NLRP3 inflammasome expression in idiopathic pulmonary fibrosis and rheumatoid lung.

In this study we investigated the implication of NLRP3 inflammasomes in the pathogenesis of idiopathic pulmonary fibrosis (IPF) and rheumatoid arthritis-usual interstitial pneumonia (RA-UIP).NLRP3 inflammasome activation at baseline and following stimulation with lipopolysaccharide/ATP was evaluated by measuring interleukin (IL)-1ß and IL-18 levels released in the bronchoalveolar lavage fluid (BALF) fluid and by cultures of BALF cells. IL-1ß and IL-18 levels were significantly elevated in the BALF and BALF macrophage cultures from RA-UIP patients, consistent with pre-existing inflammasome activation in these patients. In contrast, in IPF, BALF levels of IL-1ß were significantly less elevated relative to RA-UIP and IL-18 was lower than controls. Furthermore, upon inflammasome stimulation, IPF BALF macrophage cultures failed to upregulate IL-1ß and partly IL-18 secretion, in contrast to controls, which showed robust IL-1ß and IL-18 upregulation. Interestingly, RA-UIP BALF cell cultures treated with lipopolysaccharide/ATP showed a potent stimulation of IL-18 secretion but not IL-1ß, the latter being already elevated in the unstimulated cultures, while examination of the intracellular IL-1ß levels in RA-UIP BALF cells upon NLRP3 inflammasome stimulation showed a significant upregulation of IL-1ß suggesting the NLRP3 pathway could be further activated.Taken together, our results suggest distinct inflammasome activation profiles between autoimmune and idiopathic lung fibrosis.

Can a left internal jugular catheter be used in the hemodialysis of a patient with persistent left superior vena cava?

A patient with a persistent left superior vena cava (PLSVC) was incidentally diagnosed after positioning of a dual lumen catheter for hemodialysis into the left internal jugular vein. Although PLSVC is a relatively rare condition, it is the most common congenital anomaly of thoracic venous circulation. It represents the persistence of the left horn of the embryonic sinus venosus, which normally involutes during embryogenesis to become the coronary sinus. The existence of a PLSVC can cause a significant diagnostic dilemma during catheterization of the left internal jugular vein, pertaining to the positioning of the catheter. It may also be associated with significant clinical implications such as systemic embolization, provocation of arrhythmia, and thrombosis of the vessel. The safety of such catheterization has not been adequately evaluated due to the rarity of this condition. We believe that a diagnostic workup including blood gas analysis, echocardiography, and computed tomography is necessary to confirm a right atrial drainage and a patent innominate vein as prerequisites to maintain the catheter in position.

High incidence of pulmonary toxicity of weekly docetaxel and gemcitabine in patients with non-small cell lung cancer: results of a dose-finding study.

PURPOSE: To determine the maximum tolerated doses (MTD) and the dose-limiting toxicities (DLTs) of the weekly administration of docetaxel and gemcitabine as first-line treatment in patients with advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Chemotherapy-naïve patients with histologically or cytologically confirmed unresectable stage III(B) or IV NSCLC were enrolled onto the study. Escalated doses of gemcitabine (starting dose 700 mg/m(2) per week) and docetaxel (starting dose 30 mg/m(2) per week) were given on a weekly basis for three consecutive weeks in cycles of 4 weeks. RESULTS: Twenty-six patients received a total of 94 chemotherapy cycles. At the doses of docetaxel 40 mg/m(2) per week and gemcitabine 1000 mg/m(2) per week, the MTD had not yet been reached. However, the study was prematurely closed because of a high incidence of severe pulmonary adverse events. Six (23%) patients developed fever and pulmonary dysfunction (severe dyspnea, hypoxia in association with diffuse interstitial pneumonitis), which was fatal in two of them. No risk factors were identified contributing to these pulmonary adverse events; four patients had a low absolute number of peripheral blood CD4+ lymphocytes. Grade 3/4 neutropenia occurred in five (19%) patients and grade 3/4 anemia in two (8%). CONCLUSION: The weekly administration of gemcitabine and docetaxel in patients with advanced NSCLC is associated with a high incidence of severe pulmonary toxicity, which does not seem to be dose-related. The regimen cannot be used outside a clinical protocol.

Fatal methotrexate-induced pneumonitis in a psoriatic patient.

Pulmonary toxicity, as an adverse effect of methotrexate (MTX) therapy, is uncommon in psoriatics. This report concerns a patient with psoriatic arthritis who developed fatal pneumonitis with a histopathological pattern of the organizing stage of diffuse alveolar damage and who was receiving MTX at a dose of 15 mg weekly for 1 month. The patient died despite the immediate withdrawal of MTX, the administration of corticosteroids, and adequate supportive care. Since MTX pneumonitis is a potentially fatal complication, new pulmonary symptoms, even in patients on low-dose MTX treatment, should be appropriately investigated.

Relevance of the restoration of humeral length and retroversion in hemiarthroplasty for humeral head fractures.

Sixteen patients, with a fracture of the upper humerus treated with hemiarthroplasty, were followed-up for 45.7 +/- 15.1 (20-72) months after surgery. The results were assessed using the Constant-Murley scale. The mean score was 75.8 +/- 15.7 (54-96) points out of a possible maximum of 100. At the time of their last follow-up they underwent CT of the fractured and contralateral humerus. Humeral length and retroversion were measured and evaluated. A very good final outcome (Constant score more than 71) was achieved in patients with a difference in retroversion less than 10 degrees and a difference in length less than 14 mm, between fractured and sound humerus. The mean difference in retroversion was 8.7 degrees and the mean difference in length was 0.65 cm, between fractured and sound humerus. We attribute the very good clinical outcome in our series to the quality of the anatomical reconstruction that was performed.

An unusual infection on an unusual gastroenteritis.

A 35-year-old lady was admitted to our Department due to fever and symptoms from the respiratory and gastrointestinal system. She was recently diagnosed with eosinophilic gastroenteritis and had been on steroids until two months prior to admission. Legionella pneumophila pneumonia was diagnosed and targeted therapy was initiated. The combined approach to the two entities is discussed as well as the options for maintenance therapy.

Migratory azygos vein: a case report.

We report a case of a "migrating" azygos vein developing after an abrupt spinal deformity adjacent to the azygos arch. A woman with a previously identified azygos lobe had a follow-up chest computed tomography that demonstrated the azygos vein dislocated medially to the fissure in its usual mediastinal position. The azygos lobe was intact. The woman had developed kyphosis angled at the level of the T4 vertebra, where the azygos vein arches anteriorly.

Stereological estimation of total intracranial volume on CT images.

This study aims to investigate the possibility of generating stereological estimations of total intracranial volume (TIV) on CT scans. The study group included 16 consecutive patients referred for a cranial CT examination. The TIV was estimated using the stereological point counting technique. Volume measurements were optimized by systematically sampling CT sections and by defining an optimum spacing between test points of the grid. The intraobserver and interobserver variability of the optimized volumetric technique was determined. Stereological TIV estimations were compared with the respective planimetric measurements. The application of a test grid with a point spacing of 2.4 cm on 6-8 systematically sampled CT sections provided TIV estimations with a coefficient of error of less than 5%. The intraobserver and interobserver coefficient of variation values were found to be 2.4 and 4.0%, respectively. The 95% limits of agreement between stereological and planimetric TIV measurements were equal to -91.4 and 103.4 cm3. The mean time (+/- SD) needed to obtain stereological TIV estimations was 2.9 +/- 0.6 min. The application of the optimized stereological technique on CT scans enables the efficient estimation of TIV.