Showing papers by "James F. Fries published in 1973"

Scleroderma-like lesions and the carcinoid syndrome.

Abstract: Patients with scleroderma-like lesions secondary to metastatic secreting carcinoid tumors are different in several ways from patients with progressive systemic sclerosis. Scleroderma resulting from a carcinoid does not have an acrosclerotic distribution but develops first in dependent regions of the body following pronounced pitting edema. Raynaud's phenomenon is absent. Results of serological tests are negative. The typical internal organ changes of systemic sclerosis are not seen. Differences in end-organ (skin) response to exogenous serotonin creatinine sulfate suggest metabolic differences as well. It is probable that scleroderma arises by a different mechanism when associated with the carcinoid syndrome than when seen independently, and that this mechanism involves capillary permeability and tissue edema induced by serotonin or other active tumor metabolites.

Adrenocortical steroid treatment of rheumatic diseases. Effects on lipid metabolism.

Abstract: For a three-month period, all patients attending an immunology clinic were screened for disorders of lipid metabolism in order to study the relationship between plasma lipids and adrenocortical steroid therapy. Among women, significantly higher cholesterol and triglyceride levels were found in treated patients than in untreated patients. The number of men screened was insufficient for statistical analysis. A prospective study was therefore carried out that indicated corticoid treatment led to increased plasma levels of cholesterol and triglyceride, and also to an increased plasma insulin response to orally given glucose and to increased pre-β-lipoprotein turnover. These metabolic changes are compatible with the following scheme: diminished glucose tolerance stimulates compensatory hyperinsulinemia, and the latter stimulates increased hepatic production of pre-β-lipoprotein, which leads to elevated plasma levels of this lipoprotein.

Testing the 'preliminary criteria for classification of SLE'.

Abstract: Systemic lupus erythematosus (SLE) is a disease with varied manifestations involving multiple organ systems, accompanied by multiple laboratory abnormalities, and characterized by exacerbations and remissions. Noting that 'uniform classification of defined groups of patients is necessary in order to assemble and compare data from different sources concerning natural history, evaluation of therapy, and epidemologic description', the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association recently approached the formidable task of assembling criteria for the classification of SLE (Cohen, Reynolds, Franklin, Kulka, Ropes, Shulman, and Wallace, 1971). To increase the utility of the criteria in population studies, the use of 'exclusions' and 'duration of manifestations' was avoided. A distinction between 'major' and 'minor' criteria was also not used. Thus, the form of these criteria differs from that of the Jones Criteria for Rheumatic Fever and the ARA Criteria for Rheumatoid Arthritis (Arthritis Foundation, 1964). The committee collected a data base of 245 patients with unequivocal SLE, 234 patients with rheumatoid arthritis, and 217 patients with miscellaneous nonrheumatic diseases. Data was contributed by 52 investigators throughout the United States, who were requested to submit patients with 'unequivocal' SLE, and with 'classic' or 'definite' rheumatoid arthritis. Patients whose clinical course was atypical or in whom diagnostic uncertainty remained were excluded from these two groups. Data was sought on 74 variables of disease considered of potential value for classification. Adequate data was obtained on 57 potential criteria, and the list was reduced to 21 by exclusion of variables which were least useful in distinguishing patients with 'SLE' from 'RA' and 'other' diseases. The final 21 variables were reduced to fourteen 'criteria' by grouping several variables within a single criterion (Table 1, overleaf). The criteria were then tested against the data base, by simple reclassification. A level offour or more positive criteria best distinguished the populations and was recommended by the committee. Tested against the same populations, this level included approximately 90 per cent. ofthe patients with 'SLE' and excluded all but 1 per cent. of the patients with 'rheumatoid arthritis' and all but 2 per cent. of the patients with 'other' diseases. This study evaluates the proposed criteria in the context of five questions: (1) How representative was the ARA test patient population? (2) How adequate are the criteria when tested against an 'outside' patient population? (3) How much does the sensitivity and specificity of the criteria depend upon the point in the course of the patient's illness at which they are applied? (4) How much 'interdependence' is present between various criteria and how much effect does this have on the performance of the criteria? (5) Which diseases might exhibit four or more positive criteria and what percentage of the time may such 'false positives' be expected? Two concepts useful for the testing of criteria are proposed: (1) Testing against a computer-based clinical databank, (2) Testing against 'simulated' patient populations created by computer from known characteristics of the population.

Fenoprofen calcium in rheumatoid arthritis. A controlled double-blind crossover evaluation.

Abstract: Fenoprofen Calcium (Lilly, Compound 69323) is a new nonsteroidal analgesic and antiinflammatory drug proposed for the treatment of rheumatoid arthritis and allied conditions. In a controlled double-blind crossover study comparing 6 weeks of Fenoprofen therapy with 6 weeks of treatment with high-dose acetylsalicylic acid, the aspirin proved minimally more effective and substantially more toxic. Nine of 27 patients found Fenoprofen equal to aspirin, and 6 preferred it. Twelve patients preferred aspirin. The safety of the drug suggested by animal studies appears to be confirmed by these short-term studies in relatively small numbers of patients. It appears likely that Fenoprofen will provide a useful, although not dramatic, additional agent with which to manage the patient with rheumatoid arthritis.