IgG deposits can be detected in cell nuclei of patients with both lupus erythematosus and malignancy

The purpose was to find immunological disturbances in lupus erythematosus (LE) patients with concomitant malignancy. 159 LE patients have been analyzed. Routine laboratory analyses including screening of serum autoantibodies and analyzing peripheral blood mononuclear cells by using flow cytometry have been performed. Malignant diseases have been revealed in 12 (7.5%) cases. All patients suffered from internal malignancies. LE patients with vs without malignancy had significantly decreased anti-double stranded DNA (16.6 vs 31.6%; p < 0.05) and increased anti-SSA/SSB (83.3 vs 32.2%/26.4%; p < 3 × 10⁻¹²) antibodies. Patients with neoplastic disease had increased IgG within the cell nuclei (76.6% ± 9.6 vs 51.8 ± 4.6%; p < 2 × 10⁻⁷). IgG penetrating living cells has been shown previously in SLE but has so far not been found in association to LE patients with malignant disease.     

The relationship between nail- and distal phalangeal bone involvement severity in patients with psoriasis

We aimed to investigate the relationship between nail involvement and joint manifestations and whether there was a correlation between nail psoriasis severity and bone manifestations in psoriatic patients without symptomatic psoriatic arthritis in plaque type psoriasis. Thirty-one patients with nail involvement (16 men, 15 women, mean age 45.29 ± 18.73) and 39 patients without nail involvement (16 men, 23 women, mean age 38.41 ± 17.33) were enrolled in the study. X-ray of the hands and feet with magnification were performed. The distal interphalangeal (DIP) joint and bone (tuft of terminal phalanx) were evaluated. A scoring method was performed on the patients with nail involvement. There was no difference in DIP joint involvement in patients with or without finger- and toenail involvement (p = 0.085 and p = 0.062, respectively). However, the prevalence of bone involvement was higher in patients with finger- and toenail involvement than without finger- and toenail involvement (p = 0.039 and p = 0.021, respectively). A positive correlation was also determined between finger- and toenail psoriasis severity and bone involvement severity (r = 0.379, p = 0.001 and r = 0.288, p = 0.015).     

Computed direct magnification radiography of bone tumors

The purpose of this study was to assess the diagnostic performance of computed direct magnification radiography in diagnosing bone tumors as compared with conventional radiography. Ninety-one patients with primary bone tumors and tumor-like lesions were radiographed with conventional and magnification techniques. All radiographs were analyzed by one orthopedic surgeon and two radiologists and the findings were correlated with histopathology. Two microfocal X-ray units were used for computed direct magnification radiography with a focal spot size of 20–130 μm. Using magnification versus conventional radiography, the diagnosis of benign and malignant lesions as well as the individual tumor diagnosis was obtained with higher accuracy (85% versus 71% and 69% versus 51%, respectively, P < 0.01). Margins of destruction, periosteal reactions, and matrix patterns were evaluated with higher accuracy by all observers (P < 0.01). We conclude that computed direct magnification radiography may improve evaluation and diagnosis of bone tumors. Received: 28 September 1999 / Accepted: 30 June 2000     

Impact of a comprehensive safety program on radiation exposure during catheter ablation of atrial fibrillation: a prospective study

