Aural symptoms and hearing loss in patients with lupus

OBJECTIVE: Systemic lupus erythematosus causes widespread tissue injury from deposition of immune complexes. The prevalence of aural symptoms in this disease was evaluated. METHODS: The presence of tinnitus, hearing loss, and fluctuating hearing was evaluated by a self-directed questionnaire in patients aged 65 or less from a lupus clinic. Patients reporting aural symptoms were compared with those reporting none, by use of demographics and disease duration. Comparison was also made with historic serologic data. Audiometry was offered to all patients with lupus reporting aural symptoms and was completed in 10. RESULTS: Twenty-six (31%) of 84 patients with lupus reported aural symptoms. Patients reported a combination of symptoms: unilateral hearing loss with or without tinnitus in 13 (15%) of 84 and bilateral hearing loss with or without tinnitus in 14 (17%) of 84. No statistical difference was measured between symptomatic and asymptomatic patients when compared by average age, duration of disease, history of noise exposure, head trauma, and infectious ear diseases. Statistically significant differences were detected only when comparing average creatinine and C3 levels. Of those patients tested by audiometry, 7 of 10 had abnormal pure-tone thresholds. Asymmetric findings were present in 6 of these 7 patients tested. CONCLUSION: Aural symptoms are prevalent among patients with lupus. Asymmetric symptoms and hearing loss are most common. The cause may relate to immune-complex disease and/or vasculitis. (Otolaryngol Head Neck Surg 1998;118:762-5.)     

The Left Subclavian Vein as an Alternative Site for Implantation of the Second Defibrillation Lead

The optimal placement for the second defibrillation lead in a twolead system has never been addressed. We retrospectively reviewed the data of 33 patients with an average age of 59.2 years (range 41–78 years), predominantly mala (n = 29), who underwent implantation of a cardioverter defibrillator (ICD) for treatment of ventricular tachycardia (n = 19) or ventricular fibrillation (n = 14). In all patients an attempt was made to implant an endovenous ICD device (leads only, no subcutaneous patch). In group I (n = 18) the defibrillation anode, a separate unipolar lead, was placed in the common position, the superior vena cava. In group II (n =15) the lead was placed in the left subclavian vein. At least two consecutive shocks reverting ventricular fibrillation at energies ±24J were required for implantation of the ICD device. All shocks were monophasic. The success rate of endovenous defibrillation was significantly higher in group II than in group I (67% vs 28%, P < 0.05). Thus, it could be demonstrated that the position of the defibrillation anode can influence the defibrillation efficacy in transvenous ICD systems. Prospective randomized trials are needed to investigate the optimal position for the second defibrillation electrode, which may gain increasing importance as soon as dual chamber ICDs become available.     

Antigenic diversity and size diversity of Plasmodium falciparum antigens in isolates from Gambian patients. I. S-antigens

Ring-stage asexual parasites of P. falciparum were collected from six Gambian children and the S-antigens radiolabelled by 3H-glycine uptake during in vitro culture up to rupture of infected cells and merozoite release. Ouchterlony double diffusion of boiled culture supernatants against a panel of adult Gambian sera identified one S-antigen precipitin arc for five isolates and two precipitin arcs for one isolate. Five of the six isolates were serologically distinct. Analysis of S-antigens by comparison of SDS-polyacrylamide gel electrophoresis patterns of heat-treated soluble proteins revealed a more complex pattern of 3H-labelled S-antigens that was different for each isolate. There were between two and six different 3H-labelled bands for each isolate in the size range of molecular weight 137 000 to 285 000. This result confirms the large size range of S-antigens identified with culture adapted P. falciparum. Several bands were relatively weakly labelled with 3H-glycine, suggesting that natural isolates contain one or two predominant S-antigen phenotypes and several other S-antigen phenotypes expressed by minor parasite subpopulations. Immunoprecipitation was performed using a panel of sera from Gambian adults, or, acute and 3 week convalescent sera from the same patients used for S-antigen radiolabelling. Adult sera generally immunoprecipitated some of the S-antigens in each isolate, including antigens that must represent extremely minor parasite subpopulations since they could not be seen in the patterns of non-immunoprecipitated heat-stable proteins. Sera from convalescent children were generally negative on immunoprecipitation, even with the homologous isolate. In one case we observed the acquisition of specific immunoprecipitating antibody to one of the homologous S-antigens during the convalescent period. The antigenic and structural complexity of S-antigens in natural isolates that have not been submitted to the selection pressure of adaptation for in vitro culture is clearly greater than for culture adapted P. falciparum.     

