Biomedical subjects
Publications and source records attributed to M Yaron.
A patient with systemic lupus erythematosus who developed osteonecrosis in 13 sites is presented. Most lesions occurred while corticosteroid dose was increased during disease exacerbations. Pathogenetic mechanisms are reviewed and possible simulation of polysynovitis is discussed.
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There is an increased incidence of arthritides and tendinitis in patients with hyperlipidemias, especially types II and IV. The mechanism responsible for these manifestations is at present not known. It is important to recognize this association and to test plasma lipid levels in any case of arthritis which does not fit into one of the well-established diagnostic entities.
A case of juvenile dermatomyositis developing intermuscular fascial plane calcification in the thighs early in the course of the disease is described. The use of CT was helpful in localizing the calcium deposits between the muscular layers before surgical removal of the calcification. These procedures may have prevented fistulization and development of contracture of the joints.
One hundred and twenty patients with hemisacralization of the L5 vertebra associated with LBP underwent clinical, conventional X-ray and CT examinations. More than 50% of the patients had scoliosis. One third of the patients had disc lesions. Sacroiliac joint sclerosis was noted in two thirds of the cases. Almost all patients had an articulation between the hemisacralized side of L5 and the sacrum, which usually showed degenerative changes. Clinical symptoms are correlated to the CT and X-ray findings.
A review of the medical literature was carried out to determine guidelines for cost-effective and safe use of chest radiography in the emergency department. Screening radiographs are indicated in specific populations in the search for occult tuberculosis or carcinoma and in routine or preoperative cases. Radiography is clinically indicated in the asthmatic patient, the elderly patient, and the symptomatic patient, and its indications are modified by the patient's age and presenting signs and symptoms. Based on the information reviewed, rational guidelines for the use of chest radiography are presented.
In an attempt to study the variation of associations between HLA and rheumatoid disease a population of 44 Ashkenazi and 29 non-Ashkenazi patients with Rheumatoid Arthritis were tested for HLA-A, B, C and DR antigens and compared with the relevant control groups. In contrast to the results obtained in Middle European or North American Caucasians, Rheumatoid Arthritis in Israel is not associated with B15 and Cw3, indicating that it is very unlikely that B- and C-locus antigens are involved in coding for disease susceptibility for RA. The allele DR4 which is found associated with RA in almost all populations tested so far was in the total patient group (47.9%) slightly but not significantly more frequent than in the control group (38.3%). This difference was entirely due to a nonsignificant increase in the frequency of DR4 in the Ashkenazi patients (54.5%) compared to controls (40%), while the frequency of DR4 in non-Ashkenazi patients and controls was virtually identical (38.0% vs 36.7%). Another surprising finding was that the frequency of HLA-DR1, which has been reported to be increased in different populations of patients with RA was found to be completely normal in the present study on Israeli patients. The alleles of the Bf and the GLO system did not show any significant difference between patients and controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Antibodies to native human Type I + III collagen were measured by a radioimmunoassay in sera samples of 42 rheumatoid arthritis (RA) patients. Sixteen patients (38%) had significant antibody titers. Although the frequency of HLA-DR antigens of RA patients did not differ from that of the random Israeli population, there was a significant association (P less than 0.01) between the presence of collagen antibodies and HLA-DR4.
Typing for HLA-A,B,C and DR antigens was performed in 61 Israeli patients with juvenile chronic arthritis (JCA) and in 120 unrelated controls. No significant associations were apparent in the overall patient group. DR5 was significantly increased in the non-Ashkenazi patients with pauciarticular onset of disease. The only three DRw8 positive patients in the study had pauciarticular onset. DR5 and DRw8 were found in 9 of 10 patients with age of onset less than 3 years. Increased frequencies of Bw50 and Cw6 were observed in patients with systemic onset. Typing for properdin factor (Bf) and glyoxylase (GLO) was carried out in 45 and 50 of the patients, respectively. No associations with alleles of the complement Bf system or the HLA linked GLO system were evident. The confirmation in the ethnically distinct Israeli population of the previously described association of DR5 with pauciarticular JCA suggests that this gene may be closely related to the disease susceptibility gene.
Three male patients with psoriatic arthritis of the temporomandibular joint (TMJ) were evaluated by computerized tomography (CT). Only one patient showed changes of the mandibular condyle on the panoramic view, which failed to show the condition in the other 2 patients. All 3 had normal conventional radiographs of the affected TMJ. In all 3 cases the high resolution CT scan demonstrated significant changes of the mandibular condyle and glenoid fossa, which were consistent with the clinical diagnosis of psoriatic arthritis of the TMJ.
