High Frequency Ultrasonography of the Hand in Rheumatoid Arthritis, Psoriatic Arthritis, Gout and Osteoarthritis Patients.

Over the past decades, management of rheumatic diseases improved both due to development of new drugs and to new imaging techniques. OBJECTIVE: The aim of this study was to evaluate the type and frequency of different structures involvement in the hand of patients with rheumatoid arthritis, psoriatic arthritis and gout compared to patients with osteoarthritis of the hand Methods: We designed an observational, transverse study, which included 110 consecutive patients evaluated in the Rheumatology Department, Emergency County Hospital Craiova, during one year 2014-2015, from which 50 were diagnosed with rheumatoid arthritis, 20 with psoriatic arthritis, 20 with gout and 20 with osteoarthritis. All patients uderwent clinical, biological and US examination. RESULTS: The global prevalence showed any US abnormalities at the hand level in 47 (94%) RA patients with respect to 17 (85%) patients in PsA group, 15 (75%) patients with gout and 12 (60%) patients in OA group (p=0.01) (Table 1). In all groups, except PsA patients, the tendon involvement (Figure 3a,b) was present in less than 30% of the patients, the high global prevalence being explained by the joint involvement (Figure 3c,d). In most of the patients with tendon involvement, we found joint involvement too. CONCLUSIONS: In conclusion, although further studies are needed, with more patients and more homogenous population, the study reveals some US involvement pattern depending on the patient's disease.

Ultrasonography Role in Evaluation of Achilles Tendon Enthesis in Reactive Arthritis Patients.

Reactive arthritis is an inflammatory joint disease which develops after 1-4 weeks following an enteral, genital or ORL infection, with a higher frequency in HLA-B27 positive patients. As a group feature, enthesitis is defined as inflammation in bone insertions of tendons, ligaments and muscular fascia. Aims: the main object of this study was to demonstrate the importance of musculoskeletal ultrasonography in Achilles tendon evaluation in patients with reactive arthritis. Patients and methods: we designed a transversal, retrospective study which included 15 patients diagnosed, based on ESSG criteria, with reactive arthritis (ReA), in Rheumatology Department, Emergency County Hospital. From those 15 patients, 9 were positive for a genital infection with Chlamydia trachomatis and 6 patients with enteral infection, 2 with Shigella, respectively 4 with Yersinia. Healthy control group included 15 patients, with no inflammatory joint diseases. After clinical examination, all patients and controls underwent ultrasound (US) evaluation for Achilles tendon changes, using an Esaote MyLab 25 machine, with a linear high frequency probe (10-18 MHz), using EULAR recommendations and OMERACT definitions for enthesitis, tendinitis and erosions. The cutoff value for the Achilles tendon thickness was 5.29mm, as described by Balint et al. Results: We examined 30 Achilles tendons in 15 patients, with a mean age of 35,2years±10,19 standard deviation (SD) and 30 tendons in 15 controls with a mean age of 35,8 years ±12,00 SD. In both groups sex prevalence showed more males than females (66,66% males in controls vs. 60,00% in patients group). We found a statistic significant higher ESR and CRP in patients group, compared to controls (24,86mm/h vs. 11,8mm/h; 18.90mg/dl vs. 6.22mg/dl). Most frequent finding in patients group was retrocalcaneal bursitis (56.66%), followed by tendon thickening (46.66%), compared to control group in which we found more frequently osteophytes (36.66%) and calcifications (23.33%). Tendon thickness was significantly higher in the patients group compared to control group 5.30mm±1.39SD vs. 4.42mm±0.77SD, p=0.008). When compared to clinical examination, US found at least one change in all patients (100% vs. 40.0%). Conclusions: A higher prevalence of retrocalcaneal bursitis and tendon thickening were found in reactive arthritis patients compared to control group. The US found more changes compared to clinical examination and manage to discriminate between the types of changes found more frequently in inflammatory conditions.

Histopathological Study on Conservatively Operated Breast Carcinomas.

