B Cell Lymphoma mimicking Rheumatoid Arthritis

Non Hodking´s lymphoma (NHL) may involve bones but synovial involvement is uncommon. We describe a patient who presented with polyarthritis, sicca symptoms and rash suggestive of rheumatoid arthritis. An atypical skin rash prompted skin and synovial biopsies. A diagnosis of synovial and skin malignant large B-cell lymphoma anaplastic subtype was performed. Chemotherapy with dexamethasone, vincristine and rituximab was started. Following treatment the patient had complete resolution of cutaneous and articular lymphoma manifestations.

Immunophenotypical characterization in Andalusian horse: variations with age and gender

Assessment of lymphocyte subsets is an effective method for characterizing disorders such as leukemia, lymphomas, autoimmune and infectious diseases. In order to clinically interpret these parameters, normal reference values should be set, estimating age- and gender-related variations. This research aimed to: (1) characterize lymphocyte subpopulations in Andalusian horse, and (2) evaluate age and gender-related variations of lymphocyte subsets. Jugular blood samples were obtained from 159 animals, 77 males and 82 females, belonging to four age groups-1: 1-2 years (N=39; 21 males and 18 females), 2: 2-3 years (N=38; 16 males and 22 females), 3: 3-4 years (N=41; 19 males and 22 females) and 4: 4-7 years (N=41; 21 males and 20 females). T lymphocytes subsets were quantified by flow cytometry with monoclonal antibodies specific for CD2, CD4 and CD8 cell markers. B and NK cell counts were estimated by using a mathematical formula. No variations were found in T, B lymphocytes and NK cells between males and females. Animals of group 1 and 2 had a higher number of CD2, T, CD4+, CD8+, B lymphocytes and NK cells than animals of groups 3 and 4. The percentage of CD2 in group 1 was significantly lower than in group 4. The percentage of T and CD4+ lymphocytes in the group 1 were significantly higher than groups 2 and 3, respectively. Whereas the percentage of B cells calculated by flow cytometry was significantly lower in group 2 compared to group 4, the percentage of B cells calculated by a mathematical formula was higher in group 1. NK cells percentage was significantly lower in group 3 and 4 than in younger animals. In conclusion, in Andalusian horse, gender does not influence absolute numbers and percentages of T, B and NK. There is an age-related decline in absolute number of CD2, T, CD4+ and CD8+ lymphocytes, B lymphocytes and NK cells, with increasing percentage of CD2, T, CD4+ and B lymphocytes, and a decrease in NK with no differences in CD4/CD8 ratio. The decline of lymphocyte population numbers with age is a natural process in many animal species, and could be the origin for immune dysfunction observed in geriatric individuals.

Outcome-impact of a cervical cancer (CC) screening program (SP) in a developing country

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Background: CC is the 2nd cause of cancer death in women in Argentine. Early detection following screening programs has demonstrated to reduce mortality in CC. The evaluation of the efficacy and efficiency of CC SP is associated with the proportion of positive cases in the smears and with the relation between pre-invasive lesion (CIN III) and invasive carcinoma (IC) in the biopsies done in positive cases. In 1997 a population based CC screening program was started in our province. The objective of this trial was to determinate the relationship between CIN III and IC in the program population and compare this results with this proportion in pre-program years an as an indicator of the quality of the program. Methods: We analyzed 2446 cervix biopsies performed in public Hospitals of Tucuman between 1985 and 2004 (archives of biopsies of the Serv. de Patología del Hosp. Centro de Salud Z. Santillán, Regional M. Belascuain and Hospital Angel C. Padilla), Since 1997 biopsies were done in patients within the SP We analyzed the proportions of pre-invasive lesions (CIN III) and invasive lesions in periods of 4 years. Results: The proportion of CIN III by periods of 4 years was: 85–88: 13%, 90–92: 20%; 93–96: 20%; 97–00 32% and 01–04 37%. The proportion of CIN III in pre-screening years was 21% and during the SP: 54%. Conclusion: These results shows an increase of CIN III over IC which could translate into a better survival. The quality control analysis of the public programs must be central in the public health policy.