Bronchoalveolar lavage (BAL) was performed to assess the nature of pulmonary involvement in 12 asymptomatic nonsmoking patients with rheumatoid arthritis (RA). All 12 patients had normal lung function tests, including diffuse capacity for carbon monoxide and normal blood gases. Four patients (33%) had mild basilar interstitial changes on chest radiographs. In these 4 patients an elevated lymphocytic count in BAL fluid (30.7 +/- 8.3%) was found, as compared to the 8 patients with normal chest roentgenograms (7.2 +/- 1.9%; p less than 0.001). We suggest that BAL may be used as a sensitive tool for early diagnosis of pulmonary involvement in patients with RA.
Two girls, one with progressive systemic sclerosis and a second with dermatomyositis, developed calcinosis in the skin of the prepatellar area. Calcinosis was accompanied by local inflammation and skin ulceration. Oral colchicine therapy in a dosage of 1 mg per day was followed within two months by significant regression of local inflammation and healing of the skin ulcers.
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In order to assess the value of the leukergy test in which leukocytes aggregate in citrated whole blood, we examined 65 patients with various rheumatic conditions. In addition, plasma samples from 40 patients were examined for neutrophil aggregation activity in vitro. Results of the leukergy test were found to be in very good correlation with disease activity (P = 0.0001), whereas no increased neutrophil aggregation activity was found in the 40 plasma samples examined. The value of the leukergy test in assessing patients with rheumatic disease and its theoretical etiopathogenic role in these diseases are discussed.
C-reactive protein levels were measured in sera of 111 patients with rheumatoid arthritis and were compared with erythrocyte sedimentation rate. The patients were divided into six groups according to drug therapy. Comparison between the groups suggests that CRP correlates best with ESR in patients treated with penicillamine and in patients in clinical remission. Patients treated with gold, NSAID or methotrexate have a weaker correlation between the two parameters, while steroid therapy yields the poorest correlation which is not statistically significant. Our data suggest that although CRP is a sensitive index of disease activity, the specific drug taken by the patient must be considered before interpreting the results.
An unusual case of neuropathic arthropathy in a patient with tabes dorsalis is presented. The special feature consisted of multiple joint involvement in the upper limbs and spine. This uncommon location of Charcot joints can probably be attributed to the patient's occupation which involved heavy strains on his upper limbs.
The first instance of familial amyloidotic polyneuropathy affecting a Jewish family is reported. Vitreous opacities were its presenting feature in the father at age 30 and the son at 25. Severe autonomic dysfunction and progressive peripheral neuropathy affecting initially the lower extremities soon followed. Death, suicidal in the son, occurred after seven and four years of illness. Their amyloid contained three proteins-an entire variant monomer of prealbumin, glycine replacing threonine as residue 49, and both products of its cleavage at the point of substitution. Lower limb familial amyloidotic polyneuropathy has been recorded in many families in Portugal, Sweden and Japan and occasionally in families of various ethnic stocks. This ethnic diversity prompts consideration of genetic heterogeneity. Differentiation on a genetic basis is forestalled since all pedigrees are compatible with autosomal dominant transmission and clinical data are marred by observer variance, even regarding vitreous opacities. Notwithstanding, an isolated British family is unique in the frequent occurrence of intractable peptic ulceration, cataracts, deafness and renal disease not attributable to amyloidosis and a striking predominance of males afflicted. Biochemically, monomeric prealbumin has been demonstrated by electrophoretic and immunologic techniques as the single protein constituent of amyloids isolated from Portuguese, Japanese and Swedish patients. The variant prealbumin of Japanese amyloid is characterised by methionine replacing valine as residue 30 and is identical to that found in plasma (but not as yet in amyloid) of affected Swedes. These limited data suggest that: (a) derivation of their amyloids from prealbumin is the biochemical common denominator of lower limb familial amyloidotic neuropathies regardless of the ethnic derivation of the afflicted; (b) to the extent that ethnic diversity reflects genetic heterogeneity, this will be demonstrable in the amyloid (and hopefully in the plasma) of the afflicted as entity-specific variant prealbumin monomers distinguished by different single amino acid substitutions; (c) on clinical and biochemical grounds, lower limb familial amyloidotic neuropathies include at least three genetic entities. In the upper limb and facial forms of familial amyloidotic polyneuropathy first recorded in Swiss and Finns respectively, the differences in their patterns of neurological disease and ocular lesions could be the result of their amyloids deriving from proteins other than prealbumin.
Serum from a 45-year-old patient with scleromyxedema (withdrawn prior to therapy) was added to synovial and foreskin human fibroblast cultures and its effect compared to that of normal human serum. The patient's serum stimulated production of both hyaluronic acid and prostaglandin E by fibroblast cultures. This stimulation was inhibited by hydrocortisone and indomethacin and was not accompanied by stimulation of cell proliferation.