Poststreptococcal reactive arthritis with thoracic spine involvement in an adult

It is controversial whether poststreptococcal reactive arthritis (PSReA) is an entity separate from acute rheumatic fever (ARF) or is a forme fruste of ARF. Although there are many case series of PSReA in children, this entity is not common in adults. We describe an adult patient with polyarthritis and thoracic spine involvement attributed to PSReA.     

Targeting vascular risk in patients with metabolic syndrome but without diabetes

There are no prospective data on the effect of a multitargeted treatment approach on cardiovascular disease (CVD) risk reduction in nondiabetic patients with metabolic syndrome (MetS). Furthermore, the optimal hypolipidemic drug treatment in these patients remains controversial. In this prospective, randomized, open-label, intention-to-treat, and parallel study, 300 nondiabetic patients with MetS, free of CVD at baseline, were studied for a period of 12 months. Age- and sex-matched subjects without MetS (n = 100) acted as controls. All patients received lifestyle advice and a stepwise-implemented drug treatment of hypertension, impaired fasting glucose, and obesity. For hypolipidemic treatment, the patients were randomly allocated to 3 treatment groups: atorvastatin (n = 100, 20 mg/d), micronized fenofibrate (n = 100, 200 mg/d), and both drugs (n = 100). Clinical and laboratory parameters, including the lipid profile and C-reactive protein (CRP), were assessed at the baseline and at the end of the study. The primary end point was the proportion of patients not having MetS or its component features at the end of the 12-month treatment period. The secondary end points were the difference in 10-year CVD risk (Prospective Cardiovascular Munster risk calculator) and the degree of CRP reduction. By the end of the study, 76% of the patients no longer had MetS, and 46% had only one diagnostic MetS factor. The estimated 10-year (Prospective Cardiovascular Munster) risk of all patients with MetS at baseline was 14.6%. This was reduced in the atorvastatin group to 6.4%, in the fenofibrate group to 9.2%, and in the combination group to 5.5% (P < .0001 for all vs baseline). The 10-year risks of the atorvastatin and combination groups were not different from that of the control group (5.0%). C-reactive protein was significantly reduced in all treatment groups, with the atorvastatin and combination groups having the greatest reduction (65% and 68%, respectively, P < .01 vs the fenofibrate group, 44%). Lipid values were significantly improved in all 3 treatment groups, with those on the combined treatment attaining lipid targets to a greater extent than those in the other 2 groups. A target-driven and intensified intervention aimed at multiple risk factors in nondiabetic patients with MetS substantially offsets its component factors and significantly reduces the estimated CVD risk. The atorvastatin-fenofibrate combination had the most beneficial effect on all lipid parameters and significantly improved their CVD risk status. Atorvastatin and combination treatment were more effective than fenofibrate alone in reducing CRP levels.     

Verbal fluency in institutionalized patients with schizophrenia: age-related performance decline

Several studies have reported a relatively stable level of cognitive deficits among patients with schizophrenia regardless of age, while others have suggested continued deterioration with age. We compared the performance of 42 institutionalized patients with schizophrenia and 42 age- and education-matched healthy controls on a semantic and phonemic verbal fluency test. Each group was divided into young participants (<65 years old) and elderly participants (> or =65 years old). We found a fluency condition x diagnostic group x age group interaction on total words produced, a fluency condition x diagnostic group interaction on the number of cluster-related words, and a fluency condition x age group interaction on the number of switches. Patients with schizophrenia generally used similar strategies (i.e., semantic or phonemic cluster-related words and switches) as healthy individuals when generating words, but to a lesser degree. We found a disproportionate decline in the elderly schizophrenic patients relative to that of healthy controls only on the phonemic, relative to the semantic test. This decline in performance appears related to the effects of aging rather than severity or chronicity of illness, duration of institutionalization, or a progressive degenerative process associated with the disorder.     

Management of ovarian cysts with aspiration and methotrexate injection

PURPOSE: To evaluate prospectively ultrasonography (US)-guided cyst aspiration and methotrexate injection in the management of simple and endometriotic ovarian cysts in selected patients. MATERIALS AND METHODS: Authors obtained informed patient consent and approval from hospital ethics committee. Study included 162 female patients (aged 15-77 years) with simple or endometriotic ovarian cysts (3.0-10.6 cm) at a tertiary hospital. Criteria for inclusion in the study were (a) persistence of the cyst for at least 6 months, (b) benign appearance of the cyst at US, and (c) normal serum CA-125 level measurement before the procedure. Authors performed transabdominal aspiration of the cysts with direct US guidance and injection of methotrexate (30 mg). Cytologic examination was performed in all cases. Follow-up US was performed at 1, 3, and 6 months. If the cyst persisted, the procedure could be repeated. Main outcome measure was resolution or persistence of cysts. chi(2) Test or Mantel-Haentszel chi(2) tests for univariate analysis and multiple logistic regression were used for multivariate statistical analysis. RESULTS: Of 162 patients, 148 were available for follow-up. Malignant cells were not found in any of the cases at cytologic examination. At follow-up US, cysts had disappeared in 124 patients (83.8%) and persisted in 24 (16.2%). Cyst diameter proved to be a significant prognostic factor for cyst resolution (P = .01). No major complications were observed. Patients received neither analgesia nor antibiotics. CONCLUSION: US-guided transabdominal aspiration of cyst fluid and subsequent methotrexate injection appears to be an alternative treatment for both simple and endometriotic ovarian cysts in selected cases.     

