Biomedical subjects
Publications and source records attributed to H Capell.
A 47 year old woman presented with a six month history of vasculitic rash, splenomegaly, and cardiac murmurs. Investigations showed the presence of mixed cryoglobulinaemia and raised titres to Coxiella burnetii consistent with chronic Q fever infection. The patient was treated with tetracycline (1 g four times a day).
Explore the source record for details and available documents.
In normal serum complement prevents precipitation of antigen-antibody complexes (PIP). However rheumatoid arthritis (RA) serum contains an inhibitor of this complement-mediated function. We have undertaken two prospective studies in order to look for any relationship between the presence and levels of inhibitory activity in sera and synovial fluids (SF) of patients with RA and disease activity (study A), and the presence of systemic manifestations (nodules and vasculitis) of RA (study B). In study A, levels of inhibitory activity were highest in the sera and synovial fluids of patients with seropositive RA. However there was no correlation between the inhibitory levels and indices of generalised disease activity (articular index, erythrocyte sedimentation rate (ESR), haemoglobin, white cell and platelet counts). Local joint tenderness score correlated weakly with the inhibitory level in SF (P less than 0.05). There was no correlation, however, with either the SF protein concentration or white cell count. In study B, PIP was shown to be lower in patients with the systemic manifestations of RA than in those with purely articular manifestations. PIP was particularly low in those patients with vasculitis compared to those with subcutaneous nodules. Serum levels of inhibitory activity were highest in patients with vasculitis and lowest in those with articular disease only, whereas patients with nodules had intermediate levels. Our conclusion is that inhibition of immune precipitation is not associated with disease activity, but is associated with the extra-articular manifestations of RA. The inhibitory factor may play a role in the pathogenesis of RA.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Two groups of outpatients (7 in each group) with Raynaud's syndrome, matched for severity of illness, were randomly allocated to receive at weekly intervals for three weeks either a 5 h intravenous infusion of buffer or epoprostenol (prostacyclin, PGI2) in buffer (7.5 ng/kg/min after the first hour). PGI2 reduced the frequency and duration of ischaemic attacks (both p less than 0.01). Hand temperature measurements with a thermocouple were significantly improved at 1 week; 6 weeks after the last infusion hand temperatures had returned to baseline. There was a corresponding loss of clinical response 8-10 weeks after the last infusion.
1 UK-37248 (dazoxiben), an orally active thromboxane synthetase inhibitor, was evaluated in a double-blind trial of patients with severe Raynaud's syndrome. 2 Twenty patients were enrolled in the study. Eleven of these patients received dazoxiben 400 mg day and nine received matching placebo capsules. Treatment was given for 6 weeks and the patients reviewed at 2 weekly intervals during the study. 3 Assessment of response was judged by clinical symptoms and hand temperature measurements. Haematological and haemostatic studies were also carried out. 4 Results show a significant clinical improvement in patients receiving dazoxiben for six weeks. Hand temperature measurements, and haematological and haemostatic blood tests remained unchanged, however, apart from the expected lowering in plasma thromboxane B2 levels. 5 The mechanism of action of the drug would appear not to be mediated through increased prostacyclin production and further studies are under way to determine how improvement has been obtained in these patients.
A patient with seropositive rheumatoid developed a bullous eruption localised to the jewellery areas 12 hours after a test dose of sodium aurothiomalate (Myocrisin). Investigation showed that she was allergic to nickel rather than gold. Small quantities of nickel were found in the Myocrisin solution after a short contact with a metal needle, suggesting an explanation for the reaction.
There is evidence to suggest that platelet activation occurs in Raynaud's syndrome. We evaluated the effect of prostacyclin (PGI2) a potent antiplatelet and vasodilator agent in 5 female patients with Raynaud's syndrome. Outpatient visits were made at weekly intervals for 4 weeks. At the first visit buffer solution (Wellcome Laboratories) was infused intravenously for 5 hrs, thereafter three five hr infusions of PGI2 at a peak dose of 10 ng/Kg/min were given. Six weeks after the infusions patients were reviewed. Symptomatic improvement, including healing of ischaemic ulcers, occurred in 4 out of 5 patients. Thermography confirmed an increase in hand temperature after PCI2. Subjective and objective improvement has persisted for at least 6 weeks after the last treatment.
Certain measures of the auditory average evoked response are sensitive to alcohol and provide evidence for abstinence and tolerance during and after 10 days of alcohol consumption by nonalcoholics. Electroencephalographic techniques provide a single sensitive measure for the study of the etiology of tolerance and abstinence with particular reference to a new area of investigation with nonaddicted humans.
Explore the source record for details and available documents.
1. Subjective. Two of the major deficiencies of drug trials in rheumatoid arthritis are inadequate patient numbers and too brief a duration of study. For the past 5 years we have conducted a continuous programme of patient and drug assessment. Cohorts of patients with classical rheumatoid arthritis are encouraged to select the first-line drug of their own choice. (Within safe limits they are encouraged to vary the dose to suit their own symptoms.) The end point is the day on which the patient feels the drug is either ineffective or produces intolerable side effects. Each cohort comprises 100 patients and the results obtained with a variety of NSAID will be discussed in the context of the placebo response. 2. Objective. We have shown that 99mTc uptake is elevated over inflamed when compared with normal joints an that it may be reduced by first- and second-line treatment of patients with rheumatoid arthritis in proportion to the changes observed with other subjective and objective assessment methods. Results in the 125I-fibrinogen and with radioactive gallium compared with radioactive 99mTc will be presented.
Explore the source record for details and available documents.