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ID PMID Title PublicationDate abstract
8339484 Internal fixation of supracondylar fractures after condylar total knee arthroplasty. 1993 Aug Condylar buttress plates were applied in six patients with total knee arthroplasties and supracondylar fractures. According to the criteria of Cain, 50% of the patients had a satisfactory result with an average follow-up period of 17 months. Time to union (full weight bearing) averaged 14 weeks. The final coronal femorotibial alignment averaged 5 degrees of valgus, whereas preoperative valgus had averaged 8 degrees. Four patients were pain free and the two others had minimal pain that did not interfere with daily activity. Knee motion averaged 97 degrees. All patients were ambulating; five of six patients needed two crutches outdoors for reasons unrelated to the index fracture. Four patients had rheumatoid arthritis (RA) with multiple joint involvement, and the fifth was debilitated secondary to old age. No nonunion, loss of fixation, or infection occurred. Open reduction and internal fixation (ORIF) using the condylar buttress plate provides stable fixation, allowing early knee motion and ambulation. If extreme osteoporosis is present, the addition of bone cement enhances screw fixation.
7685161 Leukocyte gelatinase B cleavage releases encephalitogens from human myelin basic protein. 1993 May 14 Gelatinase B, a marker enzyme for chronic inflammatory diseases such as rheumatoid arthritis and multiple sclerosis (MS), was found to cleave human myelin basic protein (MBP). Human MBP was digested with gelatinase B from leukocytes. The MBP peptide fragments were separated by RP-HPLC and the gelatinase B cleavage sites established by aminoterminal sequence analysis. Several novel P1-P1' cleavage sites for gelatinase B were found. The positions of the cleavage sites in human MBP were such that at least one peptide coincided with a documented major MBP-autoantigen. This study annotates human MBP as a substrate for human gelatinase B, determines novel P1-P'1 cleavage sites and defines one of the metalloproteinases as a possible link in the pathogenesis of demyelinating diseases such as MS.
7683617 Present status of autoimmune hepatitis in Japan. 1993 Mar The clinical and biochemical features of patients with autoimmune hepatitis (AIH) in Japan during the 15-year period, 1975 to 1990, were evaluated by a nationwide survey using a questionnaire prepared by the Intractable Diseases Study Group organized by the Ministry of Health and Welfare. Data on a total of 866 cases with AIH were collected and analyzed, and of these, 632 cases underwent follow-up study. AIH was predominant in females, with a male:female ratio of approximately 2:19. Biochemical investigation on the occasion of the first examination showed abnormalities of liver function tests, including increased serum total bilirubin, transaminase activity and gamma-globulin levels. The main complications of autoimmune diseases were rheumatoid arthritis, Sjögren's syndrome and chronic thyroiditis. All patients with complications were female. Of 253 AIH patients, 50 were positive for anti-C100-3 antibody. ICG clearance and platelet count, which are stigmata of liver cirrhosis, were the main factors of prognostic importance in AIH. Therefore, early diagnosis prior to the development of liver cirrhosis is important to improve the prognosis of AIH.
8330894 [Increased activation of CD8-positive lymphocytes in patients with Crohn's disease]. 1993 Feb CD8+ (suppressor/cytotoxic) T lymphocyte subpopulations were studied in the peripheral blood of patients with Crohn's disease by flow cytometry analysis. Consistent with earlier reports, increased numbers of CD8+CD57+ cells were observed as compared with controls. However, expanded CD8+CD57+ cells were not found to be present in a distinct clinical subset of patients. A substantial number of patients had enhanced numbers of DR+ and CD45RO CD8+ cells. In addition, high numbers of CD8+ cells which were CD57CD45RO double positive, and a correlation between numbers of CD8+CD57+ and CD8+DR+ lymphocytes were detected. By use of an enzyme immunoassay, significantly elevated levels of soluble CD8 antigen were demonstrated in patients' sera, and results were associated with ESR values. Taken together, the data suggest increased activation of CD8+ lymphocytes which might result from systemic disease activity. Disturbances within CD8+ lymphocytes do not seem to be specific to Crohn's disease since similar alterations could be observed in patients with another inflammatory condition, rheumatoid arthritis.
