No evidence for increased risk of cutaneous squamous cell carcinoma in patients with rheumatoid arthritis receiving etanercept for up to 5 years

OBJECTIVE: To determine the incidence of cutaneous squamous cell carcinoma (SCC) in patients with rheumatoid arthritis receiving etanercept, a tumor necrosis factor antagonist, for up to 5 years. DESIGN: An etanercept clinical trials' database and an etanercept postmarketing surveillance database were retrospectively analyzed for the incidence of SCC. SETTING: Patients enrolled in clinical trials of etanercept were from private and institutional practices. The postmarketing database comprised reports from postmarketing trials and solicited and spontaneous reports.Patients A total of 1442 patients with rheumatoid arthritis with 4257 patient-years of etanercept exposure (median exposure, 3.7 years) are included in the clinical trials' database. More than 125,000 patients with more than 250,000 patient-years of etanercept exposure are included in the etanercept postmarketing database.Interventions Most patients enrolled in clinical trials of etanercept received a dosage of 25 mg of etanercept subcutaneously twice weekly for most of the time they received etanercept therapy. RESULTS: Only 4 cases of SCC were observed in the etanercept clinical trials' database, an incidence that compares favorably with the expected incidences based on general population data from Arizona (13.1) and Minnesota (5.9). Similarly, few cases of SCC (1 per 10,000 patient-years) have been reported during postmarketing surveillance of etanercept therapy. CONCLUSION: In patients with rheumatoid arthritis, etanercept use of up to 5 years does not seem to be associated with an increase in the incidence of cutaneous SCC.     

Total hip prosthesis CT with single-energy projection-based metallic artifact reduction: impact on the visualization of specific periprosthetic soft tissue structures

Objectives

To compare the image quality of CT with iterative reconstruction alone and in association with projection-based single-energy metal artifact reduction (SEMAR) for the visualization of specific periarticular soft tissue structures in patients with hip prostheses.

Methods

CT studies from 48 consecutive patients with a hip prosthesis (24 unilateral and 24 bilateral) were retrospectively reconstructed using two different methods: iterative reconstruction (IR) alone and IR associated with SEMAR. The influence of metallic artifacts on the identification of various periarticular structures was evaluated subjectively by two readers. The image quality was compared in patients with unilateral and bilateral prostheses.

Results

Visualization of periprosthetic soft tissue was significantly improved by the SEMAR algorithm (p?<?0.0001). When SEMAR was associated with IR, the gluteus minimus and medius tendons, obturator internus muscle, prostate/uterus and bladder could be seen with medium or high confidence. There were no significant differences in image quality between patients with unilateral or bilateral prosthesis when SEMAR was used (p?>?0.2). This algorithm increased the detection of periarticular masses by 30 %.

Conclusion

SEMAR significantly improves the image quality of periarticular soft-tissue structures in patients with hip prostheses.     

Linear signal hyperintensity adjacent to the subchondral bone plate at the knee on T2-weighted fat-saturated sequences: imaging aspects and association with structural lesions

Objective

To describe the association between linear T2 signal abnormalities in the subchondral bone and structural knee lesions.

Materials and methods

MR studies of patients referred for the evaluation of knee pain were retrospectively evaluated and 133 of these patients presented bone marrow edema pattern (BMEP) (study group) and while 61 did not (control group). The presence of linear anomalies of the subchondral bone on T2-weighted fat-saturated sequences was evaluated. The findings were correlated to the presence of structural knee lesions and to the duration of the patient’s symptoms. Histologic analysis of a cadaveric specimen was used for anatomic correlation.

Results

Linear T2 hyperintensities at the subchondral bone were present in 41 % of patients with BMEP. None of the patients in the control group presented this sign. When a subchondral linear hyperintensity was present, the prevalence of radial or root tears was high and that of horizontal tears was low (71.4 and 4.8 %, respectively). Sixty-nine percent of the patients with a subchondral insufficiency fracture presented a subchondral linear hyperintensity. It was significantly more prevalent in patients with acute or sub-acute symptoms (p?Conclusions The studied linear T2 hyperintensity is located at the subchondral spongiosa and can be secondary to local or distant joint injuries. Its presence should evoke acute and sub-acute knee injuries. This sign is closely related to subchondral insufficiency fractures and meniscal tears with a compromise in meniscal function.     

