Relationship between the development of blindness in Churg-Strauss syndrome and anti-myeloperoxidase antibodies

Occular involvement is infrequent and blindness rare in Churg-Strauss syndrome. We describe a patient with Churg-Strauss syndrome who presented with blindness. This was associated with the appearance of circulating autoantibodies to myeloperoxidase.      

Early diagnosis of nonviable pregnancy with endovaginal US

The mean diameter of the gestation sac and the presence or absence of a yolk sac or embryo and/or cardiac pulsations on endovaginal ultrasound (US) images were correlated with normal and abnormal outcomes of pregnancy. Sixty-two patients who were less than 10 weeks pregnant (menstrual age) underwent endovaginal US. In 59 patients with gestation sacs greater than or equal to 8 mm, the absence of a yolk sac predicted a nonviable pregnancy with a sensitivity of 67% and a specificity of 100%. In 35 patients with gestation sacs greater than or equal to 16 mm, the absence of an embryo predicted a nonviable pregnancy with a sensitivity of 50% and a specificity of 100%. When the absence of cardiac pulsations was added to the latter group of patients, the sensitivity was 100% and the specificity was 100%. The combination of these criteria (gestation sac size; demonstration of yolk sac, embryo and/or cardiac pulsations) enabled the early (less than 10 weeks menstrual age) diagnosis of a nonviable pregnancy with endovaginal US.     

Augmented Central Pain Processing in Vulvodynia

Vulvodynia (VVD) is a chronic pain disorder wherein women display sensitivity to evoked stimuli at the vulva and/or spontaneous vulvar pain. Our previous work suggests generalized hyperalgesia in this population; however, little is known about central neurobiological factors that may influence pain in VVD. Here we investigated local (vulvar) and remote (thumb) pressure-evoked pain processing in 24 VVD patients compared to 13 age-matched, pain-free healthy controls (HCs). As a positive control we also examined thumb pressure pain in 24 fibromyalgia patients. The VVD and fibromyalgia patients displayed overlapping insular brain activations that were greater than HCs in response to thumb stimulation (P < .005 corrected). Compared to HCs, VVD participants displayed greater levels of activation during thumb stimulation within the insula, dorsal midcingulate, posterior cingulate, and thalamus (P < .005 corrected). Significant differences between VVD subgroups (primary versus secondary and provoked versus unprovoked) were seen within the posterior cingulate with thumb stimulation and within the precuneus region with vulvar stimulation (provoked versus unprovoked only). The augmented brain activation in VVD patients in response to a stimulus remote from the vulva suggests central neural pathology in this disorder. Moreover, differing central activity between VVD subgroups suggests heterogeneous pathologies within this diagnosis.PerspectiveThe presence of augmented brain responses to pressure stimuli remote from the vulva was observed in vulvodynia patients. These findings may guide treatment decisions for better response, as brain mechanisms may be a factor in some VVD patients.     

A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery

Allogeneic blood transfusion has been implicated as an independent risk factor for postoperative bacterial infection in clinical and animal studies. The association among transfusion, quantitative immunologic factors, and infection was examined in 102 patients undergoing 109 spinal fusion procedures. In 60 procedures, patients received autologous blood only; in 24 procedures, they received at least 1 unit of allogeneic blood, and in 25 procedures, they received no transfusions. Twenty-two patients developed bacterial infections, in 8 cases while in hospital and in 14 cases after discharge. Univariate analysis revealed that patients who received any allogeneic blood and those who received no allogeneic blood differed significantly in the rate of hospital-acquired infection (20.8 vs. 3.5%), length of stay (12.3 vs. 9.7 days), days of fever greater than or equal to 38 degrees C (4.0 vs. 2.9), days on antibiotics (3.9 vs. 2.5), duration of surgery (309 vs. 231 min), blood loss (1343 vs. 887 mL), surgeon, and postoperative drop in natural killer (NK) cells (-174 vs. -42/microL). Multivariate logistic and linear regressions revealed that the number of allogeneic units transfused was the only significant predictor of in-hospital infection (p = 0.016) or days on antibiotics and length of stay. None of the clinical, surgical, or transfusion variables was significantly associated with posthospital infection, although a significantly greater drop in NK cells had occurred in patients who developed infection (p = 0.0035). These data strongly implicate allogeneic transfusion as a risk factor for in-hospital postoperative bacterial infection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Detailed per-oral small bowel examination vs. enteroclysis. Part I: Expenditures and radiation exposure

Time involved, patient reaction, and radiation exposure were compared for 25 patients undergoing a per-oral small bowel series and 18 having enteroclysis. For the per-oral study, mean room time was 17 minutes and fluoroscopy time was 4 minutes; for enteroclysis, mean room time was 44 minutes and fluoroscopy time was 22 minutes. Side effects were categorized as mild to moderate in two thirds of patients having enteroclysis, whereas they were minimal in 20% of those having the per-oral examination. Radiation exposure was five times greater for enteroclysis. These factors should be considered along with the age of the patient, indications for the examination, and the accuracy of the technique when planning a study of the small bowel.     

Carpal alterations in adult-onset Still disease, juvenile chronic arthritis, and adult-onset rheumatoid arthritis: comparative study

A specific pattern of pericapitate involvement of the wrist has been described in the rheumatologic literature as characteristic of adult-onset Still disease (AOSD), a relatively rare disorder that is often diagnosed by exclusion after extensive and frequently invasive tests. To evaluate the potential diagnostic value of carpal radiography in suspected cases of AOSD, a retrospective blinded analysis of 48 patients (16 each with AOSD, juvenile chronic arthritis, and adult-onset rheumatoid arthritis) was performed. Pericapitate articular alterations without radiocarpal involvement were found to be distinctly unusual among patients with rheumatoid arthritis but frequent in the setting of AOSD. In juvenile chronic arthritis severe pericapitate involvement also occurs frequently but is more likely to be associated with interosseous fusion and severe pancompartmental disease.