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Biomedical subjects

M Jayson

Publications and source records attributed to M Jayson.

8 recordsLinked to original sources
PubMed1999

The "distal-dorsal difference" as a possible predictor of secondary Raynaud's phenomenon.

OBJECTIVE: To investigate the possibility that a hand distal-dorsal difference in temperature of greater than 1 degree C (fingers colder than the dorsum) at a room temperature of 30 degrees C is a good predictor of secondary Raynaud's phenomenon (RP). METHODS: We imaged the hands of patients with primary Raynaud's phenomenon (PRP) and systemic sclerosis (SSc) using a thermal camera at room temperatures of 23 and 30 degrees C. From these images we measured the distal-dorsal difference in temperature for all fingers excluding the thumbs. At a room temperature of 23 degrees C we also performed a cold challenge test using water at 15 degrees C for 1 min and thermally imaged the rewarming process for 15 min. Several variables were derived from the rewarming curve. The procedure was repeated within 3 days to assess reproducibility. RESULTS: The best discriminator between PRP and SSc was found to be a distal-dorsal difference of > 1 degree C at 30 degrees C (p = 0.005). There is reasonable reproducibility when considering groups of patients. However, the intra-subject standard deviations were large, indicating that measurements for the same patient on separate visits may vary considerably. CONCLUSION: Our results suggest that the finding of a distal-dorsal difference of > 1 degree C (cold fingers) at 30 degrees C in a patient with RP is specific for underlying connective tissue disease.

Adolescent↗
PubMed1998

Increased incidence of serendipitously discovered renal cell carcinoma.

OBJECTIVES: To determine the proportion of renal cell carcinomas that are discovered serendipitously, and to compare the tumor stages of symptomatic versus incidental tumors. METHODS: We reviewed the charts of 131 consecutive patients who had a nephrectomy for renal cell carcinoma between 1989 and 1993. We excluded from the numerator any patients with abdominal pain or mass related to the tumor, even if the diagnosis of renal cell carcinoma had not been entertained before imaging studies. RESULTS: Eighty (61%) of 131 patients were diagnosed with renal cell tumors in the absence of flank pain, flank mass, or hematuria. Of these 131 patients, 31 (24%) presented with gross hematuria, 13 (10%) with flank pain, and 10 (8%) with flank or abdominal mass. Only 1 patient presented with the classic triad of flank pain, flank mass, and gross hematuria. Eighty-five percent of asymptomatic tumors were Stage I or II, and 77% of symptomatic tumors were Stage I or II. CONCLUSIONS: The great majority of renal cell tumors are found incidentally. The tumor stage is the same in the incidentally discovered cases as it is in the symptomatic cases.

Carcinoma, Renal Cell↗
PubMed1994

Abnormal thermoregulatory responses in patients with reflex sympathetic dystrophy syndrome.

OBJECTIVE: To look for asymptomatic thermoregulatory abnormalities in the noninvolved limbs in patients with well established reflex sympathetic dystrophy syndrome (RSDS). The study was prompted by the observation of development of severe upper limb Raynaud's phenomenon in a young woman with a history of RSDS affecting both lower limbs. METHODS: Eleven patients and 11 age and sex matched control subjects underwent a standard thermal stress test: cold water immersion of a hand unaffected by RSDS in water at 15 degrees C for one min. All controls had had injuries uncomplicated by RSDS. RESULTS: Lag time (the lag phase between the end of the cold challenge and the onset of rewarming) was significantly increased (p < 0.01) in the patient group (median 5.67 min, range 0.50 to > 15) compared to the control group (median 0.50 min, range 0.50 to 12.92). The median maximum temperature recovery was lower in the patient group (81.6%, range 0 to 170.4) than in the control group (119.3%, range 49.1 to 153.1). CONCLUSION: Our findings support an association between RSDS and a generalized abnormal response to cold challenge. Further studies are required to examine the temporal relationship underlying this. Early screening for thermoregulatory dysfunction of patients after fractures might allow identification of patients at risk of developing RSDS.

Adolescent↗
PubMed1987

Autoantibodies and immunogenetics in 30 patients with systemic sclerosis and their families.

