Bertrand L. Stolzer

Malignancy following treatment of rheumatoid arthritis with cyclophosphamide: Long-term case-control follow-up study

A long-term retrospective case-control study was performed comparing 119 patients with rheumatoid arthritis treated with cyclophosphamide and 119 matched control patients with rheumatoid arthritis not treated with cyclophosphamide to determine the risk of subsequent malignancy. Thirty-seven malignancies were detected in 29 cyclophosphamide-treated patients, while 16 malignancies were found in 16 control patients (p less than 0.05) during a mean follow-up period of more than 11 years. Urinary bladder cancer (six cyclophosphamide-treated patients, no control patients) and skin cancer (eight cyclophosphamide-treated patients, no control patients) were identified as differing statistically between the groups, and hematologic malignancy (five cyclophosphamide-treated patients, one control patient) showed a similar trend. Survival analysis indicated that the rate of development of malignancy in the cyclophosphamide-treated patients was significantly greater than in the control patients at six years following drug initiation, and that this increased rate persisted even at 13 years (p less than 0.01). Of the many risk factors evaluated, mean total cyclophosphamide dose and duration and tobacco use were significantly increased in patients in whom cancer subsequently developed. These long-term complications must be considered seriously when cyclophosphamide or other cytotoxic drugs are initiated for the treatment of rheumatoid arthritis.

Metatarsal Head Resection in the Treatment of Rheumatoid Arthritis

SUMMARY A review of 169 cases of metatarsal head resection in 88 rheumatoid patients with severely involved feet demonstrates good results in 88 per cent of the cases. The major pitfall of the surgery regardless of the operative procedure was the inadequate and improperly performed resection of the bony elements. Metatarsal head resection is one of the most satisfactory of all surgical procedures for the rheumatoid patient.

Postarsenical obstructive jaundice complicated by xanthomatosis and diabetes mellitus

Abstract 1.1. A case of postarsenical jaundice of the obstructive type with complicating xantho-matosis and diabetes mellitus is presented. 2.2. An allergic reaction to arsenic has been postulated as the cause of the obstructive jaundice. 3.3. The occurrence of xanthomatosis with intrahepatic obstructive jaundice of known and unknown etiologies is discussed.

Effect of oxytetracycline therapy of streptococcal sore throat on the incidence of acute rheumatic fever.

Excerpt Although penicillin, Chlortetracycline, Oxytetracycline and erythromycin have been shown to be effective in alleviating the symptoms of acute streptococcal disease, only penicillin and Chlo...