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Biomedical subjects

R D Altman

Publications and source records attributed to R D Altman.

At least 109 records · Page 6Linked to original sources
PubMed1985

Long-term follow-up of therapy with intermittent etidronate disodium in Paget's disease of bone.

A long-term trial of etidronate disodium therapy in 93 patients with Paget's disease of bone yielded generally favorable results. Treatment or retreatment was initiated for symptomatic Paget's disease with elevated serum alkaline phosphatase and urinary hydroxyproline values. Improvement occurred in 60 percent of patients even in the presence of secondary osteoarthritis. There appeared to be three types of responses: (1) Patients with prolonged clinical and chemical improvement after a single course of therapy (40 percent); these patients tended to have less active disease on the basis of initial alkaline phosphatase and hydroxyproline values, with suppression to normal in 76 percent of patients after etidronate disodium therapy. (2) Patients with response to retreatment (45 percent); these patients had modest disease on the basis of alkaline phosphatase and hydroxyproline values and required retreatment less often than once a year. (3) Patients with response to retreatment but eventual development of resistance to etidronate disodium (15 percent); these patients had the most severe disease clinically and on the basis of alkaline phosphatase and hydroxyproline values. In this last group, resistance to etidronate disodium (5 mg/kg per day) was common and early, and patients received etidronate disodium more often than one course per year; alkaline phosphatase response was transient, often of less than three months' duration.

Aged↗
PubMed1984

Review of ibuprofen for osteoarthritis.

Pain is the predominant reason for seeking treatment in patients with osteoarthritis. Management is multifactorial, involving psychological, physical, pharmaceutical, and sometimes surgical measures. Nonsteroidal anti-inflammatory agents play a valuable role in the overall treatment program. A review of 28 clinical trials involving ibuprofen for osteoarthritis shows sometimes conflicting results in efficacy, often because of inadequacies in study design or dosage. In fact, 17 of these 28 studies employed doses of less than 1,600 mg/day. Nonetheless, several trends are clear. Ibuprofen at a dose of over 1,200 mg daily was superior to placebo and at doses of 1,200 to 1,800 mg/day was as effective or more effective than 3,200 to 3,600 mg/day of aspirin or 4,500 mg/day of aspirin plus acetaminophen. In trials with a wide variety of other nonsteroidal anti-inflammatory drugs, ibuprofen was often as effective as the comparison agent. Tolerability was consistently excellent with ibuprofen, and adverse reactions were few.

Acetaminophen↗
PubMed1984

The effects of a partially purified fraction of an ant venom in rheumatoid arthritis.

A partially purified extract of an ant venom from the South American tree ant Pseudomyrmex sp. was tested in a double-blind, controlled study of patients with rheumatoid arthritis. Venom treated patients demonstrated an improvement in global efficacy and a decrease in the number of tender/painful joints and swollen joints. Swollen joint index improved in 60% of venom treated patients. Other parameters did not demonstrate significant change. Reduction of joint swelling was followed by symptomatic improvement that was sometimes delayed by weeks. Reactions were limited to erythema at the injection site (all patients), local pruritus (two-thirds of the patients), and fever with malaise (one-third of the patients). Further study of this venom in rheumatoid arthritis appears warranted in view of its apparent favorable efficacy-to-toxicity ratio.

Adult↗
PubMed1984

Biomechanical and biochemical properties of dog cartilage in experimentally induced osteoarthritis.

The finding of other investigators that increased water content is often associated with signs of a torn collagen network in human osteoarthritic (OA) cartilage led to this study. In the Pond-Nuki model of post-traumatic OA experimental but not control femoral condylar cartilage showed evidence of breakdown and stiffening of collagen network as assessed by measurement of swelling properties and indentation behaviour respectively. These changes in the unstable knees occurred despite lack of erosion of that surface cartilage ascertained from carbon black mapping and history. The stiffening rather than softening change was therefore attributed to cartilage oedema of the middle and deep certilagenous zones, wherein breakdown of collagen network has been postulated to occur. Because of insignificant reduction of total hexuronate in these cartilages, a proteoglycan (PG) profile of sedimentation coefficients for aggregate (PGA) and subunit species (PGS) was analysed to see if collagen network changes in the dog preceded PG alteration. Despite minimal histological changes our results confirmed previous findings in the tibial plateau cartilage in this model, that PGA was reduced in size and PGS increased in amount. Slight enzymatic breakdown of PGs, or altered synthesis due to cellular responses to either the injury directly or to synovial inflammation, seems necessary to explain such changes in the absence of cartilage erosion.

