23 patients with proven pseudolupus-syndrome were observed over a period of five years; titers of specific antimitochondrial antibodies (AMA) were tested in a follow-up study after the last intake of Venopyronum-Dragees (VPD), a drug combination of plant glycosides, horse-chestnut extracts and phenopyrazone. Cellular immune reactions against the eliciting drug, depended on the date of the acute phase and were examined in two patients after reexposure. High titers in the acute phase decreased rapidly in most of the cases within the first six months. After reexposure with VPD, AMA rose within three days up to the five fold compared with the initial titer. Only the analgetic component of VPD, phenopyrazone, was able to induce a significant increase of AMA-titer after reexposure. A specific cellular sensitivity to this substance could be demonstrated by lymphocyte stimulation in the presence of a phenopyrazone containing drug preparation. There was no chronic course of the disease; clinical exazerbation could be observed only after new intake of the drug. The analysis of drug history shows, that other pyrazolone containing drugs may also be able to induce a pseudolupus-syndrome.
Sera from 550 patients with primary biliary cirrhosis were tested by ELISA and the complement-fixation test (CFT) for the antimitochondrial antibodies (AMA) anti-M2, anti-M4, anti-M8 and anti-M9. Four profiles were defined and correlated with morphological and biochemical criteria - A: only anti-M9 positive by ELISA; B: anti-M9 and (or) anti-M2 positive by ELISA; C: anti-M2, anti-M4 and (or) anti-M8 positive by ELISA; D: anti-M2, anti-M4 and (or) anti-M8 positive by ELISA; D: anti-M2, anti-M4 and (or) anti-M8 positive by ELISA and CFT. Liver biopsies were obtained in 385 patients. Analysis of histological stage at the time of first serological testing revealed PBC stages I/II or only nonspecific lesions in all group A patients and in 90% of group B patients, while 49% of patients in group C and 59% of those in group D had stage III/IV or had histological features of chronic active hepatitis or "mixed form". Levels of alkaline phosphatase and GPT were significantly higher in groups C/D than groups A/B patients (P less than 0.05), and bilirubin and IgG levels were more frequently elevated in the former groups of patients (P less than 0.05). It is concluded that classification of PBC into AMA profiles may help in identifying patients at high or low risk of progression of the disease.
Übersichten Glossar ACTH = Adrenokortikotropes Hormon ANS = Autonomes Nervensystem aMSH = ALPHA-Melanozyten stimulierendes Hormon AVP = Arginin-Vasopressin CRH = Corticotropin releasing Hormon FSH = Follikelstimulierendes Hormon HPA = Hypothalamus-Hypophysen-Nebennieren-Achse HPG = Hypothalamus-Hypophysen-Gonaden-Achse HPS = Hypothalamus-Hypophysen-Wachstums-Achse HPT = Hypothalamus-Hypophysen-Schilddrüsen-Achse LC = Locus coeruleus LH = Luteiniserendes Hormon LHRH = Luteinisierendes Hormon Releasing Hormon NE = noradrenerge Neurone NFG = Nerve growth Factor NPY = Neuropeptid Y PVN = paraventrikulärer Nukleus VIP = vasoaktives intestinales Peptid VIP vasoaktives intestinales Peptid Definition Ein Charakteristikum funktionell-somatischer Störungen ist die Vielfalt vegetativer, funktioneller und psychischer Symptome ohne eindeutige Hinweise auf deren Ursachen. Die Diagnose setzt also den Ausschluss von Krankheiten voraus, die mit ähnlichen relevanten Symptomen einhergehen. Insofern stellt ihre Differenzialdiagnose ein interdisziplinäres Problem dar (5). Rheumatologisch-autoimmune sowie endokrinologische, aber auch infektiöse und tumoröse Prozesse sollten in erster Linie ausgeschlossen werden. Nicht selten vergehen Jahre, bevor die richtige Diagnose gestellt wird, und die Frequenz der Arztbesuche ("doctor's shopping") kann erheblich sein. Ein Grund dafür könnte in dem Umstand liegen, dass diese Patienten, ausgehend von ihren Hauptbeschwerden, zuerst den dafür zuständigen Spezialisten aufsuchen, der vor allem den Organ-bezogenen Befund differenzialdiagnostisch abzuklären versucht, dagegen dem breiten Spektrum der damit assoziierten funktionellen Störungen zu wenig Beachtung schenkt. So gehört es zu den charakteristischen Merkmalen funktionell-somatischer Störungen, dass sie meist überlappend (als "Cluster") auftreten (1). Besonders hoch ist die Koexistenz des Fibromyalgiesyndroms mit dem Reizdarmsyndrom (bis zu 70 %) und dem posttraumatischen Stress-Syndrom (PTSD) (bis zu 56 %) (44). Gut dokumentiert ist auch die Komorbidität mit Angststörungen, depressiven Verstimmungen oder Persönlichkeitsstörungen (5,18). Bei diesen Patienten besteht nicht selten auch eine genetische Disposition zu allergischen und autoimmunen Erkrankungen. Abhängig von den jeweiligen individuellen Gegebenheiten ist das komorbide funktionelle Beschwerdebild von Leitsymptomen bestimmt, welche die einzelnen Syndrome prägen: Schmerz (Fibromyalgie-Syndrom, temporo-mandibulären Schmerzsyndrom, chronischen Beckenbodenschmerz (chronic pelvic pain syndrome), Leistungsabfall und Erschöpfung (Chronisches Müdigkeitssyn-drom, CFS), viszerale Hyperalgesie (chronisches Reizdarmsyndrom oder Reizblase), Dysmenorrhoe (prämenstruelles Syndrom), Überemp-findlichkeit gegen Umweltstoffe und Gift (multiple Chemikaliensensitivität), Panikattacken und Angststörungen (posttraumatisches Syndrom, PTSD), Zwangsstörung (obsessive compulsive disorder, OCD), nicht selten assoziiert mit Anorexia nervosa bzw. Bulimie. Diese Patienten bedeuten für den Arzt in der Praxis eine erheb...
After accidental re-exposure to metamizole a 50-year-old patient developed severe jaundice within five hours (total bilirubin 43.9 mg/dl) with a rise of GOT to 147, of GPT to 222, of gamma-GT to 380 and of alkaline phosphatase to 497 U/l. The allergic genesis of this reaction was demonstrated in the lymphocyte transformation test which, in the presence of the causative substance and its metabolites, was performed five times during a period of 232 days. The first three tests were positive with stimulation indices up to 2.3. Sensitization to the metabolite 4-aminoantipyrine was demonstrated: this is known to be the first of four metabolites formed within 1-1 1/2 hours and constituting 40% of the four metabolites in the blood.
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