RESUMO
OBJECTIVE: To study patients with side effects secondary to the injection of modelants. METHODS: We studied their clinical, serological, histopathological, radiographic, immunoregulatory and fibroblast culture features by standard methods. We studied thirty patients, 24 women, mean age: 38.2 years. Patients had received either mineral oil, guayacol, silicone or a mixture of these substances; some had received unknown material(s). RESULTS: The mean time between the injection and the onset of symptoms was six years (range: 0.1-24 years). All patients had sclerodermatous skin changes, subcutaneous nodules, edema and/or hyperpigmentation at the site(s) of injection(s); five individuals also had skin changes at sites remote from the injection. Thirteen patients had clinical features of an autoimmune disease. Eleven patients gave a history of arthralgias including four that had symmetrical non-erosive polyarthritis. Twenty of 28 patients (71%) had positive anti-nuclear antibodies. We found intracellular spontaneous production of IL-1 (interleukin-1) by patients' macrophages which was almost absent in normal cells (p < 0.001). Silica-stimulated monocytes from patients also secreted more IL-1 than those from normal subjects (p < 0.001) in autologous mixed lymphocyte reaction. Twelve patients had an early proliferative response. At day seven, a decreased proliferative response was seen in 12/19 patients (p < 0.001). Skin fibroblasts from 3/3 patients synthesized 3-to-5-fold more 3H-hyaluronic acid than normal control cells (p < 0.001). CONCLUSIONS: This report confirms the association between the injection of modelants and the development of autoimmune disease (human adjuvant disease, HAD). Our results implicate IL-1 in the amplification of the disease process. The similarities between primary scleroderma and human adjuvant disease now include immunological and connective tissue data. The study of these patients may help to understand the etiopathogenesis of some autoimmune diseases.
Assuntos
Doenças do Tecido Conjuntivo/induzido quimicamente , Óleo Mineral/efeitos adversos , Silicones/efeitos adversos , Pele/efeitos dos fármacos , Adulto , Doenças Autoimunes/induzido quimicamente , Doenças do Tecido Conjuntivo/imunologia , Doenças do Tecido Conjuntivo/patologia , Feminino , Fibroblastos/efeitos dos fármacos , Humanos , Ácido Hialurônico/biossíntese , Imunofenotipagem , Injeções Subcutâneas , Interleucina-1/biossíntese , Pessoa de Meia-Idade , Óleo Mineral/farmacologia , Silicones/farmacologia , Pele/imunologia , Pele/patologia , Cirurgia PlásticaAssuntos
Síndrome do Túnel Carpal , Corticosteroides/uso terapêutico , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Síndrome do Túnel Carpal/epidemiologia , Síndrome do Túnel Carpal/etiologia , Diagnóstico Diferencial , Eletrofisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Gravidez , Complicações na Gravidez , Piridoxina/uso terapêuticoRESUMO
We studied 500 consecutive patients with systemic lupus erythematosus (SLE) for antibodies to phospholipids (APLA) by an ELISA method using cardiolipin as antigen and antiimmunoglobulins G, M and A to determine their isotype. Once entered into this prospective study the patients were followed for up to 16 months (mean 7.7 +/- 4.72 SD) with periodic determinations of APLA. Of the 500 patients with SLE, 88 had had thrombocytopenia, 25 had had hemolytic anemia, 25 had had both, and 362 had no history of these hemocytopenias. If we considered the odds ratio of these 362 patients for having high titer APLA as 1, patients with a history of thrombocytopenia, hemolytic anemia or both had significantly higher odds ratios of having APLA than did those without hemocytopenia. Patients with thrombocytopenia had significantly higher levels of IgG APLA, those with hemolytic anemia had significantly higher titers of IgM APLA and patients with both had significantly higher titers of both of these APLA isotypes, than did patients without hemocytopenias. A correlation between positive direct Coombs' tests and IgM APLA was also found. We conclude that APLA is associated with these hemocytopenias in SLE. This might be due to their interaction with negatively charged phospholipids in the cell walls of the respective cells.
Assuntos
Autoanticorpos/análise , Células Sanguíneas/patologia , Hemócitos/patologia , Lúpus Eritematoso Sistêmico/patologia , Fosfolipídeos/imunologia , Anemia Hemolítica/complicações , Cardiolipinas/imunologia , Contagem de Células , Humanos , Leucopenia/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Linfócitos/patologia , Trombocitopenia/complicaçõesRESUMO
We describe 3 young individuals with acute myocardial infarction that developed after extenous stress followed by the intake of cold fluids. The patients had retrosternal chest pain and EKG changes suggestive of posterior-inferior myocardial infarction. Coronartiography demonstrated 40% and 50% narrowing of the right coronary artery. The remaining case had normal coronary arteries.