Biomedical subjects
Publications and source records attributed to R H Ferguson.
A case of tuberculous fasciitis with tenosynovitis is described. No other organs were affected and tissue histology was not diagnostic. The diagnosis was confirmed by tissue culture and our patient was treated by surgical debridement and antituberculous drug therapy. A high index of suspicion for tuberculosis will alert clinicians to the correct diagnosis in unusual clinical presentations.
Most of the patients with the Felty syndrome suffer from such complications as fevers, infections, cutaneous ulcers, and vasculitis. Unfortunately, there are no therapeutic interventions that are predictably beneficial. We report our experience with 20 patients who received parenteral gold therapy for 2 to 114 months (mean, 23.6 months). All had complications of the Felty syndrome. On parenteral gold therapy, 60% had a complete response, 20% had a partial response, and 20% were unresponsive by preselected criteria. No serious complications were encountered. We think that parenteral gold therapy should be considered early, before other agents, in the treatment of this condition.
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To evaluate the effectiveness of cyclophosphamide in the treatment of lupus nephritis, we designed a prospective study of patients with diffuse proliferative lupus nephritis. Twenty-six patients received prednisone (average dose, 40 mg per day) and 24 combined prednisone (average dose, 29 mg per day) and cyclophosphamide (average dose, 107 mg per day) for six months. Thereafter, all patients received maintenance doses of prednisone. Most of the patients improved (84 per cent) after six months of initial treatment with either program. Early progression of disease, ending mainly in end-stage renal disease, was equally frequent in the two treatment groups in patients with already advanced disease. In a four-year follow-up study there was a higher incidence (P approximately 0.04) and average rate (P approximately 0.02) of clinical recurrence of nephritis in the group initially given only steroid than in the group initially given both drugs. However, the proportion of patients alive after four years with stable or improved renal function was similar in the two treatment groups.
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In published reports, the incidence of pleuropulmonary involvement in ankylosing spondylitis varies from 0 to 30%. A review of the records of 2,080 patients with ankylosing spondylitis disclosed 28 who had pleuropulmonary manifestations that we believe are typical of those associated with ankylosing spondylitis (an incidence of 1.3%). Among these 28 patients, the most common abnormality was upper lobe fibrobullous lesions. Five had aspergillomas and two had infections-one caused by Mycobacterium kansasii and one by Mycobacterium avium. Three patients had transient pleural effusion of an exudate with normal sugar content. Two had nonspecific pleuritis, found on pleural biopsy. Thoracotomy for aspergilloma was followed by bronchopleural fistula in one of two cases--approximately the ratio found in the literature.
We report a prospective randomized study of 39 patients with systemic lupus erythematosus and progressive glomerulonephritis who were assigned to treatment groups that received either prednisone alone or prednisone and cyclophosphamide combined. They received treatment for 6 months and were then followed up for an additional 18 months. No difference in outcome was seen in the two groups at the end of 6 months. Among patients followed up for an average of 24 months, fewer individuals showed later renal progression among those treated with cyclophosphamide and prednisone than among the group treated with prednisone alone.
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