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ID PMID Title PublicationDate abstract
2355027 Unsatisfactory results with a ceramic total hip prosthesis. 1990 Jun We reviewed the results of forty-two total hip replacements that had been done with the self-locking Autophor ceramic total hip prosthesis in thirty-four patients. The patients ranged in age from twenty-five to sixty-seven years (average, forty-eight years). The diagnoses were avascular necrosis (eight patients), degenerative arthritis (nineteen patients), ankylosing spondylitis (one patient), post-traumatic arthritis (two patients), and rheumatoid arthritis (four patients). Seven procedures were revisions: five, of a loose cemented total hip prosthesis and two, of a loose noncemented endoprosthesis. No revision was done for infection. The length of follow-up ranged from twenty-seven to sixty-six months (average, fifty-one months). The patients were evaluated by physical examination, serial radiographs, and questionnaires. The hips were rated with the modified Harris hip score. At the time of follow-up, eleven of the twenty-seven patients who had had a primary hip replacement complained of at least moderate pain that limited activities; however, only three patients had to have a revision. The femoral components had a notable tendency to subside more than five millimeters, and in fifteen hips there was radiographic evidence of progressive loosening. Our experience with the self-locking Autophor ceramic total hip prosthesis has been disappointing. We no longer use it.
2263227 Proliferative response of synovial fluid and peripheral blood mononuclear cells to arthrit 1990 Cellular immune responses to microbial antigens have been implicated in the pathogenesis of some forms of arthritis including reactive arthritis, Reiter's syndrome, ankylosing spondylitis and rheumatoid arthritis. We investigated the proliferative T cell responses of paired peripheral blood (PB) and synovial fluid (SF) mononuclear cells (MC) to so-called arthritogenic bacteria (Yersinia enterocolitica and Salmonella typhimurium), to control antigens, such as Candida albicans, mumps virus and purified protein derivative, to the recombinant mycobacterial 65-kDa heat-shock protein (hsp 65) and the mitogen phytohemagglutinin (PHA) in 16 patients with different inflammatory rheumatic diseases. The [3H]thymidine uptake of unstimulated cells (medium control) as well as the proliferative response to the different antigens tested was markedly increased in SFMC irrespective of the underlying rheumatic disease. In contrast, mitogenic stimulation was decreased in SFMC. The proliferative response to the hsp 65 correlated significantly with the responses to Yersinia, Salmonella and Candida. These results may reflect an enhanced function of SF antigen-presenting cells, different functional properties and subset distributions of PB and SF T cells with a preferential accumulation of helper-inducer/memory T cells or a maintenance of an ongoing immune response by T cells cross-recognizing self epitopes such as epitopes located on the hsp 65. Thus, care should be taken in the interpretation of SF T cell responses to microbial antigens as diagnostic tools in arthritis.
2584785 [Coronary artery bypass grafting in a patient with Sjögren's syndrome and other autoimmun 1989 Oct Coronary arterial involvement in collagen disease is a very rare complication. Particularly in Sjögren's syndrome is there no report of coronary artery bypass grafting (CABG). We report a 68-year-old woman with various autoimmune diseases who underwent successful CABG for unstable angina pectoris. She had a history of Sjögren's syndrome, hypothyroidism, thrombocytopenia and lupoid hepatitis, and had been on the regimens of prednisolone and levothyroxine sodium during the last 4 years. Two months prior to admission when the doses of these drugs were increased, she began to complain of angina on mild exertion and occasionally even at rest. Selective coronary angiograms revealed 75% stenosis at Seg. 2 and 99% stenosis at Seg. 6. Based on these findings and severity of the angina, saphenous vein CABG to the posterior descending and the left anterior descending branches was performed. Despite the associated autoimmune diseases, the patient's postoperative course was uneventful and she is now doing well with no attack of angina, 12 months following the operation.
3699952 Deep granuloma annulare in adults. 1986 Mar Subcutaneous nodules with the histopathologic features of rheumatoid nodules can occur in both rheumatic and nonrheumatic diseases. When there is no evidence of systemic disease, they often are classified as deep granuloma annulare. While there are numerous reports of such nodules occurring in children without systemic disease, there are few reports of similarly affected adults. Two adults are described with multiple subcutaneous nodules that were overlying joints and were histologically similar to rheumatoid nodules. Neither patient had other clinical or laboratory manifestations of rheumatic disease. These cases most likely represent an adult form of deep granuloma annulare. The wide clinical spectrum in which similar nodules can occur and their pathogenesis is discussed.
