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Biomedical subjects

B Rozman

Publications and source records attributed to B Rozman.

At least 55 records · Page 3Linked to original sources
PubMed2000

Small vessel thrombosis without major thrombotic events in systemic lupus erythematosus patients with antiphospholipid syndrome.

Antiphospholipid syndrome has been defined by the presence of antiphospholipid antibodies or lupus anticoagulant in association with certain clinical events, including recurrent arterial or venous thromboses and recurrent fetal loss. It comprises two separate clinical entities: simple, characterized by large vessel occlusions, and catastrophic, with multiple occlusive events predominantly affecting small vessels. Three patients with systemic lupus erythematosus and permanently increased IgG anticardiolipin antibody levels are being described. Only postmortem histopathological examination revealed microangiopathic thrombotic changes in different organs, which were clinically silent in early stages of the disease and misinterpreted later in its course because of a peculiar clinical picture. All patients presented features of catastrophic antiphospholipid syndrome in the final stage of the disease.

Adolescent↗
PubMed2000

Immunoserological aspects of idiopathic inflammatory muscle disease.

In the present study, the autoantibody profile of 31 Slovenian patients with idiopathic inflammatory muscle disease was estimated: 11 with polymyositis, 11 with dermatomyositis--both groups diagnosed according to the criteria of Bohan and Peter--and 9 with myositis-overlap syndromes. Autoantibodies against most relevant muscle specific (Jo-1, Mi-2) and non-specific antigens (PM-Scl, U1RNP, native Ro, Ro60, Ro52, and La) were detected with one or more detection techniques: counter-immunoelectrophoresis, enzyme-linked immunoassay, immunoblot and immunoprecipitation, each using different antigen preparations (native, recombinant). With counter-immunoelectrophoresis using a native antigen substrate (rabbit thymus extract), we were able to detect anti-PM-Scl antibodies more readily than with other techniques, probably due to conformational epitopes of native PM-Scl. Patients with this serological profile constituted a distinct group, sharing features of polymyositis and systemic sclerosis. Compared to previously reported data, the greater frequency of anti-Jo-1 found in all groups of patients (64-87% for PM, 18-20% for dermatomyositis and 33-44% for overlap syndromes) was probably due to the various methods used and the different clinical characteristics of patients. The greater prevalence of anti-Mi-2 antibodies in dermatomyositis patients (67%) and in particular in polymyositis patients (33%) and myositis-overlap syndromes (33%) seemed to be mainly due to methodological differences. A strikingly high prevalence of anti-Ro52 positive patients with polymyositis (55%), dermatomyositis (22%), and myositis-overlap syndromes (33%) was demonstrated, but was detected by only one technique. Moreover, concurrence with anti-Jo-1 antibodies was noted (69%).

Autoantibodies↗
PubMed2000

Marginal erosive discovertebral "Romanus" lesions in ankylosing spondylitis demonstrated by contrast enhanced Gd-DTPA magnetic resonance imaging.

OBJECTIVE: To assess the value of Gd-DTPA magnetic resonance (MR) imaging in the demonstration of marginal destructive discovertebral Romanus lesions in ankylosing spondylitis. DESIGN AND PATIENTS: A prospective study of Gd-DTPA MR imaging was performed in 39 patients with a clinical diagnosis of ankylosing spondylitis and typical Romanus lesions seen on radiographs of the thoracolumbar spine. MR morphological appearances and signal intensity changes at the discovertebral junctions were analysed and compared with the radiographic findings. RESULTS: Ninety-nine discovertebral junctions with Romanus lesions showed low signal intensity on T1-weighted and high signal on T2-weighted and T1-weighted postcontrast images at the vertebral corners consistent with oedematous hyperaemic inflammatory tissue. There were nine discovertebral junctions with similar MR findings but normal radiographs. Fifty-three discovertebral junctions showed syndesmophyte formation with increased signal intensity on both T1- and T2-weighted images with no contrast enhancement. Sixty-five discovertebral junctions showed a mixture of radiographic features and varied high and low signal changes at the vertebral rim on MR imaging with rims of enhancement in the vertebral body following contrast administration. CONCLUSION: Gd-DTPA MR imaging demonstrates a variable signal pattern and degree of contrast enhancement which may reflect the evolutionary stages of discovertebral enthesitis in ankylosing spondylitis. MR imaging may identify early erosive changes in radiographically normal vertebra. The role of MR imaging needs further investigation.

