Biomedical subjects
Publications and source records attributed to W F Barth.
A middle-aged man with diabetes mellitus and cardiomyopathy developed both cryptococcal arthritis and cellulitis. Unusual aspects included the benign nature of the joint effusion and lack of contiguous osteomyelitis.
HLA-DR locus antigens were studied in a large population of Black Americans with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). An association was found with DR4 in RA (p less than 0.001) and DR3 in SLE (p less than 0.01). Our findings are similar to those reported in Caucasians. No significant correlations between clinical manifestations and DR locus antigens were apparent in either disease. Our results support the association of D locus antigens with disease susceptibility more than with clinical severity.
Three patients experienced rapidly reversible azotemia related to the use of naproxen or ibuprofen but tolerated full-dose sulindac. This article discusses renal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs), with emphasis on the role of inhibition of prostaglandin synthesis, and reviews evidence supporting a renal-sparing property of sulindac. The current literature assumes that all NSAIDs possess a similar potential for renal toxicity. The data presented suggest that sulindac has less potential for renal toxicity and may be the preferred NSAID for use in patients with impaired renal function.
Reiter's syndrome was found in three men who presented with cardiac conduction disturbances. In two patients, Reiter's syndrome had been present for more than 30 years and had been previously unrecognized. These patients included a 67 year old man with complete heart block of 13 years' duration, and his son, who had left bundle branch block and chronic generalized cardiomyopathy. A chart review of 19 other patients with Reiter's syndrome who were seen at this institution disclosed five patients with conduction abnormalities. Transient first-degree heart block was the most common disturbance detected and was usually associated with active Reiter's syndrome. Some conduction abnormalities appeared after a long latent period at a time when other manifestations of Reiter's syndrome were inactive. An association with this disorder was therefore not obvious. In all five patients with Reiter's syndrome and conduction disturbances, testing for B27 antigen gave positive results. Both clinical and histopathologic changes in the heart in Reiter's syndrome are analogous to those in ankylosing spondylitis, also associated with B27 antigen. We suggest that the heart, like the joints and iris, may be a target organ for B27-associated disease by a mechanism that remains to be defined.
A 21-year-old woman with systemic lupus erythematosus (SLE) had meningismus, conjunctivitis, lymphadenopathy, and elevation of liver function values following ibuprofen therapy. All symptoms and laboratory value abnormalities resolved rapidly when the drug therapy was stopped. Two years later, a similar reaction occurred after taking tolmetin sodium. Fever, adenopathy, aseptic meningitis with a polymorphonuclear pleocytosis, and serum transaminase level elevations resolved rapidly after use of the drug was discontinued. The mechanism of this reaction to nonsteroidal antiinflammatory drugs in patients with SLE is not known.
Explore the source record for details and available documents.
We have studied the temporal relation between psoriasis and psoriatic arthritis in 27 patients receiving photochemotherapy for treatment of psoriasis. Patients were classified as either spondylitic or nonspondylitic. For spondylitic patients, psoriasis was difficult to control, arthritis did not improve, and skin and joint activity appeared to vary independently. In contrast, 67% of nonspondylitic patients receiving photochemotherapy treatment remained clear of psoriasis, with 49% mean improvement in articular index. There was an inverse relation between initial percentage of psoriasis and improvement in peripheral arthritis. These results suggest that aggressive management of psoriasis helps control synovitis in at least a subgroup of patients with psoriatic arthritis.
Explore the source record for details and available documents.
A young black male with sarcoidosis developed quadriplegia after a fall. Roentgenograms of the spine revealed extensive lytic and scierotic changes with paravertebral bony bridges simulating ankylosing spondylitis. He recovered on corticosteroid therapy after laminectomy and cervical fusion. Review of the literature suggests that this case of vertebral sarcoidosis is the most severe yet reported and the first with paravertebral ossification.
The diagnosis of pyogenic arthritis may be difficult to confirm since culture results are sometimes negative. This study attempted to evaluate the utility of the limulus lysate assay for the early detection of pyogenic arthritis due to gram-negative organisms. Seven-one specimens of synovial fluid from 46 patients were evaluated for reactivity in the limulus test, pyrogenic responses in rabbits, total white blood cell count, total neutrophil count, total red blood cell count, and protein and glucose concentrations. All patients with culture-proven septic arthritis or presumptive septic arthritis had joint fluid specimens that yielded a positive result in the limulus assay (12 patients). However, 52.9% of patients (18 of 34) who had a nonseptic cause for their joint effusion also had a joint fluid specimen that was positive in the limulus test. A positive limulus test result showed a significant correlation with an elevated total white blood cell count (P less than 0.0005), an elevated absolute neutrophil count (P less than 0.0005), and a decreased concentration of glucose (P less than 0.005) in synovial fluid, and the production of fever in rabbits after injection of synovial fluid (P less than 0.05). Thus, this study suggests that a positive result in the limulus test on joint fluid is nonspecific for a septic process, but a negative result would be evidence against it.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.