3473620 Lymphoproliferative disorders in Japanese patients with Sjögren's syndrome. 1986 Fourteen Sjögren's syndrome (SS) patients with monoclonal gammopathy (MG), 4 SS patients with malignant lymphoma (ML) and one with pseudolymphoma (PL) were described. Among the 14 MG patients, the IgG class was found in 3, IgA in 6, IgM in 3, and 2 M proteins (IgM/IgG and IgA/IgG) were found in 2 patients. The monoclonal rheumatoid factor (RF) was found in 4 patients (3 IgA and one IgM). Idiotypes (Id) of M proteins were studied in 11 out of 14 patients. The histology of ML showed the diffuse, large cell, medium-sized cell and follicular, mixed cell type. The monoclonal surface membrane Ig (SmIg) and/or cytoplasmic Ig (CIg) were identified (3 IgM and one IgG). A review of the Japanese literature on lymphoproliferative disorders (LPD) in SS patients disclosed additional 15 MG patients (3 IgG, 5 IgA, 6 IgM and one Bence Jones protein) and 22 LPD patients (14 non-Hodgkin's ML, 4 PL, 2 plasmacytomas and 2 thymomas). The literature was also reviewed on LPD in non-Japanese SS patients; 26 patients with MG (4 IgG, 2 IgA, 19 IgM and one Bence Jones protein) and 104 patients with LPD (59 non-Hodgkin's ML, 4 Hodgkin's lymphomas, 23 PL, 5 thymomas, 4 immunoblastic lymphadenopathies (IBL), 2 Lennert's lymphomas and 7 others) were found. These results indicate that non-IgM class MG was more dominant in Japanese than in non-Japanese SS patients and that there was a higher incidence of MG in primary than in secondary SS patients, and also that B cell lymphomas (9 in Japanese and 11 in non-Japanese) were more common in SS patients.
2379346 Primary Sjögren's syndrome with secondary hyperparathyroidism. 1990 May The case history of a 43-year-old woman with primary Sjögren's syndrome is presented: in 1970, xerostomia and keratoconjunctivitis sicca; in 1980, arthritis; in 1982, chronic tubulointerstitial nephritis with renal tubular acidosis and vasopressin-resistant hyposthenuria. The renal function gradually deteriorated. Chronic atrophic gastritis with vitamin B12 deficiency and chronic duodenitis with diminished disaccharidase activity in the mucosa were also diagnosed. From 1985, repeated multiple fractures of the ribs occurred, with secondary hyperparathyroidism in the background. The renal and intestinal involvement suggests that, besides the elevated parathyroid hormone level, an acquired vitamin D deficiency plays a pathogenetic role in severe osteopenia. The patient is being treated at present by haemodialysis, and subtotal parathyroidectomy and renal transplantation are planned.
1692037 Fine epitope mapping of the human SS-B/La protein. Identification of a distinct autoepitop 1990 May To analyze the autoepitopes on the SS-B/La protein, a cDNA covering the entire region coding the protein was isolated from a human cDNA library. The cDNA was subcloned into an expression plasmid vector, pEX, to express its protein product as a fusion protein with cro-beta-galactosidase in Escherichia coli. A recombinant pEX plasmid expressing three-fourths of the protein (amino acid 112-408) was also constructed. The antigenicities of these recombinant proteins were confirmed with a patient's serum. Their various deletion mutants were produced with exonuclease III treatment from the 3' ends of the cDNAs without changing the proper translational frame. Immunoblot analysis and enzyme-linked immunosorbent assay were used to evaluate the reactivities of the recombinant proteins with patients' sera to determine the autoepitopes. A narrow segment (amino acid 88-101) and the region where several epitopes were located (amino acid 283-338) on the SS-B/La protein were universally recognized by all the sera with anti-SS-B/La antibodies examined. An additional epitope region (amino acid 179-220) was recognized by some patients' sera. Computer analysis revealed that the most distinct autoepitope, amino acid 88-101, had a striking homology to a retroviral gag polyprotein. These findings indicate that exogenous or endogenous retroviruses may play a role in initiation of the anti-SS-B/La autoimmunity.
1844372 [A new method to evaluate xerostomia in Sjögren's syndrome]. 1991 Jun The extension of wetting in a standardized piece of filter paper was used to evaluate saliva output in 26 patients with Sjogren syndrome and 101 control subjects. The mean value for normals was 33.6 +/- 6.8 mm/5 min without significant differences for age and sex. Corresponding value for patients with Sjogren syndrome was 11.8 +/- 13.9 Accordingly, this is a simple and sensitive method to quantify xerostomia.
3473645 Immunopathologic mechanisms of inflammatory vascular disease in primary Sjögren's syndrom 1986 Our laboratory has been studying the immunopathogenesis of inflammatory vascular disease (IVD) in patients with Sjögren's syndrome (SS). In parallel, we have developed the autoimmune strain of MRL/Mp mice as a model of IVD. Sjögren's syndrome patients and MRL/Mp mice both develop two main histopathologic types of IVD (i.e. mononuclear and neutrophilic) which have differential serologic associations with respect to serum autoantibodies and complement levels. We present evidence that mononuclear (lymphocytic) vasculitis may exist as a distinct form of vascular inflammation and also may transition into neutrophilic vasculitis. On the basis of these studies we propose a new model of lymphocyte initiated vascular inflammation as an alternative to classical immune complex mediated vasculitis.
