Value of test for antinuclear antibodies in rheumatic diseases.
Explore the source record for details and available documents.
Antibodies, Antinuclear↗
Biomedical subjects
M M Steven
Publications and source records attributed to M M Steven.
The nature of iron deposits in haemophilic synovitis. An immunohistochemical, ultrastructural and X-ray microanalytical study.
Using a computerized electron-probe X-ray microanalytical technique to measure phosphorus/iron ratios we have defined the iron saturation of ferritin in vitro from prepared ferritin standards of known iron loading. This technique has been applied to the study of 5 haemophilic synovial membranes. At light microscope level the distribution and relationship of iron/ferritin were defined using Perls' reaction and an immunoperoxidase technique respectively. The synovia from all cases contained intra and extra-cellular deposits of Perls' positive material which were granular in nature in the most superficial synovial cells. There were increasing numbers of pheomorphic (1-12 micron diameter ovate bodies in the deeper synovial layers. Immunoperoxidase ferritin staining produced a strongly positive reaction in the granular material but the ovate bodies were negative with the exception of some peripheral staining. X-ray microanalysis showed the granular material to be highly iron saturated ferritin and the ovate bodies to be almost pure iron. We suggest that iron saturated ferritin in the synovial membrane could increase/perpetuate inflammation by promoting lipid peroxidation.
Electron Probe Microanalysis↗
Diffuse (eosinophilic) fasciitis. A series of six cases.
Six patients with diffuse fasciitis are described. Their ages range from 12 to 45 years. Five had a typical clinical illness which responded well to corticosteroid therapy but one patient relapsed a year after discontinuation of corticosteroids. One patient had severe skin ulceration resistant to corticosteroids, cytotoxics and plasma exchange and was further complicated by the development of life threatening local and generalised sepsis. Eosinophilia of the blood was not present in any of the cases and not unduly prominent in biopsies of the affected tissue, but characteristic fascial thickening and infiltration by chronic inflammatory cells was diagnostic when a full-thickness biopsy was examined. The natural history and optimal treatment of this condition remain unclear.
Adolescent↗
Enhanced bacterial phagocytosis by peripheral blood monocytes in rheumatoid arthritis.
To assess the functional state of peripheral blood monocytes in rheumatoid arthritis, we have measured phagocytosis of Staphylococcus aureus and Proteus mirabilis in 48 patients and 28 controls. Using radiolabelled bacteria preopsonised in normal human serum we have demonstrated significantly enhanced uptake of both organisms by patients' monocytes: (Median % uptake Staph. aureus: patients = 35.8; controls = 19.3; p less than 0.001. Median % uptake P. mirabilis: patients = 32.3; controls = 19.8; p less than 0.01.) These results indicate that patients' monocytes exist in an activated state, which may be important in the pathogenesis of rheumatoid arthritis.
Adult↗
Systemic lupus erythematosus and invasive thymoma: report of two cases.
Two cases of invasive thymoma in patients with systemic lupus erythematosus (SLE) are described. In both instances the suspected diagnosis of a mediastinal tumour proved difficult to confirm. Neither surgical removal of the thymoma in one case nor irradiation in the other had any apparent clinical or serological effect on the course of the SLE. Both patients subsequently suffered from respiratory problems and the distinction between recurrent tumour and pulmonary involvement by SLE proved difficult. One patient had a good response, however, to pulse methylprednisolone, but the other later developed recurrence of tumour and died of Pneumocystis carinii infection following cytotoxic therapy three years after discovery of the tumour.
Female↗
The physiological cost of gait (PCG): a new technique for evaluating nonsteroidal anti-inflammatory drugs in rheumatoid arthritis.
The physiological cost of gait (PCG) provides a technique for reproducibly quantifying the physical disabilities occasioned by inflammatory joint disease. The preferred walking speed (PWS) and the physiological cost index (PCI) related to achieving that PWS are shown to be abnormal in rheumatoid arthritis (RA) and objective improvement can be demonstrated with naproxen and indomethacin, two commonly-used nonsteroidal anti-inflammatory drugs (NSAIDs). Twenty patients with active RA were studied by double-blind cross-over technique and 16 completed the two-month study. Reliable PCG data obtained in 13 patients showed statistically significant improvement in PWS and PCI with NSAID therapy. Improvement was not correlated with conventional clinical measures of joint inflammation such as pain score, articular index, haemoglobin or ESR but the trends were similar. PCG may offer a reproducible, objective method of quantifying disability and response to treatment.
Arthritis, Rheumatoid↗
Total knee arthroplasty in haemophilic arthritis.
The results of total knee replacement in five patients aged between 22 and 37 with severe haemophilia A or B are described. All patients had been managed conservatively without success. Frequent bleeds, severe pain and limitation of movement were the indications for operation. Despite close haematological surveillance, bleeding problems occurred in three of the patients and large quantities of plasma concentrates were required. Review of the patients over a period of 25 to 48 months after operation showed dramatic lessening of pain and maintenance of a satisfactory range of movement. The frequency of haemarthrosis diminished markedly and the requirements for factor concentrate in the years after operation fell substantially. Two patients returned to employment. Total knee replacement led to marked clinical improvement in all the patients, but the long-term results are not yet known.
