Personal non-commercial use only

ABSTRACT. Objective. Infections and thromboses are known complications of systemic lupus erythematosus (SLE). We investigated if infectious episodes in patients with SLE were followed by an increased risk of thrombotic events. Methods. A cohort of 571 patients with prevalent or incident SLE was followed for a mean of 8.9 ± 7.6 years. All episodes of hospitalized infections or episodes of cutaneous herpes zoster as well as arterial and venous thrombotic events were identified by retrospective chart review and prospective updating of a clinical database. For time-dependent analyses adjusted for age, sex, and ever-presence of antiphospholipid antibodies, thrombotic events were classified as occurring during the time at risk of 1 year after an infection or during the remaining control observation time. Infections and thromboses occur at an increased rate in patients with systemic lupus erythematosus (SLE) and, together with active SLE, are the most frequent causes of death in patients with SLE 1,2,3 . In general, acute infections have been recognized to be associated with the development of arterial thromboses, including myocardial infarction (MI) and stroke 4 . Also, the risk of MI and stroke after an acute respiratory tract infection is greater than after less severe urinary tract infection 5 . Large retrospective studies consistently find a 2-fold to 3-fold increase in the risk for acute coronary syndromes within 1-2 weeks after a respiratory infection, and this risk remains significant at 3 months 4 . It has been hypothesized that infections, in addition to eliciting systemic inflammatory responses, can also have direct inflammatory effects on atherosclerotic plaques and coronary arteries 4 . Studies have also demonstrated that there is a transient (up to 1 year) increased risk of venous thromboses [deep venous thrombosis (DVT) and pulmonary embolism (PE)] after respiratory infection 6,7 and urinary tract infection 7 in the general population. Clayton, et al found a 2.6-fold increased risk of DVT in the month following a respiratory infection persisting up to a year, as well as a 2.5-fold increased risk of PE for the same period 6 . We investigated whether infectious episodes in patients with SLE were followed by an increased risk of arterial and venous thrombotic events. MATERIALS AND METHODS Patients and procedures. Our SLE cohort was started and the majority of data (on 513 patients) were retrospectively collected in 1995 as part of previous study 8 . Patients were followed at several hospital centers in Denmark, including university hospitals that have specialized functions in diagnosing and treating SLE, and locally identified by means of a national disease coding system. Data collection on consecutive patients with SLE seen at one of the university hospitals is continuing, and we included further incident cases, resulting in data on 571 adult patients with SLE fulfilling the modified American College of Rheumatology (ACR) 1982 9 or 1997 10 classification criteria. The electronic SLE database includes basic demographics, SLE symptoms and dates of symptom onset, immunologi

Personal non-commercial use only

ABSTRACT. Objective. Infections and thromboses are known complications of systemic lupus erythematosus (SLE). We investigated if infectious episodes in patients with SLE were followed by an increased risk of thrombotic events. Methods. A cohort of 571 patients with prevalent or incident SLE was followed for a mean of 8.9 ± 7.6 years. All episodes of hospitalized infections or episodes of cutaneous herpes zoster as well as arterial and venous thrombotic events were identified by retrospective chart review and prospective updating of a clinical database. For time-dependent analyses adjusted for age, sex, and ever-presence of antiphospholipid antibodies, thrombotic events were classified as occurring during the time at risk of 1 year after an infection or during the remaining control observation time. Infections and thromboses occur at an increased rate in patients with systemic lupus erythematosus (SLE) and, together with active SLE, are the most frequent causes of death in patients with SLE 1,2,3 . In general, acute infections have been recognized to be associated with the development of arterial thromboses, including myocardial infarction (MI) and stroke 4 . Also, the risk of MI and stroke after an acute respiratory tract infection is greater than after less severe urinary tract infection 5 . Large retrospective studies consistently find a 2-fold to 3-fold increase in the risk for acute coronary syndromes within 1-2 weeks after a respiratory infection, and this risk remains significant at 3 months 4 . It has been hypothesized that infections, in addition to eliciting systemic inflammatory responses, can also have direct inflammatory effects on atherosclerotic plaques and coronary arteries 4 . Studies have also demonstrated that there is a transient (up to 1 year) increased risk of venous thromboses [deep venous thrombosis (DVT) and pulmonary embolism (PE)] after respiratory infection 6,7 and urinary tract infection 7 in the general population. Clayton, et al found a 2.6-fold increased risk of DVT in the month following a respiratory infection persisting up to a year, as well as a 2.5-fold increased risk of PE for the same period 6 . We investigated whether infectious episodes in patients with SLE were followed by an increased risk of arterial and venous thrombotic events. MATERIALS AND METHODS Patients and procedures. Our SLE cohort was started and the majority of data (on 513 patients) were retrospectively collected in 1995 as part of previous study 8 . Patients were followed at several hospital centers in Denmark, including university hospitals that have specialized functions in diagnosing and treating SLE, and locally identified by means of a national disease coding system. Data collection on consecutive patients with SLE seen at one of the university hospitals is continuing, and we included further incident cases, resulting in data on 571 adult patients with SLE fulfilling the modified American College of Rheumatology (ACR) 1982 9 or 1997 10 classification criteria. The electronic SLE database includes basic demographics, SLE symptoms and dates of symptom onset, immunologi

Hyperinsulinaemic hypoglycaemia - a diagnostic challenge. A report of two atypical cases

Objectives: The authors describe 2 atypical cases of patients with hypoglycaemia, suspected for insulinoma. Methods: The 2 reports are accompanied by a concise review of the literature. Results: Patient 1 had a distal pancreatectomy performed for suspected insulinoma, and was diagnosed with a glucagonoma and beta-cell hyperplasia (nesidioblastosis). To the authors’s knowledge, co-existing glucagonoma and nesidioblastosis had not been previously reported. Patient 2 was diagnosed with a benign insulinoma and 5 years later with metastatic disease. Conclusion: The authors conclude that insulinomas are rare entities which often present a diagnostic and therapeutic challenge. In such cases, patient referral to tertiary multidisciplinary centers is recommended

A Comparison of Anti-Nuclear Antibody Quantification Using Automated Enzyme Immunoassays and Immunofluorescence Assays

Anti-nuclear antibodies (ANA) have traditionally been evaluated using indirect fluorescence assays (IFA) with HEp-2 cells. Quantitative immunoassays (EIA) have replaced the use of HEp-2 cells in some laboratories. Here, we evaluated ANA in 400 consecutive and unselected routinely referred patients using IFA and automated EIA techniques. The IFA results generated by two independent laboratories were compared with the EIA results from antibodies against double-stranded DNA (dsDNA), from ANA screening, and from tests of the seven included subantigens. The final IFA and EIA results for 386 unique patients were compared. The majority of the results were the same between the two methods (n = 325, 84%); however, 8% (n = 30) yielded equivocal results (equivocal-negative and equivocal-positive) and 8% (n = 31) yielded divergent results (positive-negative). The results showed fairly good agreement, with Cohen's kappa value of 0.30 (95% confidence interval (CI) = 0.14–0.46), which decreased to 0.23 (95% CI = 0.06–0.40) when the results for dsDNA were omitted. The EIA method was less reliable for assessing nuclear and speckled reactivity patterns, whereas the IFA method presented difficulties detecting dsDNA and Ro activity. The automated EIA method was performed in a similar way to the conventional IFA method using HEp-2 cells; thus, automated EIA may be used as a screening test