Adult↗
PubMed2000

Determinants of reduced bone mineral density and increased bone turnover after kidney transplantation: cross-sectional study.

AIM: To analyze bone metabolism and the risk factors of bone loss in kidney transplant recipients. METHODS: The bone mineral density (BMD) of the lumbar spine, femoral neck, and radius was determined by dual-energy X-ray absorptiometry in 52 patients 8 days to 228 months after kidney transplantation. Total and bone alkaline phosphatase (BAP), osteocalcin, procollagen, type I collagen telopeptide, collagen cross links, calcium, intact parathyroid hormone (iPTH), and creatinine were measured in all patients. RESULTS: The BMD of the spine and femoral neck was reduced in 57%, and of the radius in 72% of the patients. Reduced BMD was associated with significantly increased levels of iPTH, osteocalcin, and procollagen. Dialysis duration negatively correlated with the radius BMD in all patients and the femoral neck BMD in women. No relationship between BMD and length of post-transplantation time, age, cumulative steroid dose, or serum creatinine level was established. All biochemical parameters negatively correlated with the spine BMD, but not with the BMD of the femoral neck and radius. The correlation between BAP and telopeptide and length of post-transplantation time was also negative. No difference in the incidence of osteopenia was found between genders. CONCLUSION: Osteopenia/osteoporosis and increased bone turnover were present in more than a half of the kidney transplant recipients. Reduced BMD was associated with enhanced bone remodeling, primarily mediated by PTH hypersecretion. The length of post-transplantation period, cumulative steroid dose, gender, and age could not be identified as risk factors of reduced BMD.

Absorptiometry, Photon↗
PubMed1999

Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. European Leflunomide Study Group.

BACKGROUND: Phase II trials of leflunomide, an inhibitor of de-novo pyrimidine synthesis, have shown efficacy in rheumatoid arthritis. This double-blind randomised trial compared leflunomide with placebo and sulphasalazine in active rheumatoid arthritis. METHODS: 358 patients were randomly assigned leflunomide (100 mg daily on days 1-3, then 20 mg daily), placebo, or sulphasalazine (0.5 g daily, titrated progressively to 2.0 g daily at week 4). The primary endpoints were tender and swollen joint counts and investigator's and patient's overall assessments. Analyses were by intention to treat. FINDINGS: The mean changes in the leflunomide, placebo, and sulphasalazine groups were -9.7, -4.3, and -8.1 for tender joint count; -7.2, -3.4, and -6.2 for swollen joint count; -1.1, -0.3, and -1.0 for physician's overall assessment; and -1.1, -0.4, and -1.1 for patient's overall assessment. Leflunomide and sulphasalazine were significantly superior to placebo (p=0.0001 for joint counts; p<0.001 for assessments). Radiographic disease progression was significantly slower with leflunomide and sulphasalazine than with placebo (p<0.01). Most common adverse events with leflunomide were diarrhoea (17%), nausea (10%), alopecia (8%), and rash (10%). Transiently abnormal liver function was seen in three leflunomide-group patients and five sulphasalazine-group patients. There were two cases of reversible agranulocytosis in the sulphasalazine group. INTERPRETATION: Leflunomide was more effective than placebo in treatment of rheumatoid arthritis and showed similar efficacy to sulphasalazine. Leflunomide was well tolerated. This drug may be a useful option as a disease-modifying antirheumatic drug.

Algorithms↗
PubMed1999

Systemic lupus erythematosus: clinical features in patients with a disease duration of over 10 years, first evaluation.

