phenylephrine-hydrochloride and Arthritis--Rheumatoid

Basilar invagination is a rare clinical condition characterized by upward protrusion of the odontoid process into the intracranial space, leading to bulbomedullary compression. It is often encountered in adults with rheumatoid arthritis. Transoral microscopic or endonasal endoscopic decompression may be pursued, with or without posterior fixation. We present a case of basilar invagination with C1-C2 autofusion and discuss an algorithm for choice of anterior versus posterior approaches.. A 47-year-old woman with rheumatoid arthritis presented with severe occipital and cervical pain, dysphagia, hoarseness, and arm paresthesias. Findings on magnetic resonance imaging revealed moderate cranial settling with the odontoid indenting the ventral medulla but no posterior compression. Computed tomography demonstrated bony fusion at C1-C2 without lateral sag. Given autofusion of C1-C2 in proper occipitocervical alignment and the absence of posterior compression, the patient underwent endoscopic endonasal odontoidectomy without further posterior fusion, with satisfactory resolution of symptoms.. Endoscopic endonasal odontoidectomy offers a safe and effective method for anterior decompression of basilar invagination. Preoperative assessment for existing posterior fusion, absence of posterior compression, and preservation of the anterior C1 ring during operative decompression help stratify the need for lone anterior approach versus a combined anterior and posterior treatment.

Topics: Arthritis, Rheumatoid; Decompression, Surgical; Female; Humans; Magnetic Resonance Imaging; Medulla Oblongata; Middle Aged; Neuroendoscopy; Nose; Odontoid Process; Tomography, X-Ray Computed; Treatment Outcome

The ureter is an unusual location for lesions of Wegener's granulomatosis (WG). A patient in whom recurrence of WG after kidney transplantation was manifested by obstructive uropathy due to granulomatous vasculitis (WG) at the ureterovesicle anastomosis, as well as nasal and lung involvement, is reported. The occurrence of WG in the ureter in relation to the processes causing ureteral obstruction and the recurrences of WG after kidney transplantation and its treatment are briefly reviewed.

Topics: Adolescent; Adult; Arthritis, Rheumatoid; Child; Combined Modality Therapy; Diagnostic Errors; Female; Glomerulonephritis; Granulomatosis with Polyangiitis; Humans; Immunosuppressive Agents; Kidney Glomerulus; Kidney Transplantation; Lung; Male; Nose; Postoperative Complications; Recurrence; Ureteral Obstruction

This study investigated Staphylococcus aureus carriage in patients with microbial keratitis (MK). 215 patients with MK, 60 healthy controls and 35 patients with rheumatoid arthritis (RA) were included. Corneal scrapes were collected from patients with MK. Conjunctival, nasal and throat swabs were collected from the non-MK groups on a single occasion and from the MK group at presentation and then at 6 and 12 weeks. Samples were processed using conventional diagnostic culture. 68 (31.6%) episodes of clinically suspected MK were classed as recurrent. Patients with recurrent MK had a higher isolation rate of S. aureus from their cornea than those with a single episode (p < 0.01) and a higher isolation rate of S. aureus from their conjunctiva compared to control participants, 20.6% (14/68) versus 3% (5/60) respectively (p = 0.01). Significantly more patients with recurrent MK (12/68, 17.6%) were found to have S. aureus isolated from both their conjunctiva and nose than those with a single episode of MK (7/147, 4.8% p = 0.002) and compared to patients in the control group (3/60, 5.0% p = 0.03). The results indicate that patients with recurrent MK have higher rates of carriage of S. aureus suggesting endogenous site colonisation as a possible source of recurrent infection.

Topics: Arthritis, Rheumatoid; Cornea; Diagnostic Tests, Routine; Female; Humans; Keratitis; Male; Middle Aged; Nose; Pharynx; Staphylococcal Infections; Staphylococcus aureus

Trichorhinophalangeal syndrome type 1 is a rare skeletal dysplasia of autosomal-dominant inheritance due to defects in the TRPS-1 gene. The syndrome is characterised by sparse slow-growing hair, a bulbous pear-shaped nose, cone-shaped epiphyses and deformities of the interphalangeal joints resembling those in rheumatoid arthritis. We present a case of trichorhinophalangeal syndrome in a 23-year-old man who presented with symmetrical painless progressive deformity of the fingers in both hands.

