Biomedical subjects

D G Borenstein

Publications and source records attributed to D G Borenstein.

31 records · Page 2Linked to original sources

PubMed1988

Autoantibodies to the insulin receptor as a cause of autoimmune hypoglycemia in systemic lupus erythematosus.

A 52-year-old black woman presented with clinical features of systemic lupus erythematosus (SLE) and severe fasting hypoglycemia. Hypoglycemia was secondary to autoantibodies to the insulin receptor that were detected in the patient's serum. There were no anti-insulin antibodies, and other causes of hypoglycemia were excluded. Treatment with high-dose glucocorticoids resulted in restoration of euglycemia associated with resolution of circulating anti-receptor antibodies and parallel improvement in clinical and laboratory features of SLE. This case is compared with other cases of autoimmune hypoglycemia due to anti-receptor antibodies.

Autoantibodies↗

PubMed1988

Evaluation and outcome of low-back pain of unknown etiology.

Between January 1980 and January 1985, 5,362 patients with low-back pain were evaluated prospectively using a standard approach. The majority improved with routine therapy or could be placed in a definitive diagnostic group. One hundred and nine (2%), however, failed to improve or could not be assigned a specific diagnosis. These patients, defined as having chronic low-back pain of unknown etiology, were referred to a rheumatologist for evaluation. The average time to referral was 6 months. A specific diagnosis was obtained for 14 of the 109 patients. The remaining 95 were placed on new treatment plans, which included detoxification, a change of physicians, and arbitrary changes in therapy. The results indicated that approximately 75% of the group had 50% or greater reduction of pain, and half of the workers' compensation patients returned to some form of employment (although perhaps only intermittent).

Back Pain↗

PubMed1987

Successful joint arthroplasty following Proteus morganii (Morganella morganii) septic arthritis: a four-year study.

Proteus morganii (Morganella morganii) is an uncommon cause of septic arthritis. We describe a 53-year-old woman with severely deforming rheumatoid arthritis, who developed an indolent septic arthritis secondary to infection with this organism. She was treated with antibiotics and closed drainage, and subsequently, underwent successful arthroplasty. She continues to do well 4.5 years later. This patient's disease course shows that gram-negative septic arthritis, effectively treated, does not preclude successful total joint arthroplasty.

Arthritis, Infectious↗

PubMed1986

Hemophilus influenzae septic arthritis in adults. A report of four cases and a review of the literature.

The clinical and diagnostic features of 29 adult patients with H. influenzae septic arthritis are reviewed. Twelve men and 17 women ranging in age from 22 to 82 years developed the infection. H. influenzae septic arthritis is an acute, febrile disease with a mean duration of symptoms before diagnosis of 4 days. Fifteen patients had monoarticular arthritis, 6 with an infected knee. Polyarticular involvement, with a range of 2 to 9 joints, was diagnosed in 14 patients. Nineteen patients had concurrent extraarticular sites of infection, including meningitis, pneumonia, pharyngitis, sinusitis, conjunctivitis, and cellulitis. Twenty-two of 29 patients had predisposing factors for infection, including ethanolism, trauma, rheumatoid arthritis, systemic lupus erythematosus, diabetes mellitus, splenectomy, multiple myeloma, lymphoma, gout, and acquired common variable hypogammaglobulinemia. Characteristic synovial fluid findings included purulent, greenish fluid, elevated WBC count, and gram-negative pleomorphic microorganisms. Treatment for these patients included antibiotic therapy, most often ampicillin and chloramphenicol, and joint drainage by repeated arthrocentesis or arthrotomy. A favorable outcome was reported in 25 of 29 patients. Hemophilus influenzae septic arthritis should be suspected in adults who are immunocompromised and have a concurrent extraarticular source of infection.

Adult↗

PubMed1986

Progressive systemic sclerosis and Graves' disease. Report of three cases.