Strategy to Eliminate Inappropriate Shocks Secondary to T-Wave Oversensing in a Biventricular ICD

T-wave oversensing represents a common cause of inappropriate shocks in patients with implanted cardiac defibrillators. This case report demonstrates a strategy of device programming using V-V pace delay (sequential rather than simultaneous biventricular pacing) to eliminate T-wave oversensing without decreasing sensitivity to detect true tachyarrhythmia.     

Immunotoxicologic Assessment of Subacute Exposure of Rats to Carbon Tetrachloride with Comparison to Hepatotoxicity and Nephrotoxicity

Immunotoxicologic Assessment of Subacute Exposure of Rats toCarbon Tetrachloride with Comparison to Hepatotoxicity and Nephrotoxicity.SMIALOWICZ, R.J., SIMMONS, J. E., LUEBKE, R. W., AND ALLIS,J. W. (1991). Fundam. Appl. Toxicol 17, 186-196. The immunotoxicity,hepatotoxicity, and nephrotoxicity of subacute exposure to carbontetrachloride (CCI4) were evaluated in young adult (8-9 weeksold) male Fischer 344 rats dosed by gavage with CCI4 for 10consecutive days at 0, 5, 10, 20 or 40 mg/kg/day. Two days followingthe last treatment rats were evaluated for alterations in immunefunction by monitoring the following; body and lymphoid organweights; mitogen and mixed leukocyte reaction lymphoproliferativeresponses; natural killer cell activity; and cytotoxic T lymphocyteresponses. A separate group of similarly dosed rats was immunizedwith sheep red blood cells (SRBQ on Day 9 of dosing, and theprimary antibody response was assessed 4 days later. Hepaticand renal toxicity were assessed 2 days after the last treatmentby monitoring organ weights, serum indicators of hepatic andrenal damage, and hepatic cytochrome P450 levels, as well asby histological evaluation. Significant increases in relativeliver weights were observed in rats dosed at 40 mg/kg/day. Histologically,these livers displayed mild to moderate vacuolar degenerationand minimal to mild hepatocellular necrosis. In addition, serumlevels of aspartate aminotransferase and alanine aminotransferasewere elevated at this dosage, as well as at 20 mg/kg/day. Therewere no renal effects observed at these dosages of CCU. In addition,no consistent alterations were observed in the immune parametersexamined in these same animals nor in the rats immunized withSRBC. Furthermore, there was no difference in the antibody responseto SRBC in another set of rats dosed at 40, 80, or 160 mg/kg/dayCCI⁴. These results indicate that CCU is not immunotoxic inthe rat at dosages that produce overt hepatotoxicity.     

VERTEBRAL OSTEOPOROSIS IN RHEUMATOID ARTHRITIS PATIENTS: EFFECT OF LOW DOSE PREDNISONE THERAPY

The effect of low dose prednisone therapy on spinal bone massis controversial. We measured lumbar trabecular and corticalbone mineral density (BMD) in 74 rheumatoid arthritis (RA) patientsby dual energy quantitative computerized tomography in a cross-sectionalstudy. The presence of vertebral deformities was evaluated ona lateral spine radiograph. Patients who had never been treatedwith corticosteroids (n=44) were compared with patients on long-termlow dose ( 10 mg/day) prednisone therapy (n=30). After correctionfor confounding variables the lumbar BMD was highly sig nilicantlyinfluenced by prednisone therapy in postmenopausal patients(estimated influence –31.2% on trabecular BMD and –37.2%on cortical BMD). Vertebral deformities were also significantlymore frequent in prednisone treated postmenopausal patients.No negative effect of prednisone treatment could be demonstratedin male patients. In contradiction to previous reports we concludethat long-term prednisone therapy may be associated with developmentof spinal osteoporosis in postmenopausal RA patients, even whenlow doses are used. KEY WORDS: Corticosteroids, Osteoporosis, Bone densitometry, Dual energy quantitative computerized tomography, Vertebral fractures, Postmenopause     

Assessment of Hepatic Indicators of Subchronic Carbon Tetrachloride Injury and Recovery in Rats

