Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
6223741 The alternative complement pathway control protein H binds to immune complexes and serves 1983 Jan During solubilization of immune complexes C3b becomes fixed to the immunoglobulin part and serves as a receptor for the alternative complement pathway control protein H. The H-C3b immune complex interaction can be made detectable using 4% polyethyleneglycol to separate free from bound 125I-H. Tetanus toxoid (Te)/anti-Te complexes kept soluble with fresh serum and containing 125 IU of specific antibody bound 18% of 125I-H; when fresh serum was chelated with 10 mM EDTA, 125I-H binding was only 5%. On sucrose density gradients, the H-binding material sedimented in the range of 12 to 30 S. In 36 serum samples from rheumatoid arthritis (RA) patients and in 12 serum samples from patients with systemic lupus erythematosus (SLE), 125I-H binding was significantly elevated to 9.5 +/- 4.7% (mean +/- 1 SD) and 13.3 +/- 5.6%, respectively, while 125I-H binding by 36 normal human sera was 4 +/- 2%. RA samples (17/36, 47%) and SLE samples (9/12, 75%) had H-binding values increased by more than 2 SD above the normal mean. The serum samples were also assessed for conglutinin- and C1q-binding activities; a significant correlation between H and C1q binding was observed (P less than 0.001); there was no correlation between H and conglutinin binding. Although binding to immune complexes through its interaction with C3b, H clearly detects a population of complexes other than conglutinin, thus expanding the possibilities of further characterizing pathological complexes.
6129306 Tissue and blood concentrations of chloroquine following chronic administration in the rat 1982 Nov The antimalarial drug, chloroquine, is extensively distributed in tissue and slowly eliminated such that after a single dose, a plasma half-life of 3-5 days has been found (McChesney & McAuliff 1961; McChesney et al 1967). A peak tissue/plasma concentration ratio greater than 300 is obtained in many tissues and after a single dose the drug can be found in the liver and urine for up to five years (Gaudette & Coatney 1961; Rubin et al 1963; Zvaifler et al 1963). Chronic administration of chloroquine for the treatment of rheumatoid arthritis has revealed an ocular toxicity due to accumulation of the drug in the pigmented layers of the eye, particularly the choroid (Fuld & Horwish 1958; Fuld 1959). A more recent indication for chronic administration of chloroquine is in the prophylaxis of malaria, for which the drug is administered at a dose of 300-600 mg weekly to adults. The long term toxic effects of chloroquine when administered in this way are unknown but no ocular toxicity has been reported even after five years of such use. Since tissue toxicity and other untoward effects are largely determined by tissue stores (Fuld & Horwish 1958; Fuld 1959) and blood levels (Laaksonen et al 1974; Frisk-Holmberg et al 1979) of the drug, it is useful to know the changes occurring in tissue and plasma concentrations during chronic administration. Previous studies in animals have given conflicting results. McChesney et al (1965) found a steady increase in the tissue and plasma concentrations in rats throughout a 3-month period although the increase was fastest in the first month. Grundmann et al (1972) found that most rat tissues were saturated with chloroquine between the 10th and the 16th weeks. Plasma concentrations were not measured hence the effect of tissue saturation on blood levels was not determined, yet saturation of tissue stores would be expected to lead to a rapid increase in plasma concentration that could affect the pattern and incidence of adverse reactions to the drug. We have reinvestigated the uptake of chloroquine by rat tissues during chronic administration of the drug and in particular to relate the tissue levels to plasma concentrations.
