ABSTRACT
Large vessel vasculitis and particularly Temporal Arteritis are systemic diseases that may affect the aorta and its major branches, mainly involving extra cranial branches of the carotid artery. We report a 72-year-old man presenting with weight loss, fever and malaise. Positron emission computed tomography (PET CT) showed an extensive inflammation of the aorta and its major branches. Temporal artery biopsy confirmed the presence of vasculitis with granulomas. Treatment with a high dose of steroids had an excellent clinical response. This case underscores the utility of PET CT in the assessment of this disease.
Subject(s)
Humans , Male , Aged , Aortitis/pathology , Aortitis/diagnostic imaging , Giant Cell Arteritis/pathology , Giant Cell Arteritis/diagnostic imaging , Aortitis/drug therapy , Temporal Arteries/pathology , Giant Cell Arteritis/drug therapy , Biopsy , Positron Emission Tomography Computed TomographyABSTRACT
Large vessel vasculitis and particularly Temporal Arteritis are systemic diseases that may affect the aorta and its major branches, mainly involving extra cranial branches of the carotid artery. We report a 72-year-old man presenting with weight loss, fever and malaise. Positron emission computed tomography (PET CT) showed an extensive inflammation of the aorta and its major branches. Temporal artery biopsy confirmed the presence of vasculitis with granulomas. Treatment with a high dose of steroids had an excellent clinical response. This case underscores the utility of PET CT in the assessment of this disease.
Subject(s)
Aortitis/diagnostic imaging , Aortitis/pathology , Giant Cell Arteritis/diagnostic imaging , Giant Cell Arteritis/pathology , Aged , Aortitis/drug therapy , Biopsy , Giant Cell Arteritis/drug therapy , Humans , Male , Positron Emission Tomography Computed Tomography , Temporal Arteries/pathologyABSTRACT
Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Infliximab/therapeutic use , Peritoneal Neoplasms/drug therapy , Adult , Biopsy , Diagnosis, Differential , Female , Humans , Myofibroblasts , Neoplasm Recurrence, Local , Peritoneal Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions.
Subject(s)
Adult , Female , Humans , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Infliximab/therapeutic use , Peritoneal Neoplasms/drug therapy , Biopsy , Diagnosis, Differential , Myofibroblasts , Neoplasm Recurrence, Local , Peritoneal Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Parvovirus B19 infection is highly prevalent in children and the most common manifestation is a facial rash. In adults, acute polyarthritis and skin rash are often the presenting features. We report three patients with the disease. A 40-year-old female presenting with fever, myalgias and painful swelling of elbows, knees, wrists and feet, with functional limitation, after having a respiratory infection. Additionally, an erythematous skin rash appeared in both extremities. IgM antibodies against Parvovirus B19 were positive. The skin biopsy disclosed a leukocytoclastic vasculitis. The patient was treated with anti-inflammatory drugs and antihistaminics. A 40-year-old female, presenting with skin rash and pain in wrists and hands. IgM antibodies against parvovirus were positive. The patient was treated successfully with acetaminophen. A 38-year-old male with psoriasis, presenting with generalized and progressive polyarthralgia. A Parvovirus viral load determination found 239000 copies of the virus and IgM antibodies were positive. He was successfully treated with non-steroidal anti-inflammatory drugs.
Subject(s)
Adult , Female , Humans , Male , Arthritis, Infectious/virology , Parvoviridae Infections , Acute Disease , Antibodies, Viral/immunology , Immunoglobulin M/blood , /immunologyABSTRACT
Parvovirus B19 infection is highly prevalent in children and the most common manifestation is a facial rash. In adults, acute polyarthritis and skin rash are often the presenting features. We report three patients with the disease. A 40-year-old female presenting with fever, myalgias and painful swelling of elbows, knees, wrists and feet, with functional limitation, after having a respiratory infection. Additionally, an erythematous skin rash appeared in both extremities. IgM antibodies against Parvovirus B19 were positive. The skin biopsy disclosed a leukocytoclastic vasculitis. The patient was treated with anti-inflammatory drugs and antihistaminics. A 40-year-old female, presenting with skin rash and pain in wrists and hands. IgM antibodies against parvovirus were positive. The patient was treated successfully with acetaminophen. A 38-year-old male with psoriasis, presenting with generalized and progressive polyarthralgia. A Parvovirus viral load determination found 239000 copies of the virus and IgM antibodies were positive. He was successfully treated with non-steroidal anti-inflammatory drugs.