1767345 [Comparison of clinical features of childhood and adult onset Still's disease]. 1991 Oct Physical findings, laboratory data, treatments and prognosis were investigated in detail using 26 Japanese childhood Still's disease (CHSD) patients and 19 Japanese adult onset Still's disease (AOSD) patients as the subjects. High spiking fever and arthritis were present in all the patients. Seventy and seven percent of CHSD and 53 percent of AOSD had polyarthritis (the number of joints involved being 5 or more during the first 6 months of the disease). A comparison of the groups showed no significant difference in the initial systemic manifestations except for sore throat (CHSD: AOSD; 19%: 68%). Initial laboratory data were the same for these groups except for serum iron levels (CHSD: AOSD; 20.8 +/- 13.7 micrograms/dl: 83.0 +/- 54.2 micrograms/dl). As to joints and physical prognosis, the results were also the same for CHSD and AOSD under the similar treatment. On the basis of these data, we conclude that CHSD and AOSD are of the same disease entity so far as the present clinical features are concerned.
1649487 [Central and peripheral neurologic lesions in primary Gougerot-Sjögren syndrome. Clinicop 1991 A 51 year old woman presented with cerebellar ataxia and paralysis of conjugate lateral movement of the eyes. She had xerophtalmia and xerostomia. Biopsy of minor salivary glands showed mononuclear infiltrates typical of Sjögren's syndrome. Peripheral neuropathy was of the axonal type, and nerve biopsy showed a vasculitis made of a mononuclear infiltrate with only a few polymorphonuclears. The patient deteriorated despite corticosteroid therapy, plasma exchange and cyclophosphamide. Ciclosporin seemed to be transitorily beneficial. Epileptic seizures (auditory hallucinations) occurred. MRI showed hypersignal in the right temporal lobe. At post-mortem examination, a small ischaemic lesion with a large lymphocytic infiltrate was present in the left putamen. Neuronal loss and gliosis with some rod cells and glial stars were found in the brainstem, dentate nucleus and internal part of the right temporal lobe. Inflammatory changes were limited. The posterior columns of the spinal cord were pale, and some residual nodules of Nageotte were present in the spinal ganglia. These lesions were similar to those seen in encephalomyelitic syndromes associated with carcinoma. Lesions of the peripheral nerves were associated with vasculitis but changes in the central nervous system were morphologically similar to those observed as remote effects of carcinoma.
2470801 Tumoral calcinosis in scleroderma. 1989 Feb A 36-year-old female patient with scleroderma/Sjögren's syndrome developed multiple cystic tumors on the dorsal aspect of her left hand, right elbow, and left shoulder joint two years after the onset of scleroderma. Histologically, amorphous eosinophilic substances located in subcutaneous tissue showed a strong positive reaction to PTAH and rosindole stain, and focal positive reaction to Von Kossa stain. Rheumatoid rice body like substances with chalky fluid were discharged from tumoral lesions. From these results, this case was diagnosed as tumoral calcinosis secondary to connective tissue degeneration due to the pathogenetic mechanism underlying scleroderma/Sjögren's syndrome.
2519235 [Primary sclerosing cholangitis associated with Sjögren's syndrome, retroperitoneal fibro 1989 Primary Sclerosing Cholangitis (PSC) is an unusual chronic, cholestatic disease of unknown etiology, more frequently seen in young adults in close relationship with Chronic Ulcerative Colitis. We report the case of a 30 year old woman, coming from the peruvian amazon with PSC associated with Sjögren Syndrome, Chronic Pancreatitis and Retroperitoneal Fibrosis, without colonic involvement. She was treated with external biliary drainage and controlled for 12 months. In this paper, clinical, biochemical, radiological, histological and therapeutic features are reviewed as well as its possible immunologie autoimmune origin.
3127481 Sicca syndrome with iron deposition in the salivary glands. 1988 Feb A case of iron deposition in the labial accessory salivary glands associated with prominent xerostomy and xerophtalmy is reported. Suffering from a myelodysplastic syndrome with refractory anaemia, this patient received multiple transfusions over the past 7 years. A transfusional haemosiderosis gradually developed. Histopathologic examination of accessory salivary glands demonstrated haemosiderin deposition in the serous alveoli and in the epithelial cells of intercalated and interlobular ducts. A relationship between the iron deposition in the salivary glands and the development of the sicca syndrome is suggested. The literature related to iron deposition in salivary glands and sicca syndrome is reviewed.
