Diplopia and skin rash in a patient treated with immunotherapy nivolumab regimen

This is a case report of an 80-year-old caucasian male patient with metastatic urothelial bladder carcinoma and bone/liver metastases, who was being presented with diplopia, raynaud’s syndrome and skin rash on both legs, in response to immunotherapy with anti-PDL-1 Nivolumab regimen.

The Promising Role of a Superb Microvascular Imaging Technique in the Evaluation of Raynaud’s Syndrome in Systemic Sclerosis: Theory and Practical Challenges

In recent years, a novel Doppler ultrasonography (US) modality—superb microvascular imaging (SMI)—has been presented as a reliable method to evaluate small vessel blood flow with minimised motion artefacts. In this review, we present the challenges of incorporating SMI in daily practice with detailed and comparable US images of a fingertip. The main focus of this paper is the discussion of all tested US techniques, artefacts, and practical challenges for evaluating Raynaud’s syndrome in systemic sclerosis. Despite a few reports on SMI use in assessing nailfold capillaries, there is still a need for more evidence of its value and possibilities for its standardisation.

Finger blood flow after the cold challenge with primary Raynaud’s syndrome: a case report

Background Raynaud’s syndrome is a commonly encountered disorder. The relationship between the grade of Raynaud’s phenomenon and severity of vasoconstriction is unclear. Recently, various methods including colour Doppler ultrasonography have been used for assessment of vascularity of the extremities including fingers. Case summary A 53-year-old man had a 6-year history of Raynaud’s phenomenon with typical tri-coloured changes proceeding from white, blue to red and slight pain and slight paresthaesia in the fingers of both hands when his fingers were exposed to cold. He was diagnosed with primary Raynaud’s syndrome. After treatment with the calcium channel blocker amlodipine (5 mg once daily), a cold challenge did not induce Raynaud’s phenomenon on the fingers in the present patient. After the cold challenge, colour Doppler ultrasonography showed that vascularity was markedly decreased or was absent, whereas there was little difference in skin colour of the fingers. Discussion In Raynaud's phenomenon, vasospasm may occur even if the symptoms are well-controlled with a calcium channel blocker. It is unlikely that clinical symptoms in patients with Raynaud’s syndrome always reflect the severity of vasoconstriction in their fingers.

EXPOSURE OF OPERATORS TO CHAINSAW VIBRATION IN FOREST HARVESTING

The implementation process of mechanized systems which occurred in the last decades in Brazil has brought numerous benefits of profitability, quality and safety for forestry activities. However, mechanization can cause harmful effects to the health of operators, among which include the excess of vibration that is responsible for numerous disorders such as Raynaud’s syndrome. The objective of this study was to evaluate the degree of exposure to vibration of chainsaw operators in cutting eucalyptus trees on farms. Thus, a portable accelerometer with a triaxial attachment positioned at the fingers of the operators was used to measure the data. The methodology proposed by NHO-10 was used to classify the degree of exposure. According to the results, 55% of the operators presented above the acceptable levels of exposure, requiring interventions which enable reduced hand-arm vibration. The vibration effects were observed to be more severe in the left hand socket of the operators. Based on the obtained results, it is concluded that there is a need for preventive and corrective measures which reduce the exposure of the operators as an intervention in the design of the machines, more rotation between operations, and greater care with the maintenance of the machines, training and reduced exposure time.

Efficacy of acupuncture and acupressure for the treatment of Raynaud’s syndrome: Protocol for a meta-analysis of randomized controlled trials

ABSTRACTRaynaud’s syndrome is a rare vascular disorder that causes the contraction of blood vessels, usually in the fingers and toes, when there is a decrease in temperature or during emotional events. As a result, blood cannot reach the tissue in these areas, causing them to appear blue or white. It had long been speculated that acupuncture and acupressure may help mediate symptoms of Raynaud’s syndrome, however no knowledge synthesis project regarding this topic had ever been conducted (to our best knowledge). We propose a meta-analysis that investigates whether the use of acupuncture or acupressure can improve symptoms of Raynaud’s syndrome. Our proposed outcomes are incidences of positive cold water immersion test, incidences of positive temperature recovery after cold water immersion tests, incidences of remission/short-term remission, number and duration of attacks per day, and outcomes relating to nailfold microcirculation examinations (including capillary blood flow velocity, capillary deformity and capillary density).

