Showing papers by "Lluís Puig published in 2005"

Adverse cutaneous reactions to anakinra in patients with rheumatoid arthritis: clinicopathological study of five patients.

Abstract: Summary Background Anakinra, a recombinant human form of interleukin-1 receptor antagonist, is used to treat patients with active rheumatoid arthritis (RA). Objectives To report five patients with cutaneous adverse drug reactions due to anakinra and to evaluate the histopathological and immunohistochemical findings with the aim of understanding the possible mechanisms involved. Methods Five patients of a series of 10 patients with RA undergoing treatment with anakinra in a clinical trial presented inflammatory lesions at the anakinra injection sites. In each case, clinical features were recorded and skin biopsy specimens were obtained. In one patient sequential biopsy specimens were obtained from skin lesions at different stages of development. Tissue sections of the biopsy specimens were stained with haematoxylin and eosin and May–Grunwald–Giemsa, and were immunoreacted with antibodies to leucocyte common antigen, CD68, CD3, CD45RO, CD20 and CD45RA. Results The onset of reaction was within the first month of treatment and appeared as well-defined erythema and oedema involving the injection sites. In two patients the treatment had to be discontinued because of the skin reaction, and in one patient it was associated with systemic involvement. All biopsy specimens exhibited marked dermal oedema and a lichenoid dermal infiltrate composed mainly of lymphomononuclear cells with prominent populations of eosinophils and large CD68+ dermal macrophages and an increase in the number of mast cells, which were spindle shaped in a significant proportion. Conclusions Cutaneous toxicity is a frequent, usually well-tolerated complication of treatment with anakinra in patients with RA, although in some cases it can be associated with systemic involvement. The most relevant histopathological findings include dermal oedema and a lichenoid, perivascular and periadnexal predominantly lymphomononuclear infiltrate, with many eosinophils and the presence of enlarged CD68+ macrophages. These findings resemble those seen in skin reactions in patients receiving chemotherapy and colony-stimulating factors. We also found an increase in mast cell numbers that could be a specific effect of anakinra.

Onset of flexural psoriasis during infliximab treatment for Crohn's disease.

Abstract: disease. The patient has now been followed up for 12 months and remains clinically free of disease. These are the first reported cases of Bowen’s treated successfully with diclofenac HA gel. The histological and clinical clearance of Bowen’s disease in our patients after 80–90 days of topical application of diclofenac HA gel indicates that this therapy may be of help in this condition. One patient experienced moderate inflammation at the application site that necessitated early discontinuation, without loss of efficacy. Adverse effects of this preparation have been reported in 51–72% of patients, with local irritation and dryness being the most commonly reported. The mechanism of action of diclofenac HA gel is as yet unknown. However, diclofenac has been shown to inhibit murine angiogenesis induced by chronic granulomatous reaction and to exhibit an antitumour effect in murine colon-26 growth. It is postulated that this antitumour mode of action may be related to the inhibition of the cycloxygenase pathway that is mediated by nonsteroidal anti-inflammatory drugs, specifically to reduction of prostaglandin E2 synthesis via substance P. The good clinical response to this therapy in our two cases suggest that diclofenac HA gel may be a useful addition to the array of pharmacological treatments available for Bowen’s disease. However, further studies to ascertain optimum dosage regimens and long-term followup are recommended.

Consensus Statement on the Safety Profile of Topical Calcineurin Inhibitors

Abstract: a University of Bonn, Bonn , Germany; b University of Sheffi eld Medical School & Sheffi eld Children’s Hospital, Sheffi eld , UK; c University of Michigan Medical School, Ann Arbor, Mich. , USA; d University of Verona, Verona , Italy; e St. Johns Institute of Dermatology, St. Thomas’ Hospital, London , UK; f Dalhousie University, Halifax , Canada; g University of Münster, Münster , and h Dresden University of Technology, Dresden , Germany; i St George Hospital, University of New South Wales, Sydney , Australia; j NYU School of Medicine, New York, N.Y. , and k Northwestern University’s Feinberg School of Medicine, Chicago, Ill. , USA; l Hôpital Necker-Enfants Malades, Paris , France; m Hospital Santa Creu i Sant Pau, Barcelona , Spain; n Technical University Munich, Munich , Germany; o University Hospital, Geneva , Switzerland; p University of Kiel, Kiel , Germany; q University of Toronto, Toronto , Canada; r Medical University of Vienna, Vienna , Austria; s Central Hospital, University of Bordeaux, Bordeaux , France; t Aarhus University Hospital, Aarhus , Denmark

Prognostic significance of p27Kip1, p45Skp2 and Ki67 expression profiles in Merkel cell carcinoma, extracutaneous small cell carcinoma, and cutaneous squamous cell carcinoma

