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Biomedical subjects

M I Jayson

Publications and source records attributed to M I Jayson.

At least 109 records · Page 6Linked to original sources
PubMed1989

Intervertebral foramen venous obstruction. A cause of periradicular fibrosis?

Disc herniation into the intervertebral foramen (IVF) or osteophytic outgrowths from the margins of the apophyseal joints that project into the IVF may compress the neural structures, but in this cadaveric study of 160 lumbar foramens (age range, 35-91 years), the authors have found that they were much more commonly associated with compression and distortion of the large venous plexus within the IVF. In the absence of direct nerve compression (seen in only eight specimens), the most severe neural changes were associated with compression, congestion, and resultant dilatation of foraminal veins. Pathologic changes within and around the nerve root complex included peri- and intraneural fibrosis, edema of nerve roots, and focal demyelination. Inflammatory cells were notably absent. Vascular changes within the thickened fibrous sheath about damaged nerves, namely, basement membrane thickening, suggestive of endothelial cell injury also were observed. The association between vascular compression, tissue fibrosis, and endothelial injury distant from the compression may be causal--probably due to ischemia as a result of reduced venous outflow. Such observations have led the authors to propose that venous obstruction may be an important pathogenic mechanism in the development of perineural and intraneural fibrosis.

Adult↗
PubMed1989

Platelet serotonin in systemic sclerosis.

Platelet serotonin concentrations were measured in 43 patients with systemic sclerosis, in 11 patients with primary Raynaud's phenomenon, and in 38 normal controls. Patients with the CREST variant (calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia) had significantly lower platelet serotonin concentrations than normal controls. Patients with diffuse systemic sclerosis had normal platelet serotonin concentrations. In patients with CREST treatment with ketanserin, a specific serotonin antagonist, normalised platelet serotonin concentrations. These data provide further evidence suggesting that in systemic sclerosis, particularly the CREST variant, there is widespread platelet activation.

Adult↗
PubMed1989

Ketanserin: an effective treatment regimen for digital ischaemia in systemic sclerosis.

We have studied the therapeutic effects of ketanserin, a specific serotonin antagonist, on digital ischaemia in 11 patients with the CREST syndrome of systemic sclerosis. Ketanserin was administered as a bolus of 10 mg intravenously, followed by an infusion over 72 h and then oral therapy. Skin blood flow as measured by thermography, bolometry, ultrasound Doppler pulses and laser light scattering, showed significant improvement. There was also marked clinical improvement with a reduction in the pain and healing of digital ulceration. These improvements were maintained on oral therapy. In 7 patients detailed studies were performed comparing oral and intravenous ketanserin therapy. When ketanserin was administered as a bolus 10 mg intravenous dose, followed by an infusion at 2 mg/h, steady state was reached by 12 h. Following oral treatment (40 mg tds) therapeutic blood levels were achieved.

Administration, Oral↗
PubMed1988

Psychiatric disorder and illness behaviour in rheumatoid arthritis.

A detailed physical and psychiatric assessment of 80 patients with definite or classical rheumatoid arthritis was performed using diagnostic criteria for psychiatric disorder appropriate for those with physical illness. Seventeen (21%) patients had depression or anxiety severe enough to warrant treatment. The presence of pychiatric disorders was not related to the duration of the arthritis nor to 11 other indicators of its severity with the exception of grip strength (p less than 0.002) and Fries Functional grade (p less than 0.005). It was significantly related to the presence of social stress (p less than 0.05) and lack of social support (p less than 0.005). Those with psychiatric symptoms scored higher on an illness behaviour scale, indicating that they perceived their illness as very severe. These also worried excessively about it and failed to be reassured by the doctor. Such illness behaviour was displayed by some patients who had severe arthritis but lacked social support. In others the complaints were unfounded because their arthritis was mild. They also experienced much social stress and lacked social support. We conclude that psychiatric illness occurs in rheumatoid arthritis with similar frequency to that of other general medical patients. It is principally related to social stress and lack of support rather than severity of arthritis, and may lead to abnormal illness behaviour. Since lack of social support appears of prime importance in determining disability, its assessment is essential for the rehabilitation of the disabled patient with RA.

Adolescent↗
PubMed1988

Autonomic neuropathy in systemic sclerosis.

