Hypothalamo-pituitary-thyroid system in patients with rheumatoid arthritis]

OBJECTIVE: To determine the effect on the uptake of breast screening of a personalized letter from the general practitioner recommending mammography, sent to coincide with an invitation from the NHS breast screening programme. DESIGN: Randomised control trial with stratification of prognostic variables. SETTING: A group practice in Hackney, east London. SUBJECTS: 473 women invited for breast screening by the City and East London Breast Screening Service. OUTCOME MEASURE: Attendance for mammography. RESULTS: All women in the randomised trial were followed up; 134 of 236 (57%) randomly allocated to receive the prompting letter attended for mammography compared with 120 of 234 (51%) controls This difference was not significant (chi 2 = 1.43, p = 0.23) CONCLUSION: Personal recommendation by a letter prompting attendance for mammography from the general practitioner known best to women due to be screened did not improve uptake of breast screening in this east London practice. Other strategies are needed to increase uptake of mammography in inner cities.     

Stress and the immune system: preliminary observations in rheumatoid arthritis using an in vivo marker of immune activity

This study measured volumetric liver blood flow and galactose clearance concurrently during orthotopic liver transplant in human subjects. Ultrasound transit time flowmeters measured hepatic artery and portal vein flow 1-3 h after reperfusion. Galactose (100 mg/min) was infused over 45-60 min to steady state for calculation of clearance. Mean +/- S.D. total volumetric flow was 1966 +/- 831 ml/min with portal flow contributing 86%. Mean galactose clearance was 1988 +/- 641 ml/min. There was a significant correlation (p < 0.05, r = 0.61) between volumetric total liver blood flow and galactose clearance. The data show that: (i) the newly transplanted liver is capable of metabolizing galactose within 1-3 h of reperfusion; and (ii) liver blood flow is high in the newly implanted liver. The clinical importance of this observation is that there is increased clearance of high first pass substances by the transplanted liver which may be of importance in patient management.     

Changes in the pituitary-testicular system with age

In order to provide a comprehensive account of pituitary-testicular function in man, 466 subjects, ranging in age from 2 to 101 years, were studied to examine blood levels of the pituitary gonadotrophins (LH and FSH), the sex steroids testosterone and oestradiol, the binding capacity of the sex hormone binding globulin (SHBG), the free testosterone and oestradiol fractions, and the transfer constant for the peripheral conversion of testosterone to oestradiol. The results were compared with clinical indices of testicular size, sexual function and secondary sex hair distribution. Serum LH and FSH were low before puberty, increased in pubertal adolescents to levels somewhat above those of adults and subsequently increased progressively over the age of 40 years. Testosterone levels fell slowly after the age of 40, while there was a slight rise in plasma oestradiol with increasing age. FSH and testosterone showed small seasonal variations in young adult men, the lowest values being seen in winter. SHBG binding capacity was high in two prepubertal boys, fell in adult men, but increased in old age. Free testosterone and oestradiol levels fell in old age. The metabolic clearance rates (MCR) of testosterone and oestradiol also fell in old age, while the conversion of testosterone to oestradiol was increased. Many correlations were observed between various hormonal and clincial measurements. The evidence is consistent with a primary decrease in testicular function over the age of 40 years.     

Lymphocyte depletion in patients with rheumatoid arthritis

Sixteen patients with severe rheumatoid arthritis, marked inflammation of the synonvial membrane and high rheumatoid titer were cannulated by the thoracic duct for a period rangin between 82 up to 100 days. The patients being not under any medication during that time. Quantitative and qualitative analysis of the lymphocytes were performed, as well as responses to mitogens, rheumatoid factor, circulating antibodies and delayed hypersensitivity. By the 14th day nearly all the patients had a partial or almost complete remission of their disease. No complications were observed. These results will be discussed.     

Chloroquine retinopathy in patients with rheumatoid arthritis

The paper presents data on the differential fertility of schizophrenics and controls, and the fertility of their siblings. This study used several methodological procedures in the study of schizophrenia reproduction, which strengthens the validity of the findings. Firstly, both male and female rates were examined. Secondly, the method of selection of a control avoided the biases introduced by using census data or other non-matched controls. Third, a diagnostic criterion was used which minimizes the possibility of the inclusion of other psychiatric illnesses. The results obtained support prior reports of the lowered reproductive rates of schizophrenics. Further, the siblings of schizophrenics were found not to have a reproductive advantage when contrasted to control siblings. The failure to find a reproductive advantage conflicts with a hypothesis of a balanced polymorphism as the mechanism maintaining an apparent constant rate of schizophrenia.     

HLA-DM polymorphisms in patients with rheumatoid arthritis

OBJECTIVE: To investigate the contribution of HLA-DMA and DMB genes, which play a crucial role in the HLA class II restricted antigen presentation pathway, in susceptibility to rheumatoid arthritis (RA). METHODS: The distribution of DMA and DMB alleles was examined in patients with RA and in healthy subjects by oligotyping of PCR amplified genomic DNA with sequence specific oligonucleotide probes. RESULTS: There were no significant differences in the prevalence of DMA and DMB alleles in patients with RA as compared to healthy controls. In addition, no significant differences in frequencies of DMA and DMB alleles were observed in RA susceptibility epitope positive RA patients and controls. CONCLUSION: DMA and DMB genes do not appear to play a role in susceptibility to RA.     

