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C J Michet

Publications and source records attributed to C J Michet.

36 records · Page 2Linked to original sources
PubMed1989

A population-based case-control study of temporal arteritis: evidence for an association between temporal arteritis and degenerative vascular disease?

The first population-based incident case-control study of temporal arteritis (TA) in the US was conducted using the unique data resources of the Rochester Epidemiology Project. During the period 1950-1985, 88 newly diagnosed cases of biopsy-proven TA were identified among residents of Olmsted County, Minnesota. Cases were each matched to four Olmsted County community controls on age, sex and duration of community medical record. Odds ratios (OR) were calculated for marital status, education, Quetelet index, pregnancy, age at menopause, thyroid disease, diabetes, smoking, hypertension, angina, myocardial infarction, peripheral vascular disease, and stroke. Multivariable conditional logistic regression analysis identified statistically significant adjusted OR for smoking (2.3, 95% CI = 1.3-4.1). Elevated ORs which were not statistically significant were noted for angina, myocardial infarction, and peripheral vascular disease. These data suggest that TA and arteriosclerosis may share a common causal pathway. Alternatively, histopathological misclassification of temporal artery biopsies may have resulted in the observed association. Due to the limited power of this population-based study, multicentre collaboration should be encouraged to more precisely define the epidemiology of TA.

Aged↗
PubMed1989

Lymphoreticular disorders masquerading as rheumatic disease syndromes.

We describe four cases, each with a distinct rheumatologic presentation. Three had lymphoma, and the fourth, though initially suggestive of lymphoma, had a tuberculous infection. Clinicians should be alert for diseases masquerading as diverse clinical syndromes. It is important to establish rheumatic, lymphoproliferative, or infectious etiology because of major differences in therapeutic and prognostic implications.

Adult↗
PubMed1988

Epidemiology of Reiter's syndrome in Rochester, Minnesota: 1950-1980.

The incidence of Reiter's syndrome in a predominantly white, community-based population is reported. The age-adjusted annual incidence rate for males younger than age 50 was 3.5 per 100,000. No female cases were identified. Over time, a greater proportion of cases have been identified among younger males. In 63% of the patients, either a prolonged or relapsing disease course occurred.

Adolescent↗
PubMed1988

Trends in incidence and clinical presentation of temporal arteritis in Olmsted County, Minnesota, 1950-1985.

Ninety-four Olmsted County, Minnesota residents with temporal arteritis (TA) initially diagnosed between 1950 and 1985 (incidence cohort) were identified. The age- and sex-adjusted incidence of TA per 100,000 population age 50 years or older was 17.0 (95% confidence interval [CI] 13.6-20.5), with a marked increase in incidence with age and a threefold greater incidence in women (23.4, 95% CI 18.2-28.7) than in men (7.4, 95% CI 3.7-11.0). The previously described secular increase in TA incidence in Olmsted County women continued from 1970 through 1985, while TA incidence in men declined in this latter time period. Although the frequency of classic clinical manifestations of TA declined over time, the percentage of patients undergoing biopsy who have positive specimens remained relatively constant (women 41%, men 26%). The incidence rate of temporal artery biopsy also increased for women during this period, but declined for men, suggesting that the differing trends in TA incidence by sex may be partially attributable to a detection bias. Future research in TA etiology and epidemiology should focus on possible causal factors linked to the differential TA incidence by sex.

Aged↗
PubMed1988

Eosinophilic fasciitis: clinical spectrum and therapeutic response in 52 cases.

