Felty's syndrome without rheumatoid arthritis?

Felty's syndrome (FS) is characterized by neutropenia and splenomegaly in patients with seropositive (RF+, anti-CCP+) rheumatoid arthritis (RA). As a result of neutropenia, affected persons are increasingly susceptible to infections. In the majority of patients, FS appears in the course of long-standing and well-established RA. Manifestations of FS without clinical but only with laboratory features of RA are extremely rare. We present a case of severe neutropenia and mild splenomegaly in a patient with high titers of RF and anti-CCP. For 4 years, patient's neutropenia remained asymptomatic. The neutropenia reduction to agranulocytosis was followed by successful methotrexate-corticosteroid therapy. Efficacy of the standard anti-RA therapy confirmed autoimmune mechanism of the Felty's neutropenia. The most important lesion from our case is to recognize this condition in the range of autoimmune rheumatic diseases without delay. We reviewed literature with non-articular FS.

Elongated eccentric soft coronary plaque: major diagnostic pitfall on quantitative coronary angiography overpowered by computed tomography coronary angiography and intravascular ultrasound.

We describe a significant left anterior descending coronary lesion in a patient with unstable angina pectoris. This lesion was erroneously underestimated using quantitative coronary angiography; however, CT coronary angiography correctly showed a significant, elongated, eccentric, soft plaque that was later confirmed by repeated quantitative coronary angiography with intravascular ultrasound. As showed, CT coronary angiography may offer a reliable non-invasive alternative to quantitative coronary angiography and intravascular ultrasound by enabling a true 3-D coronary lumenogram combined with plaque detection and characterization.

A large arteriovenous fistula between the femoral artery and the femoral vein after cardiac catheterization manifesting as high-output cardiac failure.

Arteriovenous fistula is a potential complication of cardiac catheterization. Most of these fistulas cause no harm. We describe a case of high-output heart failure caused by an arteriovenous fistula in the groin. The heart failure was resolved by surgical closure of the fistula.

Oribatid mite (Acari: Oribatida) contribution to decomposition dynamic of leaf litter in primary forest, second growth, and polyculture in the Central Amazon.

We studied the contribution of oribatid mites in the dynamics of litter decomposition in an experiment using litterbags of three different mesh sizes (20 microns, 250 microns, and 1 cm). The experiment was carried out at a primary forest (FLO), a secondary forest (SEC), and at two polyculture systems (POA and POC). We compared the weight loss of the leaves of Vismia guianensis and the changes of the oribatid mite species community. We processed the samples after 26, 58, 111, 174, 278, and 350 days from the beginning of the experiment by using the Berlese-Tullgren to extract the animals. We hypothesized that: 1. the abundance and diversity of oribatid mites would exert an influence in the decomposition process; 2. there would be a successional changing of the species during decomposition; and 3. there would be differences in the colonization of species in relation to the mesh size of the litterbags. A total of 95 species of oribatid mites was found. The biomass data was the first registered for the Amazon region. The great dominance of oribatid mites did not exert an influence in the decomposition process. There was not a successional changing of the species during the course of the decomposition process, unlike those shown by results obtained in the temperate forest, because we found neither early colonizers nor species that prefer advanced decomposition stages. The oribatid mite community, which developed in the litterbags under tropical conditions, was atypical of the normal stages of leaf litter breakdown and decomposition. There were differences in the colonization of species in relation to the mesh size of the litterbags. These differences were very closely related to the specific habits and habitat of the dominant species.

[Talus bipartitus]. / Talus bipartitus.

Talus bipartitus is an exceptional congenital malformation consisting in the presence of two non-fused bony talar fragments. We report the case of an adolescent girl who complained of mechanical pain in the left ankle which became increasingly invalidating. Plain radiographs, CT-scan and MRI led to the diagnosis of this congenital anomaly: talus bipartitus. Surgical correction by subtalar arthrodesis provided improvement at the cost of reduced ankle mobility. Surgical treatment should be proposed for talus bipartitus in patients with invalidating pain or stiffness when rehabilitation fails to provide sufficient improvement.

