Destructive arthritis due to silicone: a foreign-body reaction

The authors report 3 cases of erosive arthritis resulting from a foreign-body reaction to a silicone implant in the wrist. No patient had a history of inflammatory arthritis. Radiographic changes included well-defined lytic lesions with thin, sclerotic margins, normal mineralization, and loss of volume of the implant. Pathologically, a destructive foreign-body reaction was seen, with intra- and extracellular silicone debris.     

高交联聚乙烯与钴铬合金和陶瓷股骨头匹配使用的磨损和蠕变

髋关节骨关节炎患者进行金属对超高分子量聚乙烯(ul tra-high molecular weight polyethylene,UHMWPE)的全髋关节置换是二十世纪最为成功的外科手术之一.据文献报道使用UHMWPE衬垫的骨水泥假体20年成功率达到75%以上[1].     

AIDS-associated cryptococcosis: a comparison of epidemiology, clinical features and outcome in the pre- and post-HAART eras. Experience of a single centre in Italy

Objectives

To assess the prevalence, clinical and immunological characteristics, risk factors and survival of patients with AIDS‐related cryptococcosis in the era of highly active antiretroviral therapy (HAART).

Methods

All newly diagnosed cryptococcosis cases identified retrospectively from among a series of AIDS patients hospitalized consecutively at a single institution in Italy in 1985–1996 (pre‐HAART period, n=165) and 1997–2006 (post‐HAART period, n=40) were analysed comparatively.

Results

The prevalence of cryptococcosis decreased from 4.7% (165/3543) to 2.2% (40/1805) between the pre‐ and post‐HAART periods (P=0.0001). There were no differences in the clinical features or immunological status of the patients between the two cohorts. The variables associated with the occurrence of cryptococcosis in the post‐HAART era were older age (P<0.001), no previous diagnosis of HIV infection (P<0.001) and infection in homosexual males (P=0.004). During the post‐HAART period, immune reconstitution inflammatory syndrome associated with cryptococcosis was observed in five patients (19.3%) a median of 15 weeks after the start of HAART. Thirty‐day survival (P=0.045) and overall survival (P=0.0001) were significantly better among patients diagnosed with cryptococcosis in the post‐HAART compared to those diagnosed in the pre‐HAART era.

Conclusions

The AIDS‐associated cryptococcosis observed in Western countries in the HAART era has similar clinical and immunological characteristics to that observed in the pre‐HAART era, but a significantly better outcome.