Pulse methylprednisolone therapy in rheumatoid arthritis.
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Arthritis, Rheumatoid↗
Biomedical subjects
M D Smith
Publications and source records attributed to M D Smith.
Varied appearance of AIDS-related lymphoma in the chest.
The authors reviewed all cases of acquired immunodeficiency syndrome (AIDS)-related lymphoma (ARL) seen at their institution between January 1982 and September 1988 to determine the frequency and appearance of ARL in the chest. Of 35 patients with ARL, 11 (31%) had biopsy-proved thoracic involvement. This frequency is significantly greater than that previously reported. The radiologic appearance of the thoracic involvement varied. Pleural effusion, interstitial and alveolar lung disease, nodules, and, infrequently, hilar and mediastinal adenopathy were observed. ARL of the chest was most commonly extranodal. Pleural effusion and lung disease were the two most common manifestations of ARL on chest radiographs and computed tomographic scans. The authors recommend that clinicians treating patients with suspected or known AIDS consider ARL when a pleural effusion or a noninfective interstitial or alveolar process is present.
Acquired Immunodeficiency Syndrome↗
Oxygen delivery rate and sufficiency of oxygenation during ECMO in newborn baboons.
Minimum acceptable O2 delivery (DO2) during extracorporeal membrane oxygenation (ECMO) remains to be defined in a newborn primate model. The right atrium, carotid artery, and femoral artery were cannulated, and the ductus arteriosus, aorta, and pulmonary artery ligated in neonatal baboons (Papio cynocephalus) under a combination of ketamine, diazepam, and pancuronium. The internal jugular vein was also cannulated retrograde to the level of the occipital ridge. We measured hemoglobin, pH, arterial and venous PO2 (both from the pump circuit and from the cerebral venous site), serum lactate and bicarbonate concentrations, and pump flow, and we calculated hemoglobin saturations, (DO2), O2 consumption (VO2), systemic O2 extraction, and cerebral O2 extraction. Six baboons were studied during each of two phases of the experiment. In the first, flow rates were varied sequentially from 200 to 50 ml.kg-1.min-1 with saturation maximized. In the second, flow was maintained at 200 ml.kg-1.min-1 and saturation was reduced sequentially from 100 to 38%. VO2 fell significantly below baseline at a flow rate of 50 ml.kg-1.min-1 and a DO2 of 8 +/- 2 (SE) ml.kg-1.min-1 in phase 1 and at DO2 of 12 +/- 5 in phase 2. Both systemic and cerebral O2 extraction rose significantly at a flow of 100 ml.kg-1.min-1 and DO2 of 17 +/- 4 ml.kg-1.min-1 in phase 1, whereas neither rose with decreasing DO2 in phase 2. In fact, cerebral extraction fell significantly DO2 of 16 +/- 6 ml.kg-1.min-1.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Concentrations of sulfasalazine and its metabolites.
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Arthritis, Rheumatoid↗
Tips of the trade #19. An intraoperative technique for measuring compartmental pressures.
A useful technique is described for measuring compartmental pressures. Readily available standard operating room anesthesia equipment can be used to obtain accurate, easily reproducible measurements.
Compartment Syndromes↗
Cytokines in synovial fluid in rheumatoid arthritis.
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Arthritis, Rheumatoid↗
Chest wall hamartoma of infancy.
Chest wall hamartoma is a rare intrathoracic mesenchymal tumor occurring in infants and usually present from birth. The tumor arises from the ribs and is a histologically benign focal overgrowth of normal skeletal elements. Infants often present with respiratory problems. We report a case of a 5-month-old infant with a chest wall hamartoma who presented with a fever of unknown origin.
Hamartoma↗
Interleukin 2 and interleukin 2 inhibitors in human serum and synovial fluid. I. Characterization of the inhibitor and its mechanism of action.
