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Biomedical subjects

P Barland

Publications and source records attributed to P Barland.

At least 19 recordsLinked to original sources
PubMed2002

Combined autoimmune disease in a patient with AIDS.

Immune dysregulation in HIV-infected patients, along with the new medications for treatment of AIDS that possess immunomodulating potential, may lead to an increased incidence of autoimmune diseases in this patient population. However, the presence of combined autoimmune diseases in an AIDS patient is rare. Relapsing polychondritis (RP) is an uncommon inflammatory disease manifested by recurrent attacks of auricular chondritis. The presence of type II and IX collagen antibodies, and their association with HLA-DR4 and other autoimmune diseases, suggests that antiself reactions may be present. Sarcoidosis is a granulomatous disease manifested by inflammation of the lungs, eyes and joints. In the peripheral blood there is depressed cellular immunity and enhanced humoral immunity. We here describe a case of coexisting RP and sarcoidosis in an AIDS patient.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Orbital mucosa-associated lymphoid tissue (MALT)-type lymphoma in a patient with relapsing polychondritis.

Relapsing polychondritis is characterized by recurrent inflammation of the cartilaginous tissues of the ears, nose, peripheral joints, and the tracheobronchial tree. The eye is also a frequent target organ in relapsing polychondritis, and proptosis is a well-recognized manifestation of eye involvement. Similar to other rheumatologic diseases, an association of relapsing polychondritis with malignancy has been reported. We describe a patient with relapsing polychondritis who presented with exophthalmos. When treatment directed toward control of her underlying disease was only partially effective, further investigation revealed that she had an orbital mucosa-associated lymphoid tissue (MALT)-type B cell lymphoma. We hypothesize that the lymphoma resulted from malignant transformation of the relapsing polychondritis-induced inflammatory pseudotumor and emphasize that neoplastic disease should be considered in the differential diagnosis in patients with relapsing polychondritis presenting with exophthalmos.

Adult↗
PubMed2001

Sensorineural hearing loss in conjunction with aortic insufficiency in systemic lupus erythematosus.

Sensorineural hearing loss may occur in SLE, but aortic insufficiency has been very rarely reported. We are describing two patients with well-established SLE who developed bilateral hearing loss and aortic insufficiency, associated with serological evidence of active lupus. Neither patient had evidence of keratitis, and thus did not satisfy criteria for Cogan's syndrome. The aortic insufficiency in one patient stabilized after treatment with high doses of steroids while in the second patient, who refused medical treatment, it progressed requiring surgical valve replacement. Our observations suggest that the aortic valve and the inner ear may share some antigenic crossreactivity not shared by the cornea. In SLE patients, with sensorineural hearing loss, echocardiography should be performed looking for evidence of aortic insufficiency, which may be steroid responsive.

Adult↗
PubMed2000

Rheumatoid arthritis exacerbation caused by exogenous interleukin-12.

Interleukin-12 (IL-12) is a pleiotropic cytokine with proinflammatory, immunoregulatory, antitumor, and antimetastatic properties. It plays a crucial role in the development of the Th1 response and subsequent interferon-gamma production and enhancement of cell-mediated cytotoxicity. Recently, IL-12 has been used as an experimental therapy for cancer. Given the multiple immunomodulatory properties of IL-12, there are potential concerns associated with its clinical use. Of special interest are the possible side effects of IL-12 therapy in patients with autoimmune diseases, especially those that are T cell mediated, such as rheumatoid arthritis (RA). We present a case of severe RA exacerbation caused by treatment with IL-12 for metastatic cervical cancer. This is the first reported case of RA flare caused by exogenous IL-12.

Arthritis, Rheumatoid↗
PubMed1999

Increased serum stromelysin-1 levels in systemic lupus erythematosus: lack of correlation with disease activity.

