["Mechanic's hands" during antisynthetase syndrome: a marker of systemic involvement?]

BACKGROUND

Antisynthetase syndrome is characterized by the presence of interstitial lung disease, inflammatory myopathy, joint disease, Raynaud's phenomenon and characteristic skin lesions of the hands known as "mechanic's hands" associated with the presence of serum antibody to aminoacyl transfer-RNA synthetases. We report the case of a patient in whom cutaneous relapse consistently preceded CT evidence of pulmonary fibrosis flare-up.

PATIENT AND METHODS

A 56-year-old patient consulted for recent exertional dyspnoea and dry cough. Clinical examination showed the skin of the tips and edges of the fingers to be thickened, hyperkeratotic and fissured. High-resolution computed tomography thoracic scans revealed interstitial lung lesions affecting both lower lobes. Lab tests showed elevated serum creatine kinase and positivity for anti-Jo-1 antibodies. Response to treatment with corticosteroids and cyclophosphamide was marked by an improvement in symptoms and regression of radiological anomalies together with disappearance of cutaneous signs. Nine months later, after changeover from cyclophosphamide to mycophenolate mofetil, cutaneous relapse and flare of interstitial lung disease were observed. A second course of cyclophosphamide followed by azathioprine resulted in regression of the cutaneous and pulmonary lesions.

CONCLUSION

Mechanic's hands may be considered a marker of visceral involvement and should be sought in any instance of suspected antisynthetase syndrome flare-up.

EBT2 films response to alpha radiation at 48.3 MeV

To advance the development of a radiobiological experimental set-up for alpha particle irradiations at the Arronax cyclotron, experiments were performed to get the dose response of Gafchomic EBT2 films for alpha particles at 48.3 MeV. A system has been developed using a thin monitor copper foil and an X-ray spectrometer to measure the beam intensity and to calculate the delivered dose. On the other hand, the authors have irradiated EBT2 films, with 6-MV X rays, to get the dose response of EBT2 films for photons. The dose response curve for alpha particles shows an effect of polymerisation saturation compared with the dose response curve for photons.

High-dose sublingual immunotherapy in patients with uncontrolled allergic rhinitis sensitized to pollen: a real-life clinical study

BACKGROUND

High-dose pollen sublingual immunotherapy (SLIT) is indicated in patients with moderate to severe allergic rhinitis (AR), especially those who are unable to control their disease with pharmacotherapy. We explore the use of high-dose SLIT in patients with severe AR and sensitized to pollen, in real-life clinical practice. We also analyzed the effect on asthma.

METHODS

This was a prospective observational study conducted at the Allergy outpatient clinic at Hotel Dieu de France Hospital (HDF), Beirut, Lebanon. The cohort, composed of 118 patients between 7 and 55 years old, was regularly evaluated at inclusion, at 12 months, and at 36 months. Fifty-five percent of AR patients had associated controlled asthma. Patients received a standardized pollen extract (Staloral 300IR). The pollen combination was 1 to 3 pollens, the most commonly used were Parietaria judaica, Cupressaceae, 5 grasses, and Oleaceae. In a previous study, those were the main allergenic pollens correlated to AR in the same population. Global assessment of the effect of SLIT was measured using a rhinitis total symptom score (RTSS), a rhinitis medication consumption score (RMCS), a global asthma score (ASS), and an asthma medication consumption score (AMCS).

RESULTS

Using a t test we found that the average scores at inclusion, 12 months, and 36 months, respectively, were as follows: RTSS: 31.32, 16.39 (p < 0.041), and 13.35 (p < 0.041); RMCS: 6.96, 1.96 (p < 0.0162), and 1.61 (p < 0.0162); ASS: 4.62, 1.96 (p < 0.0005), and 1.33 (p < 0.0005); and AMCS: 2.35, 0.78 (p < 0.0005), and 0.7 (p < 0.0005).

CONCLUSION

Our study showed favorable results of SLIT to aeroallergens in patients with uncontrolled AR. The effect is also applicable to the subgroup of patients suffering from concomitant, controlled asthma.

Return to sport following amputation

Amputation in athletes has a substantial impact on lifestyle and sporting activity, as well as self-perception and quality of life. The impact of limb loss on athletic ability will vary depending on the cause of amputation and the anatomical location of the amputation. The use of sporting activity for rehabilitation of amputees was first introduced in 1944 at Stoke Mandeville Hospital. The first international paralympic games were founded in 1960. Following these events the opportunity to participate in sport following limb loss has increased significantly. Sport participation has been aided by the development of sporting prostheses, however multiple factors will determine the exact prosthesis used. These include the nature of the sporting activity as well as the level of the amputation. The biomechanics involved in walking and running are altered following the loss of a limb or part thereof. This can cause subsequent degenerative changes within the remaining joints on the amputated limb as well as the contralateral limb. Factors affecting return to sporting activity are multivariate and inter-related, including patient factors, surgical factors, nature and level of the sporting activity and prosthetic factors. The authors review current literature, detail predictive factors of return to sport and the physical and psychosocial impact on patients following limb amputation.

Repair of an aberrant subclavian arterioesophageal fistula following esophageal stent placement

A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal complication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The patient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidisciplinary approach needed to diagnose and manage such a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possibility of such an anomaly in view of the growing popularity of esophageal stents, especially in the setting of a leak.

Granulocyte colony-stimulating factor therapy is associated with a reduced incidence of acute rejection episodes or allograft vasculopathy in heart transplant recipients

BACKGROUND

We evaluated the potential effects of granulocyte colony-simulating factor (G- CSF) on the incidence of rejection and allograft vasculopathy in heart transplant recipients.

METHODS

Of 247 patients undergoing heart transplantation from 2000 to 2007, 52 (21%) developed leukopenia (white blood cell [WBC] <2.5 × 10(9) cells/L) in the absence of active infection, rejection, or malignancy. In 24 (46%) patients a clinical decision was made to treat the leukopenia with G-CSF (G-CSF group), and 28 (54%) Patients received no G-CSF (non-GCSF group). Patients followed up for 1 year after the period of leukopenia were assessed for allograft vasculopathy and acute rejection incidence.

RESULTS

At baseline, the G-CSF group and the non-GCSF group did not differ in age, gender, race, heart failure etiology, creatinine, left ventricular ejection fraction (LVEF) or immunosupressive regimen. During 1-year follow-up there were no deaths in the G-CSF group, and 1 death in the non-GCSF group (P = .34). The incidence of rejection or progressive allograft vasculopathy was lower in the G-CSF group when compared with the non-GCSF group (2 [8%] vs 15 [53%]; P < .01). Multivariate analysis identified both prior rejection episodes and G-CSF therapy as factors associated with the combined end-point of rejection or progressive allograft vasculopathy (odds ratio [OR] = 7.89 [1.67-37.2] and OR = 0.09 [0.02-0.52], respectively).

CONCLUSIONS

G-CSF therapy appears to be associated with a decreased incidence of acute rejection episodes or allograft vasculopathy in heart transplant recipients, suggesting a potential immunomodulatory effect of G-CSF.