Treatment of nodular vasculitis with colchicine

Nodular vasculitis (NV) refers to a chronic relapsing lobular panniculitis that is thought to be a hypersensitivity reaction to antigenic triggers. While it is commonly associated with tuberculosis, in many cases no underlying cause is found and the condition is difficult to manage. Here, we report three patients with refractory idiopathic NV effectively treated with colchicine, leading to a significant improvement or complete resolution of their symptoms. Colchicine was successfully used as a steroid‐sparing agent, and in one patient its cessation was associated with a flare of disease.     

Description of an orthopedic–geriatric model of care in Australia with 3 years data

Aim:   Orthopedic–geriatric units have been established worldwide to improve the care of older patients admitted with fractures. This study describes one type of orthopedic–geriatric model which has been implemented in Victoria, Australia, named the Orthopedic Aged Care and Rehabilitation Service (OARS) and evaluates patient characteristics and outcomes including inpatient mortality.
Methods:   Eight hundred and thirty-four consecutive admissions under OARS between May 2003 and May 2006 were analyzed.
Results:   Mean age was 76.6 years, the majority of patients were female (73%) and had come from home (77%). Fractured neck of femur represented 51% of all fractures managed by OARS followed by lower limb fractures (20%) and upper limb fractures (13%). The majority of patients required inpatient rehabilitation (49% of patients overall and 61% specifically for fractured neck of femur). Inpatient mortality for all fractures was 2.5% and specifically 3.5% for fractured neck of femur.
Conclusion:   The OARS model involves close liaison between orthopedic and geriatric teams and promotes a multidisciplinary approach. Mortality rate for fractured neck of femur was lower than the state average, suggesting that combined orthopedic–geriatric care can improve outcomes.     

Improved cardiovascular variables during acetate free biofiltration.

BACKGROUND AND AIM: Acetate free biofiltration (AFB) provides a well-tolerated and efficient renal replacement therapy. Replacement of most of the acetate by bicarbonate in standard hemodialysis has resulted in a decrease in intradialytic hypotensive episodes. This has been attributed to a decrease in the acetate-induced impairment of myocardial contractility. The aim of the present study was to investigate whether the total absence of acetate in AFB would further enhance dialysis stability and improve cardiovascular status. PATIENTS AND METHODS: In a long-term, randomized trial we included 11 patients on AFB and 9 patients on bicarbonate hemodialysis (HD) for one year. Patients were matched for age, sex and urea reduction rate, but not for the presence of hypertension or cardiovascular history. During each dialysis session blood pressure was measured automatically and the presence of significant hypotension was recorded. Antihypertensive medication was registered every three months. Before and at the end of the study M-mode echocardiography was performed and left ventricular mass index (LVMi) was calculated. Every six months serum lipids were measured. RESULTS: At baseline, mean arterial pressure (MAP) before and after dialysis, the percentage of hypotensive dialyses, LVMi and serum lipids did not differ between AFB and HD. Pre-dialysis MAP decreased in AFB (from 112.5 to 107 mmHg) and increased in HD (from 101.7 to 105.3 mmHg; p = 0.01, HD versus AFB). Postdialysis MAP remained stable in both groups (AFB 91.6 mmHg at 0 months and 90.6 mmHg at 12 months, for HD respectively 83.9 and 86.5 mmHg, NS). The percentage of hypotensive dialyses did not differ significantly between the groups during the study. LVMi decreased in AFB from 195.4 to 162.1 gr/m2 and increased in HD patients from 153.8 to 182.5 gr/m2 (p = 0.03 HD versus AFB). The number of antihypertensive medications per patient did not differ between groups. Serum lipids remained unchanged during the trial. CONCLUSION: In conclusion, AFB provided better control of pre-dialysis MAP compared to HD, and stable postdialysis MAP. The percentage of dialysis sessions with hypotension did not differ. LVMi decreased significantly in AFB, but rose in HD.     

Malignant melanoma of the cervix

Primary malignant melanoma of the cervix was diagnosed in a 52-year-old woman. Extended hysterectomy and partial vaginectomy were performed. A vulval recurrence was treated with wide excision and total vaginectomy. She subsequently underwent radiotherapy for metastatic lesions in the pelvis and para-aortic nodes, but succumbed to widespread metastatic disease 2 years after initial diagnosis. Diagnosis, therapy, and prognosis for malignant melanoma are discussed.     

Endogenous central cholinergic systems and baroreflex modulation in the conscious dog

Summary— Intracisternal atropine and mecamylamine failed to modify baroreflex sensitivity in dogs, suggesting a lack of cholinergic neurons integrated in baroreflex pathways. Conversely, neostigmine lowered baroreflex sensitivity suggesting a putative cholinergic modulation.     

Fibroma of a tendon sheath at the wrist: a rare cause of compression of the median nerve.

We report a case of fibroma of a tendon sheath, a rare benign tumour, which presented as a painless swelling at the wrist and caused symptoms of median nerve compression. We have also reviewed similar cases.