8327025 Drug abuse as a risk factor of multiple sclerosis: case-control analysis and a study of he 1993 The etiology of multiple sclerosis (MS) remains unknown despite considerable research involving a number of disciplines for many decades. Cluster analysis was used to disentangle the possible heterogeneity of MS, based on clinical characteristics of 108 subjects. Further on, a case-control study was conducted within each subgroup found with the cluster analysis, to test with more validity environmental risk factors, such as alcohol, tobacco, medication and drug abuse. The controls with a rheumatoid arthritis condition were matched to the cases on age, gender and same postdiagnostic period and were recruited from the same hospital. Three main groups of MS subjects were obtained from the cluster analysis, distinguished by the gender, the presence or not of family history and the degree of severity of their physical disability. The results showed that drug abuse was the only risk factor with a statistically significant odds ratio for overall and for the unique female group without familial history of MS.
1638768 Activation of IL-6 production by UV irradiation of blood mononuclear cells from patients w 1992 Aug Cultured mononuclear cells from patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and normal donors were assayed for their ability to secrete IL-6 both spontaneously and after exposure to UV light. Mononuclear cells from SLE, RA and atopic control patients produced IL-6 spontaneously, while those from normal donors did not. Spontaneous production of IL-6 occurred in the non-adherent cell population. UV light-induced IL-6 production was confined exclusively to the SLE patients and was present only in the macrophage/monocyte fraction. This stimulation was induced by wavelengths in the UVA, UVB but not the UVC portion of the spectrum. These results suggest that cytokine release may be involved in the exacerbations of SLE provoked by photosensitivity.
1611738 Onlay technique for occipitocervical fusion. 1992 Jul Twenty-eight occipitocervical fusions using the onlay technique were performed in 27 patients ranging in age from 13 to 77 years (average age, 47.6 years). The indications for fusion included neurologic involvement from atlantoaxial instability associated with superior migration of the odontoid and destructive changes at the occiput-C1-C2 articulation, causing pain unrelieved by conservative treatment. Preoperative diagnoses included rheumatoid arthritis, congenital anomalies, posttraumatic, failed C1-C2 fusions, ankylosing spondylitis, and tumor. A standard posterior exposure of occiput-C1-C2 was used, and iliac crest bone graft was placed over the area to be fused. Postoperative immobilization consisted of skull tong traction, minerva jacket, and halo apparatus. There were no neurologic complications, two superficial wound infections, and minor difficulties with halo loosening. There was one perioperative death. Primary fusion was obtained in 89% of patients at an average of 12.8 weeks. Occipitocervical fusion by the onlay technique is safe, requires no internal fixation, and has a high success rate when compared with other methods of obtaining fusion in the occipitocervical region.
1579781 [Magnetic resonance imaging of the normal and the pathological knee in the child]. 1992 Apr 21 The results of magnetic resonance imaging (MRI) studies performed on the knee region of 60 children including 20 normally growing subjects are reported. In healthy children, MRI permitted to study the normal maturation of bone marrow and cartilaginous structures. The patients studied had bone tumors (11 patients), rheumatoid arthritis (8 patients), lesions of traumatic origin (7 patients), osteochondritis (4 patients), vascular and tissular dysplasia (3 patients), osteomyelitis (3 patients) and soft-tissue tumors (3 patients). In all patients, MRI showed clinically relevant abnormalities that were not detected by conventional X-rays or physical examination. MRI offers the ability to study disorders of bone, bone marrow, cartilage, menisci and ligaments in a noninvasive way. MRI has replaced arthrography of the knee and is the examination of choice in pediatric patients.