OBJECTIVE: Most information available about the disease course of patients with systemic lupus erythematosus (SLE) is restricted to the first 5 yr after disease onset. Data about the disease course 10 yr after disease onset are rare. The aim of this multicentre study was to describe the outcome of SLE patients with a disease duration of >10 yr. METHODS: Outcome parameters were the SLE Disease Activity Index (SLEDAI), the European Consensus Lupus Activity Measure (ECLAM), the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR), a global damage index (DI) and required treatment. In 10 different European rheumatology centres, all SLE patients who were evaluated in the last 3 months of 1994, and who had been diagnosed with SLE at least 10 yr ago, were included in the study. RESULTS: It should be stressed that our results are confined to a patient cohort, defined by a disease duration of at least 10 yr, and who are still under clinical care at the different centres in Europe. These SLE patients still showed some disease activity, related to symptoms of the skin and musculoskeletal systems, next to the presence of renal involvement. A total of 72% of the patients needed treatment with prednisolone (</=7.5 mg). The cumulative damage was overall related to clinical features of the central nervous system (14%) and renal involvement (14%), next to deforming arthritis (14%), osteoporosis (15%) and hypertension (40%). The prevalences of obesity, Cushing appearance and diabetes are highly suggestive that the ongoing treatment and that in the past might have had an impact on the total sum of end-organ damage. CONCLUSIONS: After 10 yr, a high proportion of patients in our cohort continued to show evidence of active disease, defined by the SLEDAI as well as ECLAM. The DI was related to the involvement of the central nervous system, renal involvement and the presence of hypertension.

Adult↗
PubMed1998

The significance of histologic analysis of skin lesions in porphyria cutanea tarda. Light microscopy, electron microscopy, immunohistochemical and immunofluorescence analysis.

Porphyria cutanea tarda (PCT) is one of several entities in the differential diagnosis of scleroderma. We report a 62-year-old man with PCT diagnosed since two decades. Clinical data and the results of light microscopy, immunohistochemistry, immunofluorescence and electron microscopy of skin biopsies are presented. The biopsy revealed sclerosis of the dermis mainly due to increased collagens I and III, and accumulation of collagen IV, which had caused the vessel wall to thicken. Immunofluorescence for detection of immune reactants was negative. It was concluded that the histomorphology of PCT of long duration may be similar to that of scleroderma. Nevertheless, in addition to clinical findings, detailed skin biopsy studies including contemporary techniques can contribute to the differentiation of these diseases.

Adult↗
PubMed1998

Treatment of rheumatoid arthritis with recombinant human interleukin-1 receptor antagonist.

OBJECTIVE: To evaluate the efficacy and safety of interleukin-1 receptor antagonist (IL-1Ra) in patients with rheumatoid arthritis (RA). METHODS: Patients with active and severe RA (disease duration <8 years) were recruited into a 24-week, double-blind, randomized, placebo-controlled, multicenter study. Doses of nonsteroidal antiinflammatory drugs and/or oral corticosteroids (< or =10 mg prednisolone daily) remained constant throughout the study. Any disease-modifying antirheumatic drugs that were being administered were discontinued at least 6 weeks prior to enrollment. Patients were randomized to 1 of 4 treatment groups: placebo or a single, self-administered subcutaneous injection of IL-1Ra at a daily dose of 30 mg, 75 mg, or 150 mg. RESULTS: A total of 472 patients were recruited. At enrollment, the mean age, sex ratio, disease duration, and percentage of patients with rheumatoid factor and erosions were similar in the 4 treatment groups. The clinical parameters of disease activity were similar in each treatment group and were consistent with active and severe RA. At 24 weeks, of the patients who received 150 mg/day IL-1Ra, 43% met the American College of Rheumatology criteria for response (the primary efficacy measure), 44% met the Paulus criteria, and statistically significant improvements were seen in the number of swollen joints, number of tender joints, investigator's assessment of disease activity, patient's assessment of disease activity, pain score on a visual analog scale, duration of morning stiffness, Health Assessment Questionnaire score, C-reactive protein level, and erythrocyte sedimentation rate. In addition, the rate of radiologic progression in the patients receiving IL-1Ra was significantly less than in the placebo group at 24 weeks, as evidenced by the Larsen score and the erosive joint count. IL-1Ra was well tolerated and no serious adverse events were observed. An injection-site reaction was the most frequently observed adverse event, and this resulted in a 5% rate of withdrawal from the study among those receiving IL-1Ra at 150 mg/day. CONCLUSION: This study confirmed both the efficacy and the safety of IL-1Ra in a large cohort of patients with active and severe RA. IL-1Ra is the first biologic agent to demonstrate a beneficial effect on the rate of joint erosion.

