Refractory multisystem sarcoidosis responding to infliximab therapy

Chronic progressive multisystem granulomatous disease is seen in 10-30% of patients with sarcoidosis and can result in end organ damage. Corticosteroids are the mainstay of treatment with the addition of cytotoxic agents in severe cases. Some patients are refractory to such treatment and, therefore, management is a challenge. There is currently limited evidence for biological agents such as infliximab, a monoclonal anti-tumor necrosis factor-α antibody in the treatment of multisystem sarcoidosis. We report outcomes of three patients with extensive multisystem sarcoidosis refractory to conventional treatment and treated at our center. Clinical assessment and radiographic imaging were used to assess the response to infliximab treatment. Infliximab therapy induced clinical remission in all three patients, and this clinical response correlated with radiographic evidence of the resolution of granulomatous disease. Serum ACE level was reduced in all cases, and daily steroid dosage was reduced. We propose that infliximab can be an effective treatment in patients with multisystem complex sarcoidosis refractory to conventional drug therapy and can result in sustained clinical remission. Our experience supports the urgent need for randomized controlled clinical trials of anti-TNF therapy in refractory systemic sarcoidosis.     

The influence of resection height on proximal femoral strain patterns after Metha short stem hip arthroplasty: an experimental study on composite femora

Purpose

The number of candidates for a total hip arthroplasty (THA) is steadily increasing, while the average patient age is decreasing for primary THA. The rise in THA is mainly due to excellent clinical outcomes and the extended longevity of modern implants. Short stem arthroplasties with predominantly metaphyseal fixation such as the Metha® stem are suggested for young patients. It is hypothesised that the more physiological load transfer of these devices reduces stress shielding, which in turn may reduce the risk of aseptic loosening. However, patients with femoral deformities often require a deviation of the resection height. To this end, our aim was to evaluate how resection height influences strain patterns in order to characterise possible limits for short stem implantation.

Methods

Biomechanical testing using ten strain gauges on synthetic bone illustrated the strain patterns of three different resection heights (0, +5 and +10 mm) for the Metha stem.

Results

The greatest differences in strains were displayed at the “high” (most proximal) resection height (+10 mm) when compared to the non-implanted strain pattern. At the medial calcar, the strain was 143 % for +10 mm, 96 % for +5 mm and 94 % for 0 mm. Overall, discrepancies were less for deeper resections.

Conclusions

The deeper the resection, the more similar the strain patterns are when compared to a non-implanted synthetic bone. Changes in strain patterns are induced by variation in the varus/valgus positioning of the implant and by different offsets.     

Is flow diversion the death of cerebral bypass and coiling/stent-assisted coiling for giant cavernous aneurysms? A critical review on comparative outcomes and ongoing clinical trials

The classic surgical treatment for symptomatic giant aneurysms originating from the cavernous segment of the carotid artery has been either microsurgical direct clip-reconstruction or carotid occlusion followed by additional cerebral bypass for those patients who fail in a balloon test occlusion. Nevertheless the emergence of new endovascular techniques, especially flow-diverting devices, has promised to revolutionize the treatment of giant cavernous aneurysms, possibly avoiding major microsurgical operations. In this review the authors summarize the current “state-of-art” of treatment of giant cavernous aneurysms, comparing the overall outcomes, complications, morbidity and mortality rates of new flow-diverting devices in relation to traditional microsurgical series.     

Divergent Patterns of Social Cognition Performance in Autism and 22q11.2 Deletion Syndrome (22q11DS)

Individuals with developmental disorders frequently report a range of social cognition deficits including difficulties identifying facial displays of emotion. This study examined the specificity of face emotion processing deficits in adolescents with either autism or 22q11DS compared to typically developing (TD) controls. Two tasks (face emotion recognition and weather scene recognition) were used to explore group differences in visual scanpath strategy and concurrent recognition accuracy. For faces, the autism and 22q11DS groups demonstrated lower emotion recognition accuracy and fewer fixations compared to the TD group. Individuals with autism demonstrated fewer fixations to some weather scene stimuli compared to 22q11DS and TD groups, yet achieved a level of recognition accuracy comparable to the TD group. These findings provide evidence for a divergent pattern of social cognition dysfunction in autism and 22q11DS.