Rheumatic fever and rheumatic heart disease.
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Humans↗
Biomedical subjects
L C Miller
Publications and source records attributed to L C Miller.
The role of causal sequence in the meaning of actions.
Single actions, taken out of context, typically have numerous meanings. Yet, when we observe such actions as part of a sequence of behaviour, we are often unaware of this multiplicity of possible meanings. In this article, we argue that the specific meaning of an action is the result of a process in which people, by making appropriate inferences, relate the actions in a sequence to each other and construct a coherent scenario from them. One implication of this position is that the meaning of actions should be extremely sensitive to the order in which they occur, since order affects which knowledge structures are currently active and is an important clue to the causal and means-end relations among actions. In fact, meaning should be so sensitive to order that it should be possible to construct sets of actions, such that merely by changing the order, the same set of actions could have two radically different meanings. Five sets of such actions were designed. Subjects read one of the two orders for each set of actions and then answered a number of open-ended questions about them. Subjects receiving different orders identified different causes and reasons for the actions, made different predictions about what would happen next, and came to different conclusions about the identities of actors and and objects in the sequences, thus indicating that they had constructed very different meanings for the same actions.
Concept Formation↗
Distribution of cells bearing "rheumatic" antigens in peripheral blood of patients with rheumatic fever/rheumatic heart disease.
Cell surfaces of some peripheral blood cells from individuals with a history of rheumatic fever/rheumatic heart disease (RHD) have been demonstrated by the use of monoclonal antibodies to be antigenically distinct from the majority of the population. Our study examines the distribution of cells bearing these "rheumatic" antigens in 23 subjects with rheumatic fever/RHD of Maori, Polynesian and Caucasian ancestry and 182 members of their families (rheumatic fever/RHD families) as well as in 46 members of families in which no member had been demonstrated to have had rheumatic fever/RHD (control families). Mononuclear cells from the blood of all cooperating family members were prepared and non-T cells isolated by sheep red blood cell rosette depletion. The binding of monoclonal antibodies 83S19.23 and D8103 to non-T cells was measured using an immunoperoxidase technique. Subjects with rheumatic fever/RHD had a significantly higher proportion of cells binding the antibodies than the unaffected members of all families. Unaffected members of rheumatic fever/RHD families had significantly higher levels of such rheumatic cells than control families. An increase in the proportion of rheumatic cells with age was noted in unaffected members of rheumatic fever/RHD families but not in rheumatic fever/RHD subjects of control families. A level of 13% 83S19.23 positive non-T cells optimally discriminated between rheumatic and nonrheumatic individuals. The relative risk for rheumatic fever/RHD with 13% or greater positive cells was 9.48. The negative predictive value of having less than 13% positive cells was 98.3%. In the population studied, 83S19.23 seems especially capable of identifying those with low risk for rheumatic fever/RHD.
Aging↗
Cytokines and immunoglobulin in rheumatic heart disease: production by blood and tonsillar mononuclear cells.
Rheumatic fever and rheumatic heart disease are considered to result from abnormal immune responses after Group A streptococcal pharyngitis. Production of interleukin 1 (IL-1), tumor necrosis factor-alpha (TNF), interleukin 2 (IL-2) and immunoglobulin (Ig) by blood and tonsillar mononuclear cells from rheumatic or healthy children was measured after stimulation in vitro by pokeweed mitogen (PWM) or the streptococcal extracellular product, blastogen A (BLA). Tonsillar cells from patients with rheumatic heart disease produced significantly less IL-1, TNF, IL-2, and Ig than control tonsillar cells. In contrast, blood mononuclear cell cultures from rheumatic children produced more TNF and IL-2 than controls. Our findings suggest that abnormal regulation of cytokine and Ig production may contribute to the pathogenesis of acute rheumatic fever and rheumatic heart disease.
Cells, Cultured↗
Drug selection for rheumatic manifestations of acquired immunodeficiency syndrome.
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Acquired Immunodeficiency Syndrome↗
Factor-analytically derived scales for the Louisville Behavior Checklist.
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Child↗
Augmentation of cytotoxic activity by mitogens in rheumatic heart disease.
