Progressive multifocal leukoencephalopathy resembling central nervous system systemic lupus erythematosus

OBJECTIVE: The purpose of this paper is firstly to highlight the ease with which the antegrade balloon aortic valvuloplasty can be performed with the Inoue balloon and secondly, the utility of the Inoue rubber nylon self-positioning balloon catheter used for twin valve dilatation. STUDY DESIGN: Percutaneous balloon valvuloplasty is being increasingly practised for treatment of multivalvular stenoses. We describe the case of a young (21 years), male who successfully underwent combined dilation of rheumatic mitral and aortic stenosis via the transseptal antegrade approach using Inoue balloon catheters for both valves. RESULT: Following the procedure, the mitral valve area increased from 0.6 cm2 to 1.7 cm2 and the peak systolic gradient across the aortic valve decreased from 100 mm Hg to 8 mm Hg without causing significant regurgitation at either. CONCLUSIONS: This report highlights the ease of performing balloon aortic valvuloplasty via the antegrade transvenous route and utilizing the advantages of Inoue balloon catheter.     

Central retinal vein occlusion complicating systemic lupus erythematosus

Retinal lesions occur in 25 to 30% of patients with systemic lupus erythematosus (SLE). Visual loss, however, is rare. A patient who developed central retinal vein occlusion and blindness during the course of active SLE is described. The pertinent literature is reviewed with attention to possible pathophysiologic mechanisms.     

Depressive symptoms in patients with systemic lupus erythematosus: association with central nervous system lupus and Sj?gren's syndrome

OBJECTIVE: To determine if patients with systemic lupus erythematosus (SLE) with depressive symptoms differ in regard to organ involvement and serological activity from other patients with SLE. METHODS: Disease manifestations were compared between 71 patients with SLE with a history of depressive symptoms and 278 patients without a history of depressive symptoms by univariate analysis and multiple logistic regression. RESULTS: Both univariate and logistic regression analysis revealed an association of depressive symptoms with neuropsychiatric lupus and secondary Sj?gren's syndrome (SS). Patients with neuropsychiatric lupus had an adjusted odds ratio of 3.43 (95% CI 2.55, 4.63; p = 0.00005), and patients with secondary SS had an adjusted odds ratio of 2.97 (95% CI 2.08, 4.25; p = 0.0006) for depressive symptoms. No other organ involvement or serological abnormality was associated with depressed mood. CONCLUSION: These discrete associations of depressive symptoms with neuropsychiatric lupus and secondary SS suggest that depression does not occur purely as a response to social stresses, and may be a manifestation of autoimmune disease in some patients.     

Analysis of cognitive and psychological deficits in systemic lupus erythematosus patients without overt central nervous system disease

OBJECTIVE: To examine cognitive and psychological functioning in relation to antiribosomal P protein autoantibodies in patients with systemic lupus erythematosus (SLE) who had no previous history of central nervous system disease (non-CNS SLE). METHODS: Comprehensive neuropsychological and psychological tests were administered to 51 non-CNS SLE patients, 29 rheumatoid arthritis (RA) patients, and 27 healthy controls. RESULTS: Twenty-nine percent of the non-CNS SLE patients, 31% of the RA patients, and 11% of the control subjects were classified as cognitively impaired. Similar reductions in intelligence, attention, and fluency were detected in the non-CNS SLE and RA patients compared with controls. The non-CNS SLE patients showed a distinct deficit in learning compared with the RA and control groups. Forty-two percent of the non-CNS SLE patients demonstrated psychological distress, compared with 7% of the RA patients and 6% of the controls. In the patient groups, neither cognitive dysfunction nor psychological distress was associated with disease activity or prednisone dosage. Elevated serum levels of autoantibodies to ribosomal P protein were not associated with either psychological or cognitive abnormalities. CONCLUSION: These results suggest that certain cognitive deficits in non-CNS SLE patients may not be specific to the immunopathology of SLE. In contrast, it is possible that deficits in learning, as well as psychological distress without major psychiatric pathology, may be subtle manifestations of CNS lupus.     

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.