Tumour necrosis factor alpha blockade in treatment resistant pigmented villonodular synovitis

BACKGROUND: Pigmented villonodular synovitis (PVNS) is considered to be a neoplastic-like disorder of the synovium histologically characterised by villonodular hyperplasia, resulting in dense fibrosis and haemosiderin deposition. The pathogenesis of the disease is still unknown. CASE REPORT: A patient presented with severe treatment resistant PVNS of the right knee joint. Several conventional treatment regimens, including open surgical synovectomy and intra-articular injections of yttrium-90 ((90)Y) failed to control the disease. After finding marked tumour necrosis factor alpha (TNF alpha) expression in arthroscopic synovial tissue samples, treatment with an anti-TNF alpha monoclonal antibody (infliximab) at a dose of 5 mg/kg was started. Additional courses with the same dose given 2, 6, 14, and 20 weeks later, and bimonthly thereafter up to 54 weeks, controlled the signs and symptoms. Immunohistological analysis at follow up identified a marked reduction in macrophage numbers and TNF alpha expression in the synovium. DISCUSSION: This is probably the first case which describes treatment with TNF alpha blockade of PVNS in a patient who is refractory to conventional treatment. It provides the rationale for larger controlled studies to elucidate further the efficacy of TNFalpha blockade treatment in refractory PVNS

Alien Registration- Kroot, Jennie (Portland, Cumberland County)

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Alien Registration- Kroot, Benjamin (Portland, Cumberland County)

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Alien Registration- Kroot, Fannie (Portland, Cumberland County)

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Alien Registration- Kroot, Benjamin (Portland, Cumberland County)

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Alien Registration- Kroot, Edward (Baldwin, Cumberland County)

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Alien Registration- Kaffel, Eva (Baldwin, Cumberland County)

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Feeding Villages: Foraging and Farming across Neolithic Landscapes.

This dissertation investigates the relationship between village development trajectories and changing economic practices. It is focused on the Pre-Pottery Neolithic B (PPNB) of west-central Jordan, examining three specific dimensions of economic change: (1) subsistence practices, (2) production systems, and (3) economic relations. This research employed survey and excavation at the PPNB site of al-Khayran, as well as scientific, knapped stone, ground stone, and faunal analyses of materials from the site. This dissertation argues for a broader view of the relationship between increasing subsistence production and productivity and village growth and development than is traditionally taken. A narrow set of variables, the primary one being domestication, have been viewed as the key to understanding subsistence intensification in the early villages of southwest Asia by most researchers. However, novel choices about settlement patterns, time management, and economic relations are all attested to within the remains of al-Khayran. This shows that the development of agriculture was embedded in wider systems of economic change. Specifically, it is argued that al-Khayran is a type of site which has yet to be identified in the PPNB: the agricultural field house. Such a settlement type is a secondary residential site for a household production unit. It allows for dual residence mobility, whereby members move between a village household for most of the annual cycle and an in-field structure during period of high in-field labor demands. The study highlights the ways that feedback between social structures and spatial and temporal practices created novel behavioral patterns in the early Neolithic. New forms of economic relations, such as strengthened property rights and household land tenure, and new production units, such as the nuclear family household, opened up space for new production behaviors, such as the use of field houses. These new behaviors opened spaces for new economic relations, such as access rights or even control of natural resources like flint and water sources. Thus, we see that not only did the development of agricultural technologies and practices contribute significantly to later historical developments, but so did the ideological underpinnings of these methods.PhDAnthropologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/107181/1/mkroot_1.pd