Background  Pulmonary vein antral isolation (PVAI) is an effective treatment for atrial fibrillation and involves prolonged procedure and fluoroscopy times. This study assesses the impact of a comprehensive radiation safety program on patient and operator radiation exposure during PVAI. Methods and Results  We evaluated a comprehensive radiation safety program including: (1) verbal reinforcement of previous fluoroscopy times (2) effective collimation (3) minimizing source-intensifier distance and (4) effective lead shield use. Exposure doses in 41 consecutive patients without (group-I, n = 21) and with (group-II, n = 20) the use of radiation safety program were assessed. PVAI was done using intracardiac echo (ICE) guided roving circular mapping catheter. A 3-dimensional mapping system was used in 27% cases for additional guidance. Operator and patient exposure was measured during the PVAI. The age, gender, body mass index and AF duration were similar in both of the groups. The total procedure (166 ± 56 vs 178 ± 38 min, p = 0.54) and fluoroscopy times (74 ± 24 vs 70 ± 20 min, p = 0.72) were comparable. Group-II had significantly lower dose area product (234 ± 120 vs 548 ± 363 Gy cm², p = 0.03) compared to group-I. The mean operator exposure was reduced by half and mean patient peak skin dose by three to ten times with comprehensive radiation safety program. None of the patients were noted to have radiation related skin injuries. Additional lifetime cancer risk was significantly lower in group-II patients (0.08 vs 0.2%, p < 0.001) than group-I. Conclusions  Implementation of a comprehensive radiation safety program described above significantly decreases the radiation exposure to the patient as well as the operator.     

Clinical characteristics and outcomes of patients with idiopathic inflammatory myopathies from Jordan 1996–2009

To describe demographic characteristics, clinical features and outcome of Jordanian patients with idiopathic inflammatory myopathies (IIM), a retrospective chart review of all patients diagnosed with IIM at Jordan University Hospital between 1996 and 2009 was carried out. Thirty patients with IIM were identified. Female to male ratio was 1.7:1, with mean age at diagnosis 34.3 ± 9.2 (10–72) years with bimodal presentation at 21 and 49 years and a mean follow-up of 6.5 ± 5.7 years. Eleven patients had polymyositis (PM); 19 patients had dermatomyositis (DM); 1 patient had DM with malignancy; 2 patients had juvenile DM; and 2 patients had DM/PM with other rheumatologic diseases. Raynaud's phenomenon was present in 26% of patients, dysphagia in 40%, fever in 16%, arthralgia/arthritis in 26%, and dyspnea was present in 26% patients. Positive muscle biopsy and EMG were present in 81% and 92% of patients, respectively. Elevated serum creatinine kinase (CK), AST/ALT and LDH were found in 90%, 72%, and 88% of patients at presentation, respectively. Interstitial fibrosis identified on high-resolution computed tomography (HRCT) was found in 7/14 (50%) patients. Restrictive lung disease was present in 16/21 (76%), low diffusion capacity of lung of carbon monoxide (DLCO) in 10/17 (59%) and pulmonary hypertension in only 3/19 (16%) patients tested. Arab Jordanian patients with IIM showed very low prevalence of malignancy, lower mean age than previous reports, and similar other clinical, laboratory and serologic markers, and survival rate to previous reports. Of interest, we found that extra-muscular manifestations were mainly associated with dermatomyositis.     

Treatment of primary defective iron-reutilization syndrome: revisited

 We encountered two patients who presented with hypochromic–microcytic anemia and were refractory to iron therapy. The symptoms were suggestive of anemia of chronic disease (ACD); however, there was no evidence of any such disease, either inflammatory or malignant. These patients were reminiscent of patients originally described as having primary defective iron reutilization. The hematologic picture consisted of hypochromic–microcytic anemia, low serum iron, low to normal iron binding capacity, high serum ferritin, and increased bone marrow iron in the absence of ringed sideroblasts. These patients had symptomatic anemia and received danazol (200 mg orally) three times per day to which they responded very well with an increase of approximately 3 g in the hemoglobin concentration over 1 year and amelioration of their symptoms. Danazol was well tolerated and did not cause any virilizing side effects. Doses were lowered in maintenance after 1 year to 200 mg once per week, and responses were sustained up to 36 months of follow-up duration. In the differential diagnosis of hypochromic–microcytic anemia, especially in postmenopausal women, one has to consider this type of treatable anemia when more common types such as iron deficiency, chronic inflammation, malignancy, sideroblastic anemia, or thalassemia have been ruled out. Received: 16 June 1999 / Accepted: 1 February 2000     