Topics: Arthritis, Rheumatoid; Diagnosis, Differential; Disease Progression; Fingers; Hair Diseases; Humans; Langer-Giedion Syndrome; Male; Nose; Occupational Therapy; Radiography; Toes; Young Adult

Pathological processes in the craniovertebral region (clivus, C1 anterior arch, odontoid process and body of the C2 vertebra, i.e. C0-C1-C2 segments) are very difficult to diagnose and treat. The craniovertebral junction instability may develop in the case of a significant lesion of C1-C2 segments. Among diseases causing destruction of the clivus structures and C1-C2 vertebrae and compression of the spinal cord, the following ones are most common: chordoma, giant cell tumor, osteoblastoma, rheumatoid lesion, metastases, platybasia, and basilar impression. These diseases can cause the initial instability of the craniovertebral junction and be accompanied by gross neurological disorders, which complicates the diagnosis and surgical treatment of these patients.. We operated on two patients diagnosed with invagination of the odontoid process of the C2 vertebra. In both cases, one-stage operation was performed that included occipitospondylodesis and endoscopic endonasal removal of the C2 odontoid process.. In the postoperative period, partial regression of the neurological symptoms was observed that included an increase in the strength and range of motions in the arms and distal legs, regressed spasticity in the arms and significantly reduced spasticity in the legs, and a significant improvement in all kinds of sensitivity in the arms, legs, and torso. Postoperative liquorrhea was observed in 1 case (patient 2); re-operation to close a CSF fistula was conducted. Later, no signs of liquorrhea were noted. In both cases, control MRI and spiral CT revealed a postoperative bone defect of the C2 odontoid process and clivus, complete decompression of the medulla oblongata and upper cervical spine segments, and no evidence of spinal canal stenosis; the stabilizing system was competent and properly placed.. The endoscopic endonasal approach, compared to the standard transoral approach, has significant advantages in that the soft palate remains intact, the oropharynx area is less damaged, and the hospitalization and rehabilitation duration is reduced. Also, there are no problems and complications such as possible failure of sutures in the oral cavity and a large wound surface in the oropharynx area. The patient can eat on his own immediately after the operation without the use of a stomach tube (it does not cause any inflammatory complications of the oral cavity). However, the surgical technique of the endoscopic endonasal approach to the C1-C2 segment is more complex than that of transoral surgery and requires the surgeon to be skilled and experienced.. Патологические процессы в краниовертебральной области (скат черепа, переднее полукольцо С1 позвонка, зубовидный отросток и тело С2 позвонка, т.е. сегменты С0, С1 и С2) представляют большие трудности для диагностики и лечения. При значительном поражении сегментов С1-С2 возможно развитие нестабильности краниовертебрального сочленения. Из заболеваний, вызывающих деструкцию структур ската, С1 и С2 позвонков и компрессию верхних отделов спинного мозга, наиболее часто встречаются: хордома, гигантоклеточная опухоль, остеобластома, ревматоидное поражение, метастазы, платибазия и базилярная импрессия. Эти заболевания могут вызывать изначальную нестабильность краниовертебрального сочленения, сопровождаться грубыми неврологическими нарушениями, что усложняет диагностику и хирургическое лечение этих пациентов. Материал и методы. Нами оперированы 2 пациента с диагнозом инвагинация зубовидного отростка С2 позвонка. В обоих случаях произведена одномоментная операция: окципитоспондилодез и эндоскопическое эндоназальное удаление зубовидного отростка С2 позвонка. Результаты. В послеоперационном периоде отмечен частичный регресс неврологической симтоматики: увеличение силы и объема движений в руках и в дистальных отделах ног, регрессировала спастика в руках и значительно уменьшилась спастика в ногах; значительно улучшились все виды чувствительности в руках, ногах и на туловище. Послеоперационная ликворея была в одном случае (второй пациент), проведена повторная операция по закрытию ликворной фистулы. В дальнейшем признаков ликвореи не отмечалось. На контрольных МРТ и СКТ в обоих случаях выявлены поражения: послеоперационный костный дефект зубовидного отростка С2 и ската, полная декомпрессия продолговатого мозга и верхних шейных сегментов спинного мозга, отсутствие признаков стеноза позвоночного канала, стабилизирующая система состоятельна и установлена правильно. Заключение. По сравнению со стандартным трансоральным доступом эндоскопический эндоназальный доступ имеет значимые преимущества, заключающиеся в том, что мягкое небо остается неповрежденным, а область ротоглотки менее травмированной, сокращаются сроки госпитализации и реабилитации. Также отсутствуют такие проблемы и осложнения, как возможная несостоятельность швов в полости рта, значительная раневая поверхность в области ротоглотки. Больной может питаться самостоятельно сразу после операции без использования желудочного зонда (это не грозит какими-либо воспалительными осложнениями полости рта). Однако хирургическая

