Avaliação dos resultados clínicos após cirurgia descompressiva em cães com doença de disco intervertebral

Clinical results after decompressive surgery were evaluated in 45 dogs with cervical or thoracolumbar intervertebral disk disease. After surgery, 35 dogs recovered totally, eight (17.8%) partially, and two (4.4%) did not present any change in clinical findings. Eight dogs with paraplegy and loss of deep pain perception showed improvement, with total recovering in 62.5% of cases. Surgery was effective in four dogs with tetraparesy. Decompressive surgery (cervical slot or hemilaminectomy), with removal of disk material from inside the vertebral canal, was an effective form to produce functional improvement in dogs with this disease.

Avaliaram-se os resultados clínicos após realização de cirurgia descompressiva em 45 cães com doença do disco intervertebral cervical ou toracolombar. Após a cirurgia, 35 cães (77,8%) recuperaram-se totalmente, oito (17,8%) parcialmente e dois (4,4%) não apresentaram alteração do quadro inicial. Em oito cães com paraplegia e perda da sensibilidade dolorosa profunda houve completa melhora do quadro clínico, com recuperação total em 62,5% dos casos. Em quatro cães com tetraparesia, a cirurgia foi eficaz. A cirurgia descompressiva (slot cervical e hemilaminectomia toracolombar), com a retirada do material do disco do interior do canal vertebral, foi uma forma efetiva de gerar melhora do quadro funcional.

Avaliação dos resultados clínicos após cirurgia descompressiva em cães com doença de disco intervertebral / Evaluation of clinical results of decompressive surgery in dogs with degenerative disk disease

Avaliaram-se os resultados clínicos após realização de cirurgia descompressiva em 45 cães com doença do disco intervertebral cervical ou toracolombar. Após a cirurgia, 35 cães (77,8 por cento) recuperaram-se totalmente, oito (17,8 por cento) parcialmente e dois (4,4 por cento) não apresentaram alteração do quadro inicial. Em oito cães com paraplegia e perda da sensibilidade dolorosa profunda houve completa melhora do quadro clínico, com recuperação total em 62,5 por cento dos casos. Em quatro cães com tetraparesia, a cirurgia foi eficaz. A cirurgia descompressiva (slot cervical e hemilaminectomia toracolombar), com a retirada do material do disco do interior do canal vertebral, foi uma forma efetiva de gerar melhora do quadro funcional

Clinical results after decompressive surgery were evaluated in 45 dogs with cervical or thoracolumbar intervertebral disk disease. After surgery, 35 dogs recovered totally, eight (17.8 percent) partially, and two (4.4 percent) did not present any change in clinical findings. Eight dogs with paraplegy and loss of deep pain perception showed improvement, with total recovering in 62.5 percent of cases. Surgery was effective in four dogs with tetraparesy. Decompressive surgery (cervical slot or hemilaminectomy), with removal of disk material from inside the vertebral canal, was an effective form to produce functional improvement in dogs with this disease

Fibromyalgia syndrome: experience in a pediatric rheumatology clinic.

OBJECTIVE: To report our experience of fibromyalgia syndrome (FMS) in pediatric rheumatology clinic settings. METHODS: Clinical and laboratory data were reviewed in all patients with FMS between March 1992 and March 1996. Patients with FMS and an underlying rheumatic disease were excluded from the study. At presentation and follow-up visits, all patients had a tender points (TP) count that was conducted by thumb palpation. Both the children and their parents were questioned concerning the presence of widespread pain or aching. All the patients fulfilled the ACR criteria for the diagnosis of primary FMS. All children were evaluated by a protocol that included relevant information on FMS. Telephone survey questionnaires were used for patients who missed some of their follow-up visits. RESULTS: There were 59 children (47 F and 12 M) diagnosed with primary FMS. The mean age at onset was 13.7 years, and the mean age at diagnosis was 15.5 years. The mean duration of follow-up was 18.3 months. Diffuse aching was reported in 57 patients (97%), headaches in 45 (76%), and sleep disturbances in 41 (69%). Less common were stiffness in 17 (29%), subjective joint swelling in 14 (24%), fatigue in 12 (20%), abdominal pain in 10 (17%), and joint hypermobility and depression in 8 (14%) and 4 (7%) patients, respectively. The mean ESR was 15 mm/h, RF was negative in all patients, and ANA was positive (mean titer 1:160) in 17 patients. The mean initial TP count was 14.6. Nine patients were not available for follow-up. There were 50 patients available for follow-up and survey analysis, and of these 30 (60%) had improved, while 18 (36%) remained unchanged, and 2 (4%) became worse when compared with initial presentation. At the end of study follow-up, 37 patients (74%) were still taking medication (20 of them daily). Out of 25 patients whose TP counts were available at the end of follow-up, the mean TP dropped from 14.12 to 12.04 (p = 0.09) for the total group, and 14.05 to 10.84 (p < 0.01) for the patients who had improved. 22 out of 30 patients in the improved group and 7 out of 20 in the unchanged or worse group had continued active exercise programs (p < 0.001). CONCLUSION: The clinical spectrum of FMS in children is similar to that of adults but with better outcomes. The TP count correlates with clinical status only in patients who had improved. Active exercise programs seem to correlate with better outcomes. Prospective and larger patient population studies, and a longer follow-up of children with FMS are needed to clarify these findings.