Very low levels of vitamin D in systemic sclerosis patients

Vitamin D displays many extraosseous immunomodulatory effects. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis (SSc) and to analyze the associations between the concentration of the vitamin and clinical manifestations. In March-April 2009, 65 consecutive SSc patients underwent evaluation of vitamin D concentrations by the LIAISON immunoassay (normal 30-100 ng/ml). Serum levels between 10 and 30 ng/ml were classified as vitamin D insufficiency, while concentrations <10 ng/ml as vitamin D deficiency. None of the patients were receiving vitamin D supplementation at the time of or during the year prior to study entry. The mean level of vitamin D was 15.8 ± 9.1 ng/ml. Only three cases showed normal values; vitamin D insufficiency and deficiency were found in 43 and 19 cases, respectively. Patients with vitamin D deficiency showed longer disease duration (13.1 ± 6.8 versus 9.4 ± 5.5 years, P = 0.026), lower diffusing lung capacity for carbon monoxide (63.7 ± 12.4 versus 76.4 ± 20.2, P = 0.014), higher estimated pulmonary artery pressure (28.9 ± 9.9 versus 22.8 ± 10.4, P = 0.037) and higher values of ESR (40 ± 25 versus 23 ± 13 mm/h, P = 0.001) and of CRP (7 ± 7 and 4 ± 2 mg/l, P = 0.004) in comparison with patients with vitamin D insufficiency; moreover, late nailfold videocapillaroscopic pattern was more frequently found (52.6% versus 18.6%, P = 0.013). None of the patients showed evidence of overt mal-absorption. Low levels of vitamin D are very frequent in patients with SSc. Intestinal involvement is not likely the cause of vitamin D deficit; other factors such as skin hyperpigmentation and reduced sun exposition for psychological and social reasons may be implicated. Patients with vitamin D deficiency showed more severe disease in comparison with patients with vitamin D insufficiency, above all concerning lung involvement. Further trials are awaited to determine whether vitamin D could represent a modifiable factor able to interfere with SSc evolution.     

Clinical associations of anti-endothelial cell antibodies in patients with systemic lupus erythematosus

The aim of this study was to define the clinical associations of anti-endothelial cell antibody (AECA) in systemic lupus erythematosus (SLE) patients by measuring serum AECA titers to correlate with the disease activity and clinical manifestations. Forty-one SLE patients and 27 controls were studied. Serum samples were collected at the time of patient presentation with disease exacerbation and 4 weeks after the start of treatment. The disease activity was evaluated by the SLE Disease Activity Index (SLEDAI). AECA was detected by enzyme-linked immunosorbent assay (ELISA) methods with the surface antigen of the immortalized human microvascular endothelial cell line (HMEC-1). The mean immunoglobulin (Ig)G-AECA and IgM-AECA optical densities (ODs) were significantly higher in patients with SLE compared with controls [mean ± standard deviation (SD), 0.32 ± 0.15 vs 0.18 ± 0.16 and 0.29 ± 0.14 vs 0.21 ± 0.09, respectively]. There was a positive correlation between IgG-AECA and the SLEDAI scores. The positivity rate of AECA in the groups with digital vasculitis, neuropsychiatric lupus, and anti-cardiolipin antibody was significant. In conclusion, AECA may be involved in the pathogenesis of SLE and was correlated with the disease activity. It was also associated with clinical manifestations such as digital vasculitis, neuropsychiatric lupus, and anti-cardiolipin antibody positivity. Received: 10 January 2000 / Accepted: 4 May 2000     