The clinical course of 52 cases with eosinophilic fasciitis observed at the Mayo Clinic has been described. Cutaneous changes included pitting edema, peau d'orange, and induration, and may affect virtually any body surface area. In addition, localized morphea was present in 15 cases. Arthritis was observed in 21 patients; 29 patients had flexion contractures and 12 had carpal tunnel syndrome. Associated hematologic diseases were found in five patients; thrombocytopenia in two, myeloproliferative disorder in one, myelomonocytic leukemia in one, and chronic lymphocytic leukemia in one. Peripheral blood eosinophilia was noted in 33 of 52 patients, hypergammaglobulinemia was noted in 17 of 49, and elevated sedimentation rate was noted in 15 of 52. Nonspecific EMG changes were seen in 11 of 15 patients. None had clinical involvement of the kidneys, lungs, or heart. No significant association between any HLA-A, -B, or -DR and eosinophilic fasciitis was seen. Prednisone and hydroxychloroquine seemed equally beneficial in treatment; however, some cases showed spontaneous recovery, making evaluation of therapeutic efficacy difficult. Relapses occurred in some cases.

Adolescent↗
PubMed1988

Economic outcome under Medicare prospective payment at a tertiary-care institution: the effects of demographic, clinical, and logistic factors on duration of hospital stay and part A charges for medical back problems (DRG 243).

We investigated the effects of prospectively identified factors on the duration of hospital stay and part A charges in 240 hospitalizations (of 230 patients) for the diagnosis-related group "medical back problems" (DRG 243) at a tertiary-care institution in 1985 to determine whether heterogeneity existed within this reimbursement category. We confirmed our initial postulates that nonosteoporotic fractures and neck problems, as well as hospitalizations primarily for myelography after outpatient neurologic evaluation, had considerably different economic outcomes and thus excluded these categories from further analysis. Statistical analysis (forward stepwise regression) of the remaining 132 patients who had "general medical back problems" showed that increasing age, associated osteoporosis, and therapeutic injections best explained variation in the natural logarithm of duration of stay (R2 = 0.16). Total number of diagnoses, spondylosis, associated osteoporosis, age, therapeutic injections, and performance of special procedures best explained the variation in the logarithm of part A charges (R2 = 0.29). The ability to identify factors within a specified category that affect the duration of hospitalization and part A charges jeopardizes the fairness of prospective payment, and we believe that DRG 243 should be adjusted for age, comorbidity, and readily identifiable clinical syndromes that have disparate economic consequences. Because of poorly substantiated efficacy and a significant association with longer hospital stays and higher part A charges, clinicians should review the use of therapeutic injections for medical back problems. Analysis of case-mix such as ours should be helpful in promoting efficient practice and ensuring the fairness of any reimbursement system.

Adult↗
PubMed1988

Thromboangiitis obliterans with eosinophilia (Buerger's disease) of the temporal arteries.

Thromboangiitis obliterans (Buerger's disease) is a nonatherosclerotic, inflammatory, occlusive vascular disease occurring almost exclusively in young male smokers. It involves principally medium sized and small arteries and veins of the lower and upper extremities, and only rarely the visceral and cerebral blood vessels. Buerger's disease of the temporal arteries, unassociated with the involvement of blood vessels of either the upper or lower extremities has not been previously reported. Three such cases, clinically mimicking the classic (giant cell) temporal arteritis of the elderly, are described. This unusual arterial lesion also bears some resemblance to subcutaneous angiolymphoid hyperplasia with eosinophilia (Kimura's disease).

Adult↗
PubMed1987

Auranofin-associated colitis and eosinophilia.

Gold compounds, often used in the treatment of rheumatoid arthritis, have been associated with gastrointestinal disturbances in some patients. Use of auranofin, an oral gold preparation, in a 50-year-old woman with rheumatoid arthritis resulted in diarrhea, abdominal tenderness, nausea, and vomiting, which persisted despite discontinuation of auranofin therapy. The presumptive diagnosis was gold-induced colitis and eosinophilia. Administration of cromolyn sodium provided relief. Although this complication may be rare, evolving bowel symptoms in patients receiving auranofin demand prompt attention.

Arthritis, Rheumatoid↗
PubMed1987

Renal involvement in relapsing polychondritis.

