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Biomedical subjects

S T Shulman

Publications and source records attributed to S T Shulman.

At least 181 records · Page 10Linked to original sources
PubMed1979

The significance of serial measurements of serum complement C3 and C4 components and DNA binding capacity in patients with lupus nephritis.

Eighteen patients with systemic lupus erythematosus (SLE) and proliferative glomerulonephritis, underwent serial serum determinations of C3, C4, and native DNA binding capacity, as well as repeat renal biopsy 7 to 48 months (median 25 months) following initial biopsy. Highly significant correlations were found between serum C3 levels and renal histologic changes (P less than 0.0001), and between serum C3 levels and DNA binding capacity (P less than 0.03). Histologic deterioration correlated with depressed C3 levels, while improvement was associated with normalization of C3 levels. No correlation between renal histologic changes and either serum C4 levels or DNA binding capacity was found. The data suggest that the serum level of C3 is the best index of activity of lupus nephritis.

Adolescent↗
PubMed1978

Periorbital and orbital cellulitis in children.

The clinical and laboratory data on 87 cases of orbital and periorbital cellulitis were reviewed. Two distinct clinical presentations were encountered. One group of 45 patients had no history of trauma or apparent focus of infection. Blood cultures on these patients were positive in 34%. Haemophilus influenzae accounted for 82% of the positive blood cultures. This group of patients shares common features with children who have facial cellulitis due to H. influenzae type b. The second group consisted of 42 patients with adjacent soft tissue focus of infection. There was only one positive blood culture in this group. Staphylococcus aureus and/or group A beta-hemolytic Streptococcus were isolated from conjunctival or wound exudate in the majority of these patients. Thirteen patients with orbital cellulitis were encountered among the 87 cases. These patients were older and had a higher incidence of demonstrable sinus disease when compared with the overall group. The pathophysiology of orbital and periorbital cellulitis is reviewed and an approach to the management of these disorders is formulated.

Adolescent↗
PubMed1976

The significance of the left atrial appendage in rheumatic heart disease.

The possible diagnostic value of an enlarged left atrial appendage (LAA) on the posterior-anterior or right anterior oblique chest film as a means of implicating a rheumatic etiology for mitral valve disease in children was investigated. Chest films were examined without prior knowledge of clinical or laboratory data, and the results were later correlated with this information in 113 children and adolescents. The clinical and laboratory data included application of the modified Jones criteria for the diagnosis of acute rheumatic fever, streptococcal antibody titers and clinical and cardiac catheterization findings. In children with mitral valve disease, our data suggest that as enlarged LAA, especially in the presence of pulmonary venous obstruction, is characteristic of rheumatic heart disease. This finding appears to be particularly useful, in conjunction with streptococcal antibody studies, in distinguishing rheumatic from nonrheumatic patients with mitral insufficiency.

Cardiomegaly↗
PubMed1976

Severe staphylococcal sepsis in adolescents.

During the three-year period beginning in early 1972, nine previously healthy children, ages 8 to 15 years, presented with manifestations of life-threatening septicemia due to coagulase-positive Staphylococcus aureus. In no patient was a predisposing cause for such infection, such as immunologic deficiency, drug abuse, or previous antibiotic or immunosuppressant therapy, discovered. Seven patients manifested evidence of bone and/or joint infection, while eight had pulmonary disease of varying degrees of severity, characterized initially by multiple small septic pulmonary emboli. One patient succumbed to the pulmonary complications of her disease. S. aureus was recovered from specimens of blood (seven patients), joint fluid (four), bone (four), pleural fluid (two), urine (one), sputum (one), and pericardial fluid (one). All organism isolated were methicillin-sensitive; isolates from only one patient were penicillin-sensitive. In several instances, lack of clinical response was related to delay in adequate surgical drainage of infected material. Review of hospital records for the preceding five-year period failed to reveal similar cases of severe systemic staphylococcal infection in healthy adolescents. Although no direct evidence for a causal relationship is available, the occurrence of these cases corresponds temporally with implementation of restrictions upon the use of hexachlorophene.

Adolescent↗
PubMed1975

Cholangitis complicating congenital hepatic fibrosis.

A patient with cholangitis complicating congenital hepatic fibrosis is presented. In contrast to most other reported cases, many of whom have been treated surgically, this patient had a benign course. The likelihood that this complication of congenital hepatic fibrosis will respond to appropriate conservative therapy suggests that more aggressive forms of treatment should be reserved for those patients who fail to respond to medical management.

Biopsy, Needle↗
PubMed1975

Staphylococcal osteomyelitis, sepsis, and pulmonary disease. Observations of 10 patients with combined osseous and pulmonary infections.

The clinical and roentgenographic findings in 10 patients with combined staphylococcal infection fo the bones, joints, and lungs are reviewed. Chest roentgenograms early in the course of the illness suggested septic embolic disease, but in most cases the associated osseous infections were overlooked. Primary therapy, directed toward the sepsis and pulmonary complications, was often unsuccessful until the associated osteomyelitis was recognized and treated. The radiologist and clinician should recognize the roentgen pattern of septic pulmonary emboli and be alert to the possibility of associated skeletal infection. Surgical drainage is often necessary.

Adolescent↗
PubMed1974

Qualitative and quantitative aspects of the human antibody response to streptococcal group A carbohydrate.

The lack of impressive quantitative differences in antibody to various streptococcal extracellular and cellular antigens among patients with acute rheumatic fever, acute glomerulonephritis, and following uncomplicated streptococcal infection has prompted investigation of qualitative aspects of the antibody response among these patients. By using a radiolabeled antigenically univalent hapten derived from streptococcal A carbohydrate, affinity of serum antibody to A-carbohydrate (A-antibody) was studied by an ammonium sulfate precipitation technique. The data obtained demonstrate average association constants (K0S) of acute rheumatic fever patient sera to be significantly lower than those of acute glomerulonephritis or streptococcal infection patients (P<0.02 and P<0.001, respectively). Further analysis of the data from hapten binding studies documents the fact that the radioimmune precipitin assay for the determination of A-antibody level is little influenced by K0 but directly correlates with the concentration of antibody binding sites. These data suggest that qualitative differences in A-antibody are present between rheumatic and non-rheumatic individuals. It is unclear whether the finding of low-affinity A-antibody among acute rheumatic fever patients reflects a generalized phenomenon or one restricted to the A-antibody-A-carbohydrate system.

Adolescent↗