[Two patients with joint pain as initial presentation of a haematological malignancy]. / Twee patiënten met gewrichtsklachten als initiële presentatie van een hematologische maligniteit.

A 75-year-old man and a 53-year-old woman had longstanding joint pain, for which they had been treated with NSAIDs. When the symptoms worsened, a thorough diagnostic investigation was conducted that revealed myeloproliferative bone-marrow disorders in both patients. The man, who had polyarticular gout secondary to chronic myelomonocytic leukaemia, was able to maintain control of his joint pain with medical treatment. In the woman, with a history of stable joint pain due to polyarthritis, deterioration of the symptoms and the development of pancytopaenia led to a diagnosis of acute lymphocytic leukaemia; she died after receiving multiple courses of chemotherapy. The possibility of an underlying malignancy should be considered in patients with atypical symptoms in the locomotor system, an unexpected course or anomalous secondary symptoms.

Pustular skin lesions in patients treated with infliximab: report of two cases.

Two cases are presented in which repeated use of the TNF-alpha blocker infliximab may have led to development of pustular skin lesions. These findings might result in an improved understanding regarding the safety of infliximab with long-term usage.

High resolution angiometers for the assessment of the elastic modulus.

Distensibility and compliance are vessel wall properties of large arteries that determine their dynamic behaviour and play a role in cardiovascular disease. At present, arterial distensibility and compliance can be accurately investigated using noninvasive ultrasound techniques. Echo-tracking devices in particular are suited to study local distensibility and compliance of several superficial large arteries. The best-known echo-tracking devices (Nius02 and Wall Track System) are briefly outlined with respect to their advantages and disadvantages. These techniques have shown a good reproducibility and accuracy. The two devices are complementary and can be applied to different parts of the arterial tree. The results of the studies done with echo-tracking devices give insight in the pathophysiologic mechanisms underlying cardiovascular diseases in different arterial territories. In to the future it may be possible to use local arterial wall properties together with cardiac wall hypertrophy as important markers of future cardiovascular risk and as relevant parameters for the evaluation of pharmacological interventions.

Treatment of elderly patients with isolated systolic hypertension with isosorbide dinitrate in an asymmetric dosing schedule.

Nitrates decrease pulse pressure more than mean arterial pressure (MAP) and are advocated for the treatment of isolated systolic hypertension (ISH). Nitrates show drug tolerance during chronic treatment so an asymmetric dosing regimen may prevent loss of effect of nitrates. This study investigates the anti-hypertensive effect of isosorbide dinitrate (ISDN) given in a twice daily asymmetric dosing regimen in elderly patients with ISH. After a 6-week placebo run-in period, patients entered the double-blind study. Ten patients received placebo and 11 patients ISDN 20 mg b.i.d. for 8 weeks. This dose could be doubled once. Office systolic and diastolic blood pressures (SBP/DBP) and ambulatory BP were measured. Pulse pressure was calculated as SBP-DBP. Office pulse pressure was more reduced during ISDN (17.9%) than with placebo (5%; P < 0.05). SBP and MAP decreased compared to baseline, but the changes were not statistically significant between the two groups. DBP tended to increase with ISDN compared to placebo. Mean 24-h, mean daytime and mean night-time pulse pressure decreased after treatment with ISDN (10.7%, 12.1%, 7.9%, respectively). Pulse pressure tended to decrease more during the day than during the night with ISDN. No changes could be demonstrated with placebo. In conclusion, pulse pressure decreased with ISDN, resulting in a lower SBP without a decrease in DBP. The latter may preserve coronary perfusion in ISH. With the asymmetric dosing regimen the decrease in pulse pressure was not clear at night. Whether a decrease in nocturnal BP, in addition to the spontaneous decrease, is advisable in ISH remains a matter of debate.

An unwanted side effect of hydroxyurea in a patient with idiopathic myelofibrosis.

A patient with idiopathic myelofibrosis is reported who developed a drug fever after treatment with hydroxyurea, a generally effective and well-tolerated drug in chronic myeloproliferative syndromes. Typically, this form of fever develops after a few weeks of exposure to the drug and disappears with discontinuation of the drug. Possible interactions with prostaglandin or leukotriene metabolism may play a role.