Progressive systemic sclerosis (PSS) is associated with a broad spectrum of autoimmune thyroid diseases. While an association between PSS and hypothyroidism is well established, a relationship between PSS and hyperthyroidism is less well defined. We treated three patients with PSS whose course was complicated by Graves' disease. Because hyperthyroidism can simulate many of the symptoms of PSS progression and treatment of hyperthyroidism can lead to resolution of clinical deterioration in such patients, it is important to recognize the simultaneous occurrence of these diseases.

Adult↗

PubMed1983

Synovial fluid inhibits killing of Staphylococcus aureus by neutrophils.

Serum in the extracellular environment promotes neutrophil bactericidal activity apart from its opsonizing properties. We examined the effect of non-inflammatory osteoarthritic synovial fluid on serum-mediated neutrophil killing of Staphylococcus aureus. This was done to evaluate the effect of synovial fluid on neutrophil bactericidal activity independent of opsonin concentration. With an initial inoculum of 5 X 10(6) CFU/ml, 1.47 +/- 0.14% bacteria survived after 120 min of incubation with 10% serum and neutrophils. In contrast, 4.07 +/- 0.33% bacteria survived after incubation in serum plus synovial fluid (P less than 0.001). This inhibitory effect was directly related to the concentration of synovial fluid in the incubation mixture. Increasing the concentration of synovial fluid resulted in an increased percent survival. Studies utilizing preopsonized bacteria and radiolabeled organisms demonstrated that synovial fluid did not interfere with opsonization or phagocytosis. Intracellular bactericidal activity was assayed separately from phagocytosis by utilizing a brief ingestion period followed by the removal of extracellular bacteria by either differential centrifugation or lysostaphin treatment. The reincubation of cells and associated bacteria with serum or serum plus synovial fluid revealed that synovial fluid significantly inhibited the promoting effect of serum on neutrophil bactericidal activity. After 60 min of incubation with 10% serum, 13.0 +/- 1.2% bacteria survived, whereas 21.5 +/- 2.3% survived after incubation in serum plus synovial fluid (P less than 0.005). Superoxide production was not affected by the presence of synovial fluid. These findings suggest that the inhibitory effect of synovial fluid is due to an interaction between synovial fluid and the serum factors that promote intracellular killing.

Blood Bactericidal Activity↗

PubMed1983

Gas-liquid chromatographic analysis of synovial fluid: volatile short-chain fatty acids in septic arthritis.

Volatile short-chain fatty acids (SCFA) in synovial fluid from 80 patients were quantified by gas-liquid chromatography (GLC). Characteristic patterns of volatile SCFA could not be associated with septic, nonseptic inflammatory, or noninflammatory groups. Mean concentrations of pentanoic and hexanoic acids were similar in all groups studied. In the septic arthritis group 3 of 4 patients with acetic acid and of 3 of 3 with 3-methyl butanoic acid had culture-proved staphylococcal infections. In patients with synovial fluid findings consistent with septic arthritis, including markedly raised leucocyte count, decreased glucose level, or detectable succinic acid, the detection of acetic and 3-methyl butanoic acids by GLC analysis may increase the suspicion that Staphylococcus aureus is the cause of the septic arthritis.

Arthritis↗

PubMed1982

Gas-liquid chromatographic analysis of synovial fluid. Succinic acid and lactic acid as markers for septic arthritis.

Nonvolatile short-chain fatty acids from 80 synovial fluids were quantified by gas-liquid chromatography. Succinic acid was detectable in all 23 septic synovial fluids infected with either gram-positive or gram-negative organisms and in only 5 of 57 nonseptic synovial fluids. Lactic acid was present in all of the effusions but was correlated with septic arthritis only when present in concentrations greater than 250 mg%. Neither short-chain fatty acid was more sensitive than high white blood cell counts (greater than 50,000 mm3) or depressed glucose concentration (less than 40 mg/dl) in diagnosing septic arthritis before antibiotic therapy; however, the detection of succinic acid was helpful in identifying patients with septic arthritis who had been given antibiotic treatment before arthrocentesis. Thus, gas-liquid chromatography, a rapid and sensitive method for the detection of short-chain fatty acids, may complement the currently available methods used to diagnose septic arthritis.

