Rheumatic disorders developed after hepatitis B vaccination.
(9/722)
OBJECTIVE: To obtain an overview of rheumatic disorders occurring after hepatitis B vaccination. METHODS: A questionnaire was sent to rheumatology departments in nine French hospitals. Criteria for entry were rheumatic complaints of 1 week's duration or more, occurrence during the 2 months following hepatitis B vaccination, no previously diagnosed rheumatic disease and no other explanation for the complaints. RESULTS: Twenty-two patients were included. The observed disorders were as follows: rheumatoid arthritis for six patients; exacerbation of a previously non-diagnosed systemic lupus erythematosus for two; post-vaccinal arthritis for five; polyarthralgia-myalgia for four; suspected or biopsy-proved vasculitis for three; miscellaneous for two. CONCLUSIONS: Hepatitis B vaccine might be followed by various rheumatic conditions and might trigger the onset of underlying inflammatory or autoimmune rheumatic diseases. However, a causal relationship between hepatitis B vaccination and the observed rheumatic manifestations cannot be easily established. Further epidemiological studies are needed to establish whether hepatitis B vaccination is associated or not with an incidence of rheumatic disorders higher than normal. (+info)
Patellofemoral pain syndrome: a review and guidelines for treatment.
(10/722)
Managing patellofemoral pain syndrome is a challenge, in part because of lack of consensus regarding its cause and treatment. Contributing factors include overuse and overload of the patellofemoral joint, biomechanical problems and muscular dysfunction. The initial treatment plan should include quadriceps strengthening and temporary activity modification. Additional exercises may be incorporated as dictated by the findings of the physical examination. Footwear should be closely evaluated for quality and fit, and the use of arch supports should be considered. (+info)
Identification of cation-independent mannose 6-phosphate receptor/insulin-like growth factor type-2 receptor as a novel target of autoantibodies.
(11/722)
Two human monoclonal autoantibodies, B-33 and B-24, were generated from the B cells of a patient with scleroderma. Both monoclonal antibodies (mAbs) were composed of mu and lambda chains, and recognized cytoplasmic vesicular structures by indirect immunofluorescence on Hep-2 cell line slides, although mAb B-24 showed an additional diffuse cytoplasmic staining pattern. By Western blot, mAb B-24 exhibited a polyreactive-like binding pattern, whereas mAb B-33 failed to recognize any electroblotted Hep-2 antigen. The polyreactive versus monospecific behaviour of mAbs B-24 and B-33 was further confirmed by enzyme-linked immunosorbent assay (ELISA) with a variety of foreign and autoantigens. The N-terminal sequence of a protein band isolated by affinity chromatography with mAb B-33 was identical to that of cation-independent mannose 6-phosphate receptor (CI-MPR), also known as the insulin-like growth factor type-2 receptor (IGF-2R). Immunofluorescence experiments on Hep-2 cell line slides demonstrated a striking co-localization between the staining pattern exhibited by these mAbs and the pattern obtained using a goat anti-CI-MPR serum, indicating the recognition by B-24 and B-33 of a structure located predominantly in late endosomes. Sequence analysis of the V-region gene segments of B-33 and B-24 showed both to be identical, except for the existence of a point mutation in B-33 located in the H-complementarity-determining region 3 (H-CDR3) (position 100D), which produces a non-conservative replacement of Gly by Ser. This single replacement appears to be responsible for the dramatic change in reactivity of human mAb B-33. The data shown here provide new evidence of the critical role played by the H-CDR3 region in distinguishing a polyspecific from a monospecific antibody. A population study demonstrated the existence of immunoglobulin G (IgG) reactivity against CI-MPR/IGF-2R in serum specimens from five individuals with different pathological conditions, thus indicating that this molecule is a potential target for the human autoimmune response. (+info)
Radiofrequency electrocution (196 MHz).
(12/722)
Radiofrequency (RF) electrocutions are uncommon. A case of electrocution at 196 MHz is presented partly because there are no previous reports with frequencies as high as this, and partly to assist in safety standard setting. A 53-year-old technician received two brief exposures to both hands of 2A current at 196 MHz. He did not experience shock or burn. Progressively over the next days and months he developed joint pains in the hands, wrists and elbows, altered temperature and touch sensation and parasthesiae. Extensive investigation found no frank neurological abnormality, but there were changes in temperature perception in the palms and a difference in temperature between hands. His symptoms were partly alleviated with ultra-sound therapy, phenoxybenzamine and glyceryl trinitrate patches locally applied, but after several months he continues to have some symptoms. The biophysics and clinical aspects are discussed. It is postulated that there was mainly surface flow of current and the micro-vasculature was effected. Differences to 50 Hz electrocution are noted. Electrocution at 196 MHz, even in the absence of burns may cause long-term morbidity to which physicians should be alerted. Safety standards should consider protection from electrocution at these frequencies. (+info)
Correlation of bone scintigraphy and histological findings in medial tibial syndrome.
