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Biomedical subjects

R J Enzenauer

Publications and source records attributed to R J Enzenauer.

At least 37 records · Page 2Linked to original sources
PubMed1994

The prevalence of hypothyroidism in gout.

PURPOSE: To examine the potential relationship between gout and hypothyroidism. PATIENTS AND METHODS: Fifty-four consecutive patients with a diagnosis of monosodium urate crystal-proven gouty arthritis on joint aspiration were prospectively evaluated for hypothyroidism with an ultrasensitive thyroid-stimulating hormone (TSH) assay. Twenty-five patients with a diagnosis of monosodium urate crystal-proven gout were retrospectively identified from a population of 137 patients receiving uric acid-lowering medications. These patients were also screened for hypothyroidism. Age, race, sex, and weight matched patients with noninflammatory rheumatic diseases and no history of gout served as controls. Hypothyroidism was diagnosed when a TSH was greater than 6.0 microU/mL or if a history of hypothyroidism requiring replacement therapy was documented. RESULTS: The prevalence of hypothyroidism in the prospective group was significantly increased compared to controls (P < 0.05). Overall 15% of these patients, 25% of women and 12% of the men, had hypothyroidism. These rates were 2.5 times greater in women and 6 times greater in men than found in the controls. The mean TSH of the prospective gouty patients was also significantly greater than those levels found in control patients (5.2 +/- 12 versus 1.8 +/- 1.1 microU/mL, P < 0.05, chi-square), even when all abnormally elevated TSH values were excluded from analysis. The prevalence of hypothyroidism in the retrospective group was even higher: 20% overall, 40% in women and 15% in men. CONCLUSIONS: The prevalence of hypothyroidism is significantly increased in patients with aspirate-proven gouty arthritis. Screening for hypothyroidism with an ultrasensitive thyroid-stimulating hormone assay should be considered in all patients presenting with gouty arthritis and those with a history of recurrent gouty flares.

Aged↗
PubMed1993

Chronic septic arthritis caused by Borrelia burgdorferi.

Chronic arthritis occurs in 10% of Lyme disease patients. A patient had chronic septic Lyme arthritis of the knee for seven years despite multiple antibiotic trials and multiple arthroscopic and open synovectomies. Spirochetes were documented in synovium and synovial fluid (SF). Polymerase chain reaction (PCR) analysis of the SF was consistent with Borrelia infection. Persistent infection should be excluded with silver stains and cultures in any patient with chronic monoarticular arthritis and a history of Lyme disease.

Adult↗
PubMed1992

Sarcoidosis in autoimmune disease.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Sarcoidosis coexisting with connective tissue diseases, once considered rare, complicates various such disorders, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome, and the spondyloarthropathies. Symptoms common to sarcoidosis and autoimmune disease include keratoconjunctivitis sicca, weight loss, fever, lymphadenopathy, pulmonary complaints, and cutaneous lesions. Consequently, the diagnosis of sarcoidosis in association with connective tissue disease is often difficult and may require biopsy of the lung, liver, skin, lymph node, muscle, or bone marrow for pathological confirmation. Abnormalities of immune function as well as autoantibody production, including rheumatoid factor and antinuclear antibodies, are seen in sarcoidosis and in connective tissue diseases, suggesting a common immunopathogenic mechanism. The severity and course of sarcoidosis associated with autoimmune disease is variable. The incidence of sarcoidosis in association with rheumatic disease may be underestimated if new symptoms of sarcoidosis are attributed to the primary rheumatic disease and a secondary diagnosis is not pursued.

Adult↗
PubMed1992

Predicting outcome from intensive care for patients with rheumatologic diseases.

OBJECTIVE: To evaluate 2 prognostic scoring systems in patients with an underlying rheumatologic diagnosis admitted to an intensive care unit (ICU). METHODS: A retrospective case series review, carried out at a medical ICU in a military referral hospital. All adult ICU admissions with a known rheumatologic diagnosis were evaluated during 28 consecutive months. There were 48 ICU admissions available for review in 36 patients (1.33 ICU admissions/patient) during the study period. All patients were assigned an APACHE II and TISS score based on the first 24 h of ICU admission. RESULTS: Eleven ICU admissions resulted in patient death (22.9%) and the remaining 37 admissions (77.1%) in patient survival and hospital discharge. Overall patient mortality was 30.6% for the study population. The APACHE II and TISS scores were each significantly different for survivor and nonsurvivor subgroups (APACHE II p less than 0.0001; TISS p less than 0.0001). CONCLUSIONS: In this group of patients evaluated at a single institution both the APACHE II and TISS scoring systems allowed subgroup separation between survivors and nonsurvivors of ICU admission. However, these scoring methods demonstrated limitations in terms of outcome prediction when applied to the individual patient.

Critical Care↗
PubMed1992

Acute gonococcal flexor tenosynovitis in an adolescent male with pharyngitis. A case report and literature review.

