RESUMO
A recent publication reported a high prevalence of double-stranded DNA antibodies quantitated by RIA in patients with Graves' disease. We, therefore, measured antibodies to a variety of nuclear antigens in 20 patients with Graves' disease, most of whom where hyperthyroid. Fluorescent antinuclear antibody tests using HEp-2 cells as substrate were positive in serum of 15 of the 20 patients but in only 2 of 20 normal subjects. DNA binding, determined by RIA, was increased in 12 of 18 patients with Graves' disease. However, a more specific indirect immunofluorescence assay for antibodies to double-stranded DNA using Crithidia luciliae was negative in all 20 patients. Furthermore, antibodies to single-stranded DNA, measured by counterimmunoelectrophoresis, and ribonucleoprotein and Sm antigens, measured by double diffusion in agar, were undetectable in all patients tested. These results demonstrate a high frequency of antinuclear antibody in patients with Graves' disease. The presence of antibodies to double-stranded DNA was not confirmed when assayed by the highly specific and sensitive Crithidia luciliae method, suggesting nonantibody DNA binding in the DNA RIA.
Assuntos
Anticorpos Antinucleares/análise , Doença de Graves/imunologia , Ribonucleoproteínas Nucleares Pequenas , Animais , Autoantígenos/análise , Crithidia , DNA/imunologia , DNA de Cadeia Simples/imunologia , Imunofluorescência , Humanos , Imunoeletroforese Bidimensional , Ribonucleoproteínas/imunologia , Proteínas Centrais de snRNPRESUMO
Although the actions of immunosuppressive agents on lymphocytes are well characterized, their influence on leukocyte-endothelial cell adhesive interactions has not been defined. The objective of this study was to determine whether cyclosporine and L-683,590 (FK520) could modify the adhesion and emigration of leukocytes in postcapillary venules that are exposed to inflammatory mediators such as platelet activating factor (PAF) and leukotriene B4 (LTB4). The rat mesentery was prepared for in vivo microscopic observation. Venules with internal diameters ranging between 25 microns and 35 microns were selected for study. Erythrocyte velocity, vessel diameter, leukocyte rolling velocity, and the number of adherent (stationary for > 30 sec) and emigrated leukocytes were measured during superfusion of the mesentery with bicarbonate-buffered saline. Repeat measurements of adhesive and hemodynamic parameters were obtained between 50 and 60 min of superfusion with either 100 nM PAF or 20 nM LTB4 added to bicarbonate-buffered saline. In some experiments, animals were treated with either cyclosporine or L-683,590. Both PAF and LTB4 caused increases in leukocyte adherence and emigration, and reductions in leukocyte rolling velocity and venular shear rate. Cyclosporine prevented all of the adhesive and hemodynamic alterations induced by PAF, but not LTB4. L-683,590 was effective in preventing the responses elicited by both PAF and LTB4. These results indicate that modulation of leukocyte-endothelial cell adhesive interactions may represent a novel mechanism of action for cyclosporine and L-683,590.
