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Biomedical subjects

W N Roberts

Publications and source records attributed to W N Roberts.

34 records · Page 2Linked to original sources
PubMed1991

Reversal of the vasospastic component of lupus vasculopathy by infusion of prostaglandin E1.

The responses of 3 patients with systemic lupus erythematosus (SLE) and progressive digital ischemia to intravenous prostaglandin E1 (PGE1) were studied prospectively in an open 3-day trial. All patients were unresponsive to corticosteroids, one had vasculitis proven by biopsy. Digital ischemia diminished in all 3 patients. In one patient, angiograms documented reappearance of a previously obstructed deep palmar arch. Vasospasm plays a role in the outcome of SLE vasculitis even in the absence of Raynaud's phenomenon. As suggested by animal models of necrotizing and leukocytoclastic vasculitis, and by case reports, intravenous PGE1 may be a relatively nontoxic, adjunctive treatment for vasculitis.

Adult↗
PubMed1990

Reproductive factors, smoking, and the risk for rheumatoid arthritis.

Risk factors for rheumatoid arthritis were examined in a cohort of 121,700 female nurses aged 30-55, followed in the Nurses' Health Study. Baseline information on reproductive variables, cigarette smoking, obesity, and other variables was obtained in 1976 and updated every 2 years. Cases of rheumatoid arthritis were defined by standardized questionnaire and review of medical records. During 883,187 person-years of follow-up, 217 new cases of rheumatoid arthritis were identified (115 had definite rheumatoid arthritis and 102 had "undifferentiated polyarthritis"). When compared with women who experienced menarche at age 13 years, the age-adjusted relative risk of rheumatoid arthritis among women with early menarche was 1.9 (95% confidence interval, 0.9-2.4). There were, however, no significant associations between parity, age at birth of the first child, menopause, or obesity and the incidence of rheumatoid arthritis. Cigarette smokers had a slight apparent increase in the risk of rheumatoid arthritis. Among current smokers, the age-adjusted relative risk for RA rheumatoid arthritis was 1.3 (0.9-2.1); among former smokers, the relative risk was 1.5 (0.9-2.3).

Adult↗
PubMed1989

Sensitivity of anthropometric techniques for clinical trials in ankylosing spondylitis.

To determine whether anthropometric techniques widely used for assessment of ankylosing spondylitis (AS) would be useful outcome measures in long-term clinical trials, 52 AS patients at the Royal National Hospital for Rheumatic Diseases were studied. All patients had well documented AS with a mean age of 38.1 years, and had been diagnosed for an average of 7.6 years. Measurements were taken before (B) and after (A) 3-week intensive inpatient physical therapy (PT). Short-term therapeutic effects (over 3 weeks) were significant (adjusted p less than 0.0001) for all five measures tested (chest expansion, finger-to-floor distance, height, lumbar flexion, and cervical rotation). Height (adjusted p less than 0.0001), finger-to-floor distance (adjusted p = 0.047) and cervical rotation (adjusted p = 0.012) diminished over the course of follow-up. Therefore, 3 weeks of hospitalization with intensive physical therapy produces measurable short-term change; minute but measurable change with treatment occurs even in long-standing AS; and detectable changes in physical measurements occur over a 5-year period even in long-standing AS. Anthropometric measurements are useful outcome variables for long-term clinical trials in AS, but the potential for improvement in clinical measurements in long-standing AS is predictably small.

Adult↗
PubMed1988

Stability of normal joint findings in persistent classic rheumatoid arthritis.

We reviewed the records of 44 patients, retrospectively selected because they had had persistently active rheumatoid arthritis for more than 5 years (mean +/- SD followup 9.8 +/- 2.6 years) and because they met the American Rheumatism Association criteria for classic disease, to determine the change in extent of the anatomic distribution of joint involvement over time. The positive predictive value of a lack of inflammation in a joint during the first year for the lack of involvement over the ensuing 4 years was 87%. Thirty-eight of the 43 joints that required replacement were inflamed in the first year of disease.

Arthritis, Rheumatoid↗
PubMed1988

Effects of warming up on reliability of anthropometric techniques in ankylosing spondylitis.