Ankle arthrodesis in patients with rheumatoid arthritis

The results of 26 ankle arthrodeses performed for rheumatoid arthritis on 21 patients were reviewed. Tibiotalar arthrodesis was performed in 14 ankles, and tibiotalocalcaneal arthrodesis was performed in 12. External fixation was used in 20 ankles, and internal fixation was used in six. Followup was available in 24 of 26 ankles (19 patients), and averaged 5 years (range, 2-8 years). There was no pain experienced in 19 ankles; mild, occasional pain was experienced in four ankles; and moderate, daily pain was experienced in one ankle. Daily activities were limited in five patients and recreational activities were limited in 11. All patients reported some difficulty walking on uneven terrain. Nearly all patients were satisfied; two were satisfied with reservations and two were dissatisfied. Union was achieved in 25 of 26 (96%) ankles. Ankle arthrodesis is an effective operation in patients with rheumatoid arthritis. Unlike previous reports, union and complication rates in this series were comparable with rates for arthrodesis for posttraumatic and degenerative arthritis.     

Antioxidants in the respiratory system

BACKGROUND: Reactive oxygen species can participate in the airways reactivity changes after oxidants. The authors have observed an increase in airways reactivity after an exposure to toluene in guinea-pigs and cats in previous experiments. There literature data provide information on the prevention or the delay of free radical damage by antioxidants. MAIN PURPOSE: The aim of our study was to evaluate the effect of nonenzymatic antioxidants--vitamin C and vitamin E on the airways reactivity changes after the exposure to toluene vapours. METHODS: After a one-month-lasting pretreatment with 500 mg/kg/day vitamin C and 50 mg/kg/day vitamin E the guinea-pigs were exposed to toluene for 3 days 2 hours. Then the reactivity of trachea and lung strip smooth muscle to histamine was evaluated. RESULTS: The pretreatment with vitamin C did not evoke statistical significant changes of trachea and lung strip smooth muscles reactivity when compared with the control group. The pretreatment with vitamin E produced a statistically non-significant decrease in trachea smooth muscle reactivity, but an increase in contraction amplitude of lung strip smooth muscle. Trachea was without expressive histological changes. The lung showed granulomatous inflammation with lymphocytes and eosinophils. SUMMARY: Antioxidants in used doses did not prevent the reactivity changes evoked by toluene exposure. (Fig. 2, Tab. 4, Ref. 14.)     

Changes in (markers of) bone metabolism during high dose corticosteroid pulse treatment in patients with rheumatoid arthritis

The aim of this study was to validate an incremental field test performed by wheelchair-dependent (WD) athletes. Nine male paraplegic subjects (mean age 28.9 +/- 4.2 years) performed an incremental field test (FT) and a comparable laboratory test (LT) with their own usual wheelchairs. Both tests started with an initial speed of 4 km.hr(-1) and increased by increments of 1 km.hr(-1) every minute until volitional exhaustion. The FT was an adapted Léger and Boucher test (ALBT) and was conducted on a 400 m tartan field marked-off every 50 m with pylons. Ventilatory data were collected every 15 s using a portable telemetric system (Cosmed K2, JFB International, Italy). The LT was performed on an adapted treadmill (Sopur, Germany) and ventilatory data were collected every minute using a breath-by-breath automated system (CPX, Medical Graphics, MN, USA). The LT and the FT were not significantly different for duration (8 min 50 +/- 1 min 24 vs 9 min 55 +/- 29 s), percentage of maximal heart rate (HR, 86.2 +/- 3.9 vs 89.7 +/- 5.3%), maximal minute ventilation (VE, 101.6 +/- 28.5 vs 96.8 +/- 28.2 1.min(-1)) and peak oxygen uptake (VO2 peak, 39.7 + 7.3 vs 36.1 + 5.8 ml.kg(-1).min(-1) assessed with the CPX and the K2, respectively. We concluded that the FT proposed in the present study is a valid test for direct VO2 peak assessment in wheelchair athletes using a portable VO2 telemetric system. Nonetheless, the Léger and Mercier model equation did not accurately predict VO2 max and further investigation is needed to determine a valid VO2 max prediction equation for these subjects during the FT.     

Endogenous opioid tone in patients with rheumatoid arthritis

A monoclonal antibody giving a dominant reaction with the group-specific polysaccharide of streptococcus group B in an ELISA test has been developed. The purified polysaccharide exhibited a high positivity with reference anti B streptococcal antiserum in the ELISA test. Cross-tests of antibodies with other groups of streptococci provided a minimum cross-reaction only in the case of G streptococci. Monoclonal antibodies were prepared using Streptococcus agalactiae S 589 MT strain isolated from a case of bovine mastitis which does not express Ia, Ib, II, III, IV and V type antigens, nor C, R and X protein antigens.     

