Biomedical subjects
C Lavalle
Publications and source records attributed to C Lavalle.
Sulfasalazine treatment in Reiter's syndrome patients may not be sufficient: comment on the article by Youssef et al.
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Prolactin and gonadal hormones: a key relationship that may have clinical, monitoring and therapeutic implications in systemic lupus erythematosus.
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Tru-cut needle biopsy of subcutaneous fat in the diagnosis of secondary amyloidosis in rheumatoid arthritis.
In order to investigate the presence of secondary amyloidosis in patients with rheumatoid arthritis (RA), we performed an abdominal subcutaneous fat biopsy with a tru-cut needle in 50 patients. The tissue was stained with Congo red and was observed with polarized light microscopy. We found amyloid deposits in 78% of our patients. We randomly selected ten patients with a positive biopsy and a second procedure was performed. Tissues were studied with electron microscopy. We found unbranched fibrils characteristic of amyloid in all of them. We found a direct correlation with rheumatoid factor titers: the more intense the amyloid deposit, the higher the rheumatoid factor titers (p < 0.001). We did not find any correlation between amyloid deposits and clinical manifestations of disease. Amyloid deposits in RA are more frequent than previously thought, and their clinical importance remains to be determined.
An acute remission of Reiter's syndrome in male patients treated with bromocriptine.
We describe 4 male patients with Reiter's syndrome treated with bromocriptine. All 4 had infectious gastroenteritis and chronic Reiter's syndrome with arthritis and enthesopathy that persisted despite treatment in 3 with antiinflammatory drugs and 1 with sulfasalazine for long periods. In all patients treatment was cancelled 8 days before bromocriptine treatment. In 2 patients a dramatic improvement was observed 24 h after 2.5 mg/day of bromocriptine. Two patients improved after 4 days of bromocriptine treatment (5 mg/day). All 4 patients remained asymptomatic for at least 4 months of bromocriptine treatment. Bromocriptine may be useful for treating male patients with Reiter's syndrome.
Prolactin--a hormone with immunoregulatory properties that leads to new therapeutic approaches in rheumatic diseases.
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Does prolactin have a role in the pathogenesis of systemic lupus erythematosus?
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Transverse myelitis in systemic lupus erythematosus--the effect of IV pulse methylprednisolone and cyclophosphamide.
Transverse myelitis is a rare but serious complication of systemic lupus erythematosus (SLE). Standard treatment with medium to high doses of oral prednisone has been inadequate to control neurologic sequelae, and patients remain confined to a wheel chair or even die. We employed aggressive treatment in 7 patients with transverse myelitis complicating SLE with pulse methylprednisolone for acute episodes followed by pulse cyclophosphamide for a mean of 6 months; most of our patients are currently able to walk and have partial or total sphincter control.
Prolactin, immunoregulation, and autoimmune diseases.
Cells of the immune system synthesize prolactin and express mRNA and receptors for that hormone. Interleukin 1, interleukin 6, gamma interferon, tumor necrosis factor, platelet activator factor, and substance P participate in the release of prolactin. This hormone is involved in the pathogenesis of adjuvant arthritis and restores immunocompetence in experimental models. In vitro studies suggest that lymphocytes are an important target tissue for circulating prolactin. Prolactin antibodies inhibit lymphocyte proliferation. Prolactin is comitogenic with concanavalin A and induces interleukin 2 receptors on the surface of lymphocytes. Prolactin stimulates ornithine decarboxylase and activates protein kinase C, which are pivotal enzymes in the differentiation, proliferation, and function of lymphocytes. Cyclosporine A interferes with prolactin binding to its receptors on lymphocytes. Hyperprolactinemia has been found in patients with systemic lupus erythematosus. Fibromyalgia, rheumatoid arthritis, and low back pain patients present a hyperprolactinemic response to thyrotropin-releasing hormone. Experimental autoimmune uveitis, as well as patients with uveitis whether or not associated with spondyloarthropathies, and patients with psoriatic arthritis may respond to bromocriptine treatment. Suppression of circulating prolactin by bromocriptine appears to improve the immunosuppressive effect of cyclosporine A with significantly less toxicity. Prolactin may also be a new marker of rejection in heart-transplant patients. This body of evidence may have an impact in the study of rheumatic disorders, especially connective tissue diseases. A role for prolactin in autoimmune diseases remains to be demonstrated.
Role of prolactin in autoimmune diseases and autoimmunity.
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Prolactin and gonadal hormones during pregnancy in systemic lupus erythematosus.
We performed prospective hormonal studies in 9 patients (5 active and 4 inactive) with systemic lupus erythematosus (SLE) during pregnancy (Weeks 10 to 37). Nine healthy pregnant women and 5 patients with rheumatoid arthritis (RA) were used for comparison. Serum prolactin (PRL), testosterone and estradiol (E2) levels were determined by RIA. The patients with SLE showed higher serum PRL levels, the difference being statistically significant at Week 20, and reaching the highest levels at Weeks 30 to 40 (p = 0.05 when compared to healthy pregnant women). The 5 patients with active SLE had the highest serum PRL levels; one of these had fetal wastage. In active SLE the serum testosterone and E2 levels were decreased significantly from Weeks 10 to 30 compared with controls (p = 0.001). In patients with RA serum PRL levels, although higher than in controls, did not differ significantly, nor did the lower testosterone and E2 levels. We conclude that gonadal hormones and PRL changes observed in SLE are present also during pregnancy and may be related to fetal wastage and reactivation of disease.