Assessment of Hepatic Indicators of Subchronic Carbon TetrachlorideInjury and Recovery in Rats. ALLIS, J. W., WARD, T. R., SEELY,J. C, and SIMMONS, J. E. (1990). Fundam Appl. Toxicol. 15, 558–570.To determine the course of hepatic recovery from subchronicoral administration of carbon tetrachloride (CCl₄), male F-344rats were gavaged with 0, 20, or 40 mg CCl₄/kg, 5 days/week,for 12 weeks. Exposure to CCl₄ caused dosage-dependent increasesin relative liver weight and the serum levels of aspartate aminotransferase,alanine aminotransferase, lactate dehydrogenase, alkaline phosphatase,and cholesterol as well as a dosage-dependent decrease in hepaticcytochrome P450. Centrilobular hepatocellular vacuolar degeneration,necrosis, and cirrhosis occurred at both 20 and 40 mg/kg, withdosage-dependent severity. Reversibility of these reported effectsvaried with parameter. By Day 8 postexposure, necrosis had disappearedand all serum indicators and cytochrome P450 had returned tocontrol levels. By Day 15 postexposure, the severity of thevacuolar degeneration had decreased. Reversibility of cirrhosiswas dosage dependent; complete recovery occurred in the low-but not the high-dose group by Day 15. The disappearance ofthe increase in relative liver weight was also dependent ondosage; the low- but not the high-dose group had returned tothe control level by Day 22. In an attempt to measure persistenthepatic damage, liver uptake relative to the spleen was determinedfor a sulfur colloid labeled with technetium-99m and for tritiated2-deoxyglucose. Neither method consistently measured hepaticdamage in cirrhotic livers due, in part, to the high degreeof variability in the tracer uptake data.     

Perioperative Management of Anticoagulant Therapy during Cutaneous Surgery: 2005 Survey of Mohs Surgeons

BACKGROUND: The perioperative management of anticoagulation and antiplatelet therapy is a controversial topic in the field of dermatologic surgery. Dermasurgeons must weigh the risk of bleeding against the risk of thrombotic complications when deciding how to manage perioperative anticoagulation. OBJECTIVE: Our aim is to present a summary of current practice in anticoagulation management perioperatively during cutaneous surgery. We compare our results to those found in a similar survey in 2002. METHODS AND MATERIALS: A questionnaire surveying current practice in perioperative management of anticoagulant therapy was mailed to 720 dermasurgeons. RESULTS: Thirty-eight percent of dermasurgeons responded to the questionnaire. Of the responding physicians, 87% discontinue prophylactic aspirin therapy, 37% discontinue medically necessary aspirin, 44% discontinue warfarin, 77% discontinue nonsteroidal anti-inflammatory drugs (NSAIDs), and 77% discontinue vitamin E therapy perioperatively at least some of the time. Although clopidogrel was not surveyed, 78 physicians included comments about the management of this agent. CONCLUSION: Dermasurgeons were more likely to continue medically necessary aspirin and warfarin in 2005 compared to 2002, with the most dramatic shift evident in the management of warfarin. They were more likely to discontinue prophylactic aspirin, NSAIDs, and vitamin E. Surgeons were concerned about bleeding with the antiplatelet agent clopidogrel. More evidence-based medicine is necessary to set guidelines for the management of anticoagulation and antiplatelet therapy perioperatively.     

Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta‐analysis

Aim The aim of this study was to review systematically evidence about the efficacy of motor interventions for children with developmental coordination disorder (DCD), and to quantify treatment effects using meta‐analysis. Method Included were all studies published between 1995 and 2011 that described a systematic review, (randomized) clinical trial, or crossover design about the effect of motor intervention in children with DCD. Studies were compared on four components: design, methodological quality, intervention components, and efficacy. Twenty‐six studies met the inclusion criteria for the review. Interventions were coded under four types: (1) task‐oriented intervention, (2) traditional physical therapy and occupational therapy, (3) process‐oriented therapies, and (4) chemical supplements. For the meta‐analysis, effect sizes were available for 20 studies and their magnitude (weighted Cohen’s d [d_w]) was compared across training types. Results The overall effect size across all intervention studies was d_w=0.56. A comparison between classes of intervention showed strong effects for task‐oriented intervention (d_w=0.89) and physical and occupational therapies (d_w=0.83), whereas that for process‐oriented intervention was weak (d_w=0.12). Of the chemical supplements, treatment with methylphenidate was researched in three studies (d_w=0.79) and supplementation of fatty acids plus vitamin E in one study (no effect). The post hoc comparison between treatment types showed that the effect size of the task‐oriented approach was significantly higher than the process‐oriented intervention (p=0.01) and comparison (p=0.006). No significant difference in the magnitude of effect size between traditional physical and occupational therapy approaches and any of the other interventions emerged. Interpretation In general, intervention is shown to produce benefit for the motor performance of children with DCD, over and above no intervention. However, approaches from a task‐oriented perspective yield stronger effects. Process‐oriented approaches are not recommended for improving motor performance in DCD, whereas the evidence for chemical supplements for children with DCD is currently insufficient for a recommendation.