ABSTRACT
Lyme disease has been reported in Minnesota since 1980. Until now, it has not been regarded as endemic in Olmsted County. We reviewed the medical records of all 68 cases of Lyme disease diagnosed in residents of Olmsted County for 1980-1990. Only 17 of the 68 cases met Centers for Disease Control surveillance criteria for definite Lyme disease (13 men, 4 women). Of these 17 cases, 3 were likely acquired in Olmsted County. The age and sex adjusted incidence rate was 2.3/100,000 (95% CI 1.1-3.4). Although reporting of Lyme disease is mandatory in Minnesota, only 7 suspected or definite cases were actually reported to public health officials. Of these, 4 met the case definition. In this population Lyme disease was both over-diagnosed and underreported. This observation questions current data and could have important health policy implications if confirmed nationally.
Subject(s)
Lyme Disease/epidemiology , Adolescent , Adult , Aged , Blotting, Western , Child , Child, Preschool , Enzyme-Linked Immunosorbent Assay , Female , Humans , Incidence , Male , Middle Aged , Minnesota/epidemiologyABSTRACT
We conducted a prospective study of captopril therapy in patients with scleroderma and combined hypertension and renal insufficiency. In all seven patients studied during a 1-year period, control of blood pressure was achieved, and in six of the seven, renal function stabilized or improved. The total daily dosage of captopril ranged from 32 to 100 mg, divided into doses taken every 6 to 8 hours. Although one patient had a suspected captopril-induced rash for a short time, none of the other patients had any adverse side effects. Renal biopsies were performed in six patients; in three of them, specimens were obtained both at the beginning and at the end of the study. The initial biopsy specimens showed changes that were similar to those described in other reports. Findings on repeat biopsies were unchanged except for evidence of chronicity. In the six patients with controlled blood pressure and improved or stabilized renal function, the improvement was maintained for 1 1/2 to nearly 3 years on this drug therapy. Using specific measurements of skin compliance and vascular blood flow in the upper extremities, we could detect no evidence, however, of concomitant improvement in these other features of the disease. Although the blood pressure was controlled with captopril, one patient had progressive skin induration, one had progressive pulmonary insufficiency, and another had progressive renal failure.
Subject(s)
Captopril/therapeutic use , Hypertension, Renal/drug therapy , Scleroderma, Systemic/drug therapy , Adult , Aged , Captopril/adverse effects , Female , Humans , Hypertension, Renal/blood , Hypertension, Renal/pathology , Kidney Diseases/blood , Kidney Diseases/drug therapy , Kidney Diseases/pathology , Male , Middle Aged , Prospective Studies , Renin/blood , Scleroderma, Systemic/pathology , Skin/pathologyABSTRACT
In a randomized, double-blind, controlled study, 28 patients with early scleroderma received dipyridamole (225 mg/day) and aspirin (975 mg/day) or placebo for 1-2 years. No significant clinical or objective laboratory improvement was noted in either group. Platelet survival time, plasma renin activity, and coagulation tests were not predictive of disease course. Biomechanical and vascular tests of the hands correlated with clinical extent of skin induration and presence of finger ulcers, respectively.
Subject(s)
Aspirin/administration & dosage , Blood Platelets/drug effects , Dipyridamole/administration & dosage , Scleroderma, Systemic/drug therapy , Aspirin/therapeutic use , Biomechanical Phenomena , Blood Coagulation/drug effects , Clinical Trials as Topic , Dipyridamole/therapeutic use , Double-Blind Method , Drug Therapy, Combination , Fingers/physiopathology , Humans , Movement , Scleroderma, Systemic/blood , Scleroderma, Systemic/physiopathology , Skin/physiopathologyABSTRACT
A system was developed to evaluate the hand function of patients with scleroderma objectively in terms of joint contracture, range of movement, dexterity, strength, and skin compliance. Twelve patients with progressive systemic sclerosis were evaluated using this technique to determine the effectiveness of classic physical therapy methods. A statistically significant improvement in hand function was found after a single physical therapy treatment. This conservative mode of treatment may contribute to improved hand function in patients with scleroderma.
Subject(s)
Hand/physiopathology , Physical Therapy Modalities , Scleroderma, Systemic/physiopathology , Biomechanical Phenomena , Female , Humans , Male , Scleroderma, Systemic/therapyABSTRACT
A patient with blue-gray discoloration of the skin of her face, neck, and hands is described. She was a patient with rheumatoid arthritis who had received a large total cumulative dose of gold. Light microscopy of skin biopsy tissue from the forehead revealed deposits of heavy metal in macrophages. On electron microscopy, the particles were found in the lysosomes of the cell. X-ray microanalysis confirmed the presence of gold. This condition, which is called chrysiasis, may be incorrectly diagnosed as cyanosis.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Aurothioglucose/adverse effects , Gold/adverse effects , Pigmentation Disorders/chemically induced , Female , Humans , Microscopy, Electron , Middle Aged , Pigmentation Disorders/pathologySubject(s)
Arthritis, Rheumatoid/immunology , T-Lymphocytes/immunology , Animals , Humans , Immune Adherence Reaction , SheepABSTRACT
An atraumatic method for measuring digital capillary blood flow with(133)xenon is described here. It has the advantage of not requiring the handling of xenon in the gaseous phase, and is a comfortable procedure for the patient. A study of rheumatoid patients without overt vaculitis, and controls showed similar values, suggesting that despite digital deformities, the digital blood flow of the usual rheumatoid is adequate.
