Immune thrombocytopenia and α-interferon therapy

Thrombocytopenia is often found in patients with liver diseases, especially due to congestive splenomegaly caused by portal hypertension. Immune thrombocytopenia has been described rarely, and it seems to be especially associated with hepatitis C virus, which has been described as having a particular interaction with the immune system contributing to the induction of autoimmunity. Interferons, on the other hand, because of their immunomodulatory properties, are able to induce or exacerbate autoimmune diseases. Mild thrombocytopenia is a common adverse effect of interferon therapy. Severe life-threatening thrombocytopenia is extremely rare. We report two cases of severe immune thrombocytopenia in patients with chronic hepatitis C, probably induced by α-interferon. Bone marrow aspirate and elevated platelet-associated IgG antibodies, determined by indirect immunofluorescence, were suggestive of immune thrombocytopenia. None of the patients had any clinical sign of autoimmune syndrome, including arthritis, serositis, Sicca syndrome, vasculitis, thyroid abnormalities and others. Cryoglobulins and rheumatoid factors were tested and were undetectable. The patients' histories of exposure to α-interferon and the exclusion of other causes are most consistent with drug-induced immune thrombocytopenia. After α-interferon withdrawal, thrombocytopenia was treated successfully with prednisolone and immunoglobulins. Response to treatment was consistent with the diagnosis of α-interferon-induced immune thrombocytopenia and peripheral consumption of platelets.     

The relationship of distinct craniofacial features between Turner syndrome females and their parents

The present study aimed to assess the relationship of craniofacial features between females with Turner syndrome (TS) and their parents. Lateral cephalograms of 63 TS females and 80 family members with normal karyotype were analysed using 13 linear and eight angular cephalometric measurements. The statistical differences of the measurements between adult TS females and their mothers (n = 41) and between adult TS females and their adult sisters (n = 27) were calculated to define the distinct craniofacial features of subjects with TS. Regression models were computed to assess the association of distinct craniofacial features between TS females and their parents (n = 41 for mothers and n = 12 for fathers).Distinct craniofacial features of the subjects with TS were an increased cranial base flexion, shortened posterior cranial base length (S-Ba), retrognathic maxilla and mandible (相似文献   

Temporomandibular joint sound evaluation with an electronic device and clinical evaluation

Sound analysis to diagnose internal derangement has received much attention as an alternative to radiographic examination. The purpose of this study was to compare findings with an electronic device (sonography) and clinical examination to magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ). Twenty-three symptomatic patients (46 joints) were evaluated for this study. All patients had jaw joint pain and one or more of the following findings; limitation of jaw opening, painful mandibular movement with or without clicking or crepitation. The presence or absence of joint sounds was evaluated clinically by palpation and auscultation and with sonography. If sounds were present (clicking or crepitation) on either examination the patient was considered positive for disc displacement for that examination. Two by two tables were constructed comparing sonography and clinical examination with MRI findings. The sensitivity of the sonogram was 84% and the specificity was 33% when compared with MRI findings. The sensitivity of the clinical examination was 70% and the specificity was 40% when compared with MRI findings. This study suggests that clinical and sonographic examination has a high sensitivity (low false negative examinations) but low specificity (high false positive examinations).     

Can Nucleos(t)ide Analogue (NA) Therapy Ever be Stopped in HBeAg-Negative Chronic Hepatitis B?

In this review, evidence is presented that the majority of HBeAg-negative CHB patients previously treated with lamivudine and subsequently with adefovir and entecavir, experience virological and clinical relapse if these therapies were discontinued. Thus current treatment guidelines both of AASLD and EASL recommend indefinite duration of NA treatment in such patients. However, the recommendations of APASL are different, advising a stop of NA treatment if HBV-DNA is negative in three consecutive assays at least 6 months apart. It is clear that the duration of post-treatment sustained remission is variable and its final outcome unpredictable. However, fluctuations of post-treatment HBV-DNA levels are not uncommon and HBeAg-negative CHB patients may experience long periods of transient HBV-DNA undetectability. Data on the frequency of post-treatment HBsAg loss are promising but still limited. The need for prospective, multinational, multicenter studies is stressed.