AB0484 PROTEINASE 3–ANTINEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA)–POSITIVE AND ANCA–NEGATIVE OR MYELOPEROXIDASE–ANCA–POSITIVE PATIENTS WITH GRANULOMATOSIS WITH POLYANGIITIS: DISTINCT PATIENT SUBSETS

Background:Most patients with clinical diagnoses of Granulomatosis with polyangiitis (GPA) are proteinase 3 (PR3)-ANCA positive, but a significant minority are myeloperoxidase (MPO)-ANCA positive or are negative for ANCA [1]. Several clinical and genome-wide association studies have suggested that classification based on ANCA type, i.e., PR3-ANCA positivity as opposed to MPO-ANCA positivity, may be more relevant clinically than the traditional classification based on specific diagnosis [2].Objectives:To analyze demographic feature, disease manifestations and laboratory findings of patients with PR3-ANCA positive GPA in comparison with patients ANCA-negative or MPO- ANCA positive GPA.Methods:This is a retrospective analysis of 37 patients with GPA from a single center in Ukraine observed from 2010 till the end of 2019. The clinical and demographic data, initial Birmingham vasculitis activity score (BVAS/WG), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between patients with PR3-ANCA positive GPA and ANCA-negative or MPO-ANCA positive GPA.Results:Of the 37 patients analyzed, 24 (64.9%) had PR3-ANCA–positive GPA, 6 (16.2%) had MPO-ANCA–positive GPA and 7 (18.9%) had ANCA-negative GPA. ANCA–negative GPA patients were younger at diagnosis compared to PR3-ANCA–positive and MPO-ANCA-positive patients (36 versus 47 and 49 years; p = 0.04). The gender ratio was similar in patients with PR3-ANCA–positive GPA and patients with MPO-ANCA–positive GPA or ANCA-negative GPA (33% vs 38% male, p= 0.61). The ocular manifestations - conjunctivitis/episcleritis (15% vs 50%) and ear involvement - otitis, mastoiditis (0% vs 33%) occurred more often in patients with PR3-ANCA–positive GPA (p<0.05), whereas sensory peripheral neuropathy (54 % vs 21%) and Raynaud’s syndrome (31 % vs 0%) were more frequent in compared group (p<0.05). ANCA-negative patients with GPA had lower, but no significant, initial BVAS/WG score than PR3-ANCA–positive or MPO-ANCA-positive patients with GPA (17.9 versus 23.5 and 24.8; p=0.20). There were no significant differences between groups in ESR or CRP levels and in the frequency of involvement of other organs and systems.Conclusion:We demonstrate clinical differences between PR3-ANCA–positive patients with GPA and MPO-ANCA–positive or ANCA-negative patients with GPA. The eye and ear involvement are common for patients with PR3-ANCA–positive GPA. The MPO-ANCA–positive GPA or ANCA-negative GPA is characterized by higher frequency of sensory peripheral neuropathy and Raynaud’s syndrome.References:[1]Lyons PA, Rayner TF, Trivedi S, Holle JU, Watts RA, Jayne DR, et al. Genetically distinct subsets within ANCA-associated vasculitis. N Engl J Med. 2012;367:214–23.[2]Finkielman JD, Lee AS, Hummel AM, Viss MA, Jacob GL, Homburger HA, et al. ANCA are detectable in nearly all patients with active severe Wegener’s granulomatosis. Am J Med. 2007;120:643.e9–14.Disclosure of Interests: :None declared

Late effects of antitumor treatment on the nervous system

This article is devoted to the analysis of problems related to the state of the nervous system in patients who have survived malignant neoplasm in childhood. The main diseases and pathological conditions that can develop in this population are considered. The risks of the development of pathological changes in the nervous system, treatment and prevention are described. Separately analyzed issues of peripheral neuropathy, Raynaud’s syndrome, chronic pain.