Assuntos
Ciclosporina/farmacologia , Leucócitos/citologia , Tacrolimo/farmacologia , Animais , Capilares/citologia , Adesão Celular/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Leucotrieno B4/farmacologia , Masculino , Fator de Ativação de Plaquetas/farmacologia , Ratos , Ratos Sprague-Dawley , Vênulas/citologiaRESUMO
Systemic lupus erythematosus (SLE) frequently involves the pleura with resultant pleural effusion. Previous studies have reported that detection of antinuclear antibodies (ANA) in pleural fluid using animal tissue as substrate was a sensitive and specific method for distinguishing SLE pleural effusions from other etiologies. The HEp-2 ANA, which uses a human cell line as substrate, is now the preferred ANA test; however, to our knowledge, no studies on pleural fluid using this assay have been reported. To determine its sensitivity and specificity, when measured in pleural fluid, HEp-2 ANA levels were determined in pleural effusion samples associated with a variety of different etiologies, including SLE, malignancy, congestive heart failure, pneumonia, tuberculosis, and a miscellaneous group of diseases. Pleural fluid ANA results were positive in 14 of 82 samples. Six of the eight (75 percent) pleural fluid samples collected from patients with SLE were ANA positive, and all but one had high titers (> 1:160) with a homogenous staining pattern. The remaining two patients with SLE with negative pleural fluid ANA had recurrent pulmonary emboli and congestive heart failure, rather than lupus pleuritis. Eight of 74 patients (10.8 percent) without clinical evidence of SLE had a positive pleural fluid ANA, with the majority having a speckled pattern. High titers were noted in three. These results indicate that a negative or low titer ANA and a speckled staining pattern in pleural fluid from a patient suspected of lupus pleuritis suggest an alternative diagnosis. High pleural fluid titers (up to 1:640) were seen occasionally in patients with inflammatory pleural effusions in the absence of SLE.
Assuntos
Anticorpos Antinucleares/análise , Derrame Pleural Maligno/diagnóstico , Derrame Pleural/diagnóstico , Adulto , Especificidade de Anticorpos , Ensaio de Imunoadsorção Enzimática , Feminino , Imunofluorescência , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Sensibilidade e EspecificidadeRESUMO
To examine the hypothesis that patients with inflammatory muscle disease have impairments in cardiac and/or pulmonary function that are masked by peripheral muscle weakness, complete PFTs, echo/Doppler studies and exercise testing were performed in 11 patients with polymyositis. Maximal inspiratory and expiratory pressures and expiratory flow rates were normal. One patient had evidence of restrictive lung disease; two had a reduced Dsb. Seven patients had evidence of pulmonary hypertension. Only three patients had normal aerobic capacity; VO2 max in the other 8 patients was 46 +/- 8 percent of predicted when they stopped exercising. Four patients had a normal O2 pulse; seven patients had a reduced O2 pulse while five of seven patients exceeded 85 percent of their target heart rate. We conclude that while asymptomatic impairments in pulmonary function are uncommon in polymyositis, the incidence of pulmonary hypertension is high, but symptoms may be masked by the peripheral muscle weakness.
Assuntos
Exercício Físico/fisiologia , Hipertensão Pulmonar/fisiopatologia , Miosite/fisiopatologia , Ecocardiografia Doppler , Eletrocardiografia , Teste de Esforço , Feminino , Coração/fisiopatologia , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Miosite/complicações , Testes de Função RespiratóriaRESUMO
A previously healthy 15-year-old boy was seen with a loculated right lower lobe empyema. Group F beta-hemolytic streptococci were cultured from the pleural fluid. Surgical intervention was required. An unsuspected aspirated grass inflorescence and a bronchopleural fistula were discovered during a decortication procedure.
Assuntos
Empiema/etiologia , Corpos Estranhos/complicações , Pulmão , Poaceae , Infecções Estreptocócicas , Adolescente , Fístula Brônquica/etiologia , Fístula/etiologia , Humanos , Masculino , Doenças Pleurais/etiologia , StreptococcusRESUMO
OBJECTIVE: To describe a case of autoimmune exocrinopathy in a child at the age of 3 months who presented with the original diagnosis of recurrent parotitis. DESIGN: This a case report of a 9-year-old girl with recurrent parotitis who was later found to have Sjögren's syndrome. The literature relating to primary Sjögren's syndrome in the pediatric population is reviewed. SETTING: The patient was seen in the rheumatology and otolaryngology clinics at a university medical center. INTERVENTIONS: This study did not address therapy. MAIN OUTCOME MEASURE: Diagnosis of Sjögren's syndrome. RESULTS: The patient had xerostomia, an abnormal result of a salivary gland biopsy, SSA and SSB antibodies, and the histocompatibility antigens HLA-B8 and HLA-DR3 that are associated with Sjögren's syndrome. CONCLUSION: Primary Sjögren's syndrome should be considered in cases of recurrent parotitis of childhood. More studies are needed to assess the natural history of autoimmune exocrinopathy in children.
