Neuropsychiatric systemic lupus erythematosus and the syndrome of inappropriate secretion of antidiuretic hormone: a case report with very late onset systemic lupus erythematosus.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with neuropsychiatric lupus (NP-SLE) is rare. We report a case of SIADH associated with the new onset of SLE in an 88-yr-old female. The unique features of this case include the extreme age of onset of SLE presenting with neuropsychiatric manifestations and positive antiribosomal P antibody titres. Both the NP manifestations of SLE and SIADH were highly correlated with the SLE disease activity. This case illustrates a novel presentation of NP-SLE with SIADH which may develop due to antibody-mediated hypothalamic dysfunction.

Cardiovascular fitness in children with asthma correlates with psychologic functioning of the child.

Abnormalities in fitness in asthmatic children are assumed to derive from illness severity. We studied 90 children with moderately severe to severe but stable asthma for (1) fitness levels using bicycle ergometry, (2) measures of asthma severity, (3) clinician's impression of child (Child Global Assessment Scale), and (4) mother's rating of child's behavior (Child Behavior Checklist). Fitness values ranged from 15% to 120% of normal values for age, sex, and body surface area: 48% were abnormal (less than 2 SD below mean) and 5% were borderline (1 to 2 SD below mean). Associations between levels of fitness and medical and psychologic criteria were tested using regression analyses. Of the 11 medical variables used to define the severity of asthma, recent exacerbation of disease, forced expiratory volume in 1 second, and specific airway conductance together accounted for 8.1% of the variability in the workload ratios (ie, R2 = 0.081). The importance of the psychologic factors in determining the variability in the workload ratios was tested after the importance of the medical variables had been considered: Child Global Assessment Scale accounted for a significant amount of variability, improving the R2 to 0.180 (an increase to 0.100, P = .003). These data suggest that, within the spectrum of disease presented by the patients in this study, adjustment to the disease is at least as important as severity of disease in determining fitness.

Normalization of cardiopulmonary endurance in severely asthmatic children after bicycle ergometry therapy.

Sixty-five children with severe asthma were tested on a bicycle ergometer to determine their cardiopulmonary endurance and to determine whether they could achieve normal levels of endurance after a physical rehabilitation program. Workloads on entry into the study ranged from 12% to 222% (median 70%) of predicted. Abnormalities in cardiopulmonary endurance did not correlate with historical features commonly used to define severe asthma or degree of airways obstruction. Forty (58%) patients required further bicycle ergometry training two to five times per week: 32 had scores less than 2 SD below the mean, and eight had scores between 1 and 2 SD below the mean. No adverse side effects were encountered during either testing or training. Of the children with scores less than 2 SD below the mean, 84% achieved normal workloads within 2 to 17 weeks of hospitalization. Rates of improvement were similar in the 27 children who subsequently passed and the five children who did not pass, suggesting that duration of program participation was the most important variable in determining success. Thus severely asthmatic children with abnormal fitness levels can achieve normal cardiopulmonary fitness after training on the bicycle ergometer.