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Biomedical subjects

R M Bernstein

Publications and source records attributed to R M Bernstein.

At least 73 records · Page 4Linked to original sources
PubMed1993

Acemetacin in the long-term therapy of rheumatoid arthritis.

An open label study was carried out to assess the long-term use of acemetacin in patients suffering from rheumatoid arthritis. One hundred and two patients were treated with acemetacin, some patients for up to a 12-month period. Analysis of efficacy showed that acemetacin therapy was associated with statistically significant sustained improvements in the target variables of duration of morning stiffness, Ritchie articular index and left and right grip strength. With regard to tolerability, a number of adverse events were recorded but were generally reported as either mild or moderate. In total, 28,988 patient days' treatment with acemetacin were completed and acemetacin proved an effective and well-tolerated long-term therapy in patients with rheumatoid arthritis.

Adolescent↗
PubMed1993

Computed tomography in sternocostoclavicular hyperostosis.

Sternocostoclavicular hyperostosis is a rare but recognized entity characterized by new bone formation and ligamentous ossification which limits mobility of the sternoclavicular joints. Aetiology is obscure and debated. There may be considerable delay in establishing the diagnosis, even by specialists. In confirming the diagnosis plain radiography is of limited value but radionuclide bone scan and computed tomography (CT) may be helpful. Four cases are described to emphasize these points and illustrate the clinical and radiological features of the condition. High resolution CT with thin sections (5 mm or less) is the examination of choice for demonstrating the characteristic features and is essential if the condition is to be confirmed in its early stages when treatment might be more successful in delaying progression.

Adult↗
PubMed1993

Autoantibodies in myositis.

Several autoantibodies are found specifically in myositis. Mostly this is myositis in the context of a connective tissue disease with associated features such as Raynaud's phenomenon, arthralgias, pulmonary fibrosis or scleroderma. The patterns of disease amount to overlap syndromes or subsets in which one can often predict the presence of a particular type of autoantibody. There are HLA associations, particularly with DQ alleles, related more closely to the antibody than to myositis overall. There is also a suggestion of seasonal and geographical variation within the United States distinguishing the advent of particular autoantibodies with the myositis. The myositis antigens are mainly ribonucleoprotein particles (RNA-protein complexes) functioning in RNA processing, protein translation and protein translocation into the endoplasmic reticulum. Within the cell the antigens are not accessible to antibody, with the possible exception that antibody to U(1)RNP may enter cells. If antibodies are to have a role in pathogenesis it is more likely to be through binding to cell membranes (there to activate complement or mediate T lymphocyte activity) or through immune complex mechanisms. The myositis antigen Ku has been detected on cell membranes, but generally in myositis there is scant deposition of immunoglobulin or complement in muscle except within small blood vessels. If autoantibodies really have little part to play in the pathogenesis of myositis their existence must relate to the earlier events of aetiology, like fingerprints on fragments of a terrorist's bomb.

Autoantibodies↗
PubMed1993

Family practice informatics: research issues in computerized medical records.

There are unique features of family and general practice which lead to unique issues in medical informatics for family physicians. The nature of practice in office based community settings and the discipline of dealing with all ages, sexes, and health conditions over the lifetime of a patient and his/her family lead to models of the thinking that are different from those used in most other specialties. Research is urgently needed to verify the models of thinking that physicians use during patient care encounters and the associated nomenclatures and classifications which support them. User interfaces need to be optimized for accuracy and speed. Standards for medical records computing in family practice need testing and validation.

Ambulatory Care Information Systems↗
PubMed1992

Psychiatric disorder and cognitive impairment in systemic lupus erythematosus.

OBJECTIVES: To determine the point prevalence of psychiatric disorder in patients with systemic lupus erythematosus (SLE). To investigate associations between psychiatric disorder and social stress, cognitive impairment, systemic disease activity, and corticosteroid therapy. METHODS: A cross-sectional study of 73 consecutive patients with SLE assessed using standardized psychiatric and clinical research methods. RESULTS: Current psychiatric disorder was present in 15 patients (20.5%) and was significantly associated with social stress, lack of social support, and impairment on 2 tests of cognitive function (Verbal Fluency Test and Benton Visual Retention Test, Part A, number of errors). There was no association with systemic disease activity or corticosteroid therapy. Cognitive impairment on 2 or more tests was found in 26% and was associated with clinical evidence of central nervous system (CNS) disease, but not systemic disease activity or corticosteroid therapy. CONCLUSIONS: The point prevalence of psychiatric disorder in this cohort of patients with SLE was found to be similar to that observed in patients with rheumatoid arthritis. It was independently associated with social stress and 2 indicators of cognitive impairment, but not with systemic disease activity or corticosteroid therapy. Marked cognitive impairment was present in a significant percentage of patients even when there was no overt evidence of CNS involvement.

Adult↗
PubMed1992

The clinical and immunogenetic features of patients with autoantibodies to the nucleolar antigen PM-Scl.

The clinical and laboratory features of 32 patients with anti-PM-Scl were studied. Patients with this rare autoantibody suffered from a homogenous overlap connective tissue disease defined by Raynaud phenomenon (32/32), features of scleroderma (31/32), arthritis (31/32, erosive in 9/32), myositis (28/32), lung restriction (25/32), calcinosis (15/32), and sicca (11/32). Significant renal and neurologic involvement was uncommon. All patients examined (22/22) had HLA-DR3, and 50% of these patients were homozygous. Our patients responded favorably to moderate immunosuppression and, with therapy, the disease generally has a good prognosis; over 50% of our series (17/32) remained well on minimal or no immunosuppression after a median follow-up of 8 years.

