Characteristics of tumor necrosis factor production in rheumatoid arthritis.

The biological effects of tumor necrosis factor (TNF) include the enhancement of fibroblast proliferation, the secretion of collagenase and prostaglandin E2 (PGE2) by fibroblasts, and the resorption of bone and cartilage, suggesting a role for this cytokine in arthritic conditions. To investigate this, we measured the levels of TNF in synovial fluids and evaluated its secretion by synovial fluid mononuclear cells and tissues from patients with rheumatoid arthritis, osteoarthritis, and seronegative arthritis and normals. TNF was found to be secreted in all arthritic conditions but not in normals.

The relationship between borderline personality disorder and anxiety disorders.

Eleven "pure" borderlines, ten borderlines with depression, 16 "pure" depressives, and 31 normal subjects were compared on a number of standardized inventories of anxiety. While patient groups experienced more anxiety of all types than did normals, borderlines did not emerge as more anxious than other patient groups. Qualitative differences in the anxiety experienced by borderlines and nonborderlines are discussed.

[Psychiatric approach to problems of pain].

The problem of pain is presented from a liaison-psychiatric point of view. Pain is a frequent symptom of medical illness but may also be a manifestation of a psychiatric disorder or a psychological condition, as in the somatization of affect. Pain is not only a symptom but also a set of behaviors, an expression of personality traits, and a personal way of coping.

Spontaneous atlantoaxial subluxation: an unusual presenting manifestation of Reiter's syndrome.

A male Sikh presented with spontaneous neck pain. Plain cervical radiography showed gross atlantoaxial subluxation (AAS). Computed tomography showed soft tissue anterior to a subluxed odontoid peg.

Epidermoid and cholesterol cysts in the apex of the petrous bone.

Cystic lesions in the petrous apex are nearly always either epidermoid cysts, with a soft but solid content, or cholesterol cysts, containing brown fluid. They may be symptomless, produce progressive cranial nerve palsies or, occasionally, reach the CSF pathways thus leading either to meningitis or a CSF leak. Thirteen cases and four unverified cases have been encountered amongst a series of more than 500 cerebellopontine angle tumours.

Prostaglandins, H2-receptor antagonists and peptic ulcer disease.

Peptic ulcer develops when offensive factors overwhelm defensive processes in the gastroduodenal mucosa. Offensive factors include NSAIDs, hydrochloric acid-peptic activity, bile reflux, and some products of the lipoxygenase pathway such as leukotriene B4; whereas defensive processes are largely mediated by prostaglandins through poorly understood mechanisms uniformly termed cytoprotection. Cytoprotection, a physiological process working through the products of arachidonic acid metabolism, may result from the net effect of the protective actions of prostaglandins versus the damaging actions of leukotrienes.

Cementing technique and the effects of bleeding.

We report the results of simple laboratory experiments which showed that bleeding pressures known to occur at the bone surface during total hip arthroplasty may compromise the integrity of the bone-cement interface and the cement itself. Such undesirable effects can be prevented by maintaining adequate pressure on the cement until its increased viscosity can resist displacement caused by the bleeding pressure.

Biomechanical evaluation of various forms of fixation of transverse patellar fractures.

A study was undertaken to evaluate the strength and ease of application of four different forms of patellar fracture fixation. Modified tension band, screw fixation, Lotke longitudinal anterior band (LAB), and Magnusson wiring were examined using a Materials Testing System. Using cadaver lower extremities, the tibia was mounted in a fixed base and the tibiofemoral joint was fixed at 36 degrees.

Normative data of hemoglobin concentration and free erythrocyte protoporphyrin in a private pediatric practice.

Free erythrocyte protoporphyrin (FEP) and hemoglobin concentrations in 788 children were investigated during routine check-ups in a private pediatric practice. FEPs greater than 3.0 ZPP/gm hemoglobin were found in 29.

Renal disease associated with toluene inhalation.

A 32-year old woman developed severe quadriparesis, hypokalemia, and distal renal tubular acidosis following paint sniffing for one week. A review of literature indicated that a spectrum of renal diseases may develop in association with inhalation of toluene-containing substances. Toluene inhalation should be considered in the differential diagnosis in any young patient who presents with an unexplained renal disorder.

Irreducible lateral dislocation of the patella: a case report.

Acute lateral dislocation of the patella is a common clinical entity. The dislocation often reduces spontaneously or with the assistance of the patient or someone in attendance at the time of the injury. Very occasionally the patient presents to an emergency room with the patella still dislocated, and it is usually easily reduced at that time without an anesthetic by a physician.

Sudden death of a champion athlete. Autopsy findings.

We report the autopsy findings after the sudden death of a champion swimmer. The athlete was asymptomatic and had only recently retired from a sport in which he had been the South African captain for 4 years and the national record holder in the 400 m medley event. He died suddenly shortly after returning from a 5 km run.