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Herpes simples virus thymidine kinase (HSV-TK) expression plasmid DNA was injected into the joint space of rabbits with antigen-induced arthritis (AIA). Purified plasmid DNA was able to mediate transfection of synovial lining cells and transient overexpression of HSV-TK in the context of active synovial inflammation. The pharmacodynamic distribution of intraarticular expression plasmid DNA was confined to the joint space. Arthritic rabbits treated with intraarticular expression plasmid DNA followed by intravenous ganciclovir (GCV, 5 mg/kg) twice daily for 3 days showed histologic evidence of synovial lining layer cytolysis when articular tissues were examined 21 days posttreatment. There was also a reduction in joint swelling in the TK-treated knees. No untoward clinical effects were observed in the rabbits and no evidence of cytolytic damage specific to the TK-GCV gene therapy was observed either in the articular cartilage or bone. The application of TK-GCV intraarticular gene therapy using purified expression plasmid DNA for the induction of synovial cytolysis may be applicable to the treatment of human inflammatory arthritis.

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OBJECTIVE: To assess the nature of pleuropulmonary abnormalities, with particular reference to interstitial lung disease (ILD), in patients with systemic lupus erythematosus (SLE). METHODS: 29 patients were prospectively evaluated using high resolution computed tomography (HRCT), plain chest radiography (CXR) and pulmonary function tests (PFTs). Clinical assessments, drug therapy, disease activity, smoking status and serologic markers were also noted. RESULTS: The HRCT was abnormal in 72% (20/29) of patients, while 34% (10/29) had an abnormal CXR. The most frequently detected primary HRCT abnormality was suggestive of ILD and was noted in 11 patients (38%) In 9 of these, ILD was clinically unsuspected, including one patient who had an HRCT suggestive of active alveolitis. Pleuropericardial abnormalities were seen on HRCT in 5 patients (17%). Of 15 patients who were asymptomatic, and had a normal examination, normal CXR and normal PFTs, four (26%) had HRCT features of ILD. There was no correlation between the HRCT appearances and symptoms, disease duration, ds-DNA titres, smoking history or non-pulmonary involvement. Although no statistical significance was noted between abnormal pulmonary function tests and ILD on HRCT (0.10 < p < 0.20), a trend towards significance was noted between disease activity and ILD (0.05 < p < 0.01). CONCLUSION: HRCT is more sensitive than PFTs or CXR in the evaluation of pleuropulmonary disease in SLE. We report an unusually high prevalence of HRCT appearances suggestive of ILD in patients with SLE. Subclinical lung disease is common in patients with SLE.

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Previous studies on the association of ankylosing spondylitis and abnormalities of the lung parenchyma have been based largely on plain radiography and pulmonary function testing. This study, although uncontrolled, is the first to use high-resolution computed tomography to examine the entire lung parenchyma in ankylosing spondylitis patients, and to correlate the findings with clinical assessment, plain radiography and pulmonary function testing. The study population comprised 26 patients meeting the New York criteria for idiopathic ankylosing spondylitis who attended the out-patient department at our institution. High-resolution computed tomography examination revealed abnormalities in 19 patients (70%): these included interstitial lung disease (n = 4), bronchiectasis (n = 6), emphysema (n = 4), apical fibrosis (n = 2), mycetoma (n = 1) and non-specific interstitial lung disease (n = 12). Plain radiography was abnormal in only four patients and failed to identify any patient with interstitial lung disease. All patients with interstitial lung disease on high-resolution computed tomography had respiratory symptoms and three of the four had evidence of a restrictive process on pulmonary function testing. This study raises, for the first time, the possible association between interstitial lung disease and ankylosing spondylitis, and highlights the use of high-resolution computed tomography in detecting such disease in ankylosing spondylitis patients.

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OBJECTIVE: The aims of this study were to identify the spectrum of abnormalities seen on high-resolution CT in patients with ankylosing spondylitis and to compare our findings with reports of plain film pulmonary manifestations of the disease. SUBJECTS AND METHODS: We prospectively studied 26 patients with documented ankylosing spondylitis. All patients underwent plain chest radiography (posteroanterior and lateral views), thoracic helical CT, high-resolution CT, and pulmonary function tests. RESULTS: High-resolution CT revealed abnormalities in 18 patients (69%), whereas plain chest radiography revealed abnormalities in four patients (15%). The most common abnormalities seen on CT were interstitial lung disease (ILD) (n = 4), bronchial wall thickening and bronchiectasis (n = 6), paraseptal emphysema (n = 3), mediastinal lymphadenopathy (n = 3), tracheal dilatation (n = 2), and apical fibrosis (n = 2). CONCLUSION: This study, which describes high-resolution CT findings in patients with ankylosing spondylitis, reveals a spectrum of abnormalities unlike those described in previous reports in which researchers used plain chest radiographs as the sole imaging technique. In addition to apical fibrosis, high-resolution CT revealed nonapical ILD, bronchiectasis, paraseptal emphysema, and tracheobronchomegaly. Of these new findings, we believe that identification of ILD is the most important. We suggest that nonapical ILD should be actively sought as an explanation for pulmonary symptoms developing in patients with ankylosing spondylitis. High-resolution CT should form an integral part of such workup.

