Biomedical subjects
Publications and source records attributed to R K Chow.
Critical to the proper management of pyoderma gangrenosum are correct diagnosis, identification and treatment of any underlying disorder, and the proper choice of topical and systemic therapy. Many agents are available for the treatment of pyoderma gangrenosum. We review the current therapeutic options, their efficacy and side effects, and we offer some guidelines for their proper selection.
A case of graft-vs.-host disease (GVHD) arising solely within an area affected by piebaldism is described. The patient, a 35-year-old woman with a single hypopigmented patch on the right leg present since birth, had received an allogeneic bone marrow transplant (BMT) from an HLA-identical sibling donor, for treatment of a myelodysplastic syndrome (MDS). Beginning on day +38 post-BMT, the patch developed changes which were histologically consistent with GVHD. Syngeneic mixed epidermal cell-lymphocyte reaction (MECLR) testing of tissue from the patch, and from adjacent normal skin, showed differences which suggest that piebaldism-affected skin is immunologically different from normal skin. These findings may offer new insight into the pathophysiology of this disorder.
BACKGROUND: We review the literature and report a case of refractory erythema elevatum diutinum associated with IgA paraproteinemia that was successfully controlled with intermittent plasma exchange (PLEX). OBSERVATIONS: Typical lesions of erythema elevatum diutinum developed in a 72-year-old patient with IgA paraproteinemia; the condition predictably flared whenever IgA levels reached a threshold of 8 g/L. After 8 years of unsuccessful treatment with various agents, we instituted a trial of PLEX during an acute flare. Following 6 exchanges over a period of 2 weeks, the IgA level decreased from 8 to 2 g/L and the skin lesions cleared. Three weeks later, new skin lesions developed and the IgA level had rebounded from 2 to just over 8 g/L. A second course of PLEX was administered, with excellent results, and a 3-month course of oral chlorambucil (2 mg/d) was initiated. The patient's condition remained in clinical remission for 10 months. Over the ensuing 9 years, she suffered 11 further flares, each of which was associated with IgA levels of 8 to 10 g/L and each responding dramatically to 3 to 5 PLEXs followed by a consolidative dose of intravenous cyclophosphamide (250-500 mg). CONCLUSION: We believe that PLEX may have an important role in the management of severe erythema elevatum diutinum associated with monoclonal paraproteinemia refractory to other therapy.
This study illustrates a cognitive recall method based on time lines and retrieval cues to reconstruct the patterns of use of selected dairy products as important calcium sources. We administered a semiquantitative retrospective instrument that assessed past intakes of milk, milk-based chocolate beverages, and cheese to 35 healthy women aged 50 to 65 years. The recall time line for each subject began at the age of 20 and continued forward to the interview. Thirty-one women reported a change in calcium intake from the baseline level at age 20. Seventeen had changed their intake by more than 50%. Milk was the food item the most subject to change. The magnitude of change along the time line was quite important as intraindividual intakes differed by 100 to 300 mg of calcium per day in 11 women and differed by more than 300 mg of calcium per day in 12 others. After age 50 there was an upward trend in calcium use, which coincides with higher calcium requirements after menopause. Health concerns and food preferences were the prominent motives that triggered changes. The findings suggest that the cognitive recall method could provide necessary information on lifelong food patterns implicated in chronic disease development.
Kyphosis is commonly associated with ageing and osteoporosis of the spine. This study was conducted to evaluate whether physical fitness and bone mass in post menopausal women, between the ages of 50-60 years, may influence the degree of kyphosis. The level of physical fitness was determined by 1) calculating maximum oxygen uptake, (VO2 max), attained by a graded exercise treadmill test, and 2) evaluating the muscle strength in performing one repetition maximum on the bench press. In vivo neutron activation analysis was used to measure the bone mineral content in the axial skeleton and proximal femurs. It is expressed as Calcium Bone Index (CaBI). The normal range was 1.00 +/- 0.12 (I.S.D.). The degree of kyphosis was measured indirectly by calculation of an index of kyphosis, (I/K), using a surveyor's flexicurve. Individuals with I/K greater than 13 showed a clinically apparent kyphosis. Fit individuals (VO2 max greater than 29 ml/kg/min) had a significantly lower I/K (p less than 0.001) than average persons. Individuals with normal bone mass (CaBI greater than 0.8) also had a significantly lower I/K (p less than 0.05) than those with bone loss. Similarly, subjects who were fit, and had normal bone mass, had a significantly lower I/K (p less than 0.001) than those who were less fit and had bone loss. There was a significant correlation between I/K and VO2 max (p less than 0.02, df 45), I/K and CaBI (p less than 0.05, df 45) and I/K and bench press (p less than 0.05, df 45).(ABSTRACT TRUNCATED AT 250 WORDS)
The study was conducted in order to determine the effect of exercise on osteoporotic patients with a mean age of 65 years. The majority of these patients had been on sodium fluoride for at least 2 years. Thirty-eight patients were assigned to either the hospital or home group. Nineteen were in the former group, which performed the 1 hour exercise twice weekly in the Hospital. The patients in the latter group were taught the exercises and were expected to continue them at home. The exercise protocol consisted of muscle-strengthening and aerobic activities. Bone mineral mass was determined by neutron activation analysis, which measured total calcium in the trunk and pelvis. It is expressed as a calcium bone index (CaBI), with a normal range of 0.75 to 1.2. The level of physical performance was determined by calculating the maximum oxygen uptake, VO2max, attained by a graded exercise test on the treadmill. Calcium bone index and VO2max were obtained before and after the 12.5 month study. Prior to the study, the hospital and home groups had low calcium bone index values (0.68 and 0.66 respectively). Both groups showed a significant increase in calcium bone index (p less than 0.001 for the hospital group, p less than 0.01 for the home group) after the study. When compared to the home group the hospital group was found to have a significantly higher post-study calcium bone index value (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
This study was conducted to determine if bone mineral mass is influenced by the level of physical fitness in active, healthy, postmenopausal women from 50 through 59 years of age. In vivo neutron activation analysis (NAA) was used to measure calcium or bone mineral in the trunk and proximal femurs. The NAA measurement is expressed as calcium bone index (CaBI), which relates the subject's Ca value to the estimated mean value for normal subjects of the same size based on height and arm span. The normal CaBI is 1.00 +/- 0.12 (ISD). The level of physical fitness was determined by calculating the maximum oxygen uptake (VO2max), attained by a graded exercise test on the treadmill, and evaluating the muscle strength in performing one repetition maximum in the bench press and leg press. The "above-average fit" group (VO2max greater than 29 ml/kg/min) when compared to the "average fit" group (VO2max 21-29 ml/kg/min) had significantly higher CaBI (p less than 0.001) and leg press (p less than 0.01). There was significant correlation between VO2max and CaBI (p less than 0.01). The findings suggest that level of physical activity may modify the amount of bone loss in postmenopausal women.
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