7110563 Post-traumatic spinal epidural hematoma. 1982 Jul Five patients with vertebral fracture and spinal epidural hematoma (SEH) are described. Another 58-year-old man developed a post-traumatic SEH without bony damage. From the literature, 38 patients (31 male, 4 female, and 3 unknown) were collected. Ankylosing spondylitis or rheumatoid arthritis was noted in 9 of 12 subjects between 50 and 75 years of age. Two groups of patients were identified: Group 1--16 patients with spinal fracture (aged 23 to 63 years), and Group 2--22 patients without spinal fracture (the age was less than 18 years in 12 subjects). In Group 2, a coagulation defect or spinal epidural vascular malformation resulted in a SEH in 6 patients. The preoperative myelopathy was complete in 3 patients each from Group 1 (23.1%) and Group 2 (16.7%). Of the 31 patients operated upon, 9 of the 13 from Group 1 (69.3%) and 6 of the 18 from Group 2 (33.3%) underwent laminectomy within 1 week after the onset of symptoms. Postoperative neurological return was observed in 38.5% (5 of 13) and 88.9% (16 of 18) of these two groups of patients, respectively. Post-traumatic SEHs, predominant in the male population, are often associated with vertebral disease in elderly patients. In the very young patient, there is usually no fracture/dislocation of the spine. A predisposing lesion may be present when spinal fracture is not evident. The prognosis after surgical intervention is better in patients without spinal fracture than in those with vertebral damage, probably because of less contusion to the spinal cord and the presence of very young subjects in the former group of patients.
6976194 Granulocyte-associated IgG in neutropenic disorders. 1982 Jan We applied a radiolabeled antiglobulin test to a study of patients with a variety of neutropenic disorders. After defining the nature of the interaction of radiolabeled anti-IgG with the neutrophil, we studied 16 patients with neutropenia of uncertain etiology and adequate bone marrow granulocyte precursors. Twelve of these 16 patients had increased neutrophil-associated IgG (PMN-IgG). Patients with the highest levels of PMN-IgG had the lowest neutrophil counts. The majority of patients with neutropenia and increased PMN-IgG had an underlying immunologic disorder that included immune thrombocytopenic purpura in 5 patients and autoimmune hemolytic anemia in 1 patient. In some patients, elevated PMN-IgG preceded other evidence for immunologic disease. The direct antiglobulin test helped to distinguish neutropenic patients with increased PMN-IgG both from patients with neutropenia due to a known nonimmune disorder and from nonneutropenic patients with rheumatoid arthritis or systemic lupus erythematosis. Each of four patients with increased neutrophil-associated IgG treated with systemic corticosteroids responded clinically with an associated fall in neutrophil IgG and a rise in the circulating neutrophil count. The radiolabeled antiglobulin test appears useful in defining a subpopulation of patients with neutropenia due to an underlying immunologic disorder.
7038816 [Hormonal contraceptive therapy and thromboembolic disease]. 1980 Dec A group of 55 patients with rheumatoid arthritis (RA) and 25 healthy persons is studied. In peripheral blood, the number of E rosettes is similar in both groups but in patients with RA who are not on steroid therapy, these is a decreased number of the absolute value of T lymphocytes. There is a positive correlation between quantitative cellular immunity and different biologic and clinical parameters.
2990642 Characterization of human bone cells in culture. 1985 May Cultures of human bone cells were established, maintained, and characterized with respect to several metabolic parameters. These studies were undertaken with a view to using the bone culture system as a means of studying mechanisms of bone metabolism. The donor patients' ages ranged from 1 to 90 years and their disease states included congenital limb anomalies, exostosis, and osteo- and rheumatoid arthritis. Cultures were maintained up to 5 months. The osteoblast-like character of these cells was confirmed with the use of measurements applied to bone cells from other systems. Analyses showed that (a) the cells' appearance resembled that of cultured osteoblasts from other animal sources, b) intracellular cAMP was stimulated by human parathyroid hormone, c) osteocalcin was detected in the medium of all tested bone cell cultures and its production was found to be stimulated by 1,25-dihydroxycholecalciferol, and d) newly synthesized collagen was almost exclusively type I. In contrast, cultures of human fibroblasts, established in one instance from tissue specimens of the same donor patient, grew faster, reached a higher limiting density, and produced a greater proportion of type III collagen than the corresponding bone cells. Furthermore, fibroblasts did not accumulate osteocalcin in their culture medium. The conditions described in this report to maintain human bone cells in culture should provide a suitable test system to study the regulation of human bone metabolism.