Adolescent↗
PubMed1998

[Porphyria cutanea tarda with severe clinical complications. A 20-year follow-up].

A patient with porphyria cutanea tarda developed distinctive sclerodermoid changes with extensive dystrophic calcification and ulcerations in the sclerotic areas. In addition to these skin complications, over the course of 20 years other internal problems also appeared, such as diabetes mellitus, fatty cirrhosis and ocular inflammation. These severe clinical complications were related to omission of treatment and the alcohol abuse.

Adult↗
PubMed1998

Skeletal muscle immune deposits in systemic lupus erythematosus. Correlation with histologic changes, autoantibodies, and clinical involvement.

Skeletal muscle biopsy and autopsy samples of 132 SLE patients were studied by immunofluorescence and light microscopic techniques. Immune deposits were compared to histologic abnormalities and clinical and serologic findings. Immune deposits with a mainly granular pattern were observed at different locations in 49 patients (37%). They correlated significantly (p<0.001) with inflammatory myopathy, demonstrated in 33(25%), with noninflammatory myopathy which occurred in 38 (29%) vasculitis, observed in 13(10%), and with noninflammatory vasculopathy which was noted in 10 patients (8%). The correlation of muscle immune deposits with anti-DNA antibodies was significant at p= 0.016. Anti-Sm and anti-U1 RNP antibodies were associated significantly with the intensity of immune deposits. Furthermore, a correlation of immune deposits with increased creatine phosphokinase and myopathic electromyogram, but not with evidence of clinical involvement, was shown. A key pathogenetic role of immune deposits in the development of skeletal muscle histologic abnormalities in SLE was demonstrated.

Adolescent↗
PubMed1998

Clinical experience with leflunomide in rheumatoid arthritis. Leflunomide Investigators' Group.

Leflunomide is a novel isoxazol drug with disease modifying properties for the treatment of rheumatoid arthritis (RA). Several Phase II trials have been completed and 3 large Phase III trials are nearing completion. A multicenter Phase II randomized, double blind, placebo controlled, 24 week study of 402 patients with active RA revealed that leflunomide 25 mg once daily was significantly (p < 0.05) superior to placebo in all primary and secondary outcome measures; leflunomide 10 mg daily was also statistically superior to placebo for all outcome measures except tender joint count and score. Significantly (p < 0.05) more patients responded to leflunomide 10 and 25 mg than to placebo. Leflunomide appears to be well tolerated in patients treated for up to 18 months. Gastrointestinal events, weight loss, rash/allergic reactions, and reversible alopecia were the most frequently reported drug related adverse events. Patients treated with leflunomide were not more susceptible to infections than those given placebo. Based upon the results of a population based pharmacokinetic/pharmacodynamic model, leflunomide 20 mg was selected as optimal dose for the Phase III studies; these are 6 to 12 month multicenter, randomized, double blind, controlled trials that include as active comparators methotrexate and sulfasalazine. Once-daily administration of leflunomide is effective in patients with active RA.

Antirheumatic Agents↗
PubMed1998

[Significance of histopathologic analysis of skin lesions in scleromyxedema. Light microscopy, electron microscopy, immunohistochemistry and immunofluorescence microscopy].

Scleromyxedema (SM) may be considered as a possible disease entity in the differential diagnosis of scleroderma. Clinical data and the results of light, immunohistochemical, immunofluorescence and electron microscopic study of skin biopsies taken from a 53-year old patient with SM are reported. In the patient with SM in which abnormal serum paraprotein was not identified, the skin biopsy showed mucinous material in the dermis and proliferation of fibroblasts accompanied by mild dermal sclerosis. Immunofluorescence showed scanty granular IgG along the epidermal basement membrane and IgG and C1q focally along the connective tissue fibres in the dermis of clinically involved skin. In addition to clinical findings, detailed skin biopsy studies including contemporary techniques can contribute to the diagnosis of the disease.

