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Biomedical subjects

R L Kaufman

Publications and source records attributed to R L Kaufman.

At least 19 recordsLinked to original sources

Factors related to failure of structural bone grafts in acetabular reconstruction of total hip arthroplasty.

Structural bone grafts in acetabular reconstruction of total hip arthroplasty have come into more common usage with the increasing number of revision arthroplasties. The authors present the outcome of 40 bone grafts with follow-up periods of 2-8 years. Primary and revision arthroplasties with both cemented and noncemented fixation are included. Factors that had a statistically significant relationship to failure of the bone graft included fit and fixation of bone graft to host, fit and fixation of prosthesis to host, union of bone graft to host, and the presence or absence of the confluence of the anterior and posterior columns of the acetabulum. Other findings of interest were a higher failure rate of multiple grafts as compared to a single graft and freeze-dried femoral heads. Migration of the socket of more than 3 mm is statistically related to failure of the socket.

Acetabulum

Cardiac compression in rheumatoid pericarditis.

Rheumatoid pericarditis occurs in approximately one third of rheumatoid arthritis (RA) patients. However, clinically apparent rheumatoid pericarditis is infrequent. The authors found clinical pericarditis in 12 of 960 patients admitted for RA, 5 of whom had manifestations of cardiac compression. These 5 had longer duration of RA, worse functional class, and more extraarticular features than the patients without cardiac compression. Presenting features of cardiac compression included dyspnea, edema, chest pain, and pulsus paradoxus. Treatment of patients with cardiac compression due to rheumatoid pericarditis may include a trial of systemically administered corticosteroids, but this should not delay surgical intervention for impending tamponade. Pericardiocentesis should only be performed as an emergency, life-saving procedure. It may be followed by intrapericardiac injection of corticosteroids, but this does not prevent recurrence. Longer-lasting benefit is obtained by surgical decompression. Two-year mortality in patients with cardiac compression was 100%. The literature on the subject is reviewed.

Adrenal Cortex Hormones

Candida septic arthritis in rheumatoid arthritis.

We describe a patient with a 10-year history of rheumatoid arthritis who developed septic arthritis of the knee secondary to Candida albicans. Joint sterilization was obtained by debridement and 865 mg. of IV amphotericin B. We review 23 other cases of candidal arthritis in adults with specific reference to disease recognition and treatment.

Aged

Search for nicotinic acetylcholine receptors on human leukocytes: absence of alpha-bungarotoxin binding in studies of healthy individuals and myasthenia gravis patients.

To investigate whether nicotinic acetylcholine receptors might be present on blood mononuclear cells we studied the binding [125I]alpha-bungarotoxin to mononuclear cells from three normal controls and seven myasthenia gravis patients. The medulloblastoma cell line, TE671, which expresses a functional nicotinic acetylcholine receptor having pharmacological properties similar to that of skeletal muscle receptor, was used as a positive control for alpha-bungarotoxin binding. None of the mononuclear cell samples studied exhibited specific binding of alpha-bungarotoxin.

Bungarotoxins

Pseudothrombophlebitis in neuropathic arthropathy.

The pseudothrombophlebitis syndrome is a complication of large, ruptured, or dissecting popliteal cysts. We report a patient with neuropathic arthropathy of the knee and the pseudothrombophlebitis syndrome secondary to a dissecting popliteal cyst. This represents another form of arthritis associated with this syndrome.

Arthrography

Acute myelocytic leukemia after the use of cyclophosphamide in the treatment of polyarteritis nodosa.

The use of cyclophosphamide has been associated with the delayed appearance of neoplasms. We report a woman who developed myelodysplastic syndrome leading to acute myelocytic leukemia, 4 years after receiving 13 g of cyclophosphamide over 6 months for severe polyarteritis nodosa. Cytogenetic abnormalities typical of damage induced by alkylating agents, including partial deletions of chromosomes 5 and 7, were present. This case represents the first reported occurrence of cyclophosphamide associated malignancy in polyarteritis nodosa.

Adult

Halo-body jacket immobilization in rheumatoid arthritis patients with cervical myelopathy.

The rehabilitation nurse may care for patients with arthritis in a variety of settings. When the patient has advanced RA, the problem of cervical myelopathy may require surgical intervention and use of the halo-body jacket immobilization orthosis. Expert pre- and postoperative management requires a knowledge of surgical nursing as well as rehabilitation nursing, in the traditional sense, to prevent complications and promote optimum recovery. When dealing with people who have lived with RA for many years, the rehabilitation nurse must continue to assess the patient's knowledge of the disease and use of self-management strategies and community resources.

Arthritis, Rheumatoid

Antibody production by blood lymphocytes in myasthenia gravis: reduction in disease of long duration.

We measured acetylcholine receptor antibody (AchR Ab) and IgG secreted in vitro by blood lymphocytes from myasthenia gravis patients and controls. Eleven of 20 patients secreted AchR Ab. Controls did not secrete AchR Ab. IgG secretion was lower in patients who were nonsecretors of AchR Ab (351 +/- 127 ng/ml/10 days) than in secretors (3,563 +/- 949) and both groups differed from controls (1,305 +/- 353). Absence of secretion of AchR Ab and low IgG secretion correlated with long disease duration. The data suggest that nonspecific suppression of B cell mediated immune function may occur in long-standing myasthenia gravis.