Oribatid mite (Acari: Oribatida) contribution to decomposition dynamic of leaf litter in primary forest, second growth, and polyculture in the Central Amazon

A contribuição da comunidade de ácaros oribatídeos na dinâmica da decomposição de folhas foi estudada em experimentos com sacos de náilon com três tamanhos de malhas (20 µm, 250 µm e 1 cm). O experimento foi efetuado em floresta primária (FLO), secundária (SEC) e em dois sistemas de policultivo (POA e POC). Comparamos a perda de peso de folhas de Vismia guianensis com as mudanças da comunidade de espécies de oribatídeos após 26, 58, 111, 174, 278 e 350 dias de início do experimento. Utilizamos o aparelho de Berlese-Tullgren para extrair os animais. Hipotetizamos que: 1. a dominância e a diversidade dos oribatídeos influenciariam o processo de decomposição das folhas; 2. haveria mudanças na sucessão de espécies durante o curso da decomposição; e 3. registraríamos diferenças na colonização de espécies em relação ao tamanho da malha do saco de náilon. Registramos um total de 95 espécies de oribatídeos. Os dados de biomassa foram os primeiros registrados para a região. A grande dominância de oribatídeos não exerceu influência no processo de decomposição das folhas, não havendo mudanças na sucessão de espécies durante o curso da decomposição. Nesse aspecto, nossos resultados foram diferentes dos obtidos em florestas temperadas, uma vez que não registramos espécies colonizadoras primárias ou espécies que preferiram estágios mais avançados de decomposição. A comunidade de ácaros oribatídeos que se desenvolveu nos sacos de malha nas condições tropicais foi atípica em relação aos estágios normais de quebra e decomposição da serapilheira. Registramos diferenças na colonização de espécies em relação ao tamanho da malha; essas diferenças estão diretamente relacionadas ao hábito e ao habitat específico da espécie dominante.

Pomegranate juice flavonoids inhibit low-density lipoprotein oxidation and cardiovascular diseases: studies in atherosclerotic mice and in humans.

The beneficial health effects attributed to the consumption of fruit and vegetables are related, at least in part, to their antioxidant activity. Of special interest is the inverse relationship between the intake of dietary nutrients rich in polyphenols and cardiovascular diseases. This effect is attributed to polyphenols' ability to inhibit low-density lipoprotein (LDL) oxidation, macrophage foam cell formation and atherosclerosis. Pomegranate polyphenols can protect LDL against cell-mediated oxidation via two pathways, including either direct interaction of the polyphenols with the lipoprotein and/or an indirect effect through accumulation of polyphenols in arterial macrophages. Pomegranate polyphenols were shown to reduce the capacity of macrophages to oxidatively modify LDL, due to their interaction with LDL to inhibit its oxidation by scavenging reactive oxygen species and reactive nitrogen species and also due to accumulation of polyphenols in arterial macrophages; hence, the inhibition of macrophage lipid peroxidation and the formation of lipid peroxide-rich macrophages. Furthermore, pomegranate polyphenols increase serum paraoxonase activity, resulting in the hydrolysis of lipid peroxides in oxidized lipoproteins and in atherosclerotic lesions. These antioxidative and antiatherogenic effects of pomegranate polyphenols were demonstrated in vitro, as well as in vivo in humans and in atherosclerotic apolipoprotein E deficient mice. Dietary supplementation of polyphenol-rich pomegranate juice to atherosclerotic mice significantly inhibited the development of atherosclerotic lesions and this may be attributed to the protection of LDL against oxidation.

Management of seat-belt syndrome in children. Gravity of 2-point seat-belt.