Clinical significance of anti-Ro antibodies in rheumatoid arthritis

The objective of our study was to determine the frequency of anti-Ro antibodies in patients with rheumatoid arthritis (RA), their clinical significance and possible serologic and genetic associations. Consecutive patients with RA (ACR ’87) were studied. Other connective tissues diseases were excluded. Demographic characteristics, extra articular manifestations, and treatment were reviewed. Presence of leukopenia, thrombocytopenia, hypergammaglobulinemia, hypocomplementemia, and cryoglobulinemia were consigned. Rheumatoid factor (RF), antinuclear antibodies (ANAs), anti-Ro, and anti-La were determined by ELISA in all patients; and HLA-DR was determined by PCR and oligotyping. X-rays of the hands and feet were evaluated by Larsen’s score. The study included 106 patients, 94 women and 12 men; mean age was 50.3 ± 11.4 years, mean disease duration was 11.2 ± 6.8 years. Main extra articular manifestations were subcutaneous nodules, xerophthalmia, and xerostomia; 75.5% of the patients were RF+. Anti-Ro antibodies were detected in 12.2% of the patients. When positive and negative anti-Ro patients were compared, no significant difference in any studied variable was observed. According to our results, anti-Ro antibodies lack clinical relevance in patients with RA.     

Clinical Features of Ileal Pouch Polyps in Patients with Underlying Ulcerative Colitis

Purpose Polypoid lesions rarely occur in the ileal pouch in ulcerative colitis patients after restorative proctocolectomy. Clinical features, malignant potential, and management of pouch polyps have not been characterized. Methods We identified 23 ulcerative colitis patients with large polyps (size≥1 cm) of the ileal pouch from our 2,512-case ulcerative colitis pouch database. Demographic, clinical, endoscopic, and histologic data were reviewed. The Pouchitis Disease Activity Index symptom score (range, 0–6) was used to quantify patients’ symptoms before and after polypectomy. Results Of the 23 patients, 95.7 percent (22 patients) had pouch endoscopy indicated for the evaluation of symptoms when polyps were detected, and 60.9 percent of patients had the polyps in the pouch, 26.1 percent in the anal transitional zone, and 21.7 percent in the afferent limb. The mean size of pouch polyps was 1.9 cm ± 1 cm. Twenty-one patients (91.3 percent) had concomitant pouchitis, cuffitis, or Crohn’s disease. On histology, 21 patients (91.3 percent) had inflammatory-type polyps, and 2 (8.7 percent) had dysplastic or malignant polyps. In 18 patients who had endoscopic polypectomy with concurrent medical therapy, the prepolypectomy and postpolypectomy mean symptom scores were 3.4 ± 1.7 and 1.1 ± 1.2 points, respectively (P = 0.015). Two patients (8.7 percent) had pouch excision for malignancy or for concomitant chronic refractory pouchitis. Conclusions The majority of patients with large ileal pouch polyps were symptomatic. These polyps were typically detected on the background of pouchitis, cuffitis, or Crohn’s disease. Although the majority of polyps were inflammatory type, polyps in two patients were dysplastic or malignant. Endoscopic polypectomy with concomitant medical therapy seemed to improve patients’ symptom scores. Supported in part by a NIH grant R03 DK 067275 and an American College of Gastroenterology Clinical Research Award (to B.S.). Poster presentation at meeting of the American College of Gastroenterology, Honolulu, Hawaii, October 30 to November 2, 2005. Reprints are not available.     

Earlier Eradication of Intra-Anal Warts with Argon Plasma Coagulator Combined with Imiquimod Cream Compared with Argon Plasma Coagulator Alone: A Prospective,Randomized Trial