Anticardiolipin antibodies in childhood rheumatic disorders.

Anticardiolipin antibodies (aCL) have been reported to occur in a wide variety of autoimmune and non-autoimmune disorders in adults. Our objective was to investigate the prevalence and isotype distribution of aCL and its relationship with the features of antiphospholipid syndrome (APS) in childhood rheumatic disorders. Between November 1995 and May 1996, all patients who visited our paediatric rheumatology clinic whose guardians signed a consent form participated in the study. The study population included 106 patients (36 systemic lupus erythematosus (SLE), 28 juvenile rheumatoid arthritis (JRA), 11 fibromyalgia, 7 sarcoidosis, 5 dermatomyositis, 3 rheumatic fever (RF), 3 vasculitis, 2 scleroderma, and 11 miscellaneous). aCL measurements were performed by enzyme linked immunoabsorbent assay (ELISA). All patients were carefully evaluated for symptoms and signs of APS. Eighteen of the 106 patients (17%) were tested positive for one or more of the three aCL isotypes. In SLE, aCL were found positive in 13 of 36 (37%); in JRA 2 of 28 (7%); in sarcoidosis 2 of 7; and in RF 1 of 3. aCL of IgG isotype were found positive in 16 patients (11 SLE, 2 sarcoidosis, 2 JRA, and 1 RF). This isotype was usually detected at low titers (16-24 GPL). aCL of IgM isotype were found positive in five patients (2 sarcoidosis, 2 SLE, 1 JRA), and aCL of IgA isotype were found positive in only three patients (2 SLE, 1 sarcoidosis). Clinical features of APS were rarely seen in our SLE population and were not associated with the presence of aCL. None of the patients in the other groups exhibited any clinical manifestations of APS. In conclusion, aCL were found in 37% of our childhood SLE patients as compared with only 7% in JRA. These were mostly aCL of IgG isotype of low titers and therefore were not associated with the main features of APS. Prospective studies with a larger sample size may be needed to ascertain the exact prevalence and clinical significance of aCL in childhood-onset SLE.

Characteristics of gouty arthritis in the Guatemalan population.

The purpose of this study was to determine the characteristics of gouty arthritis in an urban Guatemalan population. We reviewed the medical records of 148 (145 males and 3 females) patients with a diagnosis of acute gouty attack seen at an urban rheumatology clinic in Guatemala City between 1982 and 1993. Mean age at diagnosis was 49 years (range 21-87), mean age of onset was 42 years, mean duration of disease 7.4 years, family history of gout 42 (28%), peak prevalence 5th decade 39 (26%). Seventy-one (48%) had monarticular, 49 (33%) oligoarticular, and 22 (15%) polyarticular attacks, respectively. Podagra was seen in 34 (23%) patients; however, 108 (73%) developed it at any moment of their life. Tophaceous gout was seen in 33 (22%). Mean serum urate concentrations (enzymatic method) were higher than 7.0 mg % in 90 (60%) patients. At follow-up, 44 (30%) patients never returned to our clinic, and a large majority of them [66 (45%)] were seen only during acute attacks. Associated disorders included hypertension (43%), obesity (27%), nephrolithiasis (16%), ischaemic heart disease (7%), renal insufficiency (2%), stroke (0.6%), and diabetes mellitus (0.6%), and two died due to sepsis; high alcoholic intake was found in 58 (39%) patients. In conclusion, our findings indicate that gout is not an unusual disorder in the Guatemalan population. It presents with the same characteristics as those reported in Caucasians, with the possible exception of a lower frequency of diabetes mellitus as an associated disorder.

Induction of experimental antiphospholipid antibody syndrome in PL/J mice following immunization with beta 2 GPI.

