Capillary malformation-arteriovenous malformation syndrome: a multicentre study

BACKGROUND

Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a rare syndrome with characteristic skin lesions that are associated with fast-flow vascular malformations (FFVMs) in one-third of patients. Few case series have been described, and none in Spain.

AIM

To identify the prevalence of dermatological parameters, FFVMs and associated features in a large series of patients with CM-AVM.

METHODS

We conducted an observational study of patients with CM-AVM syndrome diagnosed in 15 Spanish hospitals over 3 years. The main clinical, radiological, genetic findings and associated diseases were analysed.

RESULTS

In total, 64 patients were assessed. In 26.5% of cases, the diagnosis was incidental. In 75% of patients, there was one significantly larger macule, which we termed the 'herald patch'. FFVMs were detected in 34% of the patients, with 30% located on the skin, 7.8% in the brain and in 1.5% in the spine. There was a positive family history in 65% of the 64 patients. Genetic analysis was performed for RASA1 mutations in 57 patients, of whom 42 (73%) had a positive result. All 4 patients tested for EPHB4 mutations had a positive result. No tumour lesions were detected in the series, except for five infantile haemangiomas.

CONCLUSIONS

Our data on clinical lesions, associated FFVM, family history and genetics are similar to those previously published in the literature. An extensive data analysis failed to demonstrate any statistically significant association between the presence of an FFVM and any clinical, familial or genetic parameter that could predict its onset, although a link between the presence of a herald patch on the midline face and the presence of a brain FFVM was observed. We did not detect any genotype-phenotype correlation.

Factors contributing to unintentional parathyroidectomy during thyroid surgery

Unintentional parathyroidectomy during thyroid surgery has an incidence ranging between 1% and 31% across institutions. Many studies have identified malignancy and central neck dissection as risk factors for losing parathyroid glands, but few studies have evaluated the impact of other factors such as lymphocytic thyroiditis, hyperthyroidism, or concomitant primary hyperparathyroidism. The purpose of this study was to investigate which factors contribute to parathyroid loss during thyroid surgery. Charts of 269 patients undergoing thyroid surgery at a tertiary care medical center from 2010 to 2013 were retrospectively reviewed. Sixty-six patients (24.5%) experienced unintentional parathyroidectomy. Bivariate analysis showed no significant differences in patient characteristics. Patients with unintentional parathyroid removal had a significantly smaller largest thyroid nodule size (P = 0.002), higher rate of central neck dissection (30.3% vs 7.9%, P < 0.0001), and higher rate of malignancy (50% vs 36.0%, P = 0.04). Multivariable analysis showed that the strongest risk factor for unintentional parathyroidectomy was central neck dissection (P = 0.0008; odds ratio 4.72, confidence interval 1.91-11.71). In conclusion, central neck dissection for thyroid malignancy is the strongest risk factor for unintentional thyroidectomy. The presence of concomitant primary hyperparathyroidism, lymphocytic thyroiditis, or hyperthyroidism did not appear to increase the risk of unintentional parathyroidectomy.

Low serological positivity in patients with histology compatible with celiac disease in Perú

OBJECTIVE

To study the frequency of positive serology for celiac disease (CD) in patients with duodenal biopsies suggestive of this disease.

MATERIAL AND METHODS

Cross sectional study. We included patients with duodenal biopsies histologically compatible with CD and antigliadin, antiendomysial and IgA antitransglutaminase antibodies. We defined a "case" of CD if there was a positive biopsy and either antiendomisial or antitransglutaminase positive antibodies.

RESULTS

Thirty one patients were included in our study. Six were antiendomysial positive and 5 antitransglutaminase positive while the antigliadin was positive in 14 cases. Therefore, out of 31 patients only 10 had a serology compatible with CD and only one had positive both antibodies, antiendomysial and antitransglutaminase.

CONCLUSIONS

a) We have found that most of the duodenal biopsies compatible with CD are not diagnosed with positive serology; and b) we found a low correlation between serological diagnostic tests.

