Mucocutaneous side effects and continuation of aurotherapy in patients with rheumatoid arthritis.

AIM: To examine the possibility of the continuation of therapy after achieving clinical improvement in patients with mucocutaneous side-effects of parenteral gold compound therapy (Tauredon, "Byk Gulden", Germany). METHODS AND RESULTS: 40 patients with active seropositive rheumatoid arthritis (average age 42.8 years, average duration of disease 2.8 years) received Tauredon in a dosage of 50 mg/week intramuscularly. 19 patients (47.5%) developed mucocutaneous side effects. Four of them were excluded from the study because of severe skin reactions. In 15 patients with mild or moderate side-effects (local skin rash and stomatitis) aurotherapy was continued after the resolution of adverse reactions. Four out of the 15 patients were withdrawn from the study after restarting the lower dose treatment due to recurrence of dermatitis. 11 out of 19 patients finished 1 year of study with low dose Tauredon. Clinical remission occurred in 4 patients (36.4%) while improvement was registered in 6 patients (54.5%). In one patient (9.1%) no clinical effect was observed. None of these 11 demonstrated any Tauredon toxicity. CONCLUSION: The development of mucocutaneous side-effects should not be considered as an absolute contraindication for the continuation of gold compound therapy. A low dose regimen may allow maintenance of therapeutic effect and improve tolerance in this group of patients. Gold salts, such as disodium aurothiomalate (ATMO have been used in the treatment of rheumatoid arthritis (RA) for over 70 years. They suppress inflammation and retard radiological progression of joint damage [1], but their use is limited by a high incidence of toxic side-effects in about 30% of patients. The commonest side-effect of chrysotherapy is skin toxicity, accounting for up to 60% of all adverse reactions [2]. Rash is most frequent in the first year of therapy, but can occur at any time. Stomatitis occurs in 1-12% of patients and may occur concomitantly with skin rash. The causes of skin rash and stomatitis are still unknown. When mucocutaneous reactions develop, the drug should be withheld until the condition resolves [3]. Approximately 2-3% of patients have to stop treatment because of severe skin rash and mouth ulcers [4]. However we, together with other authors [5, 6, 7, 8, 9] consider that mild to moderate mucocutaneous reactions are not an absolute contraindication for the continuation of gold therapy. The aim of our study is to examine the possibility for the continuation of therapy after achieving clinical improvement in patients with skin rash and stomatitis as a result of treatment with ATM (Tauredon, "Byk Gulden", Germany).

[The characteristics of amino acid metabolism in premature infants on different types of feeding]. / Osobennosti aminokislotnogo obmena u nedonoshennykh detei pri razlichnykh vidakh vskarmlivaniia.

Analysis of the free amino acids (AA) in a blood plasma of premature infants receiving kinds of baby food has allowed to reveal a feature of AA metabolism. A significant increasing of sum of the free AA and stable contents of aromatic AA have been found in blood of premature infants fed Prepiltti [correction of 'Prepilti'] that testified to adequacy of protein in Prepiltti [correction of 'Prepiltu'] to requirements of premature infants. Also it has been established different changes of concentration methionine and cystine in this group of the babies that confirms a hypothesis about immature of liver enzymes catabolizing a methionine.

[The carbohydrate composition of human milk]. / Uglevodnyi sostav zhenskogo moloka.

The carbohydrate content of breast milk was investigated by capillary gas liquid chromatography. The milk samples obtained from 16 normal lactating mothers contained glucose, galactose, lactose, and 3-fucosidolactose. The content of monosaccharides in breast milk was 2-12 times higher than that in cow's milk. The lactose content amounted to 84-95%, whereas the ratio of alpha- tox beta-froms was within 0.92-0.95%. Breast milk was found to contain alpha- and beta-forms of 2- and 3-fucosidolactose which do not occur in cow's milk. The content of these forms accounted for 3%. The biological role of breast milk carbohydrates is discussed.

Immunological protection of the neonatal gastrointestinal tract: the importance of breast feeding.

Immunoglobulins A, M and G were measured in the milk of 20 nursing mothers at the beginning of lactation and simultaneously in the faeces of their children. The IgA level in the human milk was very high especially during the first week of lactation. After the start of breast-feeding IgA rapidly increased in the faeces, whereas IgG and IgM concentrations were consistently very low. In 74 normal full-term bottle-fed infants IgA appeared in the faeces at the age of 3-4 weeks but the level was significantly lower than the IgA level in breast-fed infants at the same age. Secretory IgA of human milk is stable and resistant to gastrointestinal juices and enzymes, thus giving passive immunological protection to the digestive tract of the newborn infant.

[Effect of a liquid acidophilic mixture on the intestinal microbiocenosis of infant patients in the 1st months of life]. / Vliianie zhidkoi atsidofil'noi smesi na mikrobiotsenoz kischechnika bol'nykh detei pervykh mesiatsev zhizni.

The effect of a liquid acidophilic mixture on intestinal biocenosis was studied in 10 premature infants aged 19 days to 1 1/2 months (Group I) with focal inflammation and neurological disorders after hypoxia in the perinatal period, and in 11 children aged 19 days to 3 1/2 months (Group II) with sepsis and intestinal diseases of staphylococcal, proteus and obscure etiology. Before application of the mixture, all the children demonstrated microbiocenosis disorders which were more remarkable in Group II. The liquid acidophilic mixture was shown to have a correcting action as regards lactobacilli, and the quantitative and qualitative composition of intestinal bacteria. The correcting effect exhibited by the mixture was found inadequate to neutralize an adverse effect of the infectious process and intense antibiotic therapy and chemotherapy on intestinal microbiocenosis in children of the first months of life suffering from sepsis and intestinal diseases, provided the mixture was used for 11-20 days.

[Formation of a local IgA system in the intestines of infants in the 1st weeks of life]. / K voprosu o formirovanii lokal'noi sistemy IgA v kishechnike detei pervykh nedel' zhizni.

Formation of the IgA passive and active system in the gastrointestinal tract of children of the first weeks of life was studied on the basis of determining the IgA content in coprofiltrates and the level of immunoglobulins in the breast milk. The predominant class of immunoglobulins contained by the breast milk during the first lactation week involved IgA that was present in considerable concentrations. The IgA level in the milk declined by the end of the first week. Before giving babies the breast, their coprofiltrates did not show IgA. Afterwards its concentration grew intensively in infants fed native breast milk and lowered gradually by one month and a half to two months of age. IgA was not detectable in coprofiltrates of infants of the first two weeks of life fed pasteurized breast milk. With age the frequency of detection increased, however, even during the second month of life IgA was not detectable in all the cases, its concentration being three times less as compared to that in breast fed children of the same age.

[Natural feeding and its importance in forming local immunological protection in the gastrointestinal tract during the neonatal period]. / Estestvennoe vskarmlivanie i ego znachenie v formirovanii mestnoi immunologicheskoi zashchity zheludochno-kishechnogo trakta v period novorozhdennosti.

The immune proteins content in the breast milk at the 1st week of lactation as contrasted to the data obtained by investigating immunoglobulins in feces of newborns breast-fed was studied. Both in the breast milk and in feces the A-class immunoglobulins being of great importance in the immunological protection of the mucosae prevail. A high level of immune proteins resistant to proteolytic enzymes ensures the state of local passive immunity in neonates receiving breast milk.