Subclinical pulmonary involvement in children with juvenile rheumatoid arthritis and systemic lupus erythematosus: Clinical, functional, high-resolution computed tomographic and laboratory findings

Early detection of collagen-associated pulmonary disease could have an important effect on prognosis and therapeutic strategies to prevent irreversible pulmonary damage. The aim of this study was to determine the prevalence and characteristics of pulmonary involvement in children with juvenile rheumatoid arthritis [JRA] and systemic lupus erythematosus [SLE] of less than 2-year duration and without prior clinical evidence of lung disease. Twenty-eight patients with JRA [18M and 1OF, mean age 10.3 +/- 2.8 years] and twenty with SLE [6M and 14F, mean age 12.9 +/- 3.1 years] and twenty age- and gender-matched controls were studied. Patients were evaluated using the following measures: clinical, pulmonary function testing [PFT], chest radiography [CXR], high resolution computed tomogram [HRCT], induced sputum cells, phospholipids [PLs] and surfactant protein-A [SP-A] concentrations were also measured in 19 JRA and 12 SLE patients. Results: Measurements of PFT and sputum cellular and biochemical variable were significantly different in study patients as compared to controls. Abnormalities in PFTs, CXR, HRCT and sputum cells and SP-A/PL in JRA were 21.4%, 0.0%, 32.2%, 52.6% and 31.6%, respectively; and in SLE were 30%, 10%, 45%, 54.8% and 33.3%, respectively. Restrictive pattern was the commonest PFT abnormality. PFT results correlated significantly only with age in JRA and with hematological data in SLE. HRCT findings correlated significantly in JRA patients with seropositve disease, high activity grade, and diminished diffusion lung capacity [DLCO], and in SLE with PFTs: FVC, FEVI,FEF25-75% and DLco. Neutrophic alveolitis was closely associated with HRCT changes, low DLco and low sputum SP-A values. Pulmonary changes in children with recent onset JRA and SLE are frequent. The significance of these changes is being determined in a longitudinal study

Bone mineral density and biochemichal markers in children with chronic liver disease

Metabolic bone disease is known to complicate chronic liver disease. The aim of the present study was to determine bone mineral density [BMD] and bone turnover in children with chronic liver disease [CLD] and to assess the possible correlations with the severity of liver disease. Thirty hospitalized children with CLD,14 males and 16 females, aged 2-14 years and twenty age- and sex - matched healthy controls were enrolled. BMD was measured by dual energy X-ray absorptiometry at the lumber spines. Serum levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone [PTH], osteocalcin and carboxy- terminal telopeptide of type I collagen [ICTP] were measured. The severity of liver disease was assessed using Desmet's modification of Knodell's histological activity index. BMD was significantly lower in patients than in controls and osteoporosis was found in 8 [27%] of the patients. BMD was significantly correlated negatively with severity of liver disease and positively with serum osteocalcin level. No correlation was found between BMD and calcium, phosphorus? alkaline phosphatase, PTH, and ICTP serum levels. Serum osteocalcin level was significantly lower and serum ICTP was higher but not statistically significant in patients than in controls. Serum calcium, phosphorus, and PTH values in patients did not differ from those of controls. Levels of osteocalcin, but not PTH and ICTP9 were significantly correlated inversely with severity of liver disease. Ascitic patients had significantly lower BMD and serum osteocalcin values than non-ascitic patients, and also had significantly higher serum levels of ICTP than the controls. The results of this study indicate that BMD is decreased in children with CLD that is related to the severity of liver disease. The biomarkers of bone turnover reflect that decreased bone formation, rather than increased bone resorption, is the major contributor of bone loss in these patients

Kinetics of eliminations of some ethyl 2-cyano-5-oxopentanoates

The rates of elimination were determined for the reaction of ethyl 2-cyano-5-oxo-5-phenyl-3-[p-substituted phenyl] pentanoates Ia-f, and ethyl 2-cyano-5-oxo-3-phenyl-5-[p-substituted phenyl] pentanoates Ig- k, with sodium ethoxide in absolute ethanol. The products were found to be the corresponding substituted propenones IIa-k. Linear free energy correlation was found to give a positive reaction constant [rho]. A mechanistic E1cB mode was suggested and the reaction transition state is of the carbanion character