Topics: Adult; Arthritis, Rheumatoid; Atlanto-Axial Joint; Axis, Cervical Vertebra; Cervical Atlas; Decompression, Surgical; Endoscopy; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nose; Odontoid Process; Spinal Cord Compression; Tomography, X-Ray Computed; Treatment Outcome

Object The goal of the study was to report a series of consecutive patients who underwent endoscopic transnasal odontoidectomy (ETO) without resection of nasal turbinates. The techniques for this minimally invasive approach are described in detail. Methods The authors conducted a retrospective review of consecutive patients who underwent ETO for basilar invagination. All the patients had myelopathy caused by compression at the cervicomedullary junction, which required surgical decompression. Preoperative and postoperative data, including those from radiographic and clinical evaluations, were compared. Morbidity and mortality rates for the procedure are also reported in detail. Results Thirteen patients (6 men and 7 women) with a mean age of 52.7 years (range 24-72 years) were enrolled. The basilar invagination etiologies were rheumatoid arthritis (n = 5), trauma (n = 4), os odontoideum (n = 2), ankylosing spondylitis (n = 1), and postinfectious deformity (n = 1). The average follow-up duration was 51.2 months (range 0.3-105 months). One patient died 10 days after the operation as a result of meningitis caused by CSF leakage. Among the other 12 patients, the average postoperative Nurick grade (3.2) was significantly improved over that before the operation (4.1, p = 0.004). The mean (± SD) duration of postoperative intubation was 1.5 ± 2.1 days, and there was no need for perioperative tracheostomy or nasogastric tube feeding. There also was no postoperative velopharyngeal insufficiency. There were 6 (46%) intraoperative and 2 (15%) postoperative CSF leaks in the 13 patients in this series. Conclusions ETO is a viable and effective option for decompression at the ventral cervicomedullary junction. This approach is minimally invasive and causes little velopharyngeal insufficiency. The pitfall of this approach is the difficulty in repairing dural defects and subsequent CSF leakage.

Topics: Adult; Aged; Arthritis, Rheumatoid; Decompression, Surgical; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Odontoid Process; Retrospective Studies; Spinal Fractures; Spondylitis, Ankylosing; Tomography, X-Ray Computed; Treatment Outcome; Turbinates; Young Adult

Transoral odontoidectomy is the treatment of choice in cases of anterior bulbo-medullary compression. The development of endoscopic procedures has made it possible to perform odontoidectomy via a minimally invasive endoscopic endonasal approach. We discuss the feasibility, advantages, and limitations of this surgical approach.. We report a two-center retrospective series of patients who underwent endoscopic endonasal odontoidectomy between September 2011 and February 2013. Preoperative characteristics, intraoperative data, clinical course, and postoperative complications were studied. The patients were followed for a minimum of 6 months. Cervico-occipital posterior fusion was performed during the same hospital stay in cases of preoperative instability.. Nine patients underwent decompressive odontoidectomy, for rheumatoid pannus in five cases and basilar impression in four cases. All had progressive neurological symptoms. Seven patients also underwent posterior fusion. In six patients, the C1 anterior arch was preserved. Decompression was achieved satisfactorily in all nine cases. The patients were able to resume oral feeding the day after the intervention. No patient required tracheostomy. We observed no dural fistulae or infectious complications. One patient died 2 months after the intervention of a pulmonary embolism. All patients improved in terms of their preoperative neurological status.. This short series shows the feasibility of the endoscopic endonasal approach for resection of the dens. This approach allows optimal viewing when using angulated instrumentation and seems to result in low morbidity. In some cases, this approach makes it possible to preserve the C1 anterior arch, thus limiting the risk of cranial settling.. IV retrospective study.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Decompression, Surgical; Feasibility Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Odontoid Process; Retrospective Studies; Spinal Cord Compression; Treatment Outcome

