HLA-B27 and ankylosing spondylitis in African blacks.
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Biomedical subjects
Publications and source records attributed to P Klemp.
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Cutaneous blood flow was determined before and immediately after rubbing the skin of 7 patients with atopic dermatitis and 6 normal subjects, using the local atraumatic 133Xe-method. In the atopic patients the rubbing of eczematous skin produced white dermographism and simultaneously the cutaneous blood flow decreased in all the patients from 15.2 +/- SEM 1.7 ml/100 g . min before the rubbing to 6.2 +/- SEM 1.6 ml/100 g . min during white dermographism (p less than 0.002). In all the normal subjects the rubbing stimulus was followed by an increase in blood flow from 5.2 +/- SEM 0.6 to 24.4 +/- SEM 3.1 ml/100 g . min (p less than 0.001), although red dermographism was not seen in all. It is concluded that the most reasonable explanation for the pallor during white dermographism is the reduced cutaneous blood flow.
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Muscle blood flow (MBF) in m. trapezius was examined in 12 subjects with chronic fibromyotic pain syndrome of the m. trapezius and in 12 healthy volunteers with no symptoms from m. trapezius or other muscles of the shoulder or neck, using the local 133xenon clearance method. The MBF was slightly higher in the fibromyotic group than in the normal group, but the difference was statistically insignificant, 3.04+/-SEM 0.56 and 2.37+/-SEM 0.37 ml/100 g/min, respectively.
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Twenty-two patients with active rheumatoid arthritis were entered into a trial during which an oral gold formulation was administered at two dosages (4 mg/d and 6 mg/d) for 12 weeks. Seventeen patients completed the trial. Both dosages produced a similar improvement in the indices of inflammation. Five patients were not benefited by the treatment, adverse side-effects were reported in 10 and 5 were withdrawn from the trial.
During the period 1971-1979, 114 patients with rheumatoid arthritis attending the arthritis clinics at Groote Schuur Hospital and Princess Alice Orthopaedic Hospital were treated with gold sodium aurothiomalate (Myocrisin). Data obtained from 104 completed protocols showed that 70 patients (67,3%) benefited from chrysotherapy. Forty of these patients went into complete remission. Therapy was discontinued in 58 patients, side-effects accounting for this in 33 cases (31,8%). Adverse reactions included skin rashes in 41 (39%) and renal complications in 16 (14%); 7 (6%) developed haematological complications, which resulted in death in 2 cases. HLA tissue typing in 37 patients with side-effects showed no increase in the HLA Dw2 or HLA Dw3 antigen. There was, however, a significant increase in the HLA DRw4 antigen in both Whites and Coloureds (P less than or equal to 0,008 and P less than or equal to 0,001 respectively).
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99mTc-labelled heparin was used to examine acute deep-vein thrombosis in the leg. 99mTc-heparin (4 mCi) was injected into a dorsal foot vein. Rapid-sequence scintiphotos were taken of the lower legs and thighs. One hour after the injection, images were taken to reveal possible late accumulation of 99mTc-heparin in the thrombi. The venous outflow was assessed by a strain gauge technique. X-ray phlebography was performed on the same or the subsequent day. All patients having an abnormal X-ray phlebography also had an abnormal isotope phlebography. Acute deep-vein thrombosis in the leg can be diagnosed reliably with the combined method of 99mTc-heparin scintigraphy and measurement of venous outflow. Late accumulation of 99mTc-heparin in thrombi of the deep veins was seen in 6 of 12 patients with acute thrombosis. Patients with chronic changes were difficult to evaluate, since the resolution of the scintillation camera does not allow detection of minor changes.
Plasma DNA has been measured by a new physiochemical approach based on fluorimetric analysis of phenol extracted nucleic acids electrophoresed on polyacrylamide gels. This method is specific for native double-stranded DNA of molecular weight greater than 5 x 10(6). The use of plasma rigorously freed of leucocytes is essential to prevent falsely high values. When such precautions are taken levels seldom exceed 50 ng/ml in normal individuals. Plasma DNA was assayed in 107 samples from 47 patients with both active and inactive systemic lupus erythematosus. In direct contrast to several previous reports no significant increase of plasma DNA was found.
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The clinical course and management of a 37-year-old woman with systemic lupus erythematosus (SLE) who developed atlanto-axial subluxation as an acute transient phenomenon are presented. The musculoskeletal manifestations of SLE and their pathogenesis are discussed in relation to this manifestation.
A double-blind crossover, within-patient trial was conducted, to compare the efficacy of tolmetin (Tolectin; Ethnor) with that of aspirin in the treatment of rheumatoid arthritis. Tolmetin significantly improved morning stiffness (P less than 0.01), while aspirin was superior in reducing the number of painful joints (P less than 0.001) and the articular index (P less than 0.01). Tolmetin, in marked contrast to aspirin, was well tolerated, producing virtually no side-effects. An elevation of the alkaline phosphatase was noted in 4 patients on tolmetin therapy. When used after aspirin, tolmetin had a significantly adverse effect on the erythrocyte sedimentation rate (P less than 0.05). The results of this study indicate that tolmetin is a useful addition to the therapeutic agents for the treatment of rheumatoid arthritis, because of its ability to reduce morning stiffness and its lack of side-effects.