To determine the effect of warm-up on anthropometric measures, 10 patients with ankylosing spondylitis and 10 normal control subjects were measured over a 1-hour period by one therapist. A series of 4 measures--a modified Schober's test, finger-to-floor with the subject standing on a 23-cm stool, chest expansion, and cervical rotation using an arthrodial protractor--were repeated completely 4 times. Subjects exercised between each series (except between the third and fourth series). Intra-rater reliability was determined by comparing measurement 3 with measurement 4, and the warm-up effect was determined by comparing measurement 1 with measurement 3. The Schober's test and chest expansion are stable measures and are not affected by warm-up. However, the finger-to-floor and cervical rotation exercises require warm-up to ensure stable values for clinical or research followup of spondylitis.

Adult↗
PubMed1988

Hip pain.

Hip pain can be categorized as either anterior groin pain, lateral trochanteric pain, or posterior buttock pain. Reproduction of the pain during passive and active range of motion of the hip against resistance provides the most accurate localization. The very important intra-articular diagnoses with poorer prognoses and more urgent requirement for treatment, such as a septic joint and hip fracture, often present with anterior groin pain. Trochanteric bursitis is the most common cause of lateral pain next to osteoarthritis. Buttock pain occasionally represents a radiation from lumbar disc or facet joint disease but more commonly is muscular in origin. Management of osteoarthritis of the hip successively challenges the primary care physician to provide effective patient education regarding NSAIDs, assistive devices for walking, and optimal timing of total hip arthroplasty.

Diagnosis, Differential↗
PubMed1988

Diagnostic value of the history and examination in giant cell arteritis: a clinical pathological study of 81 temporal artery biopsies.

To determine the value of the history and examination in predicting a temporal artery biopsy result, 81 temporal artery biopsies between 1974-1980 were studied. Each biopsy was scored blindly and independently by 2 pathologists and correlated with clinical data and the indications for biopsy at the time of the biopsy. Thirteen biopsies had giant cells and were considered positive, 8 had mononuclear inflammatory cells in the wall (7 cases) or healed arteritis (1 case) and were considered probable, and 60 were negative. In patients with an elevated sedimentation rate, the presence of a sign (tenderness or abnormal temporal artery), or a symptom (visual change or headache) predicted 18 of 21 (86%) positive-probable biopsies, but misclassified 32 of 60 negative biopsies. Attempts to derive a clinical decision rule with improved specificity resulted in unacceptably low sensitivity (missing 5 of 21 positive-probable biopsies). A minimum 5-year followup showed that those patients treated with steroids had a 6-fold increase in fractures and a 4-fold increase in cataracts.

Aged↗
PubMed1987

Colchicine in acute gout. Reassessment of risks and benefits.

Colchicine is an effective and relatively specific treatment for acute gout and has a long, venerable history. Serious toxic reactions to colchicine could be prevented if guidelines for its use were followed strictly, but because of its relatively infrequent use and conflicting recommendations, considerable toxic effects might occur and still be undetected by passive surveillance. A review of a teaching hospital's four years' experience showed two deaths (2% incidence) due to inappropriate use. Colchicine has the smallest benefit-to-toxicity ratio of drugs that are effective for acute gout. This article gives specific recommendations for the use of colchicine in different clinical settings.

Administration, Oral↗
PubMed1986

Cost-effectiveness of total joint arthroplasty in osteoarthritis.

Although total joint replacement (TJR) is a major advance in the treatment of patients with osteoarthritis, its cost-effectiveness has been questioned. We report the results of a study of the costs and benefits of TJR in consecutive osteoarthritis patients, 6 months after the surgery. Health status was measured by the Index of Well-Being. Costs of services for arthritis were determined by interview and billing records. Six months after TJR, significant improvements were seen in global health and in functional status. The average cost of care for the 6 months prior to TJR was $933. The average cost during the 6 months beginning with the TJR was $22,730 per patient--due almost entirely to costs of surgery. In general, the surgery did not change work status, probably because the mean age of the patients was 66.4 years. There were large effectiveness/cost differentials (the larger the effectiveness/cost differential, the higher the degree of cost-effectiveness [CE]). At 6 months, for all patients, the CE was associated with initial health status. The highest CE was observed in 10 patients who initially had the poorest health. TJR is more cost-effective for patients with the most to gain and less effective for those with better preoperative health status.

