Biomedical subjects
Publications and source records attributed to J E Brick.
Patients with pain, dysethesias, or dysfunction of an extremity may present to a neurologist or rheumatologist for the same complaints. A careful history, physical examination, and a simple investigation will usually, but not always, allow for assignment to the proper clinic. This article addresses the ground shared by these two specialties with particular emphasis on common diseases.
Rheumatoid arthritis (RA) is a common disease with a significant economic and social impact on Americans. Many patients with RA are unresponsive to or intolerant of conventional therapy or the limited therapeutic options available. For many of those patients, immunosuppressive drugs have been the mainstay of therapy. Our experience with methotrexate for these patients indicates that this drug provides symptomatic relief and improvement in objective parameters. Significant toxicity was uncommon. Methotrexate should be considered for selected patients with severe rheumatoid arthritis when conventional measures have been exhausted.
Explore the source record for details and available documents.
Because hormonal influences on autoimmune disease in MRL-lpr and MRL-+/+ mice have not been defined completely, we examined animals which had been castrated and implanted with the opposite sex hormone. Antibodies directed at non-DNA antigens in a calf thymus nuclear extract (designated CTE) and specific anti-DNA antibodies were increased in estrogen-treated males, testosterone-treated females, and sham-operated female controls compared to sham-operated males. Analysis by sucrose gradient ultracentrifugation revealed that gonadal hormones exerted marked differences in the distribution and nature of circulating IgM anti-CTE antibodies. Although 19 S IgM was the predominant form of anti-CTE antibodies in experimental groups showing elevated anti-CTE responses, estrogen-treated male MRL-lpr mice expressed a large additional population of anti-CTE IgM antibody released by acid dissociation of apparently cryptic complexes. An unexpected additional finding was the presence of cryptic anti-CTE IgG (7 S) in all groups of MRL-lpr and MRL-+/+ mice, revealed only in sucrose gradient analysis under acid conditions. It is suggested that sex-related factors may account, in part, for apparent differences in levels of circulating autoantibodies observed in MRL mice by influencing the degree to which autoantibody populations exist in circulating complexes.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Hormonal, neurologic, and vascular factors affecting potency were evaluated in 10 men with scleroderma and in 10 age-matched men with rheumatoid arthritis. Impotence was reported by 6 of the patients with scleroderma and none with rheumatoid arthritis. Studies of serum testosterone, free testosterone index, follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, thyroxine, and thyrotropin did not show a hormonal basis for impotence in any patient. Neurologic causes were not found on physical examination. Penile blood pressures were markedly abnormal in 4 impotent patients, intermediate in 2 impotent and 3 potent patients, and normal in 11 potent patients. A history of claudication and diminished ankle blood pressures indicated large vessel disease in 2 impotent patients; the remaining 4 impotent men had normal ankle pressures, suggesting that their poor penile blood pressures and impotence were due to small vessel disease, perhaps the small artery lesions of scleroderma.
Explore the source record for details and available documents.
Previous work suggested that gonadal steroids influence immunity through the thymus, but the mechanisms were unclear. To investigate the effects of these hormones on immune responses to T1 and TD antigens in autoimmune mice, we studied hybrid NZB/W mice and the nonautoimmune DBA/2 strain. Mice castrated at 14 days of age were implanted with Silastic capsules releasing, in adults, physiologic levels of E2 in males or Te in females. Sham-operated controls received empty capsules. Splenic PFC were quantified 4 to 5 days after challenge with the TI2 antigen TNP-Ficoll, the TI1 antigen TNP-LPS, or the TD antigen SRBC. Young castrated NZB/W males implanted with E2 had striking enhancement of IgM responses to TNP-Ficoll when compared to castrated Te-treated females and comparable sham-operated controls of both sexes. E2 also stimulated responses to TNP-LPS. In response to challenge with SRBC, young E2-treated NZB/W males had a consistent trend to increased IgM PFC, and the stimulatory effect of E2 on IgG plaques was variable. Physiologic doses of Te had no consistent effect on responses in young mice. In old female NZB/W mice, Te caused PFC response after immunization with TNP-Ficoll to resemble age-matched NZB/W males. As sham-operated NZB/W females grew older, PFC responses to SRBC fell. This age-related phenomenon was delayed, however, in female castrates implanted with Te. In contrast, Te clearly suppressed responses to TNP-LPS. Implantation of E2 did not alter responses to TNP-Ficoll, TNP-LPS, or SRBC in nonautoimmune DBA/2 males. This finding suggested that exogenous E2 given in physiologic doses did not influence immunologic responsiveness in a normal strain to the degree seen in hormone-sensitive NZB/W mice. It was concluded that E2 enhanced responses to a variety of exogenous antigens in autoimmune NZB/W mice. The most consistent E2-induced increase in PFC response was observed with TI antigens, suggesting that E2 exerted its effects on B cells or Ts.
Two male patients with scleroderma and hypogonadism are described. One patient had Klinefelter's syndrome. The second had normal testosterone but elevated gonadotrophins. Possible relationships between scleroderma and hypogonadism are discussed.
Sixteen patients with acute myocardial infarction were subjects of a study of the changes in plasma magnesium and long-chain free fatty acid (FFA) levels. In each patient, there was a sharp fall of magnesium levels and a sharp rise of FFA levels shortly after onset of pain. Magnesium and FFA values returned to normal within three days. An absolute fall in total magnesium level and a probable fall in magnesium ion concentration could be important factors in arrhythmias during the first two days. The simultaneous rise in FFA and fall in magnesium levels in a variety of pathologic and physiologic conditions affords an explanation for divergent changes in FFA and magnesium concentrations in acute myocardial infarction. The FFA rise appears to be the fall in magnesium levels, which has been previously unexplained.
Explore the source record for details and available documents.
Cardiac bradyarrhythmias upon swallowing have been reported previously and most commonly have been related to esophageal abnormalities. We have reported the case of an unusual patient who experiences bradycardia and syncope only upon swallowing cold liquids.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
To compare medical records of patients treated for acute low back pain in the departments of Family Medicine, Internal Medicine, Occupational Medicine and Emergency Medicine in an academic medical center to determine if there was variation in patient population, diagnostic and treatment procedures and outcomes. Records were randomly reviewed using a standardized form for patients diagnosed with ICD 9 codes pertaining to back pain. Of the 96 patients with acute back pain seen in outpatient areas, 66 were seen by Family Medicine, 26 by Medical Group Practice (MGP), and four by Occupational Medicine. One hundred seven were seen in the Emergency Department. There was no significant difference in duration or type of pain or the type of findings or treatment. Very few had positive physical findings, (9% outpatient and 10% Emergency Department), but many more, (38% outpatient and 17% ED), had psychosocial findings (smoker, dissatisfaction with work, previous psychiatric history, psychosomatic history, or abnormal social adjustment) documented, Plain films of the lumbrosacral spine done in both practice settings did not change treatment.