Adolescent↗
PubMed1992

Monoclonal antibody epitopes of mycobacterial 65-kD heat-shock protein defined by epitope scanning.

The binding sites for MoAbs to the 65-kD heat-shock protein (hsp65) of mycobacteria have been investigated by epitope scanning. Five hundred and twenty-six 8-mer peptides representing the complete sequence of Mycobacterium tuberculosis hsp65 were synthesised in duplicate using the Epitope Scanning Kit (CRB Ltd.). The epitopes of six MoAbs raised to the hsp65 of M. tuberculosis or M. leprae were investigated. We have identified the epitope of a new MoAb (DC16); this epitope is continuous, hydrophilic in nature and 11 amino acids long. We have also confirmed the location of the epitopes of three MoAbs (IIH9, ML30 and IIC8). Thus the epitope scanning technique has proved suitable for the detection of continuous epitopes of hsp65.

Amino Acid Sequence↗
PubMed1992

Antibody to a 63 kilodalton insect protein in ankylosing spondylitis.

Ankylosing spondylitis (AS) is associated with antibodies to a heat shock puff on drosophila chromosomes. This observation was investigated by immunoblotting using extracts of the Schneider insect cell line and HeLa cells, before and after heat shock. An insect protein of 63 kilodaltons (but no equivalent human protein) was recognised by 21 (46%) of 46 serum samples from patients with AS, one of two patients with Reiter's syndrome, four (7%) of 60 patients with systemic lupus erythematosus, and two (4%) of 50 control subjects, but not by serum samples from patients with rheumatoid arthritis (RA). Previous heat shock did not appear to affect the strength of reaction, but ML-30, a monoclonal antibody to the mycobacterial 65 kilodalton heat shock protein (hsp65), also recognised an insect protein of 63 kilodaltons by immunoblotting. Antibodies to recombinant mycobacterial hsp65 were measured by enzyme linked immunosorbent assay (ELISA) in serum samples from patients with AS and RA. IgA binding to hsp65 was increased in 41% of AS and 19% of RA serum samples, but there was no correlation with detection of antibody to the insect 63 kilodalton protein.

Animals↗
PubMed1992

Enteric coated naproxen; a double blind trial comparing the tolerance of enteric coated and standard formulations.

Enteric coated naproxen (Nycopren) was compared with standard naproxen in a double blind comparative trial of 348 patients with either rheumatoid or osteoarthritis. There were slightly fewer gastric side effects and slightly fewer withdrawals because of side effects in the enteric coated naproxen group but the differences did not reach statistical significance. There was no significant difference in the efficacy of the two formulations. A satisfaction index was used to assess the therapeutic ratio with visual analogue scales assigned to both efficacy and side effects. The scale performed as intended and is worthy of further exploration.

Adult↗
PubMed1991

An abnormal T cell repertoire in hypergammaglobulinaemic primary Sjögren's syndrome.

T cell antigen specificity is determined by the products of the genes which encode the variable regions of their receptors. Of the T cell receptor (TCR) variable region gene products examined, only V beta 6.7a TCR-positive lymphocytes were reduced in primary Sjögren's syndrome patients with IgG1 hypergammaglobulinaemia compared with an age-, sex- and HLA-matched control population. The levels of V beta 6.7a T cells were also significantly reduced when these patients were compared with an age- and sex-matched but HLA-unmatched control group and non-tissue typed normal people of both sexes. Since published studies show no such abnormality in rheumatoid arthritis, systemic lupus erythematosus or other autoimmune diseases, this abnormality may reflect a pathogenic process specific to primary Sjögren's syndrome.

Adult↗
PubMed1991

Congenital lipofibromatosis associated with macrodactyly of the foot.

Congenital lipofibromatosis of the foot, a type of paracrine growth disorder, is a distinct clinical entity that must be differentiated from other causes of macrodactyly, with specific diagnostic and therapeutic considerations. Eleven skeletally immature patients with congenital lipofibromatosis and macrodactyly of the foot were studied. Diagnostic histopathologic criteria were documented. The most specific pathologic finding of congenital lipofibromatosis is an overabundance of fibrofatty tissue on the plantar aspect of the foot and involved toes. Surgical defatting or debulking procedures, ray resection, and phalangeal epiphysiodesis produced significant cosmetic improvement. Syndactylization and phalangeal resection were not as beneficial.

Adolescent↗
PubMed1990

Polymyositis, pulmonary fibrosis and autoantibodies to aminoacyl-tRNA synthetase enzymes.

The clinical and laboratory features of 29 patients who had one of three anti-aminoacyl-tRNA synthetase autoantibodies, anti-Jo1 (histidyl-tRNA synthetase), anti-PL12 (alanyl-tRNA synthetase) or anti-PL7 (threonyl-tRNA synthetase) were analysed and compared with the findings of other published reports. These autoantibodies were found to be associated with a syndrome delineated by inflammatory myositis (24 patients) and pulmonary fibrosis (23 of 29), but also including inflammatory arthritis (26/29), keratoconjunctivitis sicca (17/29), sclerodactyly (21/29), Raynaud's phenomenon (27/29), hepatitis (8/29) and subcutaneous calcinosis (7/29). The most important clinical determinant of outcome in this group of patients was the severity of the interstitial pulmonary disease. No patient fulfilled the classification criteria for systemic lupus erythematosus, although 10 had autoantibodies to extractable nuclear antigens including Ro, La, RNP, and Sm, and two patients had anti-dsDNA antibodies. Although it seems unlikely that anti-aminoacyl-tRNA synthetase antibodies are directly responsible for causing disease, they may provide an important clue to the aetiology of this unusual syndrome.

Adolescent↗