[Hematocolpos : an unappreciated diagnosis of hymen imperforation]

The imperforation of the hymen is a relatively rare congenital malformation. It usually manifests itself in adolescence by a hematocolpos. Hematocolpos is the vaginal retention of menstrual blood at puberty. It results clinically in painful amenorrhea and more rarely in a pelvic mass syndrome. The diagnosis is easy, it is primarily clinical. Pelvic ultrasound and nuclear magnetic resonance are the complementary examinations to be performed as a preoperative assessment and to detect any associated genito-urinary malformations.

Hepatitis B Virus Reactivation Associated With Direct-Acting Antiviral Therapy for Chronic Hepatitis C Virus: A Review of Cases Reported to the U.S. Food and Drug Administration Adverse Event Reporting System

BACKGROUND

Direct-acting antiviral agents (DAAs) are used increasingly to treat hepatitis C virus (HCV) infection. Reports were published recently on hepatitis B virus (HBV) reactivation (HBV-R) in patients with HBV-HCV co-infection. Hepatitis B virus reactivation, defined as an abrupt increase in HBV replication in patients with inactive or resolved HBV infection, may result in clinically significant hepatitis.

OBJECTIVE

To assess whether HBV-R is a safety concern in patients receiving HCV DAAs.

DESIGN

Descriptive case series.

SETTING

U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS).

PATIENTS

29 patients with HBV-R receiving HCV DAAs.

MEASUREMENTS

Clinical and laboratory data.

RESULTS

The FDA identified 29 unique reports of HBV-R in patients receiving DAAs from 22 November 2013 to 15 October 2016. Two cases resulted in death and 1 case in liver transplantation. Patients in whom HBV-R developed were heterogeneous regarding HCV genotype, DAAs received, and baseline HBV characteristics. At baseline, 9 patients had a detectable HBV viral load, 7 had positive results on hepatitis B surface antigen (HBsAg) testing and had an undetectable HBV viral load, and 3 had negative results on HBsAg testing and had an undetectable HBV viral load. For the remaining 10 patients, data points were not reported or the data were uninterpretable. Despite provider knowledge of baseline HBV, HBV-R diagnosis and treatment were delayed in 7 cases and possibly 7 others.

LIMITATIONS

The quality of information varied among reports. Because reporting is voluntary, HBV-R associated with DAAs likely is underreported.

CONCLUSION

Hepatitis B virus reactivation is a newly identified safety concern in patients with HBV-HCV co-infection treated with DAAs. Patients with a history of HBV require clinical monitoring while receiving DAA therapy. Studies would help determine the risk factors for HBV-R, define monitoring frequency, and identify patients who may benefit from HBV prophylaxis and treatment. DAAs remain a safe and highly effective treatment for the management of HCV infection.

PRIMARY FUNDING SOURCE

None.

[Adenomyosis]

Adenomyosis is a medical benign condition of the endometrium-myometrium interface that is histopathologically characterized by the presence of ectopic tissue (endometrial glands and stroma) in myometrium. The diagnosis is complicated by the low specificity of its symptoms and the frequent associations with others gynaecologic pathologies. Consequently, paraclinic investigations are essential to make the diagnosis.

[Pregnancy and systemic lupus erythematosus: compatible?]

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease that predominantly occurs in women of childbearing age. The risk of obstetric complications in lupus parturients is significant. In addition, pregnancy may be associated with flares of the disease requiring immunosuppressive therapy. For these reasons, SLE pregnancies are considered high risk and involve careful collaboration of the obstetrician and rheumatologist. Through the latter and medical advances including a better and better understanding of the binomial mother-child, most pregnancies end in a success.

Expression of mRNA for epidermal growth factor, transforming growth factor-alpha and their receptor in human prostate tissue and cell lines

