Sinovitis colinérgica: descripción de 4 casos

We present the clinical and ultrasound findings of four patients with moderate synovitis and urticarial skin lesions associated with sports activity in warm environments. We include progress after treatment with hydroxycin. We suggest a causal relationship similar to cholinergic urticaria where the neighbouring synovium responds with effusion that self-limits once the triggering process has been halted.     

Feasibility of use of magnesium reabsorbable scaffolds in complex coronary artery disease: True bifurcation,multiple overlapping scaffolds and chronic total occlusion treatment

We present first-in-human treatment with bioabsorbable magnesium scaffolds for percutaneous coronary intervention in a patient with nickel allergy. We present images from angiography and optical coherence tomography at three months. We also review the current status of these novel devices.     

Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications,technique, and results

We report the case of a child with tetraplegia after cervical trauma, who subsequently underwent diaphragmatic pacemaker implantation. We reviewed the major indications for diaphragmatic pacing and the types of devices employed. We highlight the unequivocal benefit of diaphragmatic pacing in the social and educational reintegration of individuals with tetraplegia.     

Tangible digital master for product lifecycle management in augmented reality

We present a novel approach, called tangible digital master (TaDiMa), based on a flexible access to Product Lifecycle Management (PLM) database using a tangible/graphical user interface and augmented reality. We developed and tested a technical drawing template with automatically embedded markers for augmentation. We embedded the Mozilla FireFox engine into our annotation system for the integration of web 2.0 applications in the AR environment. We also extended the concept of web feed to PLM for notification of technical contents. We implemented a dynamic labelling management with view-driven filtering and placement. We also present a tangible management for layers visualization and users access by marked tokens. We validated the TaDiMa approach in a selection of possible scenarios for different PLM applications. The main benefit of the TaDiMa system is the easy and low-cost integration in the product lifecycle process.     

Effect of programming different AV intervals on mitral insufficiency in patients with DDD pacemaker]

OBJECTIVE: To study the effect of programming three different atrioventricular intervals (AVI) on mitral insufficiency (MI) in patients with permanent pacemaker due to complete atrioventricular block. METHODS: We included 9 patients (mean age 62 +/- 11 years; 6 men), with permanent DDD pacemaker, isolated MI and normal ventricular function. We evaluated MI (in a quantitative way) and cardiac output (CO) through echocardiographic examination with three different AVI (100, 150 and 200 ms). RESULTS: We observed a reduction in the severity of MI with the reduction of the AVI (best results obtained with AVI of 100 ms). We also observed an increase in the CO in 4 patients (those with MI of greater degree) with AVI of 100 ms. CONCLUSIONS: We observed a correlation of longer AVI with greater degree of MI; our results point to the possibility of increasing the CO of patients with greater degrees of MI with shortening of the AVI (probably due to a partial recovery of the regurgitant volume).     

Hypokalemic rhabdomyolysis and tetany as a presentation of celiac disease in an adult

We describe the case of a 38-year-old man with an hypokalaemic rhabdomyolysis and tetany as a presentation of celiac disease. We discuss the several electrolytic disturbances found in this patient with chronic diarrhoea and malabsorption syndrome and also the treatment which conduced to complete clinical resolution. We conclude that celiac disease should be considered a cause of hypokalaemic rhabdomyolysis.     

Time course of vagal effects studied in clinical electrocardiograms

We consider the transient effects of brief bursts of vagal stimulationon cardiac excitation and conduction as manifested in the clinicalelectrocardiogram. We hypothesize that such vagal effects maybe more frequent than commonly recognized and that they mayaccount for some types of arrhythmias that are commonly ascribedto other mechanisms. We first briefly review the direct chronotropicand dromotropic effects of brief vagal stimulus bursts in animalsand man. We next consider the effects of brief vagal burstson heart period in various arrhythmias in man, particularlyventriculophasic sinus arrhythmia with various degrees of A–Vblock, and various patterns of A–V dissociation. We illustratethese points with numerous clinical ECGs from our patient population,and with other cases from the literature. We next consider theeffects of brief vagal bursts on A–V conduction time,and illustrate this with clinical cases of: (a) prolongationof A–V conduction after premature beats, (b) ‘supernormal’A–V conduction, (c) Wenckebach periodicities, and (d)alternation of A–V conduction times. We review the evidencethat brief vagal bursts are generated in vivo, and are a naturallyoccurring reflex phenomenon. We therefore suggest that suchbrief vagal effects should perhaps be considered more commonlywhen ascribing mechanisms to some complex and often difficultto interpret arrhythmias.     

