Greek rheumatoid arthritis patients have elevated levels of antibodies against antigens from Proteus mirabilis.

Patients with rheumatoid arthritis (RA) from different ethnic groups present elevated levels of antibodies against Proteus mirabilis. This finding implicates P. mirabilis in the development of RA. The aim of this study was to investigate the importance of P. mirabilis in the etiopathogenesis of RA in Greek RA patients. In this study, 63 patients with RA and 38 healthy controls were included. Class-specific antibodies IgM, IgG, and IgA against three human cross-reactive and non-cross-reactive synthetic peptides from P. mirabilis-hemolysin (HpmB), urease C (UreC), and urease F (UreF)-were performed in all subjects, using the ELISA method. RA patients had elevated levels of IgM, IgG, and IgA antibodies against HpmB and UreC Proteus peptide which are significantly different compared to healthy controls: p = 0.005, p < 0.001, and p = 0.003 and p = 0.007, p = 0.002, and p < 0.001, correspondingly. Also, elevated levels of IgM, IgG, and IgA antibodies against the UreF Proteus peptide-which are non-cross-reactive with human tissue antigens-were observed and their significant difference compared to healthy controls (p = 0.007, p < 0.001, p < 0.001). Anti-peptide antibodies in RA patients showed a significant correlation with rheumatoid factors (Rf), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), especially when patients were divided into subgroups according to the receiving treatment. Greek RA patients present elevated levels of antibodies against P. mirabilis antigenic epitopes, such as in North European populations, albeit Greek RA patients presenting the cross-reaction antigen in a low percentage. These results indicate that P. mirabilis through the molecular mimicry mechanism leads to inflammation and damage of the joints in RA.

A metabolic syndrome in diffuse idiopathic skeletal hyperostosis. A controlled study.

OBJECTIVE: I addition to diabetes mellitus (DM), high incidence of common metabolic conditions such as dyslipidemia (DL) and hyperuricemia (HU) has been found in patients with diffuse idiopathic skeletal hyperostosis (DISH). Our objective was to confirm such observations comparing data from patients with DISH and appropriate controls. METHODS: One hundred randomly identified inpatients with DISH were compared with 100 DISH-free inpatients with various rheumatic disorders matched for age, sex, body mass index, and excess body weight. The prevalence of metabolic disturbances was compared in the 2 groups. Data was analyzed statistically by chi-squared test and 4-fold table analysis. RESULTS: In our DISH population, metabolic abnormalities were found in 70%, versus 45% in the control population (p < 0.0001). High prevalence of DL and/or HU associated with DM was observed among patients with DISH (p < 0.0001). Patients with uncomplicated diabetes (or DL or HU) were almost equally distributed between the 2 groups, with no significant differences (p > 0.1). Combined metabolic features of DM+DL, DM+HU, or DM+DL+HU were shown to be the main risk factor for DISH (K = 14). They may constitute a metabolic syndrome with high diagnostic specificity (u = 1.0) and nosologic sensitivity (g = 1.0), despite their lowest prevalence (0.07). Dyslipidemia occurred with the highest prevalence (p = 0.36), the highest positive predictive value (v = 0.44) and, together with HU and diabetes, the highest nosologic specificity (f = 0.55 in both cases). CONCLUSION: We found metabolic disturbances confined to the group with DISH. Followup studies of the number of bridging ossifications in identically aged patients or bridging ossifications/year/patient could be a useful tool to determine their effect on the extent and progression rates of DISH.

Primary angiosarcoma of the brain: case report.

A 41-year-old patient with a primary angiosarcoma of the brain is reported. The tumor was located in the left parietal lobe and was radically removed. The diagnosis of angiosarcoma was established by immunohistochemistry. The patient was postoperatively treated with adjuvant chemotherapy and then radiation therapy. After 41 months, she was in excellent clinical and neurological condition without any sign of recurrence.

Foreign body in the sphenoid sinus.

Foreign bodies in the paranasal sinuses, especially in the sphenoid sinus are uncommon. We report a rare case of a foreign body in the sphenoid sinus after an occupational accident.

Acute subdural hematoma with and without multiple injuries.

A series of 109 patients with clotted subdural hematomas operated on within 72 hours of closed head injuries was evaluated retrospectively. Twenty-seven patients with multiple injuries showed a mortality rate of 77%, those without 59%.

Intracerebral granular cell tumor.

A case of a primary intracerebral granular cell tumor (GCT) in a 71-year-old woman is reported. The computed tomographic scan showed a contrast-enhancing, noncalcified mass in the left parieto-occipital region. The tumor was operated upon and the histological findings showed a granular cell tumor with mitotic activity. After radiation therapy the patient recovered well. The origin of intracerebrally growing GCT's remains unclear. Involvement of astrocytes is discussed. Primary GCT's of the cerebrum are potentially more malignant than those of the pituitary region.