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Biomedical subjects

L H Gerber

Publications and source records attributed to L H Gerber.

46 records · Page 3Linked to original sources
PubMed1979

Chest wall syndrome. A common cause of unexplained cardiac pain.

Twelve patients with severe, often incapacitating chest pain initially believed to be cardiac in origin were shown on subsequent evaluation to have chest wall syndrome. Diagnosis was suspected by the atypical nature of pain in 11 of 12 patients and confirmed by chest wall tenderness simulating the spontaneously occurring pain in all. Seven patients had chest wall syndrome in conjunction with other associated cardiac conditions. Five patients had isolated chest wall syndrome. All five had normal ejection fractions and no regional wall abnormalities on radionuclide cineangiographic studies performed during symptom-limited supine exercise, findings observed in few patients with coronary artery disease. Chest wall syndrome should be considered in all patients with chest pain, as its recognition can greatly aid in patient care.

Adult↗
PubMed1979

Avascular necrosis in systemic lupus erythematosus. Silent symmetric osteonecroses.

The symptomatic joint disease secondary to avascular necrosis of bone (ANB) in 31 of 375 (8 per cent) patients with systemic lupus erythematosus (SLE) was characterized by polyarticular (90 per cent) and symmetric (83 per cent) involvement. Progressive deterioration requiring orthopedic intervention occurred in 11 (35 per cent) patients. No distinguishing clinical or treatment differences were found comparing patients with symptomatic ANB and selected cortico-steroid-treated, asymptomatic, control subjects with SLE. Complete roentgenographic surveys revealed symmetric, polyarticular abnormalities of subchondral and cortical bone consistent with ANB in eight of 31 (26 per cent) of the control subjects. A positive correlation was found between roentgenographic ANB and disease treatment with high doses of corticosteroids. The study suggests that ANB may be present in excess of 30 per cent of the patients with SLE and is most often subclinical, asymptomatic and nonprogressive.

Adult↗
PubMed1979

Photochemotherapy and psoriatic arthritis. A prospective study.

We have studied the temporal relation between psoriasis and psoriatic arthritis in 27 patients receiving photochemotherapy for treatment of psoriasis. Patients were classified as either spondylitic or nonspondylitic. For spondylitic patients, psoriasis was difficult to control, arthritis did not improve, and skin and joint activity appeared to vary independently. In contrast, 67% of nonspondylitic patients receiving photochemotherapy treatment remained clear of psoriasis, with 49% mean improvement in articular index. There was an inverse relation between initial percentage of psoriasis and improvement in peripheral arthritis. These results suggest that aggressive management of psoriasis helps control synovitis in at least a subgroup of patients with psoriatic arthritis.

Arthritis↗
PubMed1979

A prospective study of the rehabilitation of the above-knee amputee with rigid dressing. Comparison of immediate and delayed ambulation and the role of physical therapists and prosthetists.

Twenty-four above-knee amputees (AKA) treated with rigid plaster dressings were randomized to receive ambulation on pylon within 24 hours of surgery or at time of suture removal. Casts were applied by physical therapists in half of each group, and by a prosthesist in the other half. There were no statistically significant differences among the groups with respect to age, sex, stump length, gait characteristics and wound healing. Time to prescription of final prosthetis was similar in all groups. Specifically, there was no delay in the group ambulated immediately. The immediate ambulators did have significantly greater stump pain requiring more analgesia than the group ambulated after suture removal. Patients with case applied by physical therapists used their prostheses more than patients with cases applied by prosthetists. There was no detectable difference among treatment groups with regard to participation in therapy, acceptance of prosthesis, and psychological status. Recommendation for management of AKA's include: use of rigid dressing; ambulation on pylon after suture removal; utilization of physical therapist for application of rigid dressings and alignment of pylon.

Adolescent↗
PubMedDate not supplied

Number of active joints, not diagnosis, is the primary determinant of function and performance in early synovitis.

