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Biomedical subjects

G A McCain

Publications and source records attributed to G A McCain.

35 records · Page 2Linked to original sources
PubMed1989

The problem of longterm disability payments and litigation in primary fibromyalgia: the Canadian perspective.

The determination of disability in fibromyalgia syndrome is problematic because of its perceived subjective nature and the absence of well defined criteria for diagnosis. This, together with an unclear idea of the natural history, creates problems in litigation and determination of rehabilitation costs. Lawyers and third party payers must cooperate with physicians to determine the "hidden costs" of fibromyalgia so that a fairer estimate of longterm disability is achieved.

Canada↗
PubMed1989

Diurnal hormone variation in fibromyalgia syndrome: a comparison with rheumatoid arthritis.

Twenty patients with fibromyalgia syndrome and 20 patients with rheumatoid arthritis (RA) were assessed as outpatients over a 3 day period with respect to peak and trough levels of plasma cortisol, growth hormone, prolactin, ACTH and thyroid stimulating hormone. Patients with fibromyalgia syndrome had loss of diurnal variation in plasma cortisol (trough levels 347.3 +/- 254.7 vs 232.8 +/- 70.0 nmol/l, p less than 0.001) compared with RA patients. Thirty-five percent (7/20) of patients with fibromyalgia syndrome and only 5 percent (1/20) of those with RA exhibited abnormal dexamethasone suppression tests (p less than 0.001). No differences were noted in the diurnal variation of other hormones tested. Beck Depression Inventory scores were similar in both groups and no patient exhibited clinical evidence of depression. These data suggest alteration in the pituitary hypothalamic axis with respect to cortisol secretion in fibromyalgia syndrome, perhaps as a consequence of chronic pain.

Arthritis, Rheumatoid↗
PubMed1989

Nonmedicinal treatments in primary fibromyalgia.

To date, few nonmedicinal treatments for primary fibromyalgia have been studied using acceptable scientific standards. This has led to rather arbitrary use of disparate treatment modalities, often in a haphazard sequence. Because primary fibromyalgia syndrome is a chronic painful condition, rationale for treatment should be based on present concepts of pain perception supported by studies in the basic sciences. Recent clinical studies in the treatment of primary fibromyalgia syndrome conforming to the scientific method have been discussed in light of what is presently known about pain transmission and perception.

Biofeedback, Psychology↗
PubMed1988

A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia.

Forty-two patients with primary fibromyalgia were randomized into a 20-week program consisting of either cardiovascular fitness (CVR) training or simple flexibility exercises (FLEX) that did not lead to enhanced cardiovascular fitness. Patients were supervised by the same medical fitness instructors. Patients in neither group had contact with members of the other group, and were blinded as to the exercise taught to the alternative group. Groups met for 60 minutes 3 times each week. The compliance rate was 90%. Thirty-eight patients completed the study (18 with CVR training and 20 with FLEX). Blind assessments (standardized in preliminary trials to achieve acceptable inter-rater agreement) were performed by the same 2 examiners. After 20 weeks, patients receiving CVR training showed significantly improved cardiovascular fitness scores compared with those receiving FLEX training (t[35] = -4.22, P less than 0.003). Logistic regression analysis showed clinically and statistically significant improvements in pain threshold scores, which were measured directly over fibrositic tender points, in patients undergoing CVR (t[35] = 2.21, P less than 0.04). There was also a trend toward improvement in pain scores (visual analog scale) in the CVR group, but this did not reach statistical significance. There was no improvement in the percentage of body area affected by fibrositic symptoms or the number of nights per week or hours per night of disturbed sleep (self-report inventories). However, compared with the FLEX group, the CVR-trained patients improved significantly in both patient and physician global assessment scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Consultation letters as a method for assessing in-training performance in a department of medicine.

This study examined the feasibility of using outpatient consultation letters as a means of assessing the clinical performance of clerks and house staff in a large teaching hospital. A total of 222 assessments were obtained based on samples of consultation problems from two clinical services. The method involved a two-stage rating scale based on the performance areas of Data Base, Problem Formulation, Diagnostic Tests, Management and Overall Assessment. The technique was investigated in terms of the objectivity, reliability, validity and efficiency of the performance ratings. Product-moment coefficients were used to assess inter- and intrarater agreement in scoring the consultation letters. These analyses identified a consistent difficulty in assessing the category of Data Base. For the remaining performance categories, interrater coefficients in the range .19-.76 and intrarater coefficients in the range .23-.96 were obtained. Other preliminary findings indicated good potential for a reliable and valid assessment. The method is technically feasible, and is based on a novel and reasonably unobtrusive approach to assessing trainee performance in a clinical setting.

Canada↗
PubMed1988

Sodium aurothiomalate inhibits T cell responses to interleukin-2.