(13/722)
OBJECTIVE: To correlate bone scintigraphy and histopathological findings in patients with medial tibial syndrome. METHODS: Twenty patients (32 limbs) with a clinical diagnosis of medial tibial syndrome had surgery. Bone scintigraphy before the operation was compared with the histological appearance of bone and periosteal specimens obtained at surgery. RESULTS: Delayed bone scintigraphy showed normal appearance in 11 limbs, characteristic diffuse tubular pattern uptake in 16 limbs, and focal uptake in five. Periosteal histology disclosed fibrous thickening as the most common finding associated with increased vascularity, occasionally with chronic inflammatory cell infiltration, haemosiderin, and acid mucopolysaccharide deposition. Loss of osteocytes was the main finding of bone histology associated with some enlargement of lacunae and lamellar structure disruption. A grading system was used to score normal and abnormal histological appearance. For analysis the findings were regrouped to provide tables using Fisher's exact test. There was no correlation between bone scintigraphy and the histology of bone and periosteum, but two interesting observations were noted. Those cases with periosteal thickening had mostly normal bone scan appearance (p = 0.0028). Those cases with low levels of osteocyte loss had mostly abnormal bone scintigraphy. CONCLUSION: Abnormal histological appearance of bone and periosteum is a feature of medial tibial syndrome. These histological findings show poor correlation with bone scintigraphy. The exact pathogenesis of this syndrome remains unclear. (+info)
Potential errors in recognition of Erysipelothrix rhusiopathiae.
(14/722)
Here we describe four isolations of Erysipelothrix rhusiopathiae associated with polyarthralgia and renal failure, septic arthritis, classic erysipeloid, and peritonitis. Although the biochemical identification was straightforward in each case, recognition presented a challenge to the clinical microbiologist, since in three cases E. rhusiopathiae was not initially considered due to unusual clinical presentations, in two cases the significance might not have been appreciated because growth was in broth only, and in one case the infection was thought to be polymicrobic. Because the Gram stain can be confusing, abbreviated identification schemes that do not include testing for H(2)S production could allow E. rhusiopathiae isolates to be misidentified as Lactobacillus spp. or Enterococcus spp. in atypical infections. (+info)
Beta2-microglobulin and amyloidosis.
(15/722)
Dialysis-associated amyloidosis is a serious complication in chronic dialysis patients. Its clinical expression in terms of arthralgias, destructive arthopathies and carpal tunnel syndrome is often associated with amyloid deposits, which are mainly composed of beta2-microglobulin (beta2-M) fibrils, but in addition contain a number of other compounds. It is probable that beta2-M-amyloid deposition is related, at least in part, to the elevated plasma beta2-M that is characteristic of chronic renal failure. The latter can decrease with high-performance dialysis techniques but cannot be reduced to the normal range. Almost certainly, several other systemic and local factors are involved, including beta2-M transformed by advanced glycation end products and advanced oxidation protein products, serum P component, ubiquitin, calcium crystals, cytokines, immunoglobulin light chains, proteases and antiproteases, as well as modified collagen and glucosaminoglycans. It is also possible that the beta2-M protein, in its native or modified form, exerts noxious effects on bone and joint tissues, in addition to its mere 'passive' presence as amyloid fibrils. Several retrospective studies and one prospective study suggest that dialysis strategies with highly permeable, synthetic membranes and/or ultrapure dialysate may be partially protective or at least delay the onset of dialysis amyloidosis. Successful kidney transplantation generally halts the disease process and leads to rapid relief of osteoarticular pain although regression of beta2-M-amyloid deposits probably does not occur. (+info)
Anterior knee pain syndrome.
(16/722)
The aim of this study was to correlate the distribution of substance-P nerve fibres within the knee joint in 20 patients complaining of anterior knee pain syndrome, with the clinical picture, patellar motion, power of the quadriceps mechanism, and the psychological profile. A comparison was made with 2 similar groups of patients with knee problems (patients with osteoarthrosis and patients with anterior cruciate ligament rupture or meniscal lesions), and with a further group of 20 healthy volunteers. The results suggest that anterior knee pain might be a psychosomatic syndrome associated with sub-clinical patellar instability and with little if any relation to levels of physical activity. (+info)