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ID PMID Title PublicationDate abstract
8377877 Erythropoietin: mechanisms of action and indications for treatment. 1993 Jun We review data concerning site and regulation of erythropoietin (EPO) production, its effects on target tissue, routes of administration and clinical applications. In the anaemia of chronic renal failure (ACRF) treatment with recombinant human erythropoietin (r-Hu-EPO) has been shown to be effective in both improvement of the anaemia and increase in quality of life. In the anaemia of chronic disease (ACD), associated with various malignant, infectious and inflammatory disorders, many investigators have demonstrated an inappropriately low EPO response to anaemia. Therapeutic trials in patients with ACD mostly lacked sufficient numbers of patients for evaluation of the effects. The results obtained from some studies in AIDS and rheumatoid arthritis and the effect on the number of units of autologous blood obtained from patients planned for elective surgery are encouraging, however. Adverse reactions of r-Hu-EPO treatment are mainly confined to the ACRF population and include hypertension, shunt thrombosis and pain at the injection site. The exact mechanism of action of EPO is not yet fully understood. Large scale clinical trials are required to establish its effects on both the anaemia and quality of life in anaemias other than ACRF.
8421154 Diaphragm disease of the ascending colon. Association with sustained-release diclofenac. 1993 Jan We describe the clinicopathological features of six patients, two with rheumatoid arthritis and four with osteoarthritis, in whom intake of sustained-release diclofenac for one or more years was associated with ulceration and or stricture of the ascending colon. All were referred for further evaluation of anemia and changes in bowel habits. Three had chronic watery diarrhea, one suffered from progressive constipation and subsequently needed a right hemicolectomy because of complete intestinal obstruction. In five patients, colonoscopy revealed single to multiple semilunar ulcers, predominantly localized on the crest of the haustra of the ascending colon. In five of six cases the lumen was narrowed, from slight accentuation of the haustrum to almost pinhole-like concentric stenosis. All except one patient had multiple diaphragm-like strictures. The macroscopic and microscopic appearances closely resembled those of similar lesions previously described in the terminal ileum in patients treated with nonsteroidal anti-inflammatory drugs. It appears that the slow-release form of a nonsteroidal anti-inflammatory drug, such as sustained-release diclofenac, predisposes to manifestations of such lesions in the ascending colon.
7678486 [Angiogenesis and its regulation]. 1993 Jan Angiogenesis (formation of new blood vessels) is essential in embryonal development, female reproduction and wound repair. Under these physiological conditions, angiogenesis is highly regulated by the endogenous angiogenic factor and its inhibitor. However, angiogenic diseases such as rheumatoid arthritis, diabetic retinopathy, solid tumor, hemangioma and psoriasis are driven by persistent unregulated angiogenesis. The angiogenic process consists of such multi-steps as degradation of basement membrane, cell migration and proliferation, and tube formation following activation of vascular endothelial cells by stimulators appearing at the pathological site. Thus, for modulating the pathological conditions, it is most important to elucidate the angiogenic mechanism at the molecular level. It is not sufficiently clear yet as compared with the blood coagulation and hematopoietic systems. On the other hand, there have been advances in the study of new anticancer metastatic agents as a target of activated endothelial cells and they have been found to have promising substances. In this study, the angiogenic factor, its inhibitor, and then the anticancer effect of the angiogenic inhibitor, have been investigated from the standpoint of cancer therapy.
1595299 [The lung as a reflection of internal medicine diseases]. 1992 Apr The lungs are called "mirror of internal medicine" because they are often involved in multisystem diseases. The morphologic changes of the lungs are uncharacteristic and the classification is only possible in relation to other manifestations of multisystem diseases. In this article clinical syndromes with pulmonary manifestations will be reviewed. Congestive heart failure and congenital diseases may lead to pulmonary features. Most cardial pleural effusions are transudates except postcardiac injury syndrome causes pleural exsudates. Almost all connective tissue diseases may affect the lungs and the pleura. Scleroderma, systemic lupus erythematodes, vasculitis, polymyositis, Sharp's syndrome, Wegener's granulomatosis, Goodpasture and Sjögren's syndrome, rheumatoid arthritis, ankylosing spondylitis and sarcoidosis are discussed. There is an association of gastroesophageal reflux and asthma. Acute pancreatitis may cause an adult respiratory distress syndrome. Endocrine and hematologic diseases seldom cause pulmonary changes. Many malignant tumors are going along with metastasis in the lungs. Renal insufficiency causes "fluid lung", nephrotic syndrome pleural effusions. Finally different drugs induce pulmonary diseases.