[Table: see text]

No significant financial relationships to disclose.

Frequency of biopsies (BX) and colposcopy (CP) of intraepitelial lesions (IL) in the cervical cancer screening program (CCSP)

11000

Background: Cervical cancer is a public health problem in developing countries that can be prevent by screening programs. The loss of patients with PAP smears with IL is one of the main concern in the CCSP. The objectives of this study were establish the frequency of IL in the CCSP of Tucumán and determine the frequency of BX and CP in patients with IL within the program. Methods: Data was taken from the clinic-epidemiological charts of CCSP, and pathology reports of 29,169 cytologies (CX) done in women entered in CCSP of Tucumán between 1997 and 2004 The PAP smears were done and informed following Bethesda system and centralized in Hospital Centro de Salud: Zenón Santillán of Tucumán. Results: 2% of the CX were IL. In the beginning of program in 1997 in HSIL and LSIL a BX was performed in 22% and 18% of patients respectively and in 2004 BX was performed in 61% and 25% respectively. There were no data of CP before 2001 but in 2001 a CP was performed in HSIL and LSIL in 21% and 9% and in 2004 CP was performed in 43% and 14% respectively. Conclusion: The percentage of BX and CP performed in IL patients included in the CCSP, increased in the last year of program achieving a 60% and 43% in HSIL which is quite acceptable in a developing country.

No significant financial relationships to disclose.

Risk of congenital anomalies in the vicinity of municipal solid waste incinerators

BACKGROUND

Although municipal solid waste incineration (MSWI) has contributed to increase the overall environmental load of particulate matter containing dioxins and metals, evidence of health consequences to populations is sparse.

AIMS

To assess at a regional level (in southeast France) the impact of these emissions on birth defect rates.

METHODS

Communities with fewer than 50 000 inhabitants surrounding the 70 incinerators that operated at least one year from 1988 to 1997 were studied. Each exposed community (n = 194) was assigned an exposure index estimated from a Gaussian plume model. Poisson models and a reference population of the 2678 unexposed communities in the region were used to calculate relative risks for congenital malformations, adjusted for year of birth, maternal age, department of birth, population density, average family income, and when available, local road traffic.

RESULTS

The rate of congenital anomalies was not significantly higher in exposed compared with unexposed communities. Some subgroups of major anomalies, specifically facial clefts and renal dysplasia, were more frequent in the exposed communities. Among exposed communities, a dose-response trend of risk with increasing exposure was observed for obstructive uropathies. Risks of cardiac anomalies, obstructive uropathies, and skin anomalies increased linearly with road traffic density.

CONCLUSIONS

Although both incinerator emissions and road traffic may plausibly explain some of the excess risks observed, several alternative explanations, including exposure misclassification, ascertainment bias, and residual confounding cannot be excluded. Some of the effects observed, if real, might be attributable to old-technology MSWIs and the persistent pollution they have generated.

Hemorheological profile in chronic venous insufficiency after surgery

In recent years, there have been rheological abnormalities reported in chronic venous insufficiency (CVI), mainly an increase of erythrocyte aggregability (EA), which probably take part in the pathophysiology of the disease. The aim of this study was to analyze the hemorheological profile after stripping in 45 patients suffering from CVI. Follow-up included laboratory tests on the 7th, 60th and 180th day after surgery. EA was assessed with a photometric aggregometer (MA1, Myrenne) in stasis and low shear (3 s(-1)). The results show an increase of EA on the 7th day after surgery (p<0.001). Two and 6 months later, EA values returned to those found prior to surgery. The plasma fibrinogen level changes in a way parallel to EA. The association between rheological disturbances and thrombogenesis is well known, so the hyperaggregability found supports the antithrombotic prophylaxis in the early postsurgical period. On the other hand, the hemorheological abnormalities persist after stripping, so postsurgical treatment to inhibit EA may be beneficial.

Maternal occupational risk factors for oral clefts. Occupational Exposure and Congenital Malformation Working Group

OBJECTIVES

This study investigated the role of maternal exposures at work during pregnancy in the occurrence of oral clefts.

