design conditions. The Compressible Medium Filter (CMF) also known as the “Fuzzy Filter” involves the use of a synthetic compressible fiber (polyvaniladene) porous material as the filtering medium instead of conventional granular material. The optimization of the CMF operation is discussed in this paper. Both the CMF removal performance and backwash water ratio (BWR) increase significantly as the medium compression ratio (MCR) is increased. The optimum MCR (for turbidity removal purposes) is the minimum MCR that results in the required degree of turbidity removal to prevent excessive BWR. The optimum MCR for the filtration of conventional activated sludge secondary effluent (for wastewater reuse application) increases from approximately five percent to 25 percent as the average influent turbidity increases from 4 NTU to 7 NTU. The filtration model developed for CMF application can be used to predict the optimum MCR curves for different and more complex filtration conditions. Chemical requirements are also eliminated or minimized with the CMF technology by increasing the MCR when the influent conditions get worse.</jats:p