PROBLEM: Immunization with beta 2-glycoprotein I (beta 2 GPI) induces antiphospholipid antibodies (aPL) in normal mice and rabbits. Recently we reported early onset of autoimmunity in MRL/(+2) mice following immunization with beta 2 GPI. There is a close association between aPL with thrombosis, recurrent fetal loss, and intrauterine growth retardation. In this study we evaluated the effect of beta 2 GPI-induced aPL on pregnancy outcomes in an inbred strain of mice (PL/J). METHOD: Three groups of seven-week female PL/J mice (12 per group) were studied. Group A was immunized with beta 2 GPI and group B with ovalbumin; group C was not not immunized. After two booster injections, the mice were tested for aPL, anti-DNA by ELISA, and for ANA by indirect immunofluorescence. Platelet count and pregnancy outcomes were studied at the age of 14 weeks. RESULTS: The aPL and anti-DNA levels were higher at 12 and 14 weeks in group A; the optical densities (OD) were 1.72 +/- 0.6 and 0.699 +/- 0.25 for group A, 0.09 +/- 0.040 and 0.230 +/- 0.47 for group B, and 0.0435 +/- 0.003 and 0.119 +/- 0.26 for group C (comparing group A with groups B and C combined, P < 0.001). ANA titers rose in groups A and B by age, but they were significantly higher at 14 weeks in group A. The mean titers were 1/286, 1/90, and 1/16 for A, B, and C, respectively (P < 0.001). The platelet counts were not significantly different among the three groups. The titer size was significantly smaller in group A, as evidenced by the numbers of viable fetuses among the mice that became pregnant in each group: 0.75, 2.45, and 5.5 in groups A, B, and C, respectively. Seven pregnant mice in group A had complete resorption, seven pregnant mice in group B showed focal (partial) resorption areas, by only one mouse in group C had complete resorption of the embryos, as shown by histopathological studies, although the fecundity rate was similar in the three groups. CONCLUSION: Our data suggest a pathogenic role for beta 2 GPI-induced aPL in the development of experimental models of APS in PL/J mice.

Autoantibody profile in African-American patients with lupus nephritis.

Lupus nephritis (LN) is one of the major risk factors for morbidity and overall mortality in systemic lupus erythematosus (SLE). Its pathogenesis is multifactorial, and a number of risk factors, including serological markers, have been identified in recent years, correlating with clinical course and disease severity. Furthermore, a distinctive autoantibody profile has recently been reported in African-American SLE women with LN. The aim of this study was to characterize the autoantibody profile in 222 African-American SLE patients, 94 with LN and 128 without. Only anti-dsDNA achieved statistical significance between the two groups (P < 0.05). Fourteen (14.9%) patients with LN and 15 (11.7%) without it exhibited positive anti-Ro/SS-A, anti-Sm, and anti-nRNP, but without anti-La/SS-B (P > 0.6). We conclude that African-American SLE patients with LN do not exhibit a specific or distinctive autoantibody profile. However, our data confirm the value of anti-dsDNA in SLE patients with LN.

Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis.

OBJECTIVE: To assess the frequency of methotrexate (MTX)-induced pancytopenia in rheumatoid arthritis (RA). METHODS: A MEDLINE literature search was conducted to identify articles published during the last 15 years (1980-1995) that presented data on MTX-associated pancytopenia. Two case reports of our own experience are also presented. In addition, articles that examined risk factors associated with MTX-related pancytopenia were identified. RESULTS: A total of 70 patients with pancytopenia related to MTX therapy were identified (68 reported in the literature, 2 from our own experience). Sixty-one of the patients were described in published case reports, 7 patients were from 5 long-term prospective studies. In many of these cases, predisposing factors for the development of pancytopenia were described. The 5 long-term prospective studies reported toxicity data on patients who had been treated with MTX for at least 13 weeks. A total of 511 patients were included in the prospective trials, yielding an overall incidence of pancytopenia of 1.4% (7 of 511). Of the 70 cases reported, 12 patients died (17%). Most of them had impaired renal function, hypoalbuminemia, concurrent infection, and/or concomitant medication with more than 5 drugs. The minimal cumulative MTX dose leading to fatal pancytopenia was 10 mg, observed in one of our patients. CONCLUSION: Pancytopenia is not an uncommon side effect of low-dose pulse MTX therapy in RA. It can lead to serious complications, including death.

Poststreptococcal reactive arthritis, clinical course, and outcome in 6 adult patients.

OBJECTIVE: To analyze the clinical course and laboratory features, as well as the outcome of 6 adult patients with articular manifestations, and evidence of streptococcal infection. METHODS: A retrospective review was performed of all patients seen in a rheumatology clinic at Louisiana State University Medical Center, with a diagnosis of poststreptococcal reactive arthritis (PSReA) to summarize the clinical features, laboratory findings, and clinical outcome between July 1991 and August 1994. RESULTS: Six patients were identified with PSReA. All had acute, severe inflammatory articular involvement that began shortly after a sore throat, with serological evidence of streptococcal infection, and accompanied by extraarticular clinical manifestations including glomerulonephritis and vasculitis, and poor response to aspirin and other nonsteroidal antiinflammatory drugs. In all cases the echocardiogram was negative, and on followup there was no evidence of cardiac involvement. In these patients antibiotic prophylaxis was not required. CONCLUSION: The clinical picture and serologic abnormalities exhibited by this group of patients suggest a diagnosis of PSReA rather than acute rheumatic fever. These cases also emphasize the resurgence of poststreptococcal infection related articular manifestations in our clinic population.