Alan J. Bridges

A controlled study of lymphocyte subsets in rheumatoid arthritis.

The purpose of this study was to determine if patients with rheumatoid arthritis (RA) exhibited unique patterns of peripheral blood lymphocyte (PBL) subsets in comparison to patients with osteoarthritis (OA) and, further, if such differences related to disease activity or nondisease factors. Data from 63 RA patients and 47 OA patients revealed that the RA patients had lower absolute numbers of CD2+ and CD4+ lymphocytes. Small differences also were found in selected B-cell subsets and subsets of lymphocytes expressing CD16 and/or CD57 antigens. Further analysis revealed that these differences were due primarily to the effects of cytotoxic medications in the RA group. However, there were also alterations in some subsets independent of medication groups. PBL subsets in RA patients did not relate to chronic low-dose prednisone or measures of disease activity. This study demonstrated the need to control carefully for variables such as age and medication in immunophenotypic investigations of RA.

Tissue plasminogen activator treatment of digital thrombosis in severe Raynaud's phenomenon : a case report

A thirty-one-year-old woman with long-standing mixed connective tissue dis ease and severe obliterative vasculopathy of the digits developed digital throm bosis of the first three digits of the left hand after using an electric blow dryer. The digits remained cool, cyanotic, and painful for thirty-six hours before medi cal evaluation. She was given 100 mg recombinant tissue plasminogen activator (TPA) intravenously. Within one hour the blood flow to the digits returned, accompanied by severe intermittent vasospasm of the digits. The thumb did not necrose; however, the second and third digits required amputation. No im provement was noted in the patients baseline Raynauds phenomenon or digital pressures of the uninvolved digits after TPA treatment. This case documents the usefulness of TPA for digital thrombosis in the setting of vasculopathy of con nective tissue disease. However, it does not support the utility of a single dose of TPA for severe Raynauds phenomenon and recurrent digital ischemia in pa tients with connective tissue disease.

GALE: a graphics assisted learning environment for computer-based interactive videodisc education.

GALE, a Graphics Assisted Learning Environment, is a computer-based interactive videodisc authoring tool. GALE was created as the authoring package for AI/LEARN/Rheumatology, an independent study system for teaching rheumatology to medical trainees. GALE has potential widespread application beyond rheumatology. Interactive videodisc technology is a prime feature of GALE. Other highlights are: WordPerfect macros which simplify programming, graphics-based large text characters, tracking of user responses, hypertext-like definition capabilities, color coded screens to distinguish between hypertext branches and the mainstream of the course content and ability to overlay text on the video image. GALE runs on a PC-compatible computer with selected Pioneer LaserDisc players. GALE uses WordPerfect 5.1 for text editing and has been designed for use by non-programmers.