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Biomedical subjects

W J McCune

Publications and source records attributed to W J McCune.

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

The role of methotrexate in the management of steroid-dependent asthma.

Severe asthma often requires high-dose corticosteroid therapy. However, steroid therapy is fraught with many side effects. There are conflicting reports in the literature regarding the role of methotrexate in reducing the steroid requirements of these patients. This study examined the role of low-dose methotrexate in the management of steroid-dependent asthma. Eleven subjects with stable steroid-dependent asthma were enrolled in a placebo-controlled double-blind crossover trial. Patients received methotrexate, 15 mg/wk, or placebo each for two 12-week periods. There was significant improvement of pulmonary function and reduction of prednisone requirement in both placebo and methotrexate treatment periods. However, methotrexate was not superior to placebo. Only 3 of 11 patients responded to methotrexate. Although low-dose methotrexate therapy may have a role in a small select group of steroid-dependent asthmatics, it provided no additional benefit overall.

Adolescent↗
PubMed1994

Lupus nephritis. Classification, prognosis, immunopathogenesis, and treatment.

There is great variation in the characteristics of renal histology, in its clinical expression and clinical course, and, most likely, in the pathogenic mechanisms of glomerular damage. As the ability to more precisely characterize these lesions improves and as we better understand the multiple pathogenic mechanisms and modulating factors at play in the disease, treatment advances and improved renal survival should follow.

Antibodies, Antinuclear↗
PubMed1994

Immunosuppressive drug therapy of systemic lupus erythematosus.

This article reviews the biologic effects of cyclophosphamide and azathioprine relevant to the treatment of systemic lupus erythematosus (SLE). Other agents used less commonly for SLE, such as methotrexate, chlorambucil, and cyclosporin-A, receive more limited attention. Clinical studies of efficacy and toxicity of these agents in their treatment of SLE are then described in detail.

Azathioprine↗
PubMed1993

Atrioventricular conduction in children of women with systemic lupus erythematosus.

The neonatal lupus syndrome consists of transient cutaneous lupus lesions or permanent congenital complete heart block (or hepatic fibrosis), or both, in infants born to mothers with systemic lupus erythematosus (SLE). The frequency of conduction abnormalities was examined in 86 offspring of 53 women affected by SLE. Electrocardiograms from the offspring demonstrated normal sinus rhythm in 84 of 86 offspring. The PR interval was normal for age (< 95th percentile) in 82 offspring and normal for heart rate in 81. Three children had a PR interval > 95th percentile (i.e., first-degree heart block) for both age and heart rate. The PR interval of the other 6 subjects with first-degree heart block for age or heart rate (> or = 95th percentile) was < or = 0.18 second. In contrast, using a rank assignment of PR intervals in relation to heart rate and age derived from published standards, grouped data indicated that heart rate adjusted for age was greater and PR interval adjusted for heart rate longer in offspring of mothers who had the onset of SLE before or during pregnancy than in the normal population; this observation did not hold for offspring whose mothers developed SLE after the pregnancy. These findings indicate that offspring of mothers with SLE, even in the absence of an abnormal electrocardiogram, may have experienced a maternal internal environment that produces subclinical changes in atrioventricular conduction. However, newborns with a normal pulse rate are unlikely to have significant abnormalities in atrioventricular conduction and do not need screening electrocardiograms at birth.

Adolescent↗
PubMed1993

Immunosuppressive drug therapy for rheumatic disease.

The role of intravenous and oral cyclophosphamide in treating systemic lupus and Wegener's granulomatosis was examined in several large studies during the past year. Oral cyclophosphamide for 2 months followed by prednisone alone was relatively ineffective in preventing disease progression in lupus nephritis patients with initially abnormal serum creatinine values. A controlled trial in which three regimens for treating lupus nephritis were compared resulted in superiority of long-term intravenous cyclophosphamide therapy over pulse prednisone or short-term intravenous cyclophosphamide. Two open studies describe treatment of neuropsychiatric lupus with pulse cyclophosphamide. Patients with clinical evidence of inflammatory disease of the central nervous system appeared to respond to this therapy even if antiphospholipid antibodies were present. Analysis of a large cohort of patients with Wegener's granulomatosis showed a high incidence of cancer at long-term follow-up as well as a high incidence of recurrence, often several years after induction of remission with cyclophosphamide plus prednisone. Much progress was made in defining the mechanisms of action of cyclosporine. Additional studies examine the role of cyclosporine in necrotizing scleritis complicating rheumatoid arthritis. Concomitant administration of nonsteroidal anti-inflammatory drugs and cyclosporine to rheumatoid arthritis patients resulted in increased short-term deterioration of renal function. Studies of patients with various autoimmune diseases showed an association of the mean, maximal, and cumulative doses of cyclosporine with biopsy-proven nephropathy. Cytarabine was tried at low doses in the treatment of rheumatoid arthritis with improvement in some patients.

Cyclophosphamide↗
PubMed1993

A case report: the use of ketamine and midazolam intravenous sedation for a child undergoing radiotherapy.

The combination of ketamine hydrochloride and midazolam was used to successfully provide intravenous sedation for a child requiring daily radiation treatments. During the radiation therapy treatments, the anesthesia provider was not in direct contact with the patient. Traditional monitoring was complemented by the addition of closed-circuit television monitoring. The drug combination provided consistent cardiac and respiratory stability, as well as patient immobility, for each radiation treatment.