1314915 [Experimental study of the mechanism of auranofin-induced diarrhea]. 1992 Feb To clarify the kinetics of cell membrane and intracellular mediators in the process of auranofin (AF)-induced diarrhea, we perfused electrolyte solution containing the oral gold preparation AF, which is a treatment for rheumatoid arthritis, through the rat jejunum, and studied net water and electrolyte transport, Na+, K(+)-ATPase activity, and c-AMP and c-GMP concentrations in the jejunal mucosa. In addition, change in Ca+ concentration in isolated intestinal cells was evaluated using fura-2-acetoxyl-methyl ester. AF significantly suppressed water and electrolyte transport. Mucosal secretion was increased due to elevation of the intracellular Ca+ concentration early in the perfusion period, then due to reduction in the Na+, K(+)-ATPase activity, and increase in the c-AMP concentration late in the perfusion period. Therefore, these cell membranes and intracellular mediators are considered to be involved in the mechanism of AF-induced diarrhea.
1303609 [Secondary bronchogenic pulmonary hydatidosis]. 1992 Secondary bronchogenic hydatid disease is a rare and little known complication of primary hydatid cyst of the lung, which is even refuted by some authors. We report 7 cases of secondary bronchogenic hydatid after surgical cure of a hydatid cyst which had ruptured into the bronchi, while the last case concerned a young girl who was treated by corticosteroids for rheumatoid arthritis and who developed secondary bronchogenic hydatid from a cyst rupturing into the bronchi in the absence of surgery. Hydatid dissemination was ipsilateral to the primary cyst in 5 cases, contralateral in one case and bilateral in one case. Five patients underwent radical surgery. The patient with bilateral dissemination was operated on one side and a large number of residual cysts were eliminated by vomica, as for the last patient; these two patients are still under surveillance. The operation and general anaesthesia played a predisposing role in the pathogenesis of this complication and inhibition of immune mechanisms could also play a role. Prevention is necessary when treating a hydatid cyst of the lung which has ruptured into the bronchi. Treatment is surgical, bearing in mind that a large number of secondary cysts can be eliminated by vomica or may involute spontaneously.
24487108 Prevalence of psychosomatic and other medical illnesses in anorexic and bulimic patients. 1993 The occurrence of psychosomatic disorders (PSD) in patients with anorexia nervosa and bulimia nervosa has rarely been investigated. We examined the prevalence of four psychosomatic disorders [peptic ulcer (PU), bronchial asthma (BA), neurodermatitis (ND), and rheumatoid arthritis (RA)] in patients consecutively admitted to an eating disorders (ED) program. Responses to a validated questionnaire and clinical file information were obtained from 152 patients, 60% of whom were bulimic and 40% were anorexic. The average age of the patients was 27.5 years and all but two patients were female. There was a higher life-time prevalence of the psychosomatic disorders among anorexics compared with bulimic patients, except for RA. PU and BA were reported by 10% of anorexics compared with 7.6% and 8.7%, respectively, by bulimic patients. RA was rare in both anorexic (1.6%) and bulimic patients (5.4%). The young age of the patients under study was to be considered limiting the life-time prevalence. The study contains epidemiological data on the prevalence of other medical illnesses in ED patients as well as the prevalence of PSD and eating disorders in their families.
1609234 [Camptocormia in the elderly. A new entity by paravertebral muscle involvement?]. 1992 Mar "Camptocormism" in the elderly is an acquired kyphosis which increases during walking and is totally reducible in dorsal horizontal position in two thirds of cases. The authors report 16 cases of camptocormism in patients with a mean age of 76 (12 women, 4 men). Camptocormism was accompanied in 5 cases by an extrapyramidal syndrome, in 3 cases by articular chondrocalcinosis, in 1 case by giant cell arteritis and in 1 by rheumatoid arthritis. There was no inflammatory syndrome and muscle enzymes were raised in only 4 cases. Electromyogram of the paravertebral muscles was pathological in 5 cases, with neurogenic changes in 4 cases and a myogenic type tracing in one. CT scan or magnetic resonance imaging showed evidence in all cases of atrophy with fatty involution of the paravertebral muscles. Biopsies of the paravertebral muscles revealed moderate mononuclear cell infiltrates in 4 cases with similar abnormalities in peripheral muscles. Corticosteroids had a beneficial effect in 11 cases out of 13 and the most prolonged results were seen after bolus doses of methylprednisolone. These findings suggest that camptocormism in the elderly could be linked to inadequacy of the paravertebral muscles or, in certain cases, to interstitial myositis.
