A meningioma with a significant component of granular cells is described in the left ocular orbit of a 5-year-old male Golden retriever dog that presented with exophthalmos. The neoplastic mass surrounded the optic nerve. Microscopically, the tumour was characterized by nests of large, round to polygonal cells, variable in size, with eccentric nuclei and abundant eosinophilic cytoplasm, containing PAS-positive granules. In focal areas, cells were smaller and occasionally formed whorl-like structures. Immunohistochemical analysis revealed that neoplastic cells reacted positively for vimentin and, with less intensity, for neuron specific enolase and S-100, whereas they were negative for glial fibrillary acidic protein and cytokeratins. Metastatic growths, formed by similar cells, were seen in the lung and heart.

Animals↗

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[Death in Horton disease. Prognostic factors].

The authors reported causes of death and searched for prognosis factors in Giant Cell Arteritis (GCA). The diagnosis was confirmed by temporal biopsy in all cases. Fourteen patients died during treatment; thirty-six patients had completely recovered (follow up > 6 months after withdrawal of steroid therapy). The commonest causes of death were cardiovascular (n = 7) and digestive (n = 4); they occurred after an average of 195 days of treatment, half of them during the first three months. One death was due to GCA (autopsy) and five deaths were attributed to the treatment with corticosteroids. The prognosis factors were searched for by comparing age, sex, clinical signs, laboratory data before treatment, past medical history in the both series; further more initial dose of Prednisone and the dose after 180 days of steroid therapy were compared in the two groups. The adverse prognosis factors revealed by this study were: advanced age (p < 0.01), previous ischaemic heart disease (p < 0.05) and higher dose of corticosteroids administered at 6 months of treatment (< 0.01).

Actuarial Analysis↗

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[Atypical presentations of Horton's disease].

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Giant Cell Arteritis↗

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[Hematologic effects of dapsone (Disulone)].

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Agranulocytosis↗

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Aortic angiosarcoma clinically mimicking polyarteritis nodosa.

We report two patients in whom angiosarcoma of the aorta (ASA) with distal emboli and skin metastases was initially clinically misdiagnosed as polyarteritis nodosa (PAN). Both presented with features highly suggestive of systemic necrotizing vasculitis, including constitutional symptoms, orchitis (in one), leg pain with sensory neuropathy, livedo, focal areas of skin necrosis, painful cutaneous nodules demonstrating vasculitis or inconspicuous changes on biopsy, raised acute phase reactants, and transient improvement with systemic corticosteroids. Repeated skin biopsies revealed an atypical endovascular cell proliferation with strong reactivity for factor VIII. Magnetic resonance angiography (MRA) demonstrated an intra-luminal aortic tumour at the infra-renal level. In retrospect, the (PAN)-like features appeared to involve exclusively the lower part of the body in these patients.

Aged↗

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Head-and-neck swelling: an under-recognized feature of giant cell arteritis. A report of 37 patients.

OBJECTIVE: To describe the frequency of occurrence and characteristics of head-and-neck swelling (HNS) in temporal (giant cell) arteritis (TA). METHODS: We analyzed the charts of patients with HNS retrieved from a single department series of 260 consecutive patients with TA and reviewed the published French-English literature. Patients with a swelling limited to the temporal fossa were excluded. RESULTS: A history of HNS was elicited in 17 patients in our series (i.e. 6.5%) and in 20 previously published patients. The swelling was an inaugural feature in most cases and was often transient. Ear-nose-and-throat (ENT )symptoms were observed in 80% of the cases, including jaw claudication or pain upon opening mouth in 22, causing trismus in 10. Two patients had permanent visual impairment and 1 had sudden hearing loss. The temporal artery biopsy yielded giant cell arteritis (GCA) in all the patients but 2. The HNS was often painful and mainly involved mainly the orbital region and face, particularly the lower part of the cheeks and maxillae, less often the neck and, rarely, the forehead and tongue. Concurrent localized limb swellings were also observed in 3 patients. The HNS disappeared in all the patients, either spontaneously or under steroid treatment, and recurred only in 6 patients. CONCLUSION: HNS is not exceptional in untreated TA and is strongly associated with ENT symptoms and a positive TAB, but not with visual loss or stroke. Such characteristics imply in these cases a prominent, widespread involvement of the external carotid artery system by giant cell arteritis.

Aged↗

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[Hospital infections at an oncology hospital].

During 23 months, the authors analyzed 8122 records of cancer patients admitted to the National Institute of Cancer of Rio de Janeiro, Brazil. The rate of hospital infection was of 18.4 infection episodes per 100 admissions. Hospital infections were detected in 556 patients (57.7%) of the surgical department. The overall rate of purulence seen in 4194 surgeries was 10.1%, and among 2153 clean surgeries, the authors found 95 (4.4%) suppurated surgeries. The surgical wound (28.2%), the respiratory tract (19.2%), and the urinary tract (18.7%) were the major sites involved during infections episodes. Of the 319 ICU patients evaluated, 154 acquired infection after the first 72 hours, with a mortality rate of 48.7%. The hospital microbial flora was made-up mostly of gram-negative aerobic bacteria, with a high incidence of micro-organisms that resist to major antibiotics of hospital use. The percentage of positive results in blood culture tests requested was of 23.7%, with a predominance of gram-negative bacteria (50.9%) and a high percentage of gentamicin-resistant micro-organisms. Antibiotics of greater use in surgical interventions were amikacin, first generation cephalosporins, and chloramphenicol, whereas amikacin, carbenicillin, and first and third generation cephalosporins prevailed in nonsurgical treatments. The authors' experience and findings re-emphasize the need and the importance of a broad multidisciplinary understanding and suggest the need of strict action for an effective control and prevention in hospitals of developing countries.

Anti-Bacterial Agents↗

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[Idiopathic cyclic edema in Klinefelter syndrome (author's transl)].

After a minor abdominal traumatism, M. B., 53 years of age, presents a sudden and acute edematous syndrome. Cardiac, renal, hepatic, nutritional and thyroid etiologies ares rapidly eliminated. A cavography and lymphography reveal the integrity of the drainage pathways. The idiopatic cyclic edematous syndrome is therefore evoked by few clinical details (diurnal weight gain, diurnal oliguria...). Exploration of the renin - angiotensin - aldosterone system, the Landis test and the marked radioactive serum albumin test attest to the exaggeration of capillary permeability. Likewise, it was discovered in this patient, a Klinefelter syndrome which was, until now, unknown. This case poses interesting pathogenic problems since the idiopathic cyclic edematous syndrome is a predominantly feminine disease. Only a few cases were described in the masculine sex and, to our knowledge, this syndrome has never been associated with Klinefelter syndrome.

Edema↗

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