Sleep apnoea caused by rheumatoid arthritis

Sleep apnoea syndrome (SAS) is a rarely documented, but possibly lethal, complication of the instability of the cervical spine in rheumatoid arthritis. Five patients with SAS of a central or peripheral origin are presented, and the problems of recognizing and diagnosing the syndrome are discussed. We hope that clinicians will become more aware of the existence and the different aetiologies of SAS, thus improving early recognition and appropriate treatment. Adequate treatment has proven to increase survival in peripheral SAS and seems to be successful in doing so in central SAS.      

Reduction of patient exposure by use of heavy elements as radiation filters in diagnostic radiology

The effect on patient exposure of x-ray filters made of heavy elements has been studied in excretory urography and lumbar spine examinations. Several elements with atomic numbers between 62 and 74 were tested in experiments using radiographic phantoms and in patient studies. A holmium filter reduced skin exposure by more than 50% in excretory urography. Similar results were obtained with ytterbium and tungsten in lumbar spine studies.     

Imaging of tumoral calcinosis: new observations

Five patients with tumoral calcinosis were evaluated with radiography, bone scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging. The arthropathy of calcium pyrophosphate dihydrate deposition disease was seen in two of the patients and pseudoxanthoma elasticum-like syndrome in three. Identification of calcific particular masses on radiographs is characteristic of tumoral calcinosis. Marrow lesions could be identified as patchy areas of calcification (calcific myelitis) in long bones and the calvarium. Bone scintigraphy appears to be the best modality for detection of the masses and marrow lesions and for monitoring therapy. At CT the masses demonstrated a varied appearance, from small and solid to large and cystic. The marrow abnormality appears as an area of increased attenuation and spotty calcification that in the skull may be associated with dural and vascular calcifications. MR imaging of the particular masses was remarkable in that the masses displayed high signal intensity on T2-weighted images despite a large calcific component. Marrow lesions also showed increased signal intensity on T2-weighted images. When calcified particular masses are present the diagnosis is rarely in question. The diagnosis may be overlooked, however, when calcific myelitis is the only manifestation.     

营实挥发性成分的GC-MS分析

目的：对营实挥发油成分进行分析,为其质量评价提供科学依据。方法：采用水蒸气蒸馏法提取营实挥发油,经GC-MS结合计算机检索对其化学成分进行鉴定,用色谱峰面积归一化法确定各化学成分的相对含量。结果：从营实挥发油中分离出95个化学组分,鉴定了其中70个,占挥发油总含量的91．01％。主要成分为软脂酸甲酯和9,12,15-十八烷三烯酸甲酯,相对含量分别为9．132％和10．515％。结论：分析了营实中挥发油的组成和相对含量,该法简便、快速、灵敏度高,为其进一步的开发利用提供了理论依据。     

Clinicopathologic features of antineutrophil cytoplasm autoantibody (ANCA)-associated acute renal failure in Chinese patients

Summary: The clinical course and renal pathologic features of anti-neutrophil cytoplasm auto-antibody (ANCA)-associated renal disease were studied among Chinese patients from a single centre. Eight ANCA positive patients with acute renal impairment were studied, four of whom required dialysis shortly after presentation. Their mean age at presentation was 61.6 ± 4.2 years. Renal histology, obtained in seven patients, showed paucummune crescentic glomerulonephritis in five patients, interstitial nephritis in two patients, and small vessel vasculitis in one patient. Pulmonary baemorrhage was the other common disease manifestation, present in four of the eight patients, necessitating ventilatory support in three patients. Neurologic, cutaneous, and gastrointestinal involvement were also observed. Seven of the eight patients tested positive for pANCA and anti-myeloperoxidase, while cANCA was detected in one patient of the eight patients, six (75%) responded to therapy, consisting of prednisolone and cyclophosphamide in five patients, and antibacterial therapy alone in one patient, who had interstitial nephritis but no evidence of vasculitis. Two patients died from sepsis and severe debilitation one month after presentation. of the other six patients, five had significant improvement of renal function, while one became dialysis-dependent. the levels of ANCA and C-reactive protein remained normal, and disease reactivation was not observed during follow-up for 32.4 ± 6.1 months. Patient and renal survival rates at one year were 75% and 62.5%, respectively. It was concluded that the clinical and pathologic features of ANCA-associated renal disease in Chinese patients are, in general, similar to those described in Caucasians. Nevertheless, cANCA-positivity is distinctly uncommon. the demonstration of interstitial nephritis in two of the eight patients underlines the importance of renal biopsy for correct histologic diagnosis. Early institution of aggressive immunosuppression and supportive therapies are essential for the achievement of favourable outcome in patients with vasculitis.