9116706 C-fibre function in systemic lupus erythematosus. 1996 Dec Systemic lupus erythematosus (SLE) frequently involves the central nervous system (CNS), but to a considerably lesser degree leads to peripheral neuropathy as measured by conventional nerve conduction velocity studies. Neuropathic symptoms are, however, frequently reported. Abnormalities of other nerve fibers than the large myelinated nerves might thus be responsible for such phenomena. Three age matched groups of 44 patients with SLE, 50 patients with rheumatoid arthritis (RA) and 45 healthy controls were investigated with quantitative sensory thermotesting. Warm detection thresholds (WDT) and heat pain detection thresholds (HPDT) were found significantly higher in SLE compared to RA and controls. There were no differences between the RA and the control group. In the SLE group no association to disease duration, medication or CNS abnormalities were found. Neuropathic symptoms and vibration thresholds showed weak associations to WDT. These findings imply that there is an impairment of C-fibre function in SLE. This small fibre neuropathy is probably not part of a generalized diffuse polyneuropathy also affecting large fibres, although this can not be ruled out completely by this study.
8912569 Penicillamine-induced bullous dermatoses. 1996 Nov The successful therapeutic use of D-penicillamine (DPA) has been hindered by its many adverse effects. Autoimmune bullous syndromes are among the less common adverse DPA reactions; they are not dose dependent and appear late in the treatment of diseases of altered immunity, most often rheumatoid arthritis. The majority of the DPA-induced bullous syndromes belong to the pemphigus spectrum, usually pemphigus foliaceus or erythematosus, have a lower prevalence of demonstrable tissue-fixed or circulating antibodies than spontaneously occurring pemphigus, display abnormal direct immunofluorescent patterns, and have a generally favorable prognosis. However, many cases do exhibit a full-blown chronic disease, unaffected by DPA withdrawal. DPA-induced cicatricial pemphigoid is a severe disease of both mucous and cutaneous involvement with a prognosis similar to the spontaneous disease. Cases of DPA-induced epidermolysis bullosa acquisita and DPA-induced bullous pemphigoid were not sufficiently substantiated by immunofluorescence or immunoprecipitation criteria.
8912010 Tumour necrosis factor and lymphotoxin: molecular aspects and role in tissue-specific auto 1996 Oct Tumour necrosis factor (TNF) is a highly potent, proinflammatory cytokine with broad-ranging functions from the regulation of endothelial cell adhesion molecules to facilitate entry of leucocytes into tissues, to direct induction of cellular cytotoxicity. This diversity of function potentially attributable to TNF in the genesis of inflammatory disorders place TNF as a primary candidate for clinical targeting and considerable success in this regard has been achieved, particularly in rheumatoid arthritis (RA). In this article we provide a short overview of TNF and its homologue lymphotoxin (LT) alpha and beta. Particular emphasis is placed on recent discoveries regarding the cell surface expression of these cytokines and the role of TNF/LT in experimental autoimmune encephalomyelitis (EAE), an animal model of the human demyelinating disease, multiple sclerosis (MS).
8779010 Pain and psychologic symptoms of Australian patients with whiplash. 1996 Apr 1 STUDY DESIGN: A survey of pain intensity and psychological symptoms in patients with chronic neck pain after whiplash injury. OBJECTIVES: To describe the pain and psychological profiles of patients with chronic whiplash. SUMMARY OF BACKGROUND DATA: Reports in the literature mention a constellation of symptoms associated with chronic whiplash injury but no systematic survey using objective patient report measures has been reported. METHODS: One hundred forty consecutive referred patients with chronic neck pain after a motor vehicle accident were studied using the SCL-90-R psychological profile and the McGill Pain Questionnaire. RESULTS: Psychological profiles and pain intensity ratings, similar to profiles obtained from patients suffering from rheumatoid arthritis and low back pain of organic origin, were obtained. CONCLUSIONS: The SCL-90-R is a convenient instrument to administer to patients with whiplash. It yielded a characteristic profile of pain and appears to be more expedient than other psychometric tests for these patients.