Strange bedfellows: duodenal ulcer and cancer of the stomach

We have found only 308 cases of gastric cancer in patients with unoperated duodenal ulcer. We present seven men whose duodenal ulcer disease obscured the diagnosis of gastric cancer. We review the theoretical reasons that those with duodenal ulcer may be protected from gastric cancer, along with the current literature.     

Reply: Microalbuminuria: is it a predictor of ischaemic heart disease in rheumatoid arthritis?

We thank Mpofu and colleagues for their interest in our article.We entirely agree that more research is needed to identify themechanisms underlying the development of IHD in RA. We onlyuse the parallelism with type     

Dermatomyositis, complicated with pneumomediastinum, successfully treated with cyclosporine A: a case report and review of literature

We report a rare case of patient with dermatomyositis (DM) who developed spontaneous pneumomediastinum (PnM) and subcutaneous emphysema. She was successfully treated with oral prednisolone and cyclosporine A (CsA). We reviewed the cases of PnM in patients with DM treated with CsA. A review of four previously reported cases revealed that treatment with systemic glucocorticoid and CsA was effective for the DM and PnM. We indicate that initial and early treatment of the patients with DM and PnM with CsA enabled rapid tapering of the dose of glucocorticoid and improved the disease.     

Autologous thrombin for treatment of pseudoaneurysms

Femoral pseudoaneurysms arise in up to 2% of patients after femoral cannulation for cardiac catheterisation. We used autologous thrombin for percutaneous obliteration of pseudoaneurysms occurring after catheterisation. We prepared autologous thrombin isolates from blood of ten patients with femoral pseudoaneurysms, and injected this solution into the pseudoaneurysms with duplex imaging guidance. We then assayed thrombin activity. All pseudoaneurysms were successfully thrombosed without substantial complications, although three patients needed a repeat procedure within 24 h. We have shown that autologous thrombin-induced thrombosis of pseudoaneurysms is reliable, simple, safe, and cheaper than commercial bovine or human thrombin, and avoids risks of anaphylaxis and contamination with prions.     

Color-coded cardiac Doppler

Color flow mapping with Doppler technique was reviewed. We describe the advantages and technical was reviewed. We describe the advantages and technical limitations of the technique. The usefulness of color flow mapping in acquired and congenital disease was studied. We conclude that new information was added, concerning complex intracardiac flow, in order to the traditional study with classic continuous and pulsed Doppler examination.     

Vascular aneurysm producing divided right atrium in a patient with pulmonary atresia and intact ventricular septum

We describe a patient with pulmonary atresia and intact ventricular septum in whom the right atrium was divided by a vascular aneurysm located in the right atrioventricular groove. We postulate that the structure represents an aneursymally dilated right coronary artery taking anomalous origin from the pulmonary trunk, with fistulous communication to the right atrium. We discuss the findings relative to concepts of development of the coronary arteries in normal hearts and in pulmonary atresia with an intact ventricular septum.     

Tuberculosis infection following anti-TNF therapy in inflammatory bowel disease,despite negative screening

We present two patients with inflammatory bowel disease who, despite negative tuberculosis screening, developed a de novo tuberculosis infection after the start of anti tumor necrosis factor alpha treatment. We discuss current screening methods and their limitations, the approach after positive screening and the timing to resume anti-TNFα treatment after TB infection. We shortly mention the immune reconstitution inflammatory syndrome (IRIS), described in a few cases after the stop of anti-TNFalpha while treating the tuberculosis infection. We conclude with some remaining questions concerning tuberculosis in IBD patients.     

