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Biomedical subjects

N M Hadler

Publications and source records attributed to N M Hadler.

At least 91 records · Page 5Linked to original sources
PubMed1983

Diurnal variations in rheumatoid synovial effusions.

Diurnal variation in symptoms is characteristic of inflammatory arthritides. We performed serial arthrocenteses on 6 patients with rheumatoid arthritis, chosen because the knee studied had suffered minimal destruction in spite of persistent effusion. Cytology, resting pressures, C3 and C4 were invariant. Glucose, pH, lactate, pO2 showed wide diurnal variation. The direction of change was consistent for the first 2 measures. Such metabolic shifts might underlie symptoms and contribute to the pathophysiology of joint destruction.

Adult↗
PubMed1982

A multicenter study of outcome in systemic lupus erythematosus. I. Entry variables as predictors of prognosis.

A retrospective study of factors influencing survival in 1,103 patients with systemic lupus erythematosus (SLE) was carried out at 9 university centers diverse in geographic, socioeconomic, and racial characteristics. The mortality and disease characteristics of the patients at study entry varied widely among centers. The survival rates from the time patients with a diagnosis of SLE were first evaluated at the participating center was 90% at 1 year, 77% at 5 years, and 71% at 10 years. Patients with a serum creatinine greater than 3 mg/dl at study entry had the lowest survival rates: 48%, 29%, and 12% at 1, 5, and 10 years, respectively. Survival rate also correlated independently with the entry hematocrit, degree of proteinuria, number of preliminary American Rheumatism Association criteria for SLE satisfied, and source of funding of medical care. When data were corrected for socioeconomic status, race/ethnic origin did not significantly influence survival. Survival rates varied widely at different participating institutions, generally due to differences in disease severity. Place of treatment was independently associated with survival only in the second year after study entry. Disease duration before study entry did not account for the differences in disease severity.

Academic Medical Centers↗
PubMed1982

A multicenter study of outcome in systemic lupus erythematosus. II. Causes of death.

Causes of death were examined for 1,103 systemic lupus erythematosus patients who were followed from 1965 to 1978 at 9 centers that participated in the Lupus Survival Study Group. A total of 222 patients (20%) died. Lupus-related organ system involvement (mainly active nephritis) and infection were the most frequent primary causes of death. Causes of death were similar throughout the followup period. Hemodialysis had little impact on the length of survival for patients with nephritis. Active central nervous system disease and myocardial infarction were infrequent causes of death. There were no deaths from malignancy.

Academic Medical Centers↗
PubMed1982

Manual ability as a marker of dependency in geriatric women.

Little is known about the factors responsible for the institutionalization of the elderly. This study's objective was to discover markers associated with nursing home placement. Fifty-six white ambulatory women over 63 yrs of age were selected from 3 settings encompassing a range of dependency: 20 women from nursing homes; 16 women who lived in their own homes but requiring social assistance and 20 totally independent women. Each woman was examined for factors that might be associated with her state of dependency: age, socioeconomic status, morale, education, strength of social network, number and type of medications, mental status, manual ability, medical problems and abnormalities on physical examination. The time required to perform any of 27 manual skills discriminated the 3 groups better than any other factor (P less than 0.0001). Three manual skills predicted group membership with 92% accuracy. Manual ability may be the best marker of dependency in elderly women and should be measured in studies concerned with geriatric health status.

Activities of Daily Living↗
PubMed1982

Ultrastructure of a hyaluronic acid matrix.

Freeze-etch replicas of a hylauronic acid matrix were visualized by electron microscopy. In water a coarse branching fibrillar network of hyaluronic acid aggregates was seen. The high solvent permeability of this matrix suggests that the spaces observed are relatively devoid of unaggregated polymer. Addition of calcium disordered the matrix, resulting in a more dispersed felt of polymer.

Extracellular Space↗
PubMed1982

Medical ramifications of the federal regulation of the Social Security Disability Insurance program: Social Security and medicine.

Social Security Disability Insurance is a federally created and regulated insurance plan. The definition of disability as it relates to work capacity is exclusively the purview of government administrators. The primary physician's opinion has little, it any, impact on decision. Administering this insurance scheme requires the quantification of illness as it relates to work capacity (disability). What has evolved is a program that insures for the amount of "disease." The assumption is that with more disease, there is a greater likelihood of illness, even illness manifest as work incapacity. Leaving this underlying assumption tacit is responsible for the adversary climate that envelops the physician, the patient-claimant, and the administrators. It is also responsible for the paucity of clinical investigations into the critical issue of the amount and form of illness a diseased person will have.

Arthritis, Rheumatoid↗
PubMed1981

The physical characterization of an aggregating IgG heteropolymer containing rheumatoid factor.

An IgG heteropolymer containing rheumatoid factor activity was isolated from the serum of a patient with the polyclonal hyperviscosity syndrome. This aggregating system was characterized using ultracentrifugation, classical light scattering, and rheological methods. The degree of polymerization is shown to be reversible and dependent on both pH and concentration. Light-scattering studies show a minimum stable intermediate consisting of four IgG monomers to exist at pH 7.4. The theoretical intrinsic viscosity and radius of gyration for the feasible configurations of such a tetramer were calculated. These models were compared to the experimental values. A cyclic structure is shown to be most compatible with the experimental data. Immunochemical analysis suggests that each tetramer contains two IgG1 rheumatoid factors binding to determinants on IgG3 Fc regions.

Blood Viscosity↗
PubMed1981

Protease inhibitors in inflammatory synovial effusions.