Topics: Aged; Antibodies, Monoclonal; Antirheumatic Agents; Arthritis, Rheumatoid; Drug Eruptions; Female; Humans; Infliximab; Leishmania infantum; Leishmaniasis, Mucocutaneous; Nose

Anterior decompression of the craniovertebral junction is reserved to patients with irreducible ventral bulbo-medullary lesions and rapidly deteriorating neurological functions. Classically performed through the transoral approach, the exposure of this region can be now achieved by a minimally invasive endonasal endoscopic approach (EEA).. Four patients with irreducible, anterior bulbo-medullary compression due to rheumatoid pannus and basilar invagination were enrolled. The imaged-guided EEA was used to resect the odontoid process, trying to preserve the C1 anterior arch.. Neurological improvement and adequate bulbo-medullary decompression were obtained in all patients. In two cases, anterior C1 ring was preserved. These patients did not required a posterior fusion.. Compared with the standard transoral technique, the EEA provides the same good exposure but with potentially less complications. The preservation of the anterior C1 arch can contribute to avoid cranial settling and posterior fusion with its related risk of subaxial instability.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Cervical Vertebrae; Decompression, Surgical; Endoscopy; Female; Humans; Magnetic Resonance Imaging; Male; Minimally Invasive Surgical Procedures; Nose; Occipital Bone; Odontoid Process; Spinal Cord Compression; Tomography, X-Ray Computed; Treatment Outcome

It has been reported that anti-tumor necrosis factor-alpha therapy increases the risk of opportunistic infections including rare case reports of leishmaniasis. Here we report a case of latent cutaneous leishmaniasis, which was provoked by anti-tumor necrosis factor-alpha therapy in a patient with rheumatoid arthritis.

Topics: Adult; Amphotericin B; Animals; Anti-Bacterial Agents; Antibodies, Monoclonal; Antiprotozoal Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Biopsy; Female; Humans; Leishmania; Leishmaniasis, Cutaneous; Nasal Mucosa; Nose; Treatment Outcome; Tumor Necrosis Factor-alpha

We describe an unusual case of cutaneous necrosis of the nasal tip presenting to a facial reconstructive surgeon. The patient had developed this painless necrosis over a period of about 10 days. Her past medical history included rheumatoid arthritis. She described an exacerbation of her arthritic symptoms in the weeks preceding the development of the nasal tip necrosis. Her rheumatoid arthritis had been managed with corticosteroid and immunosuppressive therapy for more than 3 years. She had not previously experienced extra-articular manifestations (EAMs). A biopsy was taken and histological analysis identified a lymphocytic vasculitis. She was referred to her rheumatologist, and surgical management of her necrotic nasal tip commenced.

Topics: Aged; Arthritis, Rheumatoid; Biopsy; Female; Humans; Necrosis; Nose; Nose Diseases; Skin Diseases, Vascular; Treatment Outcome; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous

The transoral approach to the odontoid process is considered the "gold standard" for resection of extradural lesions at this location. A completely transnasal endoscopic approach is feasible based on anatomic studies and our experience with the expanded endonasal approach for neoplasms of the cranial base. An illustrative case is presented to demonstrate the technical details of a fully transnasal completely endoscopic approach for the resection of the odontoid process. A 73-year-old woman with a long-standing history of rheumatoid arthritis presented with progressive cervicomedullary compression. Complete resection of the odontoid was achieved with no significant morbidity. This is the first reported case of a completely endoscopic resection of the odontoid using a fully transnasal route. The report demonstrates the feasibility of this approach and larger clinical series with long-term follow-up will be needed to determine the reproducibility and validation of any potential benefits.

Topics: Aged; Arthritis, Rheumatoid; Decompression, Surgical; Endoscopy; Female; Humans; Laminectomy; Nose; Odontoid Process; Spinal Cord Compression; Treatment Outcome

