Erythema nodosum associated with antiphospholipid antibodies: a report of three cases.

Erythema nodosum is a dermatologic condition characterized by painful, erythematous nodules on the anterior surfaces of the lower extremities. Its association with a variety of conditions has been previously described. We present three cases of erythema nodosum in patients with elevated anticardiolipin antibodies. In one patient, a temporal relationship was seen in the simultaneous detection of antibodies and skin lesions. We propose an association between erythema nodosum and the antiphospholipid antibody syndrome (APS).

Long-term results of endoscopic balloon dilatation for gastric outlet obstruction.

Endoscopic balloon dilatation has been used for more than 10 years for the treatment of peptic gastric outlet obstruction. Long-term outcomes in series from tertiary centers have shown a high rate of failure in several studies. We reviewed a series of patients treated with balloon dilatation in a community hospital to evaluate the effectiveness in this procedure and factors that would affect success rate. Forty consecutive patients who had successful initial balloon dilatation for benign gastric outlet obstruction were followed for at least two years or until death or surgical therapy occurred. Data were obtained from the gastrointestinal laboratory log book, hospital, and office records. Patients were also interviewed by telephone. Twelve patients had relief of obstruction by initial dilatation. The remaining 28 patients developed recurrent symptoms and 12 in this group eventually required surgery. Factors predicting referral for surgery included younger age, need for multiple procedures, technical failure of dilatation in four patients, and long duration of treatment course. Eradication of Helicobacter pylori was associated with successful relief of obstruction without surgery, whereas continued use of nonsteroidal antiinflammatory drugs was associated with recurrent obstruction. In the community hospital, endoscopic treatment is safe and is usually successful in relieving benign gastric outlet obstruction. Repeat dilation is often needed and long-term success will be improved by elimination of H. pylori infection and nonsteroidal antiinflammatory use.

The transcriptional activator Sp1, a novel autoantigen.

OBJECTIVE: To identify one nuclear autoantigenic protein within a complex of DNA binding proteins that bind to GC-rich sequences in Epstein-Barr virus and cellular DNA, and to describe the clinical characteristics of patients whose sera contained autoantibodies to this novel autoantigen. METHODS: Antibodies to autoantigen Sp1 were initially measured by an electrophoretic mobility shift assay to detect DNA binding proteins. Nuclear extracts and purified Sp1 protein were used in these assays. Recognition of the autoantigen by autoimmune sera was confirmed by immunoprecipitation and immunoblotting. RESULTS: The autoantigen was identified as Sp1. Anti-Sp1 was detected in sera from 8 (3%) of 230 patients. These sera contained antinuclear antibodies, but lacked antibodies to double-stranded DNA or to several extractable nuclear antigens. The patients whose sera contained antibodies to Sp1 were white women with fatigue, arthritis, Raynaud's phenomenon, malar rash, and photosensitivity. CONCLUSION: Sp1 is the first described example of an RNA polymerase II transcription activator as an autoantigen. The presence of Sp1 autoantibodies is associated with undifferentiated connective tissue disease.