Since anatomopathological lesions of the adrenal gland have been frequently observed at autopsy in AIDS, we investigated the glucocorticoid function in 63 patients (51 men, 12 women) infected by the human immunodeficiency virus (HIV) in order to determine the incidence and the nature of any adrenocortical abnor-
Graves' ophthalmopathy (GO) is a specific immune-mediated disorder, whose treatment is sometimes difficult. In order to investigate the efficacy of intravenous methylprednisolone (MP) pulse therapy in GO, we studied eight patients with GO, followed up for at least 6 months by clinical patient self-assessment, ophthalmological examination and orbital computed tomography (OCT). A 12.5 mg/kg dose of MP was administered intravenously over a 10 hour period, once every month. Three to six MP pulse administrations were performed in each patient. All patients were outpatients. A 0.5 mg/kg/day oral prednisone dose was given to each patient as interpulse therapy. Clinical assessment of MP pulse therapy showed a good response in 87.5% and no response in 12.5% of patients. The treatment was rapidly efficient, mostly on patient self-assessment, soft tissue inflammation, ophthalmoplegia, corneal involvement, visual acuity and extraocular muscle enlargement on OCT. Post-treatment ophthalmic index was significantly improved (6.75 +/- 3.06 vs. 2.5 +/- 1.41: p < 0.05). MP pulse therapy had less effect on proptosis (22.94 +/- 2.32 mm vs. 21.56 +/- 2.22 mm: p < 0.05). No adverse effects were noted with MP pulse therapy. Patients showed no relapse of eye involvement during a mean follow up of 31.8 months (2-77 months). In conclusion, our results suggest that intravenous MP pulse therapy is a good immunosuppressive therapy for GO. Moreover, in comparison with the previous studies, the MP dose used in our present study appears to be optimal with high efficacy. MP pulse therapy represents a safe and efficient treatment in GO, which can easily be performed in outpatients.
Earlier studies have shown that return to work following PTCA is frequent; however PTCA is now performed in patients with more extensive coronary artery disease. The present study was designed to compare the vocational outcome of patients who underwent PTCA in 1980-1982 with that of patients who underwent the procedure in 1985. From 1980 to 1982, 53 of 73 consecutive patients who were employed before PTCA returned to work (73%). Return to work was related to primary success of the procedure (85% vs 40%, P less than 0.01) age (46.1 +/- 7.9 vs 49.3 +/- 6.6 years, P less than 0.05) and clinical status at follow-up (72% feeling well or very well vs 30%, P less than 0.01). In 1985, although the primary success rate had increased to 89%, the overall rate of return to work in the 91 patients employed before PTCA was 64%. The decrease was particularly striking for patients with primary success of the procedure (64% vs 85%, P less than 0.01). The patients in the 1985 group had greater incidences of previous myocardial infarction (40% vs 11%, P less than 0.01) and multivessel coronary disease (43% vs 8%, P less than 0.01); however, these factors were not related to subsequent return to work. In contrast, the age of the patients, which was an important determinant of work resumption, was significantly higher in the 1985 patients (49.9 +/- 7.3 vs 46.4 +/- 9.1 years, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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