Effet de cryoglobulines cristallisée et non cristallisée sur la production de TNF-α par les monocytes humains

Objectives. Since we isolated an IgG1k cryocrystalglobulinemia in the synovial fluid and the synovial membrane of a patient with destructive arthropathy, we studied the pro-inflammatory properties of this cryocrystalglobulin on TNF-α production by normal human monocytes. Methods. Normal human monocytes were isolated by plastic adhesion before culture in microtiter plates. Adherent monocytes were cultured for 6, 8 and 24 hours with sterile cryocrystalglobulin (150 μg/mL and 2 mg/mL), type I non crystallised cryoglobulin (same concentrations), monosodium urate (MSU) crystals (2 mg/mL) LPS (10 μg/mL) or medium alone. Supernatant TNF-α concentrations were assayed by an ELISA method. Results. Cryocrystalglobulin has no effect on TNF-α production by normal human monocytes. Non crystallised cryoglobulin increased on a time-dependent and concentration-dependent fashion TNF-α production in supernatants. This increased secretion was significantly lower than those achieved with MSU crystals or LPS. Conclusion. IgG1 cryocrystalglobulin has no effect on TNF-α production by normal human monocytes. A role for Fc region changes is discussed with respect to cryocrystalglobulinemia.     

Journée d’hiver de la SFMCP

Programme / Programme

Journée d’hiver de la SFMCP Samedi 12 décembre 2009     

Meningoencefalite linfomonocitária crônica,oligoartrite e eritema nodoso: relato de síndrome de Baggio-Yoshinari de longa e recorrente evolução

The Brazilian human borreliosis, also known as Baggio-Yoshinari Syndrome (BYS), is a tick- borne disease but whose ticks do not pertain to the Ixodes ricinus complex. It is caused by Borrelia burgdorferi sensu lato microorganisms and resembles clinical and laboratory features of Lyme disease (LD). BYS is also distinguished from LD by its prolonged clinical evolution, with relapsing episodes and autoimmune dysfunction. We describe the case of a young female who, over one year, progressively presented with oligoarthritis, cognitive impairment, menigoencephalitis and erythema nodosum. Diagnosis was established by means of the clinical history and a positive serology to Borrelia burgdorferi sensu strictu. The patient received Ceftriaxone 2 g IV/day during 30 days, followed by 2 months of doxicy- cline 100 mg bid. Symptoms remitted and the Borrelia serology tests returned to normality. BYS is a new disease described only in Brazil, which has a raising frequency and deserves the attention from the countrýs medical board because of clinical, epidemiological and laboratory differences from LD. Despite the fact that it is a hard-to-diagnose zoonosis, it is important to pursuit an early diagnosis because the symptoms respond well to antibiotics or it might be resistant to treatment and may evolve to a chronic phase with both articular and neurological sequelae.     

Chirurgie percutanée de l’hallux valgus : étude de sinistralité

Introduction

The objective of this study was to evaluate the malpractice claims related to percutaneous surgery of the hallux valgus using the insurance database of MIC–Branchet specialized in professional civil liability during the last 10 years.

Material and method

We identified 21 cases of claims in relation with percutaneous surgery among a total of 136 claims for hallux valgus including all techniques.

Results

All patients were female. The mean age was 48.3 (19–73 years). The courts of law were “commissions de conciliation et d’indemnisation” (CCI) in 9 cases and “tribunaux de grande instance” (TGI) in 12 cases. Complications in relation with the claims were: insufficient results in 6 cases, stiffness of the MTA in 3 cases, algodystrophy in 3 cases, hallux varus in 2 cases, infection in 2 cases, hallux flexor tendon rupture in 2 cases, metatarsal nonunion in 2 cases, and osteonecrosis of the metatarsal head in 1 case. Surgeons were exonerated in 16 cases. A technical fault was held in 4 cases and lack of information in 1 case (stiffness of the MTA).

Discussion and conclusion

It is necessary to know the specific outcomes and complications of hallux valgus percutaneous surgery to inform patients before surgery and to reduce medicolegal procedures. An adaptive and specific information must be delivered before surgery.

     

Perfil de especialistas e de serviços em reumatologia pediátrica no estado de São Paulo

IntroductionPaediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country.ObjectiveTo investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo.Patients and methodsIn 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care.ResultsMost (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as “restricted use” by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1–34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6–12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection.ConclusionThe field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.     

Estudo comparativo,randômico e duplo‐cego de petidina e cetoprofeno como adjuvantes de lidocaína em anestesia regional intravenosa

Background and objectives

A review of all the adjuncts for intravenous regional anaesthesia concluded that there is good evidence to recommend NonSteroidal Anti‐Inflammatory agents and pethidine in the dose of 30 mg dose as adjuncts to intravenous regional anaesthesia. But there are no studies to compare pethidine of 30 mg dose to any of the NonSteroidal Anti‐Inflammatory agents.

Methods

In a prospective, randomized, double blind study, 45 patients were given intravenous regional anaesthesia with either lignocaine alone or lignocaine with pethidine 30 mg or lignocaine with ketprofen 100 mg. Fentanyl was used as rescue analgesic during surgery. For the first 6 h of postoperative period analgesia was provided by fentanyl injection and between 6 and 24 h analgesia was provided by diclofenac tablets. Visual analogue scores for pain and consumption of fentanyl and diclofenac were compared.

Results

The block was inadequate for one case each in lignocaine group and pethidine group, so general anaesthesia was provided. Time for the first dose of fentanyl required for postoperative analgesia was significantly more in pethidine and ketoprofen groups compared to lignocaine group (156.7 ± 148.8 and 153.0 ± 106.0 vs. 52.1 ± 52.4 min respectively). Total fentanyl consumption in first 6 h of postoperative period was less in pethidine and ketoprofen groups compared to lignocaine group (37.5 ± 29.0 mcg, 38.3 ± 20.8 mcg vs. 64.2 ± 27.2 mcg respectively). Consumption of diclofenac tablets was 2.4 ± 0.7, 2.5 ± 0.5 and 2.0 ± 0.7 in the control, pethidine and ketoprofen group respectively, which was statistically not significant. Side effects were not significantly different between the groups.

Conclusion

Both pethidine and ketoprofen are equally effective in providing postoperative analgesia up to 6 h, without significant difference in the side effects and none of the adjuncts provide significant analgesia after 6 h.