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G A McCarty

Publications and source records attributed to G A McCarty.

18 recordsLinked to original sources
PubMed1992

The antiphospholipid antibody syndrome in the emergency department setting--livedo reticularis and recurrent venous thrombosis.

We present the case of a 26-year-old man with an exacerbation of apparent chronic asthma with chronic peripheral vascular disease due to recurrent venous thrombosis. Localized livedo reticularis, new cutaneous infarctions, severe venous insufficiency, thrombocytopenia, renal failure, and cerebral supratentorial dysfunction were noted. During hospital admission, antibodies to phospholipids in high titer were present by three different testing methods. Renal biopsy demonstrated significant renal vasculature abnormalities characteristic of hemolytic endovasculopathy, and magnetic resonance imaging showed multiple cerebral infarctions. This case exemplifies the spectrum of presentations and management of the primary antiphospholipid antibody syndrome. The clue to its presence in this patient was the livedo reticularis rash, a cutaneous marker for this syndrome that was evident in the emergency department.

Adult↗
PubMed1992

Renal thrombotic microangiopathy in patients with systemic lupus erythematosus and the antiphospholipid syndrome.

Current studies indicate that a thrombotic microangiopathy (TMA) identifies patients with systemic lupus erythematosus (SLE) who are at high risk of progressing to end-stage renal disease. We have observed two patients with SLE and one patient with a primary antiphospholipid syndrome (APS) who developed acute renal insufficiency with thrombocytopenia. Renal biopsies showed a TMA characterized by thrombi or by cellular and mucoid intimal hyperplasia of small arteries and arterioles. No arterial or arteriolar immune-complex deposits were detected by immunofluorescent or electron microscopy. Biopsies from one SLE patient and the APS patient showed no immune-complex glomerular disease. Both had serum antiphospholipid antibodies (aPL). aPL were not detected in the serum of the other SLE patient who had an active lupus nephritis. Acute renal failure and thrombocytopenia resolved in each case following treatment by plasmapheresis or prednisone and heparin. None of the patients were initially treated with cytotoxic drugs. As more knowledge is gained, the accurate identification of renal vascular lesions in SLE or related diseases could influence renal prognosis and choice of therapy. The cases reported here provide further evidence that a TMA can cause acute renal failure independent of lupus nephritis. TMA should be distinguished from other forms of renal vascular disease, particularly a noninflammatory lupus microangiopathy, which is probably mediated by subendothelial immune-complex deposits. The absence of immunoglobulin deposits in vessels involved by a TMA indicates that microvascular thrombosis is promoted by mechanisms other than those usually attributed to immune-complex disease. Phospholipid reactive antibodies may be pathogenetic in some cases.

Acute Kidney Injury↗
PubMed1992

Management of antiphospholipid antibody positivity and elective orthopedic procedures.

Current management of primary or secondary antiphospholipid antibody (aPL) syndromes with known embolic phenomena requiring anticoagulation is empiric in the setting of elective orthopedic procedures. Short-term withdrawal of warfarin with continuance of aspirin and glucocorticoid therapy was undertaken for sequential bilateral knee replacements in a lupus patient with aPL. Her course was successfully managed without thrombo-embolic complications.

Adult↗
PubMed1992

Autoantibodies to phospholipids--new looks at old diseases--a primer for physicians.

Antibodies to negatively charged phospholipids (aPL) are associated with a wide clinical spectrum. Primarily the clinical problems present as localized and/or generalized thromboses, recurrent fetal loss, strokes, and various cytopenias. The clinical settings which would prompt the physician to consider aPL as causal or contributory to pathology in many organ systems are reviewed, and guidelines for screening and confirmatory testing are defined. Since effective treatments do exist to decrease or prevent morbidity, and in some cases, mortality, the generalist as well as the specialist should be aware of the many faces these primary and secondary syndromes present to them in daily practice.

Antiphospholipid Syndrome↗
PubMed1991

Autoantibodies in scleroderma and polymyositis: an update.

Cutaneous manifestations of systemic connective tissue diseases, such as scleroderma and its variants, polymyositis, and dermatomyositis, often prompt early dermatologic consultation. Indirect immunofluorescent autoantibody determinations using tissue culture substrates are initial screening tests that are highly positive in the majority of patients with scleroderma and its variants, but are less frequently positive in patients with polymyositis and dermatomyositis. When combined with second-level analyses for the multiplicity of precipitin autoantibodies that have been defined in both these major classes of rheumatic diseases, most autoantibodies of both diagnostic and prognostic significance can be defined efficiently and cost-effectively. The major autoantibody specificities characteristic of these connective tissue diseases are summarized in this article, with emphasis on current concepts of their clinical molecular, and possible pathogenetic significance.

Autoantibodies↗
PubMed1986

Autoantibodies and their relation to rheumatic diseases.

The use of tissue culture substrates for immunofluorescence determinations of nuclear, cytoplasmic, and mitotic cell-related autoantibodies has resulted in the delineation of diverse new specificities, whose clinical correlates are now becoming apparent. This review details both major and minor autoantibody specificities, the status of knowledge regarding their target antigens, and the relation of these serologic systems to distinctive rheumatic disease syndromes.

Antibody Specificity↗
PubMed1985

Update on laboratory studies and relationship to rheumatic and allergic diseases.