An inhibitor of the murine interleukin 2 (IL-2) dependent cell line (CTLL-2) has been demonstrated in sera from healthy subjects as well as in sera and synovial fluid from patients with inflammatory arthritides. This inhibitor inhibits the mitogenic response of normal peripheral blood mononuclear cells and seems to be primarily due to impaired IL-2 production. The inhibitor does not appear to bind to IL-2 or the IL-2 receptor. This inhibition can be reversed with IL-2 but not interleukin 1. These observations may apply to the defects in IL-2 production and response demonstrable in rheumatoid arthritis and other autoimmune disorders.
Adult↗
Interleukin 2 and interleukin 2 inhibitors in human serum and synovial fluid. II. Mitogenic stimulation, interleukin 2 production and interleukin 2 receptor expression in rheumatoid arthritis, psoriatic arthritis and Reiter's syndrome.
Peripheral blood and synovial fluid (SF) mononuclear cells from 30 patients with rheumatoid arthritis (RA) were hyporesponsive to mitogenic stimulation with plant lectins and CD3 antibodies, due to depressed interleukin 2 (IL-2) production and IL-2 receptor upregulation. In contrast, in the seronegative arthritis patient group only SF mononuclear cells were hyporesponsive to mitogenic stimulation and there were no significant differences in IL-2 production or IL-2 receptor upregulation as compared with control subjects. No significant correlations were observed between IL-2 inhibitor levels and mitogenic responses, IL-2 production and IL-2 receptor upregulation on peripheral blood and SF mononuclear cells but an inverse correlation was noted between SF mitogenic responses and the expression of selected activation markers. We conclude that IL-2 abnormalities appear to be most pronounced in RA compared with other inflammatory arthritides and that these changes do not appear to be directly related to serum or SF IL-2 inhibitor levels.
Arthritis↗
Pivotal role of aortic valve area calculation by the continuity equation for Doppler assessment of aortic stenosis in patients with combined aortic stenosis and regurgitation.
Aortic regurgitation (AR) may result in overestimation of the aortic pressure gradient by continuous wave Doppler in patients with mixed aortic valve disease. However, few data are available regarding the effect of AR on noninvasive estimates of aortic valve area by the continuity equation. Therefore, 25 patients with angiographically documented severe AR and peak systolic aortic velocities of greater than 2.5 m/s were studied by continuous wave Doppler to determine the accuracy of pressure gradient and aortic valve area calculations in assessing the severity of aortic stenosis (AS) in this patient population. Peak instantaneous pressure gradient showed a general correlation to but was overestimated by Doppler (r = 0.78, Doppler = 0.70 catheter + 19.9) and did not predict aortic valve area. Mean pressure gradient by Doppler correlated more closely with catheter mean gradient (r = 0.86, Doppler = 0.79 catheter + 6.1) but was a poor predictor of the severity of AS. In contrast, the continuity equation accurately predicted the aortic valve area by catheterization (r = 0.92, Doppler = 0.89 catheter -0.08). Thus, the continuity equation provides a reliable estimate of aortic valve area in patients with severe AR and should be used to evaluate the extent of AS in such patients when high systolic aortic velocities are present.
Aortic Valve↗
A practical application of Doppler echocardiography for the assessment of severity of aortic stenosis.
This study evaluated a strategy that makes optimal use of Doppler echocardiography for estimating the severity of valvular aortic stenosis (AS). Fifty-eight patients with no more than moderate aortic insufficiency who underwent cardiac catheterization were evaluated with two-dimensional echocardiography and Doppler velocimetry to determine the peak velocity across the stenotic valve and aortic valve area (AVA) by means of the continuity equation. All 33 peak Doppler velocities of greater than or equal to 4 m/sec had critical AS (AVA less than or equal to 0.8 cm2 at catheterization). Conversely, six of seven patients with Doppler velocities of less than or equal to 3 m/sec had noncritical AS. The patient with a falsely low peak velocity had severely depressed left ventricular function. Doppler velocity alone was inadequate in determining severity of AS for patients with velocities between 3 and 4 m/sec. The continuity equation proved accurate in estimating AVA in the 46 patients for whom catheterization and ultrasound data were sufficient to compare calculated AVA (r = 0.81), and was also accurate for those patients with peak Doppler velocities between 3 and 4 m/sec (r = 0.90). These results suggest that Doppler velocimetry alone is adequate in determining critical vs noncritical AS in many patients, while the continuity equation should be applied for patients with peak velocities between 3 and 4 m/sec as well as in patients with severely depressed cardiac function.