Concordance of self-report and informant assessment of emotional well-being in nursing home residents with dementia

The emotional well-being of persons with dementia is an aspect of their quality of life. We examined the stability of informant-rated and self-reported emotion, and the influence of mental status and physical dependence on ratings; we modeled concordance between ratings at both the within- and between-person levels of analysis. We used multilevel modeling to examine data collected over 12 days from 31 nursing home residents. We found significant within-person variation in both informant-rated and self-reported emotion, such that between 40% and 60% of the overall variance in each occurred within persons. We found little correspondence between or within persons between ratings of the informants and residents, regardless of mental status. We recommend statistical techniques that describe these high levels of daily variation in persons with dementia.     

Primary care internal medicine: a challenging career choice for the 1990s

A career in primary care internal medicine can be challenging and rewarding, yet during the last decade fewer medical students have selected training in internal medicine. We wish to inform medical students, their advisors, and other physicians about the field of primary care internal medicine. We define the discipline, compare it with traditional internal medicine and with family practice, and describe features of strong primary care internal medicine training programs. We discuss common misconceptions and concerns about training programs and the career and give examples of career paths chosen by graduates of primary care programs. We encourage students to consider the option of primary care internal medicine when making career decisions and provide faculty advisors unfamiliar with primary care internal medicine training programs with a reference resource.     

Acceleration of atherosclerosis during the course of rheumatoid arthritis

Patients with rheumatoid arthritis (RA) are predisposed to atherosclerosis and cardiovascular disease. This is thought to be caused in part, by exposure to chronic systemic inflammation during the course of the disease. We hypothesized that RA disease duration augments the effect of age on atherosclerosis. We measured the carotid artery intima-media thickness (IMT) in 631 consecutive RA patients. We ascertained age, sex and disease duration, established CV risk factors, RA clinical manifestations and markers of inflammation. We used multivariable regression to model IMT, with age as the independent variable. We then added RA duration quartile x age interaction terms to estimate the IMT-age relationship within RA duration strata. We found that the rate at which the IMT increased per unit of age steepened in proportion to the RA duration, from 0.154 mm/10 years among patients with RA for 7 years or less, to 0.295 mm/10 years among patients with RA for 20 years or more (P相似文献   

Primary vasculitis at high altitude

We describe a 34-year-old mountaineer who presented with gut infarction from necrotizing vasculitis, probably due to Churg-Strauss syndrome. Subsequently, relapses occurred whenever he climbed to 4000 meters. We hypothesize that the effects of vasculitis were compounded by the physiological changes at high altitude. We suggest that patients with systemic vasculitis should be cautious about climbing and trekking at high altitude.     

Hyperinfection strongyloidiasis in a liver transplant recipient treated with parenteral ivermectin

Abstract: Severe strongyloidiasis, including hyperinfection and dissemination, is a recognized complication of solid organ transplantation. However, the development of strongyloidiasis in a liver transplant recipient has not been previously described. We present a case of severe strongyloidiasis occurring in a patient 4 months after liver transplantation and 1 month after receiving treatment for acute rejection. We assess the management challenges in this patient who remained symptomatic despite oral treatment with ivermectin and albendazole and eventual successful treatment with parenteral ivermectin. We review the published experience with alternative methods of ivermectin administration. We also investigate the possible source of infection, as the patient was not from an endemic area.     

From scleredema to AL amyloidosis: disease progression or coincidence? Review of the literature

Scleredema (also called scleredema of Buschke) is a fibromucinous connective tissue disorder of unknown cause that belongs to a group of scleroderma-like disorders. We report the case of a 64-year-old lady with long-standing scleredema, associated with a paraprotein, and progressing to multiple myeloma and AL amyloidosis. The relationship of scleredema with paraprotein and multiple myeloma is well established, but only two cases of scleredema associated with amyloidosis have been reported to date. We suggest that amyloidosis may be underdiagnosed in patients with scleredema and paraproteinaemia. Features attributed to extracutaneous manifestations of scleredema could represent systemic amyloidosis. We review published reports of scleredema associated with paraprotein and discuss the difficulties in the differential diagnosis of scleroderma-like disorders. We discuss the diagnosis of plasma cell dyscrasias and amyloidosis and their relevance in rheumatology practice.