8003561 Prevention of the acute graft-versus-host disease (GVHD) in rats by the immunomodulating d 1994 Apr The grafting of immunocompetent allogeneic cells into MHC-discordant, genetically nonresponsive F1 hybrids of inbred rat strains consistently leads to an acute, lethal graft-versus-host disease (GVHD). The novel immunomodulating drug leflunomide, which has been shown to be efficacious in animal models of autoimmunity and adverse transplantation reactions, was studied in a rat model of GVHD. It was found that this drug not only was a powerful agent to prevent this otherwise terminal disorder, but was also proficient when used as a therapy of an established GVHD. Since leflunomide has been shown to be efficacious and safe in patients with chronic rheumatoid arthritis, it would also be reasonable to investigate this drug in clinical trials for bone marrow transplantation and GVHD in human beings.
8182624 Antibodies to type II collagen in human serum: storage effects and role of IgM antiidiotyp 1994 Feb OBJECTIVE: To investigate the observation that IgG reactivity to human denatured type II collagen (denatured CII) is increased in normal human serum stored at 4 degrees C compared to serum stored at -20 degrees C. METHODS: Reactivity was measured by ELISA, and the effect of heating was also assessed. Serum was separated on affinity columns and mixing experiments were performed with the resultant fractions to test for inhibitory or enhancing effects. RESULTS: There is a storage labile and heat labile inhibitor in the IgG depleted fraction of serum stored at -20 degrees C from healthy subjects, and an inhibitor is present in some pooled human IgM preparations which reduces the reactivity of antibody to human CII in serum from both healthy subjects and patients with rheumatoid arthritis. CONCLUSIONS: Storage conditions and heat significantly affect IgG antibodies to denatured CII but not antibodies to other antigens. These effects may be mediated by the presence of an IgM antiidiotype against the IgG antibody to denatured CII.
8200300 Insulin autoimmune syndrome (Hirata disease): clinical features and epidemiology in Japan. 1994 Jan Since Hirata et al. first reported a patient with insulin autoimmune syndrome in 1970, 197 cases have been reported in Japan as of December, 1992. The clinical profiles of these 197 cases were as follows; the peak age at onset was 60-69 years and peak duration of hypoglycemic attacks was more than 1 and less than 3 months. There was no gender difference in the peak age of onset or duration of hypoglycemic attacks. Approximately 82% of the IAS patients had spontaneous remission without any positive treatment. Before diagnosis of IAS, 43% of the patients with IAS had been taking medication; methimazole (MTZ) for Graves' disease, alpha-mercaptopropionyl glycine (MPG) for cataracts, liver disease or rheumatoid arthritis, or glutathione for liver disease, all of which are sulfhydryl compounds. After such sulfhydryl compounds were discontinued, the hypoglycemic attacks subsided. Three patients with IAS experienced recurrence of the hypoglycemic attacks after re-administration of MTZ and MPG, although 6 patients who developed IAS without exposure to any drug had recurrent attacks without exposure to any drug around 1 year after the first hypoglycemic attacks had stopped. Thus, hypoglycemia in IAS is mainly transient and the development of IAS may be related to sulfhydryl compounds.
8197729 [The antiphospholipid syndrome in systemic connective tissue diseases]. 1993 Nov The aim of the study was to prove the incidence of antiphospholipid syndrome (APS) in systemic connective tissue disease (SCTD), especially in systemic lupus erythematosus (SLE) and to find out serologic markers of APS. Of 94 patients with SCTD followed up in the last three years 80 had SLE, 7 Sjogren's syndrome, 3 systemic vasculitis, 2 combined systemic connective tissue disease, 1 rheumatoid arthritis, 1 Sjogren's syndrome with vasculitis. Antiphospholipid antibodies (ApSt) were determined by ELISA method. In 31 of 80 patients with SLE (38.07%) antiphospholipid antibodies were proved. In lo of 31 (32.26%) signs of systemic lupus or the presence of APS markers have not been found, while 21 of 31 (67.74%) had some of clinical manifestations of APS (most commonly thrombocytopenia or vascular thrombosis) with evolution of the basic disease. Among our patients with SLE the most common finding was IgG antibody isotype-in 14 or 66.66% of cases. In 5 of 7 patients with Sjogren's syndrome ApAt were proved without clinical evolution of the basic disease and APS. Only 2 of 7 patients of this group showed, together with more increased ApAt, mild evolution of the basic disease and manifestation of APS (livado reticularis and recurrent venous thrombosis).
