An unusual case of temporal arteritis presenting with sensorineural hearing loss is presented. Deafness was improved dramatically by corticosteroid treatment. The diagnosis of temporal arteritis should be considered in elderly patients presenting with sensorineural hearing loss.

Aged↗

PubMed1988

Recurrent ventricular tachycardia in hypothyroidism--report of a case and review of the literature.

A 47-year-old woman suffered from recurrent attacks of ventricular tachycardia. Her electrocardiogram showed low voltage, right bundle branch block and prolonged QT interval. Hormonal studies disclosed primary hypothyroidism. The arrhythmia responded to treatment with procainamide and did not recur following thyroid replacement therapy. The QT interval returned to normal. Five similar cases reported in the literature are reviewed, emphasizing the importance of QT prolongation, in the context of hypothyroidism, as a risk factor for the occurrence of ventricular tachycardia.

Electrocardiography↗

PubMed1988

Reduced incidence of hyperkalemia and azotemia in patients receiving sulindac compared with indomethacin.

The incidence and severity of hyperkalemia and azotemia was investigated in a prospective randomized study involving 74 patients receiving either sulindac 200 mg p.o. b.i.d. or indomethacin 25 mg p.o. t.i.d. and 100 mg p.r. The mean +/- SE posttreatment increment in serum potassium was 0.8 +/- 0.1 mmol/l in patients treated by indomethacin compared to 0.5 +/- 0.1 in those receiving sulindac (p less than 0.025). The mean +/- SE posttreatment increment in blood urea nitrogen (BUN) was 3.1 +/- 0.4 mmol/l in patients on indomethacin compared to only 0.9 +/- 0.3 in patients on sulindac (p less than 0.001). In 5 patients who developed hyperkalemia while on indomethacin, changing to sulindac resulted in a sharp reduction of serum potassium in 3, and normalization of BUN in all patients. These data support the claim of a reduced risk of impaired renal function associated with the use of sulindac.

Aged↗

PubMed1987

Involvement of the peripheral nervous system in temporal arteritis-polymyalgia rheumatica. Report of 3 cases and review of the literature.

Involvement of the peripheral nervous system is very uncommon in the temporal arteritis-polymyalgia rheumatica syndrome. Three different presentations of the involvement can be recognized: mononeuropathy, polyneuropathy and brachial neuropathy--C-5 radiculopathy. We report 3 patients in whom peripheral nerve symptomatology dominated the clinical picture of the disease, and review 20 previously published cases.

Aged↗

PubMed1987

Pulmonary manifestations of temporal arteritis.

Temporal arteritis is a well-recognized multi-systemic disease. Pulmonary manifestations, however, are extremely rare. In two patients with biopsy-proven temporal arteritis, lung involvement was observed. One patient presented with multinodular pulmonary lesions, while the second had a diffuse interstitial pattern. Both patients responded well to corticosteroid treatment. In a review of the literature, only four additional cases associating lung involvement with temporal arteritis were found. The possibility of primary pulmonary vasculitis should be considered in elderly patients with temporal arteritis.

Adrenal Cortex Hormones↗

PubMed1986

Masked depression. Help for the hidden misery.

Depression that is hidden by somatic or other symptoms is called masked depression. Although one of the more common illnesses in medical practice, masked depression is often misdiagnosed or ignored and usually inappropriately treated. Treatment consists of many of the same measures used in any other major depression--a combination of antidepressant medication and psychotherapy.

Adult↗

PubMed1986

Medical problems in Ethiopian refugees airlifted to Israel: experience in 131 patients admitted to a general hospital.

Within a 2 month period 131 Ethiopian immigrants were admitted for treatment at a general hospital in Jerusalem. There were 52 patients with malaria, 13 with typhoid fever, 24 with pneumonia, seven with tuberculosis, nine with shigella and 11 with campylobacter. Over three-quarters of these patients were anaemic. In the majority of cases anaemia was normocytic and was most probably secondary to malaria and other intercurrent infections. The prevalence of diffuse non-toxic goitre was 7% in children and 19% in adults with a male to female ratio of 4:13. A positive rapid plasma reagin (RPR) test was found in 4% of sera tested and a positive HBsAg in 13%. IgG antibodies to HBc antigen were found in 75% of subjects. All patients with infectious diseases responded to therapy and, despite their poor condition at arrival, there were no fatalities and no late sequelae. The high HBsAg carrier state calls attention to the risk of vertical transmission by infected mothers and underlines the need for active immunization of infants at risk. The high prevalence of untreated tuberculosis and malaria poses a potential public health hazard, but with the current systematic screening of this population leading to identification and effective treatment of affected subjects, chances for the practical eradication of malaria and tuberculosis are excellent. Finally, the large scale transfer of a population from rural Africa to a modern and largely urban society presents a unique opportunity for a prospective study of the impact of environment on the emergence of diseases which plague modern society such as diabetes, atherosclerotic cardiovascular disease, hypertension and cancer.

Adolescent↗

PubMed1986

Hyperkalemia associated with sulindac therapy.

Hyperkalemia has recently been recognized as a complication of nonsteroidal antiinflammatory agents (NSAID) such as indomethacin. Several recent studies have stressed the renal sparing features of sulindac, owing to its lack of interference with renal prostacyclin synthesis. We describe 4 patients in whom hyperkalemia ranging from 6.1 to 6.9 mEq/l developed within 3 to 8 days of sulindac administration. In all of them normal serum potassium levels reached within 2 to 4 days of stopping sulindac. As no other medications known to effect serum potassium had been given concomitantly, this course of events is suggestive of a cause-and-effect relationship between sulindac and hyperkalemia. These observations indicate that initial hopes that sulindac may not be associated with the adverse renal effects of other NSAID are probably not justified.