8762851 Slide agglutination test for the diagnosis of pulmonary and extra-pulmonary tuberculosis. 1996 Apr OBJECTIVE: Evaluation of a 2 min slide agglutination test to detect the presence of antibodies directed against Mycobacterium tuberculosis antigens. DESIGN: The test utilizes solible antigens extracted from a cultivable new species of non-pathogenic saprophytic mycobacterium, Mycobacterium w, which shares antigenic determinants with M. tuberculosis. The soluble antigens are covalently linked to carboxylated polystyrene latex beads. RESULTS: The sensitivity of the assay was increased from 78% (reported earlier), to 90.2% for pulmonary tuberculosis and 85.7% for extra-pulmonary tuberculosis. The specificity of the test was determined by testing the sera of apparently healthy controls, and patients with other respiratory tract infections and rheumatoid arthritis. Among the apparently healthy controls, 7.3% tested positive. None of the sera from the patients with other diseases gave positive agglutination. CONCLUSION: This simple and rapid technique could be suitable for mass screening for pulmonary and extrapulmonary tuberculosis.
8620087 Anti-neutrophil cytoplasmic antibodies in generalized autoimmune diseases. 1996 Mar Anti-neutrophil cytoplasmic antibodies (ANCA) are a system of autoantibodies which are strongly associated with the primary systemic vasculitides (PSV). cANCA, as detected by indirect immunofluorescence, are mostly reactive to proteinase 3 (PR3) and bear high sensitivity and specificity for Wegener's granulomatosis. pANCA have varied subspecificities and clinical associations. The most important subspecificity of pANCA is anti-myeloperoxidase (MPO), which is strongly associated with microscopic polyaniitis and pauci-immune crescentic glomerulonephritis. pANCA also occur at low to moderate frequency in other PSV, collagen vascular disease, inflammatory bowel disease and autoimmune liver disease. In systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), pANCA of varied subspecificity have been found, including anti-MPO at low rate and low titer, while cANCA and anti-PR3 were generally absent. Consequently, anti-PR3 (PR3-ANCA) and anti-MPO (MPO-ANCA) at moderate and high titer are distinguishing features of the PSV and, in an appropriate clinical setting, argue strongly against the presence of SLE or RA. Since no significant clinical association has been found for other pANCA subspecificities, cANCA, PR3-ANCA and MPO-ANCA remain the critical elements of ANCA testing in the clinical diagnosis of generalized autoimmune diseases.
7766494 Cervical spine and radicular pain syndromes. 1995 Mar Neck pain may affect one third of the adult population from time to time and may persist for 6 months or longer in 10% to 15% of these patients. In addition, cervical spine disease or trauma may result in injury to the spinal cord or nerve roots, through a variety of mechanisms, leading to a group of syndromes that can be broadly classified as myelopathy or radiculopathy. This review addresses recent developments in the anatomy and physiology of the normal cervical spine, common ill-defined or miscellaneous neck pain problems, and cervical injuries, with emphasis on the flexion-extension injury called "whiplash." Other types of injuries, including fractures and fracture dislocations, also are discussed, as well as neurologic consequences of cervical disk and facet joint degenerative disease, with emphasis on cervical spondylitic myelopathy. The complications of inflammatory joint diseases such as ankylosing spondylitis and rheumatoid arthritis are not specifically addressed in this review.
7653968 Anti-neutrophil cytoplasmic autoantibodies--a serologic marker for vasculitides. 1995 Mar Anti-neutrophil cytoplasmic autoantibodies (ANCA) have specificity for proteins in the cytoplasmic granules of neutrophilic and the lysosomes of monocytes. ANCA occur in a high proportion of patients with Wegener's granulomatosis, microscopic polyangiitis (microscopic polyarteritis), Churg-Strauss syndrome and certain forms of drug-induced vasculitis. ANCA with different specificities from those in patients with vasculitis occur in patients with inflammatory bowel disease and rheumatoid arthritis. ANCA titres correlate to a degree with disease activity and response to treatment. ANCA are a useful diagnostic marker but because of the low prevalence of ANCA-associated diseases, their positive predictive value is good only in patients with signs and symptoms of vasculitis. In vitro data indicate that ANCA can activate cytokine-primed neutrophils and monocytes, causing them to degranulate, release toxic oxygen metabolites, adhere to endothelial cells, and kill endothelial cells. If these events occur in vivo, ANCA may be directly involved in the pathogenesis of vasculitis.
