Objectives Statin-associated immune-mediated necrotizing myopathy (IMNM) and idiopathic inflammatory myositis (IIM) are myopathies with overlapping features. This study compared the manifestations of IMNM to IIM in Native Americans. Method Twenty-one Native American patients with inflammatory myopathy (IM) were characterized as to diabetes mellitus, hyperlipidemia, statin exposure, myopathy diagnosis, muscle histology, autoimmune and myositis-specific autoantibodies, therapy, and outcome. Results IM consisted of 52.4% IMNM, 42.9% IIM, and 4.8% metabolic myopathy. IMNM vs. IIM had greater age (61.6±9.8 vs. 39.8±14.3 years), diabetes mellitus (100% vs. 55.6%), hyperlipidemia (100% vs. 33.3%), statin-exposure (100% vs. 22.2%), creatine kinase (CK) (11,780±7064 vs.1707±1658 IU), anti-HMG CoA reductase (anti-HMG CoA) antibodies (85.7% vs. 11.1%), and necrotizing IM (81.8% vs. 11.1%), but lesser disease duration (26.2±395 vs. 78.4±47.9 months), Raynaud’s phenomenon (9.1% vs. 55.6%), cutaneous manifestations (0% vs. 55.6%), antinuclear antibodies (18.2% vs. 66.7%), or any autoantibody (18.2% vs. 88.9%) (all p < 0.05). Magnetic resonance abnormalities, histologic IM, myositis-specific autoantibodies, pulmonary hypertension, esophageal dysfunction, interstitial lung disease, disability, and persistently elevated CK were similar. IMNM vs. IIM was treated more with intravenous immunoglobulin (72.7% vs. 11.1%, p = 0.009) and less with antimetabolites (45.5% vs. 88.9%, p = 0.05) and rituximab (18.2% vs. 55.6%, p = 0.09). Conclusions IMNM may occur in Native Americans and is associated with diabetes mellitus, hyperlipidemia, statin use, and older ages, and characterized by marked CK elevation, necrotizing myopathy, and anti-HMGCoA antibodies with few cutaneous or vascular manifestations.
Objectives –Aspiration of synovial fluid from non-effusive joints is undertaken for the diagnosis of crystal-associated arthritis, biomarker analysis, and to confirm intraarticular positioning. We hypothesized that pneumatic compression of the non-effusive knee would mobilize occult synovial fluid and improve arthrocentesis success. Methods – The absence of a knee effusion was determined by physical examination, imaging, and exclusion of confounding disease. Conventional arthrocentesis was performed in 111 consecutive non-effusive knees and arthrocentesis volume (milliliters) determined. Pneumatic compression was then applied, and arthrocentesis was resumed. Results – Pneumatic compression improved fluid yield: conventional: 0.4±1.0 ml, compression: 1.8±2.5 ml (319% increase, 95% CI -1.9<-1.4<-0.9; p=0.0001). Pneumatic compression reduced arthrocentesis failure (< 0.1 ml) from 74.8% (83/111) to 41.4% (46/111) (p=0.0001) and improved successful arthrocentesis in terms of adequate synovial fluid yield: 1) ≥ 0.1 ml from 25.2% (28/111) to 58.5% (65/111) (+132%, p=0.0001), 2) ≥ 0.5 ml from 22.5% (25/111) to 57.7% (64/111) (+156%, p =0.0001), 3) ≥ 2.0 ml from 11.7% (13/111) to 47.7% (53/111) (+300%, p =0.0001), and 4) ≥ 3.0 ml from 5.4% (6/111) to 36.0% (40/111) (+319%, p =0.0001). Conclusions: Pneumatic compression of the non-effusive knee improves the extraction of synovial fluid of various requisite volumes for conventional and biomarker analysis.
Aim: Complete arthrocentesis of the effusive knee ameliorates patient pain, reduces intra-articular and intraosseous pressure, removes inflammatory cytokines, and has been shown to substantially improve the therapeutic outcomes of intra-articular injections. However, conventional arthrocentesis incompletely decompresses the knee, leaving considerable residual synovial fluid in the intra-articular space. The present study determined whether external pneumatic circumferential compression of the effusive knee permitted more successful arthrocentesis and complete joint decompression.Methods: Using a paired sample design, 50 consecutive effusive knees underwent conventional arthrocentesis and then arthrocentesis with pneumatic compression.Pneumatic compression was applied to the superior knee using a conventional thigh blood pressure cuff inflated to 100 mm Hg which compressed the suprapatellar bursa and patellofemoral joint, forcing fluid from the superior knee to the anterolateral portal where the fluid could be accessed. Arthrocentesis success and fluid yield in mL before and after pneumatic compression were determined.Results: Successful diagnostic arthrocentesis (≥3 mL) of the effusive knee was 82% (41/50) with conventional arthrocentesis and increased to 100% (50/50) with pneumatic compression (P = .001). Synovial fluid yields increased by 144% (19.8 ± 17.1 mL)
The prevalence of congenital coronary artery anomalies is approximately 1% in the general population. They are a common cause of sudden death in younger persons. Congenital absence of the left circumflex artery is usually a benign condition but can cause symptoms of exertional angina. We present a case of a 59-year-old female who presented with complaints of chest pain. She was evaluated by the cardiology service. An invasive angiogram identified the absence of the circumflex artery, a large right coronary artery, and large septal and diagonal branches of the left main coronary artery possibly as a compensatory mechanism to supply blood to the LCx territories. It is important to define coronary anatomy as anomalies dictate which cardiac intervention should be attempted in cases of ischemia. ARTICLE HISTORY
The radial artery approach for cardiac catheterization has now become the preferred route for arterial access. The main reason behind this is reduced access site complications as compared to femoral artery punctures. Radial artery access also allows the advantage of early mobilization of the patient and improved patient comfort. Lesser complications in turn result in shorter hospital stay and discharge on the same day is also possible. This in turn significantly decreases the overall cost and bed occupancy as well. However, as with every procedure complications do occur and it is how we deal with them defines our success. This is a case report in which a 0.034” radial guidewire used routinely for angiography was entrapped and how it was then tackled and recovered.
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