We studied the effects of the gold compound sodium aurothiomalate (SATM) on the responses of murine CTLL2 cells, and human T cells to Interleukin-2 (IL-2). SATM inhibited tritiated thymidine (3HTdR) incorporation by CTLL2 cells stimulated with human recombinant IL-2. Human T cells were cultured with phytohemagglutinin (PHA) in separate experiments and IL-2 receptor expression measured by using immunofluorescent anti-Tac serum; SATM inhibited IL-2 receptor expression. Furthermore, SATM when added concurrently with PHA, and IL-2 inhibited 3HTdR incorporation by human T cells in 5 day cultures. The kinetics of inhibition were further studied by adding PHA to T cells for 48 hours followed by the addition of SATM and IL-2; SATM inhibited 3HTdR incorporation even though receptor expression had occurred. These results suggest that SATM inhibits the stimulatory effects of IL-2 on T cells partly by interfering with IL-2 receptor expression, and partly by other mechanisms of action. These effects of SATM may explain some of the conflicting data in the literature on T cell responses to IL-2 in rheumatoid arthritis (RA), and suggest a possible mechanism of action for the drug in the treatment of RA.

Female↗
PubMed1987

Effects of gold on the production of and response to human interleukin-1.

We studied the effects in vitro of sodium aurothiomalate (GSTM) on the production of, and response to, a monocyte supernatant with interleukin-1 (IL-1)-like activity. Monocyte supernatant was produced by human peripheral blood monocytes stimulated with lipoprotein polysaccharide, and its IL-1-like activity assayed by its effect on tritiated thymidine incorporation by C3H/HeJ mouse thymocytes. GSTM inhibited the thymocyte response to monocyte supernatant even when added to monocyte supernatant and thymocytes after 48 h of culture. GSTM also inhibited production of IL-1-like activity by monocytes, when added to culture within the first 22 h. Inhibition of both response to and production of monocyte supernatant was dose dependent. These effects of GSTM on Il-1-like activity may constitute one of the mechanisms of action of the drug in rheumatoid arthritis.

Adult↗
PubMed1987

Pain perception and personality measures as discriminators in the classification of fibrositis.

Twenty patients with fibrositis were compared to age and sex matched groups of patients with rheumatoid arthritis (RA) and normal controls regarding personality variables measured by the Basic Personality Inventory (BPI) and responsiveness to experimentally induced pain. The group with fibrositis scored significantly higher than the normal group on 4 of the BPI scales and had lower pain threshold and tolerance than the normal group. The group with RA was found to be significantly different from the normal group on hypochondriasis and pain tolerance. Using only pain and personality measures, a statistical discriminant function that was developed resulted in a 72% classification accuracy for the 3 groups studied and 85% accuracy when only the 2 clinical groups were considered.

Adult↗
PubMed1986

Role of physical fitness training in the fibrositis/fibromyalgia syndrome.

Cardiovascular fitness training has been suggested as a treatment for the fibrositis/fibromyalgia syndrome. Thirty-four patients with fibrositis/fibromyalgia who met Smythe's original criteria were randomly assigned to enter either a cardiovascular fitness training program or a program consisting only of flexibility exercises. Patients met in supervised groups three times weekly for a 20-week observation period. The cardiovascular fitness group underwent gradual heart rate-elevated training using a bicycle ergometer and achieved a 29.1 +/- 24.4 percent increase in peak work capacity at 170 beats per minute (PWC-170). Patients undergoing flexibility training had a net reduction in their PWC-170 scores of 4.3 +/- 9.4 percent. Patients in the cardiovascular fitness group had statistically significant improvements in the visual analogue pain scale of current pain intensity; total myalgic scores in which pain thresholds at five fibrositic tender points selected for acceptable intra-rater and inter-rater reliability were measured using a dolorimeter; percentage total body area affected as measured by self-administered pain diagrams; and patients' and physicians' global assessment scores. Psychologic profiles as measured by Symptom Checklist-90R also improved in the cardiovascular fitness group compared with the flexibility training group. It is concluded that cardiovascular fitness training is feasible in patients with fibrositis/fibromyalgia and that such training improves subjective measurements of pain-reporting behavior. A theoretic basis for improvements in pain measurement scales and psychologic profiles is discussed in light of recent literature.

Cardiovascular Physiological Phenomena↗
PubMed1986

Evaluation of amitriptyline in primary fibrositis. A double-blind, placebo-controlled study.

Seventy patients with primary fibrositis satisfying Smythe's criteria were studied in a 9-week double-blind trial comparing 50 mg amitriptyline with placebo. Fifty-nine patients completed the trial: 27 were treated with amitriptyline, and 32 took a placebo. The patients who received amitriptyline improved significantly in their morning stiffness and pain analog scores at 5 and 9 weeks, compared with baseline scores, whereas no changes were noted in these parameters in the placebo group. Fibrocytic point tenderness did not improve significantly in either of the treatment groups. When compared with the placebo group, the amitriptyline group improved significantly with respect to sleep pattern and patient and physician global assessments. Our data indicate that amitriptyline has some therapeutic benefit in patients with primary fibrositis.