Subject(s)
Arthritis, Infectious/virology , Parvoviridae Infections , Parvovirus B19, Human , Acute Disease , Adult , Antibodies, Viral/immunology , Female , Humans , Immunoglobulin M/blood , Male , Parvovirus B19, Human/immunologyABSTRACT
Making a diagnosis in medicine is a complex process in which many cognitive and psychological issues are involved. After the first encounter with the patient, an unconscious process ensues to suspect the presence of a particular disease. Usually, complementary tests are requested to confirm the clinical suspicion. The interpretation of requested tests can be biased by the clinical diagnosis that was considered in the first encounter with the patient. The awareness of these sources of error is essential in the interpretation of the findings that will eventually lead to a final diagnosis. This article discusses some aspects of the heuristics involved in the adjudication of priory probabilities and provides a brief review of current concepts of the reasoning process.
Subject(s)
Humans , Clinical Competence , Diagnosis , Bayes TheoremABSTRACT
Making a diagnosis in medicine is a complex process in which many cognitive and psychological issues are involved. After the first encounter with the patient, an unconscious process ensues to suspect the presence of a particular disease. Usually, complementary tests are requested to confirm the clinical suspicion. The interpretation of requested tests can be biased by the clinical diagnosis that was considered in the first encounter with the patient. The awareness of these sources of error is essential in the interpretation of the findings that will eventually lead to a final diagnosis. This article discusses some aspects of the heuristics involved in the adjudication of priory probabilities and provides a brief review of current concepts of the reasoning process.
Subject(s)
Clinical Competence , Diagnosis , Bayes Theorem , HumansABSTRACT
BACKGROUND: Systemic vasculitis are a group of heterogeneous diseases characterized by inflammation and necrosis of blood vessel walls. The etiology is not known, but geographic and environmental factors are implicated. AIM: To describe the clinical features of microscopic polyangiitis (MPA) and Wegener's granulomatosis (WG) in a Chilean cohort of patients. PATIENTS AND METHODS: Retrospective review of the medical records of 123 patients with the diagnosis of systemic vasculitis (65 MPA and 58 WG), seen from 1990 to 2001. The diagnosis were made based on the American College of Rheumatology and Chapel Hill criteria. RESULTS: The mean follow-up for MPA was 15 months (1-120) and for WG, 20 months (1-120). The median age (years) at diagnosis for MPA was 61 (19-82) and WG 50 (20-82). Gender distribution was similar in both groups (male: 68% and 57% respectively). The main clinical features in the MPA group were renal involvement (68%), peripheral nervous system involvement (57%), pulmonary hemorrhage (28%), and skin disease (32%). In the WG group were alveolar hemorrhage (62%), renal involvement (78%), paranasal sinus involvement (57%), and ocular disease (26%). In both, creatinine levels above 2.0 mg/dl were associated with a higher mortality (p< 0.01). ANCA by immunofluorescence was performed in 56 MPA patients (75% had pANCA, 4% had cANCA and 21% were ANCA negative) and in 55 WG patients (17% had pANCA, 79% had cANCA and 4% were ANCA negative). Global mortality was 18% and 17% respectively, and the most common causes of death were infections. CONCLUSIONS: The clinical features of our patients are similar to other published data. In our WG and MPA patients the main predictor for death was a serum creatinine above 2 mg/dl.