7801203 [Three cases of respiratory failure of collagen diseases accompanied by syndrome of inappr 1994 Oct We experienced three patients who have collagen diseases with respiratory failure accompanied by hyponatremia. They were one systemic lupus erythematosus patient with interstitial pneumonia, one rheumatoid arthritis patient with acute pneumonitis, and one dermatomyositis patient with pulmonary fibrosis and organizing pneumonia. In all 3 patients, hyponatremia appeared along with a decrease in arterial O2 partial pressure (PaO2) and the hyponatremia tended to improve when the PaO2 increased after inhalation of oxygen, even though their respiratory failure were not improved. In dermatomyositis patient, serum Na levels were over-corrected after increase in PaO2. The serum and urine osmolality, serum antidiuretic hormone (ADH) levels and clinical pictures demonstrated a presence of inappropriate secretion of ADH (SIADH) in all 3 cases when hyponatremia and hypoxia appeared. A close association between hyponatremia and hypoxia observed in 3 patients strongly suggested that their SIADH were associated with hypoxia since SIADH could be demonstrated by hypoxia. Therefore, it is important to realize that hypoxia-induced hyponatremia will be promptly corrected to hypernatremia by an oxygen inhalation, which could cause a lethal central pontine myelinolysis.
8259776 Antibodies to the constitutive 73-kd heat shock protein: a new marker of mixed connective 1993 Dec PURPOSE, PATIENTS, AND METHODS: This report documents the finding of an elevated titer of IgG reacting with the constitutive bovine 73-kd heat shock protein (HSP) in the serum of patients with rheumatoid arthritis, scleroderma, and mixed connective tissue disease (MCTD). RESULTS AND CONCLUSIONS: Further characterization of antibodies from patients with MCTD showed that the antibodies also recognize the human constitutive 73-kd HSP, but not the inducible 72-kd isoform. Very high levels of antibodies appeared to be specific for MCTD; the differences between levels in patients with MCTD and those in healthy subjects (blood donors) were highly significant (p < 10(-8)), with no values in this group of patients overlapping with those in the controls. This parameter might therefore represent a new diagnostic marker for this disease.
8396846 Methotrexate: new mechanisms and old toxicities. 1993 Over the last several years, information on methotrexate's mechanism(s) of action (which affects its efficacy) and toxicities continue to evolve. This popular second line agent (DMARD) is a potent anti-inflammatory drug, with effects on LTB4 and adenosine release (EC-50: 1-13 nM). As such, it may be a sufficiently potent anti-inflammatory drug to affect rheumatoid arthritis's basic course, as shown by a recent meta-analysis where methotrexate equalled gold and was better than azathioprine, when examining radiographic erosions. Its toxicities continue to be documented, with cirrhosis occurring between 2:100 and 1:1000 cases. Pneumonitis continues to be found. NSAID-MTX interactions, too, have been documented, although their kinetic mechanisms remain controversial.
1470428 Correlation of splenic function with the splenic uptake rate of Tc-colloids. 1992 Nov The splenic uptake rate of Tc-sulphur colloid or Tc-tin colloid was measured and found to correlate well with splenic function. The normal tracer uptake rate was 0.0002/s-0.0006/s (measured uptake rate divided by measured injected activity). Lower values indicated hyposplenism (sensitivity = 0.97, specificity = 0.95), and values over 0.0006/s indicated hypersplenism (sensitivity = 0.96, specificity = 0.97). Higher values of splenic uptake were associated with proportional reductions in the white blood cell and platelet counts, and to a lesser extent the haemoglobin concentration in peripheral blood. Patients with rheumatoid arthritis had increased tracer uptake, but still below the criteria for hypersplenism, whereas patients with Felty's syndrome had tracer uptake rates in the 'hypersplenic' range.