Robert P. Sheon

Immunosuppressive Drugs and Acute Leukemia

Excerpt To the editor: The introduction of cytotoxic drugs in the treatment of connective tissue disease has raised concern about the induction of hematologic and other malignancy in these patients...

Malignancy in rheumatic disease: interrelationships.

Patients with inflammatory arthritis and malignancy comprise two distinct populations. One group represents the chance occurrence of malignancy and rheumatic disease. These patients have symmetric polyarthritis, chiefly classic rheumatoid arthritis, and react positively to the rheumatoid factor test. There is no temporal relationship between tumor onset and rheumatic disease onset. In the second group, there may be a causal relationship between the malignancy and the rheumatic disease. These patients have asymmetric rather than symmetric arthritis and test results are negative for rheumatoid factor. There is a close temporal relationship between the onset of the tumor and the onset of the rheumatic disease. The mortality rate is significantly higher than in patients with symmetric polyarthritis. In 80 percent of women with asymmetric arthritis and malignancy, the tumor is mammary carcinoma. This indicates the advisability of a careful breast examination in this group of women.

Medico-Chirurgical Transactions A Cardiovascular Cluster

A cluster of papers, important to the history of cardiology and cardiovascular surgery, that were published in volume 1 of Medico-Chirurgical Transactions (1809), are discussed. These include articles by Sir Astley Cooper on ligature of the common carotid artery for aneurysm, John Abernethy on mitral stenosis, and Sir David Dundas on acute rheumatic carditis.

A joint-protection guide for nonarticular rheumatic disorders.

PreviewA burly house painter in his early 30s sees a physician because of persistent pain in his shoulder, which he injured some weeks ago during a rough touch football game. On the surface, it may seem to be an open-and-shut case diagnostically and therapeutically. Not so, according to Dr Sheon. In such cases, he recommends that the physician delve into the patients home, work, and leisure activities to unearth aggravating factors that are perpetuating what otherwise would be a self-limiting condition. In his joint-protection guide, he describes corrective measures that can alleviate the harmful effects of such factors.

1. An overview of the problem and the patients

PREVIEWAssembly-line workers, house painters, and many others whose activities entail repetitive motions can end up with swelling, pain, and limited movement in the affected muscles. Often, use of the six steps described in this article brings fairly rapid functional improvement and prevents recurrences, with a minimum of medical intervention. In some cases, though, recovery is prolonged or the outcome is unusual. The authors present additional factors to consider in such cases, such as psychosocial concerns, worker fraud, and ergonomic problems. Part 2 of this article, beginning on page 72, details six common repetitive strain injuries.