Search PubMed⌕ Search

Biomedical subjects

A Schattner

Publications and source records attributed to A Schattner.

At least 73 records · Page 4Linked to original sources
PubMed1996

Induced TNF production in vitro as a test for familial Mediterranean fever.

We have previously demonstrated an altered pattern of tumor necrosis factor (TNF) secretion in patients with familial Mediterranean fever (FMF). To examine whether TNF determination could assist in diagnosing FMF, we stimulated heparinized blood of 51 asymptomatic FMF patients with lipopolysaccharide (LPS) and then measured TNF production in response to inducers, compared to unstimulated blood cells and to cells from a control group of 12 matched healthy subjects. Following LPS pretreatment, which induced TNF release, FMF patients produced significantly less TNF than controls, whether production was 'spontaneous' or induced by either LPS or phytohaemagglutinin (p < or = 0.003). Such 'exhaustion' did not occur in untreated cells. We then used these results to classify a further group of 29 FMF patients and 10 matched healthy controls ('validation' group) who underwent the same studies. The test correctly identified 25/29 patients as having FMF and 7/10 controls as not having FMF; a sensitivity of 86% and a specificity of 70% (likelihood ratios 2.9 (positive test) and 0.2 (negative)). Identification of a blunted TNF response following previous stimulation by a simple assay, may help the diagnosis of FMF in asymptomatic patients, provided it is interpreted in conjunction with supportive clinical data.

Adult↗
PubMed1996

Chronic aortic dissection presenting as a prolonged febrile disease and arterial embolization.

Aortic dissection most often is an acute event dominated by excruciating pain and other symptoms which suggest the diagnosis. Our report and a review of the medical literature demonstrate that chronic aortic dissection may, rarely, present as a prolonged febrile illness, with night sweats, weight loss, pleural effusion, and little or no pain. These symptoms may be associated with a markedly elevated erythrocyte sedimentation rate (ESR), anemia of chronic disease, and hyperglobulinemia. Awareness of this unusual presentation, a high index of suspicion, and confirmation by an appropriate imagine technique (CT or MRI of the chest or transesophageal echocardiography have a very high sensitivity) will result in earlier diagnosis and better patient outcome.

Aged↗
PubMed1996

Poststreptococcal reactive rheumatic syndrome.

Poststreptococcal reactive arthritis remains a poorly recognized clinical entity that is rarely considered in adults. We describe a case of poststreptococcal rheumatic syndrome in a 63-year-old woman to highlight that prolonged bone pain, night sweats, arthralgia, and laboratory evidence of active inflammation may be the principal manifestations, and that it may occur even in elderly patients. Poststreptococcal rheumatic manifestations can be viewed as a continuum extending from acute rheumatic fever with or without carditis to poststreptococcal reactive rheumatic syndrome with either reactive arthritis or systemic symptoms predominating.

Arthritis, Reactive↗
PubMed1995

Case report: multiple myeloma presenting as a diastolic heart failure with no evidence of amyloidosis.

The development of severe right sided congestive heart failure led to a diagnosis of immunoglobulin G (lambda) myeloma with a predominance of light chains. Cardiac catheterization and endomyocardial biopsy showed a severe diastolic dysfunction of both right and left ventricles and extensive myocardial infiltration by intercellular fibrillar tissue, which was not amyloid. This is a rare presentation of immunoglobulin deposition disease associated with immunocytic dyscrasias.

Amyloidosis↗
PubMed1994

Survival in miliary tuberculosis complicated by respiratory distress.

An immigrant from India presented with a three months history of fever, weight loss, cough and hepatomegaly which were rapidly diagnosed as miliary tuberculosis when gastric lavage revealed acid-fast bacilli. One day after antituberculous therapy was commenced, the patient developed adult respiratory distress syndrome and disseminated intravascular coagulation which were successfully treated by corticosteroids, fresh frozen plasma and mechanical ventilation. Ten other survivors of miliary tuberculosis and adult respiratory distress syndrome were reviewed and the association of adult respiratory distress syndrome with the antimicrobial therapy is discussed.

Anti-Bacterial Agents↗
PubMed1994

[Acute acalculous cholecystitis].

A previously healthy 32-year-old man presented with fever, upper abdominal pain and leukocytosis of 5 days duration. Ultrasonography and CT-scan of the abdomen were not diagnostic. On laparotomy acute gangrenous acalculous cholecystitis was found and was successfully treated by cholecystectomy. This condition is a well-known complication in critically ill patients. However, physicians should be aware of its possible occurrence even in previously healthy ambulatory patients, since a delayed diagnosis carries a significant risk of perforation and death.

Acute Disease↗
PubMed1994

Cyclosporine enhances theophylline neurotoxicity in rats.

