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Therapy for some patients, but more patients likely would benefit if higher doses could be administered. The Role of IL-1 in Local and Systemic Disease During the early years of cytokine research, IL-1 was recognized as the prototypic pro-inflammatory cytokine, 9, 10 whereas TNF was studied for killing tumor cells. Subsequently, antibodies to TNF were reported to reduce spontaneous production of IL-1 from synovial explant cultures.11, 12 These studies helped establish the importance of TNF as the upstream mediator of IL-1 production and activity. Certainly, the use of TNF blockers to treat disease relies at least in part on direct reduction in TNF activity, but this approach may also carry the additional benefit of downstream reduction in IL-1 activity. For example, mice that overexpress TNF develop a severe ankylosing arthritis by four weeks of age, but early blockade of IL-1 receptors in these mice prevents development of the disease.13 Other examples exist.14 Therefore, one cannot exclude the possibility that in treating various conditions with TNF blockers, reductions in IL-1 contribute to the outcomes.
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1. Ahmad VU, Chaudhary MI, Akhtar MF, Ahmad M, Rizwani GH, Usmanghani U : J Nat Products in press ; . 2. Chaudhary K : Bhattacharya 's lectures notes on Pharmacology and Therapeutics, Union Book Stall, 1981. 3. Chopra RN, Nayar SL, Chopra IC : Glossary of Indian Medicinal Plants, ICSIR, New Delhi, p 99, 1986. 4. Dresdale DT, Yuccoglu YZ , Michtom RJ, Schultz M, Lunger M : J Cardiol, 4: 88, 1959. Goodman LS, Gilman A : The Pharmacological Basis of Therapeutics, MacMillan Publishing Co Inc NY, 1985. 6. Jafri SMH : The flora of Karachi. The Book Corporation, Karachi, p 312, 1966. 7. Malik KA, Ghafoor A : Ed Nasir and SI Ali, Flora of Pakistan. Acanthaceae, 188: 66, 1979. Miyase T, Ueno A, Ahmad M, Akhtar MF, Rashid S, Usmanghani K : in press ; . 9. Nandkarni AK, Chopra RN : Indian Materia Medica, Popular Book Depot. Bombay, p 1087, 1954 and methoxsalen.
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ISOLATED RENAL THROMBOTIC MICROANGIOPATHY AS AN INITIAL PRESENTATION OF SCLERODERMA WITHOUT OTHER SYSTEMIC MANIFESTATIONS OF THE DISEASE. Sri Ranga Bonam, Sirisha Chalasani, Sashidhar Bollini, Robert Grunberg, Richard Snyder The thrombotic microangiopathies TMA ; share a common pathway of vascular endothelial injury and thrombus formation. Scleroderma is an autoimmune disease and histologically, scleroderma renal crisis SRC ; is indistinguishable from a TMA. To our knowledge, there are only several cases describing an association between the two. In those cases, patients with a TMA initially presented with either limited or diffuse scleroderma. We believe that this is the first time that an association between a TMA and scleroderma has been described in a patient without a pre-existing laboratory or clinical diagnoses of scleroderma. A 70 year old white male with past medical history significant only for hypertension and coronary artery disease presented with acute kidney injury AKI ; . The patient was normotensive at this time, and prior had normal renal function. Serologic evaluation for connective tissue diseases was non-diagnostic. A renal biopsy demonstrated a TMA. The patient had no thrombocytopenia and no antiphospholipid antibodies. Because of the diagnostic dilemma concerning the etiology of the TMA, plasmapheresis and hemodialysis HD ; was started. The patient was transferred to a tertiary center where a repeat diagnostic evaluation was inconclusive. The patient was maintained on HD, and after a period of four months developed skin changes consistent with scleroderma. While the ANA was only mildly positive, and antibodies specific for scleroderma were negative. A skin biopsy demonstrated scleroderma-type changes. The skin manifestations quickly worsened, and the patient was started on D-Penicillamine and continued on HD. This case represents a rare presentation of a TMA that we think may have been a SRC with delayed onset of generalized scleroderma. A vWf cleaving protease assay may have helped in distinguishing between the SRC and TMA, as the treatment of each is different. If this was a SRC, it is also unusual that it preceded the skin manifestations. While not a leading diagnosis, scleroderma should be considered in the differential diagnosis of a TMA with AKI.
