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Biomedical subjects

E D Rosenstein

Publications and source records attributed to E D Rosenstein.

At least 19 recordsLinked to original sources
PubMed2001

Comparison of the effects of ketoprofen on platelet function in the presence and absence of aspirin.

PURPOSE: Although aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) exert inhibitory effects on platelets in vitro and in vivo, there are insufficient data to substantiate the use of NSAIDs alone as antiplatelet drugs in patients already taking aspirin. We therefore sought to determine whether aspirin, added to NSAID therapy, further suppresses platelet function. SUBJECTS AND METHODS: We enrolled 25 healthy adult volunteers who were administered ketoprofen (extended-release capsules, 200 mg daily) for 1 week, followed by ketoprofen (200 mg daily) and aspirin (325 mg daily) or ketoprofen (200 mg daily) alone during the second week. Platelet aggregation, stimulated by epinephrine and arachidonic acid, and cyclooxygenase activity, measured by thromboxane B(2), were measured at baseline, on day 8, and on day 15. RESULTS: On day 8, all subjects demonstrated abnormal platelet aggregation (>50% inhibition), which persisted at day 15 in both the aspirin and no aspirin groups. One week of ketoprofen treatment reduced thromboxane B(2) levels by 84% in the aspirin group and by 85% in the no aspirin group (P = 0.8), without any further inhibition measured on day 15. CONCLUSION: Extended-release ketoprofen significantly inhibited platelet aggregation and thromboxane B(2) production in healthy volunteers. Addition of aspirin had no additional effect. Trials are warranted to determine whether these in vitro effects result in clinical antiplatelet activity in patients who require chronic treatment with NSAIDs, thereby avoiding the toxicity of NSAID/aspirin combination therapy.

Adult↗
PubMed2001

The prevalence of insulin receptor antibodies in patients with systemic lupus erythematosus and related conditions.

Autoantibodies to the insulin receptor have been demonstrated to antagonize the physiologic actions of insulin, most often resulting in hyperglycemia unresponsive to massive doses of insulin (type B insulin resistance). Patients with these anti-insulin receptor antibodies typically have a coexistent autoimmune disorder, most commonly systemic lupus erythematosus (SLE) or undifferentiated autoimmune syndromes. Attempting to determine the prevalence and significance of anti-insulin receptor antibodies, sera from consecutive patients with SLE and early undifferentiated connective tissue disease (UCTD) were tested for the presence of anti-insulin receptor antibodies by radio-immuno assay. Thirty-eight patients participated in the study. Twenty-six had SLE and 12 had UCTD. One patient with SLE (2.6%) was positive for anti-insulin receptor antibodies. None of the patients demonstrated evidence of insulin resistance, hypoglycemia, ovarian hyperandrogenism, or acanthosis nigricans, findings commonly linked with the presence of anti-insulin receptor antibodies. The results presented here indicate that the incidence of anti-insulin receptor antibodies in patients with SLE or UCTD, without associated history of altered glucose metabolism, is quite low. Because in most cases the disturbance of glucose metabolism dominates the clinical picture at presentation and the associated systemic autoimmune syndrome presents either simultaneously with or subsequent to the diagnosis of diabetes, the measurement of anti-insulin receptor antibodies should be reserved for patients with indications of disordered glucose homeostasis.

Journal Article↗
PubMed2000

Giant cell myocarditis: most fatal of autoimmune diseases.

OBJECTIVE: To increase awareness of giant cell myocarditis (GCM), its pathogenesis, and treatment. METHODS: Review of relevant publications from the English-language literature. RESULTS: GCM is a rare, frequently fatal inflammatory disorder of cardiac muscle of unknown origin, characterized by widespread degeneration and necrosis of myocardial fibers.Congestive heart failure and ventricular tachycardia are common clinical manifestations. GCM occurs primarily in previously healthy adults, although it is frequently associated with various systemic diseases, primarily of autoimmune causes. The inflammatory infiltrate is characterized by the presence of multinucleated giant cells and is distinct from cardiac sarcoidosis. Animal models of GCM are similar to models of other autoimmune disorders such as rheumatoid arthritis. The prognosis, which is poor despite partial responsiveness to immunosuppressive medications, is improved with cardiac transplantation. CONCLUSIONS: The clinical and immunopathogenetic similarities with classical rheumatologic diseases, the differential diagnosis with sarcoidosis and other inflammatory conditions, and the use of standard immunosuppressive medications make GCM a disease process that should be added to the rheumatologist's expertise.

Animals↗
PubMed1999

Topical agents in the treatment of rheumatic disorders.

Topical drug delivery may be the optimal route for the treatment of localized musculoskeletal disorders because higher drug concentrations can be achieved at the sites of clinical significance. The rationale for the use of topical salicylates and other nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of soft-tissue rheumatic complaints and osteoarthritis is reviewed. Topical capsaicin offers another potentially beneficial therapy for the treatment of osteoarthritis of selected joints. Although there are extensive, uncontrolled experiences with DMSO that suggests its effectiveness in the treatment of musculoskeletal disorders, controlled trials yield conflicting results. The basis for the use of physical modalities such as phonophoresis and iontophoresis to improve topical drug efficacy is summarized.

Administration, Topical↗
PubMed1999

Trace elements in the treatment of rheumatic conditions.