We present our experience with a management of seat-belt syndrome in three children and draw particular attention to the severity of two-point fixation seat-belt injuries after a motor vehicle accident with 5 passengers whose vehicle was struck head-on by an oncoming vehicle. The parents were sitting in front, Adeline had a 2-point lap seat-belt, the 2 other children had 3-point seat-belts. The parents both had humerus fractures. The 4-year-old brother suffered a cervical and abdominal trauma with renal and splenic contusions and intestinal perforations. Adeline suffered multiple injuries, notably to the head, spine and abdominal viscera with erosions at the site of lap-seat-belt contact. The spinal injury was an L2 angular Chance fracture associated with paraplegia on the 7th day. Operative findings included a transverse tear of the left rectus abdominus muscle, an incomplete transection of the stomach and perforation of the ileum. The injuries were ultimately fatal. Given associated abdominal pain, skin erosions at the site of seatbelt contact, spinal fracture, and rectal muscle disruption apparent on emergency laparotomy, early diagnosis is important for better prognosis.

Polylactide acid pins versus stainless steel pins in the treatment of diaphyseal fracture: Experimental study in rats.

In order to develop a biodegradable pin for diaphyseal femoral fracture fixation, polylactide acid (PLA) pins were implanted in the femoral bone of rats. A distal diaphyseal fracture was performed. Union and tissue reaction to PLA pins versus stainless steel pins was studied after 15 days, and 1, 2 and 6 months of implantation. PLA and stainless steel pins induced the same union and a similar tissue reaction during the 6-month period. Biocompatibility of material was satisfactory.

Angiotensin II administration to atherosclerotic mice increases macrophage uptake of oxidized ldl: a possible role for interleukin-6.

The goal of the present study was to elucidate mechanisms for angiotensin II (Ang II) induction of oxidized low density lipoprotein (Ox-LDL) uptake by macrophages, the hallmark of early atherosclerosis. Compared with placebo treatment, Ang II injections (0.1 mL, 10(-7) mol/L per day) for 2 weeks to apolipoprotein E-deficient mice significantly increased Ox-LDL degradation, CD36 mRNA expression, and CD36 protein expression by their peritoneal macrophages (MPMs). These effects were abolished by treatment with losartan (5 to 50 mg/kg per day) before Ang II administration. Because no such effect was obtained in vitro, the ex vivo effect of Ang II on macrophage uptake of Ox-LDL could be mediated by a factor that is not expressed at a significant level in vitro. Because Ang II stimulates cellular production of interleukin-6 (IL-6), we analyzed the possible role of IL-6 as a mediator of Ang II-mediated cellular uptake of Ox-LDL by using several approaches. First, incubations of IL-6 with MPM or IL-6 administration in mice increased macrophage Ox-LDL degradation and CD36 mRNA expression. Second, injection of IL-6 receptor antibodies in mice during Ang II treatment reduced macrophage Ox-LDL uptake and CD36 expression compared treatment with Ang II alone. Finally, Ang II treatment of IL-6-deficient mice did not affect their MPM Ox-LDL uptake and CD36 protein levels. Thus, we conclude that a novel mechanism for Ang II atherogenicity, related to macrophage cholesterol accumulation and foam cell formation, may involve its stimulatory effect on macrophage uptake of Ox-LDL, a process mediated byIL-6.

Pomegranate juice supplementation to atherosclerotic mice reduces macrophage lipid peroxidation, cellular cholesterol accumulation and development of atherosclerosis.