Animals↗
PubMed1983

Diagnostic and therapeutic uses of the arthroscope in rheumatoid arthritis and osteoarthritis.

Both the technique and the technology involved in knee arthroscopy have undergone considerable development over the last 10 years. Diagnostically, the procedure allows visualization of synovium, hyaline cartilage, fibrocartilage (menisci), and ligaments (cruciate, patellofemoral alignment). Synovitis of rheumatoid arthritis is suspected by boggy, hyperemic, and edematous hypervilli that may undergo necrosis. In osteoarthritis, the synovium is often mildly inflamed and the cartilage demonstrates ulcerations, yellowing, softening, and areas of denuded bone. Synovectomy for rheumatoid arthritis was first performed about 1900. The apparent reduction in morbidity resulting from performing synovectomy through the arthroscope accounts for the resurgence of interest in this procedure. Removal of loose bodies, fragments of cartilage, or synovium helps to reduce synovitis and symptoms in both rheumatoid arthritis and osteoarthritis. Shaving of articular cartilage is often performed in patients with osteoarthritis. There is a suggestion that coring or shaving osteoarthritic denuded bone stimulates repair of a type of fibrocartilage that may be functional. Surgical technology and technique in the field of arthroscopy are advancing faster than the clinical studies necessary to prove their value. Guidelines for the use of these potentially destructive techniques are still needed. Arthroscopy is a rapidly developing field in medicine. The next 10 years will almost assuredly provide enhanced diagnostic and surgical capabilities with reduced morbidity in the rheumatic diseases, and particularly in rheumatoid arthritis and osteoarthritis.

Arthritis, Rheumatoid↗
PubMed1983

Collagenolytic activity and collagen matrix breakdown of the articular cartilage in the Pond-Nuki dog model of osteoarthritis.

Recent reports on the Pond-Nuki model of osteoarthritis in the dog have provided evidence for partial disruption of the collagen network. The possibility of collagenase involvement in these localized changes was studied. Animals were killed 2, 4, 8, and 12 weeks after surgery. The left knee served as a sham-operated control. Cartilages from femoral condyles were processed for light and electron microscopy and assayed for collagenolytic activity by a direct tissue assay, based on the measurement of digestion of endogenous cartilage collagen. Animals killed at 2 and 4 weeks showed fibrillation and mild erosion of femoral condyles, which usually progressed to ulceration by 8 and 12 weeks. Electron microscopy demonstrated fiber disruption of the mid-zone perilacunar collagen as early as 2 weeks after the operation. Total collagenolytic activity, measured after activation by aminophenylmercuric acetate, was significantly higher in decreased cartilage than in controls of 2, 4, and 8 weeks; the peak value was at 4 weeks. Collagenase was shown, by its specific action on type I collagen, to be present at 2 and 4 weeks; however, other metalloproteases may also contribute to the digestion. The correlation between increased collagenolytic activity and the early osteoarthritic changes in cartilage suggests a role of this enzyme activity in the disease process.

Animals↗
PubMed1983

Arthroscopy of the knee.

There has been remarkable advancement in arthroscopy of the knee since Watanabe's 21 arthroscope in 1959. Our understanding of knee pathology has been advanced and new syndromes have been described. The internal structures of the knee can now be visualized with magnification-promoting diagnostics. Equipment has been designed specifically for knee arthroscopy, allowing for advances in technical procedures and for surgery not heretofore anticipated. Skilled arthroscopists can perform meniscectomy routinely. The next few years should allow development of instruments for continued advancement of techniques and also to allow clinical research to assess the value of many of the procedures in use today. Arthroscopy, both diagnostic and therapeutic, is a safe procedure with minimum morbidity. Moreover, in the near future, arthroscopy will assuredly advance to become routine in several other joint, particularly the ankle and shoulder.

Arthroscopes↗
PubMed1983

Simultaneous multifocal sarcomatous degeneration in Paget's disease of bone. A hypothesis.

Multisite pagetic sarcoma was present in three of 18 patients with pagetic sarcomas treated during a 12-year period at two centers. A hypothesis of multifocal origin of the tumor is supported by the sarcoma arising only in pagetic bone, the infrequency of metastases to bone, evidence of multiple sites at presentation, and the rarity of new lesions developing in bone under observation. Survival was shorter with multisite disease than with other pagetic sarcomas.