Treatment with cyclosporine may be associated with adverse central nervous system (CNS) effects as well as with the potentiation of effects of certain other drugs. In particular, theophylline-induced seizures, which are often fatal and occur unpredictably over a wide range of serum theophylline concentrations, may be precipitated. To study this interaction, adult rats that were injected with cyclosporine or placebo (50 mg/kg in a single dose or on each of four consecutive days) received a constant infusion of theophylline (2 mg/min iv) until the onset of maximal seizures. At that time, blood, cerebrospinal fluid (CSF), and brain tissue samples were obtained for theophylline concentration determinations by HPLC, as well as for measurement of several biochemical parameters in the serum. Consecutive cyclosporine administration (but not a single dose) reduced serum protein levels. There was a small increase in theophylline sensitivity after a single dose of cyclosporine. The CSF theophylline concentrations at the onset of seizures were 215 +/- 10 vs 202 +/- 5 mg/L (P < 0.04); however, sequential cyclosporine treatment resulted in significant lowering of the CSF theophylline concentrations required to produce convulsions (231 +/- 8 vs 191 +/- 10, P < 0.001). Likewise, the drug concentrations at the onset of convulsions in both the brain and serum were significantly lower in cyclosporine-treated rats than in control animals. Thus, cyclosporine treatment may be a predisposing factor for theophylline toxicity and increase the risk for generalized seizures.

Alanine Transaminase↗
PubMed1994

Lymphokines in autoimmunity--a critical review.

The pathogenesis of autoimmunity remains an enigma; however, growing evidence points to a possible involvement of lymphokines both in the initiation phase and especially in the effector stage of many autoimmune diseases. Although no single experimental approach can accurately mimic the highly complex interplay of genetic, hormonal, and immune factors inherent in the development of autoimmunity, several lines of evidence strongly suggest a major role for lymphokines, in particular interferons (IFN), tumor necrosis factor (TNF), and interleukins 1 and 2 (IL-1, IL-2). These include the pleiotropic biologic activities of lymphokines which often synergize and interact, and can mediate several prominent clinical and laboratory manifestations of autoimmunity. Patients undergoing therapy with IFN or IL-2 may develop varied autoimmune syndromes, often an exacerbation of previously latent autoimmunity. Likewise, the administration of IFN to experimental animals can cause or accelerate autoimmune disease and, more importantly, specific lymphokine blockade was shown to be protective. Moreover, in the animal models of autoimmunity and in many patients with autoimmune diseases, increased lymphokine levels can be demonstrated either in the circulation or locally, often correlating with disease activity. Finally, aberrant MHC class II expression on nonlymphoid cells can be identified in the target organs of most autoimmune diseases and extensive data suggest that it can present autoantigen, activate autoreactive T cells, and initiate a cascade of self-propagating autoimmunity. Thus, a local release of IFN-gamma, the major inducer of MHC class II, may be pivotal to the development of organ-specific autoimmunity. The central role of cytokines in lymphocyte traffic into inflammatory sites as well as a growing understanding of lymphokine production patterns by different T cell subsets important in autoimmunity lends further support for this hypothesis, at the same time revealing that certain lymphokines may have a protective inhibitory effect on autoimmunity (e.g., IL-4, TGF-beta). In conclusion, varied data strongly suggest that several lymphokines, produced mainly locally and interacting with each other, have an important role in the pathogenesis of autoimmunity. Although the initiating events and complex interactions remain largely unclear, recent advances are encouraging, and may lead to specific manipulations of lymphokines in the future treatment of autoimmune diseases.

Animals↗
PubMed1994

Chlamydia trachomatis and HIV infection.

To study the interactions between Chlamydia trachomatis (CT) and human immunodeficiency virus (HIV) infections, we examined CT serologies in sequential serum samples of male homosexuals (MHS), followed over a mean period of 4 years. Of the MHS studied, 77 were HIV(-), 18 were HIV(+) and 10 patients seroconverted during the study period. Seventy matched heterosexual controls were tested concomitantly. CT-specific antibodies of both IgG and IgA isotypes were determined by an immunoperoxidase assay, indicating past and active infection respectively. Anti-CT IgG was frequently observed in both HIV(-) and HIV(+) MHS (40-50% vs. 23% of controls) and IgA antibodies were also common in both MHS groups (15-20% vs. 1.5% of controls). After HIV infection, no increase in CT antibodies occurred. We found serological data suggestive of active CT infection preceding seroconversion in 3 of 10 seroconverters vs. 5% of matched MHS controls who remained HIV(-) (P < 0.025), indicating a possible effect of CT infection on the acquisition of HIV should be further studied.

AIDS-Related Opportunistic Infections↗
PubMed1994

Effect of acute cytomegalovirus infection on drug-induced SLE.

A 58 year old woman developed systemic symptoms, interstitial lung disease, splenomegaly, leukopenia and anti-histone and anti-nuclear antibodies (ANA), while treated with hydralazine for hypertension. Five months after presentation she was admitted with high fever, skin rash and atypical lymphocytosis due to acute cytomegalovirus (CMV) infection. Worsening leukopenia and increased ANA were found, and high titres of anti-DNA antibodies, anti-cardiolipin antibodies and rheumatoid factors appeared. Hydralazine was stopped and the patient gradually became asymptomatic. All autoantibodies spontaneously disappeared (over 16 weeks), and the white cell count and spleen size became normal. The patient was found to be a slow acetylator and to have both HLA-DR4 and selective IgA deficiency. Thus, a multifactorial genetic susceptibility to develop drug-induced lupus was brought out in stages first by hydralazine and then by CMV, yet all manifestations and autoantibodies resolved spontaneously, demonstrating the complex interplay of varied environmental factors with a genetic predisposition in the pathogenesis of autoimmunity.

