PubMed · 4163510
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B Creamer, I J Pink. 1967-02-11. Paneth-cell deficiency.. https://doi.org/10.1016/s0140-6736(67)91239-1
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OBJECTIVE: To determine the frequency and clinical characteristics of diffuse distal extremity swelling with pitting edema occurring in polymyalgia rheumatica (PMR). METHODS: Clinical features and laboratory findings were recorded for all 245 residents of Olmsted County, Minnesota who developed PMR over a 22-year period (1970-1991). Those who exhibited > or = 1 episode of diffuse distal extremity edema with pitting were selected for this study, and were evaluated further. RESULTS: Thirteen women and 6 men in this incidence cohort of PMR had > or = 1 episode of distal extremity swelling with pitting edema. Giant cell arteritis was also identified in 5 patients. In 11 patients, the swelling and edema development concurrently with proximal PMR symptoms. In 2 patients, the distal swelling was the initial manifestation, and in 6 patients, the distal symptoms developed during relapses or recurrences of PMR. Both upper and lower extremities were affected, usually in a symmetric manner. Other peripheral manifestations were also common. The distal swelling and pitting edema responded promptly to corticosteroids, and slowly or incompletely to nonsteroidal anti-inflammatory drugs; a similar response was observed in the proximal symptoms. The distal swelling appeared to represent tenosynovitis and synovitis of regional structures. CONCLUSION: Distal extremity swelling with pitting edema represents a manifestation of PMR that has not been well described in previous studies. Awareness of this finding will help facilitate the proper diagnosis and institution of appropriate therapy for this disease.
OBJECTIVE: To determine if the immunotherapy with corticosteroids would improve pregnancy rate in infertile patients with ovulatory factor and patients with unexplained infertility who undergo superovulation with IUI. DESIGN: Prospective, controlled study. SETTING: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Ulsan, Seoul, Korea. PATIENTS: Nine-one infertile patients with ovulatory factors and 78 patients with unexplained infertility who underwent superovulation with IUI. RESULTS: The prevalence of autoantibodies (antinuclear antibody, lupus anticoagulant, anticardiolipin antibody, antidouble-stranded DNA antibody) was elevated significantly in patients with unexplained infertility compared with patients with ovulatory infertility (20.5% versus 3.3%). Forty-five patients with ovulatory factor underwent 72 cycles of superovulation with IUI, receiving corticosteroids. Thirty-eight patients with unexplained infertility underwent 75 cycles of superovulation with IUI, receiving corticosteroids. Forty-six patients with ovulatory factor who underwent 66 cycles of superovulation with IUI and 40 patients with unexplained infertility who underwent 75 cycles of superovulation with IUI served as controls, not receiving corticosteroids. In patients with ovulatory factor, there were no significant differences between the corticosteroid treatment group and control group in clinical pregnancy rate (38.9% versus 33.3%) or in spontaneous abortion rate (14.3% versus 13.6%). In patients with unexplained infertility, there was a significantly higher clinical pregnancy rate per cycle in the corticosteroid treatment group, with 45.3% (34/75) compared with 29.3% (22/75) in the control group but no difference between the corticosteroid treatment and control groups in spontaneous abortion rate (17.6% versus 13.6%). There were no side effects due to the use of corticosteroids.