Extraneural manifestations of chronic inflammatory demyelinating polyradiculoneuropathy
Article Abstract:
Inflammatory demyelinating polyradiculoneuropathies are nerve diseases in which inflammation and loss of the myelin sheath surrounding nerves (essential for normal function) leads to progressive weakness and loss of sensation. These diseases may be acute (AIDP; Guillain-Barre syndrome) or chronic (CIDP); the chronic form may be either relapsing or progressive. AIDP has been reported to cause complications outside the nervous system (extraneural), such as liver and kidney involvement and autoimmune disease (in which the body makes antibodies against its own molecules). Extraneural or systemic symptoms in CIDP are less common, and originally were thought to exclude CIDP from a patient's possible diagnoses. Among eight patients with CIDP who were examined between May and July of 1986, three had extraneural symptoms; these cases are described. Two of the patients had nephrotic syndrome, which affects the arteries supplying the kidney and causes proteinuria (protein in the urine, a sign of kidney disease), loss of protein from blood, and edema. The third patient had elevated levels of liver enzymes, indicative of liver damage, and proteinuria. Both neurological and kidney dysfunctions responded to treatment with combinations of prednisone (a steroid), therapeutic plasma exchange (replacement of the patient's blood with normal blood), and the immunosuppressive agent azathioprine. Patient improvement correlated with improved immunologic function, measured as diminished circulating immune complexes and the ratio of T4 to T8 lymphocytes. These cases suggests that similarities between AIDP and CIDP may be stronger than previously thought, and that a common mechanism may underlie these diseases. Further research concerning extraneural involvement in AIDP and CIDP is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Nonsteroidal anti-inflammatory drugs and antihypertensives
Article Abstract:
Over 40 million people in the United States have chronic arthritis suitable for treatment with non-steroidal anti-inflammatory drugs (NSAIDs; drugs such as aspirin, ibuprofen, and indomethacin); millions more take NSAIDs for nonarthritic conditions. NSAIDs have been shown to cause a variable increase in blood pressure, a side effect of particular concern for patients with hypertension (high blood pressure). This effect is seen both in normal individuals and patients with treated or untreated hypertension. The beneficial effects of antihypertensive medication can, in some cases, be countered by NSAID administration. It is estimated that 20 million individuals in the United States are taking both antihypertensives and NSAIDs, and that the incidence of clinically significant interaction between the drugs is about 1 percent, with elderly and black patients at highest risk. NSAIDs have been shown to diminish the effects of several classes of antihypertensives, including thiazide and loop diuretics, beta adrenergic receptor blockers, and angiotensin-converting enzyme (ACE) inhibitors. No effects have been shown on the antihypertensive actions of alpha-1 adrenergic blockers (which act through the central nervous system) or calcium channel antagonists (which prevent the uptake of calcium into smooth muscle cells in blood vessels, causing them to relax and thus lower blood pressure). High-risk hypertension patients receiving NSAIDs, particularly those receiving the antihypertensive medication known to be susceptible to NSAID modification, should be routinely monitored for the occurrence of interaction between the two drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Response to hepatitis B vaccine in Alaska natives with chronic alcoholism compared with non-alcoholic control subjects
Article Abstract:
Hepatitis B is an inflammation of the liver resulting from infection with the hepatitis B virus (HBV). The prevalence of HBV markers in the blood and response to hepatitis vaccine were compared between alcoholic and nonalcoholic Alaska natives. The subjects underwent blood testing for HBV markers, liver function tests, examination for liver disease. Sixty-four subjects were classified as alcoholics, and 60 were nonalcoholic. HBV markers were detected in 22 alcoholics and 7 nonalcoholics. Abnormal levels of the liver enzyme transaminase occurred more often in alcoholic patients than nonalcoholic subjects. Of the 95 subjects who tested negative for HBV markers, 72 received three doses of hepatitis B vaccine. The response to hepatitis vaccine was similar among all subjects. Four alcoholics and two nonalcoholics did not produce immune proteins (antibodies) to the hepatitis B surface antigen (HBsAG), a portion of the hepatitis B virus structure which provokes an immune response. The levels of anti-HBs antibodies were very low in two alcoholics and three non-alcoholics, and decreased with increasing age. The results show that HBV markers in the blood are prevalent among alcoholic Alaskan natives as compared with non-alcoholic Alaskan natives. In addition, alcoholics with blood tests negative for HBV responded well to hepatitis B vaccination. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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