Left ventricular systolic dysfunction in rheumatoid disease: an unrecognized burden?

OBJECTIVES: This study sought to ascertain whether left ventricular systolic dysfunction (LVSD) is more common among clinic patients with rheumatoid disease (RD) compared with the general population, and to assess the diagnostic utility of brain natriuretic peptide (BNP). BACKGROUND: Patients with RD are at increased risk of ischemic heart disease. However, there are few large echocardiographic studies identifying cardiac dysfunction in RD. We hypothesized that LVSD would be more prevalent in RD patients than in the general population. METHODS: A total of 226 hospital out-patients with RD (65% women) underwent clinical evaluation, electrocardiography (ECG), echocardiography, and plasma BNP assay (218 patients). Prevalence of LVSD was compared with local population estimates. RESULTS: Definite LVSD (left ventricular ejection fraction <40%) occurred in 5.3% of the RD group: standardized prevalence ratio, 3.20; 95% confidence interval, 1.65 to 5.59. Median BNP values were higher in patients with LVSD compared with those without: 16.6 pmol/l versus 8.5 pmol/l, p < 0.005, although values between the two groups overlapped. One in nine patients with an abnormal ECG had definite LVSD. CONCLUSIONS: Definite LVSD was three times more common in RD patients than in the general population. Given the prognostic benefits of treating LVSD, echocardiographic screening of RD patients with an abnormal ECG may be worthwhile.     

Reflux gastritis: the consequences of intestinal juice in the stomach.

The consequences of exposure of the intact stomach to intestinal contents were examined in six dogs. Diversion of duodenal contents through the stomach lead to the following changes: histologic gastritis in both antrum and corpus, increase in resting and postprandial serum gastrin levels, increased parietal cell density in four of six animals, and enhanced maximal acid secretory capacity in three of six animals. No significant changes were seen in insulin-stimulated acid secretion, insulin-stimulated pepsin secretion, antral gastrin levels, or G cell numbers. We conclude that chronic exposure of the intact stomach to duodenal contents results in gastritis and an amplified gastrin response to food. Parietal cell numbers and maximal acid secretory capacity are increased in some animals.     

B and T lymphocytes in Hodgkin''s disease. Analysis at diagnosis and following therapy.

B and T lymphocytes were studied in the blood and lymph nodes of fifty patients with Hodgkin's disease. At diagnosis, most patients (77%) had normal percentages of circulating B and T lymphocytes. Most patients (60%) also showed normal percentages of B and T lymphocytes in involved lymph nodes. Splenectomy had no effect on circulating B and T lymphocytes in four of five patients studied 2 weeks postoperatively. Seventeen patients were studied before and after treatment to determine the effect of therapy. Very high percentages of B lymphocytes were found in patients studied following radiotherapy. It appears that the known defects in cell-mediated immunity in Hodgkin's disease are not expressed as significant abnormalities in B-or T-lymphocyte ratios in blood or lymphoid tissues at diagnosis. The proliferation of B lymphocytes following radiotherapy could represent a compensatory mechanism to cell-mediated deficiency or a loss of normal suppressor activity of T lymphocytes.     

Impact of preoperative knee deformity on the outcome of total knee replacement using the PFC system

Backgrund. The purpose of our study was to evaluate the impact of preoperative knee deformity on TKR results and the effectiveness of unconstrained PFC systems in the correction of these deformities in knees affected by degenerative disease. Material and methods. We performed a retrospective study of 91 consecutive TKRs performed between 1995-2000 in 79 patients (71 women and 8 men, mean age 67.2 years), during which 74 PFCs and 17 PFCSs were implanted. The mean follow-up was 48.3 months (range: 13-58 years). Functional status was evaluated using the Knee Society Score (KSS), and the radiological results were assessed on the basis of standard plain x-ray pictures. Results. We found 26.7% excellent outcomes, 67.8% good, 3.3% fair and 2.2% poor. There were no statistically significant differences between the anatomical and radiological outcomes of TKR in knee joints with flexion, valgus or varus preoperative deformities. The effectiveness of the unconstrained system of total knee arthroplasty in correction of the flexion or valgus/varus knee joint deformity was very good, given proper patient selection and meticulous surgical technique. Conclusions. Clinical and radiographic studies show that preoperative knee deformation has no impact on the early results of TKR with an unconstrained PRC system. The functional and radiographic results of TKR with an unconstrained PFC system confirm the very high effectiveness of this technique in the correction of preoperative deformation of the knee with degenerative changes. The results of TKR with un-constrained PFC systems in short-term follow-up (1-5 years) are very good.     

Factors Affecting Duration of Chronic Fatigue Syndrome in Pediatric Patients

Objective  

To determine factors affecting duration of chronic fatigue syndrome (CFS) in pediatric patients.