Foreign body giant cell reaction to polytetrafluoroethylene used as interposition material in scaphoid-trapezium arthroplasty.

We present the case of a 54-year-old woman who presented with a one and a half-year history of persistent pain at the base of her right thumb. A scaphoid-trapezium interposition arthroplasty with polytetrafluoroethylene was carried out in an effort to improve function and decrease the patient's persistent pain. Approximately 7 years after surgery, she began to complain of increasing pain and radiographs showed extensive osteolytic changes, consistent with a foreign body giant cell reaction.

Expression of CS-1 fibronectin precedes monocyte chemoattractant protein-1 production during elicitation of allergic contact dermatitis.

BACKGROUND: Leucocyte migration within inflammatory skin compartments in allergic contact dermatitis (ACD) is the result of a sophisticated multi-step event where multiple molecules are involved. OBJECTIVE: Since non-antigen-specific mechanisms have been described as an early participant in elicitation of ACD, we investigated the kinetics of the expression of monocyte chemoattractant protein-1 (MCP-1/CCL2) and the type of infiltrating cells. We compared the time course production of MCP-1/CCL2 with connecting segment-1 (CS-1) fibronectin and thymus and activation-regulated chemokine (TARC/ CCL17) expression. METHODS: Biopsies from 10 individuals challenged in their back with the antigen responsible for their contact dermatitis and an irrelevant antigen were taken at different times and histology, immunohistochemistry for CS-1 fibronectin, TARC/CCL17, CD3, CD68, CXCR3, CCR4 and in situ hybridization for MCP-1/CCL2 were performed. RESULTS: At positive antigen stimulated sites expression of MCP-1/CCL2 by basal keratinocytes and isolated cells in dermis started at 10 h. CS-1 fibronectin and TARC/CCL17 expression by blood endothelial cells was found at 2 and 10 h, respectively. This was followed by dermal accumulation of mononuclear cells with a significant increase of CD3+ and CD68+cells. At 48 h, approximately 58% of infiltrating cells were CXCR3+, and 35% CCR4+. CONCLUSIONS: We showed evidence of the fact that CS-1 fibronectin expression precedes the production of MCP-1/CCL2 and TARC/CCL17 in the skin of patients with ACD, suggesting that these molecules participate in the early complex process of migrating mononuclear cells during elicitation of ACD.

Hacia un mejor diagnóstico de conjuntivitis alérgica / Towards the best diagnosis of allergic conjunctivitis

Antecedentes: la conjuntivitis alérgica (CA) tiene una elevada incidencia en la población general y el diagnóstico es realizado por oftalmólogos a través de síntomas y signos oculares característicos. Objetivo: determinar la mejor manera de realizar un diagnóstico preciso de CA. Materiales y métodos: se estudiaron veintidós pacientes con síntomas de CA en el nivel clínico, alergológico e inmunológico antes y después del tratamiento con fumarato de ketoifeno 0,05 por ciento tópico. Resultados: el 83 por ciento de la población estudiada tenía antecedentes familiares de alergia y el 100 por ciento tuvo pruebas cutáneas positivas hacia diferentes alergenos. El 30 por ciento presentó niveles de IgA sérica elevados y el 60 por ciento en lágrimas. Todos los pacientes tuvieron niveles normales de IgA secretoria y lisozima A y valores no detectables de VCAM-1s. El estudio de las moléculas CD29 y HLA-DR sobre células epiteliales conjuntivales antes del tratamiento mostró un marcado incremento en el porcentaje de las mismas con respecto a valores normales. Encontramos correlación entre valores de IgE en lágrimas y eosinófilos (r=0,56; p=0,007); índice de síntomas y signos cardinales e índice de pruebas cutáneas (r=0,50; p=0,032); índice de pruebas cutáneas y eosinófilos conjuntivales (r=0,48; p=0,024); e índice de síntomas y signos cardinales y niveles de IgE sérica (r=0,45; p=0,018). El porcentaje de células CD29+ disminuyó significativamente como consecuencia del tratamiento (p=0,03) mientras que el porcentaje de células HLA-DR+ solo disminuyó en el 41 por ciento de pacientes. Conclusiones: en el diagnóstico de la CA son parámetros críticos los signos y síntomas cardinales, pruebas cutáneas, eosinófilos conjuntivales e IgE en lágrimas

Digital enlargement in tuberous sclerosis.

A 23-year-old woman with a medical history significant for tuberous sclerosis presented with symptoms of postpartum endometritis. Focal gigantism of the third digit of her right hand was incidentally noted and is reported to be a rare manifestation of tuberous sclerosis.

Phaeochromocytoma with central nervous system manifestations.

A 35-year-old Samoan male presented with intermittent headaches and hypertensive episodes for several months. A subsequent left adrenal gland phaeochromocytoma was discovered and surgically excised. An MRI of his brain demonstrated periventricular, basal ganglia, and centrum semi-ovale infarction. We suggest that catecholamine excess and neuropeptide Y may contribute to intracerebral haemorrhage and infarcts associated with phaeochromocytomas. Additionally, our surgical approach in removing the phaeochromocytoma is discussed.

