Complete auriculoventricular block during chloroquine treatment

INTRODUCTION: The cardiac toxicity of antimalarial agents is rare, it includes conduction disorders which can be complicated by third atrioventricular block and hypertrophic cardiomyopathy. We report two observations of patients who presented a complete heart block after several years of treatment by chloroquine. CASE REPORT: Two patients followed for rheumatoid polyarthritis, treated by antimalarial agents for average 12 years and corticotherapy, presented a syncopal complete heart block which required an implantation of a pace maker. After having eliminated all the other underlying causes for complete heart block, the antimalarial agents were accused and were stopped. The clinical evolution after interruption of the treatment was favorable. CONCLUSION: Our observations illustrate rare cardiac side effects observed in our two patients after long-term treatment by antimalarial agents. The diagnosis of antimalarial agents responsibility was retained on clinical and biological arguments after having eliminated the other causes. The insidious character of these complications imposes vigilance during the use of long-term treatment by antimalarial agents.     

Stability of presynaptic vesicle pools and changes in synapse morphology in the amygdala following fear learning in adult rats

Changes in synaptic strength in the lateral amygdala (LA) that occur with fear learning are believed to mediate memory storage, and both presynaptic and postsynaptic mechanisms have been proposed to contribute. In a previous study we used serial section transmission electron microscopy (ssTEM) to observe differences in dendritic spine morphology in the adult rat LA after fear conditioning, conditioned inhibition (safety conditioning), or naïve control handling (Ostroff et al. [2010] Proc Natl Acad Sci U S A 107:9418–9423). We have now reconstructed axons from the same dataset and compared their morphology and relationship to the postsynaptic spines between the three training groups. Relative to the naïve control and conditioned inhibition groups, the ratio of postsynaptic density (PSD) area to docked vesicles at synapses was greater in the fear‐conditioned group, while the size of the synaptic vesicle pools was unchanged. There was significant coherence in synapse size between neighboring boutons on the same axon in the naïve control and conditioned inhibition groups, but not in the fear‐conditioned group. Within multiple‐synapse boutons, both synapse size and the PSD‐to‐docked vesicle ratio were variable between individual synapses. Our results confirm that synaptic connectivity increases in the LA with fear conditioning. In addition, we provide evidence that boutons along the same axon and even synapses on the same bouton are independent in their structure and learning‐related morphological plasticity. J. Comp. Neurol. 520:295–314, 2012. © 2011 Wiley Periodicals, Inc.     

Tabetic arthropathy. A report of 43 cases

Destructive tabetic arthropathy (TA) has become rare in the course of syphilis because of early diagnosis and treatment. TA is difficult to manage because of the severity of the handicap and the absence of a specific treatment. We describe the clinical, biological, and radiological characteristics of TA. In this paper, we performed a retrospective study of 24 patients with TA from 1983 to 2003. Inclusion criteria were typical radiological findings and positive syphilitic serology in blood and/or synovial fluid and/or cerebrospinal fluid. Included in the study were 15 men and 9 women, their mean age was 53.71±12.25 years, and the delay of diagnosis was 36.83±53.03 months. Thirteen patients (54.2%) had a known primary syphilitis. In the studied cases, 43 of the patients’ joints were involved, which concerned knees, hips, the spine, and ankles in 91.66, 8.33, 8.33, and 4.16% of cases, respectively. TA was bilateral in 62.5% and multifocal in 8.3%. The neurological exam found signs suggesting tabes dorsalis in seven cases. The osteoarticular exam showed an abnormal range of mobility (n=25), hydarthrosis, and articular deformation (n=17). Syphilitic serology tests were positive in synovial fluid, cerebrospinal fluid, and blood in 12 (50%), 8 (33.33%), and 24 (100%) cases, respectively. Radiological exam showed atrophic and hypertrophic forms. The frequency and severity of TA in our study may be explained by the frequency of atypical forms of syphilitis and the absence of penicillin in Morocco in the 1950s.     

Leukemia revealed by polyarthritis

INTRODUCTION: Ostéoarticular manifestation whose reveal leukaemia in 4% of the cases, regress completely with haematological remission. EXEGESIS: We report two observations of leukaemia revealed by polyarthritis. A 22-year-old woman has presented a polyarthritis 8 months before de diagnosis of acute leukaemia. A 34 years old men, has presented one month before admission an acute polyarthritis revealing chronic myeloid leukaemia. CONCLUSION: Polyarthritis may reveal an acute or chronic leukaemia. Systematic blood analysis can make a difference in diagnosis of recent polyarthritis.     

