摘要:

Nonacetylated salicylates are frequently used in the treatment of musculoskeletal complaints and pain management in older patients because of their possible lower gastrointestinal and renal toxicity as compared with other nonsteroidal anti-inflammatory agents. We report five patients with chronic salicylate intoxication seen at the Atlanta VA Medical Center. All charts of patients diagnosed with salicylate toxicity were reviewed, and cases with acute, intentional intoxication were excluded. In the study group, three patients took a nonacetylated salicylate, the other two took an acetylated salicylate. Our patients ranged in age from 51 to 78 years old. One patient died of respiratory failure and “sepsis-like syndrome,” a potentially lethal complication of salicylate toxicity. Four of the patients had altered mental status as a presenting complaint. The presence of a combined respiratory alkalosis and metabolic acidosis, present in all five patients, was the clue for diagnosis in three of the cases. Tinnitus was reported in only one patient. A significantly decreased urate level and a wide anion gap were consistent findings as well. Two of the patients improved after hydration and discontinuation of use of the drug, two required alkalinization of the urine, and one required dialysis. Clinicians need to be more aware of the potential toxicity, including life-threatening complications, with the use of salicylates, particularly in high risk populations such as elderly patients and patients with multiple medical problems.

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study was designed to evaluate the effectiveness in relief of pain and rigidity of a 10|X% trolamine salicylate cream compared with a placebo cream identical in smell and appearance, for subjects with osteoarthritis in their hands. This was a one-application, randomized, double-blind, placebo-controlled, parallel study conducted in 81 patients. Pain and stiffness were assessed in the morning upon subjects' awakening (baseline) and at 30, 45, and 120 min after a 4-min rubbing application. Analgesic response was determined using the sum of pain intensity differences (SPID) and the sum of stiffness intensity differences (SSID); the sum across the observation points derived from a pain/stiffness rating scale. Trolamine salicylate was significantly superior to the placebo in improving SPID (p = 0.0492) and in improving SSID scores for both hands (p = 0.0283). Treatment differences in absolute pain and stiffness scores were significant (p |Ml 0.05) at 45 min after application. A 10|X% trolamine salicylate cream was shown to be safe and effective for the temporary relief of minor pain and stiffness associated with osteoarthritis in the hands. This formulation has no smell or counter-irritating properties; patient acceptability was good.

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The clinical manifestations of Sjõgren's syndrome (SS) and sarcoidosis can be identical. Of the 1600 patients whom we have evaluated for dryness of the mouth and eyes, 300 proved to have SS and 5 had sarcoidosis. The patients with sarcoidosis had combinations of salivary gland enlargement, elevated antinuclear antibody titers, reduced salivary flow rates, and keratoconjunctivitis sicca, findings typically associated with SS. Finding non-caseating granulomas in a labial salivary gland biopsy specimen may be the only way to definitively differentiate these two disorders.

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Suffering is a universal experience. In everyday practice, physicians and patients confront and deal with this phenomenon. It is surprising that, despite its obvious and inexorable presence, there is no universal understanding of the real significance of suffering. In the same context, it seems that the measure of suffering could be an option, an instrument, for evaluating the efficacy of treatment. No doubt, it is easier to compare laboratory or x-ray results than to follow clinically the severity of the disease. However, patients do not understand this language, and, often, physicians do not explain to patients how they determine that treatment is efficacious. In fact, it is common to hear patients complain that they do not feel better despite the doctors' opinion that they should.Often, we must accept that our capabilities are limited and must offer some help to mitigate our patients' suffering. Empathy, and the responsibility of doctors to understand the different meanings of suffering, can help patients. Because of their skills, because they know the meaning of disease, and because of their commitment, doctors are obliged to comprehend the position of the patients who are suffering. In the middle of the storm of science, doctors need to look for disease in the voices and in the eyes of their patients. In fact, there should be no conflict between science and empathy. The magic link must rest in the intelligence and sensitivity of doctors.

