[Thorn synovitis: Report of 2 cases]. / Synovites à piquants : à propos de deux cas.

INTRODUCTION: Thorn synovitis is related to plant or animal thorn punctures. We report two cases of thorn synovitis. CASE REPORTS: The first patient was a 41-year-old-woman who presented with recurrent arthritis of the right knee after needle fish injury. The immunological tests and cultures were negative. X-rays and MRI showed the foreign bodies in the soft parts on the outer side of the knee. An arthroscopy was performed and the thorn removed. Clinical outcome was favourable with complete symptoms resolution. The second patient was a 58-year-old-man, with a family history of spondylarthritis, who was admitted with a monoarthritis of the left wrist that occurred 10 weeks after palm tree thorn injury. Patient received unsuccessfully antibiotics and anti-inflammatory drugs. Immunological tests and cultures were negative. Wrist ultrasound showed erosive synovitis. Intra-articular lesion removal by arthroscopy allowed favourable outcome. CONCLUSION: Thorn synovitis diagnosis is based on the discovery of a foreign body. Treatment is based on their removal. Suspicion of infection with deficient pathogen, especially Pantoea agglomerans, remains difficult for the practitioner.

Energy deprivation transiently enhances rhythmic inhibitory events in the CA3 hippocampal network in vitro.

Oxygen glucose deprivation (OGD) leads to rapid suppression of synaptic transmission. Here we describe an emergence of rhythmic activity at 8 to 20 Hz in the CA3 subfield of hippocampal slice cultures occurring for a few minutes prior to the OGD-induced cessation of evoked responses. These oscillations, dominated by inhibitory events, represent network activity, as they were abolished by tetrodotoxin. They were also completely blocked by the GABAergic antagonist picrotoxin, and strongly reduced by the glutamatergic antagonist NBQX. Applying CPP to block NMDA receptors had no effect and neither did UBP302, an antagonist of GluK1-containing kainate receptors. The gap junction blocker mefloquine disrupted rhythmicity. Simultaneous whole-cell voltage-clamp recordings from neighboring or distant CA3 pyramidal cells revealed strong cross-correlation of the incoming rhythmic activity. Interneurons in the CA3 area received similar correlated activity. Interestingly, oscillations were much less frequently observed in the CA1 area. These data, together with the observation that the recorded activity consists primarily of inhibitory events, suggest that CA3 interneurons are important for generating these oscillations. This transient increase in inhibitory network activity during OGD may represent a mechanism contributing to the lower vulnerability to ischemic insults of the CA3 area as compared to the CA1 area.

Comparison of the clinical characteristics of vasculitis occurring during anti-tumor necrosis factor treatment or not in rheumatoid arthritis patients. A systematic review of 2707 patients, 18 vasculitis.

OBJECTIVE: Comparison of vasculitis occurring in rheumatoid arthritis (RA) patients undergoing anti-tumor necrosis factor (TNF) treatment and those not. METHODS: Systematic, retrospective, observational study of all RA patients in one center (1997-2004). Vasculitis cumulative incidence in RA patients was calculated in patients receiving anti-TNF or those not. Clinical characteristics of RA and vasculitis were collected. Begaud's imputability tables were used to evaluate the role of anti-TNF in inducing vasculitis. RESULTS: Out of 2707 RA patients, 440 received an anti-TNF. A vasculitis occurred in 6 patients treated with anti-TNF (cumulative incidence: 1.3%), and in 12 patients treated without anti-TNF (cumulative incidence: 0.5%). Characteristics of patients not treated with anti-TNF or treated were respectively (mean): age (years) at vasculitis occurrence: 66.5 vs. 55.3, disease duration (years): 12.2 vs. 13.8, extra-articular features before vasculitis: 16% vs. 60%, number of previous DMARDs: 3.2 vs. 4.5, corticosteroid cumulated dosage (grams): 40.8 vs. 64.3. Vasculitis was cutaneous (58% vs. 67%), neurologic (58% vs. 67%), visceral (8% vs. 17%), and required a treatment in 66% vs. 83%. Using Begaud's tables, anti-TNF could be responsible for inducing vasculitis in 2 out of 6 patients. CONCLUSION: In RA, vasculitis is more frequent during anti-TNF treatment than without anti-TNF. Anti-TNF could be responsible for inducing vasculitis in 2 patients. Patients treated with anti-TNF had more severe RA. It remains to be determined whether vasculitis is a consequence of anti-TNF inefficacy or whether it is treatment-related. In vasculitis occurring with anti-TNF, classical treatment seems more suitable than a switch to another anti-TNF.

