Computed tomography demonstration of unusual diffuse metastatic calcification secondary to renal failure

We report the computed tomography findings in an unusual case of diffuse metastatic calcification secondary to renal failure.     

Characteristics of rheumatoid arthritis patients with self-reported sicca symptoms: evaluation of medical, salivary and oral parameters

OBJECTIVES: To examine the prevalence of sicca symptoms in rheumatoid arthritis (RA)-patients, and to evaluate medical, salivary, and oral parameters in matched subgroups of patients with and without sicca symptoms as well as in healthy controls.
PATIENTS AND METHODS: The prevalence of self-reported sicca symptoms was examined by a postal questionnaire in a representative cohort of RA-patients (n = 105, aged 52–74 years, disease duration 10–20 years, 77% females, 56% RF-positive).Patient subgroups and controls (9–10 in each group) underwent examinations of disease activity, blood analyses, tests of tear and salivary secretion, and examination of oral mucosa and microflora. Analyses of salivary acidic proline-rich proteins (PRPs), statherin and histatins were performed.
RESULTS: One or more sicca symptoms were reported by 65% of RA-patientS. Sicca patients (having ≥4 sicca symptoms) had a more active and severe disease with higher scores for disability, fatigue and tender joints than patients without such symptomS. Other significant findings in the sicca group were lower values of unstimulated whole saliva, output of PRPs, statherin and histatins in submandibular saliva, and higher counts of oral Candida species.
CONCLUSIONS: Sicca symptoms were prevalent in RA.Qualitative and quantitative salivary tests distinguished between sicca and non-sicca RA-patients, though overlap was considerable for some parameters.     

Establishment of a reference formulation for bioequivalence assessment of rifampicin-containing FDCs: an essential step towards improving tuberculosis treatment.

SETTING: Selection of a reference product for bioequivalence studies of rifampicin (RMP) in prequalifying fixed-dose combinations (FDC) for worldwide distribution through the WHO is critical. OBJECTIVE: To investigate the feasibility of establishing FDC formulations as reference products for bioequivalence studies of RMP in prequalification programmes. DESIGN: A biostudy was conducted as an open, two-period randomised cross-over trial. Two three-drug FDCs containing RMP, isoniazid and ethambutol hydrochloride were administered to a group of 22 volunteers with a wash-out period of 1 week. Plasma samples were collected and analysed for the concentration of RMP and desacetyl-RMP, a major active metabolite of RMP, up to 24 h. Pharmacokinetic parameters of RMP were calculated: Cmax, AUC0-24, Tmax, kel and absorption efficiencies. RESULTS: No significant difference was observed between the administered formulations with respect to the major pharmacokinetic parameters Cmax, Tmax and AUC0-24 when evaluated by parametric (two-way ANOVA) and non-parametric (Hauschke's analysis) statistical analysis. The concentration of RMP falls within the reported acceptable therapeutic range. CONCLUSION: FDCs can be developed as a reference product for bioequivalence studies.     

MR imaging of extracranial nerve sheath tumors.

We retrospectively reviewed MR images of 32 histologically proven extracranial nerve sheath tumors (NSTs). There were 23 benign (10 neurofibromas, 13 schwannomas) and 9 malignant NSTs. On T1-weighted images (T1WIs) tumors were isointense or slightly hyperintense to muscle. On T2-weighted images (T2WIs) (11 lesions) and enhanced T1WIs (1 intraspinal lesion), a target pattern with peripheral hyperintense rim and central low intensity was seen in 12 of 23 (52%) benign NSTs (5 of 10 neurofibromas and 7 of 13 schwannomas). This pattern corresponded histologically to peripheral myxomatous tissue and central fibrocollagenous tissue. The pattern was absent in lesions with cystic, hemorrhagic, or necrotic degeneration. These tumors were hyperintense and variably inhomogenous on T2WIs. Malignant NSTs were hyperintense and variably inhomogenous on T2WIs and mimicked benign variably inhomogeneous lesions unless involvement of contiguous structures was visualized. A target pattern was not visible in malignant lesions. Magnetic resonance imaging cannot distinguish schwannomas from neurofibromas, and benign tumors may mimic malignant NSTs when cystic, hemorrhagic, and necrotic degeneration is present. A target pattern may be visualized in some benign NSTs, and evaluation of this sign with assessment of location and growth along nerves may help to avoid confusion with other lesions.     

Irreversible blindness due to multiple tuberculomas in the suprasellar cistern.

A 14-year-old girl developed fever, severe headache, vomiting, and no light perception in both eyes over a 3-day period without a previous complaint of visual or other neurologic difficulties. Neuro-ophthalmologic examination was normal apart from meningismus and blindness. Brain imaging showed ventriculomegaly and multiple enhancing nodules around the optic chiasm. Lumbar puncture showed an elevated opening pressure with lymphocytic pleocytosis. Polymerase chain reaction and enzyme-linked immunoabsorbent antibody tests on the cerebrospinal fluid were positive for Mycobacterium tuberculosis. There was no evidence of tuberculosis elsewhere in the body. Standard antituberculous treatment, including corticosteroids, did not reverse the blindness.