2256788 [Chronic juvenile arthritis with serum antinuclear antibodies. Study of 136 cases]. 1990 Aug The charts of 136 patients presenting with juvenile chronic arthritis and antinuclear antibodies were reviewed. Mean age at onset was 3.6 yrs and 120 patients were females. Twenty-one patients presented with the polyarticular type of the disease from onset. Among them, 3 had polyarthritis with presence of rheumatoid factors. During the first year of follow-up, 40% of the pauciarticular forms became polyarticular. They may be subdivided into extended pauciarticular (5 to 9 arthritis = 26% of cases) or polyarticular (greater than 9 arthritis = 15% of cases) forms. The ocular involvement, present in 50 patients, preceded the articular manifestations in 5 cases (for a maximum of 4 years) whereas it followed in 30 cases (maximum delay of 14 years). Inflammatory articular involvement is not always correlated with the risk of ocular involvement. Long-term articular prognosis is generally fair. Only 15 children present with clearcut functional handicaps, of whom 4 are requiring the help of a third person.
2186721 [A case of seronegative systemic lupus erythematosus (an immunopathological study)]. 1990 A case of systemic lupus erythematosus (SLE) in a 37-year-old female is described which was primarily diagnosed as epilepsy. Immunopathologically, an immunoglobulin in the nuclei of the majority of cells in the skin biopsy and blood cells was found against the background of the lack of SLE manifestations (antinuclear factor in the circulating blood, skin lesions, etc.). Antibodies against the antigen of vascular intima are revealed in the blood by means of the indirect immunofluorescence. The epilepsy diagnosis was established due to the prevalence of the brain vessels affection (frequent loss of consciousness). The progression of the disease with the involvement of joints, heart, lungs and other organs, high indexes of the rheumatoid factor made it necessary to differentiate between rheumatoid arthritis and SLE. The immunopathological examination confirmed the SLE diagnosis. Hemosorption combined with a standard therapy was followed by the decrease of the immunopathological manifestations.
1938077 Simultaneous occurrence of subacute cutaneous lupus erythematosus and Sweet syndrome. A ma 1991 Sep A 78-year-old man presented simultaneously with subacute cutaneous lupus erythematosus (SCLE) and Sweet syndrome (neutrophilic dermatosis). He was subsequently investigated for and found to have Sjögren syndrome. We believe that the simultaneous occurrence of the above cutaneous manifestations are very suggestive of and should prompt investigation for Sjögren syndrome.
2255047 [Anesthetic management of a patient with Sjögren's syndrome and pulmonary fibrosis]. 1990 Oct We described an anesthetic management of a 63 year old man complicated with Sjögren's syndrome and pulmonary fibrosis. Sjögren's syndrome is characterized by pathological dryness of the mouth, cornea and other exocrine glands. Anesthesia was induced with thiopental and the trachea was intubated smoothly following intravenous succinylcholine. Anesthesia was maintained with enflurane in nitrous oxide and oxygen. Intraoperative muscle relaxation was adequately obtained by pancuronium. Before and during anesthesia, atropine and other drying agents were avoided. Physiological saline solution was instilled on the eyes every ten minutes against dryness. A heat and moisture exchanger (Humi-Vent) was used to maintain high moisture of the respiratory tract. Anesthesia was carried out successfully.
2640449 Analysis of submandibular gland sialograms in Sjögren's syndrome. 1989 Nov We report here the sialographic appearances of the submandibular gland in both primary and secondary Sjögren's syndrome (SS). In order to compare these with those of the parotid gland, we defined new criteria for the staging for SS based on the degree of depiction of the peripheral ducts. In 24 out of 74 cases the submandibular sialogram showed more advanced, destructive disease compared with the parotid. This study suggests that although SS involves the parotid gland first, it progresses in the submandibular gland more rapidly.
3819059 Anhidrosis (hypohidrosis) in Sjögren's syndrome. 1987 Jan There has been a relative lack of literature on the association of hypohidrosis in Sjögren's syndrome with any lesion having specific histologic findings. We looked at a recent case presentation of a 55-year-old man with complaints of dry mouth and dry eyes, becoming easily overheated in direct sunlight, and having difficulty in perspiring. Physical examination showed fissuring and atrophy of the tongue and angular cheilitis. A punch biopsy of the skin showed a moderate number of eccrine gland and ductal structures in the lower reticular dermis, each surrounded by a dense cellular infiltrate of plasma and lymphocytic cells. Our patient also had a markedly decreased sweating response to methacholine. In reviewing the literature as far back as 1951 and on the basis of findings in our present case study, we conclude that it seems probable that the severity of the skin disease is an important determining factor in predicting whether the sweat gland lesion does exist.