Proteinaceous lymphadenopathy in a patient with known rheumatoid arthritis--case report and review of the literature.

We describe a case of proteinaceous lymphadenopathy (also called lymph node hyalinosis) in a 30-yr-old woman with known rheumatoid arthritis (RA). Amyloidosis was excluded by negative staining with congo red viewed with and without polarized light. Proteinaceous lymphadenopathy should be included in the differential diagnosis of patients with lymphadenopathy and long-standing RA. The histopathologist should be familiar with the morphological appearances of this condition, which can be confused with amyloidosis. It appears that there is a good clinical response in RA-associated proteinaceous lymphadenopathy following successful treatment of arthritis.

Systemic lupus erythematosus flare-up manifesting as a cilioretinal artery occlusion.

In this report we describe a patient with systemic lupus erythematosus who was clinically stable after treatment with the antimalarial drug chloroquine and pulse cyclophosphamide therapy. Three months after the discontinuation of chloroquine, the patient developed cilioretinal artery occlusion that was the only the manifestation of a clinical flare-up without evidence of clinical disease activity elsewhere. This case report confirms the clinical belief that the antimalarial agents can maintain the clinical quiescence of systemic lupus erythematosus and its discontinuation is associated with an increase in the risk of clinical flare-up.

Syndrome of camptodactyly, arthropathy and coxa vara (CAC syndrome).

Three Saudi children (two female, one male) are described who presented with familial arthropathy associated with congenital camptodactyly. This rare but recognized clinical entity has a variable clinical presentation and may be associated with pericarditis and coxa vara. Camptodactyly was observed in the neonatal period in all patients, while joint swelling was observed between the third and 11th month. Pericarditis was suspected in the referral hospital in one patient but was not subsequently confirmed at our institution, raising the possibility that pericarditis may be reversible. Radiological examination of the hips showed coxa vara with short femoral neck in all patients. Synovial biopsy in the three patients revealed proliferating synovial epithelium with moderate fibrocollagenous densities and multinucleated giant cells, occasional lymphocytes or neutrophils but no plasma cells were identified. This is the first series of this familial arthropathy with a triad of camptodactyly, arthropathy and coxa vara (CAC syndrome) in Saudi Arabia which is to be considered in patients where more than one family member has juvenile arthritis.

The effect of colestipol and cholestyramine on ibuprofen bioavailability in man.

The purpose of this study was to determine whether a concomitant single oral dose of one of the anion exchange resins colestipol hydrochloride (10 g) or cholestyramine (8 g) administered with ibuprofen (400 mg) would alter the bioavailability of this non-steroidal anti-inflammatory agent. The study was performed according to a randomized three-way crossover design in six healthy male volunteers. After dosing, serial blood samples were collected for a period of 10 h. Plasma harvested from blood was analysed for ibuprofen by a sensitive high-performance liquid chromatographic method. There were no significant differences between colestipol treatment and control for peak plasma concentration (Cmax), time to peak concentration (Tmax), area under the plasma concentration-time curve (AUC), mean residence time (MRT), elimination rate constant (Kel), or elimination half-life (t1/2). Cholestyramine treatment resulted in a significant decrease in AUC (26%, p < 0.05) and Cmax (34.4%, p < 0.01) and a significant increase in Tmax (80%, p < 0.01) and MRT (20.2%, p < 0.05). Cholestyramine administration showed no significant effect on the Kel and t1/2 values. A significant correlation was obtained between the increase in MRT and the increase in Tmax. The confidence intervals (90%) of the mean values of the pharmacokinetic parameters (AUC0-infinity and Cmax) for the colestipol: control ratio were well within the acceptable range of 100 +/- 20, whereas those for the cholestyramine: control ratio were outside it. Colestipol treatment was found to be bioequivalent to the control treatment by Schuirmann's two one-sided t tests, while cholestyramine treatment was found to be bioinequivalent.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of cholestyramine and colestipol on the absorption of diclofenac in man.

The effect of oral administration of the non-absorbable anion-exchange resins cholestyramine and colestipol hydrochloride on the absorption of diclofenac in man was studied. Adsorption studies in vitro were also performed. In a randomized crossover study consisting of three phases, single doses of water suspensions of colestipol hydrochloride (10 g), or cholestyramine (8 g), or water only were given to six healthy male volunteers immediately following ingestion of diclofenac (100 mg). After dosing, serial blood samples were collected for a period of 8 hours. Plasma harvested from blood was analyzed for diclofenac by a sensitive and accurate high-performance liquid chromatographic method. The area under the plasma concentration-time curve was moderately (33%, p < 0.05) reduced by colestipol, and greatly reduced (62%) by cholestyramine. The maximum plasma concentration was reduced (58%) by colestipol and even more (75%) by cholestyramine treatment. The in-vitro adsorption studies showed that colestipol has a weaker capacity for adsorption of diclofenac compared to cholestyramine. The in-vivo data suggest a reduction of diclofenac bioavailability when colestipol or cholestyramine is administered concomitantly.