4055168 Pharmacokinetics of indoprofen in elderly patients following repeated oral administration. 1985 Twenty patients suffering from osteoarthritis or rheumatoid arthritis, aged between 60 and 85 years, received 200 mg indoprofen tablets thrice daily for 4-7 days. Following the last dose, plasma samples were drawn and analysed for indoprofen. The mean peak plasma concentration of 25.5 +/- 7.06 micrograms/ml indoprofen was reached after 1.25 +/- 0.71 h. The total area under the curve was calculated as 207.2 +/- 108.7 micrograms X h/ml. Indoprofen was eliminated with a mean elimination half-life of t1/2 beta = 8.29 +/- 2.93 h compared with 5.5 +/- 0.64 h in young subjects. In elderly patients receiving indoprofen, terminal plasma half-lives and area under the plasma level time curves corrected for body weight were moderately increased compared with young subjects whereas no significant differences were found for Vd beta. During the dosage interval indoprofen levels were appreciably higher in elderly patients than in healthy volunteers due to higher nadir values and slower elimination half-lives, whereas only minor differences could be detected for peak plasma levels. The differences observed between young healthy volunteers and elderly patients may be explained by the reduction of renal function with increasing age, since creatinine clearance was 30-40% lower than normal values. The dose schedule for elderly patients over 60 years of age should therefore be adjusted to 200 mg indoprofen twice daily. A further reduction of the total daily dose should be considered for patients suffering from renal diseases associated with reduced creatinine clearance.
2981091 Human immune responses to synthetic peptides from the Epstein-Barr nuclear antigen. 1985 Jan Humans infected with Epstein-Barr virus (EBV), the causative agent of infectious mononucleosis, develop antibodies against a nuclear antigen (EBNA) that is present in virally transformed B lymphocytes. The EBNA protein contains a unique glycine-alanine repeating sequence. We have synthesized peptides corresponding to various regions of the EBNA molecule within and near this sequence. Rabbit antibodies against the peptides within the sequence reacted directly with the EBNA protein, as detected by Western blotting. The sera of individuals with antibodies against Epstein-Barr virus contained abundant antibodies also reactive with one or several of the synthetic peptides within the sequence. Moreover, human antibodies against these simple peptides were induced specifically early in the course of infectious mononucleosis. When compared with normal controls, antibody levels to the glycine-alanine peptides were significantly higher in patients with rheumatoid arthritis and progressive systemic sclerosis, but not in patients with two other autoimmune diseases. These results document that i) antibodies against the peptides detect the EBNA protein, ii) humans infected with EBV produce high titers of antibodies reactive with these synthetic antigens, and iii) antibody titers against the peptides are abnormally elevated in certain autoimmune diseases.
6596815 [Effect of prostaglandins on in vitro electrolyte metabolism in human spongiosa]. 1984 Sep Prostaglandins seem to be involved in the pathogenesis of juxtaarticular osteopenia in rheumatoid arthritis. Therefore the influence of prostaglandins on in vitro electrolyte metabolism of human trabecular bone was tested. Trabecular bone was prepared from femoral heads of patients who had undergone hip replacement surgery for coxarthrosis. 500 mg samples of trabecular bone were incubated in modified Eagle's minimal essential medium. Net electrolyte movements between bone and incubation medium were measured. PGE2 caused an increase in the release of calcium (Ca) and magnesium (Mg) from bone into incubation medium as compared to controls (PGE2 1 micrograms/ml: Ca = 0.87 +/- 0.09 mmol/l*, Mg = 0.44 +/- 0.03 mmol/l*; controls: Ca = 0.81 +/- 0.09 mmol/l, Mg = 0.41 +/- 0.05 mmol/l; n = 15, *p less than 0.001). The effect of PGE2 was dose-dependent and comparable to the effect of human parathyroid hormone 1-34 (hPTH 1-34). PGE2 turned out to be the most potent prostaglandin on human trabecular bone. PGE1 and PGF2 alpha had about 50% and PGF1 alpha about 40% of the potency of PGE2. PGA1 and PGA2 had no effect. The effect of PGE2 could be completely inhibited by human calcitonin (hCT), similar to the inhibition of the effect of hPTH 1-34 by hCT. The effect of PGE2 was not further enhanced by hPTH 1-34. Magnesium metabolism was affected in all experiments in the same way as calcium metabolism. Phosphate metabolism, release of alkaline phosphatase and hydroxyproline from bone into incubation medium were not affected by prostaglandins.