Adult↗

PubMed1985

Hepatosplenic peliosis after danazol and glucocorticoids for ITP.

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Aged↗

PubMedDate not supplied

Dolichol-mediated enhanced protein N-glycosylation in experimental diabetes--a possible additional deleterious effect of hyperglycemia.

In liver cells from diabetic rats, an increased incorporation of labeled glucosamine into cellular and secretory proteins was found, when related to the incorporation of labeled leucine. This increased N-glycosylation was present in the face of decreased synthesis of hepatic cellular and secretory proteins evident from reduced leucine incorporation and diminished glycosyltransferase activity. To elucidate the mechanisms involved we incubated isolated hepatocytes with two N-glycosylation inhibitors: tunicamycin and 2-deoxyglucose. Tunicamycin exerted a marked inhibitory effect on the incorporation rate of labeled glucosamine into proteins in liver cells from diabetic rats, while 2-deoxyglucose had a negligible effect on this process in these cells. These diverse effects might be explained by the fact that tunicamycin acts through strong association with the enzyme catalyzing the first step in glycoprotein synthesis, namely, the transfer of UDP-GlcNAc to dolichol-P (indicating noncompetitive inhibition). This enzyme is reduced in liver cells from diabetic animals. On the other hand, 2-deoxyglucose exerts its effect by being attached to dolichol-P, preventing further elongation of oligosaccharide chain on the protein backbone. This latter effect might be eliminated by excess dolichol-P (indicating competitive inhibition). The dolichol content in liver extract from diabetic rats was about 2.5-fold higher compared with nondiabetic rats (51.6 micrograms/g versus 20.6 micrograms/g wet liver weight). These two lines of evidence confirm the notion that the enhanced enzymatic glycosylation in liver from diabetic animals is maintained by an increased hepatic dolichol concentration, which is most probably related to the hyperglycemia. Thus, the dolichol-N-glycosylation pathway may represent another detrimental aspect of hyperglycemia and may operate by dolichol mass action rather than through glycosylating enzyme activity.

Animals↗

PubMedDate not supplied

Rheumatoid arthritis in the aged. Incidence and optimal management.

Rheumatoid arthritis (RA) is estimated to occur in 0.3 to 3% of the general population. Up to one-third of RA patients first present for treatment after the age of 60 years (elderly-onset RA). The overall frequency in individuals older than 65 is increased, so that 30 to 40% of RA patients treated in rheumatology centres are > 60 years of age. Optimal management of all RA patients includes physical therapy, medications, both nonsteroidal anti- inflammatory drugs (NSAIDs) and remittive agents, and, in some cases, surgery. In the elderly, these treatment modalities at times need to be altered to accommodate age-related changes in body mechanics and organ function. Thus, the approach to physical therapy in older patients is different than in the young. There are fewer rest periods and more passive exercises. Drug treatment must also be modified, since NSAIDs and several remittive agents are more hazardous in elderly patients. Indications for orthopaedic procedures may also be different. The long term management of RA requires a delicate balance of benefit and risk. It is wise to begin with the least toxic medications. However, if necessary, potentially toxic medications can be given cautiously, with close monitoring for adverse effects.

Aged↗

PubMedDate not supplied

Palindromic rheumatism: effect of dietary manipulation.

OBJECTIVE: Evaluation of the contribution of dietary components in triggering the attacks of palindromic rheumatism (PR), and the effect of dietary manipulation on the frequency and severity of PR attacks. METHODS: Sixteen patients (10 males, 6 females) were diagnosed as having PR during 1994-8 in one center. Their mean age was 45 +/- 6, duration of symptoms prior to diagnosis was 4 +/- 1.4 years, and frequency of PR attacks were 3.1 +/- 1.8/month. All patients were instructed to make a list of the food that was consumed daily and to specify the dates of PR episodes. Data were evaluated after a period of 2-4 months in each patient. RESULTS: In 5 patients (31%) there was an association between episodes of PR and certain foods that were consumed within 36 hours prior to PR episodes. These were fish (2 patients), eggs, canned vegetables and processed cheese (each in one case). Elimination of the relevant food from each patient's diet resulted in complete cessation of the PR attacks in two of the cases, while the other three had milder, infrequent attacks. Four patients were rechallenged with the offending food. In all cases it resulted in recurrence of the PR attacks. No association between PR episodes and prior consumption of certain foods could be documented in the other 11 patients. CONCLUSIONS: In some PR patients ingestion of certain foods, specific for each case, can trigger the typical attack. It is suggested that this association should be looked for in any PR patient, as elimination of the offending food from the diet may help in preventing the PR attacks.

Adult↗

PubMedDate not supplied

Neurologic manifestations of giant cell arteritis.

Neurological manifestations are common in giant cell arteritis. Both the central and peripheral nervous system can be involved. The most dreaded manifestations are visual loss and stroke. Both frequently have premonitory symptoms, such as amaurosis fugax, blurry vision, diplopia, transient ischemic attacks, and jaw claudication. Although most of these manifestations occur prior to steroid therapy, they may also develop during the early phase of therapy, or during tapering of the dose of steroids. Earlier diagnosis, close monitoring and improving the treatment protocols may prevent mortality and improve morbidity in these cases.

Cranial Nerve Diseases↗

PubMedDate not supplied

Behçet's disease: does lack of knowledge result in under-diagnosis?

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Behcet Syndrome↗