CPPD crystal deposition disease.
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Biomedical subjects
Publications and source records attributed to I F Anderson.
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Twenty-four patients who had an osteochondral fracture of the dome of the talus were examined by plain radiography, magnetic resonance imaging, computerized tomography, and, when indicated, scintigraphy. When plain radiographs of the ankle are relied on for the diagnosis of an osteochondral fracture of the talus, many lesions remain undiagnosed. Stage-I osteochondral fractures show no diagnostic changes on plain radiographs, and Stage-II lesions are usually subtle and, therefore, are often overlooked by both radiologists and clinicians. The use of scintigraphy as a screening procedure and of magnetic resonance imaging for patients who have positive scintiscans showed that osteochondral fractures are more common than has previously been indicated in the literature. Scintigraphy should be used to assess patients when there is clinical suspicion of an osteochondral fracture but the plain radiographs appear to be negative. Patients who have positive scintiscans should be assessed by magnetic resonance imaging. Patients who have abnormal plain radiographs will derive no major benefits from magnetic resonance imaging; for all but one of these patients, computerized tomography was adequate for staging the fracture.
Clofazimine, at concentrations within the therapeutic range (0.01-5 micrograms/ml), stimulated human polymorphonuclear leucocytes (PMNL) to generate increased amounts of reactive oxidants (RO) when activated with the tripeptide leucoattractant N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP), calcium ionophore, phorbol myristate acetate and opsonised zymosan. Clofazimine per se did not activate the membrane-associated oxidative metabolism of PMNL, but rather primed these cells to hyperreact to the various stimuli. To investigate the therapeutic significance of these observations clofazimine was administered to patients with various chronic inflammatory diseases (lichen planus, discoid lupus erythematosus and rheumatoid arthritis) and generation of RO by FMLP-activated phagocytes was measured before and during clofazimine administration. A statistically significant potentiation of RO generation by FMLP-activated phagocytes was observed during clofazimine administration. Since RO are immunosuppressive and antimicrobial the therapeutic mechanisms of clofazimine may be related to pro-oxidative interactions of this agent with phagocytes.
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An echocardiographic study of 44 patients with active rheumatoid arthritis was carried out by means of a Picker ultrasonic laminograph. A posterior pericardial effusion was found in 14 patients (32%) and pericardial thickening in 5 (11%). The maximum amplitude of the anterior cusp of the mitral valve was reduced in 18 patients, and the diastolic (EF) slope was abnormal in 17 patients. The posterior cusp movement and left ventricle diameter were normal. The over-all incidence of cardiac involvement in these patients was 73%. The incidence of heart abnormalities given by echocardiographic diagnosis of cardiac manifestation of rehumatoid arthritis correlates well with the incidence derived from postmortem studies.
Auto-immune mechanisms are important in the evolution of pernicious anaemia, but cannot be demonstrated in all cases. Cell-mediated immunity is involved in the pathogenesis, and explains the occurrence of pernicious anaemia in patients with hypogammaglobulinaemia. The pernicious anaemia seen in these patients differs in some respects from the classical form of the disease. The case history of a patient with pernicious anaemia and hypogammaglobulinaemia is presented, and the possible pathological mechanisms are discussed.
Forty patients with active rheumatoid arthritis were treated with intramuscular injections of gold salts. A significant response was shown by 67,5% of the patients. Treatment was discontinued owing to side-effects in 35%. Dermatitis and proteinuria from renal damage were the commonest complications of treatment. The method of treatment and its side-effects are discussed.
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Pseudogout, or calcium pyrophosphate arthropathy, is a crystalline synovitis, characterised either by acute attacks of joint pain, which usually occur in the large joints, or by a more chronic, progressive form of joint disease. The essential features of the disease are chondrocalcinosis and the presence of pyrophosphate crystals in the synovial fluid. The exact pathogenesis is unknown. Case reports of 2 patients with confiemed pseudogout, and of 1 who is suspected to be suffering from the disease, as well as a summary of the outstanding aspects of the condition, are presented.
The triad of a peripheral neuropathy, skin ulceration and destruction of bones and joints of the feet is called ulcero-osteolytic neuropathy, when other common causes of similar lesions have been excluded. Malnutrition, alcoholism and local trauma predispose to the development of the condition. It is to be differentiated from burnt-out leprosy, and is a chronic condition that eventually leads to characteristic deformities.
The early diagnosis of rheumatoid arthritis ensures a timeous prognosis and appropriate therapy for this chronic disease. The radiograph of the hand is a valuable aid in making this diagnosis, but accurate interpretation is difficult. An outline of the X-ray changes seen in the rheumatoid hand is presented, and the salient points in the differential diagnosis are outlined.
Two studies on a total of 45 patients with chronic osteoarthritis using fenoprofen calcium are presented. Different methods using only subjective criteria (pain intensity scores and pain relief scores) are applied. Measurable analgesic qualities were demonstrated for fenoprofen, which is seen as a valuable addition to the drug therapy of osteo-arthritis.
Apparent regeneration of the tendons of the semitendinosus and gracilis muscles after their use for anterior cruciate ligament reconstruction was noted during routine follow-up of 225 patients. From this group, four patients were selected for thorough examination, including magnetic resonance imaging, electromyographic studies, strength testing, and clinical examination. The results demonstrate that these tendons appear to regrow and are probably functional.