Amira F. Gohara

Adherence to exercise interventions in the treatment of hypercholesterolemia

The goals of this study were to determine the rate of adherence to exercise treatment of hypercholesterolemia and to identify personality and demographic factors associated with adherence. Of the 31 subjects entering the 26-week program, 12 attended 80% or more of the scheduled sessions. Adherence was positively associated with the perceived seriousness of hypercholesterolemia, the expectation of benefit from treatment, and depressed feelings of helplessness and hopelessness. Negative associations were identified between adherence and the perception of health status being under the control of chance or of powerful others. Older subjects were more likely to be adherers at 8 and 16 weeks but not at 26 weeks.

Treatment of murine immune complex glomerulonephritis with prostaglandin E2: Dose-response of immune complex deposition, antibody synthesis, and glomerular damage

A model of immune complex glomerulonephritis (ICGN) produced in mice by the daily injection of apoferritin was employed to study the effect of treatment with various doses of prostaglandin E2 (PGE2) on glomerular damage, immune complex deposition, proteinuria, and serum anti-apoferritin antibody. Administration of PGE2, 200 micrograms twice daily, resulted in a significant decrease in glomerular damage and immune complex deposition, prevented the development of proteinuria, and significantly reduced serum levels of anti-apoferritin antibody. PGE2, 100 micrograms twice daily, resulted in a decrease in immune complex deposition as assessed by immunofluorescence microscopy, but this dosage did not significantly alter glomerular damage, proteinuria, or antibody levels. PGE2 dosages of 50 and 25 micrograms twice daily had no effect on any of these parameters. The protective effect of PGE2 on the development of ICGN occurred only at dosages that were associated with decreased anti-apoferritin antibody.

Acute interstitial nephritis in a patient with aspirin hypersensitivity

Abstract Acute interstitial nephritis developed in a patient after ingestion of analgesics, including aspirin, for arthritis. An aspirin hypersensitivity was demonstrated by in vitro lymphocyte blast transformation upon exposure to aspirin. Antibodies to human tubular basement membrane were not present. Serum IgE concentrations were elevated. We postulate that this patient had aspirin-induced acute interstitial nephritis mediated by a cellular immune mechanism.

The Toledo Exercise and Diet Study: Results at 26 Weeks

This study was designed to test whether an exercise program is additive to diet counseling in lowering elevated blood cholesterol levels. From a screened population of 1024 subjects, we randomized 66 predominantly female subjects to two intervention groups: diet counseling and diet counseling with exercise. Subjects were selected who had elevated levels of serum low-density lipoprotein cholesterol, an average or low fitness level, and a diet high in saturated fat and cholesterol. After 26 weeks of intervention, 51 subjects exhibited significant decreases in serum levels of cholesterol, high-density lipoprotein cholesterol, triglycerides, and low-density lipoprotein cholesterol. The addition of exercise to diet counseling resulted in improved aerobic capacity, losses of body fat and weight, and further nonsignificant decreases in serum cholesterol and low-density lipoprotein cholesterol levels. Since these results differ from data acquired in individuals with normal to borderline serum cholesterol levels, further studies appear indicated in hypercholesterolemic subjects, especially in women.

Quantification of thallium-201 scintigrams in acute myocardial infarction

A method has been developed for measurement of myocardial infarct size from thallium-201 scintigrams that depends on computer measurement of levels of radioactivity in the myocardium. In 16 dogs, thallium-201 scintigrams were obtained in the left lateral and left anterior oblique projections 48 hours after ligation of the left anterior descending coronary artery. Scintigraphic results were obtained by two independent observers and were compared with tissue measurements of infarct volume calculated from thallium autoradiograms and nitro-blue tetrazolium (NBT)-stained tissue slices. Infarct volumes derived from tissue measurements were used to develop criteria for the computer scintigraphic technique. There was no significant difference in the scintigraphic measurements made by the two observers. Scintigraphic infarct size in the left lateral and left anterior oblique projections correlated with tissue infarct size with r values of 0.88 and 0.75, respectively, for thallium autoradiography and 0.71 and 0.70, respectively, for NBT tissue staining. The range of infarct volume was 3.3 to 14.8 percent of the left ventricular mass. Results of this study suggest that scintigraphic quantitation of infarct size is feasible in this dog model.