OBJECTIVE: A substudy within a larger study of patients with inflammatory arthritis of less than one year, to analyze baseline measures or joint counts, laboratory values, patient questionnaires and ARA diagnostic criteria for rheumatoid arthritis, as predictors of one year performance and functional status. METHODS: 229 patients with synovitis of less than one year were enrolled and evaluated at baseline and one year. Measures included the number of swollen or tender joints [active joint counts]; biological indices of inflammation [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)]; and patient questionnaire measures of pain [Wisconsin Brief Pain Inventory], fatigue [multi-dimensional assessment of fatigue], depression [Center for Epidemiologic Studies--Depression Scale], sleep [Sleep Quality Index], performance [Human Activity Profile], and function [Sickness Impact Profile ambulation subscale and Health Assessment Questionnaire]. Correlations between these measures were evaluated using the Spearman rank order correlation. Patients were classified according to whether they met ARA criteria for RA, had high (> 7) or low (< or = 7) numbers of affected joints; and high, intermediate, or low levels of performance; and were compared using the Kruskal-Wallis test. RESULTS: At baseline, an active joint count of > 7 versus < or = 7 was associated significantly with higher age, rheumatoid factor positivity, a diagnosis of rheumatoid arthritis versus spondyloarthropathy or undifferentiated arthritis, and receiving a disease modifying antirheumatic drug (DMARD), but not with sex, race, erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), or receiving prednisone. Furthermore, high baseline active joint counts were associated significantly with patient questionnaire scores for maximum activity, fatigue and depression, but differences were not significant for sleep, ambulation and pain scores. A comparison of patients who met or did not meet criteria for RA indicated significant differences only according to the fatigue scores, but none of the other questionnaire measures. Correlations of baseline measures with one-year performance were highest for the baseline active joint count compared to laboratory and questionnaire variables. The maximum activity score at one year was predicted significantly by the baseline maximum activity score, active joint count, and age, but not by laboratory tests or whether the patient met criteria for RA. CONCLUSION: The active joint count predicts subsequent performance and function for patients with recent onset, inflammatory synovitis more effectively than whether patients met ARA criteria for RA.

Adult↗
PubMedDate not supplied

IgA-containing immune complexes in patients with psoriatic arthritis.

Using a sensitive, specific Raji cell radioimmunoassay we have analyzed the sera of 35 patients with psoriatic arthritis (PsA) for IgA-containing circulating immune complexes. In addition, the 125I-Clq binding assay and the Raji IgG radio-immunoassay were used to measure IgG or IgM containing circulating immune complexes. Twenty-eight of thirty five (80%) patients with PsA were found to have IgA-containing circulating immune complexes. In contrast, only 13 of 35 (37%) had IgG-containing circulating immune complexes detected using the Raji IgG assay and 10 of 33 (33%) had IgG- or IgM-containing immune complexes detected using the 125I-Clq binding assay. There was no significant difference in the frequency, level, or type of immune complexes detected in any of the clinical subtypes. There was however a significant correlation between the level of IgA-containing circulating immune complexes and the severity of the arthritis as determined by linear regression analysis (p less than 0.05). The finding of IgA-containing circulating immune complexes in 80% of patients with psoriatic arthritis as well as the significantly higher levels of these complexes in the patients with more severe arthritis suggests that IgA-containing circulating immune complexes may play a role in the pathogenesis of psoriatic arthritis.

Adolescent↗
PubMedDate not supplied

Immunologic abnormalities in idiopathic Raynaud's phenomenon.

Sera from 14 patients with idiopathic Raynaud's phenomenon were studied for immunoglobulin levels, autoantibodies and circulating immune complexes. In addition, the levels of immune complexes were studied in 17 sera from patients with secondary Raynaud's phenomenon. It was found that more than one half of the patients with idiopathic Raynaud's phenomenon have serologic markers of auto-immune disease. The incidence of circulating immune complexes was higher in patients with secondary (52%) compared to patients with idiopathic Raynaud's phenomenon (10%). The serologic abnormalities in idiopathic Raynaud's phenomenon patients did not correlate with asymptomatic pulmonary involvement.

Adolescent↗
PubMedDate not supplied

Human lymphocyte antigens characterizing psoriatic arthritis and its subtypes.

We performed human lymphocyte alloantigen determinations in patients with psoriatic arthritis (PsPA) who were clinically classified into arthritic subtypes and disease severity. The total PsPA group demonstrated elevations of HLA-BW38, CW6, DR4 when compared with controls (p less than 0.001). Severe arthritics have increased DR4 frequency when compared with less severe arthritics (p less than 0.02). Those with mild disease have increased A3, B7 frequency which was absent in patients with moderate or severe arthritis. Rheumatoid-like PsPA patients have increased DR4, B40 frequencies; those with spondylitis, B27, CW1. PsPA is associated with many genes in the major histocompatibility complex. Distinct groups of patients with PsPA as determined by type and severity are identifiable by the presence of specific human lymphocyte antigens.

Adolescent↗