6419600 Gold therapy in patients with systemic lupus erythematosus. 1983 Dec 30 Despite a progressively more favorable prognosis in systemic lupus erythematosus (SLE) a need remains for therapeutic agents with greater benefit and less toxicity than corticosteroids and immunosuppressive drugs. Therefore, we treated 16 patients with SLE but without renal diseases with auranofin, a drug with proved efficacy and safety in rheumatoid arthritis. A modest diminution in overall disease activity, as judged by the investigators, and a reduction in maintenance corticosteroid dosage was achieved. However, neither laboratory assessments nor more objective clinical measurements of SLE disease activity disclosed any improvement over baseline. One case each of proteinuria and thrombocytopenia was observed, most likely related to underlying disease and not the drug, suggesting that auranofin may be safe in patients with SLE. A controlled trial, utilizing a broader spectrum of patients with SLE, may be warranted.
6601679 Association of HLA-DR5 with mycosis fungoides. 1983 May Mycosis fungoides (MF) and Sézary syndrome (SS) are uncommon neoplasms of the lymphoreticular system with distinct clinical, histologic, and immunologic features. Based on the thymus-derived nature of the neoplastic cells, MF and SS are both classified as cutaneous T-cell lymphoma. While substantially greater understanding of MF and SS has been made possible, the exact mechanism for the initiation of either disease is still unknown. The possible involvement of environmental factors as well as viral etiology, i.e., retroviruses, has been suggested. In order to investigate the possible role of HLA-associated variations in genetic susceptibility, 74 patients with histologically documented MF were typed for HLA-A, -B, and -C antigens. Half of these patients were also typed for HLA-DR antigens. An increase in DR5 was the only statistically significant deviation in HLA antigen frequencies in these patients (53% in MF as compared with 20% in controls). An increased frequency of HLA-DR5 has also been associated with scleroderma and juvenile rheumatoid arthritis both of which have immunologic alterations. Also HLA-DR5 has been associated with renal cell carcinoma and Kaposi's sarcoma. The association of MF with DR5 suggests that some individuals with the DR5 antigen may be at higher risk for virally initiated and/or neoplastic diseases possibly through an HLA-linked defect in the immune system.
6971236 Does aspirin prolong bleeding from gastric biopsies in man? 1981 Feb Aspirin prolongs skin bleeding time in man by inducing abnormal platelet function. Prolongation of gastric bleeding time has been postulated as a mechanism for gastric hemorrhage after aspirin in man. To determine whether endoscopic gastric biopsy is safe in patients taking aspirin, we studied the effects of acute and chronic aspirin use on gastric bleeding time in four groups of subjects. Gastric bleeding time was assessed directly following endoscopic biopsy. Skin bleeding time was done by the Mielke method. Control subjects (group I) were studied twice at one-week intervals to determine reproducibility of the gastric bleeding time technique. The effect of aspirin on gastric and skin bleeding time when given to normal volunteers for 24 hours (group II) and for two weeks (group III) and to rheumatic disease patients on a chronic basis (group IV) was also studied. In normal volunteers given aspirin for 24 hours or two weeks, gastric bleeding time was not affected in spite of skin bleeding time being significantly prolonged over baseline. Gastric bleeding time was less then skin bleeding time in all groups including patients with rheumatoid arthritis (p less than 0.05). We conclude that aspirin ingestion does not prolong gastric bleeding time in man and that gastric biopsy is not contraindicated on th basis of recent aspirin ingestion.
