RESUMEN

Twenty-five volunteers had unilateral elbow immobilization for 24 hours in each of two positions of flexion, 45 degrees and 90 degrees . Twenty-two of the 25 volunteers preferred a position of 90 degrees of flexion. Standard functional testing revealed significant limitations in each position of immobilization, confirming that there is no single optimal position of elbow arthrodesis. This study suggests that, for most individuals, 90 degrees is the preferred position of elbow arthrodesis for activities of daily living. However, factors such as age, sex, occupation, and dominance of the extremity should be considered when choosing a position of arthrodesis.

Asunto(s)

RESUMEN

BACKGROUND: Little is known about the prevalence of atopy in adults with recurrent respiratory infections and IgG deficiency. OBJECTIVE AND METHODS: To elucidate this aspect, we skin-tested 95 consecutive adults with respiratory infections, subnormal levels of IgG subclasses or common variable immunodeficiency and usually poor response to vaccination. In 50 subjects we also measured total IgE. RESULTS: We found 67 subjects with IgG subclass deficiency, 21 subjects with mild (partial) and 5 with usual common variable immunodeficiency, and 2 subjects with functional IgG deficiency. Atopy was encountered in 42/95 subjects, 33/44 (75%) with asthma, 7/19 (38%) with isolated rhinosinusitis, 1/27 (4%) with chronic obstructive lung disease, and 1/5 (20%) with both the latter disease and asthma, respectively. Atopy was preferentially clustered in subjects with asthma (P < .05) who were less than 40 years of age (P < .05) and nonsmoking. Atopy was not affected by the type of IgG deficiency, unless it was usual common variable immunodeficiency, in which case the skin tests tended to be negative (4/5). Total IgE was within normal range but less elevated than usually seen in asthma or chronic obstructive lung disease. Total IgE was independent of the type of IgG deficiency, except for usual common variable immunodeficiency in which it remained < 10 IU/mL. CONCLUSIONS: In adults with symptomatic IgG deficiency, the prevalence of immediate hypersensitivity and its modulation by age and smoking are similar to the referred, non-IgG deficient population; however, total IgE may be lower in the former than in the latter. In common variable immunodeficiency, consistent with the literature data, both the prevalence of atopy and serum total IgE are decreased.

Asunto(s)

RESUMEN

Over a 15-yr time span, a 30-yr-old female chimpanzee (Pan troglodytes) exhibited recurrent upper respiratory disease that was suspected to be allergen induced. Until 1993, symptomatic therapy with several different antibiotics and antihistamines yielded variable results. In early 1993, the chimpanzee was consistently observed to be open-mouth breathing despite medication. Nasal polyposis was diagnosed using rigid endoscopy in September 1993, and the polyps were removed by loop excision. A fluorescent allergosorbent test was performed to differentiate hypersensitivity to specific regional allergens causing chronic inhalant allergic rhinitis. Oral immunotherapy was then instituted using standard human treatment for Sacramento Valley pollens. This combination of polyp removal and immunotherapy resulted in a marked reduction of clinical signs, and continuous oral immunotherapy has controlled these signs. Hyposensitization therapy will continue for at least 2-3 yr. The chimpanzee continues to breath normally following occasional antihistamine treatment.

Asunto(s)

RESUMEN

Shrimp is a common cause of seafood hypersensitivity. To study the mechanism of seafood hypersensitivity at the molecular level, we have determined the primary structure of the major heat-stable allergen of shrimp by cloning, expression, nucleotide sequencing, and amino acid sequence determination of an IgE-reactive cDNA clone, Met e I, isolated from a Metapenaeus ensis expression library in lambda gt 11. We first constructed a cDNA library from the shrimp M. ensis in lambda gt 11. We then screened the library with sera from patients with hypersensitivity reactions to shrimp and identified a positive IgE-reactive clone, designated as Met e I. This cDNA was purified to homogeneity and subsequently expressed in the plasmid pGEX. Serum antibodies from patients with shrimp allergy demonstrated positive IgE reactivity by immunoblotting to a protein encoded by the clone Met e I; sera from nonallergic control subjects were not reactive. The nucleotide sequence of this cDNA clone revealed an open reading frame of 281 amino acid residues, coding for a protein of 34 kd. Comparison of the Met e I amino acid sequence with the Genbank database showed that Met e I is highly homologous to multiple isoforms of tropomyosin.

Asunto(s)

RESUMEN

When faced with the diagnosis of sinusitis, the physician should carefully review the clinical setting from which the condition arose, its potential origins, as well as initiate management. In most instances, medical management will suffice for acute and subacute disease although some surgical intervention is occasionally helpful. If nasal polyps are present with radiographic evidence of sinus obstruction, standard medical treatment is initiated with the addition of systemic corticosteroids once the suppurative component is controlled. A lack of response in each of these circumstances is evaluated on an ongoing basis. If successful treatment is seen clinically, repeat radiographs with those views which best reveal the sinus involved are obtained in approximately 6 weeks to hopefully demonstrate normality. Persistent radiographic abnormalities can then be either treated surgically or, if clinical judgement dictates, further medical management can be pursued. However, in the chronic phase of sinusitis or after the patient has been followed with persistent abnormalities for over three months, irreversibly diseased mucosa is generally present and surgical intervention is commonly indicated. We would like to emphasize that during the course of treatment, frequently consider the origin of the sinusitis. Commonly it is infectious (e. g. viral) and no further investigation is necessary. However, anatomic abnormalities or systemic disease may be present whose correction can prevent the recurrence of acute sinusitis or, more importantly, the evolution into chronic irreversible sinus disease.

Asunto(s)

RESUMEN

The potential toxicity of ingested metabisulfite is a source of great concern to patients with asthma. This problem is of particular interest to the wine industry because potassium metabisulfite has been used for centuries to sterilize the mold and bacteria found in barrels or tanks as part of fermentation. Although there have been many observations on the influence of wine in asthmatics, the vast majority reflects anecdoctal case reports. Because of the relationship of metabisulfite to wine, we challenged a group of 25 asymptomatic, normal individuals and 25 patients with asthma with 4 oz of white wine containing 160 mg% of metabisulfite. Pulmonary function tests were performed immediately before, and 20 minutes and one hour after drinking the wine. Of the asthmatics who completed the study, seven of 24 decreased their FEV1 more than 10% at 20 minutes, and five of 23 decreased their FEV1 more than 10% at one hour. Furthermore, four patients decreased their FEV1 from 23% to 36%. Two patients felt symptomatic and one required treatment with a metered aerosolized dose of Alupent. These two symptomatic patients were further studied to identify the mechanism involved by drinking in a blinded fashion either a "model wine solution," prepared on the chemists shelf without metabisulfite, or a "model wine solution" prepared with metabisulfite. One patient became symptomatic when he drank either "wine".(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

Asunto(s)

Asunto(s)