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Biomedical subjects

R M Michaels

Publications and source records attributed to R M Michaels.

17 recordsLinked to original sources
PubMed1996

Serum phospholipase A2 activity in patients with rheumatoid arthritis before and after treatment with methotrexate, auranofin, or combination of the two.

OBJECTIVE: (1) To confirm a previous observation that serum phospholipase A2 (PLA2) activity correlates with disease activity in rheumatoid arthritis (RA); and (2) to determine whether serum PLA2 activity changes after treatment with methotrexate (MTX), auranofin (AF), or a combination of the 2 (COMBO). METHODS: Sera obtained at baseline and after treatment from 100 patients with RA (40 MTX, 32 AF, and 28 COMBO) who participated in a multicenter, double blind trial were tested for PLA2 activity using an assay that measures the release of radiolabeled 14C oleic acid from the cell membrane of Escherichia coli. Detailed statistical analysis was performed using previously collected clinical data to determine whether correlations exist between RA disease activity and serum PLA2 activity; whether baseline serum PLA2 activity predicted a therapeutic response in any treatment group; and whether there was a significant change in serum PLA2 activity after treatment in patients who responded to the various drugs. RESULTS: Baseline serum PLA2 activity was significantly increased in patients with RA compared to healthy controls. No correlation between serum PLA2 activity and RA disease activity was noted at baseline. Mean serum PLA2 activity did not change significantly after treatment with MTX, AF, or COMBO in either treatment responders or nonresponders. CONCLUSION: Serum PLA2 activity is increased in patients with RA compared to healthy controls, but does not correlate with disease activity in patients, nor does it predict a response to treatment with MTX, AF, or COMBO. Serum PLA2 activity also did not change significantly after treatment with any of the above agents.

Adult↗
PubMed1996

Physician burnout.

As managed care has disseminated throughout our health system, physicians have increasingly assumed the status of employees. The pressures associated with this cultural change, and the changes in medical practice style and pattern required by managed care employers, could result in a significant increase in the number of physicians experiencing burnout. This in turn could lead to a decrease in the quality and efficiency of the health care delivered by such organizations. In view of this, physician employers should become more aware of the problem and take appropriate preventive measures.

Burnout, Professional↗
PubMed1988

A controlled trial comparing sulfasalazine, gold sodium thiomalate, and placebo in rheumatoid arthritis.

One hundred eight-six patients with active rheumatoid arthritis were evaluated in a double-blind, randomized study that compared treatment with sulfasalazine (SSZ) (2 mg/day), gold sodium thiomalate (GST) (50 mg/week), and placebo (PBO). The 37-week course of therapy was completed by 109 patients. While marked improvement was seen in all 3 treatment groups, the only statistically significant differences between SSZ or GST and PBO were in a decreased erythrocyte sedimentation rate and increased grip strength in the right hand. GST is known to be superior to PBO, and the response of the GST-treated group was similar to that seen in other trials. The response of the PBO group, however, was much greater than in other placebo groups we have studied. SSZ was similar in efficacy to injectable gold, but was better tolerated. Because of adverse drug reactions (most commonly, rash, stomatitis, and proteinuria), 41% of patients were withdrawn from the GST treatment. Untoward drug effects (most frequently, rash and gastrointestinal distress) caused 16% of patients to be withdrawn from SSZ therapy.

Adolescent↗
PubMed1987

Multiple mesenteric aneurysms complicating subacute bacterial endocarditis.

Multiple visceral aneurysms complicating periarteritis nodosa are considered characteristic, though not pathognomonic, on arteriography. This arteriographic pattern has been described with hairy-cell leukemia, collagen vascular disorders, and atrial myxoma, but, to our knowledge, has not been previously reported with subacute bacterial endocarditis. A patient with enterococcal endocarditis sustained separate intra-abdominal hemorrhages, 24 hours apart, from aneurysms of the middle colic and left colic arteries. Sterile vessel cultures with inflammatory infiltrates, decreased complement levels, positive rheumatoid factor, and arteriographic evidence of multiple visceral aneurysms suggest the vasculitis was immunologically mediated and not mycotic. Antibiotic therapy after control of hemorrhage controlled abdominal symptoms.

Aged↗
PubMedDate not supplied

Eosinophilic fasciitis complicated by Hodgkin's disease.

Several cases of eosinophilic fasciitis (EF) later complicated by serious hematological disorders such as immune thrombocytopenia and aplastic anemia have been reported. Further study of these cases has led some investigators to postulate that EF may be the result of an "aberrant lymphoplasmacytic proliferation". A case of EF complicated by the later occurrence of Hodgkin's disease is reported here. This case adds further evidence to support the above hypothesis.

Eosinophilia↗
PubMedDate not supplied

Phospholipase A2 activity in peripheral blood cells of rheumatoid arthritis patients treated with methotrexate: a preliminary study.

OBJECTIVE: To measure the activity of phospholipase A2 (PLA2) in peripheral blood mononuclear cells (PBMC), polymorphonuclear leukocytes (PMN) and platelets in patients with rheumatoid arthritis (RA) before and during treatment with methotrexate (MTX). METHODS: Nine patients with RA treated with MTX were studied for six months. PBMC, PMN, and platelets were isolated at baseline and at monthly intervals thereafter. PLA2 activity was measured in lysates of the various cell fractions by the hydrolysis of radiolabeled lysocholine from phosphatidylcholine, L-Dipalmitoyl using thin layer chromatography. Data were calculated as pmol of 14C choline released per hour per milligram of cellular protein. RESULTS: At baseline, compared to normal controls, PLA2 activity was significantly increased in platelets (p = 0.02) but not in PBMC (p = 0.32) nor in PMN (p = 0.23). Seven of the nine patients responded clinically to treatment with MTX. In these 7 patients over the six-month treatment course, there was a significant decrease in PLA2 activity in the platelets which correlated with improvement in disease activity (R = 0.82, p = 0.03). PLA2 activity also decreased in PBMC and PMN, but the correlation with disease improvement was not statistically significant (R = 0.71, p = 0.07 for PBMC; and R = 0.43, p = 0.33 for PMN). CONCLUSION: PLA2 activity in platelets but not in PBMC or PMN is significantly increased in patients with RA compared to normal controls. Although PLA2 activity decreased in all the cells during treatment with MTX, only PLA2 activity in platelets correlated significantly with improvement in disease activity.

Adult↗