AIDS: current achievement, future problems.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to L H Calabrese.
Explore the source record for details and available documents.
Though gymnastics is not considered to be an endurance sport, female gymnasts appear to be prone to a variety of medical complications, among them nutritional deficiencies and menstrual dysfunction.
A variety of immunologic tests are now available to assist the clinician in the differential diagnosis of systemic lupus erythematosus (SLE) and related disorders. Knowledge of the sensitivity and specificity of each test is critical for proper clinical interpretation. Also important is a detailed consideration of the clinical situation and the pretest estimate of the likelihood SLE is present. The antinuclear antibody (ANA) test is the most sensitive test for SLE and is therefore the best screening assay for ruling out its presence. Anti-native (N)-DNA and anti-Sm (Smith antigen) tests are highly specific for SLE and have strong confirmatory powers, even in a patient unlikely to have the disease. New information regarding the operating characteristics of tests for SLE and a recent trend toward more analytic and cost-conscious use of the laboratory should allow clinicians to make more rational and cost-effective decisions about methods of diagnosis. Combination sequential testing seems to be a logical approach.
Acquired immune deficiency syndrome (AIDS) is a recently recognized disease characterized by abnormalities in cell-mediated immunity that predispose affected persons to severe opportunistic infections and unusual malignant neoplasms. We describe four cases of herpes zoster ophthalmicus in four previously healthy homosexual men. Two had signs and symptoms consistent with AIDS, and two had signs and symptoms of a lymphadenopathic syndrome associated with AIDS. We suggest that underlying AIDS be considered in young, healthy persons with herpes zoster ophthalmicus and no known cause of immunosuppression.
Explore the source record for details and available documents.
Autoimmune inner ear disease is an uncommon but distinct clinical entity. Our ignorance of the immune mediating pathways, need of further animal model experimentation, variability of laboratory test results and of patient treatment responses illustrate how poorly we understand this disorder. The purpose of this review is to compare practical vs theoretical management of autoimmune inner ear disease, based upon our current knowledge of the disease process and upon a review of clinical experience at the Cleveland Clinic Foundation. Representative case histories are presented. The following preliminary conclusions are discussed: Autoimmune inner ear disease can present as a systemic or localized otologic immune disorder. Hearing loss can begin at any age, with unilateral or bilateral sudden onset, fluctuating or progressive symptoms, with or without associated dizziness. The pathogenesis of autoimmune inner ear disease is probably multifactorial (cellular and humoral). The sensitivity and specificity of different laboratory tests vary greatly, but even the most sensitive tests may be falsely normal when symptoms are not acute or when the patient is taking immunosuppressant medication. The mainstay of autoimmune inner ear treatment is steroids: however, cytotoxic drugs are recommended when there is no response to steroid treatment. Apheresis is reserved for selected cases. Hearing improvement can be dramatic even after 2 months of profound deafness. Flare-ups of autoimmune ear disease are best managed by increasing steroid dosage or adding cytotoxic medications. Unfortunately, some patients will develop progressive hearing loss despite vigorous treatment.
The preliminary American Rheumatism Association (ARA) criteria for classification of systemic lupus erythematosus (SLE) were evaluated for sensitivity and specificity in 87 patients with SLE and 73 without SLE from a rheumatology population. Using these data, Bayes' theorem was employed to weight the criteria so that a scoring system could be developed, allowing more accurate use of the criteria in diagnosis. Combinations of serologic test results were evaluated in a similar manner. Comparison of weighted scores with criteria counts showed greater sensitivity and specificity of the former whether the 1971 or modified 1982 ARA criteria were used. Weighted criteria may be more useful in clearly defining patient populations for studies of SLE.
Explore the source record for details and available documents.
Autoimmune inner ear disease was first described by McCabe in 1979. The diagnosis is supported by cell mediated immune responses to inner ear membrane antigen stimulation. Meniere's disease consists of episodic vertigo, fluctuating sensorineural hearing loss, tinnitus and often aural pressure. Although most clinicians feel that Meniere's disease has no known cause, recently several researchers have suggested that some cases of Meniere's disease may be autoimmune in origin. In the present study, 10 patients with bilateral Meniere's disease were studied prospectively for autoimmune inner ear disease using both cellular and humoral immune tests. Results were compared with normal control subjects. One additional patient with Meniere's disease was identified retrospectively to have positive autoimmune test results. Preliminary conclusions suggest that at least some cases of presumed idiopathic Meniere's disease are autoimmune in origin. Therapeutic implications are significant: the addition of steroids, cytotoxic drugs and/or apheresis to conventional treatment may help prevent total deafness which otherwise might be inevitable.
Autoimmune inner ear disease was first described by McCabe in 1979. The diagnosis is supported by cell-mediated immune responses to inner ear membrane antigen stimulation. Cogan's syndrome consists of vestibuloauditory dysfunction, ocular inflammation, and nonreactive serologic tests for syphilis. The ocular disease can be controlled by steroids; unfortunately, some patients ultimately become totally deaf. An autoimmune etiology has long been suspected but only recently confirmed by McCabe. In our study two patients with Cogan's syndrome were studied for autoimmune inner ear disease with the use of both cellular and humoral immune tests. Results were compared to normal control subjects. On the basis of test results, preliminary conclusions were that (1) the vestibuloauditory symptoms of Cogan's syndrome are autoimmune in origin; (2) the autoimmune process is mediated through cellular rather than humoral (antibody) pathways; (3) systemic steroids may suppress positive test results; and (4) test results are more likely to be positive when symptoms are acute. Therapeutic implications are significant: the addition of cytotoxic drugs to steroids in selected cases may help prevent total deafness that otherwise might be inevitable.
Explore the source record for details and available documents.
Improvement in cardiovascular fitness is related to the mode, frequency, duration, intensity, and rate of progression of exercise. These data suggest that dance as an activity for promoting fitness will improve aerobic and physical working capacity. The commercial classes studied were of short duration and relied on elevated intensity for improvement, whereas the classes for professional dancers were low in intensity and relied on frequency and duration for improvements. Other area studied were body composition and strength.
The traditional requirement for dancers to be lean coupled with the fact that dance is a nonendurance form of exercise makes it necessary for dancers, particularly females, to follow diets of relatively low caloric content. Food faddism and irrational use of nutritional supplements are common among dancers, who have little information about nutrition. Further investigation of the general medical and nutritional problems of dancers is needed, and the information from these studies should be incorporated into the curriculum of serious dancers.
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.
Systemic lupus erythematosus developed in an 18-year-old man three years after thymectomy for myasthenia gravis. The patient had considerable defects in suppressor cell function that seemed to be partially reversed in vitro by the addition of thymic hormone.
Isolated B cells from normal subjects and patients with systemic lupus erythematosus (SLE) could be stimulated to produce IgM anti-DNA with pokeweed mitogen. Normal but not SLE allogeneic T cells abrogated this response. Normal but not SLE autologous T cells promoted a switch from IgM to IgG anti-DNA production. SLE is characterized by at least two types of immunoregulatory abnormalities: a defect in T suppressor function and a defect in the IgM to IgG switchover.