Infliximab in chronic non-infectious paediatric uveitis refractory to previous biologic therapy.

OBJECTIVES: To examine the outcome of infliximab treatment in patients with non-infectious paediatric uveitis who have previously failed biologic treatment. METHODS: A retrospective cohort study was performed at Bristol Eye Hospital, UK. Paediatric patients with chronic non-infectious uveitis who had been switched to infliximab due to inadequate uveitis control were identified. Two separate groups were evaluated: group 1 consisted of 20 children (36 eyes) who had been switched to infliximab following treatment failure with adalimumab (=in-class switching), while group 2 (5 patients; 9 eyes) included those who had been switched to infliximab from a non-TNF antagonist after failing several biologics (=across-class switching). The change in anterior chamber (AC) activity between baseline and 6- and 24-months follow-up was the primary outcome measure. RESULTS: A statistically significant reduction in AC activity was found between baseline and 6-months follow-up (RE: p = 0.002; LE: p < 0.001) and between baseline and 24-months follow-up (RE: p = 0.016; LE: p = 0.011) in group 1. No statistically significant difference was found for either eye in the number of steroid eye drops needed between time points or the difference in visual acuity in time. In group 2, analysis of change of AC activity, number of steroid eye drops and visual acuity failed to reach statistical significance. Treatment failure occurred in four patients (20% of group 1) and adverse events developed in six patients including three patients with acute infusion reactions. CONCLUSIONS: This study supports the efficacy and safety of infliximab in adalimumab-refractory patients with paediatric non-infectious uveitis.

A case of disseminated tuberculosis during a twin pregnancy following in vitro fertilization.

A woman presented with cough, fever, and dyspnea during a twin pregnancy following a 13th in vitro fertilization procedure. Ultimately, she was diagnosed with miliary tuberculosis and tuberculostatic treatment was initiated, complicated by drug-induced hepatotoxicity. In retrospect, previous pelvic tuberculosis had likely been overlooked. This case report highlights the need to recognize tuberculosis as a cause of infertility even in low-incidence countries and emphasizes that the peripartum period is a major risk factor for drug-induced liver injury.

A challenging case of septic sacroiliitis with psoas involvement.

OBJECTIVE AND IMPORTANCE: We report on a rare case of septic arthritis of the sacroiliac joint in a young patient without apparent predisposing factors. CLINICAL PRESENTATION: A 22-year-old female presented with severe right pelvic and gluteal pain and systemic illness. She had a recent diagnosis of bilateral sacroiliitis. INTERVENTION: Systemic illness quickly subsided after initiation of intravenous antibiotic treatment. Subsequently, gluteal pain gradually diminished. CONCLUSION: Pyogenic sacroiliitis should be taken into account in patients with sacroiliitis and fever onset. Magnetic resonance imaging shows signal anomalies well beyond disappearance of symptoms, which may or may not require prolonged antibiotic therapy.

Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation.

BACKGROUND: Ticlopidine has been shown to reduce the incidence of stent thrombosis compared with warfarin, but it may cause serious hematological side effects. Clopidogrel, a new thienopyridine derivative, may be a safe alternative to ticlopidine. The aim of this study was to compare the safety and efficacy of clopidogrel and aspirin with those of ticlopidine and aspirin in patients undergoing coronary stent implantation. METHODS AND RESULTS: The population of this study consisted of 2 groups: patients who underwent coronary stenting and were treated with ticlopidine and aspirin (TA group, n=1406), and patients who underwent coronary stenting followed by treatment with clopidogrel and aspirin (CA group, n=283). At 1-month follow-up, there was no difference in stent thrombosis (1.5% versus 1.4%, P=1.0) or major adverse cardiac events (3.1% versus 2.4%, P=0. 85) between the TA and CA groups, respectively. The probability of any side effect (neutropenia, diarrhea, rash) was significantly higher in the TA group (10.6% versus 5.3%, P=0.006; relative risk, 0. 53; CI, 0.32 to 0.86). CONCLUSIONS: These data suggest that clopidogrel may be an effective pharmacological regimen after coronary stent implantation. Furthermore, the simpler dosing regimen, the absence of neutropenia, and the lower frequency of other side effects make it a safe alternative to ticlopidine.

Relation between single tomographic intravascular ultrasound image parameters and intracoronary Doppler flow velocity in patients with intermediately severe coronary stenoses.