Delayed type hypersensitivity in patients with rheumatoid arthritis

This study was performed to verify and further characterize the role of neuroendocrine factors in the regulation of fetal adipose metabolism. On day 72 to 74 of gestation, pig fetuses in one uterine horn were hypophysectomized (hypoxed) by micro-cauterization, fetuses in the other horn served as sham controls. Fetuses were removed by laparotomy on day 110 of gestation. Slices of subcutaneous adipose tissue from control fetuses responded to lipolytic stimulation by norepinephrine alone (NE; 1 microgram/ml), NE plus adenosine deaminase (160 mUnits/ml) or dibutyryl cyclic AMP (5 mM). Adipose tissue from hypoxed fetuses, however, responded to lipolytic stimulation by only dibutyryl cyclic AMP, not NE. Lipogenesis in adipose tissue slices, as quantitated by 3H2O incorporation into triglyceride fatty acids, was increased 2.6 fold by hypophysectomy. These results demonstrate the necessity of a functioning pituitary in the normal regulation of fatty acid synthesis and receptor-mediated lipolytic response in developing fetal adipose tissue.     

Predictors of functional disability in patients with rheumatoid arthritis

The ability of nonactivated peritoneal macrophages to induce nitric oxide (NO) secretion in transformed and tumor cells of the same origin differing in tumorigenic (TGA) and spontaneous metastatic activities (SMA) was examined. Low tumorigenic and nonmetastatic spontaneously transformed in vitro hamster embryo cells of the STHE strain in contact with macrophages, or their non-purified soluble product were the highest producers of NO. In vivo selected STHE cell variants characterized by middle or high TGA demonstrated low, or no NO production, respectively (independently of SMA- or SMA+). Two highly tumorigenic RSV-SR (v-src) transformed cell strains (SMA- and SMA+) were both negative in NO production. Thus, NO production by tumor cells appeared to be inversely correlated with TGA level and less dependent on SMA.     

Cementless hip prosthesis in patients with rheumatoid arthritis

A recent study conducted in Sweden reported that 1) leukemia risk in children who lived near 220 or 400 kV electric-power transmission lines was associated with calculated historical magnetic field levels; 2) children living within a distance of 50 m of transmission lines had an elevated risk of leukemia; and 3) there was no association between leukemia and residential magnetic fields measured many years after diagnosis. Subsequently, these investigators found through logistic regression analysis that disease was more strongly associated with calculated historical fields than with distance. Since the calculated historical fields in that study depended predominantly on distance and transmission-line load current, the logistic regression results suggest that historical load current plays an important role in the epidemiological results. Thus, we studied hourly 1974 load-current data for six transmission lines, and we examined 1958-1985 annual load-current data for 112 transmission lines. Most lines exhibited marked diurnal load-current rhythms during 1974, and all six showed systematic weekday-weekend differences. During 1958-1985, average loadings of Swedish 220 and 400 kV lines increased by about 1.3% year. Predictive-value and kappa-statistic analyses indicated that Swedish transmission-line load currents were not stable over long periods, so that contemporaneous load current (or a contemporary magnetic field measurement) was not a good surrogate for historical load current (or historical magnetic fields). The results provide a potential explanation of the failure of the Swedish Study to find an association between leukemia and contemporaneous magnetic field levels measured many years after the etiologic period, and suggest that the inclusion of load-current data could significantly improve the quality of historical field calculations.     

Analysis of pulmonary manifestations in patients with rheumatoid arthritis

We studied chest X rays of 911 patients with rheumatoid arthritis (RA). The findings showed interstitial shadow in 28 patients (3.1%), pleuritis in 13 patients (1.4%) and nodular shadow in 3 patients (0.3%). RA patients with interstitial pneumonia were commonly male and older. And they had significantly high levels of rheumatoid factor (RF), RAPA and IgG-RF in serum, but they were not associated with high score of Lansbary index. All patients with more than 1500 IU/ml in RF value had a complication of interstitial pneumonia. These results suggest the importance of chest X-ray in the management of RA patients with high titer in RF.     

Changes in the hemostatic system indices of patients with chronic kidney failure under the influence of enterosorption and plasmapheresis

A total of 83 patients with chronic renal failure (CRF) at azotemia stage (S. I. Riabov's classification) complicating pyelonephritis were treated: 19 patients received symptomatic standard therapy (group 1), 29 patients received combined therapy with enterosorption (group 2), 35 patients received combined treatment with plasmapheresis (group 3). The efficacy of the treatments was controlled by platelet tests (platelet, coagulative hemostasis, fibrinolytic plasma activity) and parameters of kallikrein-kinin system. Treatment results in group 1 are characterized as poor: insignificant improvement of uremia, DIC syndrome against unchanged inhibition of kallikrein-kinin system. Group 2 patients achieved moderate response: uremia reduced to normal azotemia values, DIC syndrome and inhibition of kallikrein-kinin system reduced. Patients of group 3 got disappeared DIC syndrome and normal kallikrein-kinin system against high azotemia.