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Biomedical subjects

D J Wallace

Publications and source records attributed to D J Wallace.

At least 109 records · Page 6Linked to original sources
PubMed1989

The use of quinacrine (Atabrine) in rheumatic diseases: a reexamination.

Atabrine has been available for nearly 60 years. It has a variety of actions and has been administered to millions of individuals. Its antirheumatic properties have been well documented but have not been exploited optimally for a variety of reasons. The drug is generally quite safe and could be used in low doses in lupus and rheumatoid arthritis patients as a steroid-sparing agent or synergistically with hydroxychloroquine. Its bothersome side effects should not deter the clinician from using it, because they are easy to deal with or prevent (Table 5). Future studies should attempt to better characterize the immunosuppressive actions of this powerful drug, particularly in the treatment of lupus erythematosus and rheumatoid arthritis. Studies of the role of combination or single-agent antimalarial therapy in combination with other "remittive" drugs could be of great potential benefit.

Chemical Phenomena↗
PubMed1989

1,25 dihydroxyvitamin-D3 regulation of immunoglobulin production in peripheral blood mononuclear cells of patients with systemic lupus erythematosus.

Systemic Lupus Erythematosus (SLE) is a multisystem disease characterized by an increase in the secretion of autoantibodies. The mechanisms of autoantibody-induced disease have not been clarified. 1,25-Dihydroxy-vitamin D3 (1,25-D3) is known to be important in the regulation of normal human lymphocyte functions. Among its regulatory functions is the ability to inhibit mitogen-stimulated production of immunoglobulin. The experiments reported here explored the regulation of IgG production by peripheral blood mononuclear cells (PBMCs) of patients with inactive and active SLE. 1,25-Dihydroxyvitamin D3 inhibited mitogen-stimulated IgG production in cells from normal individuals and inactive SLE patients, but not spontaneous IgG production by PBMCs from active SLE patients. Addition of exogenous IL-2 (5-50 U/ml) to 1,25-D3-treated cells from all patient groups did not affect IgG production significantly under any conditions tested. The addition of IL-2 to PMBCs had no effect on IgG production in normal individuals or inactive SLE patients, but stimulated IgG production in PBMCs of active SLE patients. We conclude that the regulation of mitogen-stimulated IgG production in inactive SLE patients by 1,25-D3 and IL-2 is similar to normal individuals, but IgG production by active SLE PBMCs is unresponsive to 1,25-D3 regulation and is increased with the addition of IL-2.

Adult↗
PubMed1989

Quantitative computerized joint scanning in rheumatoid arthritis: an accurate reproducible method of quantitating synovitis--preliminary report.

Clinical trials in rheumatoid arthritis have been hampered by the highly subjective nature of disease assessment measures and lack of a consistently reliable laboratory test to follow. The authors devised a method of quantitating synovitis by computerized joint scanning and compared it with six conventional parameters in 18 patients entered into two treatment protocols and a control group. The results indicate that quantitative joint scanning probably is at least as reliable as the conventional measures and has the advantage of having no placebo or subjective component.

Adult↗
PubMed1989

Preoperative correlates of impaired wound healing after saphenous vein excision.

Although major wound complications after saphenous vein excision are infrequent, we have found broadly defined impairment in leg wound healing to be relatively common. Wound healing impairment is defined in this study as inflammation, separation, cellulitis, lymphangitis, drainage, necrosis, or abscess necessitating dressing, antibiotics, or débridement before wound healing with complete epithelialization without eschar. Healing was impaired in 245 of 1047 patients (24.3%). Significant correlations were found between impaired wound healing and female sex (p less than 0.005), body mass index (obesity) (p less than 0.005), diabetes mellitus (p less than 0.005), left ventricular end-diastolic pressure greater than 15 mm Hg (p = 0.0074), arterial occlusive disease of the legs (p = 0.0124), and preoperative hematocrit value (p = 0.0491).

Arterial Occlusive Diseases↗
PubMed1989

Correlates of preoperative hematocrit value in patients undergoing coronary artery bypass.

The patient's preoperative red cell volume and hematocrit value are among the strongest predictors of need for postoperative transfusion. We have determined the factors that correlate with preoperative hematocrit value. We performed multiple regression analysis with preoperative hematocrit value as the dependent variable. The factors that were significantly correlated with preoperative hematocrit value, in order of their decreasing contribution to variability, were sex, date of operation, preoperative hospital stay, weight, left ventricular end-diastolic pressure, age, smoking history, and recent myocardial infarction (less than 6 weeks). Factors that did not contribute significantly to predicting preoperative hematocrit value included ejection fraction, emergency operation, previous streptokinase use, number of coronary arteries diseased, body mass index (obesity), diabetes, height, body surface area, and history of percutaneous transluminal coronary angioplasty. The patient most likely to have a low preoperative hematocrit value can be characterized as a small, elderly, female nonsmoker with a recent myocardial infarction and elevated left ventricular end-diastolic pressure. The prevalence of low preoperative hematocrit value is increasing with time independent of other factors.

Aged↗
PubMed1988

Predictive value of clinical, laboratory, pathologic, and treatment variables in steroid/immunosuppressive resistant lupus nephritis.

