Biomedical subjects
Publications and source records attributed to E M Adams.
Two patients had streptococcal myositis. Both patients developed extensive muscle necrosis and overwhelming sepsis after trivial skin trauma. Death occurred within 48 hours of hospital admission despite aggressive surgical and medical treatment. Review of the literature is included to highlight the fulminant nature of this unusual infection and to contrast streptococcal myositis with other soft-tissue streptococcal infections.
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One hundred eight patients with rheumatoid arthritis received hydroxychloroquine for six to 24 months and were studied retrospectively to examine long-term efficacy and predictors of a favorable response to the drug. Response was classified in terms of reduction of active joint count and morning stiffness. Thirteen patients (12 percent) showed a complete remission. Fifteen patients (14 percent) had a 75 percent or greater response. Forty patients (37 percent) had a 30 to 75 percent response. Thirty-two (30 percent) had no response. Toxicity occurred in eight patients (7 percent) before clinical efficacy could be assessed. Seven of the 68 with response had a flare of disease after initial improvement. Of multiple clinical and laboratory parameters tested, only a stronger baseline grip strength was found to be statistically significant (p less than 0.001) in predicting a favorable response. Thus, hydroxychloroquine is an effective drug in the management of rheumatoid arthritis.
A previously healthy 40-year-old man presenting with fever, arthritis, and cutaneous vasculitis was found to have chronic meningococcemia. Evaluation of his complement system showed an absence of functional and antigenic C7, compatible with a complete deficiency of the seventh component of complement. Study of the patient's family spanning four generations showed heterozygous deficiency of C7 in five members. Chronic neisserial infection can be associated with C7 deficiency and must be distinguished from other causes of cutaneous vasculitis.
Cutaneous complications of chronic parenteral narcotic use have been described. A 61-year-old man had severe joint restriction secondary to fibrous replacement of proximal muscles. Parenteral pentazocine lactate use was implicated in the cause of his condition.
Many mammals exhibit elevated pulmonary arterial pressure when exposed to airway hypoxia. In addition, prolonged hypoxic exposure may result in elevated hematocrit and right ventricular hypertrophy. The current study was designed to test whether the hamster, a fossorial species, may possess naturally selected physiological characteristics advantageous to a chronically hypoxic environment. Hamsters and rats were studied at low altitude (1,520 m) and after 5 wk at high altitude (4,250 m). Hematocrit for low-altitude hamsters was 53 +/- 1 compared with 45 +/- 1 for low-altitude rats. Low-altitude hamsters and rats demonstrated the same right ventricular weight-to-total ventricular weight ratio (RV/T) (0.223 +/- 0.006 vs. 0.222 +/- 0.003). After high-altitude exposure the hematocrit for hamsters and rats was the same (58 +/- 1 vs. 57 +/- 1), but RV/T was less in the hamster (0.251 +/- 0.004 vs. 0.288 +/- 0.005). In addition, the hypoxic pulmonary pressor response of lungs isolated from low- and high-altitude animals was examined. Lungs from hamsters were less responsive than lungs from rats at all levels of hypoxia tested. In addition, exposure to altitude resulted in a diminished pressor response in lungs from both species. It is concluded that the pulmonary vasculature of the hamster is less responsive to hypoxia than that of the rat, and that this relative unresponsiveness may aid the hamster in an hypoxic environment.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A 58 year old female was evaluated for fever, rash, myalgias, muscle weakness and cervical lymphadenopathy. She was found to have myositis on muscle biopsy, toxoplasmic lymphadenitis on lymph node biopsy, and markedly elevated IgM and IgG antibody titers to Toxoplasma gondii. The patient was treated with prednisone and a 2 month course of sulfadiazine and pyrimethamine. The patient improved over the next six months and has been followed for approximately a five year period. During this time, antibody levels to the toxoplasma antigen have significantly decreased but the patient has developed a chronic myositis indistinguishable from polymyositis.
OBJECTIVE: To examine the constitutive pattern of cytokine production in patients with polymyositis (PM) and dermatomyositis (DM). METHODS: PBMC secreting the type 1 cytokines IL-2 and IFN gamma and the type 2 cytokines IL-6 and IL-10 were monitored by ELIspot assay. RESULTS: The frequency of IFN gamma-secreting PBMC was reduced 2-20 fold in patients with PM and DM when compared to normal controls (p < 0.01). This change correlated inversely with disease activity (p < 0.01). PM and DM were also characterized by increased numbers of cells secreting IL-10. Patients with DM had fewer IL-2 (p < 0.03) and more IL-6 (p < 0.006) secreting cells than normal controls or patients with other myopathies. CONCLUSIONS: Abnormal patterns of cytokine production characterize patients with PM and DM.