Influence of Calcium on Choline Measurements by 1H MR Spectroscopy of Thigh Muscles

Objective

To study the effects of calcium on the choline peak measurements with 1H MR spectroscopy.

Material and methods

The thigh muscles of two cadaveric specimens were prospectively evaluated on a 3 T MR unit before and after the injection of calcium carbonate (up to 0.4322 g). The choline peaks of 147 spectra from 10 different anatomic locations were quantitatively evaluated. The influence of the calcium concentration and its disposition with respect to the main magnetic field were considered. B₀ phase maps were used to evaluate field inhomogeneities.

Results

The presence of calcium led to a 43 % underestimation of the choline peak and the choline concentration (p?=?0.0002 and 0.0036). The mean choline concentrations before and after CaCO3 injection were 3.53?±?1.72 mmol/l and 1.58?±?0.63 mmol/l. The influence of calcium carbonate on the choline peak estimations was proportional to the calcium concentration. There was a significant position-dependent difference in the estimation of the choline peak amplitude (p?<?0.0154). Calcium injection led to a measurable increase in field inhomogeneities.

Conclusion

There was a significant underestimation of the choline peak amplitude and concentration in the presence of calcium, which might cause misinterpretations of MR spectra.

Key Points

? The presence of calcium led to significant underestimation of choline measurements. ? The influence of calcium is dependent on its concentration and distribution. ? Quantitative MR spectroscopy of calcified tumours should be interpreted with caution.     

Effect of age on the pharmacokinetics of busulfan in patients undergoing hematopoietic cell transplantation; an alliance study (CALGB 10503, 19808, and 100103)

Purpose

Older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome have often been excluded from myeloablative-conditioning regimens containing busulfan because of non-disease-related morbidity and mortality. We hypothesized that busulfan clearance (BuCL) in older patients (>60 years) would be reduced compared to that in younger patients, potentially explaining observed differences in busulfan tolerability.

Methods

AML patients in three CALGB hematopoietic cell transplantation studies were treated with a conditioning regimen using IV busulfan, dosed at 0.8 mg/kg. Plasma busulfan concentrations were determined by LC–MS and analyzed by non-compartmental methods. BuCL was normalized to actual (ABW), ideal (IBW), or corrected (CBW) body weight (kg). Differences in BuCL between age groups were examined using the Wilcoxon rank sum test.

Results

One hundred and eighty-five patients were accrued; 174 provided useable pharmacokinetic data. Twenty-nine patients ≥60 years old (median 66; range 60–74) had a significantly higher BuCL versus those <60 years old (median 50; range 18–60): BuCL 236 versus 168 mL/min, p = 0.0002; BuCL/ABW 3.0 versus 2.1 mL/min/kg, p = 0.0001; BuCL/IBW 3.8 versus 2.6 mL/min/kg, p = 0.0035; BuCL/CBW 3.4 versus 2.6 mL/min/kg, p = 0.0005. Inter-patient variability in clearance (CV %) was up to 48 % in both age groups. Phenytoin administration, a potential confounder, did not affect BuCL, regardless of weight normalization (p > 0.34).

Conclusions

Contrary to our hypothesis, BuCL was significantly higher in older patients compared to younger patients in these studies and does not explain the previously reported increase in busulfan toxicity observed in older patients.     

Dermatofibrom oder Melanom?

Three patients (51-, 72- and 53-year old) revealed in dermoscopy dermatofibroma-like features on skin lesions at their back. According to the pattern, 3-4 dermatofibroma side-by-side could be suggested. Differences of the principle features - postinflammatory hyperpigmentation at the periphery surrounding central scar-like hypopigmentations - must also include the differential diagnosis of a melanoma.