Articular manifestations of Beh?et's disease. Apropos of 73 cases

The authors report 73 cases of Beh?et's disease with articular manifestations. Polyarthritis, generally considered to be rare, was found in 20.5 per cent of cases in this series. The unusual features are illustrated. Amongst them, two cases presented deforming and destructive lesions, which have been only exceptionally reported in the literature. A third case is unusual because of the association of Gougerot-Sj?gren's syndrome with Beh?et's disease and polyarthritis deformans. No cases of ankylosing spondylitis were observed. Lastly, the data of this series are compared with those of the literature.     

Leuconostoc osteomyelitis

Leuconostoc spp. is a variety of streptococcus that can cause disease in humans, most notably those with HIV infection or other causes of immunodepression. We report the case of a patient who had Leuconostoc osteomyelitis in an area of lymphedema.     

Urinary release of 72 and 92 kDa gelatinases,TIMPs, N-GAL and conventional prognostic factors in urothelial carcinomas

OBJECTIVES: A urinary release of gelatinases A and B matrix metalloproteinases-2, -9 (MMP-2, -9), and tissue inhibitors (TIMP-1, -2) occurs during normal epithelial turnover. A proteinase increase, reduced inhibitors or both potentially account for cell mobility and bladder cancer progression. In order to define normal levels and thresholds for transitional cell carcinoma (TCC) patients, urinary gelatinases, tissue inhibitors and neutrophil-gelatinase-associated lipocalin (N-GAL) were investigated for end-point clinical status and compared with normal subjects during a 2-year follow-up prospective study. METHODS: Urine specimens [50 adult normal controls; 28 in situ carcinoma patients (pTa) and 23 with ruptured basement membrane (pT1-4)] were screened by gelatin zymograms, immunoblots and ELISA. RESULTS: (1) An important release of inhibitors over low levels of active enzymes was observed in controls independently of age and sex except for higher TIMP-1 levels in males. (2) In cancer patients, increased pro-MMP-9 and active MMP-2 with reduced TIMP-2 levels correlated with higher stages and histological grades. (3) Conversely, reduced MMP-9 and lipocalin levels were initial hallmarks of clinical relapses. CONCLUSIONS: The imbalance between increased MMP-2, -9 and decreased TIMP-2 levels appears to be linked to tumor stage and grade and, more importantly, to clinical events. Changes in the MMP-9 activation state and a lack of N-GAL present as novel markers of tumor progression.     

Diuretic and hypotensive effects of Nigella sativa in the spontaneously hypertensive rat

Nigella sativa (ranunculaceae) is used in Arab folk medicine as a diuretic and hypotensive plant. We report here the diuretic and hypotensive effects of dichloromethane extract of Nigella sativa seeds in the spontaneously hypertensive rat (SHR). An oral dose of Nigella sativa extract (0.6 ml/kg/day) and furosemide (5 mg/kg/day) increased significantly the diuresis by 16 and 30 per cent respectively after 15 days of treatment; urinary excretion of Cl-, Na+, K+ and urea is also increased. Simultaneously, the mean arterial pressure decreased respectively by 22 and 18 per cent in the Nigella sativa treated rat and nifédipine treated rat (0.5 mg/kg/day). In conclusion, the diuretic activity observed in the SHR rat treated with Nigella sativa seeds may be partially responsible for its diuretic action; it seems that other pathways may also be involved in their cardiovascular effects.     

Differenzialdiagnose von Kopfschmerzen in der HNO-Heilkunde

Facial pain and headaches are heterogeneous, therefore, a differential diagnosis, interdisciplinary survey and mapping of the pain symptoms are essential for determination of treatment concepts. This requires an otorhinolaryngology (ENT) adapted zoning of the various pains in the head and neck in line with the classification of the International Headache Society (IHS). In this review, idiopathic, symptomatic and neuralgic facial pain and headaches will be differentiated and classified according to their location from the ENT medical point of view. This provides otolaryngologists with a simplified, targeted diagnosis and subsequent indication for therapy.     

Total and bone-specific alkaline phosphatases in haemodialysis patients with chronic liver disease

ObjectiveThe Kidney Disease: Improving Global Outcomes “KDIGO” recommends regular sampling of bone turnover markers (BTMs) such as total alkaline phosphatases (t-ALP) and bone-specific alkaline phosphatase (b-ALP) in the case of haemodialysis (HD) patients.Design and methodsWe present our results of the regular assessment of t-ALP, b-ALP, and PTH, obtained for existing HD patients with chronic liver disease (LD).Results76 prevalent HD patients were examined. Linear regression showed that b-ALP and t-ALP levels were closely related (r²: 0.6; p < 0.0001), even when the serum PTH level was < 250 pg/mL (r²: 0.56; p < 0.001). The b-ALP/t-ALP ratio was 0.07 ± 0.12 and correlated poorly with PTH levels (r²: 0.03; p = 0.01). Both b-ALP and t-ALP levels did not correlated with PTH levels.ConclusionOur results did not confirm the KDIGO recommendation for using b-ALP as BTM in the special cases of HD patients with LDs.     

Case report: Detection of a hepatitis B surface antigen variant emerging in an elderly patient after an ischemic cerebral vascular accident

HBV reactivations are observed frequently in patients with past hepatitis B infection receiving cytotoxic and/or immunosuppressive chemotherapy for hemato‐oncological malignancies or autoimmune diseases. Recent ischemic stroke was shown to induce immunodepression by misunderstood mechanisms. To our knowledge, the association between HBV reactivation and ischemic stroke has not been reported before. This study reports the case of an anti‐HBs‐ and anti‐HBc‐positive patient who presented HBV reactivation in a context of recent ischemic stroke, with no other intercurrent iatrogenic phenomenon or usual immunosuppressive pathology. J. Med. Virol. 84:1897–1900, 2012. © 2012 Wiley Periodicals, Inc.     

Patients with complicated Pott's disease: management in a rehabilitation department and functional prognosis

ObjectiveThe objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease.Patients and methodsRetrospective study in nine patients over a period of 8 years extending from 2000 to 2008, collated in the Department of Physical Medicine and Functional Rehabilitation, CHU Sahloul, Sousse, Tunisia.ResultsThe mean age of our patients was 43.8 years; sex ratio was 5/4. The spine involvement of tuberculosis was dorsal in seven cases, dorso-lumbar in one patient, and multiple (cervical, dorsal and lumbar) in one case. All patients were paraplegic with a neurological involvement of the bladder. They had prior antituberculosis chemotherapy for at least 8 months. Decompression surgery was performed in six cases. Two female patients presented disorders of spinal posture during treatment requiring surgical revision with osteosynthesis. All patients received additional rehabilitation care. Following a mean duration of hospitalisation in the Rehabilitation department of 47 days with twice-daily sessions of tailored physiotherapy, three patients remained in complete paraplegia, autonomous in wheel-chair and with vesical and sphincter incontinence. The measure of functional independence (MFI) was at admission/discharge 71/92.ConclusionRehabilitation takes an important place in the medico-surgical management in Pott's disease, to limite or compensate the disabilities and handicap related to this pathology.