Autonomic function assessed by tests of cardiovascular reflexes was studied in 25 patients with systemic sclerosis and 10 patients with primary Raynaud's phenomenon. A comparison was made with 13 normal healthy subjects. Significant abnormalities in the cardiovascular reflexes were found in systemic sclerosis, both in the CREST (calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia) variant and also in those patients with diffuse involvement. There was sympathetic and parasympathetic dysfunction. These findings suggest that autonomic neuropathy is a feature of systemic sclerosis.

Adult↗
PubMed1988

Retained surgical swab debris in post-laminectomy arachnoiditis and peridural fibrosis.

We examined soft tissue biopsies from 26 patients with symptomatic nerve root fibrosis and arachnoiditis after a previous laminectomy. Dense fibrous connective tissue was found about the nerve roots and in 14 cases (55%) fibrillar foreign material was seen within it. This material had the histochemical characteristics of cotton fibres from swabs and neurosurgical patties. In two other cases nerve root fibrosis was associated with residual radiopaque lipid thought to derive from earlier myelography. Our findings suggest that risks may be associated with the introduction of foreign material into the vertebral canal, and that microscopic fragments of surgical swabs and patties may have a role in the pathogenesis of postoperative periradicular fibrosis.

Adult↗
PubMed1988

Dexamethasone modulated protein synthesis in polymorphonuclear leukocytes: response in rheumatoid arthritis.

Nine polypeptides whose rate of synthesis is modulated in polymorphonuclear leukocytes (PMNL) by dexamethasone were studied by 2-dimensional polyacrylamide gel electrophoresis. In each case, there was a time lag between addition of dexamethasone and the appearance of any change in rate of synthesis. In PMNL from a group of patients with rheumatoid arthritis, dexamethasone modulated the synthesis of the same polypeptides as in PMNL from a group of healthy volunteers, but the degree of response of their polypeptides to dexamethasone was significantly reduced as measured by assaying the level of synthesis of a polypeptide of molecular weight 16,000. Reduced responses of PMNL polypeptide synthesis to glucocorticoid may allow the development of rheumatoid inflammation despite apparently adequate levels of endogenous corticosteroids.

Arthritis, Rheumatoid↗
PubMed1988

Cytokines in synovial fluid. I. The presence of biologically active and immunoreactive IL-1.

Using a sensitive IL-1-dependent T cell clone we estimated interleukin 1 (IL-1)-like activity in a variety of synovial fluids (SF). Although we demonstrate that SF contains potent inhibitors of endogenous and exogenous IL-1 we were able to estimate that samples from rheumatoid arthritis, osteoarthritis and other arthritides contain the equivalent of tens or hundreds of picograms of IL-1 per millilitre, when compared to a standard IL-1 preparation. Although there was some correlation between these results and those obtained using a radio-immunoassay (RIA) for IL-1 beta, the RIA indicated that IL-1 was present in the nanogram range. The results suggest that the importance of inhibitors of IL-1 in SF merits particular attention and that it is also important to consider the bioactivity of cytokines which may be detected by physical methods.

Arthritis↗
PubMed1987

The effects of immunosuppression and anticoagulation on fibrin deposition and swelling in rat cardiac allografts.

Rat cardiac allograft recipients were injected with radiolabeled human fibrinogen at intervals after transplantation. There was a progressive increase in tracer accumulation within graft ventricles, peaking at the time of rejection at about 30-fold that within syngeneic grafts. Protein extraction experiments indicated that ca. 90% of tracer was present as cross-linked fibrin at the time of rejection. Exudation within rejecting allografts was nearly threefold that in syngeneic grafts. The weight of allografts at different times after transplantation increased in close concordance with fibrin deposition. Pharmacologically immunosuppressed recipients showed negligible fibrin deposition and swelling whereas "B" rats and thoracic-duct-lymph-drained recipients showed moderate allograft swelling in the absence of significant fibrin deposition or rejection. The decreased fibrin deposition was not a result of depressed plasma clotting factor levels. B rats reconstituted with thoracic duct lymphocytes still had reduced allograft fibrin deposition in the presence of normal amounts of swelling and exudation. The anticoagulants warfarin and heparin greatly decreased allograft fibrin but were almost without effect on allograft swelling, exudation, and rejection. The possible participation of infiltrating macrophages in allograft fibrin deposition is discussed. Unlike cutaneous delayed hypersensitivity reactions, normal amounts of fibrin deposition appear not to be essential for full cardiac allograft rejection.

