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Biomedical subjects

A Tyndall

Publications and source records attributed to A Tyndall.

At least 73 records · Page 4Linked to original sources
PubMed1999

Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities.

OBJECTIVE: To compare the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a questionnaire format of the Lequesne-Algofunctional Index in patients with OA of the lower extremities. METHODS: Longitudinal analysis of the instruments' responsiveness [standardized response mean (SRM), effect size (ES)] in ambulatory patients undergoing hip or knee arthroplasty. RESULTS: At six months 36, and at one year 40 out of 43 patients undergoing hip (N=30) or knee arthroplasty (N=13) could be examined. Both responsiveness statistics revealed the same order of responsiveness. For both indices and for both locations, the pain sections were more responsive than the function sections. However, the WOMAC scales and the WOMAC global index (hip at 12 months: SRM=2.4; knee at 12 months: SRM=2.0 ) were more responsive than the comparable Lequesne sections and Lequesne index (hip at 12 months: SRM=2.1; knee at 12 months: SRM=1.5). CONCLUSIONS: Although our results are based on a German version using a self-report format, the WOMAC scales appear to be more responsive than the Lequesne index in patients with OA of the lower extremities.

Adult↗
PubMed1999

Haematological stem cell transplantation in the treatment of severe autoimmune diseases: first experiences from an international project.

The benefit:risk ratio of HSCT in autoimmune disease appears to justify the initiation of prospective controlled comparative studies. The comparator arm is open, one possibility being mobilized (Cy 2 or 4 g/m2 + G-CSF), but not transplanted. Inclusion and exclusion criteria for different disease categories need to be standardized, as do outcome measurements. In Europe, the EBMT has established a new working party for autoimmune disease with representatives from all involved groups, including the USA. A similar parallel group is being established in North America. The aim will be consensus and standardization of disease-specific aspects. Standardization of immune reconstitution parameters could prove critical in the understanding of autoimmune mechanisms, with early guidelines being developed and available to interested groups. Data collection is critical, with advanced discussions on common registration forms between the EBMT and the American Bone Marrow Transplantation Registry (ABMTR) already taking place. Common detailed disease-specific clinical data forms are now a top priority, so that data from the two major databases may be compared. All patients fulfilling entry criteria should be registered and followed long term, including those not able to be treated for non-medical reasons, such as insurance. This will provide a prospective 'conventional treatment' control group. Regular and flexible liaison between the data managers of both groups will be encouraged, as with regulatory authorities such as the Food and Drug Administration. The following such meeting was in Basel, 8-10 October 1998.

Adult↗
PubMed1999

Hematopoietic stem cell transplantation for autoimmune disorders.

Autologous hemopoietic stem cell transplantation (HSCT) for autoimmune disease has increased lately. Insights into response to immunoablation is found in animal experiments and reports on patients receiving HSCT for concomitant malignancy. Early phase II studies and case reports of HSCT in patients with multiple sclerosis, systemic sclerosis, lupus erythematosus, rheumatoid arthritis, juvenile chronic arthritis and idiopathic thrombocytopenic purpura have been published. Dramatic responses or disease stabilization have been observed in some, but failures and disease relapses, toxic and infectious complications have been observed in others. Whether this treatment can induce true peripheral immunologic tolerance, and which been observed if any patients will benefit long-term from HSCT, remains to be determined.

Autoimmune Diseases↗
PubMed1998

[Chronic meningococcemia--a rare, but characteristic disease picture].

Chronic meningococcaemia is a rare clinical manifestation of invasive infection by Neisseria meningitidis. The clinical signs and symptoms are recurrent fever, skin rash, arthralgias and headache. This constellation is rather typical and may enable the clinician to establish the diagnosis. The clinical diagnosis is confirmed by the growth of Neisseria meningitidis in the blood culture. In addition, the clinical course under antibiotic treatment leads to a dramatic improvement within 24-48 hours. Positive cultures may be obtained by needle aspiration or skin biopsy. There are a few reports on patients with deficiency of late complement components or immunoglobulin deficiency. We report on two patients with the typical findings of chronic meningococcaemia.

Adult↗
PubMed1998

[Bone ultrasound and diagnosis of osteoporosis: correlation of 2 quantitative ultrasound methods with bone density].

In this study, 96 women (mean +/- SD, 65.3 +/- 13.2 years) were investigated by bone mineral densitometry (DXA, Hologic QDR 2000) and quantitative ultrasound (QUS) of the tibia (n = 96; Sound-Scan2000, Myriad) and phalanges (n = 84: DBM Sonic 1200, IGEA). We observed a good correlation of QUS measurement with bone mineral content (BMD) on lumbar spine and both hips (Ward and Neck). Correlation of the two QUS-techniques measuring at different skeletal sites within the same patient was good. QUS instruments measuring at the various skeletal sites and their suitability for screening patients at risk of osteoporosis are discussed. The usefulness of the different QUS methods and the best measuring site for the assessment of fracture risk in osteoporotic patients still have to be established.

Absorptiometry, Photon↗
PubMed1998

Comparison of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index and a self-report format of the self-administered Lequesne-Algofunctional index in patients with knee and hip osteoarthritis.

