SULPHASALAZINE ALONE OR IN COMBINATION WITH D-PENICILLAMINE IN RHEUMATOID ARTHRITIS

Thirty patients (22 women) with active rheumatoid arthritisparticipated in an open study of 6 months' treatment with eitherenteric-coated sulphasalazine (SASP) or SASP plus D-penicillamine(DPA). Patients were assessed at regular intervals using a numberof clinical and biochemical tests designed to detect specificantirheumatic activity. There were significant improvements in clinical and laboratoryvariables with both regimens consistent with second-line activity.Improvements were greater and more numerous with combinationtherapy. At the end of the trial period, there were nine ‘responders’in the SASP/DPA group but only six in the SASP group. Neitherefficacy nor toxicity could be related to patient acetylatorstatus. Nausea and dyspepsia were frequent problems with both treatmentregimens but dysgeusia and thrombocytopenia were confined tothe SASP/DPA group. Study withdrawals were twice as common withcombination therapy. These results suggest that a combination of SASP and DPA ismore potent than SASP alone but at the expense of poorer patienttolerance. KEY WORDS: Rheumatoid arthritis, Sulphasalazine, D-Penicillamine, Combination therapy     

Primary hepatic lymphoma in a patient with chronic hepatitis C

The case is presented of a woman with chronic active hepatitis C who developed primary hepatic lymphoma. The possible roles of viral hepatitis and therapeutic interferon in the pathogenesis and progression of this unusual maligancy are discussed. In addition, the importance of accurate tissue diagnosis to identify potentially treatable hepatic tumours is emphasized.     

Reduced high density lipoprotein in stroke: relationship with elevated triglyceride and hypertension

Lipids and lipoproteins were analysed in forty-one survivors of stroke, aged less than 65 years, and the same number of age and sex matched controls without vascular disease. The stroke subjects had no evidence of coronary artery or peripheral vascular disease. High density lipoprotein cholesterol was significantly lower (1.19 +/- 0.06 mmol/l) in the stroke subjects than the controls (1.47 +/- 0.07 mmol/l). Triglyceride was also elevated in the stroke subjects, but this was confined to those who were taking antihypertensive treatment which included beta-blockers and/or thiazides. The low levels of high density lipoprotein in stroke were independent of hypertension or its treatment. Thus low levels of high density lipoprotein appear to be associated with cerebrovascular disease, while elevated triglyceride is a complication of anti-hypertensive therapy.     

PNEUMATOSIS INTESTINALIS AND PNEUMOPERITONEUM COMPLICATING MIXED CONNECTIVE TISSUE DISEASE

A case of a young woman with a 3-year history of mixed connectivetissue disease who developed secondary pneumatosis intestinalisand pneumoperitoneum and died shortly after of rapidly progressivedisease is reported. The pathogenesis, otreatment and prognosisof this unusual complication in mixed connective tissue diseaseare discussed. KEY WORDS: Mixed connective tissue disease, Systemic scleroderma, Pneumatosis cystoides intestinalis, Pneumoperitoneum     

Domestic allergens in public places II: dog (Can f 1) and cockroach (Bla g 2) allergens in dust and mite, cat, dog and cockroach allergens in the air in public buildings

Background Sensitization and exposure to indoor allergens are the major risk factors for asthma. It is possible that significant exposure to domestic allergens occurs outside the home. Objectives To investigate the levels of Can f 1 and Bla g 2 in the dust from carpeted floors and upholstered seats in public buildings and public transport and the airborne concentrations of Der p 1, Fel d 1, Can f 1 and Bla g 2 in schools and offices. Methods Can f 1 and Bla g 2 were measured in the dust collected by vacuuming a I m² area of carpet, as well as upholstered seats in five schools, six hotels, four cinemas, six pubs, three buses and two trains. Dust was also collected from the bedroom carpet, living room carpet, mattress and sofa in 20 homes with and 20 homes without a dog in the same area. Personal airborne sampling (2 L/min) was conducted for 8 h in offices (n= 16) and classrooms (n= 9). In addition, airborne samples in schools were collected using a high volume pump (60 L/min) for 1 h in three classrooms immediately after the children vacated the school. Can f 1, Bla g 2, Der p 1 and Fel d 1 were assayed using a two–site monoclonal antibody–based ELISA. Results Can f 1 was detected in all dust samples from public places, ranging from 0.2 to 52.5 μg/g, Significantly higher levels were found in upholstered scats (geometric mean – GM 9.4 μg/g) than in carpets (GM 1.5 μg/g; P < 0.001), and levels of Can f 1 > 10 μg/g were found in 40% of upholstered seats in public places. Can f 1 was significantly higher in upholstered seats in public places than in sofas in homes without a dog (GM 1.8 μg/g; P < 0.001). Detectable levels of Bla g 2 were found in all of the schools (GM 2.4 U/g, range 0.8–4.4 U/g). Bla g 2 concentration greater than 2U/g (provisional threshold level representing risk of sensitization) was measured in 65% of the classrooms sampled. Der p 1 and Bla g 2 were below the detection limit in all airborne samples. However, airborne Fel d 1 and Can f 1 were detected in schools and offices, albeit in low concentrations. Conclusions Upholstered seats from public places constitute a reservoir for the accumulation of dog allergen, and a source of exposure to Can f 1 inside public buildings or on public transport. Exposure to cockroach allergens in schools may be important for cockroach sensitized asthmatic children.     

THE PROTECTIVE EFFECT OF CIMETIDINE ON STRESS-INDUCED ACUTE GASTRIC ULCERATION IN THE RAT

The effect of intraperitoneal cimetidine, an H₂ receptorantagonist, has been assessed on the development of cold-restraint induced acute gastric ulcers in rats. Cimetidine in doses ranging from 20–100 mg per kg body weight significantly reduced the incidence of acute gastric ulceration compared with saline controls in this model. The protective effect of cimetidine suggests a prophylactic role for this agent in stress-induced gastric or duodenal ulceration in man.