Rheumatoid arthritis is associated with a number of pleuropulmonary disorders. A retrospective study of the frequency of rheumatoid disease in patients with bronchiectasis and pulmonary fibrosis was performed. The results suggest that the frequency of bronchiectasis and rheumatoid disease is similar to that of the well established, but rare, association between pulmonary fibrosis and rheumatoid arthritis. We therefore suggest that bronchiectasis should be remembered as a pulmonary association of rheumatoid disease which occurs as commonly as pulmonary fibrosis.
Many studies have shown the indigenous elderly population and Asian immigrants to be groups at particular risk of vitamin D deficiency and osteomalacia, but there are no data on the risks in elderly Asians. In this community-based study a group of elderly Asians was compared with control groups of elderly and young whites and young Asians. Levels of 25-hydroxyvitamin D3 (25-OHD3) were significantly lower (p < 0.0001) in elderly Asians (21/37) and young Asians (7/17) compared with white controls. The difference in parathyroid hormone (PTH) between Asians and whites was also significant (p < 0.0007) as was that between young and old (p < 0.0002). Abnormal PTH and 25-OHD3 (high PTH and low 25-OHD3), indicative of a high risk of osteomalacia, occurred in 22% of elderly Asians compared with 6% of elderly whites. The calcium, phosphate and alkaline phosphatase were normal in all individuals. Among the Asians, vegetarianism was not related to lower 25-OHD3 levels. Symptoms suggestive of osteomalacia were more common (p < 0.05) in elderly Asians than in their white counterparts. This first study of 25-OHD3 levels in community-resident elderly Asians suggests that more than half were low, placing them at a significantly higher risk of osteomalacia.
Introduction: Anticoagulation is used widely for the primary prevention of embolic events in patients with atrial fibrillation. Bleeding is the most common complication with oral anticoagulation. We describe the case of a patient who developed a massive retropharyngeal haematoma after a fall. Whilst the retropharyngeal space is an uncommon site for bleeding complications, it is clinically important as the development of upper airway obstruction may be life threatening.
The serum from an 85-year-old man with a clinical diagnosis of post-transfusion purpura (PTP) was investigated for the presence of platelet-specific antibodies. Clinically, the case was typical of PTP but, unusually, the serum was found to contain multiple platelet-specific alloantibodies. Anti-HPA-1a, anti-HPA-2b and anti-HPA-3a antibodies were detected together with multispecific anti-HLA (class I) antibodies. Additional (but weaker) antibody reactivity was also observed with platelet glycoproteins (Gp) IIb/IIIa, GpIb and GpIa/IIa which lacked the antigens recognized by the alloantibodies, suggesting the presence of auto- or cross-reacting antibodies. The patient's genotype was HPA-1b/1b, HPA-2a/2a, HPA-3b/3b, HPA-5a/5b and was consistent with the platelet alloantibodies detected. The patient made a complete recovery following treatment with intravenous gamma-globulin.
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