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The humoral immune response elicits the production of immunoglobulins of different structures and biologic functions. These differences are intrinsic to the various classes (isotypes), subclasses, and allotypes of the antibodies made. The binding of antibodies to their respective specific antigens occurs because of physicochemical interactions between tertiary structures of the antibody and the target epitope. Understanding the nature of these interactions allows one to better understand binding affinity and the ability of an antibody made as part of a specific response to one antigen to bind to other, even unrelated, antigens. This ability of an antibody made during the immune response to an infection to bind to different antigens provides the plasticity needed to provide protection from different related or unrelated pathogens.Thus, antibodies made during the response to one adenovirus may be of assistance in the response to infection with a second adenovirus. Cross-reactivity between molecules in and on disparate organisms, e.g., different Gram-negative bacilli, is common; heat-shock proteins and flagellins are very similar and broadly cross-reactive. Antibodies made to one bacterium can be the basis of immune protection from another.The affinity of an antibody for its specific antigen is enhanced during the secondary immune response, because the interaction of the antigen with surface immunoglobulin on memory cells selects the production of antibodies with a “better fit” for the target antigen.In a previous article in this series, on the humoral immune response, we reviewed much of the basic terminology of immunology (epitopes, paratopes, etc.), and described many of the characteristics of antigens and immunoglobulins. In this article we proceed with a description of the various immunoglobulin classes (also known as isotypes) and some of their functional characteristics.

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SAPHO is an acronym for synovitis, acne, pustulosis, hyperostosis, and osteitis. It is used to define characteristic bone or joint lesions associated with either pustulosis palmoplantaris or acne. The bone lesions are characterized by sclerosis and hyperostosis, and there may be an associated synovitis. These bone lesions occur most frequently in the anterior thoracic wall, but may be found elsewhere. The lesions tend to have a benign course, and usually are treated with nonsteroidal anti-inflammatory drugs (NSAIDs). The etiology of the SAPHO syndrome is unknown at present. We report the following case because the patient presented with involvernent of the pubis, with a symptomatic osteitis pubis. The presence of palmoplantar pustulosis allowed proper identification of the disease.Characteristic sclerotic bone lesions, found usually in the anterior thoracic wall and associated with palmoplantar pustulosis, were initially de-scribed in Japan in 1967 (1); several similar descriptions followed (2–6). Similar skeletal lesions have also been found associated with other dermatology disorders, mainly acne conglobata (7–13). These bony lesions may occur in various sites in the axial skeleton and occasionally in peripheral bones, where they may be associated with an inflammatory synovitis. In 1987, the acronym SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) was coined to refer to this cluster of cutaneous and osteoarticular manifestations (14).Although involvement of the symphysis pubis has occasionally been mentioned in patients with SAPHO (14, 15), the features of the disease in this particular joint have not been described. In this report, we describe the case of a woman with palmoplantar pustulosis who was seen for pubic pain and sclerotic bone lesions akin to those of SAPHO.

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This case report describes a 19-year-old patient with a swelling of the interphalangeal joint of the left thumb. Conventional radiography revealed erosive changes and a periarticular osteopenia. A marked increase in bone turnover of the entire thumb and wrist region was confirmed scintigraphically. Repeated attempts at arthrocentesis were unsuccessful. By ultrasonography, using a linear 7.5-Mhz transducer, a hypoechoic area with an anechoic core was located within the soft tissue swelling dorsal of the diaphysis of the proximal phalanx of the thumb. An aspiration of this anechoic area was possible and cytological analysis revealed an exudate with about equal percentages of lymphocytic/monocytic and polymorphonuclear cells and the microscopic and cultural detection ofMycobacterium tuberculosis. Ultrasonography is less expensive than MRI and may offer an important adjunct to evaluation of soft tissue problems.

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Abdominal pain, a common condition, has been reported in up to 37|X% of-patients with systemic lupus erythematosus (SLE) (1). There are many possible causes including peritonitis, pancreatitis, mesenteric vasculitis, thrombosis of the mesenteric vessels, intra-abdominal infections, or side effects of the medications used in the treatment of the disease, especially non-steroidal anti-inflammatory drugs (1–3). However, ruptured mycotic aneurysm of the abdominal aorta has rarely been mentioned as a cause of abdominal pain in SLE (1–3). We recently saw a patient with SLE who had an acute surgical abdomen, which proved to have been caused by a rupture of a mycotic abdominal aortic aneurysm.

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1076-1608    

出版商:OVID    

年代:1998

数据来源: OVID