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Biomedical subjects

A Chalmers

Publications and source records attributed to A Chalmers.

At least 19 recordsLinked to original sources
PubMed1995

Acute local reactions after intraarticular hylan for osteoarthritis of the knee.

OBJECTIVE: To describe acute local reactions following intraarticular hylan injection and determine their frequency. METHODS: Retrospective review of all patients with osteoarthritis of the knee treated with hylan by 3 rheumatologists. RESULTS: Twenty-two patients had 88 injections to 28 knees. Six patients had reactions within 24 h of injection characterized by pain, warmth, and swelling, lasting up to 3 weeks. This occurrence was unpredictable. Corticosteroid injections were sometimes required. Synovial fluid cell counts were 5.0-75.0 x 10(9)/l, often with a prominent mononuclear component. Crystal studies and cultures were negative. Radiographic chondrocalcinosis was present in only 1 patient. One patient had serum antibodies to chicken serum proteins. CONCLUSION: Intraarticular hylan was associated with significant local inflammatory reactions in 27% of patients, or 11% of injections. The mechanism(s) and long term sequelae are unclear.

Adult↗
PubMed1995

Cyclosporin A in the treatment of adult Still's disease.

Cyclosporin A (CyA) has been used successfully in the treatment of rheumatoid arthritis. There is one case report of CyA used successfully in the treatment of severe systemic onset Still's disease. To our knowledge, there are no reports of CyA used in adult Still's disease. We present the first report of a patient with refractory adult Still's disease successfully treated with CyA. We submit that cyclosporine treatment may induce remission of symptoms in patients with adult Still's disease and reduce the steroid requirements.

Adult↗
PubMed1994

Handwritten digit recognition using two-layer self-organizing maps.

In this paper, we present a two-layer self-organizing neural network based method for handwritten digit recognition. The network consists of a base layer self-organizing map and a set of corresponding maps in the second layer. The input patterns are partitioned into subspace in the first layer. Patterns in a subspace are led to the second layer and a corresponding map is built according to the first layer performance. In the classification process, each pattern searches for several closest nodes from the base map and then it is classified into a specified class by determining the nearest model of the corresponding maps in the second layer. The new method yielded higher accuracy and faster performance than the ordinary self-organizing neural network.

Handwriting↗
PubMed1994

A comparative study of signal versus aggregate methods of outcome measurement based on the WOMAC Osteoarthritis Index. Western Ontario and McMaster Universities Osteoarthritis Index.

OBJECTIVE: To compare signal versus aggregate measurement strategies using the VA3.0S version of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index. METHODS: Seventy patients with OA of the knee were asked to identify a signal item for each of the 3 dimensions of the WOMAC OA Index at baseline and termination of a 12-week, double blind, randomized, controlled trial. RESULTS: The signal method detected statistically significant alterations in health status at relatively small sample sizes and with a relative efficiency close to or at unity. In addition to a low prevalence of deterioration in nonsignal items, we observed some inconsistency in signal selection. CONCLUSION: Signal methods of measurement may provide an alternative approach to outcome measurement provided issues of nonsignal deterioration and the consistency of signal selection can be addressed.

Aged↗
PubMed1994

Immunization of patients with rheumatoid arthritis against influenza: a study of vaccine safety and immunogenicity.

OBJECTIVE: To address the issues of immunogenicity and local and systemic reactions to vaccination with influenza vaccine in patients with rheumatoid arthritis (RA). METHODS: One hundred and twenty-six patients with RA were stratified into 3 groups: (1) those with a history of vaccination with influenza vaccine within 24 months who were receiving usual therapy for RA, (2) those receiving usual therapy for RA but without prior vaccine, and (3) those receiving immunosuppressive medication or prednisone > or = 7.5 mg/day, irrespective of their prior immunization status. Within each group, patients were randomized to receive vaccine or placebo. A group of age matched, healthy controls were also vaccinated. RESULTS: During a one month followup period, adverse reactions occurred with equal frequency among patients with RA and healthy controls. Similar significant increases in titers to the vaccine were seen in all groups of patients with arthritis and in the controls. CONCLUSION: The potential increase in susceptibility to influenza and death from respiratory illness in patients with RA and the demonstrated safety and immunogenicity of influenza vaccine should require the inclusion of patients with RA in standard immunization programs.