6766657 Selenium in human health and disease with emphasis on those aspects peculiar to New Zealan 1980 Feb Evidence is accumulating to suggest that selenium (Se) is an essential trace element for man and is reviewed with emphasis on those aspects peculiar to New Zealand. The extremely low Se levels in New Zealand soils results in a low Se content of foods, low dietary intakes, low urinary excretions, and low blood Se concentrations and glutathione peroxidase activities. Of these, plasma Se gives a short-term index of nutritional status while erythrocyte Se and glutathione peroxidase activities give a long-term index. The consequences of the low Se status of New Zealanders are not immediately apparent as a deficiency disease has not been detected in residents consuming a normal diet. However a Se-responsive muscular syndrome has been described in a surgical patient on total parenteral nutrition. Similar groups that might be vulnerable to a Se deficiency are children with metabolic disorders consuming synthetic protein diets, premature babies and infants during the first few months of life, and patients with cancer whose lowered dietary intake is coupled with the traumatic nature of their disease. Other groups that have been studied in relation to a possible role for Se in specific illnesses are patients with cardiovascular disease and hypertension, rheumatoid arthritis and other muscular syndromes and surgical patients with or without cancer. It is not yet possible to predict a minimum Se requirement for health but it appears that the intake of New Zealanders might be on the borderline. At present supplementation by the general population is not justified, but may be necessary for certain vulnerable groups such as patients on restricted diets. The most effective means of supplementation for increasing the Se status of New Zealanders is under study.
394890 In vivo anti-nuclear antibodies in epithelial biopsies in SLE and other connective tissue 1979 Dec In vivo anti-nuclear antibody (ANA) was observed by direct immunofluorescence microscopy in epithelial cell nuclei in forty-four biopsies from thirty-three patients. The tissue containing the ANA was macroscopically normal in twenty-seven patients. The thirty-three patients with in vivo biopsy ANA included twenty-three with SLE, three with mixed connective tissue disease, two each with multi-system Sjögren's syndrome, dermatomyositis, and progressive systemic sclerosis, and one with rheumatoid arthritis. Features of sicca syndrome were noted in seventeen patients. The patterns of the in vivo biopsy ANA in the thirty-three patients were speckled (21), homogeneous (6), nodular (2), and both speckled and homogeneous (4). Complement was not detected in the epithelial cell nuclei. Immunoglobulin(s) and/or complement were deposited along the dermoepidermal junction in thirty-two of the forty-four biopsies, and in dermal blood vessels in twenty-two biopsies. Each patient had serum ANA against rat liver substrate; twenty-seven had high titre ANA (1 in 1000 or greater). Elevated levels of DNA-binding were found in twenty patients (61%), but the level of DNA-binding did not correlate with the intensity of in vitro biopsy ANA staining. Serum antibody to ribonucleoprotein (RNP) was present in eight of the twenty-three patients tested (35%), all eight patients having clinical features of sicca syndrome. Hypocomplementaemia was found in thirteen patients (40%), all of whom had active SLE. In vivo biopsy ANA appears to be a real phenomenon of unknown aetiology, and not an artifact, which is found in some patients with active multisystem autoimmune disease, especially SLE.
