Prospective study of serum and urinary nitrate levels in patients with systemic lupus erythematosus

OBJECTIVE: To study prospectively whether serum and urinary nitrate levels are related to lupus activity. METHODS: Fifty patients with systemic lupus erythematosus (SLE) were studied prospectively for 2 yr. Every 4 months, the SLE Disease Activity Index (SLEDAI) was administered to the patients, and blood and 24 h urine samples were obtained; 88 healthy controls were also studied. Nitrate levels were measured by the Greiss method. Statistical analyses were performed using standard parametric and non-parametric tests, and analysis of serial measurements. RESULTS: Twelve patients suffered infections, 12 active nephritis and 17 episodes of non-renal activity. By analysis of serial measurements, serum and urinary nitrate levels did not correlate with SLEDAI. C-Reactive protein (CRP) levels, presence of infection and creatinine clearance weakly influenced nitrate levels. CONCLUSIONS: In SLE, serum and urinary nitrate levels do not parallel lupus activity. Other variables, related or not to SLE, seem to affect these levels.     

Increased serum CA125 levels in plasma cell dyscrasias

We describe two cases of malignant lymphoma presenting as inflammatory nodules of the leg and mimicking panniculitis clinically. In both cases the skin biopsies showed prominent involvement of the subcutaneous tissue by lymphoma cells. In addition, lymphoma cells invaded blood vessels in the dermis or the subcutaneous tissue. One case was characterized by predominantly extravascular and intravascular location of the lymphoma cells, and the other case by the predominantly extravascular and intramural location of lymphoma cells. These histological findings were compatible with those of angiocentric T-cell lymphoma but with some unusual features. Angiocentric T-cell lymphoma of the skin should be listed in the group of diseases which present as inflammatory nodules of the leg.     

Dehydroepiandrosterone in systemic lupus erythematosus: relationship between dosage, serum levels, and clinical response

OBJECTIVE: To examine in women with systemic lupus erythematosus (SLE) who participated in a clinical trial the relationship between daily dose of dehydroepiandrosterone (DHEA), serum levels of DHEA and DHEA sulfate (DHEAS), clinical effectiveness, and side effects. METHODS: Twenty-three women with mild to moderate SLE were treated with DHEA for a 6 month period. The starting dose was 50 mg/day, and monthly stepwise increases were allowed. Subjects were assessed monthly by the Systemic Lupus Erythematosus Disease Activity Index, Systemic Lupus Activity Measure (SLAM), Health Assessment Questionnaire, and other outcomes. Serum testosterone, DHEA, and DHEAS levels were obtained and side effects noted monthly. RESULTS: Statistically significant improvements were found in all lupus outcomes over 6 months. Serum DHEA and DHEAS levels correlated with the dose of DHEA. Serum DHEA and DHEAS correlated negatively with SLAM score. A second order regression analysis of serum DHEAS level versus SLAM score suggested that the optimal serum level of DHEAS was 1000 microg/dl. The most common side effect was acne. CONCLUSION: The clinical response to DHEA was not clearly dose dependent. Serum levels of DHEA and DHEAS correlated only weakly with lupus outcomes, but suggested an optimum serum DHEAS of 1000 microg/dl. Monitoring these serum levels appears to have limited clinical utility.     

Reduction of pleural fluid complement activity in patients with systemic lupus erythematosus and rheumatoid arthritis

In this paper the author gives a survey and a classification of 642 cases of narcolepsy and hypersomnia which he himself studied in the course of 26 years. 368 cases were classified as narcolepsy, 274 as hypersomnia. The author further classifies narcolepsies according to their etiology, clinical form and pathophysiological mechanisms of origin. Hypersomnias are divided by the author into the symptomatic and the functional groups. According to the author it is useful to distinguish "short cycle hypersomnia", i.e. those with short duration of sleep attacks (hours) and intervals, from "long cycle hypersomnia", i.e. those with long attacks (days or weeks) and intervals. The author goes on to describe different forms of symptomatic and functional hypersomnias, such as idiopathic hypersomnia, neurotic hypersomnia, the Pickwickian syndrome" and its variants as well as different varieties of periodic long cycle hypersomnias. Finally the author makes a brief mention of the syndrome of insufficiency of wakefulness.     

