Carpal predominance in rheumatoid arthritis

Radiographic and clinical evaluation of the relative severity of wrist versus hand involvement in 101 patients with rheumatoid arthritis revealed more severe changes in the wrists in 60%, equal involvement in wrists and hands in 37%, and more severe changes in the hands in 3%. There were severe changes in the wrists but little or no bone or joint change in the metacarpophalangeal and proximal interphalangeal joints in 43 (21%) of the 202 extremities studied. Serial examinations showed that, in time, the hand changes tended to overtake those in the wrist. Appreciation of this progression of wrist and hand changes can help the physician avoid diagnostic difficulties in a significant percentage of patients.     

Postoperative annular pseudocyst: report of two cases with an unusual complication after microdiscectomy, and successful treatment by percutaneous aspiration and steroid injection

BACKGROUND CONTEXT: After microdiscectomy for extruded disc fragments, patients may develop recurrent symptoms from numerous causes. Postoperative annular pseudocysts represent a unique entity not previously described in the medical literature. PURPOSE: To report unique imaging findings in two patients who presented with recurrent radiculopathic symptoms after microdiscectomy. To report successful percutaneous aspiration and steroid injection in one of these cases. STUDY DESIGN/SETTING: Report of two cases. METHODS: Two patients underwent preoperative imaging with noncontrast magnetic resonance imaging (MRI) and postoperative imaging with pre- and postcontrast MRI. One of these patients underwent therapeutic computed tomography (CT)-guided aspiration and injection. RESULTS: MRI demonstrated T2 hyperintense and enhancing collections, which conformed to the shape of the resected disc fragment and communicated with the disc annulus. One of these cases demonstrated enlargement over several months with worsening of symptoms. Aspiration of the lesion produced thick fluid. The patient experienced marked relief of symptoms after the aspiration and injection of steroid into the lesion. CONCLUSIONS: The unique imaging findings in these patients represent a previously undescribed complication of microdiscectomy, which we have termed "postoperative annular pseudocyst." We have successfully treated one case with CT-guided percutaneous aspiration and injection.     

Disseminated bacille Calmette�CGu��rin disease in HIV-infected South African infants

Objective

To determine the population-based incidence of disseminated bacille Calmette–Guérin (BCG) disease in HIV-infected infants (aged ≤ 1 year) in a setting with a high burden of tuberculosis and HIV infection coupled with a well-functioning programme for the prevention of HIV infection in infants.

Methods

The numerator, or number of new cases of disseminated BCG disease, was derived from multicentre surveillance data collected prospectively on infants with a confirmed HIV infection during 2004–2006. The denominator, or total number of HIV-infected infants who were BCG-vaccinated, was derived from population-based estimates of the number of live infants and from reported maternal HIV infection prevalence, vertical HIV transmission rates and BCG vaccination rates.

Findings

The estimated incidences of disseminated BCG disease per 100 000 BCG-vaccinated, HIV-infected infants were as follows: 778 (95% confidence interval, CI: 361–1319) in 2004 (vertical HIV transmission rate: 10.4%); 1300 (95% CI: 587–2290) in 2005 (transmission rate: 6.1%); and 1013 (95% CI: 377–1895) in 2006 (transmission rate: 5.4%). The pooled incidence over the study period was 992 (95% CI: 567–1495) per 100 000.

Conclusion

Multicentre surveillance data showed that the risk of disseminated BCG disease in HIV-infected infants is considerably higher than previously estimated, although likely to be under-estimated. There is an urgent need for data on the risk–benefit ratio of BCG vaccination in HIV-infected infants to inform decision-making in settings where HIV infection and tuberculosis burdens are high. Safe and effective tuberculosis prevention strategies are needed for HIV-infected infants.     

Effects of melatonin on thymic and oxidative stress dysfunctions during Trypanosoma cruzi infection

Although the exact etiology of Chagas disease is not completely elucidated, thymic atrophy and oxidative stress are believed to be important contributors to the pathogenesis during acute Trypanosoma cruzi (T. cruzi ) infection. We hypothesized that exogenous melatonin, administered by gavage (5 mg/kg, p.o., gavage) to young (5 weeks old) and middle‐aged (18 months old) male Wistar rats, would modulate thymic oxidative damage and reverse the age‐related thymus regression during T. cruzi acute infection. Increased levels of superoxide anion (O₂^?) were detected in the thymus of infected animals, and treatment with melatonin reverted this response. We found reduced TBARS levels as well as a significant increase in superoxide dismutase (SOD ) activity in the thymus of all middle‐aged melatonin‐treated animals, infected or not with T. cruzi . Furthermore, melatonin increased the thymic expression of SOD 1 and SOD 2 in middle‐aged control animals. Nox2 expression was not affected by melatonin treatment in young or middle‐aged animals. Melatonin reverted the age‐related thymic regression as revealed by the increase in thymus weight, total number of thymocytes, and reduction in age‐related accumulation of double‐negative thymocytes. This is the first report to directly examine the effects of melatonin treatment on the thymic antioxidant/oxidant status and thymic changes during T. cruzi infection. Our results revealed new antioxidant features that turn melatonin a potentially useful compound for the treatment of Chagas disease, a condition in which an excessive oxidative damage occurs.