528798 [Effect of D-penicillamine on vitamine B6 and collagen metabolism (author's transl)]. 1979 Nov Although D-Penicillamine (D-PeA) administration is getting popular in the treatment of rheumatoid arthritis (RA), the mechanism by which D-PeA produced therapeutic effect has not been fully elucidated. D-PeA had been shown to exert an antivitamine B6 effect. However, it has not been precisely confirmed if clinical dose of D-PeA induces vitamine B6 (VB6) deficiency. In order to clarify these questions, biochemical analyses of bone and skin collagens and determination of VB6 content in soft tissues have been performed in the rats administrated therapeutic dose of D-PeA. VB6 deficiency was not observed in the brain and skin from rats fed on normal diet containing D-PeA (13.0--33.5 mg/kg wt). There were no significant changes in the stability of collagen from bone and skin. On the other hand, significant VB6 deficiency and reduced stability of collagen were observed in rats fed on VB6 deficient diet containing the same amount of D-PeA. Aldehyde formation of collagen molecule and cross-link formation of collagen were also found to be suppressed. The same results were obtained from analyses in rats fed on VB6 deficient diet without D-PeA administration. These data indicate that D-PeA is not capable of producing VB6 deficiency in the dosage employed in patients. However, in the treatment for patients who are not taking enough nutrition, the possibility of VB6 deficiency can not be neglected. Once VB6 deficiency is induced by D-PeA administration, severe connective tissue disorder may be produced, since VB6 is required for enzymic activity of lysyl oxidase. It is unlikely that the therapeutic effects of D-PeA in the treatment of RA are produced the the disturbance of collagen cross-link formation as discussed before. Immunologic reactions of D-PeA may play more important role in the improvement of clinical symptoms of this disease.
198810 Synthesis of collagen by chondrocytes in suspension culture: modulation by calcium, 3':5'- 1977 Sep Rabbit articular chondrocytes synthesize type II collagen [3alpha(1)(II)] in vivo and type I collagen [2alpha(1)(I).alpha(2)] in monolayer cultures. In suspension culture the nature of phenotype depends on extracellular Ca(2+). The relationship of Ca(2+) and 3':5'-cyclic AMP (cAMP) in regulation of collagen synthesis has been investigated. In suspension culture, cAMP levels of chondrocytes increase by 2- to 3-fold and then reach basal values regardless of the presence or absence of extracellular Ca(2+). The cells, however, synthesize primarily type II collagen in the absence of CaCl(2) in the medium and type I collagen in medium containing 1.8 mM CaCl(2). If CaCl(2) is added when intracellular cAMP levels are low, the phenotype is type I collagen. These observations minimize the role of cAMP as a second messenger in the chondrocyte culture system. Increasing endogenous cAMP with a phosphodiesterase inhibitor or adding exogenous dibutyryl-cAMP leads the cells to synthesize type I collagen, although this effect is significantly less pronounced if the medium contains ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid (EGTA). Increased concentrations of cAMP may mobilize the intracellular calcium pools and activate the cells to switch their phenotypic expression. Prostaglandins E(2) and F(2)alpha, thought to be involved in rheumatoid arthritis and bone resorption, have no significant effect on cAMP content of chondrocytes and alter their collagen phenotype to a small extent.
1092729 Ankylosing spondylitis: open long-term and double-blind crossover studies with naproxen. 1975 Apr Participation in open and double-blind crossover studies in rheumatoid arthritis confirmed that naproxen improved pain and stiffness. This observation suggested that naproxen might be effective in ankylosing spondylitis. The initial trial was open, but at six months, a double-blind crossover "placebo pulse" was superimposed on the open trial. Thirty-six patients entered the trial taking a daily dose of 500 mg naproxen. At the end of the first month, 35 assessed naproxen as being equally effective to, or better than, previous therapy. The first ten patients to complete six months on naproxen took part in a placebo pulse study comprising two consecutive four-week periods, in one of which each patient took 500 mg naproxen, in the other, identical placebo capsules, the order being randomized. Eight patients correctly identified the placebo capsules (P=0.02). During the 16 months of trial, six patients have withdrawn, two being in remission and four for lack of efficacy. The remaining 30 patients have completed six months and 22 have completed at least 12 months on naproxen. At the end of six months pain was less (P=0.02), morning stiffness had decreased (P less than 0.01), and immobility stiffness had improved (P less than 0.01). These patients are impressed by the improvement in pain and stiffness and have little disability. All continue full-time employment and have been able to increase their leisure activities without discomfort. No persistent side effects were observed, and naproxen appears to be a useful drug in the treatment of anklyosing spondylitis.