Seasonal variation of culture positive brucellosis at a major teaching hospital.

Brucellosis is one of the main zoonoses in the world. In Saudi Arabia, it was recognized as a major health problem in 1983G and since then many measures have been implemented to control the disease. We conducted a study to determine the yearly incidence and seasonal variation of blood culture positive brucellosis (Brucella cases) diagnosed at King Khalid University Hospital (KKUH) in Riyadh between 1985G and 1991G. The results showed that there was a fivefold decline in the incidence of Brucella cases over the seven years of the study from 8.6 cases/1000 admissions in 1985G to 1.4 cases/1000 admissions in 1991G. The disease showed a prevalence that extended throughout year with the majority of cases occurring during spring, summer and early fall. The possible reasons for the seasonal variation and decreasing incidence of brucellosis noted in this study are discussed.

Pregnancy outcome in women with antiphospholipid antibodies.

The association of antiphospholipid antibodies (APA) or lupus anticoagulant (LA) and recurrent fetal loss (RFL) is well established; however, the spectrum of pregnancy outcome in relation to various therapeutic approaches versus placebo is unknown. We studied 49 women with RFL, 14 with immune thrombocytopenia (ITP) 13 of whom without a history of RFL, and 32 controls (all in the first trimester of pregnancy) for the presence of APA. Tests for APA were positive in 15/49 women with RFL (30%), 6/14 ITP (43%) and 2/32 controls (6%). Treatment in the APA positive patients consisted of: no treatment for the 8 patients who had no history of RFL (Group A; all 34 previous pregnancies successful), aspirin alone (Group B, 5 patients; all 30 previous pregnancies unsuccessful), aspirin with prednisolone (Group C, 9 patients; 69/80 previous pregnancies unsuccessful), or aspirin, prednisolone and immunoglobulin G for resistant cases (Group D, 4 patients, previously in Group C). 10/11 (90.9%), 3/7 (43%), 7/13 (53.8%) and 4/7 (57.1%) pregnancies were successful in Group A, B, C and D, respectively. There was a total of 19/45 (42%) failures including 3 pregnancies in one patient who failed to respond to all forms of therapy. This open study with small subgroups of patients draws attention to a wide range of pregnancy outcome in women with APA and to the fact that APA may serve only as a marker for a wide range of pathological conditions with variable degrees of disease severity. More studies are, however, needed to explore the real mechanism of RFL in women with APA and RFL, especially those who are resistant to therapy.

Enteric fever due to multi-resistant Salmonella typhi.

Five cases of enteric fever due to multi-resistant Salmonella typhi are reported. Four of these patients most probably contracted the disease in India and the fifth in Egypt. All of them were successfully treated either with ceftriaxone or ciprofloxacin.

Prevalence of pathogenic intestinal parasites among preschool children in Al-Medina district, Saudi Arabia.

The prevalence of pathogenic intestinal parasites among preschool children in Al-Medina district, Saudi Arabia, was determined through a randomized multistage sampling of 8000 preschool children. Duplicate specimens from each child were examined using a simple sedimentation technique. The overall prevalence of intestinal parasites among children screened was 18.4%. The most common parasite isolated was Giardia lamblia (14.5%). This was followed by Entamoeba histolytica (2.7%), Enterobius vermicularis (1.4%), Ascaris lumbricoides (1.0%) and others. Out of the 1462 children positive for parasites, 183 (12.5%) had mixed parasitic infections. Prevalence among preschool children was highly associateed with older age, rural residence, non-municipal water supply, inadequate latrine type, low level of parental education, abdominal pain, and diarrhea.

Abnormalities of T cell subsets in Behcet disease.

T cells and T cell subsets were studied in the peripheral blood of 18 patients with Behcet disease (8 active and 10 inactive) and 20 healthy controls. When the active disease group was compared with the inactive disease group and the control group, there was a significant increase (85.7% versus 71.3% and 69%) in the mean percentage of T cells for the active disease group. The mean percentage of CD4 cells for the active disease group (36%) was also significantly decreased from the mean value of the inactive disease group (36%) was also significantly decreased from the mean value of the inactive disease group (41%) and the controls (40%). There was a concomintant significant increase of CD8 cells of the group with active disease (43%) over the mean value for the group of inactive disease (32%) and controls (33%). These results indicated that there were alterations of T cells and T cell subsets in Behcet disease. In contrast to other studies, we found that the T cell number increased with disease activity in our patients; but the significance of single measurement of T cell number increased with disease activity in our patients; but the significance of single measurement of T cell subsets in a course of chronic disease must be taken into consideration.