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Wine treatment of rheumatoid skin ulcerations.

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LETTERS
934
Table 1. Values (mean f standard deviation) and statistical significance of investigated parameters.
All units given in 100 ml of serum
Duration of illness, years
Patients
Controls
74.6 5 14.3*
58.5 f 10.3*
Zinc, f f i
102.0 f 31.8
106.3 f 37.6
Copper, M
Haptoglobin, mg 306.7 ? 147.4$ 219.5 2 123.9$
126.6 c 30.3
125.0 & 31.8
C3, mg
33.3 c 7.7
33.9 2 13.3
C4, mg
<8
8-13
> 13
63.0 f 9.0t
110.0 f 41.4
305.0 t 194.6
124.8 c 32.4
36.1 t 16.3
57.9 ? 9.1
100.0 f 42.7
311.0 t 143.6
140.4 2 30.35
34.6 f 12.1
54.5 c 11.7t
109.0 f 30.7
304.0 f 107.4
114.7 2 28.48
31.3 2 12.1
5.03. P < 0.001.
< 0.05.
$ t = 2.48, P < 0.01.
8 f = 1.96, P < 0.05.
*
t
f =
f = 1.82, P
levels in RA patients compared with those in paired controls.
These levels correlated with the duration of the disease. The
only other factor which seemed to be connected with decreased zinc levels was steroid treatment; this is especially
noteworthy in view of the fact that duration of disease in the
steroid and nonsteroid treated groups was similar (12.3 years
versus 11.3 years, respectively) (1). Hypercupremia, as one
might have expected, was not present (2). Moreover, both
copper and zinc were lower than the expected mean values
or closer to the lower border of normal in our controls. A
simple nutritional deficiency does not explain the lower zinc
levels, especially when it is noted that 12 RA patients and 6
controls had serum copper levels which were above the
expected mean (although generally within the normal range).
In concluding this report of our study of zinc and
copper levels in RA patients and matched controls. the two
important findings were: 1) the low serum zinc levels found
in RA patients did not correlate with the investigated parameters and therefore seem not to reflect the degree of disease
activity; 2) zinc levels correlated with the duration of disease
and to a lesser degree with steroid treatment, which coupled
with the lack of concomitant hypercupremia could imply the
existence of other factors responsible for both (3). It should
be stressed that our findings do not permit any conclusion on
the therapeutic value of zinc administration in RA (4).
H. Morgenstern, MD
I. Machtey, MD
Rheumatology Service
Hasharon Hospital
Petah-Tikva, Israel
I . Yunice AA. Czerwinski AW, Lindeman RD: Influence of synthetic corticosteroids on plasma zinc and copper levels in humans. Am J Med Sci 282:68-74, 1981
2. Prasad AS, Brewer GJ, Schoomaker EB, Rabbani P: Hypocupremia induced by zinc therapy in adults. JAMA 240:2166-2168,
1978
3. Ambanelli U. Ferracioli GF, Serventi G, Vaona GL: Changes in
serum and urinary zinc induced by aspirin and indomethacin.
Scand J Rheumatol I1:63-64, 1982
4. Simkin PA: Oral zinc and rheumatoid arthritis (letter). Arthritis
Rheum 24:865, 1981
Wine treatment of rheumatoid skin ulcerations
To the Editor:
Skin ulcerations in patients with rheumatoid arthritis
(RA) often persist, become chronic, and respond poorly to
local therapy. Even with debridement and wound cleansing,
healing proceeds slowly, especially in seropositive RA patients receiving corticosteroids. Agents for wound cleansing,
such as 10% povidone-iodine and Sulfamylon, provide little
additional benefit. Ancient physicians with few pharmacologic agents available irrigated wounds with wine (Smith RD:
Avicenna and the canon of medicine: a millenial tribute.
West J Med 133:367-370, 1980), which we used to treat 5
patients with RA and skin ulcerations.
Three patients (ages 69, 74, and 81) with seropositive
RA (duration 2, 6, and 8 years), all receiving corticosteroid
therapy, had superficial skin ulcerations of the feet or toes,
0.5-1.0 cm in diameter and present for 2-6 months. These
patients were treated with wine compresses 15 minutes 4
times daily, with healing of the skin ulcerations in 2-6
weeks.
A SO-year-old woman with seropositive RA of 8
years’ duration, receiving corticosteroid therapy, developed
a flexion contracture of the right third toe and a full thickness
skin ulceration 6 mm in diameter at the proximal interphalangeal joint, exposing the extensor tendon. The ulcer, present
for 3 months, was treated with wine compresses 15 minutes 4
times daily, and healed in 3 months.
A 70-year-old woman with seropositive RA of 40
years’ duration, rheumatoid nodules, and hyperviscosity
syndrome, receiving corticosteroid therapy, developed a full
thickness sacral pressure ulcer 4 cm in diameter, with
undermining of the wound edges exposing tendon and bone.
This condition was resistant to intensive local and Clinitron
therapy. After 3 months of treatment with wine irrigations
and a gauze wick soaked in wine, the lesion reduced in size
to 1 cm diameter and 0.5 cm depth with clean, healthy,
wound margins. The patient was lost to followup examination; when contacted by letter, she reported that the skin
remained healthy around a small skin ulcer after 8 months of
wine therapy.