Therapy of paraneoplastic pemphigus with Rituximab: a case report and review of literature

Paraneoplastic pemphigus (PNP) is an autoimmune blistering disease with poor prognosis when associated with malignant neoplasm. We report the case of a patient with PNP associated with a CD20+ non-Hodgkin follicular lymphoma who was treated with Rituximab plus corticosteroids and short courses of cyclosporin. One and a half years after Rituximab therapy, oral ulcerations had cleared and oral methylprednisolone was slowly tapered down without further recurrences. In the course of the disease, the patient developed sepsis due to Listeria monocytogenes and viral infections by human herpes virus 1 and 3. At the end-stage of the disease she developed a cutaneous infection from Mycobacterium chelonae. The patient died 2 years and 7 months after the onset of PNP. Rituximab may be useful for PNP therapy, but further studies are necessary to confirm this hypothesis.

Why Ecosystem Management Can't Work Without Social Science: An Example from the California Northern Spotted Owl Controversy

It is increasingly obvious that social science, while not a sufficient condition for making ecosystem management effective, is a necessary condition. A social science typology of ecosystems is developed, applied, and shown to have substantial and unexpected implications for the practice of ecosystem management. Ecologists and environmental scientists, in particular, will find some conclusions uncomfortable. The application involves a case material from the California northern spotted owl controversy.KEY WORDS: Ecosystem management; Social science; Adaptive management; Top-down versus bottom-up planning; Outside-in versus inside-out planning

Evaluation of automatic and semiautomatic coagulation assay instruments

The precision of five instruments (Coag-A-Mate, Auto-Fi, Coagulyzer, Electra 600 and Fibrometer) in performing activated partial thrmboplastin time (PTT) assays were compared using three different coagulation reagent systems (Ortho, Dade, and General Diagnostics) utilizing normal and abnormal control reagents. There were wide variations in mean PTT values and co-efficient of variation (CV) among all instruments and for each instrument utilizing different reagents. The smallest CV was noted for The Coagulyzer using Dade reagents, the Coag-A-Mate using Dade and General Diagnostic reagents and the Auto-Fi using General Diagnostic reagents. Auto-Fi values were always longer than those determined with the Fibrometer whereas the optical detection instruments usually gave shorter values. The range of normal values for the prothrombin time (PT) and PTT assay was recorded simultaneously on blood samples of 52 healthy donors utilizing the Coagulyzer with Ortho reagents, the Coag-A-Mate with General Diagnostic reagents nd the Auto-Fi with Dade reagents. No differences were noted between male and female donors. There was a poor correlation among PT results recorded by all instruments. For the PTT assay, results obtained with the Coag-A-Mate and the Auto-Fi had a correlation of 0.84. The normal mean plus 2 or 3 standard deviations determined by the Auto-Fi and the Coag-A-Mate were used to classify blood samples from 263 patients as normal or abnormal when assayed by each instrument. For the PTT assay, coincidence was attained in 91.2% of the samples and discrepancies (a blood classified abnormal by one instrument and normal by the other) were evenly distributed for both instruments. For the PT assay, coincidence occurred in 85.1% of the cases and there was a statistically significant trend (P < 0.05) for the Auto-Fi in classifying abnormal samples categorized normal by the Coag-A-Mate.

Changes in antibiotic sensitivity patterns of Gram-negative bacilli in burns

Sensitivity tests with 12 antibiotics on 1,018 strains of Gram-negative bacilli isolated in a burns unit between 1969 and 1971 showed some important differences from results in similar tests on a series of strains isolated between 1965 and 1967. These changes included the emergence of a large proportion of kanamycin-resistant strains of Klebsiella aerogenes, Proteus mirabilis, and Escherichia coli and of smaller proportions of trimethoprim- and gentamicin-resistant strains; also the complete replacement of Proteus mirabilis with dissociated resistance to ampicillin by strains showing linked resistance to ampicillin and carbenicillin. The probable relationship of these changes to the emergence of an R factor determining resistance to tetracycline, kanamycin, carbenicillin, ampicillin, and cephaloridine in Enterobacteria and Pseudomonas aeruginosa is discussed.