Assuntos
Doenças Autoimunes/diagnóstico , Parotidite/diagnóstico , Síndrome de Sjogren/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Humanos , RecidivaRESUMO
We report eight patients with metastatic malignancy who developed severe back and leg pain caused by ischiogluteal bursitis. Careful evaluation excluded the possibility of bony metastases. Ischiogluteal bursitis is an easily diagnosed condition that can be effectively treated with local injection of corticosteroids. Recognition of this disorder will allow prompt therapy and unnecessary evaluation expenses.
Assuntos
Bursite/diagnóstico , Ísquio , Neoplasias/complicações , Dor/etiologia , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Adulto , Idoso , Bursite/tratamento farmacológico , Bursite/etiologia , Nádegas , Feminino , Humanos , Injeções , Lidocaína/administração & dosagem , Lidocaína/uso terapêutico , Pessoa de Meia-Idade , Neoplasias/fisiopatologia , Dor/tratamento farmacológico , Exame Físico , Redução de PesoRESUMO
Colchicine and methotrexate are commonly used in the treatment of gout and rheumatoid arthritis, respectively; however the mechanism(s) of action of these drugs remain(s) unknown. The objective of this study was to determine whether colchicine and methotrexate can modify the adhesion and emigration of leukocytes in postcapillary venules that are exposed to inflammatory mediators such as platelet-activating factor (PAF) and leukotriene B4 (LTB4). The rat mesentery was prepared for in vivo microscopic observation. Venules with internal diameters ranging between 25 and 35 microns were selected for study. Erythrocyte velocity, vessel diameter, leukocyte rolling velocity, and the number of adherent (stationary for greater than or equal to 30 sec) and emigrated leukocytes were measured during superfusion of the mesentery with bicarbonate-buffered saline (BBS). Repeat measurements of adhesive and hemodynamic parameters were obtained between 50 and 60 min of superfusion with either 100 nM PAF or 20 nM LTB4 added to the superfusate. In some experiments, 1 microM of either colchicine or methotrexate was added to the superfusate containing either PAF or LTB4. Both PAF and LTB4 caused increases in leukocyte adherence and emigration and reductions in leukocyte rolling velocity and venular shear rate. Colchicine effectively prevented all of the adhesive and hemodynamic alterations induced by both inflammatory mediators, while methotrexate was largely effective in preventing the responses elicited by PAF, but not LTB4. These results indicate that the therapeutic actions of colchicine and methotrexate may result from the ability of these agents to interfere with the adhesion and emigration of leukocytes from postcapillary venules.
Assuntos
Colchicina/farmacologia , Leucócitos/efeitos dos fármacos , Mesentério/irrigação sanguínea , Metotrexato/farmacologia , Animais , Adesão Celular/efeitos dos fármacos , Inibição de Migração Celular , Citometria de Fluxo , Humanos , Leucotrieno B4/farmacologia , Masculino , Microscopia/métodos , Neutrófilos/efeitos dos fármacos , Fator de Ativação de Plaquetas/farmacologia , Ratos , Ratos Endogâmicos , Vênulas/efeitos dos fármacos , Gravação em VídeoRESUMO
A 15-year-old girl with systemic lupus erythematosus suddenly developed fever, meningismus, and herpes zoster. Within 48 hours, transverse myelitis developed at the level of the nerve root involvement of the herpes zoster. Since both systemic lupus erythematosus and varicella-zoster have been reported to cause myelitis, therapy was initiated for both. The rapid and simultaneous resolution of both the herpes zoster and the neurologic deficits strongly supports the causal association of both with varicella-zoster. This is the second reported case of herpes zoster-associated transverse myelitis in a patient with systemic lupus erythematosus.