Natural killer cell activity and alterations in cytotoxicity after culture with streptococcal blastogen A and phytohemagglutinin (PHA) were examined in patients with inactive rheumatic heart disease (RHD) and control patients. Natural cytotoxic activity of mononuclear cells (MNC) did not differ between RHD and control patients with either peripheral blood or tonsils. In cultured blood MNC the level of cytotoxic activity stimulated by blastogen A was significantly greater in patients with RHD at all effector:target cell ratios. These differences in cytotoxic activity were not observed with cultured tonsillar MNC. In similar experiments with a different group of patients, culture with PHA or blastogen A both produced a significantly greater increase in cytotoxic activity in blood MNC from patients with RHD. The increase was significantly lower with PHA than with blastogen A. The ability of mitogens to differentially augment cytotoxic activity in cells from the blood of patients with RHD implies that a population of cells exists in these patients that could be activated during acute rheumatic fever to play a role in pathogenesis.
Adolescent↗
Quantitative muscle testing in childhood dermatomyositis.
Sixteen children with dermatomyositis were followed longitudinally by quantitative muscle testing between 1972 and 1982. The time to achievement of normal muscle strength measured quantitatively was significantly delayed (p less than .001) compared to the time muscle strength was clinically assessed as normal by manual muscle testing. A significant difference was also found between the time normal muscle strength was measured and normal muscle enzymes were achieved (p less than .05). Quantitative muscle testing is a useful adjunct to clinical assessment of muscle strength and determination of muscle enzymes in the therapeutic management of patients with dermatomyositis.
Adolescent↗
Biologic activities of interleukin-1 relevant to rheumatic diseases.
In conclusion, IL-1 has multiple biologic activities relevant to rheumatic diseases. It mediates the acute-phase response, and exerts control over many metabolic functions of connective tissue, including muscle, bone, cartilage, synovium, and endothelium. IL-1 also has a profound effect on leukocyte function. Although few clinical studies have been reported, there is suggestive evidence that IL-1 plays a role in the pathogenesis of arthritis, scleroderma, SLE and vasculitis. That drugs useful in the therapeutic management of these conditions influence IL-1 activity provides indirect support for the involvement of IL-1 in pathogenesis. Clearly, further studies are needed in this area. With the recent development of recombinant preparations of IL-1, further investigation of IL-1 in connective tissue metabolism and clinical rheumatic disease can be carried out. Finally, the future development of pharmacologic agents specifically designed to alter IL-1 responses may allow specifically targeted therapy for rheumatic diseases.
Acute-Phase Reaction↗
Childhood dermatomyositis. Clinical course and long-term follow-up.
The presentation, clinical course, and long-term follow-up (3-22 years) of 39 children with dermatomyositis followed from 1962-1982 is presented. The medical course of these patients was complicated by respiratory diseases (20%), gastrointestinal diseases (24%), and calcinosis (30%). Patients presenting prior to 1972 received a wide variety of treatments. Since 1972, treatment has consisted of long-term prednisone, supplemented in some patients with azathioprine. Ten patients died (eight of whom were first seen before 1972) of complications after intestinal perforation (5) or aspiration pneumonia (5). Of 29 survivors, three have persistent calcinosis and/or contractures. Improved outcome since 1972 probably relates to better clinical assessment, management of complications, and regulation of drug therapy.
Adolescent↗
Mononuclear cell profiles in muscle biopsies from patients with polymyositis and childhood dermatomyositis.
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Biopsy↗
Effects of ovariectomy on vertebral trabecular bone in the cynomolgus monkey (Macaca fascicularis).
Seventeen ovariectomized and twenty-one intact female cynomolgus macaques were examined for differences in vertebral trabecular bone volume. The ovariectomized group exhibited significantly less trabecular bone than the intact group (p less than .005), 22 months post-ovariectomy. This finding encourages the use of the cynomolgus monkey as a model for the mechanism of bone loss in ovariectomy or postmenopausal osteoporosis.
Animals↗
Behavioral responsiveness of young chimpanzees (Pan troglodytes) to a novel environment.
Behavioral responsiveness to a novel environment was documented in 22 chimpanzees grouped according to age; 6-months, 1-year, 2-years and 5-years. An attachment figure, a human caretaker, accompanied each subject during the 15-min test sessions so as to preclude confounding of responses to novelty with separation responses. Extreme distress reported previously for chimpanzees and human children when tested alone in a novel situation was rarely observed in these tests when an attachment figure was present. Stereotyped rocking, an indication of mild distress occurred more frequently in the younger animals. Younger animals engaged in distal visual exploration of the environment while remaining close to the attachment figure, whereas the older animals locomoted more frequently and explored the environment directly with their hands. Repeated exposure to the environment reduced the differences among the 6-month, 1-year and 2-year groups. The 6-month group, however, continued to locomote least and least frequently engaged in tactile exploration. These data on chimpanzees resemble data on human children which suggest that an attachment figure: attenuates the distress exhibited by young individuals of these species when exposed to novel stimuli, and thereby provides a secure base which supports the exploration of novel stimuli, a prerequisite to behavioral adaptation.
