Agranulocytosis under biotherapy in rheumatoid arthritis: three cases hypothesis of parvovirus B19 involvement in agranulocytosis observed under tocilizumab and rituximab for the treatment of rheumatoid arthritis.

Leukopenia is a considerably common complication of tocilizumab [TCZ] and rituximab [RTX] therapy. RTX-induced leukopenia typically exhibits delayed onset. While agranulocytosis has been reported linked to RTX treatment of lymphoma, this complication rarely occurs in rheumatoid arthritis (RA) treatment and, to our knowledge, has never been reported in association with TCZ therapy. We herein report four agranulocytosis cases in three patients, with the first two cases suspected to be secondary to human parvovirus B19 (PVB19) infection. Agranulocytosis manifested in the first patient 2 months following a third RTX course. Bone marrow (BM) polymerase chain reaction (PCR) was positive for PVB19. The patient relapsed after three TCZ courses, with her PCR again positive for PVB19. Both episodes resolved under granulocyte-macrophage colony-stimulating factor (GM-CSF). In the second patient, agranulocytosis manifested after the 74th TCZ course. Bone marrow PCR was positive for PVB19, and the evolution was favorable under intravenous immunoglobulin administration. The third case was a 53-year-old female patient with seropositive RA who presented agranulocytosis after the first infusion of her fourth RTX course. Unfortunately, no PCR PVB19 was made on myelogram. Evolution was favorable after 5 days of GM-CSF. PVB19 infection should be investigated in patients suffering from agranulocytosis manifesting during biotherapy. In cases manifesting from the 15th day of RTX treatment onwards, hemogram must be conducted before readministering the infusion.

Stump Appendicitis: A Clinical Enigma.

Appendectomy is one of the most frequently performed operations. Stump appendicitis, as a postoperative complication of appendectomy, is inflammation of the remnant residue when an incomplete excision occurs. We present a patient with stump appendicitis who had been operated on, laparoscopically, for acute appendicitis 6 months before. The patient was diagnosed with acute appendicitis, underwent surgery, and was discharged on postoperative day 3 without complications. Stump appendicitis is a rare cause of acute abdominal disease but should be considered in the differential diagnosis. Ultrasonography is helpful in the diagnosis.

[Palindromic rheumatism]. / Rhumatisme palindromique.

Palindromic rheumatism is characterized by episodes of arthritis or para-arthritis leaving no residual or radiographic changes. Several diseases should be ruled out in the differential diagnosis. Evolution to rheumatoid arthritis is common, especially in patient with positive rheumatoid factor and anticitrullinated peptides. In seronegative patients, palindromic rheumatism could be part of the spectrum of autoinflammatory diseases because of a high frequency of MEFV mutations. Treatment remains discussed. The use of antimalarials could delay the development of rheumatoid arthritis or another connective tissue disease.

Use of N-butyl cyanoacrylate in nasal septoplasty: histopathological evaluation using rabbit nasal septum model.

OBJECTIVES: This study was designed to investigate the effects of the tissue adhesive N-butyl cyanoacrylate on nasal septal tissues after septal surgery in a rabbit model. METHODS: Forty-two adult New Zealand rabbits were randomly divided into three groups (14 in each group): septoplasty alone, septoplasty plus N-butyl cyanoacrylate, and controls. The open approach was used to explore the nasal septum. After raising mucoperichondrial and mucoperiosteal flaps on both sides of the septum, the septum was detached from the nasal floor in the septoplasty alone and septoplasty plus N-butyl cyanoacrylate groups. In the septoplasty plus N-butyl cyanoacrylate group, the mucoperichondrial and mucoperiosteal flaps were fixed to the septum and the septum was fixed lateral to the nasal spine using N-butyl cyanoacrylate; in the septoplasty alone group, the septum was packed with Merocel. In the control group, no further septal surgery was performed after flap elevation. Animals were observed for bleeding and haematoma formation over the first 24 hours. Seven animals in each group were used to evaluate early histopathological effects on the septal tissues, at four weeks post-operatively; the other seven in each group were used to evaluate late effects, at 12 weeks. RESULTS: Haematoma formation was observed in 10 animals in the septoplasty alone group, in four animals in the control group, and in only one animal in the septoplasty plus N-butyl cyanoacrylate group. The difference in haematoma incidence between the septoplasty alone and the septoplasty plus N-butyl cyanoacrylate groups was significant (p = 0.000). Histopathological evaluation revealed no significant difference between the groups as regards granulation tissue formation at week four versus week 12; however, there was a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the control groups as regards inflammation at week 12 (p = 0.038). There was a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the septoplasty alone group as regards the composition of the bone-cartilage junction zone at week four (p = 0.001). There was also a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the control group as regards the cellular structure of new cartilage formation at week 12 (p = 0.004). CONCLUSIONS: In this rabbit septoplasty model, N-butyl cyanoacrylate appeared to be an effective nasal tissue adhesive, with a low complication rate.

Clinicopathologic analysis: relationship between endometrial carcinoma and uninvolved endometrium.

OBJECTIVE: The aim of this study was to compare the histopathologic features and surgical stage of endometrial carcinoma with tumor-free endometrial tissues. METHODS: Data from the files of 80 patients with endometrial carcinoma who were managed at Haseki Training & Research Hospital between January 2001 and July 2007 were evaluated. We assessed tumor-free endometrium, stage, histologic type and grade, depth of myometrial invasion, peritoneal cytology, adnexal-cervical involvement, lymphovascular space invasion (LVSI), and lymph node metastases. RESULTS: Twenty-nine patients (43%) with endometrial carcinoma had concomitant endometrial hyperplasia. Seven patients (10%) had one or more areas of metaplasia in the endometrium adjacent to the carcinoma. Endometrial carcinoma with atrophic background was significantly associated with aggressive histopathologic type (p < 0.04) and LVSI (p < 0.02). CONCLUSION: The histological characteristics of non-tumoral endometrium were found to be critical in determining the type of aggressive tumor and LVSI in atrophy-associated carcinomas.