OBJECTIVE: To compare the metric properties and validity of German versions of the WOMAC (Western Ontario and McMaster Universities) and a self-administered questionnaire-format of the Lequesne-Algofunctional-Index in patients with osteoarthritis (OA) of the lower extremities. DESIGN: Cross-sectional analysis of the instruments' internal consistency (Cronbach's coefficient alpha) and construct validity (correlation with radiological OA-severity and limitation in range-of-motion) in ambulatory patients and patients before hip arthroplasty. Test-retest reliability was assessed on a subsample after 10 days. RESULTS: Data from 51 patients out of 91 contacted could be analyzed. Twenty-nine patients had knee and 22 patients had hip OA. Both the WOMAC and Lequesne OA-indices and their scales or sections had a satisfactory test-retest reliability (Intraclass correlation coefficient 0.43-0.96). All scales of the WOMAC were internally consistent (Cronbach's coefficient alpha 0.81-0.96) and associated with radiological OA-severity and joint range of motion. However, only the function but not the symptom sections (Cronbach's coefficient alpha knee: 0.55; hip: 0.63) of the self-administered Lequesne OA index were internally consistent for both, patients with knee and hip OA. Also, the symptom components were not or only weakly associated with radiological OA-severity and joint range of motion. CONCLUSIONS: Although our results are based on a German version using a self-report format we may caution using the self-administered Lequesne OA index without prior testing of its metric properties and validity.

Aged↗
PubMed1998

Elevated PTH levels in hypovitaminosis D are more rapidly suppressed by the administration of 1,25-dihydroxy-vitamin D3 than by vitamin D3.

OBJECTIVE: To assess markers of bone metabolism in two groups of inpatients with hypovitaminosis D and elevated PTH levels receiving two different vitamin D medications. METHODS: 26 patients with secondary hyperparathyroidism (2 degrees HP) were treated either with 800 IU cholecalciferol and 1000 mg calcium or 0.5 microgram calcitriol plus 500 mg calcium daily for 6 months. 25-OH-vitamin D3, 1,25-dihydroxy-vitamin D3, intact PTH, calcium and urinary N-telopeptides of bone collagen I were measured at baseline, 3 and 6 months. RESULTS: PTH levels decreased earlier in the calcitriol group than in the cholecalciferol group. After six month no difference could be documented. Lowering of urinary N-telopeptides excretion was observed in both groups. CONCLUSION: The use of both forms of vitamin D supplementation appears to be useful for patients with hypovitaminosis D, elevated PTH levels and high telopeptide excretion.

Administration, Oral↗
PubMed1997

[Treatment of chronic polyarthritis].

Rheumatoid arthritis (RA) is a chronic autoimmune disease involving progressive destruction of multiple joints and, in the later stages, significant mortality. Worldwide, 1% of the population is afflicted. Despite new insights into the autoimmune mechanisms during the last decade a cure has not been found, although pain, disability and general suffering can be alleviated via several therapeutic approaches when carefully coordinated. Early use of immunosuppressive therapy with DMARDs (disease modifying antirheumatic drugs), while avoiding their side effects, is critical for disease control. Counselling within a good doctor-patient relationship, with the additional help of physiotherapy and ergotherapy, increases the patient's capacity to cope with the disease. Hand and joint surgery, skillfully performed, decreases pain and disability. Newer strategies of immunosuppression, while encouragingly effective, are only short term. These experimental agents are more expensive, they are associated with side effects and their future place in RA therapy has yet to be defined.

Antirheumatic Agents↗
PubMed1997

Autologous peripheral blood stem cell transplantation in a patient with chronic autoimmune thrombocytopenia.

Immunoablation by high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) is one approach currently under discussion for the treatment and possible cure of patients with severe autoimmune diseases. Chronic immune thrombocytopenic purpura (ITP) can be refractory to current therapies and in severe cases may constitute a life-threatening condition. We performed autologous PBSCT with T-cell depletion in a patient with severe chronic ITP but observed no effect on platelet levels. This contrasts with a recent report where complete remission was induced by a similar regimen in two patients with ITP Further studies will be necessary to identify subgroups of patients who might benefit from this form of therapy.

Adult↗
PubMed1997

Hemopoietic blood and marrow transplants in the treatment of severe autoimmune disease.

The past year of activities represents virtually the first year of activities in hemopoietic blood and marrow transplants in the treatment of severe autoimmune disease. The concept of profound hematoimmunoablation followed by blood or marrow transplants for severe autoimmune disease is not new, but the first publications of such cases treated for autoimmune disease alone occurred only in late 1996. Other case reports followed, and the activity has expanded rapidly such that over 40 treated patients have been described, 35 of whom have been entered into a recently created European League Against Rheumatism/European Group for Blood and Marrow Transplantation database (now extended to include data from Australasia and the United States). Four international meetings have been held, the published proceedings of which have formed the basis for an ongoing international collaborative effort. Although very early, some trends have been observed: the majority of patients (mostly with multiple sclerosis or scleroderma) have clinically improved or stabilized; the toxicity of the procedure (mostly autologous bone marrow transplantation) was as observed previously in other disorders; and better results are suggested in patients achieving significant T-cell depletion, either through conditioning, graft purging, or both. These impressions must be confirmed by prospective comparative studies using a limited number of regimens.

Animals↗