Cerebellar Neoplasms↗
PubMed1993

Systemic cytomegalovirus infection mimicking an exacerbation of Wegener's granulomatosis.

A patient with Wegener's granulomatosis developed a systemic cytomegalovirus infection that mimicked an exacerbation of her vasculitis including pulmonary infiltrates, renal insufficiency, and cutaneous necrotizing ulcers. All of her symptoms resolved with ganciclovir. Physicians should maintain a high index of suspicion for similar presentations in other patients with vasculitis with or without immunosuppressive therapy.

Aged↗
PubMed1992

Immunosuppressive drug therapy for rheumatic disease.

The use of cyclophosphamide, chlorambucil, azathioprine, and 5-fluorouracil in managing rheumatic disease is reviewed. The major focus of recent studies has been the treatment of lupus or systemic vasculitis. Long-term studies of treatment of lupus nephritis have provided additional data regarding the efficacy of regimens containing cyclophosphamide and the predictive value of renal biopsies in determining outcome. Related studies of alkylating agents in idiopathic membranous nephritis suggest that they may have a role in severe disease. Studies of immunosuppression in severe systemic vasculitis are reviewed. Controlled studies have shown that pheresis is probably not effective in this illness and suggest that the addition of cyclophosphamide to prednisone improves the control of disease activity.

Azathioprine↗
PubMed1991

Defective CD2 pathway T cell activation in systemic lupus erythematosus.

CD2 (T11; sheep erythrocyte receptor) is the surface component of an alternative, antigen-independent pathway of human T cell activation. The response to certain anti-CD2 antibodies is relatively independent of accessory cell signals and therefore provides a direct measurement of T cell function. The CD2 pathway may be important in the differentiation of thymocytes, on which the expression of CD2 precedes the appearance of the CD3-T cell receptor complex. In view of the impaired T cell regulation of immune responses in patients with systemic lupus erythematosus (SLE), we examined the activation of peripheral blood lymphocytes by anti-CD2 antibodies in 57 SLE patients and 32 normal control subjects. The CD2 pathway response was lower in the SLE patients (P less than 0.0001); 18 of the 57 SLE patients had a lower response than any of the control subjects. The SLE low-responder patients did not differ from the normal-responder patients in terms of disease activity or use of antiinflammatory and immunosuppressive medications. Low responses to anti-CD2 were corrected to normal by the coaddition of a submitogenic amount of phorbol myristate acetate (1 ng/ml). In some low-responder patients, the responses were normalized by the removal of non-T cells. The data indicate that some SLE patients have impaired responses to CD2 pathway activation and that this may reflect intrinsic T cell defects and/or regulatory influences of non-T cells.

Adult↗
PubMed1991

Immunosuppressive drug therapy for rheumatic disease.

The use and complications of intravenous cyclophosphamide, azathioprine, nitrogen mustard, and cyclosporine are reviewed. Studies have failed to demonstrate superiority of intravenous versus oral cyclophosphamide in rheumatic diseases other than systemic lupus. Azathioprine is a useful immunosuppressive agent in Beçhet's disease. Further studies of cyclosporine in rheumatoid arthritis indicate that efficacy and toxicity are both dose related.

Azathioprine↗
PubMed1990

Septic arthritis caused by treatment resistant Pseudomonas cepacia.

A case of septic arthritis of the knee caused by Pseudomonas cepacia following an intraarticular corticosteroid injection in a patient with a history of osteoarthritis is presented. This is the second report of this agent causing infection in a diarthrodial joint, which proved difficult to eradicate despite in vitro antibiotic sensitivity.

Adrenal Cortex Hormones↗
PubMed1990

Sonographic evaluation of osteoarthritic femoral condylar cartilage. Correlation with operative findings.

Femoral condylar cartilage abnormalities were evaluated in patients treated with total knee arthroplasty, and real-time ultrasonic images were correlated with the abnormalities seen in the corresponding gross pathologic specimens. Subjective impressions of abnormalities on the images recorded on film correlated well with pathologic findings. Thickness measurements were easily made in normal images but proved difficult at sites of cartilage damage where the cartilage-bone and cartilage-soft-tissue interfaces became less clear. This study suggests that with further technologic refinement, this technique may provide a rapid and cost-effective method of assessing the integrity of femoral condylar cartilage.

Adult↗
PubMed1989

Transient Lambert-Eaton myasthenic syndrome associated with systemic lupus erythematosus.

We present a patient who developed the Lambert-Eaton myasthenic syndrome (LEMS) in association with systemic lupus erythematosus (SLE). Severe proximal weakness with electrodiagnostic evidence of LEMS developed over 2 days during an exacerbation of cutaneous manifestations (bullous pemphigoid) associated with SLE. Following an increase in the daily dose of prednisone, there was complete clinical restitution of strength within 2 weeks and a slower resolution of electrodiagnostic abnormalities over 6 months. Marked serologic abnormalities were present at the onset and showed improvement over 6-8 months. LEMS had been infrequently described in association with SLE. The immunologic features of both SLE and LEMS suggest a linkage between the two diseases in this patient. We hypothesize that increased antibodies associated with exacerbation of SLE cross reacted with the neuromuscular junction membrane to produce LEMS.

Adult↗