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Biomedical subjects

E D Silverman

Publications and source records attributed to E D Silverman.

141 records · Page 8Linked to original sources
PubMed1986

Different patterns of C3 and C4 activation in the varied types of juvenile arthritis.

Quantitative assays for C3 and C4 activation were carried out simultaneously on blood from children with varied types of juvenile arthritis. Factor VIII-related antigen was also measured as an indicator of vascular damage. In active systemic juvenile arthritis, the C4d/C4 ratio was frequently elevated and was usually associated with elevated C3d/C3 ratios and elevated concentrations of factor VIII-related antigen. Children with chronic polyarticular arthritis, no matter which forms of onset they had had, also had increased levels of the C4d/C4 ratio, C3d/C3 ratio, and factor VIII-related antigen, but these were less consistent and were not associated with each other. In contrast, in pauciarticular arthritis there was a uniquely isolated increase in the C3d/C3 ratio. This work implies that there are different mechanisms responsible for complement activation in the different types and at different stages of juvenile arthritis.

Adolescent↗
PubMed1985

Immunoregulatory T cells in man. Histamine-induced suppressor T cells are derived from a Leu 2+ (T8+) subpopulation distinct from that which gives rise to cytotoxic T cells.

One mechanism of histamine-mediated inhibition of the immune response in man is to activate T suppressor cells that bear the Leu 2 (OKT8) marker. The current study was undertaken to characterize the histamine-induced suppressor cell using a monoclonal antibody (9.3) shown previously to distinguish cytotoxic T cells from antigen-specific suppressor T cells. Leu 2+ cells isolated from peripheral blood were further separated with antibody 9.3 into Leu 2+, 9.3+, and Leu 2+, 9.3- subsets and each subset was incubated with different concentrations of histamine before determining their ability to suppress immune responses in vitro. The results indicate that the Leu 2+, 9.3- subpopulation includes all histamine-induced suppressor cells, that 10(-4) M histamine is the optimal concentration for suppressor cell induction, and that exposure of Leu 2+, 9.3- cells to histamine for 30 s is sufficient to initiate the induction process. After treatment with histamine these cells inhibit both phytohemagglutinin-induced T cell proliferation and pokeweed mitogen-induced B cell differentiation. The suppression of phytohemagglutinin-induced proliferation was resistant to x-irradiation with 1,200 rad, either before or after histamine exposure, suggesting that Leu 2+, 9.3- cells need not proliferate to become suppressor cells or exert suppression. Moreover, suppression by these cells was not due to altered kinetics of the response. Finally, a histamine type 2 receptor antagonist (cimetidine) but not a type 1 receptor antagonist (mepyramine) blocked the induction of suppressor cells. On the basis of these results and our previous studies of antigen specific suppressor cells, we conclude that Leu 2+ suppressor cells in man are derived from a precursor pool that is phenotypically distinct from cells that can differentiate into cytotoxic T cells.

Antibodies, Monoclonal↗
PubMed1984

Lymphocyte subpopulation alterations induced by intravenous megadose pulse methylprednisolone.

Lymphocyte subpopulations from 9 children with different rheumatic diseases were studied before and 5, 24 and 48 h after high dose intravenous methylprednisolone. Leu-1 (+) cells, Leu-2a (+) cells, Leu-3a (+) cells and surface immunoglobulin (+) cells were counted. A panlymphopenia occurred 5 h after infusion, but numbers of all cell types were normal by 48 h. B cells were less affected than T cells. Leu-3a (+) cells were relatively more decreased than the other populations at 5 h and took longer to return to prepulse levels. This suggests a selective difference in distribution of lymphocyte subpopulations after pulse methylprednisolone infusion.

Arthritis, Juvenile↗
PubMed1984

The effect of juvenile inflammatory synovial fluid on in vitro cartilage.

Inflammatory and noninflammatory juvenile synovial fluid (SF) samples were examined in vitro for their effect on cartilage. SF from 3 of 6 patients with pauciarticular juvenile arthritis (JA), 7 of 7 patients with polyarticular JA and 2 of 2 patients with ankylosing spondylitis had significantly increased proteoglycan (PG) releasing activity in 4 day cultures of living but not of freeze-killed cartilage. Noninflammatory SF did not cause increased PG release. Cartilage collagen content was not significantly altered by either inflammatory or noninflammatory SF. Our in vitro results showed PG releasing activity was present in inflammatory but not in normal juvenile SF.

Animals↗
PubMed1983

Consumption coagulopathy associated with systemic juvenile rheumatoid arthritis.

A coagulopathy resembling disseminated intravascular coagulation may occur in systemic juvenile rheumatoid arthritis. We have seen this in seven patients with three different circumstances of disease activity or drug treatment. In one patient, a coagulopathy was not associated with drug therapy, and required corticosteroid therapy for control. A second group of patients was receiving orally nonsteroidal anti-inflammatory drugs during an acute flare-up of disease associated with low serum albumin concentrations. Coagulopathy in these patients may be a result of reduced vascular endothelial cell cyclooxygenase activity secondary to increased levels of unbound nonsteroidal anti-inflammatory drug. In these children, corticosteroid therapy was required for control. A third form of coagulopathy was seen in patients receiving a second injection of aurothiomalate. This form appears to be idiosyncratic, self-limiting, and relatively benign.