Multifocal Scedosporium apiospermum spondylitis in a cystic fibrosis patient.

We report the first case of multifocal Scedosporium apiospermum spondylitis in a cystic fibrosis patient. The infection, which occurred during voriconazole prophylaxis, disseminated contiguously from the base of the left lung and pleura and spread to vertebrae via the epidural space. S. apiospermum osteoarticular infections are rare, and are difficult to diagnose and cure because of their resistance to anti-fungal drugs.

Severe systemic inflammatory response syndrome in a patient with adult onset Still's disease treated with the anti-IL1 drug anakinra: a case report.

Interleukin 1 (IL1) plays an important role in adult onset Still's disease. Anakinra (Kineret), a recombinant IL1 Receptor Antagonist (IL 1 RA) was therefore recently proposed in adult onset Still's disease with great efficacy. Anakinra appeared to be well tolerated and safe. The case of a patient with refractory adult onset Still's disease who experienced a Systemic Inflammatory Response Syndrome and Adult Respiratory Distress Syndrome requiring intensive care unit hospitalization 10 days after the introduction of anakinra is reported.

Complication rates of 127 surgical procedures performed in rheumatic patients receiving tumor necrosis factor alpha blockers.

OBJECTIVE: Tumor necrosis factor (TNF) blockers have been reported to increase the risk of infections, thrombosis, and delayed healing. However, there is little data on the risk of complications after surgery in rheumatic patients receiving TNF blockers. The aim of this study was to assess the complication rate after surgery in such patients, to assess the effect of interrupting TNF blocker therapy, and to identify other potential predictors of complications. METHODS: This was a systematic, retrospective monocenter study of all patients treated with TNF blockers and who underwent surgery. Complications were recorded and complication rates were compared based on the type of surgery and the timing of the discontinuation of TNF blockers before surgery (above 2 or 5 half-lives). The complication rates were compared with those reported in the literature (orthopaedic procedures in RA patients: 7%, abdominal surgery: 13%). RESULTS: Between 1997 and 2004, 770 patients were treated with TNF blockers of whom 92 underwent surgery (127 surgical procedures). The most frequent underlying disease was rheumatoid arthritis (77%). Most of the surgical procedures were orthopaedic (85%). The complication rates for orthopaedic procedures and for abdominal procedures were 13% and 43%, respectively. The infection rate after orthopaedic procedures was 6.5%. Interrupting therapy before surgery did not significantly decrease the postoperative complication risk. There were no independent factors predicting complications. CONCLUSION: In daily practice the complication rate after surgery is high in patients treated with TNF blockers. Discontinuing TNF therapy before surgery should be considered, although this study did not clearly demonstrate its role.

Infections during tumour necrosis factor-alpha blocker therapy for rheumatic diseases in daily practice: a systematic retrospective study of 709 patients.

OBJECTIVE: To evaluate the rate of infections in rheumatic patients treated with tumour necrosis factor (TNF)-alpha blockers in daily practice and to determine potential risk factors of infections. METHODS: Systematic retrospective study was conducted in a tertiary-referral centre of all patients receiving at least one TNF-alpha blocker, between 1997 and December 2004. Serious infections were defined as life-threatening, requiring hospitalization or sequelae. The incidence of infections during the first TNF-alpha blocker course was compared with the incidence during the period just before such therapy, in the same patients and a number needed to harm was calculated. Univariate and multivariate analysis between patients who suffered from at least one infection during treatment or not, was conducted in order to determine potential associated risk factors. RESULTS: Among the 709 patients treated with at least one TNF-alpha blocker, 57.7% had rheumatoid arthritis; a total of 275 infectious events in 245 patients (34.5%) were reported during all treatment courses. Among these infections, 47 infections in 44 patients (6.2%) fulfilled the definition of serious infections. The incidence rate of serious infections was 3.4 +/- 38.7 per 100 patient-yrs before TNF-alpha blocker therapy vs 10.5 +/- 86.9 during the first TNF-alpha blocker course (P = 0.03, number needed to harm = 14). The single risk factor picked up by multivariate analysis to explain infections was previous joint surgery [odds ratio (OR) = 2.07, 95% confidence interval (CI) = (1.43-2.98), P < 0.0001] and, if surgery was taken out of the model, the cumulative dose of steroids [OR = 1.28 (1.04-1.59), P = 0.02]. CONCLUSION: The rate of serious infections during TNF-alpha blocker treatment observed in daily practice conditions was much higher than in phase III trials evaluating TNF-alpha blockers. Serious infections are frequent in daily practice and close monitoring is required.