Difficulties associated with removal of mesh eroding into vagina following abdominal sacrocolpopexy: a case report

This case report describes the clinical case of a patient presenting complications during removal of mesh eroding through the lower one third of the posterior vaginal wall following abdominal sacrocolpopexy. Although excellent results have been reported with abdominal sacrocolpopexy for treatment of vaginal vault prolapse, minimizing complications and their correction remains a challenge. In this case, only 3/4 of the mesh was removed vaginally and was complicated by small bowel perforation due to adhesions. The remaining mesh was removed by careful dissection from the sacral base as the risk of infection in the mesh left behind is increased. Successful management eventually requires complete removal of the mesh at laparotomy. The surgery should be performed by experienced pelvic surgeons able to resolve intraoperative complications. Although serious complications are rare, patients should nonetheless be counselled about the risk of massive bleeding, bowel perforation, infection and rectovaginal fistula formation.     

Relationship between spine osteoarthritis,bone mineral density and bone turn over markers in post menopausal women

Background  

Several studies have observed an inverse relationship between osteoporosis and spinal osteoarthritis, the latter being considered as possibly delaying the development of osteoporosis. The aim of this study was to determine the association between individual radiographic features of spine degeneration, bone mineral density (BMD) and bone-turn over markers.     

Laparoscopic-assisted vaginal hysterectomy for endometrial cancer in high body mass index (BMI) patients: a report of six cases

In this case series, six women with high and very high body mass index (BMI; range, 30–65) underwent LAVH + bilateral salphingo-ophorectomy and removal of vaginal cuff under general anaesthesia for endometrial cancer. Initial Verres needle entry and insufflation was through the left upper quadrant at sub-coastal margin. With good surgical outcome, shorter hospitalisation and improved quality of life, we found that laparoscopic surgery was feasible in high and very high BMI patients with early stage endometrial cancer. Objective: The aim of the study was to evaluate the feasibility of laparoscopic-assisted vaginal hysterectomy in the management of early stage endometrial cancer in high and very high BMI patients. Design: Prospective study, 2006–2007. Setting: Royal Blackburn Hospital, Northwest England. Main outcome measures: Success of LAVH, intra- and post-operative morbidity, and length of hospital stay.     

Behçet's disease in Moroccan children: a report of 12 cases

We report 12 cases of Beh?et's disease (BD) in children. The mean age of symptom onset was 12.4 years. Four patients (33.3%) had a past familial history of BD. Clinical manifestations were: oral aphtosis (n = 12), genital aphtosis (n = 9), ocular involvement (n = 9), neuro-Beh?et (n = 6), venous thrombosis (n = 4), articular involvement (n = 3), and entero-Beh?et (n = 1). All patients but one were initially treated with steroids; three cases with ocular involvement were treated with chlorambucil; and three other cases of neuro-Beh?et were treated with cyclophosphamide. After a mean follow-up of 4 years, four patients with neurological involvement developed steroid-dependence with recurrence of symptoms. Four patients had optic atrophy with blindness.     

Nonrandom evolution of end-stage osteoarthritis of the lower limbs

OBJECTIVE: Patients with unilateral hip or knee replacements for end-stage osteoarthritis (OA) are at high risk for future progression of OA in other joints of the lower extremities, often requiring additional joint replacements. Although the risks of future surgery in the contralateral cognate joints (i.e., contralateral hip replacement after an initial hip replacement) have been evaluated, the evolution of end-stage hip OA to OA involving the knee joints, and vice versa (i.e., noncognate progression) has not been investigated. Because characterization of OA progression in noncognate joints may shed light on the pathogenesis of multijoint OA, we investigated the pattern of evolution of end-stage lower extremity OA in a large, clinical cohort. METHODS: Total joint replacement (TJR) was selected as a marker of end-stage OA, and a database comprising all lower extremity TJRs performed at a large referral center between 1981 and 2001 was accessed. Of the 5,894 patients identified, 486 patients with idiopathic OA who underwent hip replacement and 414 who underwent initial knee replacement were analyzed to determine the relative likelihood of subsequent TJRs. Patients with the systemic inflammatory arthropathy, rheumatoid arthritis (RA), were evaluated as a control population because RA progression is not considered to be a primarily mechanically mediated process. RESULTS: The contralateral cognate joint was the most common second joint to undergo replacement in both the OA and the RA groups. However, in OA patients for whom the second TJR was in a noncognate joint, that joint was >2-fold more likely to be on the contralateral limb than on the ipsilateral limb (hip to knee P < 0.001; knee to hip P = 0.013). In contrast, among the RA cohort, the evolution was random and no laterality for noncognate TJR was observed at either the hip or the knee (P = 0.782). CONCLUSION: This characterization of end-stage lower extremity OA demonstrates that the disease evolves nonrandomly; after 1 joint is replaced, the contralateral limb is significantly more likely to show progression of OA than is the ipsilateral limb. Thus, OA in 1 weight-bearing joint appears to influence the evolution of OA in other joints. The absence of such laterality in RA suggests that OA progression may be mediated by extrinsic factors such as altered joint loading.