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OBJECTIVE: The purpose of our study was to identify high-resolution CT (HRCT) findings in patients with systemic lupus erythematosus (SLE) and to determine their significance by correlation with clinical findings, plain chest radiography, and pulmonary function testing. SUBJECTS AND METHODS: Thirty-four patients with documented SLE were prospectively studied. All patients had plain chest radiography (posteroanterior and lateral) thoracic spiral CT, HRCT, and pulmonary function testing performed. RESULTS: HRCT abnormalities were identified in 24 patients (70%), pulmonary function abnormalities were present in only 14 patients (41%), and the plain chest radiograph was abnormal in only 8 patients (24%). The most common CT findings were: interstitial lung disease (n = 11), bronchiectasis (n = 7), mediastinal or axillary lymphadenopathy (n =6), and pleuropericardial abnormalities (n =5). No correlation was found between disease activity, duration of disease, chest symptoms, drug therapy, smoking history, and the presence of abnormal HRCT findings. More importantly, no correlation was found between pulmonary function abnormalities and the presence or grade of interstitial lung disease or bronchiectasis as determined by HRCT. CONCLUSION: The results of this study, the first to describe the HRCT findings in SLE, suggest that airways disease, lymphadenopathy, and interstitial lung disease are common thoracic manifestations of SLE, whereas pleural abnormalities are less common than previously suggested. HRCT evidence of airways disease and interstitial lung disease was frequently present despite an absence of symptoms, a normal chest radiograph, and normal pulmonary function testing. HRCT provides a sensitive and noninvasive technique for detecting pulmonary involvement in SLE, with the added advantage that it can be performed in all patients, including those too compromised to undergo a surgical procedure. In patients with advanced disease, HRCT permits procedures such as bronchoalveolar lavage and lung biopsy to be directed toward areas of particular interest.

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AIM: To study the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on gastric cell turnover using an in vitro immunohistochemical method of bromodeoxyuridine (BrDU) uptake. METHODS: Thirty patients undergoing routine upper gastrointestinal endoscopy were studied. Sixteen had taken NSAIDs daily for more than 3 months and there were 14 age-matched controls. Endoscopic gastric antral biopsies were obtained and stained immediately using the BrDU technique. Cell proliferation was expressed as a labelling index percentage (LI%) defined as the number of BrDU-labelled nuclei in 10 gastric glands, expressed as a percentage of the total cells in the gastric gland. RESULTS: Gastric infection with Helicobacter pylori was excluded in all patients. Of the 16 patients on NSAIDs, four had gastritis, four had erosions or ulceration and eight had a normal examination. Endoscopy was normal in all patients in the control group. The LI% (mean +/- S.E.M.) in the entire NSAID group was 4.09 +/- 0.29 and in the control group 3.57 +/- 0.29. No significant difference was observed. In the NSAID patients with gastritis and erosions or ulceration, the LI% was 4.99 +/- 0.61 and 3.07 +/- 0.32, respectively. There was no significant difference in LI% between the endoscopic subgroups of patients on NSAIDs or between patients on NSAIDs who had normal endoscopy and the control patients. CONCLUSION: These results provide evidence that refutes the hypothesis that the prevalence of NSAID gastropathy is due to an effect on gastric cell turnover.

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We describe four patients with rheumatoid arthritis and unilateral upper limb oedema. In all cases, qualitative lymphoscintigraphy showed lymphatic obstruction in the affected limb.

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The cauda equina syndrome (CES) is an infrequently recognised and poorly understood complication of ankylosing spondylitis (AS). We report a case of CES with enlarged caudal sac and multiple posterior arachnoid diverticula eroding the laminae and spinous processes of the lumbosacral vertebrae in a patient with long-standing AS. The diagnosis was established using computerised tomography (CT) and magnetic resonance imaging (MRI).

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Thrombosis of the inferior vena cava (IVC) is a rare complication of the antiphospholipid syndrome (APS). We report a case of IVC thrombosis in a 27 year-old female who was anticoagulated at the time and who had a history of recurrent deep venous thromboses (DVT), thrombocytopenia and antiphospholipid antibodies (aPL).

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Scleroderma is primarily a cutaneous disorder but systemic involvement is common and neurological complications are increasingly recognized but previously poorly documented. Few cases of peripheral nervous system involvement in scleroderma have been reported. The peripheral nervous system, however, is rich in connective tissue and sclerodermal involvement may not be as unusual as the literature suggests. A case in which there was a mixed sensorimotor peripheral neuropathy with neurotropic ulceration in a patient with systemic sclerosis is reported.

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We performed percutaneous endoscopic gastrostomy (PEG) in 30 patients with prolonged swallowing difficulty (> 4 weeks duration). The average procedure time was 25 minutes. PEG insertion was done on an outpatient basis in four patients. The complication rate was 10% and included failed insertion, peristomal infection and herniation of the gastric mucosa at the gastrostomy exist site. At follow-up, the PEG tube continued to function in 18/22 of the surviving patients with a median in-use time of 85 days. Seven patients died from their original disease. Over a 28-day period, the weight gain among the patients ranged from 3kg to 7kg (mean 4.5kg) and average serum albumin increased from 29g/dl to 35g/dl. This confirms that PEG is a safe, easy and effective method of long-term enteral feeding in patients with neurological disease.

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