Adult↗
Observer variability in the quantitation of Doppler color flow jet areas for mitral and aortic regurgitation.
Early studies using Doppler color flow imaging have suggested that measurement of the regurgitant jet area provides information regarding the severity of valvular insufficiency. This study was performed to assess the observer variability of mitral and aortic regurgitant jet area measurements using the Doppler color technique. Color Doppler recordings from 45 patients were reviewed: 23 patients had aortic regurgitation and 22 had mitral regurgitation. To assess interobserver variability, the largest definable mitral regurgitant jets from three cardiac cycles were independently chosen and measured by planimetry by two observers who were unaware of other patient information. Measurements were repeated by both observers at a separate time to obtain intraobserver data. Videotapes from 23 patients with aortic regurgitation were similarly analyzed. Each observer measured the isovolumic aortic jet (before mitral valve opening) and the maximal aortic regurgitant jet (at any time during diastole) using computer-assisted planimetry. Both intraobserver and interobserver correlations were excellent for mitral regurgitant jet areas (r = 0.97 and r = 0.93, respectively). The intraobserver correlation for isovolumic aortic regurgitant jet was r = 0.73; the interobserver correlation for this measurement was only fair (r = 0.57). For the maximal aortic regurgitant jet area, intraobserver correlation was good (r = 0.86) and interobserver correlation was fair (r = 0.72). These findings suggest that intraobserver and interobserver reproducibility are acceptable for the measurement of mitral regurgitant jet area.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Aortic and mitral valve replacement in idiopathic hypereosinophilic syndrome.
Idiopathic hypereosinophilic syndrome is a rare systemic manifestation of eosinophilia that may cause endocardial fibrosis. Endocardial fibrosis and overlying thrombus typically lead to a restrictive cardiomyopathy and heart failure. Occasionally mitral or tricuspid regurgitation (or both) occurs as a result of the fibrosis and thrombus formation. This report describes a patient with hypereosinophilic syndrome who was seen with an unusually localized form of cardiac involvement that resulted in predominantly aortic and mitral stenosis. This was treated with bivalvular replacement.
Adult↗
Use of exercise Doppler echocardiography to evaluate cardiac drugs: effects of propranolol and verapamil on aortic blood flow velocity and acceleration.
This study evaluated the ability of exercise Doppler echocardiography to identify hemodynamic changes due to cardiac medication. Twenty young healthy volunteers (mean age 30 years) underwent continuous wave Doppler examination from the suprasternal notch at rest, during each stage of a standard exercise protocol and immediately after exercise. On completion of the control test, each subject received either 60 to 80 mg of propranolol or 120 mg of verapamil orally, and the same exercise protocol was repeated after 90 min. During the control test, values for modal velocity, acceleration and flow velocity integral all increased significantly from baseline (p less than 0.0002 for each). When exercise was repeated after propranolol administration, values for all Doppler measurements were significantly altered. Modal velocity at baseline was significantly lower after propranolol when compared with control (0.53 +/- 0.11 versus 0.63 +/- 0.17 m/s; p less than 0.0001). Similarly, modal velocity at maximal exercise was significantly lower after propranolol (1.11 +/- 0.2 versus 1.25 +/- 0.21 m/s; p less than 0.0001). The effect of propranolol on acceleration was even greater, with blunting of baseline (11.4 +/- 2 versus 15.4 +/- 5 m/s per s; p less than 0.0005) and exertional (33.4 +/- 10 versus 56.3 +/- 15 m/s per s; p less than 0.0001) acceleration. The flow velocity integral during exercise was greater after propranolol (14.1 +/- 3.1 versus 10.1 +/- 3.2 cm; p less than 0.0005) than during the control test. Verapamil failed to influence any Doppler-measured index of aortic blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Oral↗
Evaluation of imipenem/cilastatin for treatment of infection in an elderly population.