Efficacy of tumour necrosis factor blockers in reducing uveitis flares in patients with spondylarthropathy: a retrospective study.

OBJECTIVE: To evaluate the efficacy of anti-tumour necrosis factor (TNF) treatments (given for rheumatological manifestations) in reducing uveitis flares in patients with spondylarthropathy in daily practice. METHODS: A retrospective observational study of all patients with spondylarthropathy with at least one uveitis flare treated with anti-TNF in one centre (December 1997-December 2004). The number of uveitis flares per 100 patient-years was compared before and during anti-TNF treatment; each patient was his or her own control. The relative risk (RR) and the number needed to treat (NNT) were calculated. RESULTS: 46 patients with spondylarthropathy treated with anti-TNF drugs had at least one uveitis flare (33 treated with anti-TNF antibodies, infliximab or adalimumab, and 13 with soluble TNF receptor, etanercept). The mean age at first symptoms was 26 years, 71% were men. Patients were followed for 15.2 years (mean) before anti-TNF versus 1.2 years during anti-TNF treatment. The number of uveitis flares per 100 patient-years before and during anti-TNF were, respectively: for all anti-TNF treatments,-51.8 v 21.4 (p = 0.03), RR = 2.4, NNT = 3 (95% confidence interval (CI) 2 to 5); for soluble TNF receptor-54.6 v 58.5 (p = 0.92), RR = 0.9; and for anti-TNF antibodies-50.6 v 6.8 (p = 0.001), RR = 7.4, NNT = 2 (95% CI 2 to 5). CONCLUSION: Anti-TNF treatments were efficacious in decreasing the number of uveitis flares in patients with spondylarthropathy. Anti-TNF antibodies decreased the rate of uveitis flares, whereas soluble TNF receptor did not seem to decrease this rate. These results could have consequences for the choice of anti-TNF treatment in certain patients.

[Extra-meningeal meningococcal infection: report of 14 cases]. / Localisations extraméningées des infections à méningocoque : à propos de 14 cas.

INTRODUCTION AND METHOD: Fifty-five patients (17 adults, 38 children) with meningococcal infection were admitted between 1986 and 2002 in a university hospital (500 beds). Fourteen of them (nine adults, five children) presented with an extra-meningeal infection. We compared adults and children presentations. RESULTS: All adults had immunodeficiency. Septic locations were various (three bacteriemia, four pneumoniae, one infected ascitis, one cutaneous abscess). All patients received amoxicillin or third generation cephalosporin. Hospitalisation was prolonged (mean: 47 days). Seven patients required intensive care unit admission, and two of them died. All children (all were less than 36-month-old) presented with fever. Only one was immunodeficient (infected by human immunodeficiency virus). Neisseria meningitidis grew from blood in four, and in the throat for the remaining one. Hospitalisation was of short duration (mean: 4 days) and none of the children required intensive care unit. All the children recovered rapidly with antibiotics. CONCLUSION: Outcome of extra-meningeal infection with N. meningitidis is different in adults and children. Adults present with immunodeficiency, infection is severe and patients present with various clinical features; children have a more homogeneous clinical presentation (fever) and outcome is excellent.

[Bone marrow reconversion and magnetic resonance imaging: case report]. / Le phénomène de reconversion médullaire et son aspect en imagerie par résonance magnétique : à propos d'un cas.