To compare the prevalence of nasal and oral Staphylococcus aureus in patients with rheumatoid arthritis (RA) with the prevalence in controls with other rheumatic diseases, and to determine predictors of S. aureus carriage and the influence of treatment with anti-tumor necrosis factor-a (anti-TNF-alpha) agents.. Eighty-one patients with RA and 83 other control patients of 2 outpatient rheumatology clinics were cultured for nasal and oral carriage of S. aureus. Quantitative nasal cultures for S. aureus were performed from swabs of the anterior nares, the posterior pharynx, and the soft palate. Information on medications, medical conditions, and risk factors for S. aureus carriage was collected from all participants by a questionnaire and confirmed by chart review.. The S. aureus carriage rate (nasal and/or oral colonization) was 34.6% among RA patients and 32.5% among controls (p = 0.87). Being treated with an anti-TNF-alpha agent plus methotrexate (MTX) was the only independent predictor of S. aureus carriage (OR 3.24, 95% CI 1.16-9.05, p = 0.025). The S. aureus carriage rate among RA patients treated with an anti-TNF-alpha agent plus MTX was 60% (9/15) versus 23.1% (3/13) in RA patients treated with an anti-TNF-alpha agent only (p = 0.049). All S. aureus isolates were susceptible to oxacillin.. The S. aureus carriage rate among patients with RA was not higher than among controls. Treatment with anti-TNF-alpha agents was not associated with an increased S. aureus carriage rate. However, treatment with an anti-TNF-alpha agent plus MTX may predispose patients to S. aureus carriage.

Topics: Adalimumab; Adult; Aged; Anti-Bacterial Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Rheumatoid; Etanercept; Female; Humans; Immunoglobulin G; Infliximab; Male; Methotrexate; Microbiological Techniques; Middle Aged; Mouth; Nose; Oxacillin; Prevalence; Receptors, Tumor Necrosis Factor; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Tumor Necrosis Factor-alpha

To determine the prevalence of Staphylococcus aureus nasal carriage and to compare antibody responses to two superantigens, staphylococcal toxic shock syndrome toxin-1 (TSST-1) and staphylococcal enterotoxin A (SEA), in rheumatoid arthritis patients and normal subjects.. 88 rheumatoid arthritis patients and 110 control subjects were cultured for nasal carriage of S aureus; 62 isolates were bacteriophage typed. Twenty five patients and 11 spouses were tested for antibodies to TSST-1, SEA, and sonicate extracts of Bacteroides fragilis and Escherichia coli; 19 patients were HLA-DR typed.. 50% of patients and 33% of normal subjects were S aureus carriers. Bacteriophage typing of isolates suggested significant differences between strains isolated from the two groups. Patients showed higher IgG (P = 0.0025) and IgA (P = 0.0372) antibody levels to TSST-1 than normal spouses and these responses were not related to rheumatoid factor titres or HLA-DR type.. When compared to normals, rheumatoid arthritis patients more often carry S aureus in their nasal vestibule, carry a distinct subpopulation of S aureus strains, and have higher average antibody levels to TSST-1.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Bacterial; Arthritis, Rheumatoid; Bacterial Toxins; Enterotoxins; Escherichia coli; Female; HLA-DR Antigens; Humans; Immunoglobulin A; Immunoglobulin G; Male; Middle Aged; Nose; Staphylococcus aureus; Superantigens

Topics: Aged; Aminosalicylic Acids; Antitubercular Agents; Arthritis, Rheumatoid; Bronchitis; Diabetes Complications; Drug Therapy, Combination; England; Female; Humans; Male; Mass Chest X-Ray; Mycobacterium tuberculosis; Nose; Occupations; Pneumoconiosis; Pulmonary Emphysema; Rifampin; Silicotuberculosis; Sputum; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Animals; Antibodies; Antibodies, Anti-Idiotypic; Antibodies, Antinuclear; Arthritis, Rheumatoid; Binding Sites, Antibody; Cartilage; Cattle; Diabetes Complications; Ear; False Positive Reactions; Female; Fluorescent Antibody Technique; Humans; Insulin Resistance; Lupus Erythematosus, Systemic; Middle Aged; Neutralization Tests; Nose; Polychondritis, Relapsing; Rabbits; Rats; Trachea

Topics: Arthritis, Rheumatoid; Conjunctiva; Eye; Eyelids; Female; Humans; Keratoconjunctivitis; Male; Middle Aged; Nose; Penicillin Resistance; Staphylococcal Infections

Topics: Arthritis, Rheumatoid; Bacterial Vaccines; Culture Media; Cystitis; Enterococcus faecalis; Female; Haemophilus; Humans; Injections, Intradermal; Male; Microbial Sensitivity Tests; Mouth; Nose; Pharynx; Prostatitis; Proteus; Salmonella; Shigella; Urinary Tract Infections; Urine