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Erectile dysfunction is a common symptom among hypertensive patients that impairs quality of life and adherence to antihypertensive pharmacologic therapy. It is also associated with cardiovascular risk factors and disease. The Sexual Health Inventory in Men (SHIM) was administered to 105 ambulatory hypertensive patients, and large and small artery elasticity indices were measured. Each variable was examined in a simple linear regression model or 1-way analysis of variance model to determine each variable's relationship with the SHIM score. Variables that were significantly associated with the SHIM score in the univariate models included age, duration of hypertension, peripheral vascular disease, and small artery elasticity. Large artery elasticity was not significantly associated with the SHIM score. In the multivariate model, age, hypertension duration, and peripheral vascular disease were associated with a lower SHIM score. This study demonstrates a relationship between erectile dysfunction and reduced artery elasticity.

Abrupt onset of severe uncontrolled hypertension and rapidly progressive oliguric renal failure characterizes scleroderma renal crisis. The etiology is unclear, but very high renin levels are present. While scleroderma is more common in women and whites, there is no difference in the prevalence of scleroderma renal crisis by gender. However, there appears to be a higher prevalence of scleroderma renal crisis among African Americans than whites. Survival was dismal prior to the introduction of the vigorous treatment of hypertension and use of converting-enzyme inhibitors. However, most data on the benefit of these medications are derived from uncontrolled and unblinded studies. Prospective, randomized controlled trials are needed to assess the role of angiotensin receptor blockers. Prevention trials could define the role of various drugs in decreasing the rate of scleroderma renal crisis., (Copyright 2003 Le Jacq Communications, Inc.)

We have described a 38-year-old white American woman who had a 7-year history of pain in the left anterior chest, neck, right wrist, and buttocks. The pain fluctuated in severity and appeared to coincide with worsening of her skin condition, palmoplantar pustulosis (PPP). She manifested the typical skeletal features of an arthritic condition referred to as pustulotic arthro-osteitis, which is frequently associated with the characteristic rash of PPP. This is an infrequently described disorder in the United States, possibly reflecting lack of familiarity or confusion with related disorders.

Diffuse dark blue-black chromonychia was observed in 17 of 33 (52%) black patients with systemic lupus erythematosus (SLE), but not in 47 non-SLE black patients. About half of these patients had active disease. A comparison was made between patients with SLE with chromonychia and those without but no distinctive clinical or laboratory variable differentiated the 2 groups. This pattern of nail hyperpigmentation has not previously been associated with SLE.

A patient with Sjögren's syndrome (SS) developed mild renal insufficiency without significant proteinuria; the diagnosis of interstitial nephritis secondary to SS was made on the basis of history, serological data and renal biopsy. The renal biopsy revealed immunofluorescence of the interstital infiltrates and the importance of this finding in the differential diagnosis of interstitial nephritis is considered. In addition, further studies to detect anti-renal antibodies and circulating immune complexes are reported and the possible interpretation of the results is discussed in regard to pathogenesis.

A diagnosis of systemic lupus erythematosus (SLE) was established in a 54-year-old woman with a compatible history, as well as patchy alopecia, anemia, arthralgias, and a positive LE cell preparation. Sixteen months later bilateral hilar and mediastinal lymph nodes appeared on chest roentgenogram. Sarcoidosis was diagnosed when hypercalcemia and noninfectious, noncaseating epithelioid granulomas were found in the skin and liver. The sarcoidosis remitted with corticosteroid therapy, but slowly advancing renal failure ultimately resulted in the patient's death. We believe the concurrence of SLE and sarcoidosis had not been previously reported in the English literature. Immune mechanisms are discussed.

The feasibility of determining the exact site and amount of drug-induced gastric bleeding was tested. Fourteen patients with rheumatoid arthritis received equivalent therapeutic doses of the antinflammatory drugs aspirin, 4 gm/day, and fenoprofen calcium, 2.4 gm/day, in randomized order for seven days. Acetaminophen was given for 14 days just prior to each of these periods. By fiberoptic gastroscopy, antral ulceration and acute mucosal lesions were found in seven patients following aspirin ingestion, in one taking fenoprofen, and in none taking acetaminophen. Fecal blood loss in four-day stool collections, quantitated by autologous chromium 51-labeled erythrocytes shed into the stool averaged 5.0 ml/day while taking aspirin, 2.2 ml/day while taking fenoprofen calcium, and 0.8 ml/day while taking acetaminophen. The mean blood loss was greater for those in whom gastric lesions developed while taking aspirin than for those in whom lesions did not develop. The short-term risk of erosive gastritis was greater for aspirin than fenoprofen.