Inhibition of lipid peroxidation contributes to the attenuation of macrophage cholesterol accumulation, foam-cell formation and atherosclerosis. Evidence suggests that nutritional antioxidants such as pomegranate juice (PJ) can contribute to the reduction of oxidative stress and atherogenesis. The goals of the present study were to determine whether such beneficial effects of PJ exist when supplemented to apolipoprotein E-deficient (E(0)) mice with advanced atherosclerosis and to analyze the antiatherosclerotic activity of a tannin-fraction isolated from PJ. Mice (4-mo-old) were supplemented with PJ in their drinking water for 2 mo and compared with age-matched placebo-treated mice, as well as to young (4-mo-old) control mice, for their mouse peritoneal macrophage (MPM) oxidative state, cholesterol flux and mice atherosclerotic lesion size. PJ supplementation reduced each of the proatherogenic variables determined in the present study compared with age-matched placebo-treated mice. It significantly induced serum paraoxonase activity and reduced MPM lipid peroxide content compared with placebo-treated mice and control mice. PJ administration to E(0) mice significantly reduced the oxidized (Ox)-LDL MPM uptake by 31% and MPM cholesterol esterification and increased macrophage cholesterol efflux by 39% compared with age-matched, placebo-treated mice. PJ consumption reduced macrophage Ox-LDL uptake and cholesterol esterification to levels lower than those in 4-mo-old, unsupplemented controls. PJ supplementation to E(0) mice with advanced atherosclerosis reduced the lesion size by 17% compared with placebo-treated mice. In a separate study, supplementation of young (2-mo-old) E(0) mice for 2 mo with a tannin fraction isolated from PJ reduced their atherosclerotic lesion size, paralleled by reduced plasma lipid peroxidation and decreased Ox-LDL MPM uptake. PJ supplementation to mice with advanced atherosclerosis reduced their macrophage oxidative stress, their macrophage cholesterol flux and even attenuated the development of atherosclerosis. Moreover, a tannin-fraction isolated from PJ had a significant antiatherosclerotic activity.

Selective distribution of oxysterols in atherosclerotic lesions and human plasma lipoproteins.

The presence of oxidized sterols (oxysterols) in human serum and lesions has been linked to the initiation and progression of atherosclerosis. Data concerning the origin, identity and quantity of oxysterols in biological samples are controversial and inconsistent. This inconsistency may arise from different analytical methods or handling conditions used by different investigators. In the present study, oxysterol levels and distribution were analyzed by an optimized GC-MS method, in human atherosclerotic coronary and carotid lesions, in atherosclerotic apolipoprotein E deficient mice (E degrees mice) and in native and in vitro oxidized human low and high density lipoproteins. Oxysterol levels were analyzed with a limit of detection of 0.06 - 0.24 ng, with 25-hydroxycholesterol (25-OH) being the least sensitive. In human coronary and carotid lesions, obtained from endatherectomic samples, 27-hydroxycholesterol (27-OH) was the major oxysterol, with about 85% as sterols esterified to fatty acids. While total cholesterol and oxysterols levels were similar in both kinds of human lesions, oxysterol distribution was significantly different. In coronary lesions the mean levels of 27-OH and 7beta-hydroxycholesterol (7beta-OH) were 38% and 20% of total oxysterols, whereas in carotid lesions their mean levels were 66% and 5%, respectively. Unlike in human aortic lesions, 27-OH was entirely absent in E degrees mice, whereas the level of 7alpha-hydroxycholesterol (7alpha-OH) was 28% of the total oxysterols, vs. 5% in human coronary lesions. As 27-OH is an enzymatic product of cholesterol oxidation, this finding may indicate that such an enzymatic process does not take place in E degrees mice.

A case report of olanzapine-induced hypersensitivity syndrome.

Hypersensitivity syndrome is defined as a drug-induced complex of symptoms consisting of fever, rash, and internal organ involvement. The hypersensitivity syndrome is well recognized as being caused by anticonvulsants. Olanzapine is an atypical antipsychotic agent whose side effects include sedation, weight gain, and increased creatinine kinase and transaminase levels. To date, there have been no reports of hypersensitivity syndrome related to this drug. A 34-year-old man developed a severe generalized pruritic skin eruption, fever, eosinophilia, and toxic hepatitis 60 days after ingestion of olanzapine. After termination of olanzapine treatment, the fever resolved, the skin rash was reduced, eosinophil count was reduced to normal, and the transaminase levels were markedly reduced. Clinical features and the results of skin and liver biopsies indicated that the patient developed hypersensitivity syndrome caused by olanzapine.