Lymphoma in Sjogren's syndrome.

Sjogren's syndrome is an autoimmune disease with a known predisposition for lymphoma development. Eight of 120 patients with primary Sjogren's syndrome followed at the University of Ioannina over the past 7 years developed non-Hodgkin's lymphoma diagnosed according to the Kiel classification. The lymphomas differed by location and grading. Six were called low grade (immunocytoma) and two intermediate grade non-Hodgkin's lymphomas. Five of the immunocytomas involved the minor salivary or lacrimal glands. Immunoperoxidase staining for light chains revealed monoclonal populations. Two patients showed spontaneous regression not previously reported in Sjogren's syndrome. Thus, in Sjogren's syndrome, low grade non-Hodgkin's lymphomas and especially immunocytomas are the most common lymphomas. These lymphomas tend to evolve very slowly and may regress spontaneously. Given these facts, a conservative approach to treatment is indicated in those patients with only localized disease.     

Unusual eye manifestations in systemic lupus erythematosus patients

Summary One hundred and twelve records of patients with systemic lupus erythematosus were reviewed and four cases with unusual ocular manifestations are described. We found that anterior uveitis is not an uncommon manifestation of systemic lupus erythematosus and physicians must be aware of it during the patient's evaluation, since it can be treated without serious visual loss. Optic neuritis is uncommon in systemic lupus erythematosus and visual loss may be permanent despite therapy.     

Validation and cross-cultural adaptation of Greek version of Achilles tendon Total Rupture Score

Background

The purpose of this study was the translation, cross-cultural adaptation and validation of the Achilles Tendon Total Rupture Score (ATRS) in Greek population.

Open versus endovascular repair of acute aortic transections—a non-randomized single-center analysis

Purpose  

To analyze early and midterm results after open and endovascular treatment of traumatic aortic transections (TAT).     

Sj?gren's syndrome in systemic lupus erythematosus

Sixty unselected consecutive patients with systemic lupus erythematosus (SLE) were prospectively evaluated for evidence of Sj?gren's syndrome. This was diagnosed in the patients whose minor labial salivary gland biopsy was graded greater than or equal to 3 (according to Chisolm and Mason), who also had keratoconjunctivitis sicca (positive rose bengal eye test) and/or xerostomia (subjective xerostomia and decreased stimulated parotid flow rate). Lip biopsy revealed focal round cell infiltration compatible with a greater than or equal to 3 grade in 11 patients, minimal perivascular infiltration in 21 patients and no infiltration in 28. In the positive biopsy group (greater than or equal to 3 grade) subjective xerophthalmia, decreased parotid flow rate, parotid gland enlargement, lymphadenopathy, presence of rheumatoid factor and anti-La (SSB) antibodies were significantly commoner than in the others. Of the 11 patients of this group, 5 had keratoconjunctivitis sicca which sufficed for the diagnosis of Sj?gren's syndrome, suggesting a prevalence of 8.3% in our population with SLE. In these individuals subjective xerophthalmia (40%), positive Schirmer's I eye test (60%), decreased parotid flow rate (80%), parotid gland enlargement (80%) and presence of rheumatoid factor (80%) and anti-La (SSB) antibodies (80%) were significantly more frequent than in the remaining patients, whereas significant differences regarding other features of SLE were not observed. Our results suggest that Sj?gren's syndrome in SLE is relatively rare and usually mild. Furthermore, it may present more similarities to primary Sj?gren's syndrome than to secondary Sj?gren's syndrome accompanying rheumatoid arthritis.     

Early rheumatoid arthritis: does gender influence disease expression?

OBJECTIVE: To investigate whether gender is an independent factor associated with disease expression in early rheumatoid arthritis (RA) patients. METHODS: 438 patients with early RA (disease duration less than one year) were studied. They all were patients with early RA who presented at the Rheumatology Clinic of the University Hospital of Ioannina during the period 1991-2000. All patients fulfilled the American College of Rheumatology criteria for RA. The demographic, clinical, laboratory, radiological and therapeutic characteristics of the disease at diagnosis, and at the last follow-up were analyzed according to gender. RESULTS: We studied 312 women and 126 men with early RA. The female to male ratio was 2.5:1 and the mean age at diagnosis was 49.4 +/- 14.9 years for women and 55.3 +/-15.6 years for men (P < 0.0003). Women had a longer duration of follow-up (P < 0.0003). There were no differences between genders in the general symptoms or the simmetricity of joint involvement at at disease onset. However at disease onset women had a higher erythrocyte sedimentation rate (ESR) (> 30 mm/1st hour), although there were no significant differences between the two groups concerninig the rest of the clinical, laboratory and radiological findings. At the last follow-up women still had a higher ESR (>30 min/1st hour), but no significant differences were found between the two groups concerning the rest of the parameters investigated independently of the follow-up duration. Finally, women and men showed the same degree of radiological changes and functional ability and were treated similarly except for the more frequent use of hydroxychloroquine in women. CONCLUSION: It seems that gender does not signficantly influence the expression of RA.     

Feeding arteries of the spinal cord at CT angiography before and after thoracic aortic endografting.

PURPOSE: To study the visualization of spinal cord feeding arteries in patients with complex thoracic aortic pathology undergoing endovascular aortic repair (EVAR) using an optimized protocol for multislice computed tomographic angiography (MSCTA). METHODS: Eighteen consecutive patients (13 men; mean age 63 years, range 45-79) with aortic type B dissections (n=5), chronic expanding aortic dissections (n=5), thoracic aortic aneurysms (n=6), or penetrating aortic ulcers (n=2) underwent 16-slice CTA before and after (mean interval 9 days) EVAR. Pulse rate and neurological status were documented. Quantitative density measurements were taken at regions of interest (ROI) in the ascending thoracic aorta and at the level of the diaphragm. Two experienced radiologists qualitatively assessed the posterior intercostal arteries (PIA; fully visible, partially visible, non-visible), dorsal branches (DB; visible/non-visible), and artery of Adamkiewicz (AKA; visible/non-visible) on multiplanar reformations and maximum intensity projection reconstructions. RESULTS: MSCTA was performed successfully in 17/18 patients before and after EVAR (1 patient was excluded after EVAR owing to rising creatinine levels). Before EVAR, MSCTA revealed 197/203 PIAs within the stented area, of which 179 were fully and 18 partially visible. No significant (p=0.37) difference was noted for overall PIA detection within the stented area on post-EVAR MSCTA (185/203 PIA), although only 124 were fully and 61 partially visible. Similar results were obtained for DB visualization. The AKA were seen in 10/17 patients pre EVAR and 9/17 post EVAR. In 2 patients, the AKA was localized within the stented aortic segment. ROI analysis revealed contrast densities of 427+/-89 HU and 398+/-84 HU on pre- and post-EVAR MSCTA, respectively. No neurological events were observed. CONCLUSION: The majority of posterior intercostal arteries and dorsal branches remain open after EVAR due to retrograde perfusion. High-resolution MSCTA permits accurate pre- and post-EVAR visualization of spinal cord feeding arteries in patients with thoracic aortic pathology.