Antibody Formation

Comparison of detection of varicella-zoster virus by the Tzanck smear, direct immunofluorescence with a monoclonal antibody, and virus isolation.

A study comparing direct immunofluorescence assay using a new monoclonal antibody specific for a varicella-zoster virus glycoprotein complex, the Tzanck smear, and virus isolation for detection of varicella-zoster virus in 56 patients with clinically apparent herpes zoster is presented. Of 47 patients with clinical herpes zoster and with cultures negative for herpes simplex virus, 30 (64%) had positive Tzanck smears, direct immunofluorescence assay results were positive in 26 (55%), and cultures were positive in only 12 (26%). Both direct immunofluorescence assay and the Tzanck smear were found to be superior to culture technics; however, direct immunofluorescence assay was found to have greater specificity.

Antibodies, Monoclonal

Erosive and subluxing cervical spine disease in patients with psoriatic arthritis.

Cervical spine involvement with psoriatic arthritis has been reported to occur in about 35% of patients and to be primarily ankylosing in nature. This previously described pattern is characterized by syndesmophytes, ankylosis and ligamentous ossification. Our study defines the incidence and clinical characteristics of a rheumatoid-like form of inflammatory cervical spine involvement. This pattern is characterized by apophyseal and odontoid erosions, and axial and subaxial subluxations. Clinical histories were obtained from 28 patients with both psoriasis and inflammatory arthritis between the years of 1971 and 1984. Cervical spine involvement was found in 75% of the group, 13/21 had ankylosing and 8/21 inflammatory characteristics. Three of our patients developed cervical myelopathy, one in the ankylosing and 2 in the inflammatory subgroup.

Arthritis

Prosthetic synovitis: clinical and histologic characteristics.

Our study of 20 patients correlates the clinical picture of each patient with the pathology of synovial tissue obtained at the time of revision arthroplasty. While 12 patients had rheumatoid arthritis and 8 had osteoarthritis, the histopathology was identical. Additionally, while 15 of the 20 had an etiology for the revision, 5 patients were revised for pain alone with no explanation other than the synovitis. The characteristic histologic findings included lining cell hyperplasia, vascular congestion, giant cells, brightly birefringent high density polyethylene chards and cysts that represented ghosts of methyl methacrylate debris.

Arthritis, Rheumatoid

Reactivity of serum antibodies to the keratin layer of rat esophagus in patients with rheumatoid arthritis.

Serum antibodies reactive with the keratin layer of rat esophagus (AKA) were found in 46 of 80 (57.5%) rheumatoid arthritis (RA) patients. In contrast, AKA were present in only 7 of 82 (9.5%) patients with other types of rheumatic disorders and in 2 of 47 (4.2%) healthy subjects. AKA were not specific for RA, however, because in the former group, AKA were present in 4 of 20 (20%) systemic sclerosis patients and in 3 of 12 (25%) ankylosing spondylitis patients. AKA belong predominantly to the IgG class and are complement fixing. Although found in some RA joint fluids, AKA were not selectively concentrated in the joint fluid. Absorption of RA serum with type I human collagen or with human epidermal keratin did not remove AKA activity. The frequency of AKA in RA patients both negative and positive for DR4 was equal. There was no relationship between the frequency of AKA and the occurrence of other serum autoantibodies such as antibodies to intermediate filaments, smooth muscle, and nuclear antigens. Serum antibody reactive with human stratum corneum found in patients with psoriatic arthritis was shown to be different from AKA. Rabbit antiserum to human keratin did not inhibit the reaction of AKA against the keratin layer of rat esophagus. Autoimmunity to structural proteins including collagen, vimentin intermediate filaments, smooth muscle antigens, and keratin is a characteristic feature of RA.

Animals

IgG rheumatoid factors and anti-nuclear antibodies in rheumatoid vasculitis.

We studied the distribution and characteristics of circulating rheumatoid factors (RF) and anti-nuclear antibodies (ANA) in 30 rheumatoid arthritis (RA) patients who had polyarthritis alone (group I), 28 RA patients with polyarthritis and extra-articular disease (group II), 28 RA patients with systemic vasculitis (group III) and 60 healthy matched controls. IgG RF occurred more frequently and in higher serum titres in group III (100%) than RA patients in group I (40%), or in group II (18%) or in normal controls (5.8%). The serum titre of IgM RF was higher in vasculitis patients than in other RA patients. ANA were found in 74% of all RA patients and although the frequency did not differ in the three patient groups, the serum titre was significantly higher in the vasculitis group. Antibodies to extractable nuclear antigen were found only in group III (18.7%). Antibodies to histones were also more prevalent in group III than in the other RA groups. The serological abnormalities in rheumatoid vasculitis differed quantitatively as well as qualitatively from other RA patients.

Antibodies, Antinuclear