Eighty-seven episodes of infection occurring in 83 patients were treated with imipenem as the sole antibiotic (1.5-4 g daily). All patients were aged 65 years or over, many with other non-infective diseases. A favourable clinical outcome (infection cured or improved) was obtained in 88% of cases. Of the 37 patients who were microbiologically evaluable, a favourable clinical outcome occurred in 92% and a favourable bacteriological outcome (pathogen eradicated or suppressed) occurred in 86% of cases. There were 13 deaths amongst the study group, which might be expected in an ill elderly population. None of the deaths was thought attributable to imipenem. Minor clinical side effects occurred in 10.6%, and one patient sustained a cerebral ischaemic episode and fits, possibly related to imipenem. No serious changes were detected in laboratory parameters.
Aged↗
Angiotensins II and III prevent captopril-induced renin release in the rat.
1. The effects of exogenous angiotensins II and III (50 pmol/min i.v.) on plasma renin release following captopril injection (5 mg/kg, i.v.) were studied in anaesthetized Sprague-Dawley rats, to determine whether angiotensin II blockade is the major mechanism by which captopril induces renin release. 2. Captopril produced a 12-fold increase in plasma renin concentration compared with saline-injected controls. This was completely reversed by pre-infusion of angiotensin II or III. 3. The fall in blood pressure following captopril treatment was also abolished by angiotensins II and III pre-infusion. Noradrenaline pre-infusion (200-800 ng/min, i.v.) also prevented the captopril-induced hypotension but did not alter the rise in plasma renin. 4. Ureteric ligation did not significantly reduce captopril-induced renin release suggesting that acute changes in sodium excretion or delivery of electrolyte to the macula densa were not involved in renin release. 5. These findings suggest that captopril induces renin release by inhibiting angiotensin II feedback control of renin secretion and that angiotensin III may also modulate renin release.
Angiotensin II↗
Duplication insertion of drug resistance determinants in the radioresistant bacterium Deinococcus radiodurans.
Escherichia coli drug resistance plasmids were introduced into Deinococcus radiodurans by cloning D. radiodurans DNA into the plasmids prior to transformation. The plasmids were integrated into the chromosome of the transformants and flanked by a direct repeat of the cloned D. radiodurans segment. The plasmid and one copy of the flanking chromosomal segment constituted a unit ("amplification unit") which was found repeated in tandem at the site of chromosomal integration. Up to 50 copies of the amplification unit were present per chromosome, accounting for approximately 10% of the genomic DNA. Circular forms of the amplification unit were also present in D. radiodurans transformants. These circles were introduced into E. coli, where they replicated as plasmids. The drug resistance determinants which have been introduced into D. radiodurans in this fashion are cat (from Tn9) and aphA (from Tn903). Transformation of D. radiodurans to drug resistance was efficient when the donor DNA was from D. radiodurans or E. coli, but was greatly reduced when the donor DNA was linearized with restriction enzymes prior to transformation. In the course of the study, a plasmid, pS16, was discovered in D. radiodurans R1, establishing that all Deinococcus strains so far examined contain plasmids.
Cloning, Molecular↗
Effects of chrysotherapy on circulating lymphocyte numbers and subsets.
In a prospective 24 week study of 25 patients with rheumatoid arthritis (RA) weekly intramuscular (IM) sodium aurothiomalate resulted in a small but significant reduction in the circulating lymphocyte count. Analysis of absolute levels of pan T cells, T4 helper cells, T8 suppressor cells, T4/8 ratio, B cells, and major histocompatibility complex (MHC) class II positive cells showed reductions in these subsets, though these changes did not reach significance. At entry there was no association between circulating lymphocyte counts and subsets and clinical and laboratory indices which reflected disease activity, and during the study gold responders could not be differentiated from non-responders with regard to changes in lymphocyte counts and subsets. Thus this study suggests that weekly IM gold leads to a modest reduction in circulating lymphocyte numbers which involves most subsets. This effect appears to be independent of the clinical efficacy of this drug.
Arthritis, Rheumatoid↗