Adult↗
PubMed1985

The effects of auranofin and gold sodium aurothiomalate on the chemiluminescent response of stimulated synovial tissue cells from patients with rheumatoid arthritis.

Mononuclear cells were obtained from synovial tissue of patients with rheumatoid arthritis. The cells were stimulated with opsonized zymosan and generation of reactive oxygen species (ROS) was assayed by chemiluminescence. The effects of gold sodium thiomalate (GSTM) and auranofin (AF) on the chemiluminescent response were observed. Synovial tissue cells showed a chemiluminescent response suggesting their ability to release ROS; this response was inhibited by AF but not by GSTM.

Adult↗
PubMed1984

Helper T cell function of rheumatoid synovial tissue lymphocytes.

The helper cell profiles of rheumatoid peripheral blood (PBT-RA), synovial fluid (SyT-RA) and synovial tissue (SyN-RA) T lymphocytes were compared both before and after irradiation with similarly treated normal peripheral blood T cells (PBT-N). Deficient helper cell profiles were noted in SyN-RA and were correlated with increased numbers of activated T lymphocytes in culture. Moderately reduced helper cell profiles were seen in PBT-RA and were the result of a functional lack of a radioresistant helper T cell and/or radiosensitive suppressor T cell. SyT-RA, however, showed normal or enhanced T helper cell profiles and similar numbers of activated T cells compared with PBT-RA. Activated helper T cells therefore play an important role in the local immune response in inflamed rheumatoid synovium.

Adult↗
PubMed1978

Antibody to extractable nuclear antigen in the rheumatic diseases.

Two hundred and eighty-four patients with various rheumatic diseases were studied for the prevalence of antibodies to extractable nuclear antigen (anti-ENA) using an improved haemagglutination technique. Anti-ENA rarely occurred in patients with rheumatoid arthritis, scleroderma, polymyositis, dermatomyositis and Sjögren's syndrome. Seventeen per cent (13/72) of patients fulfilling at least four preliminary ARA criteria for systemic lupus erythematosus (SLE) demonstrated anti-ENA. The predominant antibody was directed at ribo-nuclease-resistant ENA (anti-Sm). Antibodies to ribo-nuclease-sensitive ENA (anti-RNP) occurred in the minority of patients with SLE (2/72) and the mixed connective tissue disease syndrome (MCTD). A trend toward an increased incidence of renal disease in SLE patients with anti-Sm was present. Sequential analysis of anti-Sm in patients with SLE showed a fall in titre paralleling the normalization of anti-DNA antibody titres and serum complement values. No case of unrecognized MCTD was uncovered in our rheumatic disease population.

Adult↗
PubMedDate not supplied

MR imaging of muscle and tender points in fibromyalgia.

Fibromyalgia is a syndrome manifested by chronic, diffuse musculoskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1-weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1-weighted, gadopentetate dimeglumine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibromyalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.

Adult↗
PubMedDate not supplied

The modulation of interleukin 1 production by interferon gamma, and the inhibitory effects of gold compounds.

We have studied the in vitro effects of gold sodium thiomalate (GST) and auranofin (Auf) on the production of interleukin 1 (IL1) expressed as thymocyte co-stimulatory activity (TCSA), and interleukin 1 beta (IL1 beta) as modulated by interferon gamma (IFN gamma). Adherent cells (ADC), of which 80% were monocytes, were obtained from human peripheral blood, and stimulated with lipoprotein polysaccharide (LPS) for 24-48 h. TCSA and IL1 beta production by fresh ADC (0-24 h) was significantly higher than that of aged ADC (24-48 h). The addition of IFN gamma to ADC cultures, however, maintained the capacity of aging ADC to respond optimally to LPS. The addition of GST or Auf inhibited this modulatory effect of IFN gamma, resulting in a marked reduction of TCSA and IL1 beta production. The effects of IFN gamma on the production of IL1 may be important in the pathogenesis of rheumatoid arthritis (RA). The inhibition by GST and Auf of IFN gamma modulation may contribute to the therapeutic efficacy of these drugs in RA.

Auranofin↗
PubMedDate not supplied

Septic Discitis.

The clinical and laboratory findings in 15 patients with septic discitis are reported. The clinical picture was that of a sub-acute illness characterized by back pain, spinous process tenderness, and sciatic nerve root irritation. There was a considerable delay from clinical presentation to diagnosis (average 14 wk). The erythrocyte sedimentation rate was the most useful diagnostic laboratory blood test and the best indicator of disease activity. The relative value of plain radiographs, tomography, and radionuclide bone scans is discussed. Needle aspiration of the disc space was found to be a useful diagnostic test. We found that a diagnosis of septic discitis could be made even in the absence of positive bacterial cultures from various biologic fluids or from the disc space. Long-term oral and intravenous antibiotic therapy with controlled rest resulted in a favourable outcome.

Adolescent↗