A 60-Year-Old Woman With Acute Chest Pain and Bilateral Pleural and Pericardial Effusions.

CASE PRESENTATION: A 60-year-old woman presented with acute-onset, progressively worsening shortness of breath and pleuritic chest pain for 3 days. She also complained of a dry cough, but no fever or chills. There was no history of swelling of the feet; nor was there a history of nausea or diarrhea. She was a lifelong nonsmoker and had no history of recent travel or sick contacts. Her medical history included hypertension and ulcerative colitis. The ulcerative colitis was in remission and she had not been taking medications for this for over 7 years. Her home medications included alendronate, amlodipine, aspirin, atenolol, and vitamin D3 supplements. She had no allergies.

Antibacterial, anti-inflammatory, and antioxidant effects of Yinzhihuang injection.

The Yinzhihuang injection, a traditional Chinese medicine, has been the recent target of increasing interest due to its anti-inflammatory properties. The molecular basis by which Yinzhihuang injection could cure Riemerella anatipestifer (RA) serositis in ducks is unclear. This study evaluated the antibacterial, anti-inflammatory and antioxidant effects of Yinzhihuang injection, using disease models of RA-induced infectious serositis in ducks and heptane-induced inflammation in mice and rats. The duck mortality rate was reduced from 60% to 20% and both the inflammatory response and histological damage were ameliorated by treatment with Yinzhihuang injection (0.02 g/kg). Further studies indicated that superoxide dismutase (SOD), nitric oxide synthase (NOS), and inducible nitric oxide synthase (iNOS) were elevated while malondialdehyde (MDA), nitric oxide (NO) and RA growth were inhibited when the ducks were treated by Yinzhihuang injection. In addition, Yinzhihuang injection (0.04 g/ml) effectively inhibited xylene-induced auricle swelling in mice, (demonstrating an inhibition rate of 35.21%), egg albumen-induced paw metatarsus swelling in rats, (demonstrating an inhibition rate of 22.30%), and agar-induced formation of granulation tissue. These results suggest that Yinzhihuang injection ameliorates RA-induced infectious serositis in ducks by modulation of inflammatory mediators and antioxidation.

Juvenile diffuse systemic sclerosis/systemic lupus erythematosus overlap syndrome--a case report.

We report a rare case of diffuse systemic sclerosis (SSc) evolving into diffuse SSc/systemic lupus erythematosus (SLE) overlap syndrome. A 15-year-old boy was diagnosed as diffuse SSc with initial presentations of Raynaud's phenomenon and skin tightening. He underwent Chinese herbal treatment and clinical symptoms deteriorated in the following 3 years. On admission to our ward, serositis with pleural effusion, severe pulmonary fibrosis with moderate pulmonary hypertension, swallowing difficulty, and polyarthritis were observed. Autoantibody profiles revealed concurrence of anti-double-stranded DNA, anti-Smith, anti-topoisomerase I, and anti-ribonucleoprotein antibodies. The patient fulfills the criteria for both diffuse SSc and SLE. After drainage for pleural effusion accompanied by oral prednisolone and sildenafil, there were improvement of respiratory distress, swallowing difficulty, and pulmonary hypertension. In conclusion, connective tissue diseases may overlap with each other during the disease course. Serial follow-up for clinical symptoms as well as serological changes is recommended.

Pathogenesis and clinical manifestations of juvenile rheumatoid arthritis / 소아과

Juvenile rheumatoid arthritis (JRA) is the most common rheumatic childhood disease; its onset is before 16 years of age and it persists for at least 6 weeks. JRA encompasses a heterogeneous group of diseases that is classified according to 3 major presentations: oligoarthritis, polyarthritis, and systemic onset diseases. These presentations may originate from the same or different causes that involve interaction with specific immunogenetic predispositions, and result in heterogeneous clinical manifestations. An arthritic joint exhibits cardinal signs of joint inflammation, such as swelling, pain, heat, and loss of function; any joint can be arthritic, but large joints are more frequently affected. Extra-articular manifestations include high fever, skin rash, serositis, and uveitis. The first 2 types of JRA are regarded as T helper 1 (Th1) cell-mediated inflammatory disorders, mainly based on the abundance of activated Th1 cells in the inflamed synovium and the pathogenetic role of proinflammatory cytokines that are mainly produced by Th1 cell-stimulated monocytes. In contrast, the pathogenesis of systemic onset disease differs from that of other types of JRA in several respects, including the lack of association with human leukocyte antigen type and the absence of autoantibodies or autoreactive T cells. Although the precise mechanism that leads to JRA remains unclear, proinflammatory cytokines are thought to be responsible for at least part of the clinical symptoms in all JRA types. The effectiveness of biologic therapy in blocking the action of these cytokines in JRA patients provides strong evidence that they play a fundamental role in JRA inflammation.