Guidelines have been presented for the optimal selection and interpretation of various laboratory tests related to rheumatologic, immunologic, and allergic disorders. The last decade has witnessed many technologic changes in the performance of screening tests for autoantibodies, and an expeditious approach to the detection of the clinically useful autoantibody system has been outlined. When both an immunofluorescent assay using an actively dividing substrate such as HEp-2 and an immunodiffusion test for precipitin autoantibodies are performed on patient sera, it is likely that most of the significant diagnostic and prognostic systems will be detected. Although exact pathogenetic roles have not been defined for all autoantibodies, it is apparent that highly specific markers for certain rheumatic diseases exist and the pertinent clinical aspects of each individual autoantibody-autoantigen system has been summarized. Why so many autoantibodies are cross-reactive with seemingly unrelated antigens is a perplexing aspect of autoimmunity, a disease process for which the necessary and sufficient conditions of development have not been defined even after decades of research. One recent hypothesis regarding the generation of diverse autoantibodies is the tenet that production is interrelated in an auto-anti-idiotypic network. Support for this hypothesis comes from the recent successful use of anti-idiotypes to DNA autoantibodies in an attempt to abrogate pathogenetic effects of target organ damage in murine models of SLE. A similar approach might be undertaken with some of the other autoantibody systems in an attempt at a novel therapy for disorders of immunoregulation.

Animals↗
PubMed1985

Autoimmunity and malignancy.

This article reviews the theoretical and clinical relationships among autoimmune, musculoskeletal, connective tissue syndromes, and various malignancies. The most common tumors encountered in clinical practice, and the syndromes with which patients present, are approached in terms of their direct or indirect relationship to the malignancies.

Aged↗
PubMed1979

Deficiency of the fifth component of complement in human subjects. Clinical, genetic and immunologic studies in a large kindred.

The discovery of a large kindred with a heritable deficiency of the fifth component of complement (C5) has permitted the accumulation of new clinical, genetic and immunologic data concerning the role of C5 in human subjects. The proband, who has had nine episodes of disseminated gonococcal infection, has a hemolytic C5 level of approximately 0.5 per cent of normal. No C5 protein was detectable, but low levels of functional C5 activity could be found using a sensitive bactericidal assay. The proband's twin as well as another sister also had extremely low levels of hemolytic C5(approximately 0.5 per cent normal), but both these subjects have been healthy. Hemolytic complement and bacteriolytic activity could be restored by the addition of purified C5. No chemotactic activity for polymorphonuclear leukocytes could be generated in the C5-deficient serums upon activation of either the classic or alternative pathways, again demonstrating the importance of C5 in human subjects for the production of chemotactic factors. The chemotactic responsiveness of the patients' polymorphonuclear leukocytes and monocytes to preformed chemotactic factors was not depressed. Twenty-two of 32 other family members from three generations had depressed whole hemolytic complement levels. In 19 of 30 family members, levels of hemolytic C5 ranged from 13 to 64 per cent of normal. No linkage for C5 deficiency and the A or B loci of the major histocompatibility complex could be found. These data suggest an autosomal codominant mode of inheritance of C5 deficiency. Deficiency of C5 is compatible with good health, but it can be associated with repeated disseminated gonococcal infection.

Adult↗
PubMed1979

Articulatory effects of monaural and binaural masking in normal speaking adults wearing palatal appliances.

Ten normal speaking adults (five male, five female) performed three speaking tasks during conditions of monaural and binaural masking with and without complete palatal appliances. Significant effects on the subjects' articulation were found for the factors of masking type, palatal appliance and speaking task. No significant effects were found for monaural right- versus monaural left-ear masking or sex of the speakers. The findings are similar to previous results using binaural masking and indicate that the disruptive effect of monaural masking on the articulation of adult subjects is approximately midway between the effects of no masking and binaural masking. It is suggested that the lack of a significant effect for right-ear versus left-ear monaural masking may be due to the high degree of automatization which subjects possessed for the stimuli used in the speaking tasks.

Adult↗
PubMed1976

Intraoral infrared color photography of radiotherapy patients.

A clinical screening study was performed in which head-and-neck radiotherapy patients were photographed intraorally using infrared "false color" film and Ektachrome color film. These photographs were compared to determine if differences existed in appearance between the intraoral tissues within the field of radiation and those intraoral tissues not in the field of radiation. No differences could be detected with either the "false color" film or with Ektachrome color film. Further investigations in the use of infrared color photography as applied to the radiotherapy patient could be undertaken by using a light source that transmits infrared rays only and a lens filter that passes only infrared rays. This method would produce a film that shows only the reflected infrared rays. Both color and black-and-white film should be used in this study.

Color↗
PubMedDate not supplied

Scleroderma: DR antigens, autoantibodies and clinical manifestations.

The relationship between anticentromere antibodies (ACA), antitopoisomerase I or Scleroderma 70 (Scl-70) antibodies, HLA-DR antigens, and clinical manifestations of scleroderma were examined in 51 patients defined by ARA criteria. No association between a given HLA-DR antigen and either ACA or anti-Scl-70 was found. Statistically significant associations were noted for patients with ACA who had a lower frequency of arthritis and longer disease duration; anti-Scl-70 patients were more likely to be males with a higher frequency of pulmonary, cardiac and sicca symptoms.

Adult↗