Congenital hemangiopericytoma of the skin

A 5-month-old white boy had a pinhead red spot on his left malleolar region since birth. His mother noted progressive growth and, when he was first examined, the lesion measured 30x25x20 mm in size, had a pyramidal shape, covered by erythematous and smooth skin, with teleangiectasia. The tumor was soft on paipation and movable over the deeper structures (Fig. 1a). X-ray examination revealed no bone abnormalities at that time.
Just before the programmed incisional biopsy, the patient had a febrile episode due to upper respiratory tract viral infection during which the tumor became ulcerated, bleeding and painful (Fig. 1b). As the bleeding was constant the lesion was surgically excised, at which time the whole gelatinous mass was easily detached from the aponeurotic structures (Fig. 1c). The tumor measured 36x31 x30 mm and had a whitish, smooth cut surface crossed by small blood vessels.
Histopathologic examination revealed a tumor mass extending from the mid dermis to the subcutaneous fat and composed of tightly packed fusiform cells in close opposition with lined vascular channels (Fig. 2a). There were atypical areas and mitotic figures were frequently seen. A reticulin preparation showed a dense network surrounding vessels and pericytes. The vessels branched in a staghorn configuration (Fig. 2b). The immunoperoxidase technique with monoclonal antibody anti-Factor VIII was positive in the endothelial cells surrounded by tumor cells (Fig. 2c).
Seven months after surgery the patient returned with a painful subcutaneous mass on the upper third of his left leg that was adherent to the tibial bone. X-ray examination disclosed osteolytic lesions at the tibial base and destruction of the peroneal head (Fig. 3).
The patient was submitted to radiotherapy, amputation of the left lower limb in the middle portion of the thigh and chemotherapy. He is clinically well 3 years after treatment.     

HIV-1 control after transient antiretroviral treatment initiated in primary infection: role of patient characteristics and effect of therapy

BACKGROUND: The occurrence of viral control after interruption of an antiretroviral treatment (ART) initiated during primary HIV-1 infection (PHI) is rare and the frequency and predictive factors of such a control are unknown. METHODS: Within the French ANRS PRIMO Cohort, 164 patients interrupted ART initiated during PHI. We compared patients whose viral load (VL) remained undetectable (<50 copies/ml) or low (50-500 copies/ml) 1 year after ART interruption to those who evidenced a rapid viral rebound. RESULTS: After ART interruption, VL remained undetectable for a median time of 4.5 years in 14 patients ('post-ART controllers') and low in another 14 patients for a median time of 1.5 years. Post-ART controllers also maintained higher CD4(+) T-cell counts compared to other patients. Female gender, a high CD4(+) T-cell count and low VL during PHI, and a high CD4(+) T-cell count and low HIV DNA levels at interruption, were associated with post-ART HIV control. Treatment characteristics did not differ between controllers and non-controllers. Post-ART controllers had lower specific CD8(+) T-cell frequencies and CD8(+) T-cell activation on ART and after ART interruption than non-controllers. CONCLUSIONS: Few patients maintain very low VL after interruption of treatment initiated during PHI. Early patient characteristics were the main factors of viral control, although early initiation of ART and the effect of ART on reservoir might contribute to control.     

One clinic's experience with carbon fiber orthoses in neuromuscular disease

Introduction: The purpose of this study was to summarize our experience with off‐the‐shelf anterior shell carbon fiber ankle–foot orthoses (CFAFOs) prescribed to adult neuromuscular patients in an outpatient clinic. Methods: We studied ambulatory patients who were seen in Muscular Dystrophy Association or amyotrophic lateral sclerosis clinics between 2011 and 2014 and prescribed anterior shell CFAFOs. Charts were reviewed with attention to diagnosis, satisfaction with use, and reasons for acceptance or rejection. We included individuals who were currently using AFOs and those being prescribed AFOs for the first time. We were especially interested in reasons for acceptance or rejection of the orthosis. Results: Two hundred eighty‐three charts were reviewed. Of these, 109 of 123 (89%) patients were satisfied or extremely satisfied with the anterior shell CFAFOs, including 38 who had previously used other styles. Conclusion: Anterior shell CFAFOs should be considered for most neuromuscular patients with distal leg weakness. Muscle Nerve 55 : 202–205, 2017     

Daily cannabis and reduced risk of steatosis in human immunodeficiency virus and hepatitis C virus‐co‐infected patients (ANRS CO13‐HEPAVIH)

Liver steatosis is common in human immunodeficiency virus (HIV)‐hepatitis C virus (HCV)‐co‐infected patients. Some recent studies have found that cannabis use is negatively associated with insulin resistance in the general population and in HIV‐HCV‐co‐infected patients. Given the causal link between insulin resistance and steatosis, we hypothesized that cannabis use has a positive impact on steatosis. Therefore, we aimed to study whether cannabis use in this population was associated with a reduced risk of steatosis, measured by ultrasound examination. ANRS CO13‐HEPAVIH is a French nationwide multicentre cohort of HIV‐HCV‐co‐infected patients. Medical and socio‐behavioural data from clinical follow‐up visits and annual self‐administered questionnaires were prospectively collected. A cross‐sectional analysis was conducted using data from the first visit where both ultrasound examination data for steatosis (positive or negative diagnosis) and data on cannabis use were available. A logistic regression model was used to evaluate the association between cannabis use and steatosis. Among study sample patients (n = 838), 40.1% had steatosis. Fourteen per cent reported daily cannabis use, 11.7% regular use and 74.7% no use or occasional use (“never or sometimes”). Daily cannabis use was independently associated with a reduced prevalence of steatosis (adjusted odds ratio [95% CI] = 0.64 [0.42;0.99]; P = .046), after adjusting for body mass index, hazardous alcohol consumption and current or lifetime use of lamivudine/zidovudine. Daily cannabis use may be a protective factor against steatosis in HIV‐HCV‐co‐infected patients. These findings confirm the need for a clinical evaluation of cannabis‐based pharmacotherapies in this population. Eudract.ema.europa.eu number, DGS050367.     

用精制7—ADCA生产头孢拉定

为确保头抱拉定的色级在效期内符合药典标准,将主要原料7-ADCA进行精制,利用平行试验的方法,对比头孢拉定的色级及色级稳定性。用精制后的7-ADCA制成的头孢拉定色级由原来的5＃降至2＃,在效期内≤8＃,含量几乎不变,减少了头孢拉定的退货率。     

Trends in newborn mortality over a ten year period at the University College Hospital, Ibadan, Nigeria

Annual mortality amongst 3845 infants cared for on the Special Care Baby Unit of the University College Hospital, Ibadan, Nigeria, over a 10 year period ranged from 16.8% to 36.2%; there was a significant association between mortality and the male sex (p #lt0.05). An inverse relationship was observed between mortality and birth weight p #lt0.05. Low birth weight (LBW) followed by respiratory distress were clearly the two important causes; these were closely followed by septicaemia and birth asphyxia. Amongst the LBW infants, mortality was highest when the former was associated with septicaemia and/or respiratory distress.

For appropriate reduction in mortality, it is concluded that ways of reducing low birth weight, septicaemia and birth asphyxia must be intensified. Additionally there is a need for early referral to tertiary centres which may be better equipped for complicated deliveries.