Enhanced expression of the epidermal growth factor receptor (EGFR) or its ligands, epidermal growth factor (EGF) and transforming growth factor alpha (TGF-alpha) can increase signalling via receptor-mediated pathways which may lead to excessive proliferation and cellular transformation. Such autocrine regulation of growth has been demonstrated for prostate cancer cell lines in culture but its role in prostate cancer in vivo has not been established. To assess the potential of such a mechanism, we have examined the pathway components in prostate carcinomas (CaP) in comparison with non-malignant benign prostatic hyperplasias (BPH). In the present study, we investigate the dosage, structure and expression of EGF, TGF-alpha and EGFR genes in a series of 34 human prostate samples and 3 prostate cancer cell lines. All of the samples contained transcripts from each of the genes. The expression of pre-pro-TGF-alpha mRNA and pre-pro-EGF mRNA were significantly higher in CaP (n = 13) than BPH (n = 21) specimens (p < 0.05). The androgen-responsive prostatic carcinoma cell line, LNCaP, expressed high levels of EGF mRNA while the androgen-independent DU145 and PC-3 cell lines expressed high levels of TGF-alpha mRNA and EGFR mRNA. In general, overexpression of these mRNAs was not associated with amplification or detectable gene rearrangement; only DU145 cells demonstrated any alteration in these genes, with apparent amplification of the TGF-alpha gene. Relative to BPH, all prostate carcinomas and cell lines studied had elevated levels of mRNA for one or both mRNA coding for the ligands for EGFR.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracranial dural arteriovenous fistulas and sinus thrombosis. Report of five cases

Dural arteriovenous fistula and sinus thrombosis are sometimes associated. The relationship between these two conditions remains unclear. Thrombophlebitis of the dural sinus may induce a dural fistula. Conversely, thrombophlebitis is sometimes observed in the course of dural fistulas. We report five cases of dural arteriovenous fistulas associated with sinus thrombosis. In three cases, the angiographic and pathological data indicated the responsibility of thrombosis in the occurrence of the fistula. In the others two cases, thrombophlebitis and fistula were simultaneously diagnosed by angiography. However, in one of these cases, the clinical data showed that the fistula probably was a causative factor in the occurrence of thrombophlebitis.

Arteriovenous fistula of the internal maxillary artery in a child: case report

Direct arteriovenous fistulae supplied by the external carotid artery are unusual. Rarely, congenital fistulae have been described involving the head and neck. We describe the first case of congenital internal maxillary arteriovenous fistula in a child. Balloon embolization is currently considered the method of choice for treatment of direct arteriovenous fistula.

Treatment of type D dural carotid-cavernous fistula by embolization followed by irradiation

In a patient with dural carotid-cavernous fistula supplied by meningeal branches of both internal and external carotid arteries, particulate embolization of the meningeal branches of only the external carotid artery failed to cure the fistula. Subsequent radiation therapy achieved clinical and anatomical cure of the lesion.

The diagnostic associations of patients with antinuclear antibodies referred to a community rheumatologist

The referral of patients with positive antinuclear antibodies (ANA) to a rheumatologist for evaluation occurs commonly in clinical practice. We report our experience in a large community setting. Two hundred seventy-six patients (8.8% of total referrals) had ANA titers greater than or equal to 1:40 without a diagnosis. A specific diagnosis was made in 239 patients (86.6%) and no diagnosis in 37 (13.4%). Of those diagnosed, 142 (51.4%) had connective tissue diseases, 44 (15.9%) had organ-specific autoimmune diseases, 23 (8.3%) had infectious diseases, 8 (2.9%) had neoplasia and 30 (10.9%) had miscellaneous other diseases. The commonest were systemic lupus erythematosus (SLE) in 52 (18.8%) and autoimmune thyroid disease in 29 (10.5%). Undiagnosed autoimmune thyroid disease and SLE are common diagnostic associations of positive ANA in patients referred to a community rheumatologist and positive ANA are frequently associated with clinical disease.

Granulomatous inguinal lymphadenopathy after bilateral metatarsophalangeal joint silicone arthroplasty

Silicone elastomer arthroplasties for joint diseases involving the small joints of the hands and feet have been used worldwide since the late 1960s. While reports of axillary lymphadenopathy exist, the exact incidence of subclinical adenopathy and its relationship to arthroplasty integrity have been difficult to determine. We report a patient who developed bilateral inguinal granulomatous adenopathy as a foreign body response to regionally disseminated silicone particles from bilateral metatarsophalangeal joint prostheses.

Palmar fasciitis and arthritis with ovarian and non-ovarian carcinomas. New syndrome

Paraneoplastic syndromes affect a variety of organ systems and often suggest occult malignancy. Recently, a distinct syndrome of palmar fasciitis and arthritis has been associated with ovarian carcinomas. The two cases presented illustrate the fasciitis-arthritis association with other non-ovarian malignancies and suggest an immunologic cause for this disorder.

