Lactic acid concentrations in the synovial fluid of 84 patients with acute monoarticular arthritis were determined by gas liquid chromatography. Lactic acid values in 27 cases of nongonococcal septic arthritis were strikingly higher (mean 1170 mg/100 ml) than in 45 cases of inflammatory or degenerative arthritis (mean 34 mg/100 ml), as well as in 12 cases of gonococcal arthritis (mean 27 mg/ 100 ml). With the proper equipment, determination of lactic acid can be a relatively rapid, reliable procedure. Synovial fluid lactic acid concentrations therefore can be used as a rapid, supplemental diagnostic aid in differentiating nongonococcal septic arthritis from both gonococcal and nonseptic acute arthritis.
Three new cases of carnitine palmityl transferase deficiency are described. The syndrome consists of recurrent attacks of muscle cramps, weakness, malaise, and myoglobinuria. These attacks are especially likely to occur during prolonged exercise after fasting, eating a high-fat diet, or during cold weather. Occasionally after fasting alone, spontaneous muscle breakdown may occur. One patient studied in detail was excessively slow in producing ketones when he fasted. His mylagias and weakness appeared to be alleviated by beta-hydroxybutyrate. Of eight other patients thought to have idiopathic recurrent myoglobinuria, three were found to have myophosphorylase deficiency, whereas five did not have deficiency of either enzyme. Carnitine palmityl transferase deficiency may be more common than previously supposed, may be in part amenable to dietary therapy, can be easily distinguished from myophosphorylase deficiency, and may provide insight into the metabolism of fatty acids and ketone bodies as well as energy requirements of skeletal muscle.
A 17-year-old male with systemic lupus erythematosus presented with clinical signs of severe constrictive pericarditis that was confirmed by cardiac catheterization. At surgery, a fibrous pericardium was removed, followed by complete relief of symptoms. Immunopathology of the pericardial tissue revealed deposition of IgG, IgM, and C3. A review of the literature produced only three similar cases. Although rare, constrictive pericarditis, a potentially life threatening complication, may occur in systemic lupus erythematosus presumably with an immunological basis.Although acute pericarditis with or without pericardial effusion is a well known manifestation of the serositis that occurs with systemic lupus erythematosus, constrictive pericarditis is a rare sequela. The authors are aware of only three other cases of constrictive pericarditis associated with systemic lupus erythematosus (SLE) (1-3). These cases were reported prior to the availability of sophisticated serologic and immunologic testing. The present study reports a patient with well documented SLE who developed severe constrictive Submitted for publication May 8, 1978; accepted June 20, 1978. pericarditis associated with immunoglobulin deposition within the pericardium. CASE REPORTA 17-year-old male was admitted to the University of California at Los Angeles Medical Center for evaluation of ascites and joint effusions. He was well until 18 months prior to admission when he developed arthralgias in the hands and feet, followed by painful swelling of the left elbow. Initially, rheumatoid factor, antinuclear antibodies, and LE cell preparations were negative. The patient received symptomatic relief with aspirin. Six months later he developed chest pain, fever, polyarthralgias, and frank arthritis of the left elbow. Repeat serologic data, chest x-ray, and electrocardiogram were within normal limits. All symptomatology resolved within one week.Five months later a malar rash developed following sun exposure. At that time the ANA was positive at 1: 160 in a smooth pattern, and an LE preparation was also positive. One month later, spotty alopecia and discoid lupus developed in the scalp. Prednisone, 10 mg/day, was instituted.Four months prior to admission, the patient was noted to have increasing abdominal girth. Ascites was present on clinical examination. A liver-spleen scan was normal. Prednisone was increased to 40 mg/day without benefit. Three days prior to hospitalization bilateral knee pain and swelling developed. The patient noted mild dyspnea on exertion and reported a seven kilogram weight gain.On admission the blood pressure was 120/86 with 18 mm of pulsus paradoxus, pulse was 110, respiratory rate 20, and temperature 37.4"C. Examination of the heart revealed a regular rhythm without gallops or rubs. Jugular venous pulsations were noted 14 cm above the level of the right atrium. The abdomen was distended, with shifting dullness and a positive
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.