A 24‐week randomized clinical trial investigating the efficacy and safety of two doses of etanercept in nail psoriasis

Background Nail psoriasis is common in patients with psoriasis and can seriously affect their quality of life. Current treatments are limited and there is no standard course of therapy. Objectives To assess the efficacy and safety of etanercept (ETN) on nail psoriasis in patients with moderate‐to‐severe psoriasis. Methods Patients with moderate‐to‐severe plaque psoriasis, who had previously failed at least one form of systemic therapy for nail psoriasis, were randomized to receive open‐label ETN 50 mg twice weekly (BIW) for 12 weeks followed by once weekly (QW) for 12 weeks (BIW/QW group) or ETN 50 mg QW for 24 weeks (QW/QW group). The primary endpoint was the mean improvement in the Nail Psoriasis Severity Index (NAPSI; score range 0–8) over 24 weeks in the target fingernail with the most severe abnormalities. Results Seventy‐two patients received one or more doses of ETN (38 BIW/QW; 34 QW/QW) and 69 patients were included in the modified intent‐to‐treat population. At baseline, mean (standard error) target fingernail NAPSI score was 6·0 (0·3) in the BIW/QW group and 5·8 (0·3) in the QW/QW group. At week 24, mean target fingernail NAPSI score had decreased significantly by ?4·3 [95% confidence interval (CI) ?4·9 to ?3·7; P < 0·0001] in the BIW/QW group and by ?4·4 (95% CI ?5·0 to ?3·7; P < 0·0001) in the QW/QW group. Improvement in NAPSI showed significant correlation with Psoriasis Area and Severity Index improvement. ETN was well tolerated with no unexpected safety findings. Conclusions Both ETN regimens were effective at treating nail psoriasis in this patient population.     

Debris-Filled Duodenal Diverticulum and Lemmel’s Syndrome

Digestive Diseases and Sciences - We report a case of a 73-year-old woman affected by Lemmel’s syndrome, a rare type of obstructive jaundice caused by a periampullary duodenal diverticulum....     

Mesenteric Cyst with GI Symptoms: A Fluid Approach to Treatment—Case Report and Literature Review

Digestive Diseases and Sciences - Mesenteric cysts are defined as a heterogeneous group of intra-abdominal cystic lesions of the mesentery or omentum that may be found in any portion of the...     

Human in-stent restenosis tissue obtained by means of coronary atherectomy consists of an abundant proteoglycan matrix with a paucity of cell proliferation

Background In-stent restenosis (ISR) is a shortcoming of percutaneous coronary revascularization. Although neointimal cell proliferation is suspected to be the cause of this problem, little histological characterization of this tissue or data on cell replication exist. The purpose of this study was to examine the histologic features and proliferation profile of coronary ISR tissue derived from atherectomy procedures performed on patients with clinical evidence of ISR. Methods ISR tissue retrieved by means of atherectomy from 20 coronary lesions was subjected to histomorphological analyses and immunocytochemistry as a means of examining proteoglycan expression. Cell proliferation was assessed with 2 sensitive markers of replication, in situ hybridization for histone 3 messenger RNA expression and immunocytochemistry for Ki-67 expression. Results The ISR atherectomy specimens consisted primarily of smooth muscle cells, with occasional focal collections of inflammatory cells and organizing thrombus. All specimens had low levels of interstitial collagen and an abundant proteoglycan matrix, with biglycan being overexpressed more commonly than decorin. Cell proliferation was found in only 1 of 20 specimens (2 cells). Conclusion Established ISR lesions contained an abundant proteoglycan matrix and a paucity of proliferating cells. Future therapeutic strategies for ISR should include targeting extracellular matrix production. (Am Heart J 2002;144:702-9.)