Arthritis, Infectious↗

PubMed1982

Aqueductal stenosis: a possible late sequela of central nervous system inflammation in systemic lupus.

We have described a patient with a history of central nervous system lupus who had obstructive hydrocephalus secondary to stenosis of the aqueduct of Sylvius. The course of this patient's neurologic disease suggest that the obstruction was caused by a post-inflammatory lesion of CNS lupus. This report illustrates the importance of a complete neurologic evaluation of a patient with SLE who has CNS dysfunction.

Cerebral Aqueduct↗

PubMed1978

The myocarditis of systemic lupus erythematosus: association with myositis.

Five patients with clinically overt myocarditis in the setting of systemic lupus erythematosus were analyzed in terms of associated clinical and serologic features. Myositis and antibodies to nuclear ribonucleoprotein (RNP) were present in all. A retrospective review in 140 consecutive patients with systemic lupus erythematosus, including three of these five, showed a highly significant association of myocarditis with myositis (P less than 0.0005). The presence of antibodies to RNP in this small group did not attain statistical significance (P less than or equal to 0.10). The pathologic findings in the one patient who died showed similar patterns of inflammation in both cardiac and skeletal muscle, suggesting the possibility of a generalized inflammatory process directed against striated muscle. Furthermore, although anti-RNP antibodies were found uniformly in these patients, their significance remains to be defined.

Adolescent↗

PubMed1978

The absence of back pain in classical ankylosing spondylitis.

Despite the early description of painless spinal ankylosis, the existence of a clinical subset of ankylosing spondylitis with silent axial disease has largely been overlooked. Of 45 patients who met Rome diagnostic criteria for ankylosing spondylitis, five denied ever having back pain either as an initial symptom or during the subsequent course of their illness. All had decreased lumbar spine motion and bilateral radiographic sacroiliitis of at least grade III severity. Chest expansion was decreased in four, and radiographic involvement of the cervical and lumbar spine was observed in three and two patients, respectively. There were no differences observed in sex or race distribution, or frequencies of peripheral arthritis, heel pain, acute uveitis, genito-urinary infection or HLA-B27 positivity when these patients were compared with the remaining patients with back pain. These patients support the existence of a "latent" form of ankylosing spondylitis with silent axial disease.

Adult↗

PubMedDate not supplied

Cyclobenzaprine and naproxen versus naproxen alone in the treatment of acute low back pain and muscle spasm.

Two groups of 20 patients each, with mild to moderate acute low back pain with associated muscle spasm of ten days' duration or less, were treated with a combination of cyclobenzaprine and naproxen or naproxen alone in a randomized, 14-day open-label trial. Cyclobenzaprine was added to the naproxen regimen as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful, musculoskeletal conditions. The clinical characteristics of each study group, including the number of worker's compensation patients, were comparable. Combination therapy was associated with less objective muscle spasm and tenderness and greater motion of the lumbosacral spine (P less than 0.05). There were trends toward faster resolution of functional deficits and pain with combined therapy. Combination therapy was associated with more side effects, due primarily to drowsiness from the cyclobenzaprine. The results of this study demonstrated that patients with muscle spasm associated with acute low back strain benefited from the use of combination therapy consisting of a nonsteroidal anti-inflammatory agent (naproxen) and a muscle relaxant (cyclobenzaprine).

Adult↗

PubMedDate not supplied

Reiter's syndrome: a male and female disease.

A diagnosis of Reiter's syndrome was made in 12 males and 13 females based on an asymmetrical oligoarthritis with lower extremity predominance and at least 1 characteristic extraarticular manifestation. The pattern of disease was similar in both sexes; females had more extensive upper extremity joint involvement and ocular inflammation; males had more nonbacterial urethritis. Eighty-two % of males and 62% of females were HLA-B27 positive. We suggest that Reiter's syndrome has not been diagnosed in more females in the past because of an historical bias, a reliance on the complete classical triad, and confusion with seronegative rheumatoid arthritis.

Adolescent↗