Biomedical subjects
Publications and source records attributed to J Varga.
A 38-year-old woman with limited cutaneous systemic sclerosis and pulmonary fibrosis developed diffuse alveolar hemorrhage during the course of her disease that responded well to steroids. We present the clinical history of the patient and discuss the different theories behind the association. The importance of steroid therapy for treatment of alveolar hemorrhage in this particular condition is emphasized.
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Forty-eight preselected patients (pts) with arteriosclerosis obliterans were investigated by dipyridamole thallium scintigraphy (DTS). No correlation was found between the distribution of positive or negative exercise ECG testing (ExECG) and isotopic risk-scores (P > 0.1 in the chi-square test). We assessed cardiac ischaemia in 12 pts with insufficient ExECG. Although only 2 pts had documented previous myocardial infarction, 20 pts exhibited irreversible perfusion defect. Silent reversible or irreversible ischaemia was identified in 12 pts (25%). Seven pts would not have been diagnosed to have coronary artery disease (CAD) even by ExECG. In conclusion, DTS was found very useful in these cases. We support a stepwise cardiac risk stratification before major vascular surgery.
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In recent years, the synthetic analogue elcatonin has been used successfully in the treatment of osteoporosis. During an investigation of synthetic strategies for the production of elcatonin, a number of peptide products were generated. These could be purified by liquid chromatography and were shown to have identical amino acid compositions. Investigation by fast atom bombardment-mass spectrometry revealed three of the peptides to have a common pseudomolecular ion but notably dissimilar fragmentation patterns. Further studies involving chemical modification, mass spectrometry and chromatographic separation showed these products to be novel depsipeptides, cyclized with an ester bond between either the serine or the threonine residue and the side chain of aminosuberic acid.
OBJECTIVES: To assess current prescribing patterns, and adherence to recommended practice guidelines, for the use of intravenous colchicine in the treatments of crystal-induced arthropathies. METHODS: Medical records of patients at an urban academic medical center who received intravenous colchicine were reviewed. Information about colchicine dosing and clinical outcomes, with particular attention to interventions by Rheumatologists, was obtained. All hospitalized patients with confirmed or suspected crystal-induced arthropathies treated with intravenous colchicine during a 48-month period were included in this retrospective study. The demographic profile, medical history and clinical data were reviewed. RESULTS: Intravenous colchicine dosing schedules generally followed recommended guidelines. There was no significant difference between patients evaluated by a Rheumatologist, and those that were not, in the cumulative colchicine dose received, clinical response, or length of hospitalization. Relative contraindications to intravenous colchicine were present frequently, but no morbidity or mortality directly attributable to intravenous colchicine was recorded. Patients evaluated by a Rheumatologist prior to receiving intravenous colchicine were significantly more likely to have the diagnosis of a crystal-induced arthropathy confirmed by the identification of crystals from synovial fluid, and less likely to have received oral colchicine prior to intravenous colchicine, than patients who were not evaluated by a Rheumatologist. CONCLUSIONS: Increased involvement of Rheumatologists, and increased awareness of the appropriate indications and guidelines for the safe administration of intravenous colchicine are recommended.