Acute Upper Limb Ischemia, a Rare Presentation of Giant Cell Arteritis

Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10-15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis. We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure. The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers. GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization.

Ideal Body Size as a Mediator for the Gender-Specific Association Between Socioeconomic Status and Body Mass Index: Evidence From an Upper-Middle-Income Country in the African Region.

While obesity continues to rise globally, the associations between body size, gender, and socioeconomic status (SES) seem to vary in different populations, and little is known on the contribution of perceived ideal body size in the social disparity of obesity in African countries. We examined the gender and socioeconomic patterns of body mass index (BMI) and perceived ideal body size in the Seychelles, a middle-income small island state in the African region. We also assessed the potential role of perceived ideal body size as a mediator for the gender-specific association between SES and BMI. A population-based survey of 1,240 adults aged 25 to 64 years conducted in December 2013. Participants' BMI was calculated based on measured weight and height; ideal body size was assessed using a nine-silhouette instrument. Three SES indicators were considered: income, education, and occupation. BMI and perceived ideal body size were both higher among men of higher versus lower SES (p< .001) but lower among women of higher versus lower SES (p< .001), irrespective of the SES indicator used. Multivariate analysis showed a strong and direct association between perceived ideal body size and BMI in both men and women (p< .001) and was consistent with a potential mediating role of perceived ideal body size in the gender-specific associations between SES and BMI. Our study emphasizes the importance of gender and socioeconomic differences in BMI and ideal body size and suggests that public health interventions that promote perception of healthy weight could help mitigate SES-related disparities in BMI.

Grève de cheminots anglais, M. [le ministre du Travail George Henry] Roberts et sir David Shackleton [secrétaire permanent du ministère du Travail] quittant Downing Street : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 56199

Dodd [George], Winslow [Charles] [joueurs de tennis participant au championnat du monde à Saint-Cloud] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59419

Dodd [George], Winslow [Charles] [joueurs de tennis participant au championnat du monde à Saint-Cloud] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59424

M. Lloyd George à la conférence [interalliée] de Boulogne-sur-Mer [21 juin 1920, revue des troupes] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59796

Le général [George Francis] Milne, commandant des forces anglaises dans la Mer Noire, joue au tennis à Constantinople : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59803

Le général [George Francis] Milne [commandant des forces anglaises dans la Mer Noire, joue au tennis à Constantinople] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59804

Le général [George Francis] Milne et [le] général [Henry Hughes] Wilson à un match de football à Constantinople : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59815

[Charles George] Dandrow [lanceur de poids] (C.N. New York) : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59328

[Album autour de l'exposition "Art treasures of the United Kingdom" tenue à Manchester en 1857] / [constitué par George Barker]

Collectionneur : Ricci, Seymour de (1881-1942)

[Album autour de l'exposition "Art treasures of the United Kingdom" tenue à Manchester en 1857] / [constitué par George Barker]

Collectionneur : Ricci, Seymour de (1881-1942)