8379350 [Rheumatic diseases. A three-year retrospective study at an internal medicine service]. 1993 Jul In order to assess the weight of Rheumatic Diseases, the Authors retrospectively studied 117 patients admitted to the Internal Medicine Service of the Faro District Hospital over a 3 year period (1989-1991). The selection criterion comprised the final rheumatological diagnosis. The diseases were arranged in nosological groups according to the Classification of Rheumatic Diseases of the American Rheumatism Association. The relative frequency, in totality and by nosological groups, and other variables, were determined. The relative frequency was of 4.2%. The mean age was 52.9 years. The distribution in age groups showed 2 peaks in the sixth and seventh decades. Females were more often affected (61%). The mean time of internment was 22.3 days. The proportional mortality reached 6.8%. Diffuse Connective Tissue Diseases were the most frequently found (42.7%) and among these Rheumatoid Arthritis and Systemic Lupus Erythematous were the most prevailing.
1494711 [The diet therapy of rheumatic diseases]. 1992 Dec In the last decade the possible role of dietary therapy in the treatment of different rheumatic diseases has undergone serious reconsideration. Elimination diets may be useful in a subgroup of patients with rheumatoid arthritis, in whom food antigens probably play an important role in the onset and perpetuation of the inflammatory process. In mixed cryoglobulinemia a low-antigen-diet might reduce the amount of macromolecular food antigens which cross the mucosal barrier of the gut and cause either an immune response and/or compete with the immune complexes in the mononuclear phagocytic system. Supplementing the diet with essential fatty acids (omega-3 and/or omega-6) may inhibit the production of some of the mediators of inflammation, such as leukotriene-B4 and interleukin-1. However, currently employed doses often result in only modest or moderate clinical improvement. Controlled studies in a larger number of patients and with differentiated treatment protocols are needed to establish to what extent dietary therapy may improve the course of different rheumatic diseases, and to determine whether this therapy might be used in association with or even substitute for other well recognized treatments.
1361959 A comprehensive macrophage-T-lymphocyte theory of schizophrenia. 1992 Nov Chronic macrophage activation with subsequent failure of activated macrophages to properly control T-lymphocyte secretion of interleukin-2 and interleukin-2 receptors is proposed as the basic biological mechanism of schizophrenia. Fundamental to this theory are the clinical observations on interleukin-2 provoking the active phase symptoms of schizophrenia in psychiatrically normal human volunteers and macrophage cytokines producing the prodromal and residual phase symptoms. This theory provides a completely new and unified mechanisms for the antipsychotic action of typical and atypical neuroleptics, bromocriptine, naloxone and DMSO. Furthermore, this hypothesis reveals why the dopamine theory of schizophrenia was a false lead. The effects of prolactin, estrogens and androgens are consistent with the model. Age of onset, male/female incidence, course of the disease from prodromal to active to residual phase, the protection afforded by rheumatoid arthritis and the close relationship between depression and schizophrenia can be explained by this theory. The gastrointestinal tract is suggested as the preferred site to investigate for the cause of the immune activation in schizophrenia.
1642021 [Chemical structure, biotechnical production and clinical use of recombinant erythropoieti 1992 Jun The renal glycoprotein hormone erythropoietin is an essential growth factor for the erythrocytic progenitors in the bone marrow. Erythropoietin deficiency is the main cause of the anemia in chronic renal failure. Genetical engineering has made it possible to produce recombinant human erythropoietin (rhu-Epo) in CHO cell cultures as a pharmaceutical compound. Endogenous and recombinant erythropoietin are similar with respect to their biological and chemical properties (M(r) 30,400 Da, protein content 60%, 165 amino acids, 4 carbohydrate side chains). With few side-effects, rhu-Epo corrects the anemia of predialysis and dialysis renal failure patients. In addition, rhu-Epo treatment may reduce the need for blood transfusion in other types of anemias, including those of rheumatoid arthritis, AIDS, malignant diseases and major surgical procedures. However, rhu-Epo has not been approved as yet for treatment of non-renal anemias in Germany.
1609586 Polyethylene wear of the PCA unicompartmental knee. Prospective 5 (4-8) year study of 120 1992 Jun In Lund, 120 arthrosis knees had the PCA unicompartmental endoprosthesis during 1983-1987 and were followed prospectively for 5 (4-8) years. 17 knees were excluded from the final clinical follow-up because of the development of rheumatoid arthritis (2), severe neurologic disease (3), or death (12). Subjectively, 68 knees were much improved, 26 improved and 9 had failed. First-steps problems were only present in the uncemented group of 49 knees. Of the 9 failures (7 cemented and 2 uncemented) 6 were revised. The main reason for revision was loosening of the femoral component (2), tibial component (2), or both components (1), and polyethylene wear (1). However, all revised tibial components showed polyethylene wear, in 4 quite pronounced. Weight-bearing radiographs (61 knees) revealed major polyethylene wear in an additional 14 knees; not only in thin tibial components. There may be an increasing clinical problem due to polyethylene wear. With the presented findings the PCA unicompartmental knee endoprosthesis cannot be recommended.