Arthritis, Rheumatoid↗
PubMed1993

A multicenter study of tenoxicam and diclofenac in patients with osteoarthritis of the knee.

OBJECTIVE: To conduct the first Canadian study of the comparative efficacy and safety of tenoxicam and diclofenac in patients with primary osteoarthritis (OA) of the knee. METHODS: Tenoxicam 20 mg per os once daily (po od) was compared to diclofenac (Voltaren) 50 mg per os 3 times a day (po tid) in a 12-week, double blind, randomized, controlled, multicenter, parallel trial. The primary outcome measure was the pain dimension of the WOMAC OA Index. Following an initial screening visit and a 3 to 7 day NSAID-free washout period (i.e., baseline), patients were assessed at Weeks 2, 4 and 12; assessments including some 15 efficacy variables and safety variables. RESULTS: Ninety-eight patients [tenoxicam (n = 48), diclofenac (n = 50)] participated in the trial. Statistically significant (p < or = 0.05) improvements in all 3 dimensions of the WOMAC OA Index and six efficacy variables were noted in both treatment groups. No significant between drug differences were noted on any efficacy variable. Significantly fewer patients reported adverse events in the tenoxicam group (21 vs 33, p = 0.03). CONCLUSION: Tenoxicam is efficacious and well tolerated in patients with OA of the knee. In this group of patients it was similar in efficacy and superior in tolerability to diclofenac 150 mg/day (50 mg tid). Thus the benefit/risk ratio of tenoxicam was superior to that of diclofenac in this study.

Aged↗
PubMed1992

An electronic method for measuring joint tenderness in rheumatoid arthritis.

OBJECTIVE: To test the precision of a new electronic method for measuring joint tenderness. METHOD: Joint tenderness was measured in 30 patients with rheumatoid arthritis, using an electronic dolorimeter. The results were compared with joint tenderness counts, which were made according to the American Rheumatism Association (ARA) methods. RESULTS: The intra-observer variability using the electronic method was significantly decreased compared with the conventional ARA joint tenderness counts. CONCLUSION: The electronic method is more efficient for use in clinical trials than is the conventional ARA joint tenderness count.

Arthritis, Rheumatoid↗
PubMed1992

An objective structured clinical examination for the licentiate: report of the pilot project of the Medical Council of Canada.

The Medical Council of Canada (MCC) administers a qualifying examination for the issuance of a license to practice medicine. To date, this examination does not test the clinical skills of history taking, physical examination, and communication. The MCC is implementing an objective structured clinical examination (OSCE) to test these skills in October 1992. A pilot examination was developed to test the feasibility, reliability, and validity of running a multisite, two-form, four-hour, 20-station OSCE for national licensure. In February 1991, 240 volunteer first- and second-year residents were tested at four sites. The candidates were randomly assigned to one of two forms of the test and one of two sites for two of the four sites. Generalizability analysis revealed that the variance due to form was 0.0 and that due to site was .16 compared with a total variance of 280.86. The reliabilities (inter-station) were .56 and .60 for the two forms. Station total-test score correlations, used to measure station validity, were significant for 38 of the 40 stations used (range .14-.60). The results of the OSCE correlated moderately with the MCC qualifying examination; these correlations were .32 and .35 for the two test forms. Content validity was assessed by postexamination questionnaires given to the physician examiners using a scale of 0 (low) to 10 (high). The physicians' mean ratings were: importance of the stations, 8.1 (SD, 1.8); success of the examination in testing core skills, 8.1 (SD, 1.6); and degree of challenge, 7.8 (SD, 2.1). The results indicate that a full-scale national administration of an OSCE for licensure is feasible using the model developed. Aspects of validity have been established and strategies to augment reliability have been developed.