INTRODUCTION: Bone marrow is divided into red marrow mainly constituted of hemopoietic cells and fatty yellow marrow. In some situations, yellow marrow may be converted into red marrow and this process is called marrow reconversion. Magnetic resonance imaging may be misleading with an invading bone marrow neoplastic process. EXEGESIS: We report a patient with non-Hodgkin's lymphoma with vertebral invasion. Clinical features at presentation were misleading with lower limbs migratory pain suggestive of inflammatory myositis. An MRI study of thigh muscles revealed femoral nodular lesions suggestive of bone marrow reconversion. CONCLUSION: Bone marrow reconversion is a physiologic and reversible process. Awareness of its radiographic features may help to avoid a diagnostic biopsy procedure.

Pamidronate treatment in SAPHO syndrome.

OBJECTIVE: Pamidronate is usually administered because of its antiosteoclastic effects but seems to have anti-inflammatory properties also. SAPHO syndrome is characterized by both increased bone remodeling and inflammatory osteitis, indicating that it may respond favorably to pamidronate's dual mechanism of action. PATIENTS AND METHODS: We report five cases of SAPHO syndrome refractory to standard treatments. All patients were taking nonsteroidal anti-inflammatory drugs, either alone or in combination with analgesics, glucocorticoids, and/or second-line drugs. We used intravenous pamidronate during exacerbations of the disease. The primary evaluation criterion was the reduction in the visual analog scale (VAS) score for pain, and a response was defined as a greater than 50% reduction. RESULTS: Four of the five patients had a response after 1 week. Two of these four patients still met the response criterion after 3 months. Four of the five patients were able to reduce the dosage of their usual medications. In one patient, pamidronate therapy was associated with an increase in the intervals between exacerbations. Joint Bone

Prevalence of enteroparasites in a residence for children in the Córdoba Province, Argentina.

A study of the prevalence of enteroparasites in a population belonging to a substitute home that gives shelter to orphaned and homeless children was done using conventional methods of analysis. This home is located in Córdoba Province, Argentina, and has the following characteristics: It has nine houses located inside the main plot of ground, that shelter 139 individuals, and 25 houses outside this plot distributed randomly in Unquillo city and that shelter 257 individuals. The overall parasitic infection, pathogen and commensal organisms included, yielded 84.8% and the prevalence of the most important parasites was: Enterobius vermicularis (43.4%), Giardia lamblia (23.0%), Ascaris lumbricoides (13.1%), Entamoeba coli (45.5%), Blastocystis hominis (44.4%) and Endolimax nana (34.6%). We also analyzed the population dividing it according to the residence place (inside or outside the plot), age and sex of the individuals. In reference to the location of the patients, A. lumbricoides and E. coli showed significant prevalence in the individuals living inside the plot (p < 0.001 and p < 0.005, respectively) and of B. hominis in those living outside the main plot (p < 0.005). Results indicated a greater parasitism level in the outside residents (61.5%, p < 0.001). When the individuals were studied according to sex, no significant difference was observed, except for E. vermicularis that showed greater prevalence in the male sex (p < 0.04). When the individuals were grouped according to age ranges, a greater prevalence in individuals from 5 to 14 years was noticed (p < 0.01). In this study is also included an analysis of the multiparasitism level that comprises the whole population.

[Comparison of 2 serologic methods for the diagnosis of hydatidosis]. / Comparación de dos métodos serológicos para el diagnóstico de hidatidosis.

The sera of 176 patients with epidemiologic antecedents or radiologic and clinical signs of hydatidosis were tested by counter-immunoelectrophoresis (CIE) and enzyme-linked immunoassay (ELISA). A semipurified antigen from cysts of human origin were used for both techniques. The results were compared with those obtained from complementary radiologic studies and were confirmed by examination of excised cysts. Biopsy confirmed the diagnosis of hydatidosis in 65 patients (37%) and revealed the presence of other diseases in the remaining 111 (63%). Of the original 176 patients, 36 (20.4%) were positive by CIE and 62 (35.2%) by ELISA. Both techniques showed an excellent correlation with postsurgical diagnosis; neither produced any false positives, and the ELISA gave false negative results for only three patients (4.6%) with cysts that were infected, infertile, or calcified to some degree. The paper describes standardization of an inexpensive and easy-to-use microELISA.