Adaptation, Psychological↗
Bone measurement by enhanced contrast image analysis: ovariectomized and intact Macaca fascicularis as a model for human postmenopausal osteoporosis.
This paper presents an image enhancement and analysis system (DARWIN) based on an inexpensive microcomputer and applies the system to two bone morphometry problems relevant to postmenopausal osteoporosis. Using ovariectomized and intact female Macaca fascicularis as a model, we examined the radiodensity of the sixth lumbar vertebra and the cross-section area of the right femur. Significantly lower bone density was observed in the vertebral segments of the ovariectomized animals. No significant differences were observed in comparisons of the femoral cross sections. The reduction in radiographic density of the ovariectomized animals' vertebrae is similar to that observed in postmenopausal women, supporting the use of female cynomolgus macaques as models of bone loss in postmenopausal osteoporosis.
Absorptiometry, Photon↗
Effect of cooling on force oscillations during maximal voluntary eccentric exercise.
The effect of superficial cooling on force oscillations during maximal eccentric exercises of the quadriceps femoris was studied in 10 adults. Maximal (i) shortening (concentric) and (ii) lengthening (eccentric) exercises were performed at a velocity of 120 degrees/s through 60 degrees of knee flexion while linear envelope EMG signals were recorded from the surface of the vastus medialis muscle. Force oscillations (12.4 +/- 2.8 Hz) were present in all subjects in the first series of eccentric exercises. After 30 min of cooling, the oscillations were eliminated in two subjects and were reduced in number in two others of the five subjects in the experimental group. In contrast, all subjects in the control group still had oscillations when retested after a 30-min rest period. During the eccentric exercises, a synchronous silent period in the EMG tracings was evident just before a decrease in force. Subsequently, the EMG activity resumed and the force increased (force oscillation). Because the force oscillations were of large amplitude and occurred only during eccentric exercise, we conclude that the force oscillations were similar to physiological action tremor. Because the force oscillations and EMG patterns were altered by cooling, the mechanisms that initiate such oscillations during maximal eccentric exercise are suspected to include a neural component.
Cold Temperature↗
Wegener granulomatosis in pediatric patients.
Wegener granulomatosis is more easily recognized as a distinct clinical entity than other vasculitides because the initial clinical features frequently include granulomatous vasculitis of the upper and lower respiratory tract and glomerulonephritis. Although the disease has been lethal in the past, prolonged survival and avoidance of end-stage kidney disease can now be expected when cyclophosphamide therapy is introduced early in the course. We report four children with Wegener granulomatosis in whom the initial clinical findings suggested Henoch-Schönlein purpura. In two of the patients Wegener granulomatosis was not recognized until after end-stage kidney disease had developed. The course in these patients emphasizes the need for attention to even scant evidence of inflammation of the upper or lower respiratory tract in patients with glomerulonephritis. Appropriate diagnostic studies may then lead to recognition of Wegener granulomatosis and the prompt institution of appropriate treatment.
Adolescent↗
Nonhuman primate models of atherosclerosis: potential for the study of diabetes mellitus and hyperinsulinemia.
Nonhuman primates have been used for many years to investigate the pathogenesis and progression of atherosclerosis. The use of these animal models has resulted in a better understanding of the risk factors associated with atherosclerosis. Nonhuman primates that have consumed an atherogenic diet for several years develop lesions that are comparable to those found in human beings. Diabetes, both spontaneous and chemically induced, has been described in a number of nonhuman primate species. These diabetic models may be used to understand the accelerated progression and vascular complications of atherosclerosis in diabetic human beings.
Animals↗
Diethylstilbestrol exposure in utero and endometriosis in infertile females.
Endometriosis was found in 39% and in utero diethylstilbestrol (DES) exposure in 5% of 397 infertile women who had undergone laparoscopy and/or laparotomy among 750 consecutively evaluated infertile couples. Fifty percent of the DES-exposed infertile women also had endometriosis, similar to the 39% with endometriosis among non-DES-exposed women. Cervical stenosis was found in 25% of all DES-exposed patients and in 83% of those who had undergone cryocautery or conization. However, 40% did not have endometriosis. Thus, while the frequency of endometriosis and cervical stenosis is extremely high in infertile women exposed in utero to DES, a significant association beyond that found in non-DES-exposed patients could not be established. Some of the infertility may be associated with cervical stenosis alone.
Abortion, Spontaneous↗