10. Sharir T, Germano G, Kavanagh PB, Cohen I, Lai S, Friedman JD, Lewin HC, Berman DS. Incremental Prognostic Value of Post-stress Ventricular Volume by Gated Myocardial SPECT for the Prediction of Cardiac Death. J Nucl Med 1999; 40: 2P Gupta PK, Hosea S, Anderson S, Brown CA, DeFrance A, Waxman AS, Friedman JD, Lewin HC, Berman DS. Incremental Value of SPECT WBC Imaging in Patients with Occult Infective Endocarditis. J Nucl Med 1999; 40: 3P Lai S, Berman DS, Kang X, Dubois EA, Lewin HC, Friedman JD, Germano G. Prognostic Value of Stress Myocardial Perfusion SPECT in Patients with History of Coronary Artery Bypass Grafting. J Nucl Med 1999; 40: 6P Zellweger MJ, Dubbois EA, Lai S, Lewin HC, Fried man JD, Germano G, Sharir T, Kang X, Berman DS. Risk of Cardiac Death in Patients Early and Late after CABG Using Stress Myocardial Perfsuin SPECT: Implications for Appropriate Clinical Strategies. J Nucl Med 1999; 40: 7P Bateman TM, Case JA, Moutray K, Gainey W, O'Keefe JH, McGhie AI, Thompson TD, Shaw L, Berman D. Comparison of Outcomes in Patients with Reversible Perfuson Defects in a Single Coronary Distribution: Medical Therapy Versus Revascularization. J Nucl Med 1999; 40: 7P Sharir T, Berman DS, Cohen I, Agafitei D, Lewin HC, Friedman JD, Germano G. Incremental Prognostic Value of Rest-Redistribution Thallium-201 SPECT for Prediction of Cardiac Death. J Nucl Med 1999; 40: 8P Berman DS, Kang X, Lewin HC, Cohen I, Friedman JD, Lai S, Miranda R, Agafitei R, Germano G. Prognostic Value and Effect on Referral to Catheterization of Myocardial Perfusion SPECT in A Community Hospital. J Nucl Med 1999; 40: 42P Berman DS, Shaw LJ, Thompson TD, Germano G, Lewin HC, Hachamovitch R, Lai S, Bateman TM. Stress Myocardial Perfusion SEPCT in Patients with Angina Pectoris: Gatekeeper to the Cath Lab. J Nucl Med 1999; 40: 155P Shaw LJ, Berman DS, Thompson TD, Germano G, Lewin HC, Hachamovitch R. The Effect of Age on the Predictive Value of SPECT Imaging in Women with Suspected Ischemic Heart Disease. J Nucl Med 1999; 40: 158P Akinboboye O, Germano G, Idris O, Verna M, Coffin L, Berman D, Bergmann D, King D. Estimation of Left Ventricular Mass by Gated SPECT: Comparison with 3D Echocardiography. J Nucl Card 1999; 6: S38 20. Dubois EA, Berman DS, Lewin HC, Cohen I, Friedman JD, Shaw LJ, Hachamovitch R. Incremental Prognostic Value of Peak Stress Ejection Fraction over SPECT in Patients Post-Revascularization. J Nucl Card 1999; 6: S22 21. Lewin HC, Thompson T, Shaw L, Hachamovitch R, Friedman J, Germano G, Cohen I, Berman D. The Impact of Myocardial Perfusion SPECT In Patients with High Exercise Capacity. J Nucl Card 1999; 6: S67.
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