METHODS

The occupational exposures of 851 women (100 mothers of babies with oral clefts and 751 mothers of healthy referents) who worked during the first trimester of pregnancy were studied. All the women were part of a multicenter European case-referent study conducted using 6 congenital malformation registers between 1989 and 1992. In each center, the mother's occupational history, obtained from an interview, was reviewed by industrial hygienists who were blinded to the subject's status and who assessed the presence of chemicals and the probability of exposure. Odds ratios (OR) were estimated by a multivariate analysis including maternal occupation or occupational exposures during the first trimester of pregnancy and possible confounding factors such as center of recruitment, maternal age, urbanization, socioeconomic status, and country of origin.

RESULTS

After adjustment for confounding factors, cleft palate only was significantly associated with maternal occupation in services such as hairdressing [OR 5.1, 95% confidence interval (95% CI) 1.0-26.0] and housekeeping (OR 2.8, 95% CI 1.1-7.2). The analysis suggests that the following occupational exposures are associated with orofacial clefts: aliphatic aldehydes (OR 2.1, 95% CI 0.8-5.9) and glycol ethers (OR 1.7, 95% CI 0.9-3.3) for cleft lip with or without cleft palate and lead compounds (OR 4.0, 95% CI 1.3-12.2), biocides (OR 2.5, 95% CI 1.0-6.0), antineoplastic drugs (OR 5.0, 95% CI 0.8-34.0), trichloroethylene (OR 6.7, 95% CI 0.9-49.7), and aliphatic acids (OR 6.0, 95% CI 1.5-22.8) for cleft palate only.

CONCLUSIONS

Due to the limited number of subjects, these results must be interpreted with caution. However, they point out some chemicals already known or suspected as reproductive toxins.

Tobacco and alcohol use during pregnancy and risk of oral clefts. Occupational Exposure and Congenital Malformation Working Group

OBJECTIVES

This study examined the relationship between maternal tobacco and alcohol consumption during the first trimester of pregnancy and oral clefts.

METHODS

Data were derived from a European multicenter case-control study including 161 infants with oral clefts and 1134 control infants.

RESULTS

Multivariate analyses showed an increased risk of cleft lip with or without cleft palate associated with smoking (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.07, 3.04) and an increased risk of cleft palate associated with alcohol consumption (OR = 2.28, 95% CI = 1.02, 5.09). The former risk increased with the number of cigarettes smoked.

CONCLUSIONS

This study provides further evidence of the possible role of prevalent environmental exposures such as tobacco and alcohol in the etiology of oral clefts.

Haemorheological Proælein Chronic Venous Insufæciency

Background:

In recent years, pathophysiological studies and treatment approaches of chronic venous insufficiency (CVI) have focused on haemorheology.

Objective:

To analyse erythrocyte aggregation (EA) and blood viscosity (BV) in mild and severe stages of CVI.

Methods:

In 147 patients (three severity stages), EA was measured with a photometric aggregometer, and BV with a cone-plate viscosimeter. Patients with concomitant pathologies affecting haemorheology were excluded.

Results:

EA was higher in patients (mean EA 10M: 16.4 vs 14.5 control), increasing progressively with the evolution of CVI ( p<0.001). Greatest differences were found for stage III (mean EA 10M: 17.6) vs stage II (15.7) and stage 0 (14.5) respectively ( p<0.001), but rheological abnormalities exist in early grades (I: 16.7) ( p<0.01). Fibrinogen and age had a strong influence on EA ( p<0.003 and p<0.001 respectively). When a covariance analysis avoided their effect, significant global differences between CVI groups persisted. BV at high shear rate was increased at advanced stages (III: mean 3.3 centipoise (cp); I: 3.1 cp) ( p<0.05).

Conclusions:

We found progressive impairment of the haemorheological profile with the worsening stages of CVI, related to age, severity stage and fibrinogen. Rheological impairment is likely to play a part in the pathophysiology of CVI, and perhaps may be useful in its management.