OBJECTIVE: In view of evidence that stromelysin-1 and collagenase-1 are involved in tissue injury in inflammatory joint diseases, we sought to determine whether matrix metalloproteinases (MMP) are implicated in the pathophysiology of systemic lupus erythematosus (SLE). METHODS: Seventy-three patients with SLE and 39 healthy subjects were evaluated. Serum levels of MMP and tissue inhibitor of metalloproteinases were measured. RESULTS: Serum stromelysin-1 levels were significantly increased in patients with SLE (416+/-252 ng/ml) compared to healthy subjects (125+/-93 ng/ml). No correlation between serial measurements of stromelysin-1 and disease activity in SLE patients was noted. Serum collagenase-1, gelatinase A, and TIMP-1 levels were not increased in SLE. CONCLUSION: Serum concentrations of stromelysin-1 are increased in SLE, but the levels do not correlate with disease activity.

Disease Progression↗
PubMed1997

Growth and morphological transformations of Helicobacter pylori in broth media.

Helicobacter pylori, a cause of peptic ulcer disease and certain types of gastric cancers, has usually been cultured on diverse agar-based media, resulting in a requirement for 2 to 4 days of growth at 37 degrees C. We have developed a novel broth medium consisting of a base medium supplemented with 2% newborn calf serum, Mg2+, Cu2+, Fe2+, Zn2+, Mn2+, and 1 mg of lysed human erythrocytes per ml. This medium supports rapid growth of H. pylori, with a doubling time of about 50 min. Optimal growth was obtained in a pH range higher than that supporting most other gram-negative bacteria (at pH 8.5). H. pylori cultured in this supplemented broth retains the spiral morphology seen in both histological sections and cultures from agar-based media and also retains a high urease activity. After 18 h in this broth, H. pylori transforms to a coccal form with a complete loss of urease activity. Previously these cocci have been reported to be senescent, since they could not be subcultured on agar medium. Our experiments suggest that some of the cocci can revert back to the spiral morphology with full recovery of urease activity when subcultured in fresh microaerobic broth medium.

Animals↗
PubMed1997

The co-occurrence of acute rheumatic fever and AIDS.

We describe a patient with advanced acquired immunodeficiency syndrome (AIDS) who presented with evidence of carditis, arthritis, and chorea in the setting of fever, and serologic evidence for recent streptococcal infection. Several features atypical for rheumatic fever were present and included persistently high titer of antistreptolysin O, the simultaneous occurrence of chorea and arthritis, and the presence of chorea in a sexually mature adult man. The differential diagnosis of arthritis in a host at risk for human immunodeficiency virus should be expanded to include acute rheumatic fever, which may manifest atypical features.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Clinically occult avascular necrosis of the hip in systemic lupus erythematosus.

OBJECTIVE: To study the natural history of clinically occult avascular necrosis (AVN) of the hip in patients with systemic lupus erythematosus (SLE). METHODS: Sixty-six patients with SLE (without symptoms referable to the hip) receiving at least 5 mg/day prednisone for > or = 6 months were screened by magnetic resonance imaging (MRI) for AVN of the hip. A complete MRI evaluating class and percentage of femoral head involvement, AP and lateral radiographs of the hips, bone scan, and physical examination were performed for patients with positive MRI. Medical records were reviewed for serologic and clinical variables that might predict AVN. Repeat MRI were obtained at 3, 6, and 12 months to assess possible progression or resolution of the lesion. Patients with negative screening MRI underwent repeat screening after one year to assess the one year incidence rate. RESULTS: Eleven asymptomatic hips (8%) in 8 patients (12%) had MRI documented AVN. The percentage of femoral head involvement ranged from 1 to 46%. One lesion was MRI class B, the remaining lesions were class A. The radiographic stage of 10 hips was stage 1, the MRI class B hip was stage 2. Risk factors for clinically occult AVN included Afro-American origin, Raynaud's phenomenon, migraine headaches, and a maximal corticosteroid dose of at least 30 mg/day. After 12 months, 43 of 58 patients with an initially negative MRI underwent repeat screening examinations; no new lesions were observed. CONCLUSION: Clinically occult AVN of the hip is common in patients with SLE. The short term natural history of these lesions appears stable without spontaneous healing or clinical or radiographic progression. Risk factors for these asymptomatic lesions are similar to the risks for symptomatic AVN and surgical intervention appears not to be indicated in these patients.