1632135 [Celiac disease in adults: clinical aspects--role of endoscopy]. 1992 Mar Adult coeliac disease has a broad clinical spectrum and remains undetected for years. Among subclinical deficiency states, attributable to coeliac enteropathy, combined iron and folic acid malabsorption is predominant. An unexplained recurrent iron anaemia is an indication for small intestinal biopsy. Gastro-intestinal disorders are present in only 50% of the cases. Coeliac disease is frequently associated with other major histocompatibility complex (MMC)-linked diseases which are mediated by immunological mechanisms: dermatitis herpetiformis, oral ulcerations, IgA nephropathy, rheumatoid arthritis, sarcoidosis. Dermatitis herpetiformis is a useful model for examination of the spectrum of mucosal changes that typify gluten sensitivity and subliminal lesions without villous atrophy. An increased interest is devoted to the intra-epithelial T-lymphocyte population, not only in the small intestine, but at the level of the stomach and the colon. A "rectal challenge" test has been proposed for detecting gluten sensitivity in coeliac patients. Such a test could be an original method of screening, reducing so the need of small intestinal biopsy. The preliminary results are to be confirmed. Until now, jejunoscopy remains mandatory for the diagnosis and the survey of intestinal lesions related to coeliac disease.
34167213 Relationship of Histamine-Releasing Factors to the Human Intercrine/Chemokine Group of Cyt 1992 Histamine Releasing Factors have been characterized as a product of human mononuclear cells and platelets. MCAF/MCP-1, a monocyte-derived product is the most potent one described which acts rapidly (within 1 minute) upon basophils of over 90% of subjects tested. RANTES, a product of a subpopulation of CD4(+) lymphocytes acts similarly but is about half as potent. CTAP III/NAP-2, by contrast, is a platelet derived HRF of low potency. It is, however, a plentiful protein and NAP-2, is derived from CTAP III by cleavage with elastase. All are members of the intercrine/chemokine group of cytokine-like molecules many of which are chemotactic factors and/or activate other cells. Interleukin 8 (NAP-1), another chemokine inhibits histamine release induced by all known forms of HRF. Interleukin 3 is a primer of basophils but at high concentrations can itself induce histamine release from a subpopulation (mainly atopic) of subjects. These proteins are thought to be important mediators of protracted inflammation and histamine release seen in allergic late phase reactions and, perhaps in specific disorders such as chronic urticaria, atopic dermatitis, scleroderma, and rheumatoid arthritis.
7472777 High frequency of light chain restriction in labial gland biopsies of Sjögren's syndrome 1995 Sep A well-recognized complication of Sjögren's syndrome (SS) is the development of malignant lymphoma, with a risk 44 times that of the general population. Although a few clinical signs may indicate the onset of lymphoma, there are few reliable laboratory markers which predict the development of neoplasia. A non-isotopic in situ hybridization technique has been applied to routinely processed labial salivary gland (LSG) biopsies of patients under investigation for SS. Serial section of 70 LSGs were examined for a kappa and gamma immunoglobulin light chain mRNA using digoxigenin-labelled oligonucleotide probes. As controls, 39 biopsies from non-SS-associated sialadenitis were also examined. Sections were analysed using computer-assisted quantification to determine the percentage of kappa-expressing cells in each case. The range of kappa expression in the SS group was 24.1-93.4 percent and in the non-SS group 48.3-75.4 per cent. Light chain restriction was found in 13/70 (18.6 percent) cases from the SS group but in no cases of the control group. Of the SS cases showing restriction, 4/13 (30.7 percent) have subsequently developed extrasalivary gland lymphoma. Two patients not showing light chain restriction in LSG have subsequently developed lymphoma. The positive predictive value of this test to identify patients at risk of lymphoma was 30.7 percent with a detection rate (sensitivity) of 66.7 percent and a false-positive rate of 14.1 per cent(specificity 85.9 percent). This study has identified a high prevalence of light chain restriction in labial gland biopsies of patients with SS and provides objective quantitative criteria to identify those patients at greater risk of lymphoma development.