Abstract: Aims: To compare the immunohistochemical expression of prognostic markers p27Kip1, p45Skp2 and Ki67 in Merkel cell carcinoma (primary neuroendocrine carcinoma of the skin, MCC), small cell neuroendocrine carcinoma of lung and urinary bladder (SNC), and cutaneous squamous cell carcinoma (SCC). Methods and results: Immunohistochemistry was performed using antibodies directed against p27Kip1, p45Skp2 and Ki67 on 72 tumour cases: 24 MCC, 25 SCC, and 23 SNC (15 from the lung and eight from the urinary bladder). Percentages of positive cells were determined for each marker and statistically analysed. Expression profiles on MCC and SCC were significantly different for all three markers. MCC and SNC exhibited significant similarities in their p27Kip1 and p45Skp2 expression profiles. In contrast, MCC and SNC differed significantly in their Ki67 proliferation indices, which were much higher in SNC. Additionally, MCC cases showed an association between increased proliferation indices and the appearance of local recurrence(s) and/or metastases. Conclusion: The immunohistochemical profile of MCC differs from that of SCC, in spite of their common oncogenesis and the supposed metaplastic origin of MCC, and resembles that of SNC, except for Ki67 levels, which were higher in the latter (characterized by greater biological aggressiveness). High levels of Ki67 also appear to be a prognostic factor in MCC.

Von Willebrand gene tracking by single-tube automated fluorescent analysis of four short tandem repeat polymorphisms

Abstract: Molecular diagnosis of vonWillebrand disease (VWD) has been hampered by the large size and complex genomic characteristics of the gene involved. For this reason, indirect methods using intragenic polymorphic markers described along the vonWillebrand factor (VWF) gene are valuable tools for gene monitoring and linkage analysis. Several studies have demonstrated the four commonly utilized short tandem repeats (STRs), three located in intron 40 and one in the promoter region of theVWF gene,to be highly informative for this task.Our objective was t o develop a rapid, automated method to simultaneously analyze these four STRs for VWF gene tracking. Amplification of the four loci is achieved in a single multiplex fluorescent PCR which is then analyzed in the same run by capillary electrophoresis.Data process- ing with GeneScan and Genotyper software has simplified management and tabulation of the resulting haplotypes.Analysis of the VWF gene in DNA from 102 individuals (204 chromosomes) revealed that the three STRs within intron 40 showed significant linkage disequilibrium against each other but not against theVWP locus. Moreover, the combination of the four markers offers a high heterozygosity rate (>99%) that improves tracingVWF gene inheritance. In conclusion, the automated fluorescent capillary electrophoresis method presented here is an extremely rapid, simple and highly informative technique for association studies betweenVWD and theVWF gene in addition to genetic counseling and prenatal diagnosis by precise linkage analysis inVWD-affected families.

Fractures above and below a modular nail for knee arthrodesis. A case report

Abstract: Several techniques have been advocated for knee arthrodesis, and there has been an increasing interest in modular intramedullary nails in the recent last years. We report a case of femoral and tibial fractures at each end of a modular nail in a solidly fused knee 8 months after an arthrodesis.

Escorbuto: púrpura folicular como signo guía

Abstract: Scurvy is a set of clinical manifestations characterized by general weakness, anemia, gingivitis and cutaneous bleeding, caused by a lack of ascorbic acid in the diet. This pathology is currently a clinical rarity, although it can still be seen in cases of malnutrition associated with alcoholism or with dietary deficiencies, especially in childhood and old age. We present the case of a 45-year-old male who consulted his physician because of lower limb edema with follicular purpura, accompanied by asthenia, polyarthralgia and bleeding gums. After treatment with 1 g/day of vitamin C was initiated, the patient's symptoms quickly improved. The diagnosis of scurvy was based on the patient's clinical symptoms, dietary history and the rapid resolution of the symptoms when vitamin C supplements were initiated.

Arthroscopic Approaches to the Hip Joint

Abstract: Summary: The application of arthroscopic surgical techniques to the hip joint has gained increasing popularity in recent years. However, the particular anatomic features of this joint and surrounding tissue have made it arthroscopically inaccessible until recently. Complete arthroscopic examination of the hip requires at least 3 portals. Several major neurovascular structures in the vicinity of the joint can be injured during the establishment of these percutaneous portals. Therefore, a perfect knowledge of the anatomy of this particular area is necessary to establish stable and safe arthroscopic portals. This report examines the anatomy of the standard and nonstandard arthroscopic portals to approach the hip joint as well as the difficulties and complications related to them. Key Words: Arthroscopy—Hip anatomy—Arthroscopic portals.

Determinación de concentraciones plasmáticas de efavirenz y nevirapina en pacientes hemofílicos con infección por el VIH

Abstract: The aim of this study was to evaluate efavirenz and nevirapine plasma levels in HIV-infected hemophilic patients seen in two hospitals in Barcelona. Plasma levels of these drugs were determined by high-performance liquid chromatography (HPLC) at four-month intervals, together with viral load and CD4 cell count. Nineteen patients treated with efavirenz and 8 with nevirapine were included, and 68 efavirenz and 31 nevirapine determinations were performed. Mean study time was 12 months. Median efavirenz plasma concentration was 2.95 .g/ml (interval: 1.54-5.26 .g/ml) in patients with favorable virological response and 1.86 .g/ml (0.82-4.88 .g/ml) in patients with detectable viral load (p = 0.32). Nevirapine plasma concentrations were 4.41 .g/ml (3.50-6.72 .g/ml) and 3.12 .g/ml (2.44-3.80 .g/ml) respectively (p = 0.18).