Twenty-seven patients with lupus nephritis and nephrotic syndrome had persistent disease activity despite an adequate trial of corticosteroids and immunosuppressive drugs; 30% were Asians, compared with 7% of our overall SLE population. Two years later, seven had a very good outcome and seven a poor outcome. Thirty clinical, pathological, laboratory, and treatment variables were analyzed in a good versus poor responder subset comparison in an effort to determine which factors were associated with favorable outcome. Administration of pulse steroids (P = .069) and a low biopsy chronicity index (P = .048) were associated with the good responder subset. Serum creatinine, biopsy class, blood pressure, complement, and anti-DNA values at entry as well as the choice of immunosuppressive drug were not helpful in predicting outcome. All seven good responders were plasmapheresed (P = .026). Patients with refractory lupus nephritis who have a low biopsy chronicity index may benefit from the use of pulse steroids or plasmapheresis, and controlled studies are suggested.

Adult↗
PubMed1988

Interleukin-2 receptor expression in peripheral blood lymphocytes from systemic lupus erythematosus patients: relationship to clinical activity.

Deficient interleukin-2 (IL-2) production and other T-cell dysfunctions have been demonstrated in active systemic lupus erythematosus (SLE). The generation of IL-2 receptors is known to be important to the growth and differentiation of T and B lymphocytes. This study investigated IL-2 receptor expression in peripheral blood lymphocytes (PBL) from patients with active and inactive SLE. PBL from 27 SLE patients, diagnosed by revised ARA criteria, were assayed for IL-2 receptor expression, IL-2 and immunoglobulin (Ig) production. PBL from SLE patients with active disease spontaneously expressed increased numbers of IL-2 receptors compared to those with inactive disease (P less than 0.01) and normal donors (P less than 0.01). There was no significant increase in IL-2 receptors expression in PBL from active SLE patients in response to mitogenic stimulation with PHA compared to inactive SLE patients and normal donors. There was negligible IL-2 production in response to mitogenic stimulation and increased spontaneous IgG production by PBL from active SLE patients compared to normal donors (P less than 0.001). Purified B cells isolated from active SLE patients showed significant spontaneous IL-2 receptor expression when compared to spontaneous IL-2 receptor expression by normal B cells (P = 0.005). Therefore, in addition to derangements in Ig and IL-2 production, the level of spontaneous expression of IL-2 receptors may represent a cellular indicator of disease activity, and hence, may be a useful parameter in monitoring disease activity in SLE patients. The significance of the increased IL-2 receptor expression on B cells of active SLE patients is unknown, but may represent a marker of polyclonal activation of these cells.

Antibody Formation↗
PubMed1988

Studies of IgG, IgM and IgA antiphospholipid antibody isotypes in systemic lupus erythematosus.

We evaluated the clinical relevance of 6 antiphospholipid antibodies including cardiolipin and their IgG, IgM and IgA isotypes in 92 patients with systemic lupus erythematosus (SLE). Antiphospholipid antibodies generally had significant associations with thrombocytopenia and a history of false-positive syphilis serologies. In 4 of 6 antiphospholipid antibodies, an inverse association with renal disease was observed. Antiphospholipid antibodies may moderate or protect against renal disease, or this may reflect the high doses of corticosteroids and cytotoxic drugs received by this group. Further studies are needed to determine how many antibody families cause these activities and to elucidate whether certain SLE subgroups possess differing specificities for each of the phospholipids.

Adolescent↗
PubMed1987

The role of stress and trauma in rheumatoid arthritis and systemic lupus erythematosus.

Only one study, albeit inconclusive, has specifically addressed the etiologic role of physical trauma in RA. The weight of evidence from a variety of studies strongly suggests a role for psychologic stress in inducing, exacerbating, and effecting the ultimate outcome in RA. Well designed controlled trials aimed specifically at deciding these issues are urgently needed. This also applies to SLE, where the role of physical trauma has never been investigated, and disease exacerbation induced by emotional stress has been strongly suggested, but not yet verified in a scientifically acceptable fashion. Stress can depress immune responsiveness, but the end result of this (eg, increased susceptibility to infection, increased disease activity) is not known. It is uncertain how much or what kind of stress is required to depress responsiveness, or even how differing degrees of stress can be quantitated or reproduced. Even though eight million Americans have RA and SLE, we still know very little about the influences of stress and trauma on these disorders.

Arthritis, Rheumatoid↗
PubMed1986

An objective evaluation of special class placement of elementary schoolboys with behavior problems.

Behavioral checklists were employed to identify the type and degree of psychopathology observed in 90 boys who were referred for possible placement in classrooms for the socially and emotionally disturbed (SED). School behavior was assessed by teachers completing the Conners Teacher Rating Scale, while behavior at home was rated by parents with the Child Behavior Checklist. The checklist findings from both environments showed the boys to have high levels of psychological disturbance, especially for externalizing factors such as hyperactivity, aggression, and conduct disorder. This was especially true for those boys for whom SED placement was recommended. Further, the clinical usefulness of these checklists was investigated as an adjunctive method for the determination of the need for SED placement. By the use of discriminant function analysis, about three-fourths of the boys recommended for SED placement were accurately identified; correct classification was maximized when parent and teacher checklists were employed together.

Child↗