Purpose Despite the increasing incidence of condylomata acuminate, optimal treatment of anal warts is still undecided. This prospective, randomized study was designed to compare the efficacy of combined argon plasma coagulation and imiquimod cream vs. argon plasma coagulation alone in the management of intra-anal warts. Methods From October 2002 to March 2005, 49 patients with intra-anal warts were randomly assigned to argon plasma coagulation plus imiquimod cream (n = 24) vs. argon plasma coagulation alone (n = 25). Therapeutic sessions were repeated until the elimination of the warts. Efficacy of therapy was defined as the time needed for eradication. All patients were followed up for a mean period of 12 months for signs of recurrence. Results Elimination of warts was achieved earlier in patients receiving combination therapy compared with those receiving monotherapy with argon plasma coagulation (62.5 ± 5.4 days vs. 91.2 ± 6.4 days; P = 0.0016). A subgroup analysis performed in HIV-positive patients showed similar results (combination therapy 95 ± 22.6 days; monotherapy 124.3 ± 20.7 days; P = 0.033); however, in HIV-positive patients warts were eradicated later compared with HIV-negative patients (110.8 ± 25.7 days vs. 65 ± 25.4 days; P < 0.0001). No major complications were observed in our study population. After the follow-up period, recurrence of warts was evident in 22.7 percent of patients in the combination group compared with 34.7 percent of patients in the monotherapy group (P = 0.51). Recurrence was significantly higher in HIV-positive patients compared with HIV-negative patients (P = 0.0039). Conclusions Combination therapy with argon plasma coagulator plus imiquimod cream results in earlier clearance of intra-anal warts in both immunocompetent and immunocompromised patients; however, it does not affect the rate of recurrence. Reprints are not available.     

A comparative study of arterial stiffness, flow-mediated vasodilation of the brachial artery, and the thickness of the carotid artery intima–media in patients with systemic autoimmune diseases

Patients with autoimmune diseases may have increased vascular risk leading to higher mortality rates. Novel imaging techniques are necessary for the early assessment and management of these patients. In this study, we compared augmentation index (AIx) and pulse wave velocity (PWV), indicators of arterial stiffness, to brachial arterial flow-mediated vasodilation (FMD) and common carotid artery intima–media thickness (ccIMT), standard indicators of endothelial dysfunction and atherosclerosis, respectively. We wished to assess the vascular status of autoimmune patients by using a novel, cheap, and reproducible technique, the arteriograph. Altogether, 101 patients with systemic autoimmune diseases including primary antiphospholipid syndrome, systemic sclerosis, rheumatoid arthritis, and polymyositis, all having various types of vasculopathies, as well as 36 healthy individuals were investigated. Arterial stiffness was assessed by a TensioClinic arteriograph, a recently validated technique. Brachial arterial FMD and ccIMT were determined using high-resolution ultrasonography. Autoimmune patients exerted impaired FMD (3.7 ± 3.8%), increased ccIMT (0.7 ± 0.2 mm), AIx (1.2 ± 32.2%), and PWV (9.7 ± 2.4 m/s) in comparison to control subjects (FMD = 8.4 ± 4.0%; ccIMT = 0.6 ± 0.1 mm; Aix = −41.1 ± 22.5%; PWV = 8.0 ± 1.5 m/s; p < 0.05). We found a significant negative correlation of FMD with AIx (R = −0.64; p < 0.0001) and PWV (R = −0.37; p = 0.00014). There were significant positive correlations between ccIMT and AIx (R = 0.34; p = 0.0009), ccIMT and PWV (R = 0.44; p < 0.0001), as well as AIx and PWV (R = 0.47; p < 0.0001). AIx, PWV, and ccIMT positively correlated and FMD negatively correlated with the age of the autoimmune patients. Arterial stiffness indicated by increased AIx and PWV may be strongly associated with endothelial dysfunction and overt atherosclerosis in patients with autoimmune diseases. Assessment of arterial stiffness, FMD, and ccIMT are reproducible and reliable noninvasive techniques for the complex assessment of vascular abnormalities in patients at high risk.     

Concomitant diseases in a cohort of patients with idiopathic myositis during long-term follow-up

