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Biomedical subjects

R A DeRemee

Publications and source records attributed to R A DeRemee.

At least 73 records · Page 4Linked to original sources
PubMed1985

Wegener's granulomatosis: observations on treatment with antimicrobial agents.

Twelve patients with Wegener's granulomatosis were treated with antimicrobial agents, chiefly trimethoprim-sulfamethoxazole. The clinical course improved in 11 of the 12 patients who received this treatment. The success of antimicrobial treatment suggests the possibility of a microbial infection as the inciting cause of Wegener's granulomatosis in some patients. Alternatively, these agents--in particular, trimethoprim-sulfamethoxazole--may possess immunosuppressant activity.

Adult↗
PubMed1984

Sarcoidosis. Current perspectives on diagnosis and treatment.

Sarcoidosis is a systemic noncaseous granulomatous disorder whose chief manifestation involves the lungs and intrathoracic lymph nodes in more than 90% of cases. New insights into pathogenesis and assessment of activity of the disease have been afforded by bronchoalveolar lavage, gallium citrate Ga 67 scanning, and measurement of serum angiotensin-converting enzyme. Current evidence favors early treatment with glucocorticoids to suppress the inflammatory element and thus prevent or minimize irreversible fibrosis.

Diagnosis, Differential↗
PubMed1984

Normal serum angiotensin converting enzyme activity in patients with newly diagnosed sarcoidosis.

Twenty-four patients with sarcoidosis had normal serum angiotensin converting enzyme (SACE) values at time of diagnosis. Sixteen patients were in stage I and eight of these underwent complete remission and four followed a stable course. Seven of eight patients in stages II and III experienced improvement while receiving glucocorticoid treatment. In six, serial SACE measurements fell significantly, paralleling the clinical improvement. The data suggest that a normal SACE in stage I indicates a good prognosis. Patients in stages II and III with normal SACE levels may still have active disease potentially responsive to glucocorticoid treatment. The reduction of SACE while receiving treatment may be viewed as the "suppressible" SACE compartment, representing that portion of the enzyme elaborated by the granuloma or its cellular precursors. The level remaining after suppression by glucocorticoids may be considered "basal" SACE, probably related to normal turnover of SACE producing cells in vascular endothelium.

Adult↗
PubMed1984

Elevated serum angiotensin-converting enzyme (SACE) activity in acute pulmonary histoplasmosis.

Serum angiotensin-converting enzyme (SACE) levels were measured in 44 subjects six weeks after acute pulmonary histoplasmosis. All patients were infected in a common-source outbreak of histoplasmosis which occurred on one day. All patients had both strictly defined clinical and serologic evidence of infection. The SACE activity was elevated at six weeks compared to normal controls, and seven of the 44 had levels more than 2 SD above the normal mean. SACE levels were also measured at three and 24 weeks after acute infection in a smaller number of the same subjects. Serial observations demonstrated that all subjects (including those with normal and elevated SACE at six weeks) had a rise and fall in SACE activity following symptomatic acute pulmonary histoplasmosis. Our findings suggest that elevated SACE does not reliably separate sarcoidosis from histoplasmosis, although elevations in histoplasmosis are much less common and may occur only briefly following acute pulmonary histoplasmosis. More important, it seems that SACE activity rises acutely in all patients with symptomatic acute histoplasmosis and then falls gradually toward baseline over several months, coinciding temporally with the granulomatous response.

Acute Disease↗
PubMed1984

Treatment of varicella-zoster pneumonia with transfer factor.

A 29-year-old woman with a long history of immunoreactive disease--thrombocytopenic purpura, bullous pemphigoid, nephropathy, and hemolytic anemia--contracted generalized herpes zoster and varicella pneumonia. Respiratory failure requiring assisted respiration accompanied progressive chest findings. She recovered rapidly simultaneous with the administration of transfer factor from a healing herpes zoster patient. We believe that this therapy should be attempted in similar desperate circumstances.

Adult↗
PubMed1983

Ocular complications of Wegener's granulomatosis.

140 patients with biopsy-proven Wegener's granulomatosis were examined during a 16-year period at the Mayo Clinic. Forty patients had diverse and explosive ophthalmic involvement, including conjunctivitis, episcleritis, scleritis, corneal ulceration, uveitis, retinal vasculitis, optic neuropathy, orbital mass, orbital cellulitis, and obstruction of the nasolacrimal duct. The multiple ophthalmic and systemic complications in these 40 patients and the importance of establishing the pathologic diagnosis are discussed. Treatment with corticosteroids and immunosuppressive agents has dramatically improved the prognosis, although substantial mortality (four patients died of Wegener's granulomatosis) and ocular morbidity (three eyes were enucleated) are still associated with this disease.