Granulocyte lysosomal enzymes can potentially participate in cartilage degradation in inflammatory arthritides. However, we have shown that the quantity of several such enzymes in an inflammatory synovial effusion correlates negatively with the degree of radiographic damage of the joint from which the fluid was sampled. In the current work the quantity of the following 5 protease inhibitors was determined immunochemically in the same fluids: alpha 1 antitrypsin, alpha 1-antichymotrypsin, alpha 2-macroglobulin, inter-alpha-trypsin inhibitor, and Cl esterase inhibitor. These inhibitors are generally covariate and correlate positively with the total protein in the fluid as well as the number of granulocytes and the concentration of granulocyte lysosomal enzymes in the fluid. As did the lysosomal enzymes, the protease inhibitors correlate negatively with radiographic destruction. It is likely that lysosomal enzymes in solution in inflammatory synovial effusions are rendered effete by the presence of protease inhibitors.

Arthritis, Rheumatoid↗
PubMed1980

Enhanced diffusivity of glucose in a matrix of hyaluronic acid.

The diffusion coefficients for glucose and sucrose within matrices of hyaluronic acid are contrasted with coefficients determined in matrices of agarose. Diffusivity is similar in 0.5 and 1% matrices of both polysaccharide polymers dissolved in saline (0.9% NaCl solution) buffered at pH 7.4 with 0.01 M sodium phosphate. In a 2.5% matrix of hyaluronate, but not agarose, glucose diffusivity is enhanced 3-fold, whereas simultaneously determined sucrose diffusivity remains unchanged from that in the 1% matrix. The 1% hyaluronate matrix will enhance glucose diffusivity if an inorganic cationic serum constituent(s) with a molecular weight of less than 500 is incorporated into the solvent. This enhanced diffusivity is inversely dependent on glucose concentration and on the degree of polymerization of the hyaluronate in the matrix. The presence of an appropriately constituted matrix of hyaluronic acid endows the resultant fluid with several properties generally ascribed to membranes: permselectivity (even glucose and sucrose behave differently), saturability, and the potential to enhance translational movement of selected solutes such as glucose.

Animals↗
PubMed1980

Permeability of hyaluronic acid solutions. The effects of matrix concentration, calcium, and pH.

The permeability of hyaluronic acid solutions was measured in a chamber closed at each end of semi-permeable membranes. Permeability was strongly concentration dependent below 1.0 gm% hyaluronic acid. Small changes in the ionic environment of 1.0 gm% hyaluronic acid solutions also altered permeability. The permeability of such solutions decreased by a factor of 4.7 in the presence of as little as 5 mM calcium ion and showed optimum permeability at pH 7.0. The pH optimum was not noted in hyaluronic acid preparations known to contain only small amounts of protein.

Calcium↗
PubMed1980

Synovial fluids facilitate small solute diffusivity.

The diffusivity of water, fucose, proline, lysine, glutamic acid, glucose and sucrose was determined in a variety of inflammatory human synovial fluids. In view of the constituents of pathological synovial fluids one would predict impedence to solute movement. In several fluid diffusivity was enhanced relative to translational diffusion in water. In most fluids diffusivity was enhanced relative to diffusion in diluted serum. Diffusivity of the solutes was dependent on size and charge of the solute but independent of fluid characteristics, including glucose, protein, and complement concentrations and cellular constituents. This paper reports aberrant small solute behaviour in synovial fluids. Enhanced diffusivity relative to water was demonstrated in hyaluronate dissolved in diluted serum as well. Hyaluronate domains in the synovial fluids interact with these solutes, facilitating movement. This phenomenon affords a homoestatic mechanism as regards chondrocyte viability in spite of inflammation or a low glucose concentration.

Arthritis↗
PubMed1979

Does corticosteroid therapy affect the survival of patients with systemic lupus erythematosus?

The hypothesis that corticosteroid therapy is responsible for the striking improvement in survival of patients with systemic lupus erythematosus (SLE) was investigated with two approaches: Of 250 published papers on SLE, 52 were chosen for the first analysis because they included sufficient information on diagnostic criteria and survival but were not limited to patients selected for a particular target organ. From each article percent survival by series, average duration to death, and 1 and 5 year survival curves were abstracted. Each statistic showed linear improvement in survival since the 1930s without a significant change (P greater than 0.10) in slope for the time period following the introduction of corticosteroids. The second analysis examined the effect of corticosteroid therapy on 142 patients with SLE followed at the Massachusetts General Hospital between 1922 and 1966. Although the steroid use was conservative, the patients' survival, from year of entry, was comparable to the 52 abstracted series. A prognostic index was used to stratify patients admitted in the steroid era (after 1950) for life table analysis of survival with and without steroids. Steroids had no discernible effect on overall survival in low and medium risk groups. Use of steroids was associated with improved survival among high rish patients (P less than 0.05).

Adrenal Cortex Hormones↗
PubMed1979

Lysosomal enzymes in inflammatory synovial effusions.

The concentrations of several polymorphonuclear neutrophilic lysosomal constituents were quantitated by immunochemical and enzymatic assays in 28 inflammatory and 9 noninflammatory synovial fluids. The quantities of lactoferrin, myeloperoxidase, and enzymatically determined lysozyme were covariate with the neutrophil count. Enzymatic activities measured with synthetic substrates developed for the assay of chymotryptic-like cationic protein (cathepsin G) and elastase, along with immunochemically determined lysozyme, were independent of the neutrophil count. Although the latter assays were developed and standardized with human neutrophilic lysosomal constituents, they measure different activities in inflammatory synovial effusions. No elastase was detected if elastin was used as the substrate. Regardless of the source of the enzymes, there was a negative correlation between their concentration and the degree of radiographic destruction of the joint from which the fluid was obtained. Lysosomal enzymes in solution in synovial fluid are not likely to be primarily involved in cartilage destruction.

Cathepsins↗