Subject(s)
Granulomatosis with Polyangiitis , Polyarteritis Nodosa , Adult , Aged , Aged, 80 and over , Antibodies, Antineutrophil Cytoplasmic/analysis , Chile , Creatinine/blood , Female , Fluorescent Antibody Technique, Direct , Follow-Up Studies , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/immunology , Granulomatosis with Polyangiitis/pathology , Humans , Male , Middle Aged , Multivariate Analysis , Polyarteritis Nodosa/complications , Polyarteritis Nodosa/immunology , Polyarteritis Nodosa/pathology , Retrospective Studies , Sex DistributionABSTRACT
BACKGROUND: Polymorphisms of Fc receptors for IgG (Fc gamma R) have been proposed as a genetic factor that influences susceptibility for systemic lupus erythematosus (SLE). Human Fc gamma RIIa has 2 codominantly expressed alleles, H131 and R131, which differ at amino acid position 131 in the second extracellular domain (histidine or arginine respectively) and differ substantially in their ability to bind human IgG2. The H131 allele binds IgG2 efficiently, whereas R131 binds it poorly. Because IgG2 is a poor activator of the classical complement pathway, the H131 is essential for the disposal of IgG2 immune complexes. AIM: To determine the distribution of Fc gamma RIIA genes in a cohort of Chilean SLE patients, with or without a history of lupus nephritis. PATIENTS AND METHODS: We studied 52 Chilean SLE patients fulfilling the 1982 American College of Rheumatology (ACR) criteria, 20 of whom had a history of nephritis, and 44 ethnically matched disease-free controls. Fc gamma RIIa allotypes were genotyped by PCR. RESULTS: No significant association was observed between the low affinity Fc gamma RII receptor (FcgRIIa-R131) and the presence of SLE or lupus nephritis. However, genotype frequencies in SLE patients but not in controls, departed from the proportions predicted by the Hardy-Weinberg equilibrium, suggesting this locus might be related to the disease. CONCLUSIONS: Our results suggest that in Chilean patients with SLE, as well as in many other populations, the R131 allotype is not a major factor predisposing to the development of SLE or lupus nephritis.
Subject(s)
Antigens, CD/genetics , Lupus Erythematosus, Systemic/genetics , Polymorphism, Genetic , Receptors, IgG/genetics , Alleles , Chile , Cohort Studies , Gene Frequency , Genetic Predisposition to Disease , Genotype , Humans , Lupus Nephritis/genetics , Polymerase Chain ReactionABSTRACT
Se presenta la casuística de la colecistectomía laparoscópica (CL) del Hospital Militar en la patología vesicular, revisando los resultados obtenidos en 1.102 pacientes en un lapso de 23 meses. El 22 por ciento de los pacientes son portadores de un cuadro vesicular agudo. El 10 por ciento de las CL recibieron una colangiografía endoscópica retrógrada (CER) preoperatoria en búsqueda de coledocolitiasis, encontrándola en un tercio de ellos. Durante la intervención se detecta un 1,8 por ciento de coledocolitiasis, llegando a un 5,3 por ciento de cálculos coledocianos en toda la serie. En el 1,6 por ciento de la serie se realizó exploración coledociana trancística, lo que permite resolver el 40 por ciento de los hallazgos de coledocolitiasis intraopereratoria. Se convirtió la técnica en el 6 por ciento de las CL, existiendo 3,8 por ciento de complicaciones médicas, 3,5 por ciento de complicaciones quirúrgicas, con 0,7 por ciento de reoperaciones, 06 por ciento rehospitalizaciones 0,18 por ciento de sección del colédoco y 0,09 por ciento de mortalidad. Las cifras refuerzan sólidamente el concepto de que la CL es la técnica quirúrgica para tratar la patología vesicular no neoplásica, con un adecuado margen de seguridad, buena recuperación postoperatoria y rápida rehabilitación