Canada↗
PubMed1992

Cyclosporine A for the treatment of necrotizing scleritis and corneal melting in patients with rheumatoid arthritis.

Two of the ocular complications of rheumatoid arthritis (RA), necrotizing scleritis and keratolysis, have been associated with poor response to standard ocular therapy, and thus poor ocular outcome. We describe 6 patients with active ocular disease and active RA who failed to respond to disease modifying agents or immunosuppressive therapy and whose ocular and arthritic disease subsequently responded to cyclosporine A. Drug related complications were consistent with those reported for patients receiving similar doses for RA.

Aged↗
PubMed1992

Ten year survival of a patient with advanced pulmonary hypertension and mixed connective tissue disease treated with immunosuppressive therapy.

Pulmonary hypertension is the most frequent cause of death in patients with mixed connective tissue disease. The pulmonary hypertension is progressive and difficult to treat effectively. These patients experience considerable morbidity secondary to diminished cardiac function. We describe a case in which sequential administration of cyclophosphamide and cyclosporine A favorably altered the clinical and hemodynamic course of this serious complication.

Adult↗
PubMed1991

Relationship between severity of rheumatoid arthritis and serum alpha 1-antitrypsin.

We determined serum alpha 1-antitrypsin phenotypes and levels in 281 patients with classical or definite rheumatoid arthritis (RA). The prevalence of the MZ phenotype in our patients with RA was not increased, as there were only 3 MZ cases (1.1% of all cases and 1.4% of seropositive cases) compared to the 3% prevalence in controls. The FM phenotype was detected in 6 cases, a prevalence rate of 2.1%, significantly higher than in controls (prevalence less than 0.4%). Increased serum levels of alpha 1-antitrypsin were independently associated (p less than 0.01) with the presence of wrist joint erosions and the use of gold and/or penicillamine for treatment; this association may represent a serum antitrypsin response to more severe disease.

Adult↗
PubMed1990

Low-dose cyclosporin versus placebo in patients with rheumatoid arthritis.

144 patients with severe rheumatoid arthritis from six centres were randomised to receive oral cyclosporin or placebo for 6 months. The initial daily dose of cyclosporin was 2.5 mg/kg, which was increased cautiously with monitoring of serum cyclosporin levels and creatinine; the mean stabilisation dose was 3.8 mg/kg. There were significant improvements in the cyclosporin-treated patients compared with the controls in the major outcomes of reduction of active joints (23% improvement), pain (24%), and functional status (16%); global improvement was 27%. In the cyclosporin group serum creatinine increased by a mean of 15.6 mumols/l and mean arterial blood pressure by 6.27 mmHg; these increases were controlled in all but 2 patients by dose adjustment without withdrawal from the study.

Activities of Daily Living↗
PubMed1989

Temporomandibular pain and dysfunction syndrome associated with generalized musculoskeletal pain: a retrospective study.

Sequential patients seen in a Temporomandibular Joint Clinic were reviewed for evidence of generalized musculoskeletal pain. A greater proportion of patients with myofascial pain dysfunction syndrome than those with other causes of temporomandibular joint pain and complaints of pain outside the jaw in the head and neck region, pain on neck muscle palpation and bilateral symptoms. Demographic and other abnormalities in these patients suggest similarities to fibromyalgia syndrome.

Back↗
PubMed1989

Pilot study of etretinate in psoriatic arthritis.

A 2-center pilot study compared clinical and laboratory outcomes in 40 patients with psoriatic arthritis before and after treatment for 8 to 24 weeks with the vitamin A derivative, etretinate. The number of tender joints fell from 22.0 +/- 8.75 before treatment to 11.44 +/- 8.50 after treatment (p = .000). The duration of morning stiffness was 101.95 +/- 62.45 min before therapy and 44.53 +/- 82.10 min after treatment (p = 0.0004). Similar highly clinically and statistically significant improvement was seen in all clinical outcome measures and in the erythrocyte sedimentation rate. Primarily mucocutaneous side effects were seen in 39/40 patients and resulted in treatment termination before 24 weeks in 9 patients.

Arthritis↗