Recovery during high-intensity intermittent anaerobic exercise in boys, teens, and men

PURPOSE: This study examined the effects of age on recovery of peak torque of knee extensors (PTEX) and flexors (PTFL), and total work (TW) during high-intensity intermittent 30-s (HI30) and 60-s (HI60) exercise in boys (N=19; age, 11.4+/-0.5 yr), teens (N=17; age, 14.7+/-0.4 yr), and men (N=18; age, 24.1+/-2.0 yr). METHODS: Each age group's subjects were subdivided to participate in an HI30 or an HI60 protocol. The HI30 involved 4x18 maximal knee extensions and flexions (1-min rest between sets), and the HI60 comprised of 2x34 reps (2-min rest). PTEX (N.m.kg), PTFL (N.m.kg), and TW (J.kg) were recorded at each set. The percent recovery of PTEX, PTFL, and TW was calculated as percent of the value achieved in the first set. RESULTS: In HI60, the percent recovery for PTEX, PTFL, and TW after the first set was higher in boys compared with teens and men (P<0.01). In HI30, the percent recovery for PTEX, PTFL, and TW was higher in boys compared with men in all sets (P<0.01), and in teens compared with men in the last two sets (P<0.05). The percent recovery of PTFL and TW was higher in boys compared with teens in the last two sets (P<0.05). Lactate increase was most pronounced in men, less pronounced in teens, and least pronounced in boys (P<0.01). Heart rate recovered faster in boys compared with teens and men in both protocols (P<0.05). CONCLUSIONS: The recovery was faster in boys than in teens and men during HI30 and HI60, as evident by the greater percent recovery in boys for a given time. Furthermore, it appears that the rate of recovery during HI30 and HI60 anaerobic exercise is maturity dependent.     

Nickel content of as-received and retrieved NiTi and stainless steel archwires: assessing the nickel release hypothesis

This study assesses the nickel content of as-received and retrieved stainless steel and NiTi archwires alloys. New and used brand-matched, composition-matched, and cross section-matched archwires were subjected to scanning electron microscopy and energy-dispersive electron probe microanalysis. Elemental analysis was performed on three randomly selected areas, and the nickel content, expressed as ratios of Ni/Ti (in NiTi wires) or Ni/Fe (in stainless steel), was statistically analyzed with a t-test (alpha = .05). No changes were detected with respect to Ni content ratios between as-received and retrieved NiTi or stainless steel wires, suggesting an absence of nickel release. Wear and delamination phenomena on the wire surface and the formation of galvanic couple between the stainless steel wires and bracket brazing materials intraorally may modify the corrosion susceptibility of the wire alloys in clinical conditions.     

First trimester diagnosis of dicephalus conjoined twins

Dicephalus twinning is an extremely rare type of conjoined twins. Early prenatal diagnosis of this condition is important to provide an opportunity for pregnancy termination. We present such a case, which was diagnosed by ultrasound examination at 12 weeks of gestation. The ultrasonographic criteria are discussed together with implications for management.     

Primary paratesticular adult ganglioneuroma

Granulocytic sarcoma is a rare tumor composed of neoplastic blood cells, typically occurring during the course of, or before the onset of, acute nonlymphoblastic leukemia. We present a case of a 37-year-old man with acute testicular pain who was found to have a testicular mass diagnosed as granulocytic sarcoma (GS). Because GS virtually always progresses to leukemia, he underwent postoperative radiotherapy and chemotherapy. He was free of disease 6 months after treatment. This case highlights a rare hematologic cancer that urologists and pathologists should be aware of because it can present as a testicular mass.     

Effect of an experimental stenosis in the porcine descending thoracic aorta

OBJECTIVE: To investigate the alterations of mechanical properties in pre- (A) and post- (B) stenotic aortic regions after an experimentally induced stenosis in the descending thoracic aorta. METHODS: Eight healthy, normalipemic and normotensive Landrace pigs were subjected to thoracotomy under sterile conditions. In the upper segment of the descending thoracic aorta a circumferential symmetric constriction 5 mm in length was imposed and stabilized; thus, a 15-20 mm Hg pressure gradient was established. The pressure gradient was verified via catheterization of the vessel with pressure tip catheters. Pre- and poststenotic hemodynamic disturbances were recorded by the use of a bidirectional Doppler flowmeter. Pressure and flow measurements were carried out before, 10 min after, and 90 days after the creation of the stenosis. Euthanasia was performed after 90 days, and the descending thoracic aorta removed. In the A and B regions serial sections of aorta (5 mm in length) create appropriate aortic "rings," to test in a uniaxial tension device, in order to determine the mechanical properties of the vessel. Histological analysis was performed, so as to estimate the content (%) of collagen and elastin fibers within the aortic wall. Eight sham-operated pigs were used as controls. RESULTS: Reverse blood flow was recorded at both the A and B sites, and was maintained until euthanasia. Reverse flow in the poststenotic region B was greater than that in the prestenotic region. Mechanical analysis showed that the aortic wall in A and B regions became stiffer particularly at high strains (P < 0.05). Histological analysis indicated that the percentage of elastin fibers remained almost the same in both regions while the percentage of collagen fibers increased considerably, especially in the B region (P < 0.05). CONCLUSIONS: A nonhemodynamically significant experimental stenosis located at the level of the descending thoracic aorta induced reverse blood flow before and after the stenosis. The higher the reverse flow, the more collagen fibers were produced and the stiffer the aortic wall. Since hypercholesterolemia can be ruled out as a hardening factor in the present study, disturbed flow seems to be an independent factor which activates fibroblasts to overproduce collagen and to eventually reduce the aorta's compliance.