Are spondyloarthropathies as common as rheumatoid arthritis worldwide? A review

The high-range estimate of 1.3% by the National Arthritis Data Workgroup for the prevalence of the entire spectrum of spondyloarthropathies (SpAs) suggests that SpAs may be more prevalent than rheumatoid arthritis (RA) in the United States. Recent surveys from many European countries using the same sample population have also found SpA to be at least as common as RA in most of the studied populations, including Finnish, Swedish, Lithuanian, French, Italian, and Turkish. Among Asian populations, China has the highest prevalence of SpA, with reported estimates generally higher than that of RA. In Thailand and Vietnam, the two diseases are probably equally common, whereas RA seems to be more prevalent than SpA in the rest of Asia, the Pacific Region, and Latin America, as indicated by studies following the COPCORD (Community-Oriented Program for the Control of Rheumatic Diseases) protocol. Both rheumatic disorders are rare in Africa, but SpA is less common than RA.     

Pancréas parasitaire

The parasitic pancreas is a many-faceted entity, the study of which leads to review many nosologic settings. Internal organ not involved in the cycles of parasitic replication as opposed to what one observes for the liver and the digestive tract, the pancreas can however be concerned by cosmopolitan or exotic various parasites. Parasites as usual hosts of the small intestine or bile ducts can cause pancreatic duct obstruction after migration into the Vater ampulla or Wirsung’s canal; other parasites, from digestive or extra digestive origin, more rarely can cause lesions of the pancreatic parenchyma secondarily to unusual migration or blood infection. A systemic mechanism is more exceptionally involved, as during serious attacks of malaria or induced by the pancreatic toxicity of anti-parasitic drugs. The context of immunodepression may evoke opportunist parasites and the possibility of parasitic transmission by pancreatic transplantation. Anatomic and clinical features are eminently variable, oscillating between epiphenomenon of fortuitous or autopsic discovery until potentially serious demonstrations, as acute pancreatitis being able to engage vital prognosis. The whole set of therapeutic tools consists mainly in anti-parasitic chemotherapies, in combination with endoscopic retrograde cholangio-pancreatography or surgery in selected indications.     

Persons with screening-detected haemochromatosis: as healthy as the general population?

BACKGROUND: Hereditary haemochromatosis (HH) is a common genetic disease leading to iron deposition in the liver and other organs. Early treatment will prevent clinical disease and population-based screening for HH has been advocated. However, the benefit of screening depends on the morbidity of HH. We have compared the morbidity in HH persons detected by screening with the morbidity in the rest of the population. METHODS: All inhabitants 20 years or older in a Norwegian county (94,191 persons) were invited to participate in a health survey programme. Of 65,717 participating persons, a blood specimen for transferrin saturation was obtained from 65,238. After repeated laboratory testing and clinical examination, 269 persons were found to have phenotypic HH, while 297 had genotypic HH (the C282/C282Y mutation). Using self-reported data, clinical examinations and analysis of non-fasting blood samples, the morbidity in phenotypic and genotypic HH persons was compared with the morbidity in the rest of the population. All data were collected before subjects were diagnosed with HH, and all comparisons were corrected for age and gender. RESULTS: Compared to control persons, phenotypic and genotypic HH men and women had a higher score on 1 of 17 questions dealing with joint complaints. Phenotypic and genotypic HH women below 50 years of age had a higher prevalence of hypothyroidism (15.2% and 12.5%, respectively, compared to 3.0% in the control population). Phenotypic HH women below 50 years of age had higher diastolic blood pressure than control women. Phenotypic HH men above 50 years of age and genotypic HH men scored lower than control men on a compound myocardial infarction risk score variable, in part due to lower serum cholesterol concentration. Fewer phenotypic HH men above 50 years of age reported having angina pectoris. Otherwise, the health of phenotypic and genotypic HH persons was not different from the health of control persons. CONCLUSION: When corrected for age and gender, the morbidity in persons with screening-detected HH was not very different from the morbidity in the control group, indicating that population-based screening may not be as beneficial as anticipated.     

Superficial venous thrombosis: is it as benign as we think?

Journal of Thrombosis and Thrombolysis -     

Ventriculocoronary Revascularization: Is It as Effective as Coronary Artery Bypass Grafting?

Background: The ventriculocoronary revascularization (VCR) system creates a direct bypass flow channel between the left ventricle and a target coronary artery. We investigated the ability of such a system to support regional and global cardiac function. Methods: Three experimental groups were studied. Controls (group A, n = 4) underwent thoracotomy and left anterior descending coronary artery (LAD) dissection only. Ventricle to coronary artery bypass was performed in four pigs. After thoracotomy, a conduit was established between the left ventricle and the LAD, (group B). In group C (n = 4) the left internal thoracic artery (LIMA) was anastomosed to the LAD. In group B and C the LAD was ligated prior to the anastomosis. Changes of haemodynamics, cardiac function evaluated with the conductance catheter technique, and distal (LAD) flow were studied.Results: In group A all parameters remained stable throughout the study time. After LAD occlusion and release of VCR system (group B) ejection fraction (EF), maximum derivative of change in systolic pressure over time (dp/dt_max), and distal LAD flow decreased significantly. The end-systolic and end-diastolic pressure volume relationship (ESPVR, EDPVR) as haemodynamic parameters remained stable during the course of the experiment. In group C dp/dt_max decreased significantly after the LAD dissection but showed no significant difference to the control group at the end of the experiment. The other parameters remained stable during the study time. Conclusions: The VCR system appears to be not able to provide enough coronary blood flow to maintain regional and global myocardial function.     

Trastuzumab-Induced Cardiomyopathy: Not as Benign as it Looks? A Retrospective Study

BackgroundOne of the recent advances in the treatment of breast cancer is trastuzumab. However, a major side effect of this medication is cardiomyopathy. Our objective was to determine the incidence of trastuzumab-induced cardiomyopathy and the rate of discontinuation of trastuzumab in a clinical setting.Methods and ResultsWe retrospectively reviewed the records of all women treated with trastuzumab at the Moffitt Cancer Center between 2003 and 2007. Cardiomyopathy was defined as symptomatic heart failure or a decrease of ejection fraction by ≥10% from baseline or to <50%. Statistical analysis was done with Fisher exact test, t-test test, and Wilcoxon signed rank test. Cardiomyopathy developed in 52 of 156 (33.3%) of patients being treated with trastuzumab. In the adjuvant group, 23 (19.5%) of women permanently or temporarily discontinued therapy secondary to cardiomyopathy.ConclusionsCardiomyopathy is a common side effect of trastuzumab that leads to discontinuation of treatment in a significant proportion of patients. Further studies are indicated to establish the ways to predict, prevent, and treat cardiomyopathy to provide patients with maximal therapeutic benefit of trastuzumab.