This study aims to report the concomitant diseases observed and damage outcome in a cohort of patients with adult idiopathic inflammatory myositis (IIM) during long-term follow-up. All patients with IIM were identified from a single centre (follow-up between 1979 and 2006) and fulfilled at least three of the four Bohan and Peter criteria. Patients with inclusion body myositis, juvenile-onset myositis and overt overlap syndromes were excluded. Medical notes were retrospectively reviewed. Concomitant diseases identified were divided into 12 different organ systems (bone, cardiac, respiratory, gastrointestinal, renal, central nervous, malignancy, infection, endocrine, eyes, dermatological and haematological). Patient damage index was calculated using the Myositis Damage Index tool. Fifty-five patients (31 polymyositis, 24 dermatomyositis) were identified. The most prevalent organ system involved was lung with 40 events per 1,000 patient years follow-up. There was significant steroid-related complications with 17/18 patients with bone involvement having osteopenia/osteoporosis. Sjogren's syndrome (n = 3) was the most frequent concomitant auto-immune disease observed. Patients with a higher number of organ systems involved had a significantly higher damage index (r = 0.48, p = 0.001). White patients showed a significant trend to develop more than three other organ system involvement (p < 0.0001) and myositis-related lung disease (p < 0.0001) compared to other races. There is significant steroid-related morbidity in adult IIM patients under long-term follow-up. The prevalence of another concomitant auto-immune disease unlike patients with lupus or Sjogren's syndrome is low.     

Analysis of clinical manifestations and pathology of lupus nephritis: a retrospective review of 82 cases

Lupus nephritis (LN) is a common secondary glomerular disease with diverse clinical manifestations and pathology. We retrospectively analyzed the clinical manifestations and pathology of 82 hospitalized LN patients (73 females and nine males) during February 2004 to February 2009. The mean age at disease onset of male patients was much younger than female patients (27.6 ± 6.8 vs. 35.5 ± 13.9). The kidney biopsy showed that more than 50% was IV-type LN. The II- and III-type LN were also common; their clinical manifestations were common in nephritic syndrome and (or) asymptomatic urinary abnormalities, whereas IV- and V-type LN usually presented nephrotic syndrome. Simultaneously, we investigated that the highest incidence rates of anemia and chronic renal failure were observed in IV- and IV + V-type LN. What was more, we found that serum creatinine level was higher; the interstitial involvement was more severe with renal biopsy. The serum creatinine level and renal interstitial lesions were positively correlated. Our study showed that the different pathologic phenotypes of LN were correlated with the specific clinical manifestations. However, the conclusion should be confirmed by large-scale prospective research.     

Anti-cyclic citrullinated peptide-2 (CCP2) autoantibodies and extra-articular manifestations in Greek patients with rheumatoid arthritis

The objective of our study was to establish whether there is an association between rheumatoid arthritis with extra-articular manifestations (exRA) and anti-cyclic citrullinated peptide 2 (anti-CCP2) antibodies in Greeks. A retrospective study of 220 Greek patients with RA, 95 with exRA and 125 without extra-articular manifestations (cRA). Serum anti-CCP2 antibodies and IgM rheumatoid factor (RF) were measured. CCP2(+) were 65.3% of exRA and 58.4% of cRA patients. RF(+) were 69.5% of exRA and 60.0% of cRA patients. Among exRA patients, 37.9% had high serum anti-CCP2 antibody levels (>100 IU/ml) compared to 21.6% cRA patients (p = 0.008). Serositis and pulmonary fibrosis were found to be associated with high levels of anti-CCP2 antibodies (52.9 vs 26.6%, p = 0.02 and 63.6 vs 26.8%, p = 0.008, respectively). Serum RF levels were 265.0 ± 52.0 IU/ml (mean ± SEM) in exRA and 205.1 ± 40.6 (mean ± SEM) in cRA (NS). High serum RF levels (>268 IU/ml) were more likely to have sicca syndrome. In Greek patients with rheumatoid arthritis (RA), high serum anti-CCP2 antibodies are associated with serositis and pulmonary fibrosis. Therefore, anti-CCP2 antibodies have prognostic significance in patients with RA.     