The role of trace metallic elements (copper, selenium, zinc, gold) in chronic inflammatory states is of great interest because many of them are co-factors in metabolic processes involving articular tissues and immune system function. Deficiencies of several of these have been documented in patients with rheumatoid arthritis. Other than for the clinically approved gold compounds, there exists only inconsistent evidence for a therapeutic role of trace metallic elements in the management of rheumatoid arthritis.

Complementary Therapies↗
PubMed1999

Rheumatoid arthritis.

Explore the source record for details and available documents.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

A case of multicentric reticulohistiocytosis in a 6-year-old child.

Multicentric reticulohistiocytosis (MR) is a rare disease in which an infiltration of histiocytic cells causes destructive polyarthritis and characteristic cutaneous lesions. It predominantly affects women between the ages of 40 and 50 years. Effective treatment has not been well established. We describe a case diagnosed in a 6-year-old girl. This is the youngest patient with MR reported to date.

Biopsy↗
PubMed1998

Refractory hyperglycemia complicating an evolving connective tissue disease: response to cyclosporine.

A 33-year-old woman with longstanding rheumatoid arthritis and Sjögren's syndrome developed type B insulin resistance (diabetes mellitus due to anti-insulin receptor antibodies) simultaneous with the evolution of her rheumatic disease to mixed connective tissue disease. Cyclosporine therapy induced a remission of receptor antibody mediated insulin resistance and controlled clinical manifestations of her systemic lupus erythematosus and dermatomyositis, but had no effect on the sclerodermatous features of her illness.

Adult↗
PubMed1996

Exacerbation of rheumatoid arthritis after termination of chemotherapy for breast carcinoma.

Three women with breast carcinoma were treated with combination chemotherapy, including cyclophosphamide, 5-fluorouracil, and methotrexate, after mastectomy. Within two months of termination of chemotherapy, all 3 patients developed florid synovitis. Two patients had prior clinical manifestations consistent with rheumatoid arthritis; one patient had no antecedent history of arthritis. We suggest that this presentation may represent exacerbation of mild or subclinical rheumatoid arthritis as a consequence of withdrawal of methotrexate therapy.

Adenocarcinoma↗
PubMed1995

Case report: Langerhans cell histiocytosis associated with elevation of angiotensin-converting enzyme levels.

The authors describe a 22-year-old man with osteolytic mandibular and maxillary lesions. Biopsy substantiated the presence of Langerhans cell histiocytosis (eosinophilic granuloma). Levels of serum angiotensin-converting enzyme (ACE) were elevated repeatedly. After definitive therapy with excision and bone grafting, ACE levels returned to normal. The role of histiocytes in ACE production is discussed. Langerhans cell histiocytosis should be considered in the diagnosis of conditions occurring with elevation of serum ACE levels and clinical findings similar to sarcoidosis.

Adult↗
PubMed1994

Occult subacute thyroiditis mimicking classic giant cell arteritis.

We report the case of a 60-year-old man who presented with fever, weight loss, generalized aching, left temporal and ear pain, and an erythrocyte sedimentation rate of 125 mm/hour. Due to the presumed diagnosis of giant cell arteritis (GCA), the patient was treated with prednisone (60 mg daily), with immediate improvement in his symptoms. Biopsy of the temporal arteries revealed no significant inflammatory infiltrate. Further evaluation included assessments of thyroid function, which revealed an elevated T4 level, low thyroid-stimulating hormone level, and suppressed radioactive iodine uptake on thyroid scintigraphy. A diagnosis of subacute thyroiditis was made, prednisone therapy was tapered over 3 weeks, and treatment with beta blockers was instituted. The patient remained asymptomatic and returned to a euthyroid state. This case illustrates that subacute thyroiditis should be considered in the differential diagnosis of GCA.

Diagnosis, Differential↗
PubMed1994

Recurrence of Wegener's granulomatosis following renal transplantation.

A 43-yr-old man with a 19-yr history of Wegener's granulomatosis presented with recurrent haematuria, pulmonary infiltrate, cutaneous vasculitis, nasal mucosal involvement and elevation of ANCA levels, 2 yr following successful cadaveric renal transplantation, despite continued immunosuppressive therapy with cyclosporine, azathioprine and prednisone. Re-introduction of cyclophosphamide therapy resulted in prompt resolution of clinical and laboratory abnormalities. The superiority of cyclophosphamide over cyclosporine for maintaining suppression of Wegener's granulomatosis is substantiated in a critical review of the literature.

Adult↗
PubMed1994

Modification of cytokine production by piroxicam.

OBJECTIVE: Nonsteroidal antiinflammatory drugs have been thought to act by inhibiting the enzyme, cyclooxygenase (prostaglandin H synthetase). We sought to demonstrate additional biologic actions of this class of drugs including effects on cytokine production. METHODS: We administered the nonsteroidal antiinflammatory drug piroxicam 20 mg to 6 healthy volunteers daily for 7 days. Before and for one week after drug administration, concentrations of interleukin 1 (IL-1), IL-2, IL-4, IL-6, tumor necrosis factor alpha (TNF alpha) and interferon-gamma (IFN-gamma), produced by anti-CD3 stimulated peripheral blood mononuclear cells, were measured. RESULTS: Piroxicam treatment resulted in elevation of levels of IL-2, depression of IL-1, IL-6, TNF alpha and IFN-gamma, and no consistent effect on IL-4. CONCLUSION: Piroxicam modulates production of various cytokines in a complex fashion when administered to healthy individuals.

Administration, Oral↗