Biomedical subjects
Publications and source records attributed to P Emery.
We have devised a new approach to the therapy of aphasia. Rather than focus on rehabilitation of linguistic errors, we treat perseveration, which may be an integral component of the aphasic symptoms. In this report we provide key elements of our Treatment of Aphasic Perseveration (TAP) technique, and the successful use of this method with three aphasic patients.
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New monoclonal antibodies allow CD4 lymphocytes to be categorized into helper/inducer (HI) CD4+ 4B4+, and suppressor inducer (SI) CD4+ 2H4+ subpopulations. Blood and synovial lymphocytes from 30 patients with rheumatoid arthritis (RA), 13 patients with other articular diseases, and 24 control subjects were exposed to these monoclonal antibodies and analyzed by flow cytometry. CD4:CD8 ratios were similar for the 3 groups. In RA patients, there was a depletion of SI cells in blood and synovial fluid, and the ratio of HI cells to SI cells was elevated, particularly in the synovial lymphocytes. These data provide new evidence for T cell dysregulation in the perpetuation of RA.
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A case control study of 50 rheumatoid factor positive (RA+) and 50 rheumatoid factor negative (RA-) patients with rheumatoid arthritis has been carried out. As expected, the RA+ group has significantly more nodules and vasculitis. In terms of clinical joint involvement, the RA- had large-joint involvement. Radiologically, seropositive disease was characterized by more severe involvement of the metacarpophalangeal joints of the thumb and index fingers and in all the metatarsophalangeal joints of the feet. There was no difference either clinically or radiologically between the two groups in terms of symmetry of joint disease or wrist involvement. Of special interest was the finding that the prevalence of HLA-DR4 was elevated to the same degree in both groups but that genetic markers for ankylosing spondylitis and for psoriasis (HLA-B27 and Cw6 respectively) were similar in both groups and not increased above control population levels. It is concluded that the entity defined as RA includes patients with and without rheumatoid factor (RF) in their serum and that this determines differences in disease expression. Whether these differences are the consequences or the cause of RF cannot be concluded on the basis of this study.
Seventy-two patients with relatively early but progressive rheumatoid arthritis were treated with chloroquine sulphate, D-penicillamine or a combination of both drugs over 1 year. Chloroquine resulted in significantly fewer side-effects but combined treatment appeared to increase the risks of toxicity. Significant clinical improvements were seen with each regimen and these were indistinguishable between treatments. However, chloroquine had less impact on haemoglobin, ESR, rheumatoid factor levels and C-reactive protein than the other treatments. Furthermore, radiological deterioration was most frequent amongst those given chloroquine alone. Combination treatment with D-penicillamine and chloroquine thus offered no advantages. Chloroquine caused fewer side-effects than both D-penicillamine and combination treatment but appeared to have a less pronounced effect on the disease process as measured by laboratory and radiological indices.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A short three-treatment out-patient course of lymphocytapheresis (LA) was compared with a standard six-treatment regimen in a group of rheumatoid arthritis patients pre-selected for poor cell-mediated immunity, which has been shown to be associated with a good response to LA. Significant clinical improvements were seen with both treatments. There did not appear to be any clear difference between three and six treatments. A short course of LA may represent a possible treatment for selected rheumatoid arthritis patients.
The role of pure analgesics in the management of rheumatoid arthritis (RA) remains uncertain. In a double-blind cross-over study of 27 patients, nefopam was a more effective analgesic than placebo when given as a supplement to anti-inflammatory drugs. Both early morning stiffness and grip strength were also improved, suggesting that these are associated with pain perception rather than any other aspect of inflammation. Side-effects occurred in 9 (35%) on nefopam and none on placebo. The results suggest a valuable supplementary role for analgesics such as nefopam in the treatment of RA.
The effects induced by IA volleys, evoked with H reflex, on the blink reflex elicited upon electric activation of supraorbital nerves were investigated in 14 healthy subjects as well as in 4 cerebrovascular patients. In both groups a significant increase in amplitude of the early component (R1) of ipsilateral blink reflex has been observed. A brief discussion of possible neural systems which might be involved in these effects is given.
The levels of serum rheumatoid factors (RF) and the in vitro production of immunoglobulin were studied in 21 patients with rheumatoid arthritis (RA) and compared to the in vitro responses of 20 controls. In RA patients the levels of serum IgM RF and IgG RF were not significantly increased in patients possessing HLA-DR4 or any other DR antigen. Lymphocytes from seropositive RA patients released measurable quantities of IgM RF spontaneously, greatest in those possessing HLA-DR4. When lymphocytes were treated with either pokeweed mitogen or the T cell mitogen derived from Mycoplasma arthritidis the increased production of IgM RF was not related to HLA-DR4 status, either for RA patients or controls. Seronegative RA lymphocytes, while having similar IgM RF responses to controls, differed in having IgG RF in their serum.
The disordered cellular immunity of rheumatoid arthritis (RA) was studied in vitro by assessing the stimulatory effect of tuberculin PPD, a mycoplasma product with major histocompatility complex restricted properties in mice (MAS) and concanavalin A (Con A) on RA and control cells of known tissue type. PPD provided the best discrimination between RA and controls (RA responses 34% of latter). The only significant association with HLA-DR type was that patients with RA who exhibited poor responsiveness to MAS had a significantly increased frequency of HLA-DR4.
Cephalometric radiographs and nasal airway resistance values of 67 children were compared--correlation between each of several measurements of the postnasal airway and airway resistance from anterior nares to oropharynx was poor. At the 5% level of significance, the averaged shortest distance between the anterior face of the adenoid mass and the posterior wall of the antrum was related to be averaged airway resistance of the 67 subjects. Nasal airway resistance measurements in 22 children prior to and following adenoidectomy established that nasal airway resistance was reduced following adenoidectomy.
The relationship of tinnitus to pain is examined and a theoretical case made out for the possible use of acupuncture in the treatment of tinnitus. A double-blind cross-over controlled trial is described. The use of Visual Analogue Scales (V.A.S.) is discussed in this context. 35 per cent of patients described some benefit from the active treatment only, although we were unable to demonstrate this objectively. Statistical analysis of the group as a whole revealed no significant differences between placebo and active acupuncture treatment.