Comparative study of the clinical efficacy of two different coumarin dosages in the management of arm lymphedema after treatment for breast cancer

In a randomized, double-blind, parallel group study, we compared the clinical efficacy of coumarin 90 mg/day (Group A) with 135 mg/day (Group B) in 77 women (age 35-65 years) with lymphedema of the upper limb secondary to surgery and irradiation for treatment of breast cancer. During 12 months of coumarin therapy, the arm volume of lymphedema and a clinical score (degree of arm edema, heaviness, hardness, and neuralgia/dysesthesia) were determined. In both groups, the volume of arm lymphedema decreased (14.9% in Group A and 13.2% in Group B) (N.S.), the overall clinical score improved (12.9 +/- 4.3 to 5.7 +/- 3.5 in Group A and from 11.7 +/- 3.7 to 4.7 +/- 3.9 in Group B) (N.S.), and the overall efficacy of coumarin was similarly good or excellent (71.9% in Group A and 68.6% in Group B) (N.S.). Only mild to moderate side effects of drug therapy were recorded. Coumarin prevents a spontaneous trend toward an increase in arm lymphedema after treatment of breast cancer, decreases the severity of local symptoms, and overall improves the quality of life. No difference was found between the apparent benefits of coumarin at 90 mg/day compared with 135 mg/day.

Descriptive epidemiological survey on a given day in all palliative care patients hospitalized in a French university hospital

We conducted a descriptive study on a given day on all inpatients requiring palliative care in a French university hospital. In each department, a collaborative team made up of physicians and nurses identified and described the clinical signs, the treatment protocols, the social and family characteristics and the outcome for each patient using a standardized questionnaire. Study subjects were inpatients in the hospital and presented advanced or terminal-stage life-threatening conditions. Two-hundred-and-forty-five patients were included in the study. These patients represented 13% of the total number of inpatient beds available in the hospital on the day of the survey. Sixty-six per cent of study subjects suffered from physical discomfort and 80% suffered psychologically. Patients still received specific treatment for their condition in 45% of cases. Social problems were identified principally in medium- or long-term care department inpatients who made up 36% of the total inpatient population. A request for transfer to another care structure had been completed for 24% of patients. Assistance from the Palliative Care Unit's support team had been requested in 25% of cases, mainly to provide psychological support for the patient and the health care providers. These results have led us to reconsider the general organization of palliative care in the health care system.

Use of the Er:YAG laser for improved plating in maxillofacial surgery: comparison of bone healing in laser and drill osteotomies

BACKGROUND AND OBJECTIVE

Surgical reconstruction of bony defects in the maxillofacial region involves fixation of bony fragments with mini and micro plates. Bone stabilization during hole drilling is often challenging due to the need to apply pressure when using a conventional mechanical Hall drill. In addition, fragmentation of the fragile bones may occur and complicate the reconstruction. The pulsed Er:YAG laser offers an attractive alternative drilling modality because it does not require physical contact with the bone in order to drill holes, cuts bone with minimal thermal damage, and allows precise control of bone cutting. The objective of this study was to investigate the pulsed Er:YAG laser as an alternative to the mechanical bur by comparing bone healing using both modalities.

STUDY DESIGN/MATERIALS AND METHODS

Bone healing in an inferior border defect of the rat mandible was examined using either an Er:YAG laser or a mechanical bur for drilling. The healing of osteotomies in facial bones and of screw holes for plate stabilization of free bone fragments was studied.

RESULTS

All defects healed by 4 weeks postoperatively. Histologic evaluation demonstrated no difference in the amount of newly formed woven bone at the osteotomy site or screw holes made by either the laser or the drill. The extent of thermal damage at the osteotomy sites was comparable in laser and mechanically cut bone fragments.

CONCLUSIONS

On the basis of this study we suggest that the Er: YAG laser can be used clinically in thin, fragile bones in the maxillofacial region.

Glycoprotein biosynthesis at the time of palate fusion by rabbit palate and maxilla cultured in vitro

The dynamics of glycoprotein biosynthesis in rabbit maxillary and palatal explants at the time of palatal fusion was studied using 3H-fucose and 14C-leucine as precursors. The results show that there is an increase in glycoprotein biosynthesis in the rabbit palate in vitro at a time commensurate with the onset of contact and adherence of the palatal shelves.