Congenital lumbar hernias: A case report

Congenital lumbar hernias are rare and associated with other malformations. There have been 42 cases reported to date. The authors report the first case in the literature of isolated bilateral congenital lumbar hernias. J Pediatr Surg 37:921-922.     

Epidemiological and clinical features of giant cell arteritis in Tunisia

BackgroundGiant cell arteritis (GCA) is a systemic vasculitis of the elderly that could result in vision loss or even be life threatening. Unlike western countries, this disease is considered exceptional in Tunisia.ObjectiveThe aims of this study were to determine epidemiological and clinical features of GCA in Tunisian population and to identify management difficulties.Patients and methodsA multicentric study of 96 patients in whom GCA was diagnosed between 1986 and 2003. All patients fulfilled the ACR criteria for classification of GCA.ResultsThe majority of cases (77%) were diagnosed since 1994. The male/female ratio was 0.88 and the mean age at the time of diagnosis was 70.8 ± 7.7 years. Clinical features were characterized by gradual onset in 64.4% of cases. The most frequent clinical manifestations were headache (91.7%), abnormalities in temporal arteries (85.4%), severe ischemic manifestations (80.2%), constitutional symptoms (75%), and polymyalgia rheumatica (56.3%). Biological inflammatory syndrome was noted in all patients. Temporal artery biopsy established histological diagnosis in 73% of cases. All patients were treated by corticosteroids. Remission was obtained in 45.6%. Relapses occurred in 40.4% of cases and 30 patients were still receiving corticosteroids at the time of study. Four patients died and irreversible ischemic complications were noted in 15.6% of cases. Steroid adverse effects occurred in 56 patients.ConclusionGCA is not exceptional to Tunisia. It occurs amongst elderly patients with no female predominance noticed. Clinical features are similar to those reported in other series.     

Elderly-onset adult Still’s disease

Adult-onset Still’s disease is a rare inflammatory disorder usually affecting young adults. Elderly-onset Still’s disease (EOSD) is reported in some cases, commonly in Japan, the USA and Europe. One of the most commonly used criteria for diagnosing EOSD is Yamaguci criteria. In elderly patients more severe course of the disease and more complications may be expected than in the younger group of patients with Still’s disease. The lungs involvement is rather rare manifestation of this disease. In our article we discuss the problem of both the development of Still’s disease in the elderly and interstitial lung changes in the course of the disease, based on available literature and own cases from one centre.     

Late rupture of flexor pollicis longus tendon 10 years after volar buttress plate fixation of a distal radius fracture: a case report

We report the case of a complete rupture of flexor pollicis longus tendon in a 30-year old-man 10 years after open reduction and internal fixation of a distal radius fracture with a volar buttress plate.     

Isotopic exploration of hepatic hydrothorax: ten cases

OBJECTIVE: The aim of this retrospective study was to evaluate the performance of peritoneal scintigraphy for the diagnosis of peritoneopleural communication in patients with cirrhosis and to discuss its role in therapeutic management. PATIENTS AND METHODS: Ten patients with cirrhosis and pleural effusion were included in this study. Cirrhosis was due to viral hepatitis in eight patients, auto-immune disease in one patient and of unknown origin in one. The pleural effusion was right-sided in nine patients and bilateral in one. 99m-technetium sulfur colloid peritoneal scintigraphy was performed in all patients. RESULTS: Scintigraphy revealed peritoneopleural communication in nine patients. In four patients, radioactivity appeared in the pleural cavity within a few minutes after injection of the radiotracer. In three of them, a large diaphragmatic defect was demonstrated by ultrasonography, magnetic resonance imaging or thoracoscopy. Complete response to medical treatment was observed in four patients. Scintigraphy revealed rapid radioactivity migration in four patients; diuretic treatment led to resolution of the hydrothorax in one of them. Three patients whose hydrothorax was refractory to medical treatment were treated by pleurodesis with talc. Resolution of the hydrothorax was achieved in one of them. CONCLUSION: Peritoneal scintigraphy is a simple non-invasive method enabling confirmation of peritoneopleural communication in cirrhotic patients. The importance of the diaphragmatic defect can also be evaluated, providing a significant contribution to therapeutic decision-making.     

Antibody‐functionalized nanoparticles for imaging cancer: influence of conjugation to gold nanoparticles on the biodistribution of 89Zr‐labeled cetuximab in mice

Antibody‐labeled gold nanoparticles represent a promising novel tool regarding cancer imaging and therapy. Nevertheless, the characterization of biodistribution of such immunonanocarriers has been poorly documented. In this study, the biodistribution of ⁸⁹Zr‐labeled cetuximab before and after the coupling reaction to gold nanoparticles (AuNPs) was compared and the quantitative imaging performance of ⁸⁹Zr immuno‐PET was evaluated. Cetuximab was functionalized with the desferal moiety and labeled with ⁸⁹Zr (⁸⁹Zr–Df–Bz–NCS–cetuximab). AuNPs with a mean diameter of 5 nm were synthesized according a new method developed in the laboratory, and conjugated to ⁸⁹Zr–Df–Bz–NCS–cetuximab using carbodiimide chemistry (AuNPs–PPAA–cetuximab–⁸⁹Zr). The two tracers were injected in A431 xenograft‐bearing mice. Tumor and liver uptakes were assessed at different times after injection using quantitative PET imaging. The in vivo specificity of the binding was investigated using a saturating dose of unlabeled cetuximab. Radiolabeled cetuximab was conjugated to AuNPs with a coupling reaction yield >75%. All conjugates were stable in vitro and to a lesser extent in plasma. In vivo distribution studies revealed no significant difference in tumor uptake for cetuximab conjugated to nanoparticles up to 72 h after injection, compared with unconjugated cetuximab. Immuno‐PET studies showed that AuNPs–PPAA–cetuximab–⁸⁹Zr provided high tumor‐to‐background ratio. The liver uptake of AuNPs–PPAA–cetuximab–⁸⁹Zr was higher, compared with ⁸⁹Zr–Df–Bz–NCS–cetuximab. In vivo blocking experiments demonstrated selective tumor targeting after coupling reaction. This study showed that the conjugation of AuNPs to cetuximab did not affect its tumor accumulation and that the efficacy of EGFR‐targeted nanoparticles was unaltered. The ⁸⁹Zr‐labeled cetuximab‐targeted gold nanoparticles could be a valuable tool for theranostic purposes. Copyright © 2013 John Wiley & Sons, Ltd.     

Cerebral infarction and ventricular septal defect

With the availability of contrast echocardiography, patent foramen ovale is frequently detected in patients with stroke, especially in those with no clear etiology and/or the young patient with stroke. Before this report, an association of stroke with ventricular septal defect had not been reported. In this communication, we describe a 38-year-old patient who developed an occipital lobe infarction and who, on investigation, was found to have a ventricular septal defect. Other investigations, which included four-vessel cerebral angiography, collagen disease workup, and coagulation profile, were all normal. We believe this case further extends the spectrum of cerebral ischemic events that may occur with intracardiac shunts.