In this histopathological study we looked at 303 cases of breast carcinomas, managed though conservative breast surgery and later analysed with the help of a classical histopathological technique, paraffin embedding. The carcinomas were assessed in terms of tumor size, lymph node status, histological type, correlation between invasive tumors and an situ carcinoma component, resection margins, grading and patients age. Following assessment, we looked at associations between above morphological and clinical parameters and ipsilateral local recurrences. We concluded that more than half of our cases were carcinomas, measuring between 2 cm and 5 cm, with no associated lymph node involvement, in keeping with pTNM criteria for stage II. By far, in our study, the most frequent histopathological type was type NOS (63.37%) followed by invasive lobular carcinoma (10.56%) and mixed ducto-lobular invasive carcinoma (6.27%). Other types of invasive carcinoma were rarer, each representing less than 4% of cases. In regards to in situ carcinomas we noted the most common histological types to be both cribriform intraductal carcinoma and comedocarcinoma, each identified in 1.65% of cases. Amongst invasive breast carcinomas, infiltrating ductal carcinoma not otherwise specified (NOS) was found to be most commonly associated with in situ ductal carcinoma lesions. This was seen in 34.9% of cases, and was the only type associated with an extensive in situ component. Analysing the grading of mammary carcinomas in our study showed that the vast majority of cases (63.04%) were grade 3 tumors. In regards to surgical resection margins, ¾ of cases were noted to have negative margins. Tumor recurrences were noted in 12 cases. These cases were most commonly noted to reoccur following initial poorly differentiated, infiltrating ductal carcinomas, not otherwise specified (NOS), with positive resection margins, measuring less than 2 cm. Patiens tended to be under the age of 40 and had positive lymph nodes. The emergence of local recurrences after conservative surgery for early breast cancer is singnificantly linked to poorly differentiated primary tumors (p <0.05) but not correlated with histological type, presence of extensive intraductal carcinoma component, size of primary breast tumor or lymph node status ( p> 0.05). In terms of increasing the risk of ipsilateral recurrence the most important aspect highlighted in our sudy was the status of the resection margins. Patients with positive resection margins had a significantly high risk to develop recurrences after the conservative surgery, compared to those with negative margins (p <0.001).

Diagnosis and treatment challenges in a patient with splenic tumor and chronic viral hepatitis.

UNLABELLED: Non-Hodgkin lymphoma is a cancer of the lymphatic tissue located in various parts of the body: lymph nodes, spleen, thymus, adenoids, tonsils, and bone marrow. The disease occurs mainly in adults, with a higher incidence within the age range of 45 to 60 years. We present a clinical case of non-Hodgkin lymphoma diagnosed in a patient with chronic viral hepatitis B and D. The particularity of this case consists in the diagnosis of primitive spleen lymphoma, described in less than 1% of the cases, and also the difficult antiviral therapy recommendation for the liver disease, given the associated co-morbidity. ABBREVIATIONS: NHL = Non-Hodgkin lymphoma, HDV = Hepatitis delta virus, HCV = Hepatitis C virus, HBV = Hepatitis B virus, CT = Computerized tomography, CEUS = Contrast enhanced ultrasonography, CHOP = cyclophosphamide, doxorubicin, vincristine, prednisone, R-CHOP = cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab.

The Role of Real Time Elastography in the Diagnosis of a Patient with Liver Cirrhosis and Carcinoma of the Uncinate Process of the Pancreas - Case Study.

Hepatic cirrhosis represents the most advanced stage of any chronic liver disease characterized by progressive fibrosis. We report the case of a patient with carcinoma of the uncinate process of the pancreas and an occult form of liver cirrhosis. We concluded, based on the bioclinical profile, that the jaundice syndrome had an underlying mixed mechanism, obstructive and hepatic. Although, the clinical suspicion of pancreatic cancer was backed up by ultrasound, computed tomography and magnetic resonance imaging, we did not obtain, through these imaging investigations, any indicative features of liver cirrhosis. In order to further evaluate the presence of liver cirrhosis, we assessed liver stiffness using two non-invasive methods: Transient Elastography and Real Time Tissue Elastography (RTE). We observed highly suggestive features of liver cirrhosis only through RTE, although its diagnostic accuracy still needs large validation studies. Intraoperative assessment confirmed the diagnosis of liver cirrhosis, changing also the type of surgical approach and patient prognosis.