Adult↗
Does the order of second-line treatment in rheumatoid arthritis matter?
In a prospective study 88 patients, with rheumatoid arthritis who had stopped taking gold, penicillamine, or levamisole were randomly allocated to one of the alternative drugs and followed up for a minimum of one year. Concurrent studies of the effects of gold, penicillamine, and levamisole prescribed in 123 patients as the first second-line drug were used for comparison. No difference in toxicity or efficacy between primary and secondary use of gold or penicillamine was identified. Variation in the toxicity of levamisole could in part be accounted for by changes in the dose regimen over the four years of study. The length of the treatment-free interval between drugs did not influence subsequent development of toxicity. These results suggest that an adverse reaction to one of the three second-line drugs studied should not prejudice the selection of another.
Adult↗
Cerebellar cortical degeneration with ovarian carcinoma.
A case is described of progressive cerebellar degeneration in association with ovarian carcinoma, with nearly 4 years elapsing between the onset of neurological illness and the discovery of the carcinoma. Neither treatment with prednisolone nor surgical removal of the tumour effected any improvement, CAT scanning late in the illness showed marked cerebellar atrophy. Histology at post-mortem showed complete loss of cerebellar Purkinje cells. The cerebrospinal fluid gave weak binding to multiple neural components in a solid-phase radio-immuno-assay.
Atrophy↗
Pregnancy and liver disease.
Explore the source record for details and available documents.
Budd-Chiari Syndrome↗
The effect of plasma exchange on the in vitro monocyte function of patients with immune complex diseases.
In vitro function tests were performed on peripheral blood monocytes isolated from patients with putative immune complex diseases undergoing therapeutic plasma exchange. Bacterial killing by monocytes improved significantly after plasma exchange (pre: 29 +/- 5%; post: 39 +/- 3%). The intracellular content of the acid hydrolase N-acetylglucosaminidase (NAG) after in vitro culture rose significantly following plasma exchange (pre: 48.3 +/- 21 nmol mg protein-1 hr-1; post: 76.6 +/- 30.6), although the amount of NAG released into the supernatant was unchanged. Plasma exchange also resulted in reduced levels of immune complexes (IC) and clinical improvement in most patients. The beneficial effect of plasma exchange in patients with IC diseases may be partly due to removal of IC which are known to influence the functional activity of cells of the mononuclear macrophage series.
Acetylglucosaminidase↗
Prognosis of pregnancy in chronic liver disease.
Explore the source record for details and available documents.
Birth Weight↗
Pregnancy in chronic active hepatitis.
The outcome of pregnancy in chronic active hepatitis (CAH) was studied retrospectively, together with a survival analysis of patients and a comparison of fertility with that expected from controls drawn from the normal Australian population. Clinical records of 73 cases of CAH included 37 women who were potentially fertile (aged 15-45 years) and there were 30 pregnancies among 16 of these women. Hepatic and obstetric complications and the outcome for the foetus and the mother were compared with the results from 36 reports accumulated from the literature. The results showed an incremental increase in survival of patients with CAH according to decade of diagnosis from 1950 and similar severity of liver disease in those who did, or did not, become pregnant. Fertility was reduced in patients with CAH. Relapse of CAH occurred during pregnancy in only two patients, hepatic complications were minimal, and there was no consistent pattern of alteration in liver function; 12 of 16 mothers are alive for a mean period of eight years after pregnancy. Obstetric complications included urinary tract infections (six), toxaemia of pregnancy (nine) and prematurity (seven); of the 30 pregnancies, four were terminated on medical advice in the early years of the study, three ended in spontaneous abortion, and there were four perinatal deaths giving a foetal loss rate of 33 per cent. Despite the maternal disease and use of prednisolone and azathioprine during pregnancy, the single congenital abnormality was pyloric stenosis. We conclude that in CAH fertility is reduced but pregnancies which occur can proceed without detriment to the mother provided that prednisolone treatment is maintained; that a higher than normal foetal loss can be expected; and that babies may be born prematurely but will be normal.
Abortion, Spontaneous↗
Whole body retention of diphosphonate in rheumatoid arthritis.
The skeletal metabolism of patients with rheumatoid arthritis (RA) osteoarthritis (OA) and ankylosing spondylitis (AS) has been assessed by 24-h whole body retention of 99mTc diphosphonate (WBR). Values for RA and AS patients were significantly elevated but those of OA patients were not when compared to age and sex matched controls (27.0 +/- 8.6 vs 20.5 +/- 1.8%; 24.8 +/- 5.4 vs 19.4 +/- 1.5% greater than and 21.4 +/- 4.1 vs 21.2 +/- 1.4%, respectively). The WBR of patients taking steroids was greatly elevated and RA inpatients had higher values than outpatients, but the increased WBR could not be correlated with disease activity. The increased WBR in RA may represent an indirect effect possibly related to immobility.
Aged↗