Mediastinal lymphadenopathy and pulmonary arterial hypertension in mixed connective tissue disease

A case of mixed connective tissue disease (MCTD) is presented in which mediastinal lymphadenopathy was the most prominent radiological finding detected by plain chest radiographs and computed tomography. Pulmonary arterial hypertension, which is a rare and often fatal complication of MCTD, also developed in this patient.     

Selenium metabolism in patients on continuous ambulatory peritoneal dialysis.

BACKGROUND: Selenium is an essential trace element for living organisms. In many publications, researchers express concern about a possible Se deficiency in patients with end-stage chronic renal failure (ESCRF) undergoing continuous ambulatory peritoneal dialysis (CAPD). However, in a number of published articles, the data provide no evidence that patients under CAPD develop Se deficiency. OBJECTIVE: We investigated Se metabolism in ESCRF patients on CAPD. SETTING: The study was carried out at the Department of Propaedeutic Surgery, Athens University; the Laboratory for Material Analysis of the Nuclear Physics Institute; and the State General Hospital, Athens, Greece. PATIENTS AND METHODS: The study group included 24 patients on CAPD treatment, 14 ESCRF patients, and 17 healthy controls. We measured the Se and Fe content of serum, blood, and erythrocytes. We also measured hematocrit, serum total proteins and albumins, and Se in dialysate effluent. RESULTS: As compared with healthy subjects, the ESCRF and CAPD patients exhibited reduced serum concentrations of Se. However, considering the difference in hematocrit values, the total serum-transported Se per liter of blood was close to normal. Erythrocyte Se proved normal for both groups. The measured Se in the spent effluent indicates that patients under CAPD receive approximately 100 microg Se from their daily diet, as normal subjects do. The Se measurement data from the effluent indicate that 90% of the Se carried by the serum is bound to albumins and that only the remaining 10% is in the form of low molecular weight selenate, free to pass the peritoneal membrane. Of the 24 CAPD patients studied, 4 patients (all women) showed extremely low Se serum levels. Data suggest that those low levels are more likely due to the significantly lower serum albumin levels in the 4 patients than to an insufficient dietary intake. CONCLUSIONS: Data from the present experimental work suggest that patients undergoing CAPD receive the necessary quantities of Se from their regular diet. The data contradict statements in the relevant literature that CAPD patients develop Se deficiency.     

Recurrent hemoptysis with Penicillium marneffei and Stenotrophomonas maltophilia in Job’s syndrome

Pulmonary infection caused by the opportunistic organisms Penicillium marneffei and Stenotrophomonas maltophilia in patients with Job’s syndrome is rare and not well documented. The case of a 30-year-old man with Job’s syndrome who developed recurrent pneumonia and lung abscesses caused by P marneffei and S maltophilia, complicated by massive hemoptysis, is described. Bronchial artery embolization was successful in controlling the hemoptysis; however, the infection proved fatal despite appropriate antimicrobial therapy. A brief review of the literature on Job’s syndrome and its associated infective pulmonary manifestations is also presented.     

A survey of the surgical management of acute and chronic scapholunate instability

PURPOSE: Scapholunate instability is a challenging problem and controversy persists among hand surgeons with respect to treatment choice. The purpose of this study was to evaluate the pattern of practice among specialized hand surgeons in the management of both acute and chronic scapholunate instability. METHODS: A mailed survey study was sent to the 1,628 members of the American and Canadian Societies for Surgery of the Hand. Hand surgeons were asked to complete a comprehensive management questionnaire that examined a surgeon's treatment algorithm in the clinical case of acute and chronic scapholunate instability. The algorithm included the choices of further investigation, timing of surgery, surgical approach, surgical procedure, fixation, and predicted outcome. RESULTS: Of the 468 hand surgeons who responded to the survey the vast majority elected to perform surgery when confronted with a case of scapholunate instability. Early surgical intervention within 6 weeks of injury using an open dorsal approach was favored in both acute and chronic cases. The preferred surgical procedure in the acute case was scapholunate repair combined with a capsulodesis followed by scapholunate ligament repair alone. Favored management of the chronic case included Blatt capsulodesis alone, capsulodesis combined with a scapholunate ligament repair, or scaphotrapezium-trapezoid arthrodesis. A majority of surgeons used K-wire fixation, especially of the scapholunate and scaphocapitate in both acute and chronic cases. CONCLUSIONS: This survey confirms a consensus for the early soft tissue surgical management of acute scapholunate instability using a scapholunate ligament repair with or without a capsulodesis. The management of chronic scapholunate instability is highly variable among respondents and the choice of either a soft tissue or bony procedure may depend to a large extent on intraoperative findings.