Las variables clínicas predicen infarto y muerte en la angina inestable / Clinical markers predict myocardial infarction and death in instable angina

Se analizaron 1022 pacientes con angina inestable definida por cambios electrocardiográficos y/o antecedentes coronarios, incluídos en el estudio ENAI (enalapril en angina inestable). Se relacionaron las variables clínicas basales y después de la admisión con la aparición de eventos mayores. Se consideró angina recurrente a la aparición de síntomas con cambios electrocardiográficos o repercusión hemodinámica y angina refractaria cuando ocurría bajo tratamiento completo. Se realizó un análisis diferenciado de la recurrencia isquémica dentro de las primeras 48 horas. La edad promedio fue 62 ñ 11,5; 31,4 por ciento era de sexo femenino, 75 por ciento tenía cambios electrocardiográficos. La prevalencia de recurrencia isquémica fue 22,1 por ciento, 14,8 por ciento dentro de las 48 horas, eventos mayores 42 pacientes (infarto 2,8 por ciento y muerte 1,6 por ciento). En la angina inestable las variables preadmisión, como las características de la angina previa, y los cambios electrocardiográficos, identifican un grupo con mayor riesgo de evolucionar al infarto o muerte

Colonic sphincters revisited: simulators of organic disease.

Barium enema examinations establish the presence of neoplastic or inflammatory disease in the colon. Areas of narrowing commonly encountered appear to represent organic disease. These areas are in expected locations throughout the colon and have been described. Not much attention had been given to these areas in recent literature, however, which has led to unnecessary colonoscopies and even surgeries. The sphincters of Rossi, Balli, and Payr-Strauss are involved in nerve reflexes; the sphincters of Hirsch, Moultier, and Busi are a thickening of longitudinal and circular muscle fibers. Cannon's sphincter is an overlap of the superior and inferior mesenteric nerve plexuses. When an area of narrowing is encountered where a known sphincter is located, insufflation of more air, changing patient position, administering 2 mg of glucagon intramuscularly or 0.5 mg to 1 mg intravenously will aid in the distinction between a sphincter and organic disease.

Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography.

OBJECTIVE: Chondromalacia patellae is a condition characterized by softening, fraying, and ulceration of patellar articular cartilage. We compare the sensitivity, specificity, and accuracy of conventional MR imaging, MR arthrography, and CT arthrography in detecting and staging this abnormality. SUBJECTS AND METHODS: Twenty-seven patients with pain in the anterior part of the knee were prospectively examined with MR imaging, including T1-weighted (650/16), proton density-weighted (2000/20), T2-weighted (2000/80), and spoiled two-dimensional gradient-recalled acquisition in the steady state (SPGR/)/35 degrees (51/10) with fat saturation pulse sequences. All were also examined with T1-weighted MR imaging after intraarticular injection of dilute gadopentetate dimeglumine and with double-contrast CT arthrography. Each imaging technique was evaluated independently by two observers, who reached a consensus interpretation. The signal characteristics of cartilage on MR images and contour abnormalities noted with all imaging techniques were evaluated and graded according to a modification of the classification of Shahriaree. Twenty-six of the 54 facets examined had chondromalacia shown by arthroscopy, which was used as the standard of reference. The sensitivity, specificity, and accuracy of each imaging technique in the diagnosis of each stage of chondromalacia patellae were determined and compared by using the McNemar two-tailed analysis. RESULTS: Arthroscopy showed that 28 facets were normal. Grade 1 chondromalacia patellae was diagnosed only with MR and CT arthrography in two (29%) of seven facets. Intermediate (grade 2 or 3) chondromalacia patellae was detected in two (13%) of 15 facets with T1-weighted and SPGR MR imaging, in three (20%) of 15 facets with proton density-weighted MR imaging, in seven (47%) of 15 facets with T2-weighted MR imaging, in 11 (73%) of 15 facets with CT arthrography, and in 12 (80%) of 15 facets with MR arthrography. Grade 4 was detected in three (75%) of four facets with T1-, proton density-, and T2-weighted MR imaging, two (50%) of four facets with SPGR MR imaging, and four (100%) of four facets with MR and CT arthrography. Thus, all imaging techniques were insensitive to grade 1 lesions and highly sensitive to grade 4 lesions, so that no significant difference among the techniques could be shown. CONCLUSION: All imaging techniques studied had high specificity and accuracy in the detection and grading of chondromalacia patella; however, both MR arthrography and CT arthrography were more sensitive than T1-weighted, proton density-weighted, and SPGR with fat saturation MR imaging for showing intermediate grades of chondromalacia patellae. Although the arthrographic techniques were not significantly better than T2-weighted imaging, the number of false-positive diagnoses was greatest with T2-weighted MR imaging.