2410355 Allogeneic lymphocyte stimulation in rabbits: induction of a low MW inhibitor for trypsin 1985 Jul We have shown previously that the i.v. inoculation of allogeneic lymph node cells in rabbits induces the appearance in the serum of an alpha M-serine proteinase complex which behaves in an Ig-turnover assay as any polyclonal B-cell activator (PBA), and that this PBA activity is due to the enzyme. Here, we show that the allogeneic stimulation also induces the appearance in the low molecular weight fraction of the serum (1000-110,000 MW) of an inhibitor which blocks the PBA activity of the complex without affecting the PBA activity of LPS or dextran sulphate. The inhibitor blocked the ability of the enzyme associated with alpha M to degrade Chromozym TRY, a low MW trypsin substrate. The inhibitor also blocked the enzymatic activity of trypsin for large as well as for low MW substrates. Thus, allogeneic stimulation in vivo results in the production, not only of an alpha M-proteinase complex, but also of an inhibitor for this proteinase as well as for trypsin. The appearance of the inhibitor, along with the alpha M-serine proteinase complex as a result of allogeneic stimulation in rabbits, is of interest since a similar alpha M-serine proteinase complex and inhibitor may appear in the serum of patients with rheumatoid arthritis.
6546099 Femoral head preservation following subcapital fracture of the femur. 1984 Primary fixation of displaced subcapital fractures offers a low morbidity and low mortality approach to a very common problem. The vast majority of patients receiving this form of treatment will not require further surgery. When contrasted with the problems of primary arthroplasty which included a higher morbidity and higher mortality, a higher infection rate, and the possibility of prosthetic loosening, prosthetic dislocation, acetabular wear to subsequent pain, and protrusio, the choice seems very clear. We would reserve arthroplasty for the following: Patients with pathologic fractures of the femoral neck secondary to metastatic disease. Patients with displaced fractures of the femoral oral neck who have primary hip disease such as rheumatoid arthritis. Patients with coexistent serious illness with a grossly limited life expectancy. Enfeebled elderly patients with minimal demands (senile, demented, minimal ambulatory or not ambulatory before fracture. (We would not perform primary arthroplasty in patients with neurologic disorder leading to spasticity or contracture, since we found the dislocation rate in such patients to be unacceptably high). In patients under 60 years of age with displaced subcapital fractures of the femoral neck we would advocate the following: Anatomic reduction (open, if necessary); Sound secure fixation; Staged muscle pedicle graft to promote increased fixation and ideally femoral head vascularity; No weight bearing until the fracture unites. In patients greater than 60 years of age we would advocate the following: Anatomic or slight valgus reduction of the fracture; Sound secure fixation; Impaction of the fracture; Weight bearing as tolerated. If these principles are followed, the results of a policy of femoral head preservation in displaced subcapital fractures will be very acceptable for both the patient and surgeon alike. In our opinion, prosthetic replacement equals salvage surgery, and it should be delegated to that role.
6881605 Chronic urticaria in childhood: natural course and etiology. 1983 Aug We retrospectively studied 94 children with urticaria longer than six weeks in duration. The disease was equally distributed among the sexes and the following age subgroups (0-3.9 years, 4.0-7.9 years, 8.0-11.9 years and 12.0-15.9 years). A cause of the urticaria was identified or suspected in 15 of the patients. These included eight patients with cold urticaria, two with infection (hepatitis, sinusitis), two with food allergy, one patient with juvenile rheumatoid arthritis, one with arthralgia associated with a positive ANA and one with a low level of total hemolytic complement (CH50). Follow-up of a year of more on 52 patients revealed a median duration of urticarial symptoms of 16.0 months, with 58% of children becoming symptom free for six months or more, whereas the remaining 42% continued to have recurrent symptoms but without the development of an underlying serious illness. Results of the present study indicate that the etiology of chronic urticaria in childhood remains mostly undetermined but that the prognosis is generally favorable. However, one must consider an underlying infection or autoimmune disease as a potential etiology.