Aged↗
PubMed1983

Degenerative joint disease.

We have focused on several features somewhat unique to OA which require special attention relative to clinical trials. These include disease classification, for which the schema in Table 1 was developed, patient selection and admission criteria, and the choice of appropriate clinical outcome parameters. We suggest the following: That future trials be limited to patients with idiopathic OA with specified joint groups involved. That pain, assessed with a visual analogue scale, and both the patient's and investigator's global assessment be the primary clinical outcome variables to be analysed. That concomitant analgesic agents not be used during anti-inflammatory drug trials to prevent confounding pain relief as an outcome variable. That future, long-term studies use validated health status measures to assess functional outcomes.

Anti-Inflammatory Agents↗
PubMed1980

Musculoskeletal manifestations of Paget's disease of bone.

A review of 290 patients with Paget's disease of bone revealed 83% had one or more rheumatic syndromes. The most common finding was back pain (37%), most often related to an independent osteoarthritic process or Paget's disease precipitating or complicating spinal osteoarthritis. Paget's disease as a sole source of back pain was distinctly uncommon (2%). Osteoarthritis related to Paget's disease was present in the hip (30%) and knee (11%). Paget's disease in spondylitis was present in 4 patients and in ankylosing hyperostosis in 4 patients. The latter group had very active Paget's disease. Rheumatoid arthritis (1%), hyperuricemia (20%), and gout (4%) did not appear increased in this group.

Aged↗
PubMed1979

Method for calculating costs of steam sterilization devised.

Through a study at 10 hospitals located throughout the United States, a method for determining the costs of operating steam sterilization equipment was devised and tested. Any hospital central sterile supply manager can use this method to monitor his sterilizers' cost per hour of operation and cost per load.

Bedding and Linens↗
PubMed1977

Sodium etidronate in the treatment of Paget's disease of bone. A study of long-term results.

Subjects (109) with symptomatic Paget's disease of bone were treated with 5, 10, or 20 mg of sodium etidronate (EHDP)/kg body weight - day for 6 to 24 months. Significant decreases in serum alkaline phosphatase and urinary hydroxyproline were noted after 6 months of therapy; no significant further improvement resulted after prolonged therapy. Some patients maintained biochemical remission after withdrawal of EHDP but others showed a relapse, related primarily to the pretreatment severity. Clinical improvement was noted in 61% of the patients. Similar findings were seen after a second course of EHDP. No side-effects were noted in patients treated with 5 mg of EHDP/kg body weight - day. In patients treated with 10 or 20 mg of EHDP/kg body weight - day, severe diarrhea, bone pain, and nontraumatic fractures were noted in 3, 13, and 12 patients respectively. Quantitative histomorphometry showed mineralization delay in patients receiving 10 or 20 mg of EHDP/kg body weight - day but not in those receiving 5 mg/kg body weight - day. Five milligrams of EHDP/kg body weight - day was effective and appears to be safer than the higher doses.

Adult↗
PubMed1976

Aberrant serum enzyme patterns in dermatomyositis associated with hepatoma.

A Caucasian male developed florid dermatomyositis documented by serum enzyme elevation, electromyography, and histology of skin and muscle. Serum enzymes, including creatine phosphokinase (CPK), aldolase, glutamic oxaloacetic transaminase (SGOT), and lactic dehydrogenase (LDH), decreased initially during high dose systemic corticosteroid therapy, although profound muscle weakness persisted. Subsequent elevation of serum LDH and SGOT levels during treatment provided a clue to underlying neoplasia. Primary hepatoma with widespread metastases was found at necropsy.

Adult↗
PubMed1976

Classical rheumatoid arthritis in a patient with Reiter's syndrome.

A 44 year old white male presented with sterile urethritis, anterior uveitis, painless oral ulcers, low back pain, and synovitis of the knees and left ankle. Unilateral sacroiliitis and limited spondylitis further supported a diagnosis of Reiter's syndrome. Serum rheumatoid factor was present. The patient subsequently developed morning stiffness, symmetrical polyarthritis of the hands and wrists, and an olecranon subcutaneous nodule. Histology of the nodule and synovium was consistent with rheumatoid arthritis. Histocompatibility antigen typing established the presence of HLA B27. The occurrence of rheumatoid arthritis and Reiter's syndrome in the same patient is quite rare, and the infrequent co-existence of these two inflammatory rheumatic diseases is discussed.

Adult↗