In vitro effects of 4-hydroperoxycyclophosphamide on the morphology and function of human peripheral blood mononuclear phagocytic cells (macrophages)

Human peripheral blood mononuclear cells were incubated for 1 hr in 4-hydroperoxycyclophosphamide (0.5 to 10.0 micrograms/ml), and the adherent, esterase-positive cells (macrophages) were studied. At 2 hr, a reduction was noted in both latex particle ingestion and Fc gamma receptor binding and phagocytosis. At 24 hr, spreading and pinocytosis were reduced, and cytoplasmic vacuoles developed. This vacuolization represented dilatation of the rough endoplasmic reticulum. These morphological and functional changes occurred with 4-hydroperoxycyclophosphamide concentrations which did not reduce viability or produce detectable DNA alkylation. This effect on macrophages may offer a mechanism whereby low-dosage cyclophosphamide could modify the immune response.

Limulus assay for bacterial endotoxin in synovial fluid

The limulus assay for the detection of bacterial endotoxin has been applied to the study of synovial fluid. Three of 5 patients (60%) with culture-positive gonococcal arthritis had positive SF limulus assay results; as did 2 of 11 (18%) with presumptive evidence of gonococcal arthritis, 3 of 6 (50%) with nongonococcal infectious arthritis, and none of 47 patients with noninfectious arthritis. Endotoxin levels ranged from 0.25 to 128.0 ng/ml. As at present applied to synovial fluid the commercial limulus assay appears to be specific for the infectious process but apparently lacks sensitivity.

Function of the hypertrophied left ventricle at rest and during exercise. Hypertension and aortic stenosis

Assessment of left ventricular function may be of value in patients with pressure-loaded, hypertrophied left ventricles for the purpose of characterizing such patients as to prognostic risk. To determine whether left ventricular function is in part independent of loading stresses in such patients, and to assess the effects of removal of loading factors, we have reviewed preliminary data in 60 patients with essential hypertension and in 26 patients with aortic stenosis who were studied with radionuclide cineangiography. Patients with hypertension manifested a poor but statistically significant direct relationship between systolic arterial pressure and left ventricular ejection fraction at rest, and a poor but significant inverse relationship between systolic pressure and the magnitude of change in ejection fraction from rest to exercise. However, a strong correlation existed between echocardiographic systolic fractional shortening and end-systolic wall stress at rest. Nonetheless, many patients with normal fractional shortening-end-systolic wall stress relationships had subnormal ejection fraction responses during exercise; the two patients with subnormal fractional shortening-end-systolic wall stress relationships at rest also had subnormal fractional shortening-end-systolic wall stress relationships during exercise. Arterial pressure alone was not predictive of these functional responses. These data suggest that hypertensive patients can be categorized on the basis of left ventricular function at rest and during exercise, independent of arterial pressure. Among patients with aortic stenosis, ejection fraction at rest averaged 67 percent before valve replacement (normal = 57 percent, p less than 0.01), and changed little after operation (71 percent, not significant). However, potential functional benefits of afterload reduction in the patient with the chronically pressure-loaded, hypertrophied left ventricle was suggested by results during exercise: before surgery the ejection fraction during exercise averaged 56 percent (normal = 71 percent, p less than 0.01), but after valve replacement it rose to 72 percent (not significant versus normal). Thus, our data in patients with aortic stenosis supplement our data in patients with hypertension, indicating that myocardial functional improvement can be achieved by unloading therapy in patients with long-standing left ventricular pressure-loading and hypertrophy.

Interferon in synovial fluid and serum of patients with rheumatic disease

Interferon (IFN) was sought in simultaneously obtained samples of synovial fluid (SF) and serum from patients with a variety of rheumatological diseases. IFN was identified in 11 of 84 samples of SF and 10 of 84 specimens of serum. IFN positive specimens were contributed by patients with rheumatoid arthritis (RA), systemic lupus erythematosus, seronegative spondyloarthropathies, pseudogout, coccidioidomycosis and unclassified arthritis. Significantly, IFN was frequently found either in SF or in serum but generally not in both of the simultaneously obtained fluids. The highest titers of IFN found in SF were from patients with RA.