Adolescent↗
PubMed1983

Wegener's granulomatosis.

A review of 108 patients with Wegener's granulomatosis clarified the diverse clinical manifestations and disclosed some of the less well-known areas of involvement. Because of the frequency of nasal involvement in Wegener's granulomatosis, the otolaryngologist plays an important role in the early diagnosis and treatment.

Adolescent↗
PubMed1983

The roentgenographic staging of sarcoidosis. Historic and contemporary perspectives.

The awareness that sarcoidosis can involve intrathoracic lymph nodes and lung parenchyma in sequential fashion evolved during the first half of this century. This awareness resulted in a roentgenographic staging system that has relevance to the course and prognosis, pulmonary function changes, and the symptom of dyspnea. The following definition or roentgenographic staging is proposed as the simplest, most reproducible system based solely on the roentgenographic appearance, avoiding histopathologic and pathophysiologic inferences. Stage I: bilateral hilar lymphadenopathy; stage II: bilateral hilar lymphadenopathy plus parenchymal infiltration; and stage III: parenchymal infiltration without bilateral hilar lymphadenopathy. The early data concerning bronchoalveolar lavage, determination of serum angiotensin-converting enzyme, and gallium 67 citrate scanning appear to have no clear relationships to staging, suggesting that staging continues to have unique value to the clinician in the classification of sarcoidosis and in the delineation of its clinical course and prognosis.

Humans↗
PubMed1983

The predictive value of serum angiotensin-converting enzyme activity in the differential diagnosis of hypercalcemia.

Serum angiotensin-converting enzyme (SACE) activity is usually elevated in sarcoidosis, and this raises the possibility that SACE may be a useful diagnostic tool in distinguishing sarcoidosis from other hypercalcemic disorders. We therefore measured SACE in a large number of patients with various granulomatous, metabolic, and hypercalcemic disorders to determine its predictive value. We found elevated SACE activity in 4 of 35 surgically proven cases of primary hyperparathyroidism and in 3 of 13 patients with oncogenic hypercalcemia. In six patients with sarcoidosis and hypercalcemia, SACE activity was elevated; corticosteroid therapy lowered both the serum calcium and SACE levels to normal. We conclude that SACE activity is not a specific test for the differential diagnosis of hypercalcemia but that it remains useful as a chemical marker of successful treatment of sarcoidosis.

Diagnosis, Differential↗
PubMed1981

Wegener's granulomatosis and polymorphic reticulosis--two diseases or one? Experience with 90 patients.

Our experience with 50 patients with Wegener's granulomatosis and 40 patients with polymorphic reticulosis allowed us to compare these two disorders both clinically and histopathologically. Although these conditions are similar in some respects, they are separate and separable entities. The histologic features may be the most useful criteria for differentiation. Wegener's granulomatosis is characterized by the presence of vasculitis and necrotizing granulomas, whereas polymorphic reticulosis is typified by a mixed lymphoid infiltrate with an angiocentric growth pattern. The physician should be aware of the differences between these two disorders and should understand the implications of both conditions.

Adolescent↗
PubMed1981

Cutaneous clinicopathologic correlation of allergic granulomatosis.

Allergic granulomatosis is a distinct clinical syndrome occurring in adults with asthma, eosinophilia, and multisystem vasculitis. Atopy and drug sensitivity are other important features. The skin reactions are most commonly nodular and inflammatory lesions. A unique feature is the deep papulonodules, which may occur singly on the scalp or symmetrically on the extremities. Cutaneous findings may range from purpura to urticaria and ulceration. The most common histologic finding is the extravascular granuloma; however, necrotizing vasculitis of small vessels is seen, as well as periarteritis nodosa involving larger vessels of the skin. This varied histologic and clinical spectrum seen in patients with systemic allergic granulomatosis is a reflection of a unique host response to multiple antigens. The cutaneous findings imply that allergic granulomatosis probably represents a unique host response to the same causative and pathogenetic factors as are usually found in periarteritis nodosa and necrotizing vasculitis.

Adult↗