Twenty-nine of the 129 patients with RP seen at the Mayo Clinic between 1943 and 1984 had renal involvement. These patients were older, had arthritis and extrarenal vasculitis more frequently, and had a significantly worse survival rate than those without renal involvement. Renal biopsies were obtained in 11 of these 29 patients. The predominant lesions were mild mesangial expansion and cell proliferation, and segmental necrotizing glomerulonephritis with crescents. Small amounts of electron-dense deposits, predominantly mesangial, were noted on electron microscopy. Immunofluorescence revealed faint deposition of C3 and/or IgG or IgM, predominantly in the mesangium. Autopsies were obtained in 13 of the 47 patients who had died. Information regarding the renal pathology was available in 10 of these 13 autopsies. At the time of the initial evaluation at the Mayo Clinic, 6 of these 10 patients had evidence of renal involvement. At autopsy, none of these 10 patients had evidence of active renal vasculitis or segmental necrotizing glomerulonephritis, but 8 of the 10 patients exhibited variable degrees of vascular and glomerular sclerosis, segmental mesangial proliferation, tubular loss, and interstitial lymphocytic infiltrates. These observations expand the limited information available in the literature, which is based on 11 previously published case reports of renal involvement in RP. In only a few of our patients and previously reported patients were the manifestations of the disease limited to the systems characteristically involved in pure RP. The frequent coexistence of other autoimmune and connective tissue diseases supports the role of immune mechanisms in the pathogenesis of this syndrome. Deposition of immune complexes is likely to play a role in the pathogenesis of the glomerular lesions associated with RP. Administration of corticosteroids alone is sufficient to induce a complete remission in some cases, while in others the addition of a cytotoxic agent is necessary to control the activity of the disease or to spare corticosteroid side effects and maintain a remission. Immunosuppression-related infectious complications and undetected relapses after discontinuation of immunosuppressive therapy are largely responsible for the morbidity and mortality observed in these patients.

Adult↗
PubMed1987

Hip arthroplasty in patients with systemic lupus erythematosus.

Forty-three prosthetic hip replacements (twenty-nine conventional total hip replacements and fourteen bipolar endoprosthetic replacements) were implanted between January 1971 and June 1982 in thirty-one patients who had systemic lupus erythematosus. All but four patients had stage-III or IV osteonecrosis of the femoral head. The median age at operation was forty-three years, and the median length of follow-up was fifty-seven months. Ratings were good or excellent for all but three total hip arthroplasties at a mean of sixty-six months of follow-up. Complications included delayed wound-healing (in approximately 15 per cent) and superficial wound infection (in approximately 10 per cent). The occurrence of these complications could not be correlated with the use of corticosteroids at the time of the operation. Twenty-five per cent of the patients, who were a mean of forty-three years old at operation, died less than five years postoperatively from complications related to systemic lupus erythematosus. Conclusions regarding the systemic effects of hip arthroplasty in patients with systemic lupus erythematosus could not be drawn on the basis of this study. Total hip arthroplasty uniformly provided a good or excellent result in patients of all ages who had systemic lupus erythematosus at a mean length of follow-up of sixty-six months. An increased incidence of local wound complications, which were unrelated to the use of corticosteroids, should be expected in patients with systemic lupus erythematosus who undergo prosthetic arthroplasty of the hip.

Adult↗
PubMed1986

Ocular and systemic findings in relapsing polychondritis.

The ocular and systemic findings in 112 Mayo Clinic patients with relapsing polychondritis were reviewed. The incidence of males and females was equal, with median age at diagnosis of 51 years and the median follow-up of 6 years. Most patients had several organ systems involved at the time of the diagnosis. Twenty-one patients had ocular symptoms at the onset, and 57 developed ocular symptoms during their course. Major ocular complications included proptosis, lid edema, episcleritis/scleritis, corneal infiltrates/thinning, iridocyclitis, retinopathy, and optic neuritis. The major system involvement included otorhinolaryngeal, respiratory, arthritic, renal, cardiovascular, dermatologic, and neurologic diseases. Generally, laboratory studies were not helpful in making the diagnosis but were valuable in monitoring the disease. Based on the experience in these cases, the indications for the various therapeutic modalities are offered.

Adolescent↗
PubMed1986

Relapsing polychondritis. Survival and predictive role of early disease manifestations.

