An immunoserological study of patients with vibration syndrome

In a study undertaken to investigate the relationship between vibration syndrome and collagen disease, 90 Japanese patients with vibration syndrome (all men aged 41-86 years) were examined immunologic abnormalities, mainly by a set of immunoserology tests. Of these 90 patients, 25 had examinations at yearly intervals for 3 consecutive years, while the other 65 underwent examinations once. The results indicate that, of all the patients studied, 10 (11.1%) gave a positive RA test, 6 (6.7%) had leukopenia, 5 (5.6%) had hypergammaglobulinemia, and 15 (16.7%) had hypocomplementemia (CH50). Worthy of particular note are the 21 patients (23.3%) who were positive for nuclear-specific antibodies (1: greater than or equal to 40) (using Hep-2 cells as the nuclear substrate), with some of them suspected of having Sjögren's syndrome, progressive systemic sclerosis, or systemic lupus erythematosus. During a 3-year follow-up period, 10 (40%) of 25 patients exhibited rising titers of nuclear-specific antibodies with conversion to seropositivity for these antibodies. The facts that the positivity rate for nuclear-specific antibodies was significantly higher in these patients with vibration syndrome (23.3%) than in healthy adult men over 40 years of age (1.8%) (P less than 0.05) and that a progressive elevation of nuclear-specific antibody titer was noted in a high percentage of the patients were suggestive of some causal relationship between the appearance of nuclear-specific antibodies and the use of vibrating tools.

Collagenopathic cardiopathies

Collagenopathic cardiopathies are a subject of extreme etiologic, pathogenetic and clinical interest. These disorders are associated with congenital or acquired anomalies of the connective tissue and because of the diffusion and nearly total distribution of this tissue, have a higher frequency than what has been previously estimated. The collagenopathic cardiopathies, can be divided into two main groups: one deriving from hereditary connective tissue diseases, and the other from acquired connective tissue diseases. The first group has a Mendelian type of transmission whereas the other appears to be secondary to various kinds of stimuli (viral, immunologic etc.) although polygenic factors are present. Of the first group we considered Marfan's syndrome, the Ehlers-Danlos syndrome, osteogenesis imperfecta, pseudoxanthoma elasticum, cutis laxa and the diseases of the fundamental substance with particular reference to mucopolysaccharidosis type 1H (Hurler's syndrome). In all of these disorders a specific metabolic disturbance is responsible for the cardiovascular damage which is expressed, depending on the specific genetic component in a more or less serious form. Among the acquired diseases of the connective tissue, we examined rheumatoid arthritis, systemic lupus erythematosus, polydermatomyositis, scleroderma; of the reactive arthritis, rheumatic fever; of the seronegative forms, spondyloarthritis, ankylosing spondylitis and Reiter's syndrome, mixed connective tissue disease and Lyme's disease. It must be emphasized that all of these disorders share relatively common pathogenetic characteristics which point to the importance of the presence of various types of antigens, immune complexes and the significant role of some of the histocompatibility antigens, as well as possible disturbances of cell-mediated immunity.(ABSTRACT TRUNCATED AT 250 WORDS)

Case of lethal multiple pterygium syndrome with special reference to the origin of pterygia

A case of lethal multiple pterygium syndrome is presented. Besides the anomalies usually associated with this syndrome, cardiac hypertrophy and connective tissue abnormalities were observed. On the basis of these observations, we suggest that an abnormally fragile collagen constitution is the principal disorder in the lethal multiple pterygium syndrome, which is responsible for the pathogenesis of fetal immobility, pterygia, and many of the associated anomalies.

Diseases associated with exposure to silica and nonfibrous silicate minerals. Silicosis and Silicate Disease Committee

Silicosis, a disease of historical importance, continues to occur cryptically today. Its pathogenesis is under ongoing study as new concepts of pathobiology evolve. In this article, the gross and microscopic features of the disease in the lungs and the lesions in lymph nodes and other viscera are described. These tissue changes are then discussed in the context of clinical disease and other possible or established complications of silica exposure (ie, scleroderma and rheumatoid arthritis, glomerulonephritis, and bronchogenic carcinoma). Silicates are members of a large family of common minerals, some of which have commercial importance. Silicates are less fibrogenic than silica when inhaled into the lungs, but cause characteristic lesions after heavy prolonged exposure. The features of these disease conditions are described herein. Various aspects of the mineralogy and tissue diagnosis of silicosis and lung disease due to silicates are reviewed. An overview of contemporary regulatory considerations is provided.

Collagenosis in wallerian degeneration depends on peripheral nerve type

In the mature rat we determined the extent of peripheral nerve collagenosis in response to Wallerian degeneration and examined whether or not nonfibroblastic elements such as Schwann cells were important. Collagen was estimated as the hydroxy-proline content of normal and axotomized nerve fascicles after single or double crush lesions of both myelinated and unmyelinated nerves. Crushed unmyelinated nerve produced two to four times more collagen relative to control nerve than did the sciatic nerve. The nature of the interaction between two successive crushes was different in the two nerves. These results suggest that the degree of collagen fibrillogenesis occurring in Wallerian degeneration is dependent on peripheral nerve type and that the presence of myelin is not necessary for collagen fibrillogenesis.

Reactive perforating collagenosis in Hodgkin's disease

Two patients with Hodgkin's disease developed a condition that has been termed "reactive perforating collagenosis." In both cases, pruritus was severe and seemed to be responsible for the vigorous rubbing and scratching that caused the skin lesions. In one patient, the lesions disappeared upon remission of Hodgkin's disease. Perforating collagenosis has been described in children as a hereditary disease, and has also been described in adults with diabetes and on hemodialysis. On the basis of the changes seen in our two patients with Hodgkin's disease, we suggest that perforating collagenosis is simply a consequence of intense scratching.

[Collagenous sprue and ulcerative jejuno-ileitis in a patient with gluten-induced enteropathy]

In a 60-year-old patient with adult celiac disease complete clinical remission was achieved with a glutenfree diet, but symptoms of sprue subsequently recurred despite rigid adherence to dietary restrictions. Further investigations revealed simultaneous occurrence of two severe complications of celiac disease: collagenous sprue and ulcerative jejunoileitis. The patient died after a 2 1/2 year course of refractory, severe, relentlessly progressive malabsorption. In the light of the literature and this observation it is postulated that in every case of primary or secondary refractory celiac disease complications must be sought: to diagnose collagenous sprue, aspiration biopsy from the proximal jejunum, and possibly also from the terminal ileum, may be more efficient than simple endoscopic biopsy from the descending duodenum. If the diagnosis of collagenous sprue can be established, therapy with steroids should be attempted. The diagnosis of ulcerative jejunoileitis is usually missed by radiology and requires exploratory laparotomy.

Aldose reductase inhibition and the diabetic syndrome of limited joint mobility: implications for altered collagen hydration

Improvement in the range of motion and strength of digital flexion and extension is reported in three diabetic subjects with the syndrome of limited joint mobility. Therapy was accomplished with sorbinil, an inhibitor of the enzyme aldose reductase, which inhibits the polyol pathway. We propose that reduction in collagen hydration secondary to reduced tissue content of polyols may play a role in the clinical response.