Transverse myelitis: a manifestation of systemic lupus erythematosus strongly associated with antiphospholipid antibodies.
All 4 patients with transverse myelitis (TM) included in a prospective study of 500 patients with systemic lupus erythematosus (SLE) tested for anticardiolipin (aCL) antibodies were found to be positive. To determine if the apparently strong association between transverse myelitis and antiphospholipid antibodies (aPLA) in patients with SLE continued to hold, we chose 12 patients with SLE with transverse myelitis from 2 institutions. Eleven of the 12 patients with SLE were tested for aCL and all but one was positive. Most of them (n = 8) had both IgG and IgM isotype aCL. The one who was negative had had a positive VDRL and prolonged APTT 15 months earlier, coinciding with the episode of transverse myelitis. One patient died before she was tested for aCL but she also had a false positive VDRL. Thus, all 12 patients with SLE with transverse myelitis had evidence of aPLA. We conclude that there is strong association between transverse myelitis in SLE and the presence of aPLA.
Salmonella septic arthritis in systemic lupus erythematosus. The importance of chronic carrier state.
Salmonella bacteremia is more frequently seen in hospitalized patients with systemic lupus erythematosus (SLE) than in hospitalized patients with other diseases. In our experience. Salmonella enteritidis septic arthritis is more common in SLE than in patients with others connective tissue diseases. We report that 4 of 7 patients with SLE with glomerulonephritis and history of Salmonella enteritidis septic arthritis were chronic carriers of this bacteria, since positive cultures were obtained from feces, bone marrow and bile fluid from 20 84 months after Salmonella arthritis developed. In contrast, none of 24 patients with SLE without a history of Salmonella arthritis were chronic carriers and only one of 12 patients with rheumatoid arthritis had positive bile culture to S. typhi while otherwise being asymptomatic. From our study we conclude that patients with active SLE who have gomerulonephritis are at increased risk of becoming chronic carriers of Salmonella enteritidis and of developing Salmonella arthritis once combined prednisone cyclophosphamide treatment has begun. A chronic Salmonella carrier state must be ruled out in patients with active SLE living in endemic zones, before initiating immunosuppressive therapy.
Hyperviscosity syndrome as the initial manifestation of systemic lupus erythematosus.
We report the first case of systemic lupus erythematosus with hyperviscosity syndrome as the presenting manifestation. A polyclonal increase in all immunoglobulins was observed. Ultracentrifuge studies showed 17-19S intermediate immune complexes (IC) composed primarily of autoreactive IgG demonstrated at acid pH. This was confirmed by chromatographic fractionation of sera, since the intermediate IC eluted as did purified heat aggregated IgG. Small amounts of IgM and IgA in the intermediate IC were also demonstrated by more sensitive techniques, i.e., nephelometry, polyacrylamide gel electrophoresis, and electrophoretic blotting. The decrease of serum viscosity was associated with the decrease of circulating IC after plasmapheresis or combined treatment of prednisone and cyclophosphamide. Serum viscosity bore no relationship to the amount of dissociated immunoglobulins.
Antinuclear antibodies in scleroderma, mixed connective tissue disease and "primary" Raynaud's phenomenon.
The diversity of antibodies in patients with scleroderma, mixed connective tissue disease or "primary" Raynaud's phenomenon could be used as a laboratory aid in the clinical diagnosis. In serum samples of 75 patients we screened for antinuclear antibodies (HEp 2 cells), anti DNA, soluble nucleoprotein and extractable nuclear antigens (Sm, rRNP, U1-nRNP, SSA/Ro, SSB/La and Scl-70). Distinctive antinuclear antibodies pattern was identified in each group of patients. This immunologic profile is valuable for clinical diagnosis and the preferential association of certain autoantibodies with some diseases and not with others, suggest an antigen-driven stimulus for its production.
Correlation study between prolactin and androgens in male patients with systemic lupus erythematosus.
The hypothalamic-pituitary-gonadal axis was studied in 8 male patients with systemic lupus erythematosus (SLE), both before and after intravenous administration of luteinizing hormone-releasing hormone (LH-RH). We provide evidence herein that resting serum levels of estrone are increased and that resting serum testosterone (T) and dihydrotestosterone (DHT) levels are decreased in male patients with SLE. The decreased serum T levels were observed even after the IV administration of 25 micrograms of LH-RH. The high basal serum prolactin (PRL) levels observed in these patients with SLE is a novel finding not previously reported that could explain why serum T and DHT levels are low in this syndrome. We observed a decrease in the pituitary response to LH-RH stimulation; this low response could also be a hormonal manifestation of hyperprolactinemia. Furthermore, it has been suggested that PRL plays a role in immunocompetence, and therefore it could have influence either directly or indirectly in the altered immunoregulation observed in SLE.
Septic arthritis due to Nocardia brasiliensis.
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Bilateral avulsion of quadriceps tendons in primary hyperparathyroidism.
Avulsion of the quadriceps tendons with primary hyperparathyroidism has been reported twice before. We describe a patient with primary type 1 hyperparathyroidism who developed well defined rheumatic symptoms in both knees as a consequence of bilateral rupture of the quadriceps tendons.