Assuntos
Herpes Zoster/complicações , Lúpus Eritematoso Sistêmico/complicações , Mielite Transversa/complicações , Aciclovir/uso terapêutico , Adolescente , Anfotericina B/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Herpes Zoster/tratamento farmacológico , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Mielite , Mielite Transversa/tratamento farmacológicoRESUMO
Our objective was to identify the role of various disease states and additional risk factors in the development of thrombosis in patients with anticardiolipin antibodies (aCL). We undertook a retrospective chart review of patients with aCL (IgG or IgM titres > 20 GPL or 20 MPL by ELISA). Patients with a thrombotic event were compared to patients without thrombosis for potential risk factors: age, gender, ethnicity, hypertension (HTN), diabetes (DM), hyperlipidaemia, tobacco use and sequential aCL determinations. The role of systemic lupus erythematosus (SLE), human immunodeficiency virus (HIV), hepatitis C and renal disease was also analysed. Statistical analysis was performed using the t-test, the chi(2) test and multivariate analysis. Of the 107 patients who had moderately positive aCL (IgM and/or IgG), 53 had a thrombotic event. The patients with thrombosis were significantly older than patients without thrombosis (mean age 46.6 vs. 38.75 years, respectively, P=0.014). No significant differences in gender, race, HTN, DM, hyperlipidaemia, tobacco use or concomitant diseases were identified in the two groups. Thrombosis was more frequent in patients who were seropositive for both IgG and IgM ( P=0.027). Thrombosis was observed in equal frequencies in patients with aCL on both determinations and in patients with aCL on only one of the two determinations. In patients with aCL on two determinations a high-titre IgG aCL was associated with thrombosis. Patients with renal disease and aCL on only one of the two determinations had fewer thrombotic events ( P=0.0046). Mean aCL IgM titres were higher in thrombosis groups containing venous thromboses than in the thrombosis group with arterial thrombosis only. We concluded that risk factors for thrombosis with a single aCL determination include older age and both IgM and IgG aCL. With persistent aCL, high-titre IgG aCL was associated with thrombosis.
Assuntos
Anticorpos Anticardiolipina/análise , Trombose/etiologia , Trombose/imunologia , Adulto , Envelhecimento/fisiologia , Feminino , Humanos , Imunoglobulina G/análise , Imunoglobulina M/análise , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/complicações , Estudos Retrospectivos , Trombose/complicaçõesRESUMO
The authors prospectively performed echocardiographic and Doppler studies on 13 patients with inflammatory myopathy to evaluate ventricular function, to assess valve morphology and function, and to obtain hemodynamic data. No patient had a reduction in left ventricular function or evidence of significant valvular disease. Hemodynamic assessment suggested evidence of pulmonary hypertension in 9 patients. They conclude that cardiomyopathy in association with inflammatory myopathy is unusual and that the suggestion of pulmonary hypertension is unexplained and merits further evaluation.
Assuntos
Cardiomiopatias/diagnóstico por imagem , Dermatomiosite/diagnóstico por imagem , Ecocardiografia , Hipertensão Pulmonar/diagnóstico por imagem , Miosite/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatias/etiologia , Dermatomiosite/complicações , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Miosite/complicações , Função Ventricular Esquerda/fisiologiaRESUMO
We report on two patients who developed cutaneous necrosis from the use of pulse oximetry monitoring. One developed digital skin necrosis from a finger sensor, while the other had a lesion of the pinna from an ear probe. Pulse oximetry monitoring is often used in the management of anesthetized and critically ill patients. Recognition of cutaneous necrosis with pulse oximetry may prevent unnecessary evaluation and prompt initiation of simple measures to protect against its occurrence.
Assuntos
Oximetria/efeitos adversos , Pele/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , NecroseRESUMO
We report a patient who developed pulmonary fibrosis before the appearance of cutaneous scleroderma. This unusual clinical presentation has been infrequently reported in the English literature. Recognition that pulmonary disease may occur before extensive skin changes in scleroderma is important to ensure proper management.