Gregorio Mintz

Cardiovascular Manifestations in Systemic Lupus Erythematosus. Prospective Study of 100 Patients

One hundred consecutive female patients with active systemic lupus erythe matosus (SLE) were studied from the cardiovascular point of view by means of non invasive methods. Seventy percent of the cases presented some type of car diovascular anomaly. Seventy four percent of the resting electrocardiograms were abnormal as well as 72% of the M mode echocardiograms and 55% of the cardiac X ray series. The most frequent observed complications were: pericar ditis and or pericardial effusion (39%), arterial hypertension (22%), ischemic heart disease (16%), myocarditis (14%), congestive heart failure (10%), pulmo nary hypertension (9%), valvular heart disease (9%), pleural effusion (7%) and cerebro vascular accident (3%). We analized each one of these complications and found of special interest the high incidence of ischemic heart disease which is more frequent than has been hitherto reported. Ischemic heart disease was observed in two types of patients: a) Those with long term steroid therapy. In these, the mechanism seems to be an atherosclerotic disease probably induced by the chronic use of steroids. The management of these cases do not differ from other types of coronary heart disease due to atherosclerosis. b) Those with frank episodes of vasculitis in whom the basic mechanism is an inflammatory process of the coronary arteries and its treatment is fundamentally that of the vasculitis. We consider necessary to study routinely all patients with SLE through non invasive cardiological methods.

CONTRACEPTION WITH PROGESTAGENS IN SYSTEMIC LUPUS ERYTHEMATOSUS

To test the efficacy and tolerance of progestagens as contraceptives in systemic lupus erythematosus (SLE), 200 mg IM norethisterone enanthate was administered to 10 patients, 0.03 mg/day oral levonorgestrel to 15 patients and they were compared with 18 control patients. There were 4 episodes of active SLE in 48 patient-months on norethisterone enantate and 6 episodes in 122 patient-months on levonorgestrel as compared with 9 episodes of active disease in 298 control patient-months (p = ns). There were no pregnancies and intermenstrual bleeding led to discontinuation of medication in 30% of patients. Progestagens may be an alternative contraceptive method in SLE.

Severe osteoarthritis of the elbow in foundry workers.

Foundry workers who used tongs for lifting and twisting metal rods develop severe osteoarthritis (OA) of the elbows. The main symptom was limitation of motion with an average loss of 45° for extension, 60° for flexion, 20° for pronation, and 10° for supination. Spontaneous pain was characteristically absent, and radiological changes were those of degenerative joint disease. A new mechanism of OA of the elbow is proposed: an increase in the length of the arm lever renders it less efficient and requires greater force which results in increased tangential (shearing) friction on the joint cartilages, and leads to early and progressive derangement of the joint. This should be considered an occupationally related disability.

Submicroscopic alterations in capillaries of skeletal muscles in polymyositis

Abstract Electron microscopic changes in capillaries of muscle are described in four patients with polymyositis. Marked thickening and lamination of basement membrane and various degrees of endothelial swelling, to the point of causing obstruction of the lumen, were found when compared to control subjects.

Ultrastructure of muscle in polymyositis

Abstract The present observations on the ultrastructure of muscle fibers in polymyositis offer little basis for classification of different subtypes. Except for the lymphocytic and plasma cell infiltrates seen in a case associated with Sjogrens syndrome, the muscle lesions appeared much the same irrespective of the clinical type of polymyositis or its association with malignancy or some other connective tissue disease.

Gastro-intestinal bleeding in patients with rheumatoid arthritis: the effects of azapropazone treatment.

A comparative study was carried out, using the Cr51 red blood cell labelling method, to assess the amount of gastro-intestinal blood loss in 20 rheumatoid arthritis patients taking either 600 mg. or 1200 mg. azapropazone daily. The results demonstrate that azapropazone does not produce greater than normal gastro-intestinal bleeding, that the volume of faecal blood loss is not dose-related, and there would not appear to be any correlation between blood loss and the occasional mild gastro-intestinal side-effects reported in a few patients. These results compared favourably with those obtained previously by the investigators in a similar group of patients taking 3 g. aspirin per day.

Prospective Study of Pregnancy in Systemic Lupus Erythematosus. Results of a Multidisciplinary Approach

Our prospective study attempted to better define the reciprocal relation between pregnancy and systemic lupus erythematosus (SLE), to reduce maternal morbidity/mortality, and fetal loss. Our protocol included all the pregnancies in our total of patients with SLE between the years 1974-1983. There were 102 pregnancies in 75 patients during this period; SLE was exacerbated in 59.7% that started with inactive disease, most with mild episodes. Hematologic manifestations and renal disease, however, required moderate or high doses of steroids. There were no maternal deaths. There were 49% premature newborns in the entire group and this increased to 59% in mothers with active SLE; 23% of newborns were small for gestational age in the entire group and the rate increased to 65% in mothers with active SLE. There was a 16% spontaneous abortion rate with no difference between mothers with active or inactive disease, 5 stillbirths and one neonatal death, with a total fetal loss of 22% (compared with 6.7% in the control group p less than 0.001). There were 32 cesarean sections with live outcomes and 14 newborn infants with a weight below 1.5 kg survived. Our study shows that in patients with SLE planned rheumatologic care of the mother, with special obstetrical and perinatal attention, may reduce the high maternal and fetal morbidity/mortality.