A 15-year-old boy had acute gonococcal flexor tenosynovitis of the middle finger associated with symptomatic gonococcal pharyngitis. The patient had a history of blunt trauma to the hand. The need for a careful history in any sexually active adolescent is emphasized. Acute flexor tenosynovitis may be the only manifestation of disseminated gonococcal infection.

Acute Disease↗
PubMed1991

Mixed cryoglobulinemia associated with chronic Q-fever.

A 41-year-old woman who presented with purpura, glomerulonephritis and mixed cryoglobulinemia was found subsequently to have developed chronic Q-fever. Since Q-fever is a frequent cause of culture negative endocarditis in some endemic areas, the diagnosis of Q-fever endocarditis should be considered in patients presenting with mixed cryoglobulinemia of unknown cause.

Adult↗
PubMed1990

D-penicillamine-induced lupus erythematosus.

We describe a patient who presented with polyarthritis, pleurisy, rash, and a positive antinuclear antibody result after 5 years of D-penicillamine therapy. D-penicillamine-induced antinuclear antibodies were mainly high-titer IgG directed against the (H2A-H2B)-DNA complex. Weak IgM activity with H1 and H2B was also observed. Withdrawal of D-penicillamine therapy resulted in improvement in clinical symptoms and gradual resolution of serologic abnormalities.

Autoantibodies↗
PubMed1990

Retinal vasculopathy associated with systemic light chain deposition disease.

A 35-year-old black male with the abrupt onset of blurred vision and decreased visual acuity was found to have severe retinal vasculopathy associated with systemic light chain deposition disease. While ocular manifestations are frequently reported in other plasma cell dyscrasias; ophthalmologic symptoms have not been previously reported in systemic light chain deposition disease alone. A possible mechanism of light chain deposition and damage to the retinal vasculature is proposed.

Adult↗
PubMed1990

Corneal thinning as the sole manifestation of active undifferentiated connective tissue disease.

A patient with a two-year history of undifferentiated connective tissue disease had corneal thinning as the sole manifestation of its recurrence. Systemic immunosuppressive therapy was not indicated in view of the localized ocular disease. The patient was treated with tarsorrhaphy and ocular lubricants. One year later, when two new areas of localized thinning were found, a conjunctival wedge resection was done.

Anti-Bacterial Agents↗
PubMed1990

Tropical pulmonary eosinophilia.

Tropical pulmonary eosinophilia is an unusual pulmonary disorder caused by occult filariasis. Presentation can be varied and can mimic asthma, pulmonary tuberculosis, or atypical pneumonia. We have reported a case of tropical pulmonary eosinophilia mimicking lymphangitic carcinomatosis.

Breast Neoplasms↗
PubMed1990

Disseminated cutaneous and synovial Mycobacterium marinum infection in a patient with systemic lupus erythematosus.

A patient with systemic lupus erythematosus had a protracted skin infection with Mycobacterium marinum after a puffer fish sting. Disseminated cutaneous and synovial disease was associated with clinically active systemic lupus erythematosus two years after the initial infection. The infection was poorly responsive to multiple antituberculous regimens. Hematogenous spread of infection was the likely route of dissemination.

Adult↗
PubMed1990

Microangiopathic hemolytic anemia as the initial manifestation of porcine valve failure.

We compare the findings in a patient whose microangiopathic hemolytic anemia was the initial sign of porcine valvular dysfunction, with those of six other patients with porcine valve failure seen at Tripler Army Medical Center and with those of 12 patients with hemolytic anemia and porcine valve failure whose cases have been reported in the literature. Total bilirubin and serum lactic dehydrogenase were directly related to the degree of anemia in patients with porcine valve dysfunction. Echocardiography confirmed valve dysfunction in only four of eight patients, while cardiac catheterization confirmed valve failure in 16 of 17 patients. Laboratory evidence for hemolysis was minimal in 31 patients who had normal, functioning porcine valves. Microangiopathic hemolytic anemia in the presence of a porcine prosthetic heart valve, and in the absence of other causes, warrants a thorough evaluation to rule out valve dysfunction. Routine laboratory screening for hemolysis may aid the early diagnosis of porcine valve failure.

Anemia, Hemolytic↗
PubMed1989

Boxing-related injuries in the US Army, 1980 through 1985.

Boxing-related injuries, serious enough to involve hospitalization in US Army hospitals, were studied from 1980 through 1985. On average, there were 67 hospitalizations annually, with the injured spending an average of 5.1 days in bed and 8.9 days disabled, unfit for duty. There was one death from serious head injury and one instance of unilateral blindness from ocular trauma requiring enucleation. Head injuries accounted for 68% of all the injuries and were more common in the younger and presumably less experienced boxers. The advisability of continued promotion of boxing in the military needs to be addressed.

Adolescent↗
PubMed1989

Case report: rapidly progressive systemic sclerosis associated with carcinoma of the lung.

A patient with progressive systemic sclerosis (PSS) of recent onset had a rapid progression of cutaneous and renal disease in less than 1 year and at autopsy was found to have carcinoma of the lung. The rapid progression and atypical presentation of her PSS suggests that it represented a systemic manifestation of her primary pulmonary malignancy.

Acute Kidney Injury↗