• Affects approximately 1% of patients with rheumatoid arthritis
• High levels of IgG on the surface of neutrophils with evidence of increased granulopoiesis in the bone marrow
• Recurrent infections are due to decreased and dysfunctional neutrophils coated with IgG
• Recurring infections
• Chronic leg ulcers
• Decreased neutrophil count
• Increased granulopoiesis in the bone marrow
• High levels of IgG on the surface of neutrophils
• Pathologic analysis of the spleen in patients with Felty syndrome shows a larger proportionate increase in the white pulp as opposed to most conditions of splenomegaly
• There is evidence of excess accumulation of neutrophils in both the T cell zone of the white pulp as well as the cord and sinuses of the red pulp
Capsoni F. Sarzi-Puttini P. Zanella A. Primary and secondary autoimmune neutropenia. Arthritis Research & Therapy.
• Groin bulge inferior to the inguinal ligament elicited with the Valsalva maneuver
• Differentiation between inguinal and femoral hernias difficult clinically and often not appreciated until the hernia sac is dissected free in the operating room
• Femoral hernia protrudes through the femoral canal, bordered by the inguinal ligament superiorly, pubic ramus inferior-medially, and the femoral vein laterally
• Classification of hernias
–Reducible: Visceral contents of the hernia sac able to retract into the abdominal cavity
–Incarcerated: Visceral contents cannot be returned to the abdominal cavity
–Strangulated: Incarcerated hernia where the ...
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