To define the natural history of relapsing polychondritis, the probability of survival and causes of death were determined in 112 patients seen at one institution. By using covariate analysis, early clinical manifestations were identified that predicted mortality. The 5- and 10-year probabilities of survival after diagnosis were 74% and 55%, respectively. The most frequent causes of death were infection, systemic vasculitis, and malignancy. Only 10% of the deaths could be attributed to airway involvement by chondritis. Anemia at diagnosis was a marker for decreased survival in the entire group. There was an interaction between other disease variables and age in determining their impact on outcome. For patients less than 51 years old, saddle-nose deformity and systemic vasculitis were the worst prognostic signs. For older patients, only anemia predicted outcome. The need for corticosteroid therapy did not influence survival.

Adolescent↗
PubMed1985

Epidemiology of systemic lupus erythematosus and other connective tissue diseases in Rochester, Minnesota, 1950 through 1979.

The incidence and prevalence rates of connective tissue disease syndromes in Rochester, Minnesota, from 1950 through 1979 are reported. The incidence of definite systemic lupus erythematosus (SLE) has not increased since 1960. The incidence of SLE in the elderly population was higher than that in previous reports. Rates of SLE and discoid lupus erythematosus were approximately equal. Other diagnoses (in decreasing order of frequency) were suspected lupus erythematosus, scleroderma, drug-induced lupus, and overlapping connective tissue disease syndromes. The 10-year survival of patients with definite SLE was decreased, and the survival of patients with suspected SLE was the same as that of the general population.

Adolescent↗
PubMed1985

Splenectomy does not cure the thrombocytopenia of systemic lupus erythematosus.

Fourteen patients with systemic lupus erythematosus had splenectomies done between 1960 and 1982 for treatment of severe thrombocytopenia. Thrombocytopenia persisted or recurred within 1 month postoperatively in five patients and within 6 months in three others. Three patients had late recurrence (18, 30, and 54 months after splenectomy); in two it was probably related to withdrawal of immunosuppressive agents or corticosteroids. Median lowest platelet count before splenectomy and median platelet count at relapse or failure of splenectomy were both 8000/microL. Only two patients maintained normal platelet counts without need for corticosteroids or other treatment. These results differ from those in patients with idiopathic thrombocytopenic purpura. Other treatments should be tried before splenectomy is done for thrombocytopenia in patients with systemic lupus erythematosus.

Adult↗
PubMed1983

The epidemiology of juvenile arthritis in Rochester, Minnesota 1960-1979.

A 20-year community-based study of the epidemiology of juvenile arthritis in Rochester, Minnesota from January 1, 1960 to January 1, 1980 is described. Cases were identified using the 1977 revised American Rheumatism Association criteria for juvenile arthritis. Higher incidence and prevalence rates and a greater predominance of pauciarticular disease were observed than previously reported. Lower rates were observed when a minimum of 3 months' disease duration was used to identify incidence.

Adolescent↗
PubMed1983

Polymyositis associated with jejunoileal bypass.

We report a patient with polymyositis who had a functioning jejunoileal bypass. Although many connective tissue syndromes have been reported with small bowel bypass, the association of polymyositis is unusual even though similar pathogenetic mechanisms might be involved.

Female↗
PubMed1981

Eosinophilic fasciitis: report of 15 cases.

Clinical and histopathologic features of 15 cases of diffuse fasciitis with eosinophilia are reviewed. The patients experienced an inflammatory scleroderma-like illness without Raynaud's phenomenon or internal organ involvement. Polyarthritis and carpal tunnel syndrome were observed. The clinical courses demonstrated the potential for spontaneous remission, relapse, and late recurrence. Histopathologic features are discussed, as is their relationship to other forms of localized scleroderma. None of the 12 patients treated with corticosteroids has had complete resolution of the skin changes after a median follow-up of 10 months. Unusual associated diseases--acute myelomonocytic leukemia and an evolving myeloproliferative disorder--were observed in two patients.

Adult↗