Leonard S. Goldberg

Polymyositis and dermatomyositis: combined methotrexate and corticosteroid therapy.

Abstract Twenty-two patients with polymyositis and dermatomyositis were treated with combined prednisone and intravenous methotrexate when moderate to high-dose cortisone alone was ineffective in c...

Acyclovir treatment of varicella in otherwise healthy adolescents

STUDY OBJECTIVEnTo determine whether orally administered acyclovir is of therapeutic benefit for varicella in otherwise healthy adolescents, and to compare the severity of the disease in adolescents with that in younger children.nnnDESIGNnMulticenter, randomized, placebo-controlled, double-blind trial.nnnSETTINGnPatients homes and university hospital clinics.nnnPATIENTSnSixty-eight adolescents between 13 and 18 years of age with varicella entered the study. Of the 62 adolescents with laboratory-confirmed varicella who were included in the final analysis, 31 received acyclovir and 31 received placebo.nnnINTERVENTIONSnPlacebo or an 800 mg acyclovir tablet was given orally four times daily for 5 days, beginning within 24 hours of onset of rash.nnnMEASUREMENTS AND MAIN RESULTSnAcyclovir recipients had significant reductions in times to cessation of new lesion formation (p less than 0.001), maximum number of lesions (p = 0.019), and defervescence (p = 0.045). Mean constitutional illness score was significantly reduced on day 4 (0.5 vs 1.5, p = 0.05), as was the mean number of residual hypopigmented lesions present on 28-day follow-up examination (22.7 vs 92.7, p = 0.018). Two complications, both bacterial superinfections, occurred in placebo recipients. Adverse experiences and varicella-zoster virus antibody titers measured 28 days after enrollment were similar in both treatment groups. Comparison of placebo recipients with children 2 to 12 years of age participating in a companion study indicated that varicella is more severe in adolescents: mean maximum total lesions (421 vs 347, p = 0.003), mean maximum constitutional illness score (3.1 vs 2.2, p = 0.032), and mean number of residual lesions (92.7 vs 33.2, p = 0.01) were all greater in the adolescent population.nnnCONCLUSIONSnOral acyclovir therapy is safe and effective for treatment of varicella in otherwise healthy adolescents; this may be an appropriate subgroup for treatment with antiviral drugs because the disease is more severe in them than in younger children.

The occurrence of antibodies to collagen in synovial fluids

Abstract Synovial fluids and sera from 18 patients with rheumatoid arthritis and 10 subjects with traumatic synovitis were studied for the presence of antibodies to native and denatured collagen. Antibodies to native and denatured collagen were detected in the vast majority of rheumatoid and traumatic synovial fluids. By contrast, these antibodies were present in the sera of less than half of the rheumatoid patients and were rarely found in sera from individuals with traumatic synovitis. In selected instances, antibodies to collagen were eluted from rheumatoid synovial membranes. These data suggest that immune complexes, consisting of collagen and antibody to collagen, may exist in joints affected by chronic synovitis.

Clinical, serologic and leukocyte function studies on patients with idiopathic “acquired” agammaglobulinemia and their families☆

Abstract Investigation of ten patients with acquired agammaglobulinemia, one thought to have a preclinical form of the disease, and their forty-three firstdegree relatives demonstrated considerable heterogeneity in clinical and laboratory findings. All patients had involvement of the sinopulmonary system, but of varying severity. Four had intestinal giardiasis. Lymphoproliferative malignancies occurred in two patients. Serum IgG, IgA and IgM levels were less than 10 per cent of normal in all patients; however, IgD levels were low normal. The saliva of three patients contained detectable secretory IgA. The peripheral blood lymphocyte response to phytohemagglutinin (PHA) at seventy-two hours was diminished in all patients. Four patients had intact delayed hypersensitivity responses. Neutrophil and monocyte bactericidal capacity was normal in all cases, as was the integrity of the monocyte IgG receptor. One or more serologic abnormalities or an impairment of lymphocyte function was found in at least one member in nine of the eleven families studied. These findings provide further evidence for the concept that acquired agammaglobulinemia is a genetically determined disorder of diverse manifestations.

Secretory Immunoglobulin A: Autoantibody Activity in Gastric Juice

An immunoglobulin A of the secretory variety, present in the gastric juice of a patient with pernicious anemia, was shown to have specificity for intrinsic factor. This is the first demonstration in gastric juice of antibody activity restricted to secretory IgA; further, this is the first example of an exocrine (gastric) immune system producing an autoantibody specifically directed toward a product synthesized by that same exocrine organ.

Amyloid Arthritis Associated with Waldenstrom's Macroglobulinemia

WALDENSTRoMs macroglobulinemia, unlike other lymphoproliferative disorders, is rarely associated with amyloidosis. Only 11 cases of macroglobulinemia and amyloidosis have been reported,1 2 3 4 5 6 7 8 9 10 11 none with amyloid involvement of the joints. This report describes a case of Waldenstroms macroglobulinemia with such extensive amyloid infiltration of the synovia that the presenting signs and symptoms mimicked those of rheumatoid arthritis. Case Report G.S., a 72-year-old man, was admitted to the Wadsworth Veterans Administration Hospital complaining of stiffness of the hands for the previous 6 months. For 3 months before admission, he noted progressive loss of joint motion, primarily of the knees and shoulders and painful .xa0.xa0.

Familial Selective Malabsorption of Vitamin B12

Abstract The oldest known patient with documented familial selective malabsorption of vitamin B12 was restudied in an attempt to establish the cause of his isolated defect of vitamin B12 absorption...

The Liver and the Antigens of Hepatitis B

A decade ago an antigen was identified by immunodiffusion and subsequently proved to be closely associated with hepatitis B virus. Further studies showed that hepatitis B virus circulates as a large particle containing a protein coat and a DNA core, and that excess coat particles are produced and circulate freely. Immunization with surface protein produced protective antibodies, and this led to the development of a prototype vaccine. Patients with hepatitis may develop a variety of extrahepatic manifestations, including polyarteritis, vasculitis, and glomerulonephritis. These associated symptoms may be due to immune complexes consisting of hepatitis B surface antigen and its antibody. The role of cellular immunity in hepatitis B is unknown. The relation between type B virus and the liver is both destructive (leading to severe acute hepatic disease and eventually to cirrhosis) and symbiotic (existing among carriers who have neither liver disease nor symptoms). If the factors that cause these divergent courses were delineated and understood, the results may lead to the prevention and cure of hepatitis B and its sequelae.