Anticardiolipin antibodies in serum and cerebrospinal fluid from patients with systemic lupus erythematosus

Anticardiolipin antibodies were studied in serum and cerebrospinal fluid from 32 consecutive patients with systemic lupus erythematosus, admitted for the assessment of neuropsychiatric disease. Ten of the 16 patients with active neuropsychiatric complaints showed positive anticardiolipin antibodies in cerebrospinal fluid, including eight with the simultaneous presence of antibodies in their sera. By contrast, only 2 of the 16 patients with headaches, lacking further data of neurological disease, revealed anticardiolipin antibodies in their cerebrospinal fluid. The assessment of Q-albumin index showed abnormal values in a subset of patients with active neuropsychiatric changes who showed positive cerebrospinal anticardiolipin antibodies, suggesting that an impairment of the blood brain barrier function may lead to a leakage of intrathecal antiphospholipid antibodies from systemic circulation. Additionally, few patients revealed normal Q-albumin values with high IgG-cerebrospinal fluid index suggesting increased intrathecal synthesis of autoantibodies. The study of anticardiolipin antibodies in cerebrospinal fluid was useful to detect active neuropsychiatric disease in systemic lupus erythematosus.     

Pulmonary involvement in systemic lupus erythematosus

BACKGROUND: We wanted to find out whether the borders of the blind spot depend on the surface topography of the optic disc and its surrounding area. PATIENTS AND METHODS: We therefore examined ten eyes with parapapillary atrophy adjacent to the temporal side of the disc. Fundus perimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. We examined the horizontal meridian of the optic discs in 0.5 degree steps using Goldmann IV-stimuli with 10 different degrees of brightness and the Goldmann stimulus 1, 0 dB (greatest luminance). Six eyes with symmetric, "normal" excavation served as controls. Optic disc topography was measured with the Heidelberg Retina Tomograph (HRT). RESULTS: Stimuli with a large luminance power (Goldmann IV, 4 dB) were seen up to 0.8 degree centrally (i.e., towards the optic disc center) from the temporal edge of the parapapillary atrophy, but up to 1.9 degrees centrally from the nasal optic disc border (P < 0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy. In all six subjects with a normally shaped disc there was no such "nasotemporal asymmetry." CONCLUSIONS: The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less "blind" than the shallow temporal part, probably due to more intensive light scattering by the prominent nasal part of the disc.     

Defective phagocytosis in systemic lupus erythematosus

The authors describe a case of traumatic retinal dialysis with retinal detachment from a water balloon slingshot during a "water balloon war." A 31-year-old woman presented with decreased visual acuity in her right eye 2 days after being hit by a water balloon. The visual acuity in the right eye was counting fingers and fundus examination showed subtotal retinal detachment secondary to a superonasal dialysis. The patient underwent a scleral buckling procedure with external drainage, and at 18 months visual acuity was stable at 20/50 with attached retina. Water balloon eye injuries can result in permanent visual loss. More public awareness needs to be created regarding the potential harmful effects of this commonly used "toy."     

Body composition in systemic lupus erythematosus

Bovine enamel is commonly used in enamel bonding studies, therefore, a familiarity with some aspects of bovine enamel bonding are important in order to evaluate the studies. Bovine enamel has the advantages of easy attainability and similar microstructure to human enamel. In this study the strength of the enamel bond using an orthodontic adhesive was compared between deciduous bovine, permanent bovine, and human enamel, as well as, the effect on bond strength of multiple rebonding to bovine enamel. This study found that the bond strength to bovine enamel was 21% to 44% weaker than to human enamel, and the bond strength to deciduous bovine enamel was significantly greater than to permanent bovine enamel. Either all deciduous or all permanent bovine incisors should be used, or permanent and deciduous bovine incisors evenly distributed in sample groups. Bovine enamel was rebonded five times without significantly affecting bond strength, thus, bovine enamel can be reused in bonding studies without significantly affecting the results.     

Coronary involvement in systemic lupus erythematosus

BACKGROUND: Coronary artery disease is an uncommon event in lupus erythematosus. The mechanisms responsible for coronary occlusion are probably complex and intermixed. We report three patients with lupus erythematosus and antiphospholipid antibodies who had coronary artery disease diagnosed with coronary angiogram. OBSERVATION: Coronary artery disease occurred in three young patients aged from 21 to 35 years 3 to 11 years after the onset of lupus. They all had antiphospholipid antibodies. They had been treated with corticosteroids for 6 to 36 months. Two of them were smokers. Angiograms showed coronary occlusion two patients while the third one had probable myocardial microvasculopathy. The lupus was quiescent in all cases when coronary artery disease occurred. DISCUSSION: Antiphospholipid antibodies associated with smoking may be involved in the pathogenesis of coronary artery disease in these 3 patients.