Clinical and serological evidence of connective tissue disease was found in a high proportion of 132 family members of 30 patients with systemic sclerosis. In 20 probands with the milder CREST form of the disease, 10 had HLA-DR5 and 12 had null alleles at the C4 loci. None of 11 probands with more severe systemic sclerosis had HLA-DR5; all 11 had null alleles at the C4 loci. All but two of the probands had either HLA-DR5 or a C4 null allele, and this was also the case for the majority of the relatives with autoantibodies. Genetic markers of the major histocompatibility complex, including HLA-DR5 and C4 null alleles, appear to be closely associated with markers of disease in these probands and their families.

Antibodies, Antinuclear↗
PubMed1981

Thermography in the assessment of peripheral joint inflammation--a re-evaluation.

The reproducibility and sensitivity of quantitative infra-red thermography as a measure of peripheral joint inflammation was reassessed. Experiments were carried out in a temperature-controlled room at 20 degrees C. Initial stabilization experiments showed that in normal, medium sized, joints, there was an initial rapid cooling phase followed by a slower cooling phase which lasted longer than two hours. In the knees the differences between normal and active rheumatoid joints increased the longer patients remained in the room but for practical reasons a 30-minute stabilization period was subsequently chosen. In views of hands and fingers, rebound increases in skin temperature after entering the room, together with lesser differences between inflamed and non-inflamed joints, were found. The results suggested that the thermographic technique examined was adequate for detecting inflammatory changes in knee, ankles and elbows but unsatisfactory for quantification of inflammation in the small joints of the hands.

Adult↗
PubMedDate not supplied

The relationship between pain and depression in a trial using paroxetine in sufferers of chronic low back pain.

Previous studies have shown a positive association between pain and depression, though evidence supporting a direct link between these two variables is less robust. Using a placebo-controlled trial, the authors examined the analgesic and antidepressant efficacy of paroxetine (20 mg) in chronic low back pain sufferers. The authors examined the associations among pain, depression, disability, and illness attitudes. Paroxetine showed no effects on pain or depression compared with placebo; however, subjects randomized to paroxetine were more likely to reduce concomitant analgesic medication. The cross-sectional association of depression and pain at baseline (r = 0.2, P = 0.02) was weaker than the association between depression and disability (r = 0.3, P = 0.004). Similarly, the association of change in depression scores with change in pain (r = 0.25, P = 0.016) was weaker than change between depression and disability (r = 0.49, P<0.0005). Whereas the relationship between pain and depression became nonsignificant when disability and illness attitudes were controlled, the relationship between depression and disability remained highly significant when pain and illness attitudes were controlled. These data are consistent with the association between pain and depression being wholly modulated by disability and illness attitudes, with no direct relationship between pain and depression.

Adolescent↗
PubMedDate not supplied

A randomised, double-blind study of cicaprost, an oral prostacyclin analogue, in the treatment of Raynaud's phenomenon secondary to systemic sclerosis.

Cicaprost is a new synthetic prostacylin analogue which is metabolically stable and bioavailable after oral administration; in previous studies it has been shown to have vasodilator antiplatelet effects. In this pilot study, we investigated the clinical efficacy of and patient tolerance to two dosage levels of cicaprost (2.5 micrograms tds and 5 micrograms tds) in the treatment of Raynaud's phenomenon secondary to systemic sclerosis (SSc). This was a three centre, double-blind, placebo controlled study of 49 patients carried out over four winter months. For a period of 10 days, 16 patients were given a placebo, 16 received cicaprost 2.5 micrograms tds and 17 received cicaprost 5 micrograms tds. Response was assessed based on the total number and duration of Raynaud's attacks, the average severity of the attacks, the number of painful attacks as a proportion of all attacks, a digital ulcer count, and the patients' opinion of the treatment. Although the clinical and laboratory parameters of digital vasospasm did not show statistically significant improvement in those who received cicaprost compared with those on the placebo, the severity of attacks lessened in the patients who received cicaprost 5 micrograms tds, and a statistically significant difference was seen in the average severity at week 2 post-treatment (p = 0.02). The apparent lack of overall significance was probably related to the short treatment period and relatively low doses of cicaprost used in this exploratory study. Longer studies with dose titration are probably needed to demonstrate the beneficial effects, if any, of cicaprost in patients with Raynaud's secondary to SSc, and these are being planned.

Administration, Oral↗