Recurrent otitis media and pulmonary infiltrates as presenting features in Wegener's granulomatosis.
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Cyclophosphamide↗
Biomedical subjects
C S Wolfe
Publications and source records attributed to C S Wolfe.
Life threatening acute pneumonitis during low dose methotrexate treatment for rheumatoid arthritis: a case report and review of the literature.
A patient is described with definite rheumatoid arthritis (RA) who developed life threatening acute pneumonitis after receiving a total dose of only 12.5 mg methotrexate (MTX). This complication has been previously described, but this is probably the lowest reported dose before development of pneumonitis in a patient with RA. The possible significance of this case is discussed in the light of recent reports suggesting an increased susceptibility of patients with RA to the pulmonary toxicity of MTX.
Alveolitis, Extrinsic Allergic↗
The optimum management of arthropathies.
The aims in management of an arthropathy are to relieve symptoms, preserve function, and control the disease process. Drugs are an important, although not the only, part of any therapeutic regimen enabling us to achieve these aims. Although each individual requires a unique strategy, there is a logical progression from first-line agents to second-line agents. Third-line agents and experimental methods are reserved for aggressive or life-threatening disease. The choice of agent in each group is personal preference, but many agents have high adverse effect profiles, and close monitoring is essential.
Arthritis↗
Thermodynamic interactions in the glutamate dehydrogenase-NADPH-oxalylglycine complex.
The enzyme-reduced coenzyme-alpha-ketoglutarate ternary complex is a critical intermediate in the glutamate dehydrogenase-catalyzed reaction. Oxalylglycine, a structural analog of alpha-ketoglutarate which contains an amide carbonyl group in place of a reducible ketone group, is one of the few compounds known to complete with alpha-ketoglutarate itself. In order to examine the role of the ketone group of alpha-ketoglutarate in the ternary complex, we have carried out a calorimetric study of the corresponding oxalylglycine ternary complex, determining the complete delta H, delta G, delta S, and delta Cp profiles and the corresponding interaction parameters for that complex and have compared the various parameters with the corresponding ones previously reported for the alpha-ketoglutarate ternary complex. While the overall delta G values of the two ternary complexes differ only slightly, the enzyme-NADPH-oxalylglycine ternary complex appears to achieve much of its stability from a very tight enzyme-oxalylglycine binary complex with little or no contribution from favorable interactions in the ternary complex, while the alpha-ketoglutarate ternary complex appears to achieve the same stability by a large interaction starting from a very weak enzyme-alpha-ketoglutarate binary complex. Consideration of the enthalpic profiles, however, show that this delta G-derived picture is deceptive. The excess binding energy which stabilizes the oxalylglycine binary is in fact due to hydrogen bonding of the amide group of oxalylglycine to the enzyme; in forming the ternary complex, this hydrogen bonding is lost in favor of forming an oxalylglycine-NADPH interaction, which is very similar to the alpha-ketoglutarate-NADPH interaction which stabilizes the alpha-ketoglutarate ternary complex. We conclude that the alpha-ketoglutarate-NADPH interaction must depend on either hydrogen bonding to or steric hindrance by the ketone group and that the existence of this energetically large interaction cannot be ascribed to imine formation between the keto group and enzyme. These findings also indicate the locus on the reaction coordinate where the reduced coenzyme plays a critical role, a role other than its obvious function as a hydride donor.
Amino Acids, Dicarboxylic↗
Evaluation of a yearlong reality orientation program.
The effectiveness of Reality Orientation (RO) as treatment for disorientation and behavioral deficits in institutionalized elderly adults was assessed over a one-year period, with evaluations at 6-month intervals. Residents of a home for the aged with varying degrees of disorientation and disability were treated with a 24-hour RO program and were compared with a control group. A subsample of disoriented residents also attended RO classes and was compared with controls. Treatment effects were assessed with a Mental Status Questionnaire (MSQ) and ratings of Activities of Daily Living (ADL) and interpersonal behaviors. Compared with controls, who showed deterioration, the subsample attending RO classes showed slight, statistically significant improvement on the MSQ after 6 months. There was no favorable effect on ADL or other measures. Comparisons with other studies suggest that advanced age, severity of disorientation and disability limit the effectiveness of RO.
Activities of Daily Living↗
Tissue gases in high-risk postoperative patients.
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Aged↗
Severe hypothermia associated with prolonged cardiorespiratory arrest and full recovery.
A patient with severe hypothermia was in ventricular fibrillation for more than 1 hour. Conservative core rewarming methods were used with complete success. In dealing with severely hypothermic patients, it is important to continue treatment despite prolonged cardiopulmonary arrest. If conservative core rewarming methods are not successful, then aggressive invasive techniques might be effective.
Adult↗