Administration, Oral↗
PubMed1983

Distribution and natural history of stress fractures in U.S. Marine recruits.

In a prospective study of stress injuries of the lower extremities of U.S. Marine recruits, we derived a frequency distribution of stress fractures. The most frequently fractured bone was the tibia (73%), while the single most common site was the posterior calcaneal tuberosity (21%). The natural history of stress fractures by scintigraphy and radiography has been outlined, showing the evolutionary changes on either study as a universal progression independent of injury site or type of stress. An identical spectrum of changes should be present within any group undergoing intense new exercise. The frequency distribution of stress fractures should be a function of differing forms and intensities of exercise, therefore, our figures should not be applied to other groups. We used the presence of a scintigraphic abnormality at a symptomatic site as the criterion for diagnosis of stress fracture. Since the distribution of skeletal radiotracer uptake is directly dependent on local metabolic activity, it is expected that a focal alteration in bone metabolism will result in a scintigram approaching 100% sensitivity for the abnormality (9). In the proper clinical setting, the specificity should approximate this figure; however, a focal, nonstress-related bone abnormality which has not manifested any radiographic change, such as early osteomyelitis, could result in a false-positive examination. Specificity cannot, therefore, be accurately determined without an actual determination of the pathologic changes within the bone, necessarily involving biopsy. In summary, we believe that we have established bone scintigraphy as an early and accurate means for the detection of lower extremity stress fractures, even in the absence of radiographic findings (6). We feel that a focally abnormal scintigram, in the proper clinical setting, establishes the diagnosis of stress fracture, with radiography to be performed at the time of initial work-up only to rule out a non-stress injury (such as complete fracture, fibrous dysplasia, osteomyelitis, primary bone tumor).

Adult↗
PubMed1981

Spinal cerebrospinal fluid leak demonstrated by retrograde myeloscintigraphy.

Cerebrospinal fluid (CSF) leaks may occur following spinal surgery and are commonly associated with infection. These leaks can be successfully evaluated with retrograde myeloscintigraphy using the same techniques applied in diagnosing CSF otorrhea and rhinorrhea. This report describes the utility of this procedure in differentiating a process due solely to postoperative infection from one that involves both an inflammatory site and a fistulous tract with the subarachnoid space.

Adult↗
PubMed1979

Mechanical problems in the use of the intra-aortic balloon.

Although there are many complications in the use of the intraortic balloon (IAB) support device, they are relatively benign compared to the benefits of the device. The purpose of this paper is, firstly, to review a protocol in the safe use of this device, and secondly to remind enthusiastic users of the IAB that the use of this method is not always as benign as we would like it to be. Rarely reported findings at postmortem examination in two patients who died in cardiogenic shock are described. The aorta of one of the two cases in this report had a longitudinal tear which involved only the intima and extended from the common femoral artery to well above the renal arteries. In the second case, the balloon tip had entered at the bifurcation of the aorta in a subintimal manner and had re-entered well below the renal arteries, to be relocated in the proper site in the descending aorta.

Aortic Dissection↗
PubMedDate not supplied

MR evaluation of the temporomandibular joint in juvenile rheumatoid arthritis.

Temporomandibular joint (TMJ) disease is uncommon in children but frequently occurs in juvenile rheumatoid arthritis (JRA). Involvement is often asymptomatic; however, it can lead to growth disturbances and facial deformity. Thirty TMJs in 15 children (11 girls and 4 boys aged 3.5-18 years) with JRA were evaluated clinically and by MRI. Plain films were reviewed when available. Magnetic resonance imaging parameters included T1-weighted and in some cases T2-weighted or gradient recall echo sequences. We assessed condylar configuration, glenoid fossa changes, presence of erosions, disk abnormality, range of motion, and presence of joint effusions or pannus. Abnormalities included cortical erosions (n = 19), disk thinning (n = 18), and perforation (n = 2). Reduction of joint movement (n = 20), joint locking (n = 3), and pannus/effusions (n = 5) were also found. Magnetic resonance imaging is a useful technique for the detection of TMJ involvement in JRA. Early detection and therapeutic intervention may lessen or prevent subsequent deformities.

Adolescent↗
PubMedDate not supplied

Persistent pulmonary hemorrhage as the sole initial clinical manifestation of pediatric systemic lupus erythematosus.

Pulmonary hemorrhage (PH) is a rare but potentially life-threatening manifestation of systemic lupus erythematosus (SLE). In this report we describe a 13 year old girl with PH as the sole presenting clinical manifestation of her SLE. Her serology was diagnostic of SLE and one year after presentation she developed arthritis. She had a rapid serologic but delayed clinical response to combination therapy of intravenous pulse methylprednisolone, pulse cyclophosphamide and daily prednisone. Awareness of the possibility of pulmonary hemorrhage as a presentation of SLE may aid in the diagnosis and early, aggressive management of this condition.

Adolescent↗
PubMedDate not supplied

Intravenous immunoglobulin therapy in a child with cutaneous polyarteritis nodosa.

Cutaneous polyarteritis nodosa (CPAN) may have a prolonged recurrent course which needs chronic corticosteroids treatment to achieve remission. In this report we describe a 9 year old boy who developed CPAN, which we treated with high dose intravenous immunoglobulin (IVIG), with an immediate favourable response. We discuss the advantages of IVIG over corticosteroids and speculate on its pathogenesis and mechanism of action.

Child↗