Biomedical subjects
Publications and source records attributed to J Pinkhas.
In many rheumatic diseases fever may occur. This review presents data about the frequency of fever in rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, crystal induced arthritis, various vasculitides and sarcoidosis. The mechanism by which body temperature rises in these situations is discussed.
Seven of 60 human monoclonal anti-DNA autoantibodies derived from 3 patients with SLE were shown to bind to Raji cells by radioimmunoassay. The binding of the lupus autoantibodies to the Raji cells in solution was not affected by prior incubation of the cells with DNase. Preincubation of the monoclonal autoantibodies with polynucleotides and cardiolipin, resulted in significant inhibition which correlated with the direct binding characteristics of these antibodies. Previous results with mouse IgG monoclonal anti-DNA antibodies supported by our results with human IgM anti-DNA autoantibodies suggest caution in interpreting analyses of immune complexes of sera containing anti-DNA antibodies entailing Raji cells.
Imaging in a patient with multiple myeloma and Gaucher's disease showed space-occupying lesions in the liver and spleen. These were found to be plasmocytomas on histologic examination.
The influence of amphotericin B (AmB) on the aggregation of polymorphonuclear leukocytes (PMN) was examined by means of in vitro aggregometry as well as in an in vivo model of pulmonary leukostasis (PL). The AmB caused a dose-dependent aggregation of PMN that was partially blocked by addition of serum to the drug prior to its reaction with the PMN. No aggregation of PMN was seen after the addition of nystatin, a similar polyene antibiotic. In vivo studies were conducted in rabbits, where PL was induced by an intravenous infusion of zymosan-activated plasma (ZAP) or phorbol myristate acetate (PMA), and the degree of resulting leukostasis was expressed as the number of PMN per high power field (HPF). Animals in the control group had 6 +/- 3 PMN/HPF. This number increased to 12.4 +/- 5.6 when ZAP was infused and postmortem examination was performed 1 h later and to 17.4 +/- 4 if the examination was performed after 24 h. These numbers increased more than twice when AmB (1 mg/kg) was infused together with the ZAP. Increased PL after the infusion of ZAP and AmB was not attenuated by prior administration of methylprednisolone (30 mg/kg) to the animals. Infusions of AmB per se caused no significant PL but did cause increased pinocytosis in the pulmonary endothelium. Enhancement of PL by AmB was also examined in a model of PMA-induced PL.(ABSTRACT TRUNCATED AT 250 WORDS)
A 62-year-old woman who developed systemic lupus erythematosus 6 years following chemotherapy for malignant lymphoma is reported.
The possibility that fever may be an early manifestation of colorectal carcinoma was examined. Of 92 consecutive patients, 28 had preoperative fever. In four patients the fever was the presenting symptom of the colonic tumor, and in another six patients it preceded gastrointestinal complaints by 1 week to 4 months. Fever was thus the earliest manifestation of colorectal carcinoma in 10.8% of the patients. In 13 of the 28 patients the fever could not be explained by the intraoperative findings. We suggest that transient bacteremia may be a common but frequently overlooked manifestation of colonic cancer. Prognosis of the patient may be improved by alertness to the possibility that an episode of unexplained fever may be the first, and sometimes the only, manifestation of colorectal carcinoma.
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Benign familial leukopenia (BFL) is a hereditary phenomenon, encountered in several ethnic groups. Subjects bearing BFL are believed to be affected by bacterial infection in no greater incidence than normal subjects. In our study we investigated a group of subjects with BFL during an acute bacterial infection in comparison to subjects without BFL with the same infection. We found that the subjects with BFL had no absolute leukocytosis during the infection. Nevertheless, they reacted similarly to the other subjects in regard to their temperature and heart rate; however, they were hospitalized for fewer days than subjects without BFL. We conclude that BFL is a benign phenomenon, requiring neither specific treatment as such, nor more aggressive therapy during infection. The benign course of an acute bacterial infection in BFL indicates that perhaps the number of WBC's that are normally recruited during an infection in normal subjects highly exceeds that which is necessary.
Two patients with pneumonitis due to legionellosis are described. The etiologic diagnosis was based on high titers of immunoglobulin (Ig)M class antibodies (1/2048 and 1/512) detected by indirect immunofluorescence. The etiologic agents were presumed to be Legionella bozemanii in one case and either L. bozemanii or L. longbeachae in the other. Both patients made an uneventful recovery. Infections with these organisms have not been described in Israel previously.
Part of the "idiopathic" liver granulomas prove finally to be caused by infection, sarcoidosis, or malignancy. We looked for the initial admission parameters which may differentiate the idiopathic from the malignancy related granulomas. Patients with idiopathic granulomatous hepatitis had smaller spleen than of lymphoma related granulomas (2.15 +/- 2 versus 9.5 +/- 4.8 cm below the costal margin, p less than 0.01), smaller liver (2.61 +/- 2 cm versus 6.5 +/- 4.0 cm, p less than 0.05), a lower percent of eosinophils (2.3 +/- 1.4 versus 6.2 +/- 3.5%, p less than 0.05) and unlike patients with lymphoma, their fever did not persist beyond 4 wk (p = 0.03). Indeed, if the fever remitted spontaneously, it was likely that a benign condition was responsible for the granulomas (p less than 0.025). If fever persisted (4 wk), a liver or a spleen extending more than 4 cm below the costal margin and 4% eosinophils were attributed 1 point each; a score of 2 points had a specificity of 80 and a 100% sensitivity in detecting patients with lymphoma related liver granulomas. It is concluded that the size of the liver and spleen, the percentage of eosinophils, and the persistence of fever may differentiate between patients with idiopathic- versus lymphoma-related granulomatous hepatitis.
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Monoclonal IgG components were found in the serum of 5 of 40 patients with chronic myelocytic leukemia (12.5%), as well as in 2 of 15 patients with acute myelocytic leukemia (13.3%). These findings may represent an involvement of the lymphoplasmacytic system in myeloproliferative disorders. The significance of this association is discussed.
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A 25 year old woman suffering from recurrent attacks of hypoglycaemia underwent a laparotomy for suspected insulinoma. No tumour was found, but histology showed islet cell hyperplasia and nesidioblastosis. Although these changes have been reported as a cause of hypoglycaemia in infants, they are only rarely the cause of hypoglycaemia in adults; in the present case they were found to be the result of covert sulphonylurea administration. The fact that sulphonylureas can cause nesidioblastosis is not well recognised by either physicians or pathologists and it should be considered before "cryptogenic nesidioblastosis" is deemed the cause of hypoglycaemia in adults.
Two pregnant women with severe status asthmaticus unresponsive to intensive medical treatment are reported. Termination of pregnancies by cesarean section was followed by a dramatic improvement within 24 h. Termination of pregnancy is indicated in life-threatening status asthmaticus.