Donato Alarcón-Segovia

Erythermalgia: Review of 51 Cases

The syndrome of erythermalgia is characterized by a burning distress of the extremities that is accompanied by redness and increased temperature of the skin. These symptoms are initiated or exacerbated by an increase in environmental temperature and diminished by measures that cool the skin. Of 51 patients with this clinical syndrome seen at the Mayo Clinic during the years1951 to 1960 inclusive, 30 were considered as having primary erythermalgia because of the absence of demonstrable associated conditions, and the rest were classified as having secondary erythermalgia because the condition was associated with various diseases. Particularly significant was the relation of erythermalgia to the myeloproliferative disorders as evidenced in 10 cases. In some of these cases, erythermalgia preceded other manifestations of the myeloproliferative disorder by as long as 12 years. The primary type was found to occur in younger individuals and to be more often bilateral, to produce pain of greater intensity, and to involve larger areas of the affected extremities. The pathologic physiology of this syndrome remains unknown.

Lupus Diathesis and the Hydralazine Syndrome

CERTAIN hypertensive patients treated with hydralazine hydrochloride acquire a clinical picture that, when fully manifested, is indistinguishable from that of systemic lupus erythematosus.1,2 The relation of this drug-induced disease to spontaneously occurring lupus erythematosus, as yet undetermined, is important because it may provide some clues to the pathogenesis and prevalence of systemic lupus erythematosus and related conditions. We believe that overt systemic lupus erythematosus as presently known is the end, stage of a long standing process, possibly genetically induced, that may remain latent until unmasked or exacerbated by one of various agents with this potential.3 4 5 This latency or the .xa0.xa0.

Lupus erythematosus cell phenomenon in patients with chronic ulcerative colitis

Present knowledge of systemic lupus erythematosus, albeit scarce, has been accumulated slowly since its original description to its present recognition as a complex systemic disease responsible for a number of syndromes previously considered unrelated. The true incidence of systemic lupus erythematosus, though still unknown, evidently is much greater than was realized before the discovery of the L.E. cell phenomenon by Hargraves, Richmond, and Morton (1948). From their finding has stemmed also the concept that autoimmune mechanisms operate in systemic lupus erythematosus and probably are responsible for at least some of its clinical and laboratory manifestations. Little also is known of the pathogenesis of chronic ulcerative colitis. Studies on the role of immunity in that condition have been inconclusive (Good and Condie, 1961; Kraft, Bregman, and Kirsner, 1962) but extracolonic manifestations are being recognized with increasing frequency (Sloan, Bargen, and Gage, 1950; Hightower, Broders, Haines, McKenney, and Sommer, 1958). Particularly interesting are the associated arthritis and the hepatic damage. We have found 11 cases of systemic lupus erythematosus associated with chronic ulcerative colitis reported in the literature (Brown, Haserick, and Shirey, 1956a; Gray, Mackay, Taft, Weiden, and Wood, 1958; Bartholomew, Hagedorn, Cain, and Baggenstoss, 1958; Larson, 1961; McEwen, Lingg, Kirsner, and Spencer, 1962). Although the paucity of these reports may indicate that this association is merely coincidental, the systemic manifestations of both diseases and some peculiarities of the cases reported may indicate that the association is of some significance. During the year 1962, 475 patients with chronic

Ulceration and perforation of the nasal septum in systemic lupus erythematosus.

IN the two patients described below, ulceration and subsequent perforation of the nasal septum developed at the same time as acute exacerbation of systemic lupus erythematosus. Review of records from this institution revealed a third, similar case. No other cases of such occurrence were found in the literature. Case Reports Case 1. A 25-year-old woman was admitted to the hospital in March, 1966. For 8 years she had noticed Raynauds phenomenon later turning to persistent acrocyanosis. Since 1960, she had had episodes of erythematous rash, alopecia, sore throat, polyarthritis, fever and weight loss. In 1 episode 2 months before admission .xa0.xa0.

Effect of pregnancy on functions of circulating T cells from patients with systemic lupus erythematosus: Correction of T-cell suppression and autologous mixed-lymphocyte responses

Pregnant systemic lupus erythematosus (SLE) patients with inactive disease were found to have normal spontaneously generated suppressor-cell function and slightly higher concanavalin A-induced suppressor function as compared to matched normal pregnant and nonpregnant females. In six SLE patients studied sequentially throughout pregnancy and postpartum, suppressor functions were found to fall sharply within the first week after delivery. One of these patients had been studied before she became pregnant and found to have a decreased suppressor function. Nonpregnant SLE patients had both suppressor functions diminished despite their disease being similarly inactive. This group was also the only one to have decreased responses in autologous mixed-lymphocyte cultures. Both pregnant and nonpregnant SLE patients had decreased absolute numbers of total lymphocytes, T cells, and their subpopulations, but the proportions of these cells were similar in all four groups. Despite this apparent normalcy of immune regulation, pregnant SLE patients had higher levels of Clq-binding immune complexes than did nonpregnant ones. Functional T-cell abnormalities found in SLE patients tend to be corrected by pregnancy. This may explain in part the disease remissions that occur in them during the second half of pregnancy.

Immune mechanisms in chronic pancreatic disease

SUMMARYThe presence of precipitins to pancreatic antigens was investigated by gel diffusion in two experimental conditions in dogs: pancreatic-duct ligation, and ethionine-induced pancreatitis. Precipitins to the pancreas were not demonstrable after pancreatic-duct ligation, but were demonstrable in other dogs, after small doses of ethionine had been administered for a short time, and in the absence of clinical or other laboratory evidence of pancreatic damage.Histologic study of the pancreases of dogs that were sacrificed after ethionine administration showed disruption of acini and focal inflammation. The pancreas from a dog that was kept alive for 10 weeks following ethionine administration was found to be histologically normal-even though circulating precipitins to its own pancreas had been demonstrated in this animal.The administration of dog-pancreas antisera to normal dogs did not produce any appreciable damage to their pancreases.Our data suggest that, in dogs, certain forms of pancreatic damage may result in the production of circulating precipitating antibodies. Their significance in the production or perpetuation of pancreatic disease is unknown, but it is possible that they have no pathogenetic significance.

Immune mechanisms in chronic pancreatic disease. II. Serum precipitins to pancreatic homogenates in patients with pancreatic disease: preliminary clinical observations.

SummaryPrecipitins to pancreatic homogenates, presumably representing isoantibodies, have been found in 28 of 33 patients with various pancreatic exocrine diseases. In 4 of 5 patients without demonstrable precipitins, pancreatic damage had either occurred more than 3 years previously or had just begun at the time of the study. Similar precipitins were found in 7 of 35 diabetics but in only 1 of 52 controls with various nonpancreatic diseases.It is unlikely that these precipitins have any pathogenetic significance. Their determination, however, might prove useful in the diagnosis of pancreatic inflammation and malignant neoplasia.

ANTIGENICITY OF VARIOUS GLUTEN FRACTIONS.

SummaryThe antigenic properties of various wheat-gluten fractions were investigated and compared with their known harmful and nonharmful properties when ingested by patients with nontropical sprue. Gluten fractions were suspended in complete Freunds adjuvant and injected into the foot pads of rabbits on 5 consecutive days. A final intraperitoneal injection was also given. Investigation of antibodies in their serum 3 and 6 weeks thereafter by means of double gel diffusion showed no correlation between the reported harmful and the antigenic properties of some of the fractions. This indicates that the deleterious properties of gluten and its fractions can not be attributed to their antigenicity.