BACKGROUND: Intravascular ultrasound (IVUS) imaging parameters have been suggested as criteria to determine coronary lesion significance before intervention. However, there has not been a systematic examination of combined anatomic and physiologic data in the same patients with coronary artery disease. METHODS AND RESULTS: To examine the relation between coronary flow reserve and IVUS parameters, 41 patients with intermediately severe coronary artery stenoses had measurements of coronary flow velocity (0.014-inch Doppler flow wire), coronary flow velocity reserve (CVR) (hyperemic/basal mean flow), IVUS imaging (2.9F, Cardiovascular Imaging Systems, Inc.), and quantitative coronary angiography before intervention. Correlations between physiologic and anatomic parameters were performed by simple regression. Results were also examined by patient subgroups with CVR > 1.8 or < 1.8 to assess differences in IVUS parameters. The angiographic percent diameter stenosis was 52% +/- 17% (range 18% to 95%). Mean CVR was 1.88 +/- 0.56 (range 0.9 to 3.18). IVUS minimal luminal diameter (r = 0.312, p = 0.047) and angiographic percent stenosis (r = 3.05, p = 0.052) were weakly related to poststenotic CVR. Comparing patients with CVR < 1.8, IVUS reference segment area, IVUS lumen area, and angiographic percent diameter stenosis was higher (17.7 +/- 0.3 vs 12.9 +/- 4.4 mm2, p < 0.05; 6.20 +/- 3.76 vs 4.34 +/- 2.00 mm2, p < 0.05; and 60% +/- 14% vs 46% +/- 17%, p < 0.01, respectively) than in the group with CVR > 1.8. CONCLUSIONS: Despite a precise determination of cross-sectional vessel areas and absolute dimensions by IVUS, single tomographic measurements did not correlate well with coronary physiologic responses. These data suggest that the physiologic data may be complementary to anatomic quantitative IVUS, enhancing information for coronary interventional decision making.

Coronary histology after percutaneous transluminal coronary angioplasty.

This article describes previously unreported histologic changes in the vessels of a patient who was admitted with an evolving myocardial infarction due to subtotal occlusion of the left anterior descending coronary artery. The patient died of cardiogenic shock 15 hours after undergoing a technically successful percutaneous transluminal coronary angioplasty procedure. Upon early postmortem study, histologic sections from the proximal, middle, and distal thirds of the left anterior descending coronary artery were polymorphic in appearance. Sections from the most proximal angioplasty site revealed intimal proliferation of polymorphonuclear leukocytes, as well as intimal fibrosis with plaque cleavage. Sections from the more distal angioplasty sites revealed plaque cleavage, intimal polymorphonuclear infiltration, and intimal, medial, and adventitial fracture with dissecting hemorrhage, although mural integrity had been maintained. Intense subintimal proliferation with inflammatory cells has previously been described only in an experimental animal model. Our case also appears to be the first in which adventitial disruption has been observed after percutaneous transluminal coronary angioplasty; this finding provides new evidence that an atherosclerotic coronary artery can tolerate vigorous dilatation without rupture.

[Mechanisms of the initiation of lipid peroxidation in the synaptosomes of marine teleosts]. / Issledovanie mekhanizmov initsiirovaniia perekisnogo okisleniia lipidov v sinaptosomakh morskikh kostistykh ryb.

The initial rates of NAD- and NADPH-dependent enzymic and Fe+-ascorbic acid-dependent nonenzymic lipid peroxidation have been measured in synaptosomes from the brain of 4 teleost species. The rates of peroxidation were compared with lipid composition and fatty acid composition of total lipids in order to reveal factors accounting for the intensity of peroxidation in the excitable membranes from the brain of ectotherms. The data obtained indicate that the rates of enzymic lipid peroxidation do not correlate with lipid and fatty acid compositions, depending on the efficiency of production of oxygen in the active form by pyridine nucleotide-dependent enzymic systems. Activation of lipid peroxidation during adaptation of animals to the environment may be considered as one of the mechanisms which account for compensatory changes in fatty acid composition of the membrane lipids.

Inflammation of the coronary arteries in patients with unstable angina.

During surgery, 21 patients undergoing coronary artery bypass for unstable angina were found to have "red lines" overlying one or more coronary arteries. Adventitial biopsies showed vascular distention and inflammatory cells. The group was followed for an average of 54 months (14 to 68 months). There were no operative deaths. Recurrent myocardial ischemia developed in 38.1% (8/21); recurrent angina developed in 23.8% (5/21) and are being treated medically; myocardial infarction occurred in 9.5% (2/21); and reoperation was required in 4.8% (1/21). There was also one late death from a brain tumor. We suggest that the presence of adventitial inflammation may represent an aggressive, variant form of atherosclerosis and a less favorable clinical prognosis.

[Brain lipids of a mammoth, Elephas primigenius, which died more than 40,000 years ago]. / Issledovanie lipidov mozga mamonta Elephas primigenius, pogibshego bolee 40 tysiach let tomu nazad.

Studies have been made on the brain lipids of the 6--7-month mammoth which remained in the eternal ice for more than 40.000 years. Thin layer chromatography of chloroformmethanol extract of the brain lipids shows that all glycerophospholipids in the brain were destroyed. On the contrary, sphingophospholipid sphingomyelin yielded the evident spot which was identified by specific reactions and by comparison with sphingomyelin from the brain of rat. Sphingomyelin content was evaluated. Using gas-liquid chromatography, fatty acid composition of sphingomyelin was investigated. It was found to be close to that in contemporary mammals. Other shingolipids -- cerebrosides, sulfatides, gangliosides -- persisted (probably, only partially) and were studied quantitatively. Relative content of cerebrosides with normal fatty acids and hydrooxyacids was determined. Studies were also made on fatty acid composition of cerebrosides, sulfatides and gangliosides, as well as on the composition of spingosine bases of gangliosides. Free cholesterol was found in the brain of the mammoth. Other sterols were not detected. With respect to quantitative evaluation of the preserved lipids, it should be mentioned that on the one hand, the brain underwent dehydration which increased lipid content per a unit of "wet" weight, whereas on the other one lipids were partially degraded, this process decreasing their content.