Wound cleansing and debridement, as well as control
935
LETTERS
of infection, are of paramount importance in the treatment of
skin ulcerations. Wine contains many compounds that aid in
cleaning wounds and reducing infectionAspecially alcohols, acids, tannins, aldehydes, and sugars. Phenolic compounds in wine, particularly anthocyanins, exhibit antibacterial activity (Wine and Medical Practice [A Summary]. San
Francisco, California, The Wine Institute, 1979). Adequate
cleansing of wounds promotes healing and can be achieved
simply, inexpensively, and without compromising healthy
tissue, using wine compresses and wine irrigations.
White wine was used in all cases to avoid staining;
red wine contains compounds that may be additionally
beneficial. Wines over 10 years old lose antibacterial activity.
V. Alterescu, R N , ET
Richard D. Smith, MD
John Muir Memoriol Hospital
Walnut Creek, CA
Remittive agents in eighteenth century medicine
To The Editor:
In the 1970s the term “remittive agents” began to
appear in rheumatology literature. It refers to a group of
diverse drugs which have a beneficial effect on disease
activity in rheumatoid arthritis, and which are thought to be
occasionally capable of producing a clinical remission. In
addition, the effectiveness of these drugs occurs only after
relatively long-term administration.
Although the uords are new, the concept of a
remittive agent is not. The following quotation, from the
third edition (1778) of Domestic Medicine by William Buchan, MD (Buchan W: Domestic Medicine or The Family
Physician. Third edition. Boston, Hodge, McDougall &
Green, 1778, pp 288-289) is, to the best of my knowledge,
the earliest reference to this concept:
There are several of our own domestic plants
which may be used with advantage in the rheumatism.
One of the best is the white mustard. A tablespoonful
of the seed of this plant may be taken twice or thrice a
day, in a glass of water or small wine. The water-trefoil
is likewise of great use in this complaint. It may be
infused in wine or ale, or drank in the form of tea. The
gorund-ivy, camomile, and several other bitters, are
also beneficial and may be used in the same manner.
No benefit however is to be expected from these
unless they be used for a considerable time. Excellent
medicines are often despised in this case because they
do not perform a cure instantaneously; whereas nothing would be more certain than their effect, were they
used for sufficient length of time. The want of perseverance in the use of medicines is one of the principal
reasons why chronic diseases are so seldom cured.
Roger W. Marcus, MD
Baltimore, MD
Androgen plasma levels in female rheumatoid arthritis
patients
To the Editor:
Low androgen plasma levels in female patients with
systemic lupus erythematosus (SLE) have been recently
reported (1). In view of these data, it seemed interesting to
study plasma androgen levels in another autoimmune disease, namely rheumatoid arthritis (RA).
Ten female hospitalized RA patients (age range 1747 years) fulfilled American Rheumatism Association criteria for RA (2). Eight had active disease. Disease activity was
judged by the presence of at least 3 of the following criteria:
erythrocyte sedimentation rate a30 mm in the first houi-,
morning stiffness a60 minutes, Ritchie index > 10, Lee index
3 5 , and at least 3 joints with effusion or synovitis.
The illness control group included 11 female hospitalized patients (age range 18-44 years) without autoimmune
disease: 1 had myopathy, 2 had cerebral vascular stroke, 1
had benign ear tumor, 1 had syringomyelitis, 3 had low back
pain and sciatica, 1 had osteomyelitis, 1 had femoral head
aseptic osteonecrosis, and 1 had patellar chondropathy. The
normal control group included 13 healthy female volunteers
(age range 19-44 years).
None of the patients or the control subjects had
received any oral or intraarticular corticosteroid therapy
previously. No oral contraceptives were given. All of the
women had regular menses and normal liver function.
Blood samples were collected into EDTA between 8
and 9 A M and immediately centrifuged. Plasma was separated and stored at -20°C until hormonal assays were performed. Methods of hormone determinations have been
reported previously (1).
The 3 groups (RApatients, illness and normal control
groups) were compared using variance analysis and KruskalWallis test.
Comparison of plasma hormone levels of the RA
patients, the illness control group, and the normal control
group did not demonstrate any statistically significant differences (Table 1).
Table 1. Age and hormone levels (ng/rnl) in 10 RA patients, 1 1
other patients, and 13 healthy women*
Age. hormone level
(mean 2 SD)
Age
F
T
DHT
DHA
DHAS
A4
* RA
RA patients
(n = 10)
Illness control group
(n = 11)
Normal control group
(h = 13)
33 2 12
139.7 t 32.3
0.25 t 0.11
0.09 t 0.08
4.58 t 3.43
684 ? 410
1.14 t 0.45
32 ? 7
138.7 t 27.6
0.25 t 0.09
0.13 t 0.07
6.72 t 4.09
803 ? 351
1.57 2 0.70
30 ? 9
127.2 t 41
0.33 t 0.13
0.13 t 0.05
4.33 t 1.73
949 f 428
1.52 ? 0.60
= rheumatoid arthritis; F = cortisol; T = testosterone; DHT
dihydrotestosterone; DHA = dehydroepiandrosterone; DHAS =
DHA sulfate; A4 = androstenedione.
=
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