Massive post-transplant proteinuria with minimal histological changes.

Three patients developed massive proteinuria, hypoalbuminemia, and edema after transplantation. These findings occurred in the immediate post-transplant period in two patients, and renal failure developed. The third patient developed proteinuria 4 months post-transplantation. There was complete remission of proteinuria in two patients and recovery of renal function in one. Renal histology was similar in all. Light microscopy demonstrated that the glomeruli contained a mild increase in mesangial matrix, but were otherwise normal. No significant interstitial cellular infiltration or fibrosis was present. Immunofluorescence microscopy revealed no staining for immunoglobulins or complement. Electron microscopy demonstrated fusion of foot processes, but the glomerular basement membrane was normal. No electron-dense deposits were found. The usual causes of post-transplant nephrotic syndrome were ruled out. We believe these three patients represent a unique disorder of the transplanted kidney.

Chronic Serum Sickness in the Mouse

We studied the effect of the administration of different doses of antigen in a model of chronic glomerulonephritis produced in mice by the daily injection of apoferritin. Four groups of mice received intraperitoneal injections of 4 mg apoferritin (group 1), 2 mg apoferritin (group 2), 1 mg apoferritin (group 3), or saline (group 4) daily. Significant proteinuria and the presence of antiapoferritin antibody were demonstrated in mice immunized with apoferritin. The severity of histologic damage and the extent of staining for IgG significantly increased with larger doses of apoferritin. Electron microscopy revealed subepithelial and mesangial electron-dense deposits. Administration of large daily doses of apoferritin to mice results in a reliable model of immune complex glomerulonephritis and crescent formation.

Alteration in immune complex glomerulonephritis by arachidonic acid

We employed a model of immune complex glomerulonephritis produced in mice by the daily injection of apoferritin to study the effect of treatment with arachidonic acid (AA). Apoferritin injections produced demonstrable glomerular damage by light microscopy associated with deposition of immunoglobulin along peripheral capillary loops. Treatment with AA 100 micrograms daily resulted in significantly less glomerular damage and a shift inthe location of immune complex deposition to the mesangium. The amount of anti-apoferritin antibody was determined by hemagglutination and found to be significantly decreased in mice treated with AA. Separate studies employing this dose of AA revealed that the number of IgM antibody producing cells to SRBC was not altered by AA.

Case Report: Mesangial Proliferative Glomerulonephritis Associated with Multiple Myeloma

ABSTRACT IgA lambda multiple myeloma was diagnosed In a 58-year-old white woman after the onset of nephrotic syndrome. Serial renal histology demonstrated progressive mesangial proliferative glomerulonephritis. Electron microscopy revealed subepithelial electron dense deposits. Immunofluorescence microscopy demonstrated granular staining of peripheral capillary loops with IgG and C3. No IgA was present, No evidence of deposition of the myeloma protein in the glomeruli was found. The temporal relationship of occurrence of the two diseases and the progression of glomerular disease suggest that multiple myeloma be added to the list of malignancies causing Immune complex glomerulonephritis.

Infectious antecedent of immunoblastic lymphoma. Progressive immunosuppression in a patient with lymphogranuloma venereum

Angioimmunoblastic lymphadenopathy is a nonmalignant disease of unknown etiology often progressing to immunoblastic lymphoma. Immunologic deficiency is evident in these patients as well as in those with various infections found in association with the acquired immune deficiency syndrome (AIDS). This report describes a previously healthy young woman in whom angioimmunoblastic lymphadenopathy developed in association with lymphogranuloma venereum, with progressive loss of immunologic competence. This deterioration paralleled the evolution of angioimmunoblastic lymphadenopathy into a rapidly fatal immunoblastic lymphoma.