Biomedical subjects
Publications and source records attributed to S Carette.
A 22-year-old woman with progressive systemic sclerosis developed severe myositis and life threatening myocarditis. Her myocarditis responded to intravenous pulse methylprednisolone therapy. We stress the usefulness of echocardiography in establishing the diagnosis and following the course of myocarditis.
The sudden development of diffuse pulmonary infiltration in a patient with SLE presents difficult diagnostic and therapeutic problems to the clinician. In the past ten years, we have seen eight patients with this problem. Neither roentgenograms nor clinical findings were specific. In six patients, pulmonary hemorrhage was found, but in only two of them did it exist alone. In the other four, heart failure, uremia, and coagulopathy complicated the findings. In one patient, P carinii was the cause; in one congestive heart failure, which was not obvious clinically or radiologically, was the cause. Three patients died: one of uncomplicated pulmonary hemorrhage, one with pulmonary hemorrhage occurring during the treatment of pneumonia due to L bozemanii, and one with pulmonary hemorrhage and multiple complications including sepsis due to Candida. On the basis of this experience, we have recommended a plan of action for physicians facing this problem.
One hundred fifty war veterans with ankylosing spondylitis were entered into a prospective study in 1947. In 1957, 142 were traced, and they have been reviewed periodically. Eighty-one of these patients were still alive in 1980. Information was obtained from 67 (83%) of the survivors and 51 were reexamined. This report is based on the clinical findings in these 51 patients, who have a mean disease duration of 38 years. Forty-seven (92%) were functioning well. The disease in 21 (41%) had progressed to cause severe spinal restriction. Of those, 12 had peripheral joint involvement early in their course and 9 had iritis. Seventy-four percent of the patients who had mild spinal restriction after 10 years did not progress to having more severe restriction. Eighty-one percent of the patients who had severe spinal restriction in 1980 were severely restricted within the first 10 years. Hips that were normal after 10 years of disease did not become diseased subsequently. This study suggests that a predictable pattern of ankylosing spondylitis emerges within the first 10 years of the disease.
A 26-year-old white woman developed systemic lupus erythematosus (SLE) and extensive soft tissue calcification. Striking features of this patient related to severe complication of corticosteroids, including proximal muscle weakness and multiple areas of avascular necrosis. In addition to localized areas of erythematosus induration, the patient demonstrated yellowish papules on her legs. Biopsies of the former showed thickening of the dermis with extensive collagen deposition and focal deposits of calcium. The latter revealed eosinophilic degeneration of the subcutaneous fat.
From 1969 to 1975, 53 patients with lupus nephritis took part in randomized trials comparing prednisone, oral azathioprine plus low-dose prednisone, and oral cyclophosphamide plus low-dose prednisone. After a mean follow-up of 85 months, cyclophosphamide appears marginally superior to prednisone for maintaining renal function (p = 0.03) and preventing end-stage renal failure (p = 0.07). Chronic change shown by renal biopsy assessed by a chronicity index was found useful in predicting renal function outcomes and response to immunosuppressive therapy. Three of 21 patients with a low chronicity index and 9 of 10 patients with a high chronicity index doubled their serum creatinine (p less than 0.00003). The probability of renal functional deterioration was not different among the treatments studied. However, in 14 patients with an intermediate chronicity index, 1 of 11 patients treated with azathioprine or cyclophosphamide doubled the serum creatinine level whereas all 3 patients treated with prednisone have progressed to end-stage renal failure (p = 0.005). The study suggests that single-drug oral immunosuppressive treatment combined with prednisone is most beneficial in lupus patients with intermediate chronic change shown by renal biopsy.
Behçet's disease is reported in a newborn infant of a mother with the disease. The mother had recurrent orogenital ulcers, pustulonecrotic skin lesions, arthritis, thrombophlebitis, and colonic ulcers. Shortly after birth the infant presented with transient orogenital ulcerations and pustular cutaneous lesions. On healing, depressed scars developed which were very similar to those of the mother. The finding of circulating immune complexes in the mother's serum gives some support to the hypothesis that the infant's transient illness was caused by transplacental passage of maternal antibodies.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Twelve patients with active central nervous system systemic lupus erythematosus (CNS SLE) and 11 patients without CNS involvement, all taking corticosteroids, were studied by computerized tomography (CT). Thirty CT scans on 23 individuals were performed and read blindly and independently by 2 neuroradiologists with an 86% correlation. Minimal to moderate atrophy was the most frequent finding, both in CNS SLE and controls, severe atrophy seen in 1 patient only, and no atrophy in 3 patients and a single control. Of the 6 patients who had repeated scans, 4 showed no change in the degree of atrophy, 1 had more and 1 less atrophy. Three patients had evidence of multiple brain infarcts on scan with or without associated cerebral atrophy. Sequential scans in 1 of these patients showed total resolution of the infarcts after 30 months. Thus, there was no correlation between the presence of cerebral atrophy on CT scan and CNS SLE. Rather our findings suggest that steroids may be the cause of atrophy.