Acute Disease↗
PubMed1994

Bronchiolitis obliterans--current concepts.

We review current concepts about the clinical manifestations, diagnosis and treatment of patients with bronchiolitis obliterans (BO) with emphasis on clinical/pathological correlations and recent developments. BO is a relatively rare disease, but its incidence is probably higher than generally believed and is continuously rising, partly because of better recognition, but also because of increased exposure to industrial fumes, and its occurrence in lung transplantation. BO is characterized histologically by varying degrees of obliteration of the lumen of the respiratory bronchioles by organizing connective tissue often extending into the alveoli ('proliferative' BO with organizing pneumonia--BOOP) or by more extensive fibrosis and scarring of the more proximal, conductive bronchioles ('constrictive' BO). Diverse clinical conditions have been associated with the development of BO, notably viral and mycoplasma infection, toxic fume exposure and immune reactions in the setting of a collagen vascular disease, drug reaction or organ transplantation. The clinical course and features of BO may vary considerably according to the aetiology, histological pattern and stage of the disease. The most common presentation is that of a progressive dry cough and dyspnea, associated with diffuse patchy interstitial lung infiltrates on chest X-ray. In the more advanced cases, lung function tests show either restrictive or obstructive defects, depending on the extent of alveolar involvement, and hypoxemia without CO2 retention. The diagnosis is often possible on clinical grounds, however, in a seriously ill patient uncertainty should be resolved by tissue diagnosis, preferably by open lung biopsy. Treatment is based on symptomatic therapy. The use of corticosteroids is controversial, but common. Patients with BOOP are exceptional, in that there may be no underlying condition ('idiopathic' BOOP or cryptogenic organizing pneumonia--COP), a restrictive ventilatory defect is usual and the response to corticosteroids often remarkable.

Adrenal Cortex Hormones↗
PubMed1993

Adult respiratory distress syndrome after radical neck dissection.

The clinical management of an unusual case of postoperative ARDS is reported. A few hours following neck surgery and septic insult, the patient developed unexpected ARDS. Aetiologic and supportive treatment were successfully instituted and after 72 hours of intensive therapy, the patient's clinical status improved. The very short time lapse between the septic insult and appearance of ARDS is emphasized. A brief literature review on aetiology, diagnosis and therapy of sepsis, as well as some pertinent aspects concerning the pathogenesis of ARDS and its linkage to sepsis are presented.

Aged↗
PubMed1993

Lymphocytic meningitis as the sole manifestation of Q fever.

A young man who presented with a 3 week history of fever and severe headache accompanied by mild leukocytosis, was found to have lymphocytic meningitis due to Coxiella burnetti. Thus, Q fever can present as lymphocytic (aseptic) meningitis responsive to tetracycline with no evidence of pulmonary involvement.

Adult↗
PubMed1993

Thionyl-chloride-induced lung injury and bronchiolitis obliterans.

Thionyl-chloride (TCl) is used in the manufacture of lithium batteries, producing SO2 and HCl fumes on contact with water. We report two cases of accidental TCl exposure resulting in lung injury that may vary from a relatively mild and reversible interstitial lung disease to a severe form of bronchiolitis obliterans causing, after a latent period, an acute/chronic respiratory failure as well as other complications (spontaneous pneumothorax and bronchopleural fistula), previously unreported in TCl fume inhalation.

Accidents, Occupational↗
PubMed1992

Antibodies to reverse transcriptase in HIV infection and progression to AIDS.

Serum antibodies to the reverse transcriptase (ART) of human immunodeficiency virus 1 (HIV-1) were sequentially determined by ELISA in a group of 41 HIV-seropositive male homosexuals and 101 matched healthy controls, over 1.5-6 years (mean follow-up 3.25 years). Mean ART levels were significantly higher in the patient group as compared to the controls (195 +/- 75 vs. 75 +/- 45 absorbance (A) units; P less than 0.05). When analyzed in parallel with clinical evaluation and T-cell subset determinations, a "surge" in ART activity was associated with a more favourable course: eleven patients whose ART profile showed an increase greater than 100 A units (mean delta A 159.6 units) showed an attenuated decrease of CD4+ (T helper) lymphocytes with a mean time of 42.5 months to reach a CD4+ number of 400 cells/mm3. In contrast, 25 matched seropositive patients whose ART remained constant became CD4+ less than 400 cells/mm3 within a mean time of 10.8 months (P less than 0.05). These results as well as individual patients' data support a surge in serum ART as a favourable prognostic indicator, and may indicate a protective role for this antibody which should be followed up and possibly utilized in the treatment or in the design of a vaccine against HIV-1.

Acquired Immunodeficiency Syndrome↗