Diffuse venous malformation with intraosseous involvement.

A young boy with a large venous malformation of his left arm and hand was evaluated for Maffucci's syndrome. Initial hand films were remarkable for cystic bony lesions suggestive of enchondromas. Additional roentgenograms and magnetic resonance imaging studies showed the bony abnormalities were the result of a venous malformation infiltrating bone. Magnetic resonance imaging is a useful diagnostic tool in differentiating enchondromas from vascular anomalies. Venous malformations infiltrating bone should be included in the differential diagnosis of Maffucci's syndrome.

Choledochal cyst complicating pregnancy: antepartum diagnosis with MRI.

Choledochal cyst presenting during pregnancy is a rare condition, associated with potentially life-threatening complications for both the mother and developing fetus. Clinical symptoms are nonspecific, and radiographic evaluation is complicated by the presence of the gravid uterus. The authors describe a 34-year-old pregnant female presenting in the third trimester with obstructive jaundice and a right upper quadrant mass. Multiplanar and multisequence imaging with MR established the antepartum diagnosis of choledochal cyst, avoiding the use of ionizing radiation during pregnancy.

Magnetic resonance imaging with computed tomography of a renal leiomyoma.

Renal leiomyoma are rare, benign tumors of the kidney. There is little information about the imaging of these tumors with modern modalities. We present a case of computed tomographic (CT) and magnetic resonance (MR) imaging of a large renal leiomyoma.

Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography.

OBJECTIVE: We prospectively compared MR imaging, MR arthrography, and CT arthrography to determine the sensitivity of each technique in detecting glenoid labral tears and in determining whether the labrum is detached or degenerated. SUBJECTS AND METHODS: Thirty patients 19-39 years old (mean, 27 years old) who had either signs and symptoms of shoulder instability or shoulder pain of unexplained origin were referred for diagnostic imaging. Each patient underwent MR imaging, followed by MR arthrography after intraarticular injection of 25 ml of a dilute solution of gadopentetate dimeglumine. Twenty-eight of thirty patients underwent CT arthrography after intraarticular injection of air and radiographic contrast material. Each patient also underwent arthroscopy or open surgery. RESULTS: At surgery, labral tears were found in 28 patients; a detached fragment was found in 26 patients. The labrum was found to be degenerated in 18. A labral tear was detected on MR images in 26 (93%) of 28, on MR arthrograms in 27 (96%) of 28, and on CT arthrograms in 19 (73%) of 26. A detached labral fragment was detected on MR images in 12 (46%) of 26, on MR arthrograms in 25 (96%) of 26, and on CT arthrograms in 13 (52%) of 25. Labral degeneration was detected on MR images in two (11%) of 18, on MR arthrograms in 10 (56%) of 18, and on CT arthrograms in four (24%) of 17. MR arthrography was the best of the three imaging techniques for showing the inferior part of the glenoid labrum and inferior glenohumeral ligament. CONCLUSION: MR arthrography and MR imaging both showed labral tears with greater sensitivity than CT arthrography did. MR arthrography was the most sensitive of the three techniques for detecting a detached labral fragment and labral degeneration. Furthermore, MR arthrography afforded the best visualization of the inferior part of the labrum and the inferior glenohumeral ligament. MR imaging and MR arthrography also enabled direct visualization of rotator cuff disease and other unsuspected associated abnormalities.

Testicular microlithiasis: ultra sound appearance.

Testicular microlithiasis is a diffuse, benign condition involving both testicles without architectural distortion. Multiple, bright echoes are present on ultrasound examination which rarely cause shadowing. Many associated conditions have been reported in patients with this entity. As this is a benign entity, knowledge of its appearance and associated conditions to prevent unnecessary surgery is important.

Spontaneous regression of small cell carcinoma of lung associated with severe neuropathy.

This is a case report of small cell lung cancer (SCLC) that underwent spontaneous regression. This was associated with severe neuropathy, which was unresponsive to therapy, including corticosteroids and plasmapheresis. We present here the case report and a brief review of the literature.

Hydronephrosis after aortofemoral bypass graft. A prospective study.

This prospective study was designed to determine the frequency and natural history of hydroureteronephrosis (HUN) after placement of an aortobifemoral vascular graft. A total of 30 patients were evaluated by the study protocol, which included: pre and postoperative biological kidney function tests, preoperative and early postoperative (14th day) intravenous pyelograms and a late (mean 18th month) urologic examination by renal ultrasonic tomography. Four asymptomatic, early cases of HUN were observed in the 57 ureters examined (7%); all four complications regressed in less than 30 days. No cases of symptomatic early or late HUN were observed in this series. Asymptomatic early HUN was a frequent complication in our series (7%) but its benign course does not justify systematic screening. These asymptomatic complications contrast with the symptomatic cases of early or late HUN reported in the literature which necessitated urologic and vascular investigations.