Serum osteocalcin levels in patients with psoriatic arthritis: an extended report

The aim of the study was to investigate the rate of bone formation in patients with psoriatic arthritis (PsA) compared to controls and patients with psoriasis vulgaris without PsA (PS). Osteocalcin (OC) and other parameters of bone turnover were measured in 32 patients with PsA and 17 patients with PS and compared to controls (n= 50). Patients with PsA do not generally present with different OC levels (3.0 ± 1.6 ng/ml), than controls (3.6 ± 1.17 ng/ml), if disease activity or sex are not considered. Women with PsA had significantly lower OC levels (2.28 ± 0.44 ng/ml) than female controls (4.11 ± 1.7 ng/ml) or women with PS (3.0 ± 0.89 ng/ml). However, mean disease activity (2.27 ± 1.0 vs 2.95 ± 0.92) was also significantly lower in women than men. Furthermore, we found a significant correlation between alkaline phosphatase (AP) and OC in all patients with PsA (r=0.49, P < 0.05). Disease activity of PsA had an influence on OC levels. Patients with no disease activity had lower OC levels (2.2 ± 0.7 ng/ml) than patients with a high activity (OC 3.92 ± 1.25, P < 0.05). Similar results were obtained with alkaline phosphatase. In addition, we found a significant correlation between clinical activity and OC (r= 0.38, P < 0.02) and alkaline phosphatase (r=0.49, P < 0.01). Patients with PsA show a corresponding increase in OC levels, if disease activity is high. The proliferative changes in active PsA may be related to inflammatory mechanisms coupled with bone formation. Received: 28 May 1999 / Accepted: 11 February 2000     

Peripheral bone density in patients with rheumatoid arthritis

Bone loss in patients with rheumatoid arthritis (RA) varies at different skeletal sites. The aim of the study was to evaluate whether bone mineral density (BMD) of the forearm is significantly different in patients with RA and controls and may correlate to BMD or other parameters of inflammation or bone resorption. We included 421 patients (357 women: mean age 58.4 ± 12.87 years and 64 men: mean age 56.11 ± 12.80 years) with RA in the study. BMD values of the ultradistal forearm (0.381 ± 0.052 g/cm²) and middistal forearm (0.519 ± 0.091 g/cm²) were significantly (p < 0.01) lower in women with RA than controls (0.395 ± 0.043 and 0.535 ± 0.052 g/cm², respectively). In contrast, there was no difference in bone density at the lumbar spine (women 0.921 ± 0.l570 g/cm², men 0.941 ± 0.144 g/cm²) or hip (women 08.11 ± 0.140 g/cm², men 0.895 ± 0.143 g/cm²) in patients with RA in comparison to controls (lumbar spine: women 0.930 ± 0.146 g/cm²; men 0.960 ± 0.146 g/cm²; hip: women 0.820 ± 0.122 g/cm²; men 0.899 ± 0.144/cm²). Patients with increased inflammatory activity (elevated C-reactive protein) presented with significantly lower BMD of the hip (0.7533 ± 0.144 versus 0.825 ± 0.138 g/cm²) and ultradistal forearm (0.366 ± 0.09 versus 0.390 ± 0.07 g/cm²). This was not the case for the lumbar spine. BMD of the forearm is precise and, in contrast to BMD of the lumbar spine, significantly lower in patients with RA. It is related to inflammatory activity, grip strength, and treatment with glucocorticoids in patients with RA.     

Impact of recurrent lupus nephritis on lupus kidney transplantation

This study was conducted to delineate the frequency of recurrent lupus nephritis in a Chinese kidney transplant cohort and to estimate its impact on long-term transplant outcomes. A total of 32 lupus transplant patients were enrolled in this study, and the medical records were retrospectively reviewed. Patients with unexplained graft abnormalities were subjected to allograft biopsy. Recurrent lupus nephritis was diagnosed by light microscopy, immunofluorescence, and electron microscopy. In addition, to determine the clinical manifestations of recurrent lupus GN in these patients, serum original systemic lupus erythematosus disease activity index (SLEDAI) scores while undergoing allograft biopsy were evaluated. In total, six out of 32 patients (18.8%; mean age, 40.5 ± 9.1 years) were diagnosed as having recurrent lupus nephritis and the mean time at diagnosis was 5.1 ± 4.9 years post-transplantation. According to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 criteria, three of the six cases (50%) were defined as class I, one was class II, one was class IV, and one was class III + V. The graft and patient survival rates of recurrent lupus nephritis (n = 6) were not different from those of patients with other diagnostic entities. Although recurrent lupus nephritis was not uncommon, it did not appear to have a strong negative impact on long-term outcome in Chinese kidney transplant patients. The recurrence was potentially treatable and should not be precluded for receiving transplantation.     