Biopsy↗
PubMed1997

Influence of degraded phosphatidylserine on binding of antiphospholipid antibodies.

BACKGROUND: Antiphospholipid antibodies (aPL) show great heterogeneity. Different phospholipids, with or without protein cofactor(s), and phospholipid binding proteins alone have been proposed as the target molecules for aPL. In order to determine the influence of phospholipid degradation products on the binding of aPL, sera from 6 patients with the antiphospholipid syndrome were studied. METHODS: Fresh and aged phosphatidylserine and cardiolipin were used as coating reagents in solid-phase immunoassay procedures. Antibody reactivity was tested by enzyme-linked immunosorbent assay in the sera and in eluates from columns packed with polystyrene scrapings coated with either cardiolipin or phoshatidylserine. RESULTS: Three reaction patterns of affinity-purified antibodies were seen: (1) reactivity with phosphatidylserine but not with cardiolipin or degraded phosphatidylserine, (2) reactivity with cardiolipin and degraded phosphatidlyserine, and (3) reactivity with all three phospholipid antigens. CONCLUSIONS: Striking differences in the antiphospholipid antibody reactivity with cardiolipin, phosphatidylserine and degraded phosphatidylserine in the presence of serum proteins were observed among patients with venous thromboembolism. The analyses showed that the degradation of phosphatidylserine influences the binding of aPL in in vitro assays.

Adolescent↗
PubMed1996

[MR imaging in seronegative spondyloarthritis].

In twenty-five patients with a clinical diagnosis of suspected sacroiliitis conventional radiography, CT and MRI were performed. In ten patients no abnormalities were demonstrated. In thirteen cases CT and MRI revealed sacroiliitis. In two patients with normal plain films and CT para- and intraarticular changes of signal intensity suggested suspicious sacroiliitis. MRI can be considered as an important imaging modality for early diagnosis of sacroiliitis. In eighteen patients with a firm diagnosis of ankylosing spondylitis and plain films of the thoracolumbar junction suggesting destructive Romanus and Anderson inflammatory lesions MRI was done. Two distinct groups of inflammatory changes were found. In ten patients MRI findings compatible with active inflammatory enthesitis were revealed at the disco-vertebral junction. In eight cases focal and linear changes of signal intensity within the intervertebral disks suggested an active inflammation. Using MRI the spectrum of inflammatory changes in sero-negative spondylitis can be presented. In sixteen patients with definite clinical diagnosis (psoriatic arthritis--thirteen cases and Reiter's syndrome--three cases) plain films and MRI of small hand joints were performed. The patients fell into two distinct groups. In the first MRI findings could not be differentiated from those seen in rheumatoid arthritis. In nine cases the distribution and extent of soft tissue findings were different, similar to changes seen in enthesitis. Therefore, on the basis of MRI findings in small peripheral joints easier differential diagnosis between sero-negative spondyloarthritides and rheumatoid arthritis is possible. In five patients with a diagnosis of Reiter's syndrome having clinical signs of enthesitis plain films and MRI of calcaneus were done. MRI revealed findings compatible with active inflammation which resembled those seen at the attachment of the annulus fibrosus and collateral ligaments of the small hand joints.

Adult↗
PubMed1996

Prognostic value of contrast enhanced Gd-DTPA MRI for development of bone erosive changes in rheumatoid arthritis.

Conventional radiograms have been used to quantitate the progression of rheumatoid arthritis, mainly through the assessment of bone erosions, but this approach has many limitations. It has been suggested that an advantage of contrast-enhanced Gd-DTPA MRI over radiography may be its prognostic value due to its ability to show the natural history of active destructive to inactive fibrous pannus. The aim of this study was to evaluate the possible prognostic value of MRI for future development of bone erosive changes in small hand joints in patients with RA. The results of the study confirm that in joints in which inflammatory active pannus is shown by contrast-enhanced MRI, progression of bone-destructive changes can be expected.

Arthritis, Rheumatoid↗