Animals↗
PubMed1987

The prescribing of chloroquine and hydroxychloroquine by consultant rheumatologists in the UK.

A questionnaire on chloroquine and hydroxychloroquine prescribing was circulated nationally to 212 consultant rheumatologists and 119 replies were analysed. Of all patients receiving second-line drugs, 10% were prescribed antimalarials, with hydroxychloroquine being used four times more frequently than chloroquine. Eighty-five per cent of rheumatologists always used the same dose of hydroxychloroquine or chloroquine. Only 5% considered patient's weight in deciding the dose. Fear of ocular toxicity was expressed by many physicians; 54% had experienced corneal deposits; 4% retinopathy and 40% believed cumulative dose determined toxicity. Much confusion existed over the necessity for and frequency of ophthalmological monitoring. Only 56% requested ophthalmological tests before commencing treatment, although 86% monitored the eyes during therapy. Other side-effects were believed to affect 1-10% of patients, with no anticipated difference between doses of 250 mg chloroquine and 400 mg hydroxychloroquine daily.

Arthritis, Rheumatoid↗
PubMed1987

Acute effects of sublingual nifedipine in patients with Raynaud's phenomenon.

Measurements of peripheral blood flow using bolometry, thermography, ultrasonic Doppler index, and laser light scattering were made in nine patients with primary Raynaud's phenomenon before and after administration of 20 mg sublingual nifedipine and matching placebo. Following nifedipine treatment, there was some evidence of protection against reduction in blood flow, suggesting that this way of taking nifedipine is helpful. Self-administration of sublingual nifedipine before cold exposure may be an effective way of preventing the development of attacks of Raynaud's phenomenon in contrast with the conventional form of regular oral administration.

Administration, Oral↗
PubMed1987

Impaired fibrinolytic activity in defined chronic back pain syndromes.

Fibrinolytic activity was studied in 34 patients who had chronic low-back pain of defined types (spondylosis, post-laminectomy and postmyelography-proven arachnoiditis, postlaminectomy and postmyelography-possible arachnoiditis, chronic prolapsed intervertebral disc (PID), spinal stenosis, and nonspecific low-back pain). Fibrinolysis was significantly impaired in the back pain patients as a whole compared with matched controls. Similar changes were observed in all the different back pain syndromes. In the smaller subgroups, these did not reach significance but were significant in spondylosis, proven arachnoiditis, and nonspecific back pain. It is suggested that the abnormal persistence of a defect in fibrinolytic activity, leading to fibrin deposition and chronic inflammation, may be an important factor in the chronicity of many back pain syndromes.

Adult↗
PubMed1987

Serial measurements of fibrinolytic activity in acute low back pain and sciatica.

A fibrinolytic defect is common in chronic back pain syndromes. Its role in the chronicity of these conditions is not fully understood. To elucidate the possible mechanisms, 11 patients with acute low back pain were studied over 12 months and compared with controls. The patients showed prolongation of the euglobulin lysis time throughout the study; the fibrin plate lysis area was initially normal but became abnormal within 2 weeks. In five patients, the symptoms resolved and the initial fibrinolytic defect improved. In contrast, the fibrinolytic defect remained in six patients with persistent pain. These results suggest that the fibrinolytic defect is secondary to mechanical damage but, if persistent, may become a secondary pathogenic factor associated with the chronicity of some back pain problems.

Adult↗
PubMed1987

Risk factors that may influence development of side effects of gold sodium thiomalate.

Two hundred and seventy-seven patients who had received gold sodium thiomalate (GST), were included in a retrospective study to identify those factors that might have influenced the development of side effects. Fifty-one per cent of patients were excluded due to side effects, especially skin rash, which affected 59% of those excluded. The duration of disease when GST therapy was commenced, female sex, and a history of smoking were identified as factors influencing the development of certain side effects. There was a high incidence of skin rash in smokers. Of 99 smokers, 40% developed dermatitis, whereas in 109 non-smokers, only 17% developed a rash (p less than 0.001). Other factors such as age, weight, and concurrent drug therapy, biochemical, haematological and immunological data, do not predict development of toxicity to GST.

Adult↗