Adolescent↗
PubMed1996

Selection and use of laboratory tests in the rheumatic diseases.

Current clinical practice relies heavily on serologic testing for the prompt and accurate diagnosis of rheumatic diseases. Serologic testing should be used to support the findings of the history and physical examination, and, in some cases, to monitor disease activity. The inflammation of the rheumatoid arthritis (RA), polymyalgia rheumatica, and temporal arteritis can be assessed by the erythrocyte sedimentation rate (ESR). The C-reactive protein (CRP, an acute-phase protein) test, which is newer, correlates more closely than ESR with clinical and radiographic parameters of RA inflammation. The rheumatoid factor test is nonspecific as a screen for RA, and some argue that it is also insensitive (accounting for the existence of "seronegative" RA). High titers of rheumatoid factor are associated with progressive joint inflammation, erosions, and disability. Antinuclear antibody (ANA) tests are likewise nonspecific, but ANA subtypes have proved to be very specific for subtypes of connective tissue diseases. Examples are the presence of anti-DNA antibody in systemic lupus erythematosus; anti-centromere antibody in the CREST syndrome of scleroderma; anti-histone antibody in drug-induced lupus; and anti-Ro antibody in neonatal lupus. Anti-neutrophil cytoplasmic antibodies (ANCA) are a new group of auto-antibodies seen in Wegener's granulomatosis. Brief case descriptions are presented to illustrate appropriate selection of these antibody tests as well as tests for antiphospholipid antibodies and cryoglobulins.

Acute-Phase Proteins↗
PubMed1996

Reactivation of inactive systemic lupus erythematosus.

To characterize the features of systemic lupus erythematosus (SLE) in patients who flare after a period of inactive disease, we conducted a retrospective chart review. We identified 24 records from SLE patients who had been tapered to 5 mg/day or less of prednisone for at least 3 months. No initial clinical disease manifestations correlated with subsequent flares. Patients receiving more aggressive therapy for their initial active disease flared less often than patients who received adequate but less aggressive therapy. Patients who were tapered off of steroids were 3.2 times more likely to flare than patients who were maintained on low doses of corticosteroid. Further prospective studies are indicated.

Adult↗
PubMed1992

Soluble interleukin-2 receptor levels in lupus nephritis.

Soluble interleukin-2 receptor (IL-2R) levels were measured and correlated prospectively with clinical, histologic and serologic findings over a 9-month period in 62 lupus patients. Initially, 39 patients had clinical nephritis and 23 patients did not have nephritis. The 62 lupus patients has significantly higher IL-2R than 15 normal controls, most of this difference attributable to patients with nephritis. During lupus nephritis flare 9 of 10 patients showed significant elevations of IL-2R while only 6 of the 10 patients showed either elevation of anti-DNA antibody or decrease in CH50. During disease remission or stable clinical activity changes in IL-2R levels paralleled changes in anti-DNA antibody and CH50. Nephritis patients with cellular proliferative histology had significantly higher IL-2R levels than those with membranous or mesangial nephropathy. IL-2R correlated strongly with histologic activity and chronicity indices, IgG and C3 deposition whereas anti-DNA antibody and CH50 levels did not. IL-2R levels did not correlate with serum creatinine suggesting that elevations of IL-2R were not simply due to decreased clearance. These observations suggest that serum IL-2R level is a useful marker of disease activity in lupus nephritis and may serve as a helpful adjunct in management of this disorder.

Adult↗
PubMed1989

Effect of long-term normalization of serum complement levels on the course of lupus nephritis.