Function and Quality of Life After Transanal Excision of Rectal Polyps and Cancers

Purpose The purpose of this study was to determine the functional outcomes and health-related quality of life of patients after transanal excision of rectal cancers or polyps and to assess the relationship between functional outcomes and health-related quality of life. Methods All patients having a transanal excision at the Mount Sinai Hospital from 1989 to 2002 were included if the indication for surgery was a benign or malignant neoplasm. Physician charts were reviewed, and patients and their physicians were contacted to obtain follow-up information. Continence was assessed by using the Continence Score described by Jorge and Wexner and the Fecal Incontinence Quality of Life instrument by Rockwood and Lowry. Results Eighty-two patients fit the inclusion criteria (42 males; mean age, 71 ± 13.7 years). Of these, 29 had villous adenomas, 2 had carcinoids, and 1 had a hyperplastic polyp. Fifty had cancers, including 34 with T1, 14 with T2, and 2 with T3 cancers. Seven patients had a low anterior resection or abdominoperineal resection within two months of transanal excision because of advanced features of cancer. Five patients had salvage abdominoperineal resections or low anterior resections for local recurrences. Five patients died of rectal cancer (including 3 who had salvage surgery) and an additional seven patients died of other causes. Functional results were assessed in 58 of 61 eligible patients. The mean Continence Score postoperatively was 3.5 ± 3.9 compared with 2.4 ± 3.7 preoperatively (P = 0.03). The mean Fecal Incontinence Quality of Life scores after surgery in all patients were 3.9 ± 0.3, 3.6 ± 0.6, 3.7 ± 0.3, 3.7 ± 0.6 in the domains of lifestyle, coping, depression, and embarrassment, respectively, after surgery, indicating high quality of life. Using Spearman’s correlation, we found that the continence scores after surgery correlated well with the Fecal Incontinence Quality of Life scores. In the domains of lifestyle (Spearman’s correlation = −0.69), coping and behavior (Spearman’s correlation = −0.7), and embarrassment (Spearman’s correlation = −0.61) but did not correlate well with the domain of depression (Spearman’s correlation = −0.17). Conclusions Although functional results are worsened in a minority of patients after transanal excision, quality of life is high in the majority of patients. Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

Serum protein S100β in patients with malignant melanoma detected by an immunoluminometric assay

S100 protein is well established as a diagnostic tool in malignant melanoma immunohistology. In this study we measured S100β in serum with a recently developed luminometric immunoassay with a detection limit of 0.02 μg/l. By measuring S-100β in a group of apparently healthy individuals a mean value of 0.031 ± 0.026 μg/l was found. In the reference group, serum S100β was below 0.12 μg/l in all cases. To assess the sensitivity of the assay we investigated serum S-100β levels in 371 serum samples of 315 patients with histological proven malignant melanoma at different disease stages. Staging was performed according to the German Society of Dermatology classification. Significant differences were observed between the control group and stages IIb (P = 0.01) and IV (P = 0.001). In tumour-bearing patients of stages IIIb and IV, the difference was highly significant (P < 0.0001). S100β > 0.20 μg/l helps to distinguish between tumour-free and tumour-bearing patients with a specificity of 97.0% and a sensitivity of 64.6%. Our results demonstrate the serum S100β is of limited value as a melanoma marker. However, it has clinical significance for identifying tumour-positive patients in advanced malignant melanoma stages III and IV. Received: 13 August 1999 / Accepted: 16 September 1999