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Biomedical subjects

R M Valente

Publications and source records attributed to R M Valente.

9 recordsLinked to original sources
PubMed2001

A disease-specific activity index for Wegener's granulomatosis: modification of the Birmingham Vasculitis Activity Score. International Network for the Study of the Systemic Vasculitides (INSSYS).

OBJECTIVE: To refine and validate the Birmingham Vasculitis Activity Score (BVAS) as a disease-specific activity index for Wegener's granulomatosis (WG). METHODS: Sixteen members of the International Network for the Study of the Systemic Vasculitides (INSSYS) revised the BVAS, with 3 goals: to reduce the redundancy of some component items, to enhance its ability to capture important disease manifestations specific to WG, and to streamline the instrument for use in clinical research. We defined the items and weighted them empirically as either minor (e.g., nasal crusting = 1 point) or major (e.g., alveolar hemorrhage = 3 points). We then validated the new, disease-specific BVAS/WG in 2 simulation exercises and a clinical case series that involved 117 patients with WG. RESULTS: We removed 38 items from the original BVAS, revised 9 items, and added 7 new items. Correlations between the scores on the BVAS/WG and the physician's global assessment (PGA) of disease activity were high, even when patients in remission were excluded. In the clinical case series, Spearman's rank correlation coefficient between the BVAS/WG and the PGA was r = 0.81 (95% confidence interval 0.73-0.87). The interobserver reliability using intraclass (within-case) correlation coefficients in the 2 simulation exercises was r = 0.93 for the BVAS/WG and r = 0.88 for the PGA in the first and r = 0.91 for the BVAS/WG and r = 0.88 for the PGA in the second. There was no significant observer effect in the scoring of the BVAS/WG or the PGA. The discriminant validity of the BVAS/WG was good: r = 0.73 (95% confidence interval 0.43-0.83). CONCLUSION: The BVAS/WG is a valid, disease-specific activity index for WG. Tested in simulation exercises and in actual patients, the BVAS/WG correlates well with the PGA, is sensitive to change, and has good inter- and intraobserver reliability. The INSSYS will use the BVAS/WG to assess the primary outcome in a phase II/III trial of etanercept in WG.

Granulomatosis with Polyangiitis↗
PubMed1999

A commonsense approach to shoulder problems.

Shoulder pain is a common entity in a primary care physician's practice. The unique anatomy of the shoulder allows for almost unrestrained motion in all planes. A thorough history and physical examination are important to ensure efficient patient evaluation. Further assessment may include radiographic and diagnostic laboratory tests. This article presents an organized approach to the anatomy, physiology, and pathology of common shoulder disorders for the primary care physician. The distinction between disorders that are intrinsic or extrinsic to the shoulder joint is discussed. Treatment and the need for appropriate referral are described.

Diagnosis, Differential↗
PubMed1997

Bond strength of visible light-cured glass ionomer orthodontic cement.

In this in vitro study, tensile strength tests were conducted with a visible light-cured glass ionomer cement (Fuji Ortho LC, GC America Inc.) bonded to extracted teeth under six different enamel surface conditions: (1) dry nonetched, (2) moist etched, (3) moist nonetched, (4) moist nonetched rebonded, (5) moistened with saliva substitute, and (6) moistened with human saliva. Two resin adhesives (Rely-A-Bond and Phase II, Reliance Orthodontic Products) were applied to dry and etched enamel and served as control agents. The glass ionomer cement approached the strength observed for resin adhesives and required the presence of moisture on the enamel surface for optimal performance.

Acid Etching, Dental↗
PubMed1994

Foot and ankle surgery in patients with psoriasis.

During a 15-year period, 17 patients with psoriatic arthritis had 27 foot and ankle operations. The most common operation was forefoot arthroplasty. The stage of psoriatic skin involvement and the pattern of radiographic changes in the foot and ankle joints were evaluated, and the factors thought to influence perioperative outcome were reviewed. The complications were Koebner's phenomenon (or isomorphic response), infection, and nonunion, which were uncommon. The features predicting outcome of diagnosis and treatment were not identified.

Adolescent↗
PubMed1989

Characterization of lymph node histology in adult onset Still's disease.

Adult onset Still's disease is an acknowledged cause of fever of unknown origin. Eight patients with adult onset Still's disease each had a lymph node biopsy as part of their initial evaluation. Seven of 8 biopsies exhibited intense, somewhat atypical, paracortical immunoblastic hyperplasia. This nodal histology, while not specific for the disorder, appears distinct from that associated with rheumatoid arthritis, Sjögren's syndrome, and systemic lupus erythematosus. This paracortical cellular proliferation with apparent nodal effacement, along with atypical immunoblasts, can simulate lymphoma. Adult onset Still's disease should be added to the differential consideration of benign lymph node histology simulating lymphoma.

Adult↗
PubMed1988

Erosive spondyloarthropathy in long-term dialysis patients: relationship to severe hyperparathyroidism.

We describe the development of a destructive, erosive spondyloarthropathy in three long-term dialysis patients (mean duration of dialysis, 96 months). In all three patients, the lesions caused symptomatic vertebral pain and developed during a period of only a few months. All patients had extremely elevated levels of immunoreactive parathyroid hormone, and two patients had evidence of severe hyperparathyroidism on bone biopsy specimens. Two patients who underwent subtotal parathyroidectomy had rapid relief of symptoms and no further radiographic evidence of progression of the spondyloarthropathy. The third patient refused subtotal parathyroidectomy and had pronounced progression of the destructive spondyloarthropathy in the cervical spine. The limited experience of others, along with our currently reported findings, strongly suggests that hyperparathyroidism plays a major role in the development of this disorder. Erosive spondyloarthropathy is increasingly recognized in long-term dialysis patients and may be a unique clinical and radiographic manifestation of severe hyperparathyroidism in this population.

Aged↗
PubMed1982

Surgical history of Crohn's disease in a well-defined population.

Since 1935, 42 of 103 residents of Olmsted County, Minnesota, identified as having Crohn's disease underwent one or more surgical procedures. The incidence and type of surgical intervention, distribution of disease, and risk of recurrent disease after surgery were analyzed. Follow-up extended to 32 years, with a median of 8.5 years. Thirty-six patients underwent at least one definitive resection; eight of these patients subsequently underwent a second definitive operation. The likelihood that any patient would undergo operation was greatest within the first year of diagnosis. The proportion of patients in whom recurrent disease developed after the first and second definitive resections was 50% and 37%, respectively. Approximately half the patients who experienced a recurrence underwent further surgery. The site of diseased bowel and sex were not factors specifically influencing recurrence rates. Patients 40 years of age and older who underwent surgery appeared to fare better with respect to recurrent disease than younger patients. Although our findings suggest cumulative risks of recurrent disease after definitive resection similar to those reported from larger population groups or major referral centers, the proportion of patients who underwent surgery during the natural history of their Crohn's disease was much less than generally reported. We conclude that operation for Crohn's disease is not inevitable and that evidence to the contrary may imply both a treatment and a referral bias.

Adolescent↗