Effect of vaccinating sows and their piglets on the development of Glässer's disease induced by a virulent strain of Haemophilus parasuis serovar 5.

Ten pregnant gilts were divided into two groups of five and one group was vaccinated at 80 and 95 days of pregnancy with a commercial bacterin containing Haemophilus parasuis serovars 2, 3 and 5. Half the piglets born to each group of gilts were vaccinated at seven and 21 days of age with the same bacterin, and one week after they were weaned at five weeks, all the piglets were inoculated intratracheally with 10(6) colony-forming units of Hparasuis serovar 5. At slaughter, a significantly smaller percentage of the lungs of the pigs born to the vaccinated gilts was affected by pneumonic lesions, and significantly fewer of them had arthritic joint changes. The average daily liveweight gain of the pigs born to the vaccinated gilts was significantly greater than that of those born to the unvaccinated gilts, but the vaccination of the piglets had no effect. There was no significant difference between the feed conversion ratios of the four groups of piglets, and none between the average times they took to reach slaughter weight. The pigs born to the vaccinated gilts had higher ELISA titres to Hparasuis than those born to the unvaccinated gilts.

Ursodeoxycholic acid ameliorates ibuprofen-induced enteropathy in the rat.

BACKGROUND: The objective of the study was to determine whether ursodeoxycholic acid (Ursodiol) is protective against ibuprofen (IBU)-induced enteropathy. METHODS: Using the chronically catheterized rat model, IBU (60 mg/kg body weight per day) was infused via the gastric catheter twice daily. Pancreatic enzyme (PE; 10,000 U lipase/kg body weight per day) and Ursodiol (10 mg/kg body weight per day) in two doses were infused via the duodenal catheter. Rats were assigned to one of six treatment groups and were administered treatment for 20 days: control, IBU, PE, IBU + PE, IBU + Ursodiol, and IBU + PE + Ursodiol. The entire jejunum, ileum, cecum, and colon were available for histologic analysis using previously described techniques. RESULTS: Addition of Ursodiol to high-dose IBU and normal doses of PE showed a significant reduction in the percentage of rats with ulcers (P < 0.05), total number of serositis events (P < 0.01), total number of severe ulcers (P < 0.001), and an absence of ulcers in the large intestine. CONCLUSIONS: Ursodiol, the drug of choice for the treatment of cystic fibrosis liver disease, may offer a safe method of using high-dose IBU in these patients by ameliorating the enteropathy.

Mycoplasma hyorhinis infection of pigs selectively bred for high and low immune response.

Pigs have been selected for high (H) or low (L) combined antibody and cell-mediated immune response to test the high immune response phenotype as a candidate for an indirect approach to improving health and productivity in livestock. Mycoplasma hyorhinis infection was induced in H and L pigs of the 4th generation of selection to test the hypothesis that immune response lines differ in response to infection. The major disease sign, arthritis, was more severe in the H pigs both clinically and at necropsy. M. hyorhinis was isolated at higher colony counts from synovial fluids of the H pigs. In contrast, pleuritis and peritonitis were less severe in pigs of the H than those of the L line. Pericarditis, although less in H than L pigs, did not differ significantly by line. Synovial fluid antibody to M. hyorhinis did not differ by line but H pigs produced serum antibody earlier and to a higher titre than did L pigs. Selection for H or L immune response therefore alters response to M. hyorhinis, however there is no indication of a consistent line-related health advantage.

Mortality risks associated with specific clinical manifestations of systemic lupus erythematosus.

BACKGROUND: Mortality in patients with systemic lupus erythematosus (SLE) is often related to disease in particular organ systems. We examined the risks of mortality associated with 8 clinical manifestations of SLE and determined whether these risks differed among patients with different sociodemographic characteristics. METHODS: Using life table analysis, we determined the associations of hemolytic anemia, leukopenia, thrombocytopenia, arthritis, serositis, nephritis, psychosis, and seizures with both all-cause mortality and SLE-related mortality in a cohort of 408 patients. RESULTS: Over a median duration of follow-up of 11 years, 144 patients died; 78 deaths (54%) were SLE related. In univariate analyses, the presence of hemolytic anemia, serositis, nephritis, psychosis, and seizures was associated with greater all-cause mortality, while the presence of arthritis was protective. In multivariate analyses that controlled for patient demographic characteristics, nephritis (relative risk, 2.34) and seizures (relative risk, 1.77) were associated with poorer overall survival. Nephritis and seizures, along with thrombocytopenia, were also associated with greater SLE-related mortality, while leukopenia was protective. The risk of death in association with these clinical manifestations did not differ among patient age, sex, race, or socioeconomic subgroups. CONCLUSIONS: The presence of nephritis and seizures each increased the risk of death in patients with SLE approximately 2-fold. Thrombocytopenia also increased the risk of SLE-related mortality, while leukopenia was protective.