PURPOSE: We compared the long-term outcome of patients with lupus nephritis in whom normalization of complement levels (CH50) was sustained by adjustment of immunosuppressive therapy to those patients with persistently low complement levels despite similar immunosuppression in whom therapy was adjusted solely on the basis of clinical disease activity. PATIENTS AND METHODS: Thirty-nine female patients with lupus nephritis recruited from 1972 to 1979 were prospectively studied (mean follow-up, 116.7 +/- 11 months). Entry criteria included initial renal biopsy, low CH50, and elevated anti-DNA antibody levels. A second biopsy was performed in 24 patients after an interval of 40.6 +/- 5 months. Treatment was started with prednisone (1 mg/kg/day). Azathioprine at a dose of 1.5 to 2.0 mg/kg/day was added if complement was not normalized by prednisone alone. Twenty-five of 39 patients had normal complement levels within six months (Group 1), and immunosuppressive therapy was tapered but continuously readjusted to the lowest dosage that preserved normal CH50 and maintained clinical remission. Eight of these 25 patients subsequently became persistently hypocomplementemic due to inadequate drug intake (Group 1B), whereas the complement levels continued to be controlled in the other 17 patients (Group 1A). Despite similar therapy, the remaining 14 patients did not achieve normalization of complement within the initial six months of therapy, and therefore future treatment decisions were based solely on clinical symptoms (Group 2). Renal pathologic lesions were classified according to World Health Organization criteria and a semi-quantitative chronicity index. RESULTS: During the first six months, there were no significant differences in clinical or histologic features between patients in whom complement levels were controlled and patients in whom complement levels were not controlled. After a mean observation period of 10 years, however, patients with consistent normalization of complement (Group 1A) did much better than patients with only short-term complement control (Group 1B) or persistent hypocomplementemia (Group 2). Both groups with low complement levels had a similar outcome with significantly worse kidney and patient survival. Life-table analysis demonstrated that the differences in outcome between complement-controlled and complement-uncontrolled groups became apparent only after five or more years of follow-up. Patients with a low chronicity score on initial biopsy whose complement level was controlled did uniformly well with no renal failure or death. (ABSTRACT TRUNCATED AT 400 WORDS)

Azathioprine↗
PubMed1989

Chronic gonococcal arthritis.

We report a patient with a culture proven low grade gonococcal arthritis of 3 1/2 months' duration instead of the usual presentation as an acute, intense synovitis. Based on our experience gonococcal arthritis should be a consideration in the differential diagnosis of chronic monoarticular arthritis.

Adult↗
PubMed1987

Sjögren's syndrome: severe upper airways obstruction due to primary malignant tracheal lymphoma developing during successful treatment of lymphocytic interstitial pneumonitis.

A wide spectrum of respiratory tract involvement may be seen in Sjögren's syndrome, however, multiple manifestations in one patient are unusual. A 65-year-old woman with a 5-year history of Sjögren's syndrome presented with hoarseness and pulmonary infiltrates. Lymphocytic interstitial pneumonitis, tracheobronchitis with subglottic edema and obstructive small airways disease were initially documented. Dramatic radiographic improvement of the lymphocytic interstitial pneumonitis occurred during 14 months of corticosteroid therapy. However, a rare primary malignant lymphoma of the trachea developed and presented with steroid refractory, upper airways obstruction. Subsequent patient management and the dichotomous behavior of the lymphoid infiltrates are discussed.

Aged↗
PubMed1986

The clinical application of an ELISA technique for the detection of antihistone antibodies.

A rapid reproducible technique for measuring antihistone antibodies is described in which unfractioned nuclear histones covalently bonded to plastic discs are employed in an ELISA system. All 20 patients with drug induced lupus erythematosus had antihistone antibodies, usually at high titer. In contrast, 22% of 18 asymptomatic patients with drug induced antinuclear antibodies (ANA), 15% of 20 patients with seropositive RA and 42% of 60 patients with systemic lupus erythematosus (SLE) had detectable antihistone antibodies. High titers of antihistone antibodies were not seen in drug induced ANA or RA. This assay differentiates between patients with drug induced lupus and drug induced ANA (p less than 0.01) and drug induced lupus erythematosus and SLE (p less than 0.01). In patients with SLE antihistone antibodies had no association with disease activity.

Antibodies, Antinuclear↗