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Biomedical subjects

R Sobel

Publications and source records attributed to R Sobel.

At least 19 recordsLinked to original sources
PubMed2005

Thyroid ophthalmopathy.

Thyroid associated ophthalmopathy (TAO) is an inflammatory orbital disease of autoimmune origin with the potential to cause severe functional and psychosocial effects. It presents one of the most difficult challenges in the clinical practice of ophthalmology. Pathogenesis of the disease is not yet fully understood. It is usually associated with thyroid dysfunction. TAO has a variable clinical presentation; it may cause severe damage to vision and orbital architecture. TAO is the most frequent cause of unilateral or bilateral proptosis in adults. Potential sight-threatening complications include optic neuropathy and severe corneal exposure keratopathy. Most patients do not require specific therapy. Those with moderately severe or severe disease are treated with steroids and/or orbital radiation during the inflammatory phase and surgical therapy during the inactive phase. Decompression may be needed in either phase. Although appropriate treatment can restore near normal function and appearance in most cases, the management of TAO is difficult, controversial, and far from optimal. Disease severity is the key determinant of the indication for therapy, while therapeutic choice depends on inflammatory activity. Clinical management is difficult because no immediate or dramatic cure exists. With appropriate medical and surgical treatment, patients can be restored to normal function and appearance in most cases, but the process to reach this goal will usually be lengthy.

Diagnosis, Differential↗
PubMed2001

Prevalence and relation to risk factors of carotid atherosclerosis and left ventricular hypertrophy in systemic lupus erythematosus and antiphospholipid antibody syndrome.

The prevalence of preclinical cardiovascular disease was determined in women with systemic lupus erythematosus (SLE) and control subjects matched for traditional risk factors. Compared with control subjects, patients with SLE had a higher prevalence of carotid atherosclerosis (41% vs 9%, p < 0.005) and left ventricular hypertrophy (32% vs 5%, p < 0.005), supporting the possibility that chronic inflammation predisposes to premature cardiovascular disease in SLE.

Adult↗
PubMed2000

Primary antiphospholipid syndrome: functional outcome after 10 years.

OBJECTIVE: To analyze the 10 year functional outcome of primary antiphospholipid syndrome (APS). METHODS: We identified 39 patients with primary APS (35 female, 4 male) who developed a first thrombotic or pregnancy event before 1990. Patients meeting American College of Rheumatology criteria for systemic lupus erythematosus or other connective tissue disorders (secondary APS) were excluded. Medical records were reviewed for detailed histories and functional outcomes. RESULTS: At 10 years' followup, 15 patients (38.4%) had organ damage in the form of hemiparesis (n = 8), dementia (n = 3), quadriplegia (n = 1), dilated cardiomyopathy-myocardial infarction (n = 1), vascular insufficiency-massive pulmonary infarction (n = 1), and endstage renal disease (n = 1). Eight patients (20.5%) with organ damage were unable to perform everyday activities important to their quality of life (functionally impaired). Causes of functional impairment were cognitive dysfunction (n = 3), cardiovascular disease (New York Heart Association Functional Classification Class IV) (n = 2), aphasia (n = 1), expressive aphasia (n = 1), and locked-in syndrome (n = 1). CONCLUSION: Functional prognosis is poor in an important minority of primary APS patients with > 10 years of disease. One-third of primary APS patients had organ damage and one-fifth were functionally impaired.

Antiphospholipid Syndrome↗
PubMed1997

Anticardiolipin IgG subclasses: association of IgG2 with arterial and/or venous thrombosis.

OBJECTIVE: To determine whether the presence of anticardiolipin antibodies (aCL) of a specific IgG subclass is associated with clinical complications of the antiphospholipid antibody syndrome (APS) and whether polymorphisms of Fc receptors for IgG (FcgammaR) with differential binding preferences contribute to an increased risk of thrombotic complications. METHODS: In 60 patients with IgG aCL, we assessed clinical complications of the APS, measured the level of antibody activity, and determined the IgG subclass distribution of aCL by a modified enzyme-linked immunosorbent assay (ELISA) with murine anti-human IgG subclass monoclonal antibodies. Selective IgG subclass adsorption studies were performed to determine the relative contribution of specific IgG subclasses to overall aCL activity. Fcgamma receptor IIA (FcgammaRIIA) genotypes of aCL patients with thrombosis and of non-systemic lupus erythematosus controls were determined by polymerase chain reaction amplification of genomic DNA and allele-specific probes. RESULTS: IgG2 aCL, detected in 75% of the patients, was the major subclass of aCL. Selective adsorption studies demonstrated that IgG2, in contrast to IgG1, was the predominant subclass responsible for aCL reactivity. IgG2 aCL was the only subclass associated with clinical complications, specifically, arterial and/or venous thrombosis (P < 0.04). The presence of FcgammaRIIA-H131, a receptor expressed on platelets, monocytes, and endothelial cells and the only human FcgammaR which efficiently recognizes IgG2, was associated with thrombosis in aCL patients. Among 45 high-titer (>40 GPL [IgG phospholipid] units) aCL patients with thrombosis, 40% were homozygous for FcgammaRIIA-H131, compared with 25% of disease-free controls (P = 0.042). CONCLUSION: While all 4 IgG subclasses are found in autoimmune aCL, only the presence of IgG2 is significantly associated with thrombotic complications. Reactivity in aCL ELISA is largely due to the presence of IgG2 in high-titer patients. The presence of IgG2 aCL, particularly in association with FcgammaRIIA-H131, may be a useful clinical predictor of increased thrombotic risk in patients with autoimmune IgG aCL. Allelic variants of FcgammaRIIA with distinct capacities to interact with IgG subclasses provide a mechanism for genetic susceptibility to an autoantibody-induced prothrombotic state.

Alleles↗
PubMed1997

Psychological predictors of glycemic change with relaxation training in non-insulin-dependent diabetes mellitus.

BACKGROUND: Previous findings are unclear regarding the possible glycemic benefits of applying behavioral relaxation training in non-insulin-dependent diabetes mellitus (NIDDM). METHODS: Subjects with NIDDM were randomized to relaxation training (6 sessions of progressive muscle relaxation and imagery, n = 12) or control treatment (routine medical care, n = 10). Physiological measures were total glycosylated hemoglobin (GHb) and area under the 2-hour oral-glucose-tolerance curve (AUC). Psychological measures of generalized distress, anxiety and daily stress were also administered. All subjects were assessed before and after the 8-week intervention, and again at 16 weeks of long-term follow-up. RESULTS: There were no postintervention group differences in physiological variables. Highly distressed subjects and those who rated their glucose as more stress responsive tended to practice relaxation less between sessions. Within the treated group only, lower preintervention stress responsivity was associated with greater improvement in GHb, and lower anxiety and distress levels predicted long-term improvement in AUC. CONCLUSIONS: It remains unclear whether relaxation training produces glycemic benefits in NIDDM. Perhaps the least anxious and stress-responsive patients only benefit from group-based relaxation training, whereas anxious individuals require intensive individually administered interventions.

Adult↗
PubMed1996

The Virgil role.

The referral of a patient for subspecialty consultation and examination is but one facet of the primary care physician's involvement with his patient. Using examples from my practice, I argue that the term "gatekeeper" is an inadequate term for describing what the primary care physician does, or should do, for his patient. "Virgil Role" is offered as an alternative expression based on a proposed parallel between Dante's passage through the Inferno accompanied by his mentor-guide, Virgil, and a sick person's journey through his personal Hell of illness and the labyrinthine medical care system, guided by his physician.

Delivery of Health Care↗