Paratesticular solitary fibrous tumor: A case report.

Paratesticular solitary fibrous tumors are a very rare benign tumor that are usually low-grade neoplasms of pericytes and myofibroblast-like cells. They're slow growing and painless. We report a case of a male patient of 32 years old who came to our medical structure complaining about the appearance of scrotal mass, painful sometimes. Investigations revealed a scrotal mass which was surgically removed. Immunohisochemical study concluded to the presence of a solitary fibrous tumor.

Consequences of delayed therapy with second-line agents in rheumatoid arthritis: a 3 year followup on the hydroxychloroquine in early rheumatoid arthritis (HERA) study.

OBJECTIVE: To assess the longterm effect of delaying therapy with second-line agents in patients with early rheumatoid arthritis (RA). METHODS: One hundred nineteen patients who participated in a 9 month placebo controlled randomized trial of hydroxychloroquine sulfate (HCQ) were followed prospectively for an additional 3 years. Those randomized to HCQ are referred to as the early treatment group and those randomized to placebo as the delayed treatment group. Participants were assessed annually for pain [Arthritis Impact Measurement Scales (AIMS) and Stanford Health Assessment Questionnaire (HAQ)], physical disability (AIMS and HAQ), and the RA global well being scale (AIMS). Conversion of results into standard deviation (SD) units permitted defining a substantial difference as per Felson as > 0.30 SD units and a clinically indistinguishable difference as < or = 0.06 SD units. RESULTS: One hundred fifteen patients (97%) participated and complete data were available on 104 (87%). Compared to the early treatment group, the delayed group remained worse for both the pain and the physical disability outcomes over the additional 3 year followup. The difference in the RA global well being score became clinically indistinguishable for the early and delayed groups only after the 2 year post-trial assessment. The between-group differences were not explained by post-trial therapy with corticosteroids, other second-line agents, or nonsteroidal antiinflammatory drugs and analgesic preparations. CONCLUSION: These findings show that a delay in instituting therapy with second-line agents, even a 9 month delay in instituting a moderately powerful second-line agent such as HCQ, has significant effects on longterm patient outcome, and provides strong evidence in support of early therapy in RA.

Connective tissue disease and hyperviscosity syndrome with cryoprotein and immune complexes. Report of a case with autopsy findings and review of the literature.

A case is reported of chronic polyarthritis, hepatitis and hyperviscosity syndrome associated with the presence of intermediate and high molecular weight plasma complexes, a mixed cryoprotein and widespread endarteritis obliterans of small muscular arteries. The features of this case are compared with those of other reported cases of connective tissue disease associated with hyperviscosity syndrome.

Arthropathy as the major clinical indicator of occult iron storage disease.

Chronic arthritis was the only symptom that led to the detection of increased iron stores in four patients. In these persons, the serum iron was ordered at the time of initial examination, and ranged from 212 to 237 microgram/dl with a transferrin saturation of 83% to 100%. Liver biopsy specimens showed hepatocyte iron deposition in each person, with definite cirrhosis in only one patient. These cases illustrate that a chronic arthropathy may be the first clinical manifestation of iron overload, and can lead to discovery of the disease in patients and their family members. Treatment may then be initiated before extensive tissue damage has occurred.