Hypocomplementemic urticarial vasculitis: association with chronic obstructive pulmonary disease.

Since 1973, we have identified and collected follow-up data on 16 patients with hypocomplementemic urticarial vasculitis. Preliminary diagnostic criteria are the presence of typical urticarial skin lesions and low levels of serum complement (all components), plus two of the following: dermal venulitis, arthritis, glomerulo-nephritis, episcleritis or uveitis, recurrent abdominal pain, and C1q precipitin in plasma. Exclusions are systemic lupus erythematosus, mixed cryoglobulinemia, elevated antinuclear antibody titer, hereditary deficiency of a complement component or of C1 esterase inhibitor, and presence of anti-native DNA or hepatitis B antigen. The renal involvement is relatively benign, and generally the patients do well and respond to specific treatment when this is indicated. Eight of 10 smokers studied had evidence of chronic obstructive pulmonary disease, 1 of whom died of this complication. In three patients, severe chronic obstructive pulmonary disease developed at a young age after relatively low pack-year cigarette smoking histories. Lung disease probably results from the interaction of two major risk factors-smoking and an immunologically mediated process that has not been identified.

Low back pain: treatment of forward and backward sacral torsions using counterstrain technique.

The sacral foramen tender points are newly identified, specific indicators of somatic dysfunction. The use of counterstrain to release these tender points and relieve the associated somatic dysfunction is a safe, specific, and nontraumatic means of treating any patient even in the presence of illness or acute trauma. These new tender points and their releases provide a means of treating sacral torsions with counterstrain.

Dobutamine stress echocardiography: what role in today's ICU?

Changes in left ventricular systolic wall motion and thickness (systolic function) may develop in response to dobutamine infusions; such changes can be detected echocardiographically--a technique called dobutamine stress echocardiography (DSE). By mapping the changes to graded doses of dobutamine, DSE permits us to detect myocardial ischemia and to assess whether myocardial damage is reversible. As a result, this test can help predict which patients are likely to benefit from revascularization. DSE also allows us to determine a specific point at which evidence of ischemia begins. The test is highly accurate, safe, and comparatively inexpensive.

The technique of dobutamine stress echocardiography.

Dobutamine stress echocardiography (DSE) can be performed safely at the bedside and offers more immediate results and lower cost than other pharmacologic imaging methods. Applications in the intensive care unit include detection of coronary artery disease and assessment of myocardial viability. DSE is also a useful adjunctive study for examining valvular function or revealing obstructive cardiomyopathy. Dobutamine infusion is started at 5 mug/kg/min and peaks at 40 or 50 mug/kg/min. Four standard echocardiographic views are used to show left ventricular wall segment responses; both the extent of thickening and type of motion are assessed.

Milk hypersensitivity: RAST studies using new antigens generated by pepsin hydrolysis of beta-lactoglobulin.

RAST was performed on sera from 28 patients with a variety of allergic symptoms, giving histories compatible with milk allergy, to investigate the occurrence of IgE antibodies to new antigens (NA) generated by in vitro pepsin hydrolysis. A variety of symptoms were associated with positive RAST scores. A positive correlation was found between the degree of RAST reactivity with undigested milk proteins and reactivity with the NA's. Reactivity to the NA's was always associated with reactivity to at least one of the undigested proteins. These findings suggest that undigested milk proteins are more reactive than digested proteins. Furthermore, antigens derived from pepsin digestion do not elicit a significant antibody response in individuals who do not allow show antibody responses to undigested proteins.