Aged↗
PubMed1985

Normal function of CR1 on affected erythrocytes of patients with paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemolytic anemia in which affected erythrocytes (E) are abnormally sensitive to lysis by autologous complement. Affected E from patients with PNH (PNH-E) are deficient in an E membrane regulatory protein of complement, decay-accelerating factor (DAF). Because a functional defect in a second membrane regulatory protein of complement, CR1 (C3b receptor), has also been hypothesized, severely affected PNH-E (type III PNH-E) were tested for abnormalities in CR1 by four methods. E from two patients with 100% type III PNH-E had 3201 and 6783 sites per cell for binding of 125I-labeled rabbit polyclonal F(ab')2 anti-CR1. These values fall within the normal range of CR1 antigenic sites per cell (1267 to 7915, mean = 5,014 +/- 155 SEM) established by assaying the E from 113 healthy donors. The Ka of CR1 on type III PNH-E for 125I-labeled C3b dimer was 2.06 X 10(7) M-1, and the Ka values for the binding of the same ligand to the E from two healthy individuals were 2.45 X 10(7) M-1 and 1.58 X 10(7) M-1. In an assay designed to measure the capacity of human E (Eh) to accelerate the decay of the classical C3 convertase deposited on 1 X 10(7) bystander sheep E (EAC1gp,4bh,2agp), the half-life (t 1/2) of this convertase was diminished from 18.1 min (range 15.2 to 22.9) to 8.1 min (range 7.4 to 8.5) by the addition of 1 X 10(7) normal Eh, to 6.2 min by 100% type III PNH-E, and to 7.5 min by Eh pretreated with an IgG fraction of human antiserum directed against the D antigen of the Rh system. In contrast, Eh (t 1/2 = 7.4) pretreated with a saturating dose of F(ab')2 anti-CR1, and CR1-deficient Eh (less than 10 CR1 molecules/E) from a patient with systemic lupus erythematosus, showed a loss of convertase decay-accelerating capacity to t 1/2 = 11.6 and t 1/2 = 12.4, respectively. Type III PNH-E pretreated with anti-CR1 demonstrated a total loss of their decay-accelerating capacity (t 1/2 = 19.9). In an assay of I cofactor activity, soluble C3b was rapidly converted to iC3b by purified I plus Eh or type III PNH-E, whereas CR1-deficient Eh exhibited less than 5% the I cofactor activity of normal Eh.(ABSTRACT TRUNCATED AT 400 WORDS)

Antigen-Antibody Complex↗
PubMed1983

Rheumatoid arthritis and granulomatous hepatitis: a new association.

There are no distinct hepatic manifestations of rheumatoid arthritis (RA). Granulomatous hepatitis has rarely been described in association with RA. We report 2 patients with RA who developed granulomatous hepatitis which appeared unrelated to drug use or other etiologies.

Arthritis, Rheumatoid↗
PubMed1979

Behavioral consequences of interference with CNS development in the early fetal period.

As a part of a series of investigations into the structural and functional consequences of interference with cell proliferation, mice were treated with 5-azacytidine during two stages of early fetal life. Treatment on either the twelfth or fourteenth day of gestation led to permanent significant reductions in body weight and brain weight. Behaviorally, the earlier treatment was associated with a delay in development of the righting reflex, permanent deficits in locomotor coordination, and hypoactivity. Treatment on the fourteenth day of gestation led to decreased passive avoidance, increased active avoidance, and hyperactivity--the same syndrome observed after treatment on the eighteenth day. Both treatments led to abnormal behavior on a spatial maze task. The developmental outcome of injuries induced in the early fetal period appears similar to the outcome of injuries at later stages of development.

Animals↗
PubMed1975

Development of needles and sutures for microsurgery.

At present, the smallest needle commonly available is about 130 mum in diameter in combination with a suture of about 25 mum in diameter. Marked reductions in size, particularly of the needle, are advantageous for microvascular surgery. A needle of about 70 mum in diameter, welded to a suture of about 18 mum diameter, has been developed. In initial tests, it has performed satisfactorily in the repair of the carotid artery of the white rat. It is shown that the basic properties of materials severely limit further reductions in the size of needles and sutures.

Animals↗